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8/18/2019 Infratemporalna Fossa
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Paul W. L. Kwan, Ph.D.ufts Univ. Sch. Med.
Temporal and Infratemporal Fossa
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Paul W. L. Kwan, Ph.D.ufts Univ. Sch. Med.
Temporal and
Infratemporal Fossae
• The temporal and infratemporalfossae are interconnected spaceson the lateral side of the head.
• Temporal fossa --- above thezygomatic arch, communicates withinfratemporal fossa through the gapbetween the zygomatic arch and the
more medial surface of the skull.• Infratemporal fossa --- a wedge-
shaped space deep to the massetermuscle and underlying ramus of the
mandible.
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Paul W. L. Kwan, Ph.D.ufts Univ. Sch. Med.
Temporal Infratemporal Fossa
•Osteolog
y
• Temporal Fossa, Boundaries & Contents
• Infratemporal Fossa, Boundaries & Contents
• Muscles of Mastication• Maxillary Artery
• Pterygoid Venous Plexus
•
Mandibular Nerve V3 • Temporomandibular Joint
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Mandible
Mandibular notch
13A ICON 2003
Condylar process
Coronoid process
Head
Pterygoid fovea
Neck
Lingula
Mandibular foramen
Ramus
Angle
Body
Mental foramen
Mylohyoid
line
Mylohyoid
groove
Mandibular notch
© Saunders Elsevier 2011
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Paul W. L. Kwan, Ph.D.ufts Univ. Sch. Med.
Temporal Infratemporal Fossa
• Osteology
• Temporal Fossa, Boundaries
Contents
• Infratemporal Fossa, Boundaries & Contents
• Muscles of Mastication
• Maxillary Artery
•Pterygoid Venous Plexus
• Mandibular Nerve V3
• Temporomandibular Joint
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Temporal Fossa, Boundaries
S gw
PS/I Temporal lines
T sq
Z
Zygomatic arch
M
Pterion
F
Temporal
fossa
O
© Saunders Elsevier 2011
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8/64Paul W. L. Kwan, Ph.D.ufts Univ. Sch. Med.
Contents of Temporal Fossa
• Temporalis muscle and fascia
• Superficial temporal artery and vein
• Nerves on the surface
– V Auriculotemporal nerve etc.
– VII Temporal and zygomatic branches
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Contents of the Temporal Fossa
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Dissection Into the Infratemporal Fossa
Spare the TMJ!
Coronoid
Process Head
To catch
on
lingula
Ramus33
Arch
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Temporal Infratemporal Fossa
• Osteology• Temporal Fossa, Boundaries & Contents
• Infratemporal Fossa,
Boundaries Contents
• Muscles of Mastication
• Maxillary Artery
•Pterygoid Venous Plexus
• Mandibular Nerve V3
• Temporomandibular Joint
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M SPMP
Temporal,
squamousSphenoid,
GW Infratemporal crest
EAM
Mandibular fossa
Lateral
pterygoid plate
Foramen
ovale
Infratemporal Fossa, Exposed by removal of zygomatic arch and mandible
© Saunders Elsevier 2011
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Paul W. L. Kwan, Ph.D.ufts Univ. Sch. Med.
Contents of the Infratemporal
Fossa• Temporalis muscle, inferior part
• Pterygoid muscles, medial and lateral
• Maxillary artery, first two parts
• Pterygoid venous plexus
•
Mandibular branch of CN V (V3)• Otic ganglion
• Chorda tympani (CN VII)
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Sphenoid GW
Pterygomaxillary fissure
Inferior orbital fissure
Infratemporal surface of maxilla
Sphenopalatine foramen
Pterygopalatine fossa
Lateral plate of pterygoid
process
Hamulus, medial
pterygoid plate
Foramen ovale
Infratemporal crest
Pterygopalatine Fossa
© Saunders Elsevier 2011
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Paul W. L. Kwan, Ph.D.ufts Univ. Sch. Med.
Cranial Base: Inferior View
© Saunders Elsevier 2011
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Cranial Base: Inferior View
© Saunders Elsevier 2011
Medial surface
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Superficial Arteries and Veins of Face and Scalp
© Saunders Elsevier 2011
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Facial Nerve Branches and Parotid Gland
M
PA
T
Z
B
C
© Saunders Elsevier 2011
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Paul W. L. Kwan, Ph.D.ufts Univ. Sch. Med.
Cutaneous Nerves of Head and Neck
Auriculotemporal n.
L. Buccal n.
Mental n.
© Saunders Elsevier 2006
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Paul W. L. Kwan, Ph.D.ufts Univ. Sch. Med.
Temporal Infratemporal Fossa
•Osteology
• Temporal Fossa, Boundaries & Contents
• Infratemporal Fossa, Boundaries & Contents
•Muscles of Mastication
• Maxillary Artery
• Pterygoid Venous Plexus
•
Mandibular Nerve V3 • Temporomandibular Joint
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Paul W. L. Kwan, Ph.D.ufts Univ. Sch. Med.
