Temporal and Infratemporal Fossae Flashcards
1
Q
The ______ and ______ are interconnected spaces on the lateral side of the head. Their boundaries are formed by bone and soft tissues.
A
temporal, infratemporal fossae
2
Q
The ______ is superior to the infratemporal fossa, above the zygomatic arch, and communicates with the infratemporal fossa below through the gap between the zygomatic arch and the more medial surlace of the skull.
A
temporal fossa
3
Q
The ______ is a wedge-shaped space deep to the masseter muscle and the underlying ramus of the mandible. Structures that travel between the cranial cavity. neck, pterygopalatine fossa, floor of the oral cavity, floor of the orbit, temporal fossa, and superficial regions of the head pass through it.
A
infratemporal fossa
4
Q
Of the four muscles of mastication (______, ______, ______, and ______) that move the lower jaw at the temporomandibular joint, one (______) is lateral to the infratemporal fossa, two (______) are in the infratemporal fossa, and one fills the temporal fossa.
A
masseter, temporalis, medial pterygoid, lateral pterygoid, masseter, medial and lateral pterygoid
5
Q
Bones that contribute significantly to the boundaries of the temporal and infratemporal fossae include the ______, ______, and ______ bones, and the ______ and ______.
A
temporal, zygomatic, sphenoid, maxilla, mandible
6
Q
Parts of the ______ and ______ bones are also involved.
A
frontal, parietal
7
Q
The ______ of the temporal bone forms part of the bony framework of the temporal and infratemporal fossae.
A
squamous part
8
Q
The ______ of the temporal bone forms the posteromedial corner of the roof of the infratemporal fossa, and also articulates with the head of the mandible to form the temporomandibular joint.
A
tympanic part
9
Q
The lateral surface of the squamous part of the temporal bone is marked by two surface features on the medial wall of the temporal fossa:
A
a transversely oriented supramastoid crest, a vertically oriented groove for the middle temporal artery
10
Q
A transversely oriented ______, which extends posteriorly from the base of the zygomatic process and marks the posteroinferior border of the temporal fossa.
A
supramastoid crest
11
Q
A vertically oriented ______, a branch of the superficial temporal artery.
A
groove for the middle temporal artery
12
Q
Two features that participate in forming the temporo-mandibular joint on the inferior aspect of the root of the zygomatic process are the ______ and the ______. Both are elongate from ______ to ______.
A
articular tubercle, mandibular fossa, medial, lateral
13
Q
Posterior to the mandibular fossa is the ______.
A
external acoustic meatus
14
Q
The ______ of the temporal bone is a flat concave plate of bone that curves inferiorly from the back of the mandibular fossa and forms part of the wall of the external auditory meatus.
A
tympanic part
15
Q
When viewed from inferiorly, there is a distinct ______ between the tympanic and squamous parts of the temporal bone.
A
tympanosquamous fissure
16
Q
Medially, a small slip of bone from the petrous part of the temporal bone insinuates itself into the fissure and forms a ______ between it and the tympanic part.
A
petrotympanic fissure
17
Q
The ______ nerve exits the skull and enters the infratemporal fossa through the medial end of the petrotympanic fissure.
A
chorda tympani
18
Q
The parts of the sphenoid bone that form part of the bony framework of the infratemporal fossa are the ______ and the ______. The ______ also forms part of the medial wall of the temporal fossa.
A
lateral plate of the pterygoid process, greater wing, greater wing
19
Q
The ______ extend one on each side from the body of the sphenoid. They project laterally from the body and curve superiorly.
A
greater wings
20
Q
The ______ surfaces form the roof of the infratemporal fossa and the medial wall of the temporal fossa, respectively.
A
inferior and lateral
21
Q
The sharply angled boundary between the lateral and inferior surfaces of the greater wing is the ______.
A
infratemporal crest
22
Q
Two apertures (the ______ and the ______) pass through the base of the greater wing and allow the mandibular nerve [V3] and the middle meningeal artery, respectively, to pass between the middle cranial fossa and infratemporal fossa.
A
foramen ovale, foramen spinosum
23
Q
In addition, one or more ______ penetrate the base of the greater wing anteromedial to the foramen ovale and allow emissary veins to pass between the pterygoid plexus of veins in the infratemporal fossa and the cavernous sinus in the middle cranial fossa.
A
small sphenoidal emissary foramina
24
Q
Projecting vertically downward from the greater wing immediately medial to the foramen spinosum is the irregularly shaped ______, which is the attachment site for the cranial end of the sphenomandibular ligament.
