Second Year Dental Student

• Anatomy
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Temporal and infratemporal ‫اﻟﺜﻼﺛﺎء‬

Lecture: 3 Date: 21/2/2017
Dr’s name: Mohammad alsalem

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Asnan
Temporal Fossa
z Narrow fan-shaped space
z Borders:
z Superior: pair of temporal
lines
z Lateral: temporal fascia
z Anterior: posterior surface
of the frontal and zygomatic
bones
z Inferior: laterally, zygomatic
arch. Medially, infratemporal
crest of the greater wing of
the sphenoid

Contents of
Temporal Fossa
z Temporalis muscle
z Zygomaticotemporal
nerve
z Deep temporal
nerves
z Deep temporal
arteries
z Middle temporal
artery
Temporalis
muscle
z Origin: Bone of
temporal fossa
and temporal
fascia
z Insertion:
Coronoid process
of mandible and
anterior margin of
ramus of mandible
almost to last
molar tooth
z NS: Deep
temporal nerves
from the anterior
trunk of the
mandibular nerve
z Action: Elevation
and retraction of
mandible

Infratemporal Fossa

z wedge-shaped

z Roof: inferior
surfaces of the
greater wing of the
sphenoid and the
temporal bone,
contains the
foramen spinosum,
foramen ovale, and
the petrotympanic
fissure

z lateral wall: medial surface of the ramus of mandible, contains the opening
to the mandibular canal
Infratemporal Fossa

z Medial wall: anteriorly, lateral plate of the pterygoid process, posteriorly;

pharynx and two muscles of the soft palate (tensor and levator veli palatini
muscles), pterygomaxillary fissure anteriorly, which allows structures to pass
between the infratemporal and pterygopalatine fossae

Infratemporal Fossa

z Anterior wall: posterior surface of the maxilla, contains the alveolar

foramen, and the upper part opens as the inferior orbital fissure into the
orbit.
Infratemporal
Fossa contents
z Sphenomandibular
ligament
z Medial pterygoid
muscle
z Lateral pterygoid
muscle
z Maxillary artery
z Mandibular nerve
[V3] (branches)
z Chorda tympani of
the facial nerve
[VII]
z Lesser petrosal
(glossopharyngeal
nerve)
z Otic ganglion
z Pterygoid plexus
of veins

Infratemporal
Fossa contents
z Sphenomandibular
ligament:
z Extracapsular
ligament of the
temporomandibular
joint
z Attachments:
¾ Superiorly: spine of
the sphenoid bone
¾ inferiorly to attach
to the lingula of the
mandible
Medial pterygoid
muscle
z Origin:
¾ Deep head: medial
surface of lateral
plate of pterygoid
process
¾ Superficial head:
tuberosity of maxilla
and pyramidal
process of palatine
z Insertion: Medial
surface of mandible
angle
z NS: Nerve to medial
pterygoid from the
mandibular nerve
z Action: Elevation
side to-side
movement

Lateral pterygoid
muscle
z Origin:
¾ Upper head: roof of
infratemporal fossa
¾ lower head: Lateral
surface of lateral plate of
the pterygoid process
z Insertion: Capsule of
temporomandibular joint
in the region of
attachment to the
articular disc
z NS: nerve to lateral
pterygoid from anterior
trunk of the mandibular
nerve
z Action: Protrusion and
sideto-side movements
¾ Largest of the three
divisions
¾ Through foramen
ovale

z All branches originate

in the infratemporal
fossa
z Mixed:
¾ Sensory root:
between the tensor
veli palatini muscle
and the upper head of
the lateral pterygoid
muscle
¾ Motor root: passes through the foramen ovale and immediately joins the
sensory part of the mandibular nerve
z Two Trunks: Anterior and posterior

¾ Branches directly
from manidibular
(medial aspect)

z Meningeal branch
¾ Foramen spinosum
¾ Dura mater of the
middle cranial fossa
z Nerve to medial
pterygoid

¾ Branch to tensor veli palatini

¾ Branch to tensor tympani muscle
™ Through bony canal in temporal bone
¾ Branches from
Anterior trunk

z Buccal nerve:
¾ Between the upper
and lower heads of
lateral pterygoid
¾ lateral to the
buccinator, supply the
adjacent skin and oral
mucosa and the
buccal gingivae of the
lower molars

• Masseteric nerve: Pass laterally over the lateral pterygoid muscle and
through the mandibular notch, on the deep surface of masseter M