Temporal
fascia
Zygomatic
arch
Articular disc
of TMJ
Deep &
Superficial
parts of
Masseter
muscle
Temporalis
Muscle
Muscles Involved In Mastication (1) Masseter
© Saunders Elsevier 2011
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Paul W. L. Kwan, Ph.D.ufts Univ. Sch. Med.
Temporalis m.
Insertion of
temporalis
muscle to
coronoid process
of mandibleLateral pterygoid m.
Masseteric a. & n.
Maxillary artery
Insertion of
masseter m.
Muscles Involved In Mastication (2), Temporalis (masseter
removed)
© Saunders Elsevier 2011
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Paul W. L. Kwan, Ph.D.ufts Univ. Sch. Med.
Dissection Into the Infratemporal Fossa
Spare the TMJ!
Coronoid
Process Head
To catch
on
lingula
Ramus33
Arch
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Cranial Base: Inferior View
© Saunders Elsevier 2011
Medial surface
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Paul W. L. Kwan, Ph.D.ufts Univ. Sch. Med.
sphenoid
Lat surface
Medial surface
Lateral
pterygoid plate
Sphenoid
Bone
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Muscles Involved in Mastication (3)
Deep, The Pterygoid Muscles
Articular disc of TMJ
Articular tubercle
Lateral pterygoid m.
Sphenomandibular lig.
Medial pterygoid m.
Buccinator m.
© Saunders Elsevier 2011
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Muscles Involved In Mastication (4) Deep, Posterior view
Lateral pterygoid plate
Lateral pterygoid muscle
Medial pterygoid muscle
TMJ
Medial pterygoid plate
Masseteric a.
Maxillary a.
Inferior alveolar n.
Nerve to mylohyoid
Lingual n.
Auriculotemporal n. SML
Levator veli palatini m.
Tensor veli palatini m.Pterygoid hamulus
MMA
OG
© Saunders Elsevier 2011
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Paul W. L. Kwan, Ph.D.ufts Univ. Sch. Med.
Temporal Infratemporal Fossa
•Osteology
• Temporal Fossa, Boundaries & Contents
• Infratemporal Fossa, Boundaries & Contents
• Muscles of Mastication
• Maxillary Artery
• Pterygoid Venous Plexus
•
Mandibular Nerve V3 • Temporomandibular Joint
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Maxillary Artery: Parts Branches
(1) Mandibular / bony foramina
(2)Pterygoid / muscles
(3) Pterygopalatine / PFossa
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Ext. Carotid
Superficial temporal
Maxillary artery
Middle meningeal a.
Auriculotemporal n.TMJ
Not Shown:
Deep auricular a.
Anterior tympanic a.
Accessory meningeal a.
Inferior alveolar a.
Branch to mylohyoid
Mental
branch of
inferior
alveolar
Maxillary Artery (1) Mandibular Part
© Saunders Elsevier 2011
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Paul W. L. Kwan, Ph.D.ufts Univ. Sch. Med.
Maxillary Artery (1a) Mandibular Part
External
carotid
Superficial
temporal
Deep auricular
Anterior
tympanic
Auriculotemporal n.
Accessory and
Middle meningeal
Inferior alveolar,
cut
© Saunders Elsevier 2011
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Middle Meningeal Artery
95 ICON 2003
Pterion
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Acute Epidural Hematoma
Lenticular (lens shaped)
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© Saunders Elsevier 2011
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Epidural Hematoma
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Subdural Bleeding
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Stroke
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Deep temporal Ant.Post.aa./nn.
Masseteric a./n.
Lateral pterygoid a./m.
Medial pterygoid a./m.
Buccal a./n.
Maxillary
artery
Maxillary Artery (2) Pterygoid Part / Muscles
© Saunders Elsevier 2011
Vessel issuperficial to
LP muscle in
2/3 of time
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Paul W. L. Kwan, Ph.D.ufts Univ. Sch. Med.
Maxillary Artery (3) Pterygopalatine Part
Post.Sup.Alveolar
Infraorbital
Angular
Ophthalmic
Maxillary
artery
Middle
Anterior
© Saunders Elsevier 2011
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Maxillary Artery (3) Pterygopalatine Part
APCPASphenopalatine
Infraorbital
Post. Superior Alveolar
Descending palatine
in pterygopalatine
fossa
MaxillaryArtery
© Saunders Elsevier 2011
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Paul W. L. Kwan, Ph.D.ufts Univ. Sch. Med.
Temporal Infratemporal Fossa
•
Osteology• Temporal Fossa, Boundaries & Contents
• Infratemporal Fossa, Boundaries & Contents
• Muscles of Mastication
• Maxillary Artery
• Pterygoid Venous Plexus
• Mandibular Nerve V3
• Temporomandibular Joint
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Paul W. L. Kwan, Ph.D.ufts Univ. Sch. Med.
The Pterygoid Venous Plexus
Angular
Facial
Emissary v.
communicating
with cavernoussinus
Superior
ophthalmic
Superficial
temporal
Retromandibular
Ext. jugularPterygoid
plexus
Maxillary veins
© Saunders Elsevier 2011
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Paul W. L. Kwan, Ph.D.ufts Univ. Sch. Med.