A
spine of the sphenoid
25
The ______ is a vertically oriented sheet of bone that projects posterolaterally from the pterygoid process. Its lateral and medial surfaces provide attachment for the lateral and medial pterygoid muscles, respectively.
lateral plate of the pterygoid process
26
The posterior surface of the ______ contributes to the anterior wall of the infratemporal fossa. This surface is marked by a foramen for the posterosuperior ______ nerve and vessels. The superior margin forms the inferior border of the ______.
maxilla, alveolar, inferior orbital fissure
27
The ______ is a quadrangular-shaped bone that forms the palpable bony prominence of the cheek.
zygomatic bone
28
A ______ process extends anteromedially to articulate with the zygomatic process of the maxilla.
maxillary
29
A ______ process extends superiorly to articulate with the zygomatic process of the frontal bone.
frontal
30
A ______ process extends posteriorly to articulate with the zygomatic process of the temporal bone to complete the zygomatic arch.
temporal
31
A small ______ on the lateral surface of the zygomatic bone transmits the zygomaticofacial nerve and vessels onto the cheek.
zygomaticofacial foramen
32
A ______ of bone extends posteromedially from the frontal process and contributes to the lateral wall of the orbit on one side and the anterior wall of the temporal fossa on the other.
thin plate
33
A ______ on the temporal fossa surface of the plate where it attaches to the frontal process is for the zygomaticotemporal nerve.
zygomaticotemporal foramen
34
The ______ is quadrangular in shape and has medial and lateral surfaces and condylar and coronoid processes.
ramus of the mandible
35
The ______ of the ramus of the mandible is generally smooth except for the presence of a few obliquely oriented ridges. Most of the ______ provides attachment for the masseter muscle.
lateral surface
36
The posterior and inferior borders of the ramus intersect to form the ______, while the superior border is notched to form the ______. The anterior border is sharp and is continuous below with the ______ on the body of the mandible.
angle of the mandible, mandibular notch, oblique line
37
The ______ extends superiorly from the junction of the anterior and superior borders of the ramus. It is a flat, triangular process that provides attachment for the temporalis muscle.
coronoid process
38
The ______ extends superiorly from the posterior and superior borders of the ramus. It consists of:
• the ______, which is expanded medially and participates in forming the temporomandibular joint
• the ______, which bears a shallow depression (the ______) on its anterior surface for attachment of the lateral pterygoid muscle.
condylar process, head of the mandible, neck of the mandible, pterygoid fovea
39
The ______ of the ramus of the mandible is the lateral wall of the infratemporal fossa. Its most distinctive feature is the ______, which is the superior opening of the mandibular canal. The inferior alveolar nerve and vessels pass through this foramen.
medial surface, mandibular foramen
40
Immediately anterosuperior to the mandibular
foramen is a triangular elevation (the ______) for attachment of the mandibular end of the sphenomandibular ligament.
lingula
41
An elongate groove (the ______) extends anteroinferiorly from the mandibular foramen. The ______ is in this groove.
mylohyoid groove, nerve to the mylohyoid
42
Posteroinferior to the mylohyoid groove and mandibular foramen, the medial surface of the ramus of the mandible is roughened for attachment of the ______ muscle.
medial pterygoid
43
The ______, one on each side, allow opening and closing of the mouth and complex chewing or side-to-side movements of the lower jaw. Each joint is ______ and is formed between the head of the mandible and the articular fossa and articular tubercle of the temporal bone.
temporomandibular joints, synovial
44
Unlike most other synovial joints where the articular surfaces of the bones are covered by a layer of hyaline cartilage, those of the temporomandibular joint are covered by ______. In addition, the joint is completely divided by a fibrous articular disc into two parts:
• The ______ part of the joint allows mainly the hinge-like depression and elevation of the mandible.
• The ______ part of the joint allows the head of the mandible to translocate forward (protrusion) onto the articu-lar tubercle and backward (retraction) into the mandibular fossa.
fibrocartilage, lower, upper
45
Opening the mouth involves both ______ and ______.
depression, protrusion
46
The ______ or ______ movement allows greater depression of the mandible by preventing backward movement of the angle of the mandible into structures in the neck.
forward, protrusive
47
The ______ membrane of the joint capsule lines all nonarticular surfaces of the upper and lower compartments of the joint and is attached to the margins of the articular disc.
synovial
48
The ______ membrane of the joint capsule encloses the temporomandibular joint complex and is attached:
• above along the anterior margin of the articular tubercle,
• laterally and medially along the margins of the articular fossa,
• posteriorly to the region of the tympanosquamous suture, and
• below around the upper part of the neck of the
mandible.
fibrous
49
The articular disc attaches around its periphery to the inner aspect of the ______ membrane.
