DENTAL GROSS ANATOMY
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DENTAL GROSS ANATOMY CASE 3 INFRATEMPORAL FOSSA & TEMPOROMANDIBULAR JOINT. HISTORY Sherry Goldsmith was involved in a two-car collision and suffered severe facial injuries. EXAMINATION In the ER she was found to have the following injuries:

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Dental gross anatomy case 3 infratemporal fossa

DENTAL GROSS ANATOMY

CASE 3

INFRATEMPORAL FOSSA &

TEMPOROMANDIBULAR JOINT


Dental gross anatomy case 3 infratemporal fossa

  • HISTORY

  • Sherry Goldsmith was involved in a two-car collision and suffered severe facial

  • injuries.

  • EXAMINATION

  • In the ER she was found to have the following injuries:

  • The ramus of the mandible was shattered on the left side and displaced

  • medially into the infratemporalfossa.

  • The condyloid and coronoid processes were broken off on the left side.

  • The TMJ was driven medially breaking off the spine of the sphenoid.

  • A sliver of the windshield passed deeply into the infratemporalfossa,

  • reaching beyond the level of the infratemporal crest.

  • A large hematoma was found within the fossa shrouding the other contents.

  • After debridement of the wounds, an MRI was performed to determine the

  • total amount of the injuries.


Dental gross anatomy case 3 infratemporal fossa

  • POSTOPERATIVE OUTCOME

  • After a lengthy hospitalization and numerous surgeries, Ms. Goldsmith

  • was found to have the following neural and neuromuscular disorders:

  • Ipsilateral loss of taste sensations on the anterior part of the tongue.

  • Ipsilateral loss of general sensations on the anterior part of the tongue.

  • When the patient opens her jaw, the mandible deviates toward the side

  • of the injury.

  • Ipsilateralcutaneous anesthesia involving a strip of skin extending from

  • the lower lip and proceeding anterior to the ear and superior to the scalp.

  • Ipsilateral anesthesia of the lingual gingiva (mandibular region), floor of

  • the mouth and mandibular teeth.

  • 6. There was a reduction of the volume of saliva.


Dental gross anatomy case 3 infratemporal fossa

1. What are the bony boundaries

of the infratemporal fossa?


Dental gross anatomy case 3 infratemporal fossa

BOUNDARIES OF THE INFRATEMPORAL FOSSA

Ramus of mandible

(lateral wall)


Dental gross anatomy case 3 infratemporal fossa

BOUNDARIES OF THE INFRATEMPORAL FOSSA

Temporal fossa

Infratemporal crest of

greater wing of sphenoid

Infratemporal surface of

greater wing of sphenoid

(roof)

Infratemporal surface of maxilla

(anterior wall)

Styloid process

(posterior wall)

Lateral pterygoid plate

(medial wall)


Dental gross anatomy case 3 infratemporal fossa

  • Name the six, usually expected,

  • contents of the infratemporal fossa.

  • Muscles of mastication

  • (except masseter)

  • Pterygoid plexus of veins

  • 1st and 2nd parts of maxillary a.

  • (mandibular and pterygoid parts)

  • Mandibular division of V (V3)

  • Otic ganglion

  • Chorda tympani n.


Dental gross anatomy case 3 infratemporal fossa

CONTENTS OF INFRATEMPORAL FOSSA

Mandibular n. (V3)

Lateral pterygoid m.

Chorda tympani n.

Medial pterygoid m.


Dental gross anatomy case 3 infratemporal fossa

CONTENTS OF INFRATEMPORAL FOSSA (MEDIAL VIEW)

V3

Otic ganglion

Chorda tympani n.

Maxillary a.

Medial pterygoid m.


Dental gross anatomy case 3 infratemporal fossa

CONTENTS OF INFRATEMPORAL FOSSA

Superficial temporal v.

Pterygoid plexus

Maxillary vv.

Retromandibular v.


Dental gross anatomy case 3 infratemporal fossa

  • Discuss the specific attachments

  • and actions of the muscles of

  • mastication.


