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 &

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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:

  • 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.


  • 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.


1. What are the bony boundaries

of the infratemporal fossa?


BOUNDARIES OF THE INFRATEMPORAL FOSSA

Ramus of mandible

(lateral wall)


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)


  • 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.


CONTENTS OF INFRATEMPORAL FOSSA

Mandibular n. (V3)

Lateral pterygoid m.

Chorda tympani n.

Medial pterygoid m.


CONTENTS OF INFRATEMPORAL FOSSA (MEDIAL VIEW)

V3

Otic ganglion

Chorda tympani n.

Maxillary a.

Medial pterygoid m.


CONTENTS OF INFRATEMPORAL FOSSA

Superficial temporal v.

Pterygoid plexus

Maxillary vv.

Retromandibular v.


  • Discuss the specific attachments

  • and actions of the muscles of

  • mastication.


Temporalis fascia

Temporalis m.

Zygomatic arch

Deep part

(masseter m.)

Superficial part

(masseter m.)


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


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


  • Explain the peculiar deviation

  • of the intact mandible.


Lateral pterygoid plate

V3 injured

on this side

Lateral pterygoid m.

Medial pterygoid m.

Deviation of mandible

to paralyzed side


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?


Foramen ovale (V3)

in roof of 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


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)


Motor root

Sensory root

Mandibular n. (V3)

Tensor (veli) palatini m. and n.

Tensor tympani m. and n.

Medial pterygoid m. and n.


  • Explain the cutaneous loss

  • demonstrated by the patient.


V3

Mental n.

Buccal n.

Auriculotemporal n.


  • Explain the loss of taste on the

  • anterior part of the tongue.


Geniculate ganglion (of VII)

(sensory neurons)

Chorda tympani n.

(br. of VII) supplies

taste buds on

anterior 2/3 of tongue


  • Explain the decreased volume

  • of saliva.


V3

Lesser petrosal n.

Otic ganglion

IX

Auriculotemporal n.

Inferior salivatory nucleus

Parotid gland

Tympanic plexus

Tympanic n.

Presynaptic parasympathetic fibers

Postsynaptic parasympathetic fibers


Lingual n.

Chorda tympani n.

VII

Superior salivatory nucleus

Submandibular ganglion

Sublingual and submandibular glands

Presynaptic parasympathetic fibers

Postsynaptic parasympatheti fibers


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.


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


Middle meningeal a.

(entering foramen spinosum)

Auriculotemporal n.


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?


Calvaria

Dura mater

(Does not supply the brain)

Middle meningeal a.


  • Through what fissure does the maxillary

  • artery extend medially out of the

  • infratemporal fossa?


Pterygomaxillary fissure

(conducts maxillary a. into pterygopalatine 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?


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


12. Describe the movements of the head

of the mandible when the mouth is

opened widely.


JAW CLOSED

JAW WIDELY OPENED


MOVEMENTS OCCURRING AT TMJ


  • Name the parts of the mandibular

  • fossa and their boundaries.


Articular tubercle

Mandibular fossa

(articular part formed

by squamous temporal)

Postglenoid tubercle

Mandibular fossa

(nonarticular part formed

by tympanic temporal)


14. What bony structure offers resistance to

medial displacement of the head of the

mandible?


Middle cranial fossa

Articular disc

Spine of sphenoid


  • 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.


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.


  • Explain

  • (a) the movement resulting in the most

  • common displacement of the TMJ

  • (b) the “clicking” sound produced by

  • chronic dislocation of this joint.


DISLOCATION OF TMJ


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