fibrous
50
Three extracapsular ligaments are associated with the temporomandibular joint---the ______, ______, and the ______ ligaments.
lateral, sphenomandibular, stylomandibular
51
The ______ ligament is closest to the joint, just lateral to the capsule, and runs diagonally backward from the margin of the articular tubercle to the neck of the mandible.
lateral
52
The ______ ligament is medial to the temporomandibular joint, runs from the spine of the sphenoid bone at the base of the skull to the lingula on the medial side of the ramus of the mandible.
sphenomandibular
53
The ______ ligament passes from the styloid process of the temporal bone to the posterior margin and angle of the mandible.
stylomandibular
54
A ______ or ______ motion occurs when the movements at the temporomandibular joint on one side are coordinated with a reciprocal set of movements at the joint on the other side.
chewing, grinding
55
Movements of the mandible include ______, ______, ______, and ______.
depression, elevation, protrusion, retraction
56
______ is generated by the digastric, geniohyoid, and mylohyoid muscles on both sides, is normally assisted by gravity, and, because it involves forward movement of the head of the mandible onto the articular tubercle, the lateral pterygoid muscles are also involved.
Depression
57
______ is a very powerful movement generated by the temporalis, masseter, and medial pterygoid muscles and also involves movement of the head of the mandible into the mandibular fossa.
Elevation
58
______ is mainly achieved by the lateral pterygoid muscle, with some assistance by the medial pterygoid.
Protraction
59
______ is carried out by the geniohyoid and digastric muscles, and by the posterior and deep fibers of the temporalis and masseter muscles, respectively.
Retraction
60
Except for the geniohyoid muscle, which is innervated by the C1 spinal nerve, all muscles that move the temporomandibular joints are innervated by the ______ by branches that originate in the infratemporal fossa.
mandibular nerve [V3]
61
The ______ muscle is a powerful muscle of mastication that elevates the mandible. It overlies the lateral surface of the ramus of the mandible.
masseter
62
Origin of Masseter
Zygomatic arch and maxillary process of the zygomatic bone
63
Insertion of Masseter
Lateral surface of ramus of mandible
64
Innervation of Masseter
Masseteric nerve from the anterior trunk of the mandibular nerve [V3]
65
Function of Masseter
Elevation of mandible
66
Origin of Temporalis
Bone of temporal fossa and temporal fascia
67
Insertion of Temporalis
Coronoid process of mandible and anterior margin of ramus of mandible almost to last molar tooth
68
Innervation of Temporalis
Deep temporal nerves from the anterior trunk of the mandibular nerve [V3]
69
Function of Temporalis
Elevation and retraction of mandible
70
Origin of Medial pterygoid
Deep head—medial surface of lateral plate of pterygoid process and pyramidal process of palatine bone; superficial head—tuberosity of the maxilla and pyramidal process of palatine bone
71
Insertion of Medial pterygoid
Medial surface of mandible near angle
72
Innervation of Medial pterygoid
Nerve to medial pterygoid from the mandibular nerve [V3]
73
Function of Medial pterygoid
Elevation and side-to-side movements of the mandible
74
Origin of Lateral pterygoid
Upper head—roof of infratemporal fossa; lower head—lateral surface of lateral plate of the pterygoid process
75
Insertion of Lateral pterygoid
Capsule of temporomandibular joint in the region of attachment to the articular disc and to the pterygoid fovea on the neck of mandible
76
Innervation of Lateral pterygoid
Nerve to lateral pterygoid directly from the anterior trunk of the mandibular nerve [V3] or from the buccal branch
77
Function of Lateral pterygoid
Protrusion and side-to-side movements of the mandible
78
The ______ muscle is quadrangular in shape and is anchored above to the zygomatic arch and below to most of the lateral surface of the ramus of the mandible.
masseter
79
The more ______ of the masseter originates from the maxillary process of the zygomatic bone and the anterior two-thirds of the zygomatic process of the maxilla. It inserts into the angle of the mandible and related posterior part of the lateral surface of the ramus of the mandible.
superficial part
80
The ______ of the masseter originates from the medial aspect of the zygomatic arch and the posterior part of its inferior margin and inserts into the central and upper part of the ramus of the mandible as high as the coronoid process.
deep part
81
The masseter is innervated by the ______ nerve from the ______ nerve [V3] and supplied with blood by the ______ artery from the ______ artery.
masseteric, mandibular, masseteric, maxillary
82
The ______ nerve and artery originate in the infratemporal fossa and pass laterally over the margin of the mandibular notch to enter the deep surface of the masseter muscle.
masseteric
83
The ______ is a narrow fan-shaped space that covers the lateral surface of the skull.
temporal fossa
84
The upper margin of the temporal fossa is defined by a pair of ______ that arch across the skull from the zygomatic process of the frontal bone to the supramastoid crest of the temporal bone.
temporal lines
85
The temporal fossa is limited laterally by the ______, which is a tough, fan-shaped aponeurosis overlying the temporalis muscle and attached by its outer margin to the superior temporal line and by its inferior margin to the zygomatic arch.
temporal fascia
86
______, the temporal fossa is limited by the posterior surface of the frontal process of the zygomatic bone and the posterior surface of the zygomatic process of the frontal bone, which separate the temporal fossa behind from the orbit in front.
