Identify the specific movements of the mandible (items 1-4)

4
Identify the specific muscles (items 5-8)

5
7

8
TEMPORAL AND
INFRATEMPORAL FOSSAE
WENDY R. NICANOR, MD, DPOGS, FPSMFM
JULY 21, 2014
Temporal & Infratemporal Fossae

 The temporal region includes the

temporal and infratemporal
fossae, superior and inferior to
the zygomatic arch

 interconnected spaces on the

lateral side of the head

 boundaries are formed by bone

and soft tissues.
BONY FRAMEWORK

 Temporal

 Zygomatic

 Sphenoid

 Maxilla

 mandible
BONY FRAMEWORK: Temporal bone

 Squamous part
 Anterior & superior parts of the
temporal bone
 supramastoid crest
 groove for middle temporal artery
BONY FRAMEWORK: Temporal bone
 Zygomatic process
 + temporal process = zygomatic arch

 Tympanic part
 External acoustic opening/meatus
BONY FRAMEWORK: Temporal bone

 petromastoid
 Mastoid part- most posterior
 Styloid process
 Mastoid process
BONY FRAMEWORK: Sphenoid bone

Lateral plate of the pterygoid process

Greater wing

foramen ovale and spinosum

sphenoidal emissary foramina
spine of sphenoid
BONY FRAMEWORK: Maxilla

 Anterior wall of the infratemporal

fossa
BONY FRAMEWORK: Zygomatic bone

 Bony
prominence
of the cheek
 Maxillary
process
frontal
process
temporal
process
BONY FRAMEWORK: Mandible

 Ramus of the mandible

 Lateral- masseter
 medial- medial pterygoid muscle
 Angle of the mandible
 Mandiblular notch
 Coronoid process
 Attachment for temporalis muscle
BONY FRAMEWORK: Mandible
 Condylar process
 Neck of the mandible
 Pterygoid fovea
 Mandibular foramen
 Inferior alveolar nerve & vessels
 Lingula
 Sphenomandibular ligament
 Mylohyoid groove
 Nerve mylohyoid
 Medial surface of the ramus
TEMPOROMANDIBULAR JOINTS

 Allows opening and closing of mouth, chewing, side-to-side

movement of the lower jaw
 Synovial type
 between the head of the mandible and the articular fossa
and articular tubercle of the temporal bone
 covered by fibrocartilage
TEMPOROMANDIBULAR JOINT

Articular Disc
 Oval plate of fibrocartilage
 Tendon of lateral pterygoid
head of the mandible
 fibrous bands
TEMPOROMANDIBULAR JOINTS
 completely divided by a fibrous articular disc into two parts:
lower part of the joint
allows mainly the hinge-like depression and elevation of the
mandible

upper part of the joint

allows the head of the mandible to translocate forward
(protrusion) onto the articular tubercle and backward
(retraction) into the mandibular fossa.
TEMPOROMANDIBULAR JOINTS
TMJ: JOINT CAPSULE
 Synovial membrane- nonarticular surfaces
margins of the articular disc
 Fibrous membrane: temporomandibular joint complex
attachements:
superior-anterior margin of the articular tubercle
lateral and medial- margins of the articular fossa
posterior- region of the tympanosquamous suture
below- upper part of neck of mandible
TMJ: EXTRACAPSULAR LIGAMENT

 Lateral ligament

 Sphenomandibular
ligament

 Stylomandibular
ligament
TEMPOROMANDIBULAR JOINT

Lateral temporomandibular
ligament
 Strengthens the lateral aspect of
the capsule
 Limits the movement of the
mandible in a posterior direction
-- protecting the external auditory
meatus
TEMPOROMANDIBULAR JOINT

Sphenomandibular ligament
 medial side of the joint
 Above: spine of the sphenoid
bone
Below: lingual of the
mandibular foramen
 Remains of first pharyngeal
arch
TEMPOROMANDIBULAR JOINT

Stylomandibular ligament
 behind and medial to the joint
 apex of the styloid process to
the angle of the mandible
MOVEMENTS OF THE MANDIBLE
INNERVATION OF THE TMJ MUSCLES

 C1 spinal nerve

 Mandibular nerve
TMJ DISLOCATION
 Sideways blow to chin
fracture of mandible
 excessive contraction of
the lateral pterygoids
 mandible remains wide
open

 postglenoid tubercle &

strong intrinsic ligament
MASSETER
 Above: zygomatic arch
Below: lateral surface of the
ramus of mandible
 Superficial part
 Maxillary process of zygomatic
bone & anterior 2/3 of
zygomatic process of maxilla
 Angle of mandible & posterior
part of the lateral surface of the
ramus of mandible
MASSETER
 Deep part:

