Temple, Infratemporal Fossa, TMJ

Code: NS29
Lecturer: Dr. S. Kandiah
Date: 9th October 2013

Learning Objectives
Mandible and muscles of the first
branchial arch
Temporomandibular joint
Maxillary artery
Lingual nerve

The divisions of the trigeminal nerve are segregate to exit

the skull through separate foramen

Opthalmic (V1) Maxillary (V2) Mandibular (V3)

Standing Room Only
Superior Orbital Fissure (V1) Foramen Rotundum (V2) Foramen Ovale (V3)

The mandibular division of the trigeminal is both

sensory and motor
Trigeminal nerve (V) Motor Supply to
Opthalmic (V1)

Muscles of mastication
Sensory
-Temporalis
2 Large
-Masseter
Maxillary nerve (V2)
-Medial Pterygoid
2 Pterygoids
Sensory
-Lateral Pterygoid
And others
Mandibular division (V3) -mylohyoid
Sensory
-Ant. Belly of Digastric
2 Floor
st
Motor(1 Branchial arch)
-Tensor Tympani
-Tensor Palati
2 Tensors

The cutaneous branches of the trigeminal V3 division

1) Auriculotemporal
2) Buccal
3) Mental

V3 dermatome

What is Hiltons Law?

The boundaries of the temporal fossa

Temporal fossa
1)Occupied by
temporalis
2)Superior temporal
line
3)Zygomatic arch

Boundaries of the infratemporal fossa.

Temporal Fossa

Frontal

Parietal

Sphenoid

Temporal

Boundaries:
Lateral=Ramus of Mandible
Anterior=Maxilla
Medial=Lat. Pterygoid Plate
Roof=Sphenoid

Maxilla
Lat. Pterygoid Plate
Pterygomaxillary Fissure

Infratemporal Fossa

Osteology of the mandible

Mandibu
lar
notch
Condyl
e

Corono
id
proces
s
Body

Neck
Ram
us
Angl
e

Mandibular nerve & branches in the infratemporal fossa

1) Auriculotemporal Nerve
1) Skin over the Temple
2) Parasymapthetic to parotid gland (IX nerve)
2) Inferior Alveolar Nerve
1) Lower Teeth and associated gingivae
2) Mental Nerve
3) Lingual Nerve

1) Anterior 2/3 of the tongue General Sensatio

4) Buccal Nerve
1) Skin over the cheek + 2nd/3rd Molar Teeth
5) Motor Nerves (Masseteric etc.)

Mandibular Nerve & Branches

1) Inferior alveolar nerve supplies

lower jaw teeth
2) Local anesthetic injected deep to
last molar close to mandibular
foramen for dental surgery (can
spread to mental and lingual
nerves)
3) Mental nerve is a cutaneous
branch
4) Root canal surgery can damage
mental nerve leading to
numbness on the lower jaw skin

Maxillary Artery
One of two terminal
branches of the
external carotid artery
It passes deep to the
neck of the mandible
and enters the
infratemporal fossa
Supplies muscles of
mastication

Maxillary Artery

1) Branches
supply muscles
of mastication
2) Lower jaw teeth
3) Skin on the jaw
4) Middle
meningeal
artery

Medial view of infratemporal fossa showing external

carotid branches including maxillary artery

Middle meningeal artery

Middle meningeal artery supplies the meningeal layers protecting the brain. If the
middle menigeal artery ruptures where would bleeding occur?

Surface marker for middle meningeal artery

Jugal point

Venous Drainage
1) Pterygoid plexus
drain muscles of
mastication
2) Drains into
maxillary and
facial vein
3) Maxillary and
superficial
temporal vein
form
retromandibular
which drains into
both external and
internal veins
4) Emissary veins
connect to
cavernous
sinus(route for
infection)

Other neural structures in the infratemporal fossa

1) Otic ganglion;Post-ganglionic parasympathetic to parotid gland

2) IX nerve supply pre-ganglionic parasympathetic fibers to otic
ganglion
3) Chorda tympani (branch of the facial)

The temporomandibular joint is the only movable

joint in
the skull
Articular
eminence
Mandibular
fossa

Condyle

Osteology of the mandible

Mandibu
lar
notch
Condyl
e

Corono
id
proces
s
Body

Neck
Ram
us
Angl
e

Temporomandibular Joint - Mandible

Temporomandibular Joint
Synovial Joint, atypical
Condyloid process (head) of mandible
and articular margins and tubercle of
the mandibular fossa on squamous
part of the temporal bone
Capsule - fossa and neck of mandible

Temporomandibular Joint
fibrocartilagenous disc - upper and
lower compartments
articular surface of joint lined with
fibrous cartilage, not hyaline cartilage
like other synovial joints

Dislocation of TMJ
Dislocation - anteriorly most common,
condyloid process moves forward onto
articular eminence
Inferiorly into infratemporal fossa
Posteriorly into EAM and tympanic
cavity

Movements at TMJ
Upper compartment
- protraction - lateral pterygoids
- retraction - posterior fibres temporalis
Lower compartment
- depression - lateral pterygoids,
mylohyoid, anterior digastric
- elevation - medial pterygoids,
masseter, temporalis

Temporomandibular Joint - Movements

Masseter
Originates from the
zygomatic arch
Inserts onto the lateral side
of the mandibular ramus
V3 Massetric nerve
Masseteric artery(branch
of maxillary)
Closes the mouth,
clenches the teeth, and
protrudes the jaw

Temporalis
Temporalis muscle arises
from the temporal fossa
Fan shape with
anterior,middle and
posterior parts

Temporali
s

Inserts onto the coronoid

process and the anterior
border of the mandibular
ramus
Action: closes and retracts
mandible (posterior fibres)

Masseter

Lateral Pterygoid

Arises from the lateral

side of lateral pterygoid
plate

Inserts into the neck of

mandible, the articular
disc in the TMJ and the
capsule of the joint

Action: opens the mouth

and protrudes the jaw

The lateral pterygoid opens the mouth

and protrudes the mandible

Medial Pterygoid

Originates from the

medial side of the
lateral pterygoid plate

Inserts onto the

medial side of the
mandibular ramus

Actions: like
masseter, but also
draws mandible to
opposite side during
chewing
What then attaches to
the medial pterygoid
plate?

The suprahyoid muscles, especially the

digastric, help to depress the mandible

Nerve and Blood Supply

Superficial temporal, maxillary arteries
Auriculotemporal off Vc - referred pain
to ear and lower teeth
Mandibular Vc - muscles of
mastication, 1st Branchial Arch
Other muscles use to masticate?

FORAMEN
OVALE

The auriculotemporal
nerve is the principal
nerve supplying the
temporomandibular joint