Mandibular
nerve

¾ Branches
from Anterior
trunk

• Masseteric nerve: Pass laterally over the lateral pterygoid muscle and
through the mandibular notch, on the deep surface of masseter M
¾ Branches from
Anterior trunk

z Deep temporal
nerves:
¾ above the lateral
pterygoid muscle
¾ Temporal fossa to
supply the temporalis
muscle

• Nerve to lateral pterygoid

¾ Directly to deep surface of the lateral pterygoid muscle

¾ Branches from
Posterior trunk
z Auriculotemporal
nerve:
™ between the tensor
veli palatini and the
upper head of lateral
pterygoid muscle
™ between the
sphenomandibular
ligament and the neck
of mandible
™ curves around the
neck of mandible

z Supply: area of the temple, external ear, the external auditory meatus,
tympanic membrane, and temporomandibular joint delivers postganglionic
parasympathetic nerves from the glossopharyngeal nerve [IX] to the parotid
gland
¾ Branches from
Posterior trunk
z Lingual nerve:
™ between the tensor
veli palatini and
lateral pterygoid
muscle
™ joined by the chorda
tympani nerve
™ lateral surface of the
medial pterygoid
™ Between the posterior
attachment of the
mylohyoid muscle to
the mylohyoid line
and the attachment of
the superior
constrictor of the
pharynx

¾ Branches from
Posterior trunk
z Lingual nerve:
™ enters the floor of the
oral cavity
™ groove on the medial
surface of the
mandible immediately
inferior to the last
molar tooth
™ At risk when
operating on the
molar teeth
™ Passes into the tongue on the
lateral surface of the
hyoglossus muscle
™ attached to the submandibular
ganglion
The chorda tympani nerve
z Originates from the facial nerve
z Mastoid wall of the middle ear
z Passes through a small canal
z Separated from the tympanic
membrane by the handle of
malleus

z continues through the petrotympanic

fissure, it emerges from the skull into
the infratemporal fossa. It soon
combines with lingual nerve
¾ Taste Anterior 2/3 of tongue
¾ Preganglionic parasympathetic fibers
to submandibular ganglion

Lingual nerve
Lingual nerve
z General sensation from the anterior two-thirds of the tongue, oral
mucosa on the floor of the oral cavity, and lingual gingivae
associated with the lower teeth

¾ Branches from
Posterior trunk
z Inferior alveolar
nerve:
z originates deep to the
lateral pterygoid
muscle
z between the
sphenomandibular
ligament and ramus
of mandible
z mandibular foramen
and canal

z Before entering mandibular foramen, it gives nerve to mylohyoid

z incisive nerve
z mental nerve
Inferior alveolar nerve
z Motor : nerve to mylohyoid, supply mylohyoid and
anterior belly of digastric
z Sensory:
¾ Main trunk: molars teeth and the second premolar
¾ Incisive branch: rest of lower teeth
¾ Mental nerve: mucosa and skin of the lower lip and
skin of the chin

Hiatus for Lesser petrosal nerve Tympanic canaliculus

Lesser petrosal nerve

z The tympanic
plexus, and the
lesser petrosal
nerve
z Middle cranial
fossa, then
through foramen
ovale to auriculotemporal nerve V
infratemporal
fossa
z Postganglionic
fibers pass to
the parotid
salivary gland.
z Otic ganglion: small stellate-shaped ganglion inferior to the foramen ovale
and medial to the mandibular division of the trigeminal n.
z lesser petrosal nerve contains mainly preganglionic parasympathetic fibers
for the parotid gland

Maxillary artery

z Enter: between the

neck of mandible and
sphenomandibular
ligament
z Leave: through

pterygomaxillary fissure
z Three parts:

¾ 1st: between the neck of mandible and sphenomandibular ligament

¾ 2nd: related to the lateral pterygoid muscle

¾ 3rd: in the pterygopalatine fossa

 jugular foramen
Maxillary artery
z Branches from 1st
hypoglossal canal
part:

foramen magnum

z Middle meningeal
artery
Course

¾ Between the sphenomandibular ligament and the lateral pterygoid

¾ Between the two roots of auriculotemporal nerve
¾ Enters through the foramen spinosum

Maxillary artery
z Branches from 1st
part:

z Inferior alveolar
artery

¾ Enter the mandibular foramen

¾ Supplies all lower teeth, buccal gingivae, chin, and lower lip
¾ Gives mental artery
Maxillary artery
z Branches from 1st
part:

