Infra temporal & pterygopalatine fossae Lecture date: 5/4/2009

Today we will talk about infratemporal region and your home work will . be the pterygopalatine fossa Infratemporal region is a very important region that lies beneath the temporal bone (beneath the base of the skull) usually its deep to the ramus of the mandible so we can see this region when we cut the ramus .of mandible and the zygomatic arch Infratemporal fossa is bounded anteriorly by the posterior surface of maxilla(we will talk about the boundaries later on) and extends all the way back to the styloid process , so its the space beneath the temporal bone and greater wing of sphenoid (between the maxilla and styloid .process :Infratemporal communicates with 2 important regions superiorly and deep to zygomatic arch: with temporal region(1 medially: with pterygopalatine fossa (coz its bounded by pterygoid(2 (process of sphenoid bone, palatine bone and maxillary bone So superiorly you can find temporal fossa and when you go down you find infratempotal region, medially and deep to infratemporal fossa you .can find pterygopalatine fossa Boundaries of infratemporal fossa(the doctor repeated this part 3 :(times .Superiorly: temporal bone and greater wing of sphenoid Anteriorly: extends from posterior surface of maxilla all the way back to the styloid process (no anterior wall it just extends to that .region .Inferiorly: it extends to the angle of mandible .Medially: lateral pterygoid plate of sphenoid bone We can also say that infratemporal fossa is the space beneath the greater . wing of sphenoid and lateral to lateral pterygoid plate :Now the contents of infratemporal fossa or region two pterygoid muscles:(medial and lateral)both are mastication muscles(1

mandibular nerve: from trigeminal nerve (V3) coming from foramen(2 ovale, it gives 3 branches : A)lingual nerve, B)auriculotemporal nerve, .C)inferior alveolar nerve maxillary artery: the largest branch of external carotid artery (terminal(3 branch), we have only the 1st and 2nd part of maxillary artery in this region, and of course we have the maxillary vein and beside the maxillary vein there is a venous network over the pterygoid muscles .we call it pterygoid venous plexus spheno mandibular ligament: a ligament that extends from the spine of(4 sphenoid bone to the lingula of mandible(contributing to the movement .(of TMJ NOTE: lingula is a bony elevation ,whenever you see a bony elevation .that means there is a muscle or a ligament attachment here otic ganglion: arrangement of nerve cell body in peripheral nerve(5 system(if it was in the CNS we would call it nucleas), its called otic .because its close to the ear So there are autonomic nerve fibers doing synapse there, they can be sympathetic or parasympathetic, here in infratemporal fossa its .PARASYMPATHETIC Sympathetic nerve fibers do the synapse in sympathetic chain cause . they aggregates there(in sympathetic chain) beside vertebral column So otic ganglion is where parasympathetic fibers synapse to the parotid .gland chorda tympani: a branch from facial nerve that joins the lingual nerve(6 .to give the special sensation to the anterior 2/3 of the tongue :So in the infratemporal fossa we have 3 important nervous tissue A)mandibular nerve B)chorda tympani c)otic ganglion all of these are contents of infratemporal fossa thats why its a very .important region .Now we will talk about each content separately 1a-lateral pterygoid muscle Origin: a)superior head :arise from infratemoral surface of greater wing of sphenoid [from the roof of infratemporal fossa] . b)inferior head :arise from lateral surface of lateral .pterygoid plate
2

Insertion: both surfaces joins together and move backward to be inserted in the nick of mandible and the articualr disc of TMJ, so the muscle penetrates TMJ and go deep to be inserted to the fibrous disc there Action: a)when the lateral pterygoid contracts the lateral pterygoid and greater wing of sphenoid are fixed, the only movable structure is the joint (the mandible and the articular disc) so it moves the neck of mandible forward, in this case you are opening your mouth. .b)protrusion of the mandible Note:A and B happens when both muscles contracts {{bilateral movement C)rotation of the mandible to the opposite side .((unilateral movement Innervation : lateral pterygoid muscle is innervated by mandibular (branch of trigeminal nerve (anterior division of V3 b-Medial pteygoid muscle 1 .Origin: a)superfacial head: originate from maxillary tubercity b)deep head: originate from medial surface of lateral .pterygoid plate So we can say that both pterygoid muscles originate from lateral pterygoid plate , one from the surface while the other from the .medial surface NOTE: pterygoid muscles are NOT attached to the medial .{pterygoid plate {other muscles are attached there NOTE: between the superfacial and deep heads we can find the lower head of lateral pterygoid muscle :Function of medial pterygoid muscle a)elevation of mandible when you close your mouth OR b)work with the lateral pterygoid in the same side to rotate the .(mandible to the opposite side(unilateral movement Mandibular nerve-2 Mandibular nerve is a mixed nerve(sensory nerve +motor nerve to 8 muscles), it passes through foramen ovale in the skull which is located in the greater wing of sphenoid , after passing in foramen
3

