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Neuro Exam II > Muscles of mastication and Infratemporal Fossa - SRS > Flashcards

Muscles of mastication and Infratemporal Fossa - SRS Flashcards

1
Q

The temporal fossa is the lateral area of the skull overlying the squamous portions of the frontal, parietal, temporal, and sphenoid bones. This region is continuous inferiorly with what?

A

Infratemporal fossa

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2
Q

What are the boundaries of the infratemporal fossa?

A
  1. Anterior/superior/posterior – superior temporal line (zygomatic, frontal, parietal, temporal bones)
  2. Inferior (lateral) – zygomatic arch
  3. Inferior (medial) – infratemporal crest of temporal and sphenoid bones
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3
Q

What are the contents of the temporal fossa?

A

Upper portion of temporalis muscle and a dense temporalis fascia

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4
Q

The infratemporal fossa is the deep region of the head, lying inferior and deep (inferiomedial) to the temporal region.

What are the following boundaries?

  1. Lateral –
  2. Superior (lateral) –
  3. Superior (medial) –
  4. Medial –
  5. Anterior –
  6. Posterior –
  7. Inferior –
A
  1. Lateral – ramus of mandible
  2. Superior (lateral) – zygomatic arch
  3. Superior (medial) – infratemporal crest of temporal and sphenoid bones
  4. Medial – lateral pterygoid plate of sphenoid and pharynx
  5. Anterior – maxilla
  6. Posterior – imaginary line connecting posterior border of ramus of mandible and styloid process of temporal bone
  7. Inferior – continuous with submandibular region
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5
Q

What are the general contents of the infratemporal fossa?

(7)

A
  1. Lower portion of temporalis muscle
  2. Medial pterygoid
  3. Lateral pterygoid
  4. Maxillary artery (1st and 2nd portion)
  5. Pterygoid plexus of veins
  6. Mandibular division of CN V (V3)
  7. Otic ganglion
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6
Q

The temporomandibular joint is an articulation between what two things?

A
  1. Mandible - condyle
  2. Temporal bone – mandibular fossa and articular tubercle
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7
Q

The temporomandibular joint operates during chewing; while opening the mouth, how does the joint move?

A

The condyle of the tubercle slides anteriorly against the posterior surface of the articular tubercle.

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8
Q

What type of joint is the temporomandibular joint?

A

It is made of two synovially lined cavities separated by a dense connective tissue articular disc.

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9
Q

What is the function of the upperportion of the temporomandibular joint?

A
  • Gliding movements
  • Allows protrusion and retrusion of mandible
  • Allows elevation and depression of the mandible
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10
Q

What is the function of the lower portion of the temporomandibular joint?

A
  • Pivot-type movements
    • Allows side to side movments during chewing
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11
Q

If the mandibular condyle slides too far anteriorly (relative to the articular tubercle) the jaw can dislocate, and the patient will be unable to close the jaw. Should this happen, What structure is at risk?

How would you fix this?

A

Auriculotemporal nerve

Push the mandible inferiorly, then posteriorly to reduce.

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12
Q

The temporomandibular joint (TMJ) can develop arthritis, leading to degeneration of the cartilage and bones of the joint. What signs/symptoms would this present with?

A
  • Can be painful
  • Clicking (crepitus) or popping while opening
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13
Q

What are the three shared features of the muscles of mastication?

A
  1. Derived embryologically from the 1st pharyngeal arch
  2. Innervated by V3
  3. Function – mastication
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14
Q

What are the muscles of mastication?

A
  1. Temporalis
  2. Masseter
  3. Medial pterygoid
  4. Lateral pterygoid
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15
Q

What is the function of the temporalis muscle?

What is it’s special feature?

A

elevates (closes) and retracts jaw

1.Special feature – temporobuccinator band

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16
Q

What is the temporobuccinator band?

What is its function?

A
  • Dense fascial band that spans from temporalis tendon to buccinator muscle.
  • Function – pull buccinator muscle away from teeth.
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17
Q

What is the function of the masseter?

A
  1. elevates (closes) mandible
  2. assists with protrusion
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18
Q

What is the function of the medial pterygoid?

A
  1. Elevates (closes) the mandible
  2. Assists with protrusion and pivot movements of the mandible
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19
Q

What is the function of the lateral pterygoid?

A
  1. protrusion of mandible;
  2. acting unilateral, moves jaw towards contralateral side to produce pivot movements of chewing (side-to-side movement of jaw).
20
Q

What is Bruxism? What is it often associated wtih?

A

Teeth grinding; often associated with TMJ pain

21
Q

How is TMJ overuse/arthritix treated?

A
  1. Can be managed conservatively with OMT
  2. Arthroscopic surgery for more severe cases
22
Q

What are the two terminal branches of the external carotid artery?

A

Maxillary artery

superficial temporal artery

23
Q

The maxillary artery courses posterior to the neck of mandible (between it and the spenomandibular ligament) to enter the infratemporal fossa. What are the three portions of the maxillary artery?

A
  1. Mandibular
  2. pterygoid
  3. pterygopalatine
24
Q

The mandibular portion of the maxillary artery courses deep to the neck of the mandible. What are the branches it gives off?

(5)

A
  1. Deep auricular a.
  2. Anterior tympanic a.
  3. Middle meningeal a.
  4. Accessory meningeal a.
  5. Inferior alveolar a.
25
Q

The pterygoid portion of the pterygoid artery courses through the infratemporal region, either superficial or deep (50/50) to the lateral pterygoid muscle. What are its branches?