Anteriorly
87
The inferior margin of the temporal fossa is marked by the zygomatic arch ______ and by the infratemporal crest of the greater wing of the sphenoid ______—between these two features, the floor of the temporal fossa is open medially to the infratemporal fossa and laterally to the region containing the masseter muscle.
laterally, medially
88
The major structure in the temporal fossa is the ______.
temporalis muscle
89
Also passing through the temporal fossa is the ______ branch of the ______, which enters the region through the region through the zygomaticotemporal foramen on the temporal fossa surface of the zygomatic bone.
zygomaticotemporal, maxillary nerve [V2]
90
The ______ is a large, fan-shaped muscle that fills much of the temporal fossa. It originates from the bony surfaces of the fossa superiorly to the inferior temporal line and is attached laterally to the surface of the temporal fascia.
temporalis muscle
91
The more anterior fibers are oriented ______ while the more posterior fibers are oriented ______. The fibers converge inferiorly to form a ______, which passes between the zygomatic arch and the infratemporal crest of the greater wing of the sphenoid to insert on the coronoid process of the mandible.
vertically, horizontally, tendon
92
The ______ muscle attaches down the anterior surface of the coronoid process and along the related margin of the ramus of the mandible, almost to the last molar tooth.
temporalis
93
The ______ is a powerful elevator of the mandible. Because this movement involves posterior translocation of the head of the mandible from the articular tubercle of the temporal bone and back into the mandibular fossa, the ______ also retracts the mandible or pulls it posteriorly. In addition, the ______ participates in side-to-side movements of the mandible.
temporalis
94
The temporalis is innervated by ______ nerves that originate from the ______ in the infratemporal fossa and then pass into the temporal fossa.
deep temporal, mandibular nerve [V3]
95
Blood supply of the temporalis is by ______ arteries, which travel with the nerves, and the middle temporal artery, which penetrates the temporal fascia at the posterior end of the zygomatic arch.
deep temporal
96
The ______ nerves, usually two in number, originate from the anterior trunk of the mandibular nerve [V3] in the infratemporal fossa. They pass superiorly and around the infratemporal crest of the greater wing of the sphenoid to enter the temporal fossa deep to the temporalis muscle, and supply the temporalis muscle.
deep temporal
97
The zygomaticotemporal nerve is a branch of the ______ nerve. The zygomatic nerve is a branch of the ______ nerve, which originates in the ______ fossa and passes into the orbit.
zygomatic, maxillary, pterygopalatine
98
The ______ nerve enters the temporal fossa through one or more small foramina on the temporal fossa surface of the zygomatic bone.
zygomaticotemporal
99
Branches of the ______ nerve pass superiorly between the bone and the temporalis muscle to penetrate the temporal fascia and supply the skin of the temple.
zygomaticotemporal
100
Normally two in number, these vessels originate from the maxillary artery in the infratemporal fossa and travel with the deep temporal nerves around the infratemporal crest of the greater wing of the sphenoid to supply the temporalis muscle. They anastomose with branches of the middle temporal artery.
Deep temporal arteries
101
The ______ artery originates from the superficial temporal artery just superior to the root of the zygomatic arch between this structure and the external ear. It penetrates the temporalis fascia, passes under the margin of the temporalis muscle, and travels superiorly on the deep surface of the temporalis muscle.
middle temporal
102
The ______ artery supplies the temporalis and anastomoses with branches of the deep temporal arteries.
middle temporal
103
The wedge-shaped ______ is inferior to the temporal fossa and between the ramus of the mandible laterally and the wall of the pharynx medially. It has a roof, a lateral wall, and a medial wall, and is open to the neck posteroinferiorly.
infratemporal fossa
104
The ______ of the infratemporal fossa is formed by the inferior surfaces of the greater wing of the sphenoid and the temporal bone, contains the foramen spinosum, foramen ovale, and the petrotympanic fissure, and lateral to the infratemporal crest of the greater wing of the sphenoid, is open superiorly to the temporal fossa.