Dental gross anatomy case 3 infratemporal fossa

Temporalis fascia

Temporalis m.

Zygomatic arch

Deep part

(masseter m.)

Superficial part

(masseter m.)


Dental gross anatomy case 3 infratemporal fossa

Temporalis m.

Insertion of temporalis m.

into coronoid process and

anterior border of ramus

of mandible

Insertion of masseter m.

into lateral surface of

ramus of mandible


Dental gross anatomy case 3 infratemporal fossa

Articular disc of TMJ

Superior and inferior heads

of lateral pterygoid m.

Superficial and deep heads

of medial pterygoid m.

Pterygoid fovea

of neck of mandble

Angle of mandible


Dental gross anatomy case 3 infratemporal fossa

  • Explain the peculiar deviation

  • of the intact mandible.


Dental gross anatomy case 3 infratemporal fossa

Lateral pterygoid plate

V3 injured

on this side

Lateral pterygoid m.

Medial pterygoid m.

Deviation of mandible

to paralyzed side


Dental gross anatomy case 3 infratemporal fossa

5. Name the foramen through which the

mandibular division of the trigeminal

nerve (V3) passes into the infratemporal

fossa.

In which boundary of the infratemporal

fossa is this foramen located?

Does V3 supply any muscles other than

the muscles of mastication?


Dental gross anatomy case 3 infratemporal fossa

Foramen ovale (V3)

in roof of infratemporal fossa


Dental gross anatomy case 3 infratemporal fossa

V3 SUPPLIES ALL MUSCLES DERIVED FROM

PHARYNGEAL ARCH 1

Temporalis

Masseter

Mylohyoid &

ant. belly of digastric

NOT SHOWN

Medial & lateral

ptergoids

NOT SHOWN

Tensor palati &

tensor tympani


Dental gross anatomy case 3 infratemporal fossa

Temporalis fascia

and m.

Anterior division (V3) (mostly motor)

Posterior and

anterior deep temporal nn.

Posterior division (V3) (mostly sensory)

Foramen ovale

Masseteric n.

Lateral pterygoid n.

and m.

Auriculotemporal n.

Chorda tympani n.

Buccal n.

(sensory)

Lingual n.

Inferior alveolar n. (cut)

Mylohyoid n.

(motor)

Mylohyoid m. (cut)

Inferior alveolar n. (cut)

Digastric m. (anterior belly)


Dental gross anatomy case 3 infratemporal fossa

Motor root

Sensory root

Mandibular n. (V3)

Tensor (veli) palatini m. and n.

Tensor tympani m. and n.

Medial pterygoid m. and n.


Dental gross anatomy case 3 infratemporal fossa

  • Explain the cutaneous loss

  • demonstrated by the patient.


Dental gross anatomy case 3 infratemporal fossa

V3

Mental n.

Buccal n.

Auriculotemporal n.


Dental gross anatomy case 3 infratemporal fossa

  • Explain the loss of taste on the

  • anterior part of the tongue.


Dental gross anatomy case 3 infratemporal fossa

Geniculate ganglion (of VII)

(sensory neurons)

Chorda tympani n.

(br. of VII) supplies

taste buds on

anterior 2/3 of tongue


Dental gross anatomy case 3 infratemporal fossa

  • Explain the decreased volume

  • of saliva.


Dental gross anatomy case 3 infratemporal fossa

V3

Lesser petrosal n.

Otic ganglion

IX

Auriculotemporal n.

Inferior salivatory nucleus

Parotid gland

Tympanic plexus

Tympanic n.

Presynaptic parasympathetic fibers

Postsynaptic parasympathetic fibers


Dental gross anatomy case 3 infratemporal fossa

Lingual n.

Chorda tympani n.

VII

Superior salivatory nucleus

Submandibular ganglion

Sublingual and submandibular glands

Presynaptic parasympathetic fibers

Postsynaptic parasympatheti fibers


Dental gross anatomy case 3 infratemporal fossa

9. a. Identify the branch of the maxillary

artery which enters the middle cranial

fossa. From what part of the maxillary a.

does it arise?

b. Discuss the pathway by which this

artery enters the middle cranial fossa.