ovale as a main trunk it divides into a small anterior division and a large posterior division , the anterior division has 3 motor and 1 sensory branches , while the posterior division has 1 motor and 3 .sensory branches So we have the main trunk , 2 divisions and 8 branches ( 3 motor, 1 sensory from anterior division and 3 sensory, 1 motor from the .(posterior division :Main trunk before the main trunk divides into anterior and posterior divisions it : gives A)a motor branch called nerve to medial pterygoid which innervates medial pterygoid muscle, tensor tympani and tensor veli .palatine B)meningeal sensory branch which comes back to the skull through foramen spinosum , in your book its mentioned foramen ovale but this is rare , most of the times it comes back to the meninges through foramen spinosum, its also called recurrent meningeal nerve or nervous spinosal(sorry im not sure if the doctor said spinosal or spinosum) this nerve provide sensation to .the dura matter :Anterior division: we have A)3 motor nerves: to the mastication muscles (temporalis, masseter, (and lateral pterygoid B)1 sensory nerve: the buccal nerve (sensory to the buccinator muscle and cheek), (arise between the 2 heads of lateral (pterygoid :Posterior division: we have A)3 sensory nerves: 1)lingual nerve: the most anterior branch of posterior division ,runs lateral to medial pterygoid muscle then it passes medial to the 3rd molar, it provides the general sensation to the anterior 2/3 of the tongue. 2)inferior alveolar nerve: enter the mandibular foramen and provide sensation to the lower teeth and to the buccal gingiva, inferior alveolar nerve gives a small nerve called nerve to mylohyoid(motor nerve) before it enters the foramen. 3)auriculotemporal nerve: arising usually by 2 roots, these roots bound(wrap) the middle meningeal artery then they unite together to give auriculotemporal nerve, once they unite they go behind TMJ into the temporal region, this nerve provide

sensation to the external audiotary meatus, auricle, tympanic .membrane, TM joint and the scalp laterally Otic ganglion-3 Otic ganglion is a small bulging medial to mandibular nerve just .beneath foramen ovale Function: synapse of parasympathetic fibers happens in otic ganglion ,this synapse carries motor innervation or screto-motor innervation to the parotid gland Its hanged in its position by nerve to medial pterygoid Preganglionic fibers or presynaptic fibers comes from glossopharyngeal nerve (IX), once they arrive to otic ganglion they are carried back by auriculotemporal nerve (at this time they are ( called post ganglionic Chorda tympani-4 Its a branch from facial nerve found in middle ear (in the tympanic cavity) it crosses the tympanic cavity from its posterior wall to its anterior one then it leaves the tympanic cavity through a fissure between petrous part of temporal bone and the tympanic part of temporal bone called petrotympanic fissure, then it joins the lingual nerve just beneath the lower border of lateral pterygoid muscle in the infra temporal fossa Chorda tympani carries parasympathetic screto-motor fibers to sublingual and submandibular salivary glands :Important notes sublingual and submandibular parasympathetic innervations comes* from chorda tympani which is a branch of facial nerve (VII), while the parotid salivary gland( the largest one) is innervated by (glossopharyngeal nerve (IX if the 3 glands had the same innervations, any injury to the nerve* that supplies these glands would cause a complete salivation loss , thats why we have more than one nerve to innervate these .glands
5

Maxillary artery-4 Maxillary artery is the largest terminal branch of external carotid artery, it arise posterior to the neck of mandible then it passes anteriorly deep to the neck of mandible(in the infratemporal fossa) .all the way to enter pterygopalatine fossa Maxillary artery is divided by the lateral pterygoid muscle into 3 :parts and gives 15 branches , you have to know them all A)madibular part (1st part):post to lateral pterygoid This part extends from the origin of the artery (from external carotid artery)until the level of lateral pterygoid muscle, this part gives 5 :branches deep auricular artery:supplies external audiotary meatus(1 (anterior tympanic artery: supplies tympanic membrane(ear drum(2 middle meningeal artery: supplies the dura matter (passes through(3 (foramen spinosum accessory meningeal artery: (anterior to middle meningeal artery),(4 passes through foramen ovale inferior alveolar artery: supplies lower teeth and lower buccal(5 gingival :NOTE: we have 3 structures passing through foramen ovale a)mandibular nerve b)accessory meningeal artery c)lesser petrosal nerve( carries parasympathetic fibers from glossopharyngeal to otic ganglion B)pterygoid part (2nd part):over lateral pterygoid muscle :this part gives 4 branches deep temporal arteries: to temporalis muscle 2(1 pterygoid artery: to lateral and medial ptreygoid muscles(2 massetric artery: to the masseter muscle(pass through mandibular(3 (notch buccal artery:supplies buccinator muscle +cheek(4 NOTE: the 2nd part of maxillary artery supplies all mastication .muscles +buccinator muscle

C)pterygopalatine part (3rd part):within pterygopalatine fossa (This part gives 6 branches: (guys you have to know the first 4 only posterior.superior alveolar artery: supplies maxillary molars(1 infraorbital artery: passes through infra orbital canal(2 descending palatine artery: descends through palatine canal to the(3 palate, supplies hard and soft palates sphenopalatine artery: (terminal branch) supplies nasal cavity,(4 paranasal sinuses(mainly maxillary one) and parts of the palate artery of pterygoid canal: supplies stacian tube(5 pharyngeal artery: to the roof of pharynx(6 Pterygoid venous plexus A venous network over the pterygoid , sleeping on the pterygoid .(muscles (in the infratemporal fossa .Later on this venous plexus forms the maxillary vein So pterygoid plexus drains into maxillary vein , then maxillary vein joins the superfacial temporal vein in the parotid tissue to form retromandibular vein Pterygoid venous plexus communicates anteriorly with facial vein .in the face through a small vein called deep facial vein it also communicates with superior cavernous sinus around sella turcica (in the meninges) [we can say venous sinuses inside the brain instead of cavernous sinus] via a vein called (.)! I guess he !said messary vein or something like that : Messary vein passes in the skull through foramen ovaleforamen lacerumforamen basaliSo messary veins communicates the venous sinuses in the brain with the pterygoid venous plexus, this point is so important because .this provides a root to spread of infection from face to the brain :So infection can spread from the face to the brain by communication between facial vein and ophthalmic vein(1 communication between facial vein and pterygoid venous plexus(2
7

The most common kind of infection inside the brain beside meningitis is the cavernous sinus infection(usually a bacteria that (comes from outside the brain Pterygopalatine fossa is your homework , you have to know the .boundaries and contents and we will discuss it in the net lecture .The end

DONE BY: MOHAMED BARAKAT