roof
105
The ______ of the infratemporal fossa is the medial surface of the ramus of the mandible, which contains the opening to the mandibular canal.
lateral wall
106
The ______ of the infratemporal fossa is formed anteriorly by the lateral plate of the pterygoid process and more posteriorly by the pharynx and by two muscles of the soft palate (tensor and levator veli palatini muscles), and contains the pterygomaxillary fissure anteriorly, which allows structures to pass between the infratemporal and pterygopalatine fossae.
medial wall
107
The ______ of the infratemporal fossa is formed by part of the posterior surface of the maxilla and contains the alveolar foramen, and the upper part opens as the inferior orbital fissure into the orbit.
anterior wall
108
Major contents of the infratemporal fossa include the ______ ligament, ______ muscles, the ______ artery, the ______ nerve, branches of the ______ and the ______, and the ______ of veins.
sphenomandibular, medial and lateral pterygoid, maxillary, mandibular, facial nerve [VII], glossopharyngeal nerve [IX], pterygoid plexus
109
The ______ is an extracapsular ligament of the temporomandibular joint. It is attached superiorly to the spine of the sphenoid bone and expands inferiorly to attach to the lingula of the mandible and the posterior margin of the mandibular foramen.
sphenomandibular ligament
110
The ______ muscle is quadrangular in shape and has deep and superficial heads.
medial pterygoid
111
The ______ of the medial pterygoid muscle is attached above to the medial surface of the lateral plate of the pterygoid process and the associated surface of the pyramidal process of the palatine bone, and descends obliquely downward, medial to the sphenomandibular ligament, to attach to the roughened medial surface of the ramus of the mandible near the angle of the mandible.
deep head
112
The ______ of the medial pterygoid muscle originates from the tuberosity of the maxilla and adjacent pyramidal process of the palatine bone and joins with the deep head to insert on the mandible.
superficial head
113
The medial pterygoid mainly ______ the mandible. Because it passes obliquely backward to insert into the mandible, it also assists the lateral pterygoid muscle in ______ the lower jaw.
elevates, protruding
114
The medial pterygoid is innervated by the ______ from the ______.
nerve to the medial pterygoid, mandibular nerve [V3]
115
The ______ is a thick triangular muscle and like the medial pterygoid muscle has two heads.
lateral pterygoid
116
The ______ of the lateral pterygoid muscle originates from the roof of the infratemporal fossa (inferior surface of the greater wing of the sphenoid and the infratemporal crest) lateral to the foramen ovale and foramen spinosum.
upper head
117
The ______ of the lateral pterygoid muscle is larger than the upper head and originates from the lateral surface of the lateral plate of the pterygoid process, and the inferior part insinuates itself between the cranial attachments of the two heads of the medial pterygoid.
lower head
118
The fibers from both heads of the lateral pterygoid muscle converge to insert into the ______ of the neck of the mandible and into the ______ in the region where the capsule is attached internally to the articular disc.
pterygoid fovea, capsule of the temporomandibular joint
119
Unlike the medial pterygoid muscle whose fibers tend to be oriented vertically, those of the lateral pterygoid are oriented almost ______. As a result, when the lateral pterygoid contracts it pulls the articular disc and head of the mandible forward onto the articular tubercle and is therefore the major protruder of the ______.
horizontally, lower jaw
120
The lateral pterygoid is innervated by the ______ from the ______.
nerve to the lateral pterygoid, mandibular nerve [V3]
121
When the lateral and medial pterygoids contract on only one side, the chin moves to the ______. When opposite movements at the two temporomandibular joints are coordinated, a ______ movement results.
opposite side, chewing
122
The ______ is the largest of the three divisions of the trigeminal nerve [V].
mandibular nerve [V3]
123
Unlike the ophthalmic [V1] and maxillary [V2] nerves, which are purely sensory, the mandibular nerve [V3] is ______.
both motor and sensory
124
In addition to carrying general sensation from the teeth and gingivae of the mandible, the anterior two-thirds of the tongue, mucosa on the floor of the oral cavity, the lower lip, skin over the temple and lower face, and part of the cranial dura mater, the ______ also carries motor innervation to most of the muscles that move the mandible, one of the muscles (tensor tympani) in the middle ear, and one of the muscles of the soft palate (tensor veli palatini).
mandibular nerve [V3]
125
All branches of the mandibular nerve [V3] originate in the ______.
infratemporal fossa
126
Like the ophthalmic [V1] and maxillary [V2] nerves, the sensory part of the mandibular nerve [V3] originates from the ______ in the middle cranial fossa.