¾Deep auricular
artery: external
acoustic meatus

¾ Anterior tympanic artery: (Through petrotympanic fissure), supplies deep surface

of the tympanic membrane
¾ Accessory meningeal artery: (Through foramen ovale) supplies dura mater

Maxillary artery
z Branches from 2nd
part:

z Deep temporal arteries

z Pterygoid arteries
z Buccal artery
z Masseteric artery
Pterygopalatine Fossa
z Inverted teardrop-
shaped space
z lateral side of skull
z Walls:
¾ Anterior: posterior
surface of the maxilla
¾ Medial: Perpendicular
plate of the palatine
bone
¾ Posterior: Pterygoid
process of sphenoid
bone
¾ Roof: sphenoid bone

Pterygopalatine Fossa Gateways

Maxillary nerve
z Exits the middle cranial
fossa through the
foramen rotundum
z Exits pterygopalatine
fossa as the infra-orbital
nerve through the
inferior orbital fissure

Maxillary nerve branches

z Orbital branches
z Greater palatine nerve
z Lesser palatine nerve
z Nasal nerves
z pharyngeal nerve
z Zygomatic nerve
z Posterior superior
alveolar nerve
z Infra-orbital nerve
Maxillary nerve branches
z Greater palatine nerve
z Lesser palatine nerve
¾ Pass inferiorly from the
pterygopalatine ganglion
¾ Through the palatine
canal
¾ Through small foramina
¾ Greater:
™ Roof of the oral cavity
to innervate mucosa
as far as premolars
™ Posterior inferior
nasal nerves
¾ Lesser: supply the soft
palate

Maxillary nerve branches

Nasal branches

z Posterior superior lateral nasal nerves: (through the sphenopalatine

foramen, supply the lateral wall of the nasal cavity)
z Posterior superior medial nasal nerves: supplies the roof and the nasal
septum
z Nasal branches from the maxillary nerve:
z Nasopalatine nerve: (largest) passes forward and down the medial wall of
the nasal cavity to pass through the incisive canal onto the roof of the oral
cavity, and terminates by supplying the oral mucosa posterior to the incisor
teeth

Maxillary nerve branches

z Pharyngeal nerve
¾ Passes posteriorly
from the
pterygopalatine
ganglion
¾ Leaves through the
palatovaginal canal
¾ Supply the mucosa
and glands of the
nasopharynx
Maxillary Nerve branches
¾ Zygomatic nerve:
Pteyrgopalatine fossa
Inferior orbital fissure
ƒ Zygomaticotemporal
nerve: skin over the
temple
ƒ Zygomaticofacial N:
skin over the
prominence of the
cheek
¾ Posterior superior
alveolar nerve:
¾ through the
pterygomaxillary
fissure
¾ through a small alveolar foramen:
¾ supplies the molar teeth and adjacent buccal gingivae and maxillary
sinus

Maxillary Nerve branches

¾ Infraorbital nerve:
¾ Direct continuation of
the maxillary nerve
¾ through the inferior
orbital fissure
¾ infra-orbital canal
¾ Middle superior
alveolar
¾ Anterior superior
alveolar
¾ Exits through the infra-
orbital foramen
¾ Inferior palpebral:
skin of the lower
eyelid and cheek
¾ Nasal: the side
of the nose (ala)
¾ Superior labial:
upper lip
Nerve of the pterygoid canal
¾ Formed in the middle cranial fossa
by the union of:
¾ Greater petrosal nerve (branch
of the facial nerve)
¾ Deep petrosal nerve (branch of
the internal carotid plexus).
¾ Enters through pterygoid canal
¾ Join pterygopalatine ganglion
¾ Caries:
¾ preganglionic parasympathetic
fibers from greater petrosal
¾ postganglionic sympathetic
fibers from deep petrosal

Greater petrosal nerve

z Branch from
facial in
middle ear
cavity
z Medial wall
of the
tympanic
cavity from
geniculate
ganglion
z Leave to
Middle
cranial fossa
through the
greater
petrosal
foramen
Greater petrosal nerve
z Passes over
Foramen
lacerum, where it
joins deep
petrosal nerve to
form the nerve to
pterygoid canal
z Pterygoid canal
z Pterygopalatine
gangilion
z Maxillary nerve