 Medial aspect of the zygomatic

arch & posterior part of its
inferior margin
 Central and upper part of the
ramus of mandible as high as
the coronoid process
INNERVATION & BLOOD SUPPLY
MUSCLES OF MASTICATION
MUSCLE ORIGIN INSERTION NERVE ACTION

Masseter Zygomatic arch Lateral surface of Masseteric nerve Elevation of

and maxillary ramus of from the anterior mandible
process of the Mandible trunk of the
zygomatic bone mandibular nerve
[V3]

Temporalis Bone of temporal Coronoid process Deep temporal Elevation and

fossa and of mandible and nerves from the retraction of
temporal fascia anterior margin of anterior trunk of mandible
ramus of the mandibular
mandible almost nerve [V3]
to last molar tooth
MUSCLES OF MASTICATION
MUSCLE ORIGIN INSERTION NERVE ACTION

Medial Deep head-medial surface of Medial surface of Nerve to medial Elevation and 'side-
pterygoid lateral plate of pterygoid mandible near pterygoid from the to-side' movements
process and pyramidal Angle mandibular nerve of the mandible
process of palatine bone; [V3]
superficial head- tuberosity
and pyramidal process of
maxilla
Lateral Upper head-roof of Capsule of Nerve to lateral Protrusion and 'side-
pterygoid infratemporal fossa; lower temporomandibular pterygoid directly to-side' movements
head-lateral surface of lateral joint in the region of from the anterior of the mandible
plate of the pterygoid attachment to the trunk of the
process articular disc and to mandibular nerve
the pterygoid fovea [V3] or from the
on the neck of buccal branch
mandible
MUSCLES OF MASTICATION

temporalis

Deep part of masseter

Superficial part of masseter

MUSCLES OF MASTICATION

Lateral pterygoid
(superior & inferior heads)

Medial pterygoid
Temporal Fossa

BOUNDARIES
• Posteriorly and superiorly:
temporal lines
• Anteriorly: frontal and
zygomatic bones.
• Laterally: zygomatic arch.
• Inferiorly: infratemporal
crest
Temporal Fossa

CONTENTS
 Temporalis muscle
 Zygomaticotemporal
branches of the maxillary
nerve
TEMPORALIS MUSCLE

 Origin: bony surfaces of the

fossa superiorly to the
inferior temporal line
 Attachment: laterally to the
surface of the temporal
fascia
 Anterior fibers- oriented
vertically
 Posterior fibers- oriented
horizontally
TEMPORALIS MUSCLE

 Tendon inserts on the

coronoid process of the
mandible

 Attaches down the anterior

surface of the coronoid
process and margin of the
ramus of mandible
TEMPORALIS MUSCLE

 Elevator of the mandible

 Retracts the mandible or

pulls it posteriorly

 Side-to-side movements of
the mandible
VASCULAR SUPPLY AND INNERVATION

Deep temporal nerves

 anterior trunk of the

mandibular nerve [V3]
 Pass superiorly & around
the infratemporal crest of
the greater wing of the
sphenoid
 Enters the temporal fossa
VASCULAR SUPPLY AND INNERVATION

Zygomaticotemporal nerve

 Branch of zygomatic nerve

 Enters temporal fossa
 Penetrate the temporal
fascia to supply skin of
temple
VASCULAR SUPPLY AND INNERVATION

Deep Temporal Arteries

 Maxillary artery
 Anastomose with branches
of the middle temporal
artery
VASCULAR SUPPLY AND INNERVATION

Middle Temporal Artery

 Origin: superficial temporal

artery
 Anastomoses with
branches of the deep
temporal arteries
INFRATEMPORAL FOSSA

 wedge-shaped

 inferior to the temporal

fossa and between the
ramus of the mandible
laterally and the wall of
the pharynx
INFRATEMPORAL FOSSA: Boundaries

ROOF
 inferior surfaces of the greater
wing of the sphenoid and the
temporal bone
 lateral to the infratemporal
crest of the greater wing of
the sphenoid
 open superiorly to the
temporal fossa
 foramen spinosum, foramen
ovale, and the
petrotympanic fissure
INFRATEMPORAL FOSSA: Boundaries

Lateral wall
 medial surface of the
ramus of the mandible
INFRATEMPORAL FOSSA: Boundaries

Medial wall
 lateral plate of the
pterygoid process
 Pharynx
tensor & levator veli palatini
 Pterygomaxillary fissure
INFRATEMPORAL FOSSA: Boundaries