trigeminal ganglion
127
The ______ of the mandibular nerve [V3] drops vertically through the foramen ovale and enters the infratemporal fossa between the tensor veli palatini muscle and the upper head of the lateral pterygoid muscle.
sensory part
128
The ______ of the trigeminal nerve [V] passes medial to the trigeminal ganglion in the cranial cavity. then passes through the foramen ovale and immediately joins the sensory part of the mandibular nerve [V3].
small motor root
129
Soon after the sensory and motor roots join, the mandibular nerve [V3] gives rise to a ______ and to the ______, and then divides into anterior and posterior trunks.
small meningeal branch, nerve to the medial pterygoid
130
Branches from the ______ trunk are the buccal, masseteric, and deep temporal nerves, and the nerve to the lateral pterygoid, all of which, except the buccal nerve (which is predominantly sensory) are motor nerves.
anterior
131
Branches from the ______ trunk are the auriculotemporal, lingual, and inferior alveolar nerves, all of which, except a small nerve (nerve to the mylohyoid) that branches from the inferior alveolar nerve, are sensory nerves.
posterior
132
The ______ branch originates from the medial side of the mandibular nerve [V3] and ascends to leave the infratemporal fossa with the middle meningeal artery and reenter the cranial cavity through the foramen spinosum. It is sensory for the dura mater, mainly of the middle cranial fossa, and also supplies the mastoid cells that communicate with the middle ear.
meningeal
133
The ______ also originates medially from the mandibular nerve [V3]. It descends to enter and supply the deep surface of the medial pterygoid muscle. Near its origin from the mandibular nerve [V3], it has two small branches:
• One of these supplies the ______.
• The other ascends to supply the ______ muscle, which occupies a small bony canal above and parallel to the pharyngotympanic tube in the temporal bone.
nerve to the medial pterygoid, tensor veli palatini, tensor tympani
134
The ______ is a branch of the anterior trunk of the mandibular nerve [V3]. It is predominantly a sensory nerve, but may also carry the motor innervation to the lateral pterygoid muscle and to part of the temporalis muscle.
buccal nerve
135
The ______ nerve passes laterally between the upper and lower heads of the lateral pterygoid and then descends around the anterior margin of the insertion of the temporalis muscle to the anterior margin of the ramus of the mandible, often slipping through the tendon of the temporalis. It continues into the cheek lateral to the buccinator muscle to supply general sensory nerves to the adjacent skin and oral mucosa and the buccal gingive of the lower molars.
buccal
136
The ______ is a branch of the anterior trunk of the mandibular nerve [V3]. It passes laterally over the lateral pterygoid muscle and through the mandibular notch to penetrate and supply the masseter muscle.
masseteric nerve
137
The ______, usually two in number, originate from the anterior trunk of the mandibular nerve [V3]. They pass laterally above the lateral pterygoid muscle and curve around the infratemporal crest to ascend in the temporal fossa and supply the temporalis muscle from its deep surface.
deep temporal nerves
138
The ______ may originate directly as a branch from the anterior trunk of the mandibular nerve [V3] or from its buccal branch. From its origin, it passes directly into the deep surface of the lateral pterygoid muscle.
nerve to the lateral pterygoid
139
The ______ is the first branch of the posterior trunk of the mandibular nerve [V3] and originates as two roots, which pass posteriorly around the middle meningeal artery ascending from the maxillary artery to the foramen spinosum.
auriculotemporal nerve
140
The ______ nerve passes first between the tensor veli palatini muscle and the upper head of the lateral pterygoid muscle, and then between the sphenomandibular ligament and the neck of the mandible. It curves laterally around the neck of the mandible and then ascends deep to the parotid gland between the temporomandibular joint and ear.
auriculotemporal
141
The ______ of the auriculotemporal nerve carry general sensation from skin over a large area of the temple.
terminal branches
142
In addition, the ______ nerve contributes to sensory innervation of the external ear, the external auditory meatus, tympanic membrane, and temporomandibular joint. It also delivers ______ nerves from the glossopharyngeal nerve [IX] to the parotid gland.
auriculotemporal, postganglionic parasympathetic
143
The ______ is a major sensory branch of the posterior trunk of the mandibular nerve [V3]. It carries 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.
lingual nerve
144
The ______ nerve is joined high in the infratemporal fossa by the chorda tympani branch of the facial nerve [VII], which carries:
• taste from the anterior two-thirds of the tongue, and
• parasympathetic fibers to all salivary glands below the level of the oral fissure.
lingual
145
The ______ nerve first descends between the tensor veli palatini muscle and the lateral pterygoid muscle, where it is joined by the chorda tympani nerve, and then descends across the lateral surface of the medial pterygoid muscle to enter the oral cavity.