(5)

A
  1. Masseteric branches
  2. Anterior and posterior deep temporal
  3. Medial pterygoid branches
  4. Lateral pterygoid branches
  5. Buccal artery supplies cheek.
26
Q

The pterygopalatine portion of the pterygopalatine artery courses through the pterygomaxillary fissure to enter the pterygopalatine fossa. What are its branches?

(6)

A
  1. Posterior superior alveolar a.
  2. Infraorbital a.
  3. Pharyngeal a.
  4. Artery of pterygoid canal
  5. Descending palatine a.
  6. Sphenopalatine a.
27
Q

The pterygoid plexus of veins is a large venous plexus investing the external and internal surface of what muscle?

A

The lateral pterygoid muscle

28
Q

The pterygoid plexus of veins recieves blood from (communicates with)?

(4)

A
  1. Infratemporal fossa and nasal cavity via venae comitantes of maxillary artery
  2. Face via deep facial vein and ophthalmic veins
  3. Cavernous sinus via emissary veins
  4. Pharynx via pharyngeal veins
29
Q

What does the pterygoid plexus of veins coalesce to form? Where does this go?

A

Maxillary vein; which then exits the infratemporal fossa traveling with the maxillary artery

30
Q

The mandibular nerve exits the middle cranial fossa via what opening? Where does this opening take it>

A

Foramen ovale, to the infratemporal fossa

31
Q

What are the components of the mandibular nerve? (Fibers)

What fibers does it distribute but not strictly speaking contain?

A

Contains

GSA

SVE

Distributes

GVE-P

SVA

32
Q

Where do the GSA components of V3 go?

A

lower portion of face, including:

  1. chin,
  2. lower cheek
  3. temporal region
  4. mandibular teeth and gingivae
  5. auricle
  6. external acoustic meatus
  7. floor of oral cavity
  8. 2/3rds of tongue
  9. dura of middle cranial fossa
33
Q

To what muscles does the mandibular nerve distribute?

A

a.Muscles of mastication

  • Temporalis
  • Masseter
  • Lateral pterygoid
  • medial pterygoid

b. Tensor tympani
c. Tensor veli palatini
d. Anterior belly of digastric
e. Mylohyoid

34
Q

V3 distributes GVE-P fibers from what nerves, to what structures?

A

CNVII and CN IX to salivary glands

35
Q

Where does the mandibular nerve distribute SVA fibers? From what nerve do these fibers originate?

A

CN VII

To anterior 2/3 of tongue for taste

36
Q

What are the sensory branches of the mandibular n.?

(4)

A
  1. Meningeal Branch
  2. Buccal n.
  3. Lingual n.
  4. Auriculotemporal n.
37
Q

The Lingual branch of the mandibular nerve serves as a mule for what nerve? What does it carry?

A
  1. Carries SVA from the Chorda Tympani of CN VII
  2. GVE-P to the submandibular gland and sublingual gland
38
Q

The auriculaotemporal provides GSA to what structures?

A
  1. TMJ
  2. Temporal Region
  3. Auricle
  4. External acoustic meatus
  5. External tympanic membrane
39
Q

What fibers does the auriculotemporal n. distribute?

A

GVE-P to the parotid gland

40
Q

What are the motor branches of the mandibular n.?

A
  1. Medial pterygoid n
  2. Nerve to tensor tympani
  3. Nerve to tensor veli palatini
  4. Lateral pterygoid nn
  5. Masseteric nn
  6. Anterior and posterior deep temporal nn.
41
Q

What is the mixed branch of the mandibular n.?

What components go into the mix?

What are its branches?

A

Inferior alveolar n.

GSA and SVE

Mental n. (GSA)

Mylohyoid n. (SVE)

42
Q

Where does one inject to perform a mandibular nerve block?

A

Pass needle through mandibular notch to inject anesthetic around the main trunk of mandibular nerves.

43
Q

Where is an inferior alveolar nerve block performed?

A

Anesthetic is injected near the entrance of the mandibular foramen.

44
Q

What is the location of the preganglionic cell bodies that provide parasympathetic innervation to the parotid gland?

A

Salivatory nucleus within the brainstem

45
Q

Describe the pathway of parasympathetic innervation to the parotid gland.

A

Preganglionic

  1. Location of cell bodies – salivatory nucleus within brainstem
  2. Preganglionic fibers travel with CN IX
  3. CN IX exits at jugular foramen and gives a tympanic branch.
  4. Tympanic nerve enters middle ear via the tympanic canaliculus.
  5. Travels through middle ear and reforms as lesser petrosal nerve.
  6. Lesser petrosal nerve exits middle ear via hiatus for the lesser petrosal nerve; nerve is now in middle cranial fossa and exits via foramen ovale to infratemporal fossa.
  7. Lesser petrosal is in infratemporal fossa and synapses in otic ganglion.

_Postganglionic _

  1. Location of cell bodies – otic ganglion
  2. Postganglionic fibers travel with the auriculotemporal n of V3.
46
Q

What is the pathway of the parasympathetic innervation to the sublingual and submandibular glands?

A

Preganglionic

  1. Location of cell bodies – salivatory nucleus within brainstem
  2. Preganglionic fibers travel with the facial nerve (CN VII).
  3. CN VII courses along the posterior wall of the middle ear and gives rise to the chorda tympani n. which exits the middle ear through the petrotympanic fissure to enter the infratemporal fossa.
  4. Here, chorda tympani joins the lingual nerve.
  5. Chorda tympani portion of lingual nerve synapses in the submandibular ganglion.

Postganglionic

  1. Location of cell bodies – submandibular ganglion
  2. Postganglionic fibers travel with the lingual branch of V3.

Neuro Exam II (13 decks)

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