The Cavernous
Sinus
Copyright 2003 ICON Learning Systems
98
Cavernous sinus
III
IV
VI
V1
V2
C Pituitary
104
© Saunders Elsevier 2011
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Paul W. L. Kwan, Ph.D.ufts Univ. Sch. Med.
Pterygoid Plexus, Cavernous Sinus, Facial
Vein
Angular v.
Facial v.
Deep facial v.
Retromandibular v.
Pterygoid plexus
Cavernous sinusOphthalmic vv.
Maxillary v
© Saunders Elsevier 2011
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Cavernous sinus-01
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Danger Triangle of the Face
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The Cavernous Sinus
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Paul W. L. Kwan, Ph.D.ufts Univ. Sch. Med.
Temporal Infratemporal Fossa
•
Osteology• Temporal Fossa, Boundaries & Contents
• Infratemporal Fossa, Boundaries & Contents
• Muscles of Mastication
• Maxillary Artery
• Pterygoid Venous Plexus
• Mandibular Nerve V
3
• Temporomandibular Joint
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Paul W. L. Kwan, Ph.D.ufts Univ. Sch. Med.
Mandibular Nerve (V
3
)
SENSORY
• Long Buccal
• Auriculotemporal *
• Lingual * ♠ • Inferior alveolar
• Meningeal branch
* Also carries parasympatheticfibers
♠ and special sense of taste
MOTOR• Medial pterygoid
– N. to tensor veli palatini
– N. to tensor tympani
• Masseteric
• Deep temporal
• Lateral pterygoid
• N. to mylohyoid – N. to ant. belly digastric
Motor
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Auriculotemporal
Inferior alveolar
(cut)
N. To mylohyoid /
a.b. d
Lingual
♠
Mental
Deep Temporal Ant./Post. Foramen ovale
MB
FS
MMA
CTLong buccal
SMG
Mandibular Nerve (V
3
)
46
© Saunders Elsevier 2011
Motor
Sensory
+ ANS
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Paul W. L. Kwan, Ph.D.ufts Univ. Sch. Med.
Mandibular Nerve (V
3
) Medial View
© Saunders Elsevier 2006
Facial
Chorda tympani
Motor root
Sensory root
Trigeminal ganglion
V1, Ophthalmic
V2, Maxillary
V3
Tensor veli palatini n./m.
Medial pterygoid n./m.
Lingual
Inferior alveolarMylohyoid n.
Auriculotemporal
Maxillary
artery
MM a.
OG
LP
Tensor
tympani n./m.
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Dermatomes of Head and Neck
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Temporal Infratemporal Fossa
•
Osteology• Temporal Fossa, Boundaries & Contents
• Infratemporal Fossa, Boundaries & Contents
• Muscles of Mastication
• Maxillary Artery
• Pterygoid Venous Plexus
• Mandibular Nerve V3
•Temporomandibular Joint
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Paul W. L. Kwan, Ph.D.ufts Univ. Sch. Med.
Mandible
Condylar process
Coronoid process
Head
Pterygoid fovea
Neck
Mandibular notchLingula
Mandibular foramen
Ramus
Angle
Body
Mental foramen
Mylohyoid
line
Mylohyoid
groove
© Saunders Elsevier 2006
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Paul W. L. Kwan, Ph.D.ufts Univ. Sch. Med.
Temporomandibular Joint (1)
Lateral View
Medial View
(1) Joint capsule
(2) Lateral (TMJ) ligament
(3) Sphenomandibular ligament
(4) Stylomandibular ligament
1
2
3
3
Mylohyoid a./n/
Mandibular n./Otic ganglion
Max.a.
4
© Saunders Elsevier 2011
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Paul W. L. Kwan, Ph.D.ufts Univ. Sch. Med.
Temporomandibular Joint (3)
© Saunders Elsevier 2011
Glid /S i
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Movements of the Temporomandibular Joint
Glide/Superior
Hinge/Lower
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Movement of the Temporomandibular Joint-2
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Jaw Dislocation
Dislocation of the
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Temporomandibular Joint
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Sphenoid GW
Pterygomaxillary fissure
Inferior orbital fissure
Infratemporal surface of maxilla
Sphenopalatine foramen
Pterygopalatine fossa
Lateral plate of pterygoid
process
Hamulus, medial
pterygoid plate
Foramen ovale
Infratemporal crest
Pterygopalatine Fossa
© Saunders Elsevier 2011
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Paul W. L. Kwan, Ph.D.ufts Univ. Sch. Med.
Dissection Into the Infratemporal Fossa
Spare the TMJ!
Coronoid
Process Head
To catch
on
lingula
Ramus3 3
Arch
The
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Paul W. L. Kwan, Ph.D.ufts Univ. Sch. Med. © 2002 Lippincott Williams & Wilkins
The
Ideal
For those who
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For those who
really want to
study the
maxillaryartery