lingual
146
The ______ nerve enters the oral cavity between the posterior attachment of the mylohyoid muscle to the mylohyoid line and the attachment of the superior constrictor of the pharynx to the pterygomandibular raphe. As the ______ nerve enters the floor of the oral cavity, it is in a shallow groove on the medial surface of the mandible immediately inferior to the last molar tooth. In this position, it is palpable through the oral mucosa and in danger when one is operating on the molar teeth and gingivae.
lingual
147
The lingual nerve passes into the tongue on the lateral surface of the hyoglossus muscle where it is attached to the ______. This ganglion is where the preganglionic parasympathetic fibers carried from the infratemporal fossa into the floor of the oral cavity on the lingual nerve synapse with postganglionic parasympathetic fibers.
submandibular ganglion
148
The ______, like the lingual nerve, is a major sensory branch of the posterior trunk of the mandibular nerve [V3]. In addition to innervating all lower teeth and much of the associated gingivae, it also supplies the mucosa and skin of the lower lip and skin of the chin. It has one motor branch, which innervates the ______ muscle and the anterior belly of the ______ muscle.
inferior alveolar nerve, mylohyoid, digastric
149
The ______ nerve originates deep to the lateral pterygoid muscle from the posterior trunk of the mandibular nerve [V3] in association with the lingual nerve. It descends on the lateral surface of the medial pterygoid muscle, passes between the sphenomandibular ligament and the ramus of the mandible, and then enters the mandibular canal through the mandibular foramen.
inferior alveolar
150
Just before entering the mandibular foramen, the inferior alveolar nerve gives origin to the ______, which lies in the mylohyoid groove inferior to the foramen and continues anteriorly below the floor of the oral cavity to innervate the mylohyoid muscle and the anterior belly of the digastric muscle.
nerve to the mylohyoid
151
The ______ nerve passes anteriorly within the mandibular canal of the lower jaw. The mandibular canal and its contents are inferior to the roots of the molar teeth, and the roots can sometimes curve around the canal making extraction of these teeth difficult.
inferior alveolar
152
The inferior alveolar nerve supplies branches to the three molar teeth and the second premolar tooth and associated labial gingivae, and then divides into its two terminal branches:
• the ______ nerve, which continues in the mandibular canal to supply the first premolar, incisor, and canine teeth, and related gingivae; and
• the ______ nerve, which exits the mandible through the mental foramen and supplies the lower lip and chin. The ______ nerve is palpable and sometimes visible through the oral mucosa adjacent to the roots of the premolar teeth.
incisive, mental, mental
153
Branches of two cranial nerves join branches of the mandibular nerve [V3] in the infratemporal fossa.
These are the ______ and the ______, a branch of the tympanic plexus in the middle ear, which had its origin from a branch of the glossopharyngeal nerve [IX].
chorda tympani branch of the facial nerve [VII], lesser petrosal nerve
154
The ______ carries taste from the anterior two-thirds of the tongue and parasympathetic innervation to all salivary glands below the level of the oral fissure.
chorda tympani
155
The ______ originates from the facial nerve [VII] within the temporal bone and in association with the mastoid wall of the middle ear, passes anteriorly through a small canal, and enters the lateral aspect of the middle ear. As it continues anterosuperiorly across the middle ear, it is separated from the tympanic membrane by the handle of the malleus. It leaves the middle ear through the medial end of the petrotympanic fissure, enters the infratemporal fossa, descends medial to the spine of the sphenoid and then to the lateral pterygoid muscle, and joins the lingual nerve.
chorda tympani
156
______ carried in the chorda tympani synapse with postganglionic parasympathetic fibers in the submandibular ganglion, which "hangs off" the lingual nerve in the floor of the oral cavity.
Preganglionic parasympathetic fibers
157
______ leave the submandibular ganglion and either:
• reenter the lingual nerve to travel with its terminal branches to reach target tissues, or
• pass directly from the submandibular ganglion into glands
Postganglionic parasympathetic fibers
158
The ______ do not pass through the ganglion and are distributed with terminal branches of the lingual nerve.
taste (SA) fibers
159
A lingual nerve injury proximal to where the chorda tympani joins it in the infratemporal fossa will produce loss of general sensation from the ______, ______, ______, the ______, and the ______.
anterior two-thirds of the tongue, oral mucosa, gingivae, lower lip, chin
160
If a lingual nerve lesion is ______ to the site where it is joined by the chorda tympani, secretion from the salivary glands below the oral fissure and taste from the anterior two-thirds of the tongue will also be lost.