Dental gross anatomy case 3 infratemporal fossa

Anterior and posterior deep temporal aa.

Lateral pterygoid a. and m.

Masseteric a.

Middle meningeal a.

Maxillary a.

Infraorbital a.

Posterior superior alveolar a.

Inferior alveolar a.

Buccal a.

Medial pterygoid a. and m.

MAXILLARY A.

BRANCHES OF 1ST (MANDIBULAR) PART

BRANCHES OF 2ND (PTERYGOID) PART

BRANCHES OF 3RD (PTERYGOPALATINE) PART


Dental gross anatomy case 3 infratemporal fossa

Middle meningeal a.

(entering foramen spinosum)

Auriculotemporal n.


Dental gross anatomy case 3 infratemporal fossa

9. c. What does this artery supply?

d. Name the condition which results from

tearing this artery within the cranial

cavity. What will be the consequence if

this injury is not repaired immediately?


Dental gross anatomy case 3 infratemporal fossa

Calvaria

Dura mater

(Does not supply the brain)

Middle meningeal a.


Dental gross anatomy case 3 infratemporal fossa

  • Through what fissure does the maxillary

  • artery extend medially out of the

  • infratemporal fossa?


Dental gross anatomy case 3 infratemporal fossa

Pterygomaxillary fissure

(conducts maxillary a. into pterygopalatine fossa)


Dental gross anatomy case 3 infratemporal fossa

11. a. What type of joint is the TMJ?

Be specific.

b. What structure lies inside the TMJ

and what kinds of movement occur

in each part of the joint?


Dental gross anatomy case 3 infratemporal fossa

TMJ IS A MODIFIED HINGE TYPE OF SYNOVIAL JOINT

Lower joint compartment (hinge action)

Upper joint compartment (gliding action)

Articular disc (avascular fibrous tissue)

Articular tubercle

Joint capsule


Dental gross anatomy case 3 infratemporal fossa

12. Describe the movements of the head

of the mandible when the mouth is

opened widely.


Dental gross anatomy case 3 infratemporal fossa

JAW CLOSED

JAW WIDELY OPENED


Dental gross anatomy case 3 infratemporal fossa

MOVEMENTS OCCURRING AT TMJ


Dental gross anatomy case 3 infratemporal fossa

  • Name the parts of the mandibular

  • fossa and their boundaries.


Dental gross anatomy case 3 infratemporal fossa

Articular tubercle

Mandibular fossa

(articular part formed

by squamous temporal)

Postglenoid tubercle

Mandibular fossa

(nonarticular part formed

by tympanic temporal)


Dental gross anatomy case 3 infratemporal fossa

14. What bony structure offers resistance to

medial displacement of the head of the

mandible?


Dental gross anatomy case 3 infratemporal fossa

Middle cranial fossa

Articular disc

Spine of sphenoid


Dental gross anatomy case 3 infratemporal fossa

  • 15. Discuss the intrinsic and extrinsic

  • ligaments of the TMJ and the specific

  • function of the lateral thickening of the

  • fibrous capsule.

  • Name the arterial supply and nerve

  • supply of the TMJ.


Dental gross anatomy case 3 infratemporal fossa

Joint capsule

Lateral (temporomandibular) ligament

Styloid process

Stylomandibular ligament

.

Auriculotemporaln.

Maxillary a.

Inferior alveolar n.

Lingual n.

Sphenomandibular ligament

INTRINSIC LIGAMENT

EXTRINSIC LIGAMENTS

Mylohyoid a. and n.


Dental gross anatomy case 3 infratemporal fossa

  • Explain

  • (a) the movement resulting in the most

  • common displacement of the TMJ

  • (b) the “clicking” sound produced by

  • chronic dislocation of this joint.


Dental gross anatomy case 3 infratemporal fossa

DISLOCATION OF TMJ


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