Anterior wall
 posterior surface of the
ramus of the mandible
 Alveolar foramen
INFRATEMPORAL FOSSA: Contents

 Sphenomandibular ligament  Mandibular nerve

 Medial & lateral pterygoid  Branches of facial nerve
muscles  Glossopharyngeal nerve
 Maxillary artery  Pterygoid plexus of veins
SPHENOMANDIBULAR LIGAMENT

 Extracapsular ligament of the TMJ

 Superior attachment:
spine of the sphenoid bone
 Inferior attachment:
lingula of the mandible &
posterior margin of the
mandibular foramen
MEDIAL PTERYGOID MUSCLE
Muscle Proximal Distal Innervation Action
Attachment Attachment

Deep head medial surface of Medial surface Anterior trunk of Acting

the lateral plate of of the ramus mandibular bilaterally,
the pterygoid mandible nerve (CN V3) protracts
process and surface mandible and
of the pyramidal depresses chin
process of the
palatine bone Acting
unilaterally,
Superficial tuberosity of maxilla mandible swings jaw
head toward
contralateral
side
MEDIAL PTERYGOID MUSCLE
 LATERAL PTERYGOID MUSCLE

Muscle Proximal Distal Innervation Action

Attachment Attachment

Upper head roof of the joint capsule and Anterior trunk of Acts synergistically
infratemporal fossa articular disc of mandibular nerve with masseter to
TMJ (CN V3 ) elevate mandible;
contributes to
Lower head lateral surface of the pterygoid fovea
protrusion;
lateral plate of the on anteromedial
alternate
pterygoid process aspect of neck of
unilateral activity
condyloid process
produces smaller
of mandible
grinding
movements
LATERAL PTERYGOID MUSCLE
MANDIBULAR NERVE
 largest of the three divisions of
the trigeminal nerve
 both motor and sensory
 teeth and gingivae of the
mandible, the anterior two-
thirds of the tongue, mucosa
on the floor of the oral cavity,
the lower lip, skin over the
temple and lower face, and
part of the cranial dura mater
MANDIBULAR NERVE

NERVE INNERVATION
Branches from the main trunk
Meningeal Meninges in the middle
cranial fossa
Nerve to the Medial pterygoid muscle
medial pterygoid Tensor tympani
Tensor veli palatini
 MANDIBULAR NERVE

NERVE INNERVATION
Branches from the anterior division
Masseteric (motor) Deep surface of the
masseter
2 deep temporal Deep surface of the
(motor) temporalis muscle

Nerve to the lateral Deep surface of the

pterygoid (motor) lateral pterygoid
Buccal (sensory) Skin over the cheek
and mucous
membrane lining the
cheek
 MANDIBULAR NERVE
NERVE INNERVATION
Branches from the posterior division
Auriculotemporal Skin of auricle, external
(sensory) auditory meatus, tympanic
membrane, parotid gland,
TMJ, skin of the scalp
Lingual (sensory) anterior two-thirds of the
tongue, oral mucosa on the
floor of the oral cavity, and
lingual gingivae associated
with the lower teeth
Inferior alveolar Teeth of the lower jaw
(sensory & motor) skin of face
• mylohyoid • Mylohyoid, anterior belly of
branch digastric muscle
• Communicating • Joins lingual nerve
branch
CHORDA TYMPANI
 branch of the facial nerve in the
temporal bone
 secretomotor preganglionic
parasympathetic fibers to the
submandibular and sublingual
salivary glands
 taste fibers from the anterior 2/3
of the tongue and floor of the
mouth
 end by synapsing with cells of the
nucleus solitaries in the pons of
the brain.
MAXILLARY ARTERY
 larger terminal branch of the
external carotid artery
 behind the neck of the
mandible
 lower border of the lateral
pterygoid muscle
 enters the pterygopalatine
fossa
MAXILLARY ARTERY

Branches:
 Inferior alveolar artery
 Middle meningeal artery
 Small branches to the external
auditory meatus and tympanic
membrane
 Small muscular branches to
muscles of mastication
MAXILLARY ARTERY: Middle meningeal

 Largest of meningeal vessels

 Supplies dura mater, bone and
bone marrow of the cranial
cavity walls
 Lateral blows to the head =
extradural hematoma
PTERYGOID VENOUS PLEXUS

 Venous network associated with

the pterygoid muscles
 Communicates with the facial
vein through the deep facial vein
 Connects with small emissary
veins - route of infection
MAXILLARY VEIN

 Drains posterior end of the plexus

 Joins the superficial temporal vein

to form the retromandibular vein