Greater petrosal nerve

z Posterior margin of
the middle cranial
fossa
z Under the internal
carotid artery
z Superior surface of
the cartilage filling
the foramen lacerum
z Joined by the deep
petrosal nerve to
form the nerve of the
pterygoid canal
Deep petrosal nerve

z Postganglionic
sympathetic
fibers
z originate in the
superior
cervical
sympathetic
ganglion in the
neck
z leave the
ganglion
(superior
cervical) as the
internal carotid
nerve

Pterygopalatine ganglion
z largest of the four
parasympathetic ganglia in the
head
z postganglionic parasympathetic
fibers originate in the
pterygopalatine ganglion +
postganglionic sympathetic
fibers passing through the
ganglion
z Distribute with
¾ orbital, palatine, nasal, and
pharyngeal branches
z Supplies:
¾ Mucous glands in the nasal
cavity
¾ Salivary glands in the upper
half of the oral cavity
¾ lacrimal gland in the orbit.
Deep petrosal nerve

z Fibers from
pterygopalatine
ganglion join
main trunk of
the maxillary
nerve and
distributed
with:
¾ Zygomatic
¾ Posterior
superior
alveolar
¾ Infra-orbital

¾Fibers leave the zygomaticotemporal branch of the zygomatic nerve travels up the
lateral orbital wall to join the lacrimal nerve

™ Nerve supply of lacrimal gland

¾ The lacrimal nerve is a major general sensory branch of the ophthalmic nerve
¾ Parasympathetic innervation: originally from great petrosal nerve branch of facial
¾ Sympathatic innervation : originally from deep petrosal nerve from carotid plexus,
superior cervical ganglia
Maxillary artery
z Branches from 3rd
part:
(pterygopalatine
fossa)
z Anterior to
pterygopalatine
ganglion
¾ Posterior superior
alveolar artery
z molar and
premolar
¾ Infra-orbital artery
z through the inferior
orbital fissure
z through the infra-orbital foramen
z Anterior superior alveolar arteries: incisor and canine teeth
Maxillary artery

z Greater palatine artery

¾ Into the palatine canal

¾ Gives lesser palatine

branch (soft palate)
¾ Then superiorly
through the incisive
canal
¾ supply the anterior
aspect of the septal
wall of the nasal
cavity

Maxillary
artery

z Sphenopalatine artery: (largest) terminal branch of the maxillary artery

™ Branches
¾ Posterior lateral nasal branches

¾ Posterior septal branches

Maxillary artery
¾ Pharyngeal branch
™ Through the
palatovaginal canal
™ Supplies:
z posterior aspect of
the roof of the
nasal cavity
z Sphenoidal sinus

z Pharyngotympanic
tube

¾ Artery of pterygoid
canal
z Passes into the
pterygoid canal
z Foramen lacerum

z Terminates in
nasopharynx
TMJ

z Type: Synovial (hinge and sliding)

z Articulation: Articular tubercle and the anterior portion of the mandibular
fossa above and the head (condyloid process) of the mandible below
™ The articular surfaces are covered by fibrocartilage
z Articular disc: divides the joint into upper and lower cavities
™ attached to the capsule and tendon of the lateral pterygoid
TMJ
z Capsule: attached above to the
articular tubercle and the margins
of the mandibular fossa and below
to the neck of the mandible.
z Synovial membrane: lines both
compartments of the joint and
attached to the margins of the
articular disc
z Ligaments:
¾ Lateral ligament
™ Prevents lateral and posterior
displacement of the condyle
¾ Sphenomandibular ligament
™ Keeps same amount of tension
during both opening and closing of
the mouth
¾ Stylomandibular ligament
™ Limit anterior protrusion of the
mandible

TMJ
z Nerve supply: Auriculotemporal
and masseteric
z Blood supply: Deep auricular,
Anterior tympanic, Superficial
temporal

z Relations:
¾ Anteriorly: Mandibular notch,
masseteric nerve and artery
¾ Posteriorly: external auditory
meatus, glenoid process of the
parotid gland
¾ Laterally: parotid gland, fascia, and
skin
¾ Medially: maxillary artery and vein
and the auriculotemporal nerve
Masseter muscle
z Origin:
¾ Superficial part:
maxillary process of
the zygomatic,
zygomatic process
of the maxilla
¾ Deep part: medial
aspect of the
zygomatic arch
z Insertion: Lateral
surface of mandible
ramus
z NS: Masseteric
nerve from anterior
trunk of mandibular
nerve
z Action: Elevation of
mandible

¾Opening the mouth involves both

depression and protrusion

™ When the lateral and medial pterygoids contract on

only one side, the chin moves to the opposite
side. Chewing movement results