distal
161
The ______ carries mainly parasympathetic fibers destined for the parotid gland. The preganglionic parasympathetic fibers are located in the glossopharyngeal nerve [IX] as it exits the jugular foramen at the base of the skull. Branching from the glossopharyngeal nerve [IX] either within or immediately outside the jugular foramen is the ______.
lesser petrosal nerve, tympanic nerve
162
The ______ nerve reenters the temporal bone through a small foramen on the ridge of bone separating the jugular foramen from the carotid canal and ascends through a small bony canal (inferior tympanic canaliculus) to the promontory located on the labyrinthine (medial) wall of the middle ear. Here it participates in the formation of the tympanic plexus. The ______ nerve is a branch of this plexus.
tympanic, lesser petrosal
163
The ______ nerve contains mainly preganglionic parasympathetic fibers. It leaves the middle ear and enters the middle cranial fossa through a small opening on the anterior surface of the petrous part of the temporal bone just lateral and inferior to the opening for the greater petrosal nerve, a branch of the facial nerve [VII]. The ______ nerve then passes medially and descends through the foramen ovale with the mandibular nerve [V3].
lesser petrosal, lesser petrosal
164
In the infratemporal fossa, the ______ synapse with cell bodies of postganglionic parasympathetic fibers in the otic ganglion located on the medial side of the mandibular nerve [V3] around the origin of the nerve to the medial pterygoid. ______ leave the otic ganglion and join the auriculotemporal nerve, which carries them to the parotid gland.
preganglionic parasympathetic fibers, Postganglionic parasympathetic fibers
165
Anesthesia of the ______ nerve is widely practiced by most dentists.
inferior alveolar
166
The ______ is one of the largest branches of the mandibular nerve [V3], carries the sensory branches from the teeth and mandible, and receives sensory information from the skin over most of the mandible.
inferior alveolar nerve
167
The ______ nerve passes into the mandibular canal, courses through the body of the mandible, and eventually emerges through the mental foramen into the chin.
inferior alveolar
168
Dental procedures require ______ of the inferior alveolar nerve by local anesthetic. To anesthetize this nerve the needle is placed lateral to the anterior arch of the fauces (______) in the oral cavity and is advanced along the medial border around the inferior third of the ramus of the mandible so that anesthetic can be deposited in this region.
perineuronal infiltration, palatoglossal arch
169
It is also possible to anesthetize the ______ and ______ nerves, depending on where the anesthesia is needed.
infra-orbital, buccal
170
The ______ is the largest branch of the external carotid artery in the neck and is a major source of blood supply for the nasal cavity, the lateral wall and roof of the oral cavity, all teeth, and the dura mater in the cranial cavity. It passes through and supplies the infratemporal fossa and then enters the pterygopalatine fossa, where it gives origin to terminal branches.
maxillary artery
171
The ______ artery originates within the substance of the parotid gland and then passes forward, between the neck of the mandible and sphenomandibular ligament, into the infratemporal fossa. It ascends obliquely through the infratemporal fossa to enter the pterygopalatine fossa by passing through the pterygomaxillary fissure. This part of the vessel may pass either lateral or medial to the lower head of the lateral pterygoid. If it passes medial to the lower head, the ______ artery then loops laterally between the upper and lower heads of the lateral pterygoid to access the ______.
maxillary, maxillary, pterygomaxillary fissure
172
Branches of the maxillary artery are as follows:
• The first part of the maxillary artery (the part between the ______ and the ______) gives origin to two major branches (the ______ and ______ arteries) and a number of smaller branches (deep auricular, anterior tympanic, and accessory meningeal).
• The second part of the maxillary artery (the part related to the ______) gives origin to deep temporal, masseteric, buccal, and pterygoid branches, which course with branches of the mandibular nerve [V3].
• The third part of the maxillary artery is in the ______.
neck of the mandible, sphenomandibular ligament, middle meningeal, inferior alveolar, lateral pterygoid muscle, pterygopalatine fossa
173
The ______ artery ascends vertically from the maxillary artery and passes through the foramen spinosum to enter the cranial cavity. In the infratemporal fossa, it passes superiorly between the sphenomandibular ligament on the medial side and the lateral pterygoid muscle on the lateral side. Just inferior to the foramen spinosum, it passes between the two roots of the auriculotemporal nerve at their origin from the mandibular nerve [V3].
middle meningeal
174
The ______ is the largest of the meningeal vessels and supplies much of the dura mater, bone, and related bone marrow of the cranial cavity walls.
middle meningeal artery
175
Within the cranial cavity, the middle meningeal artery and its branches travel in the ______ of dura mater, which is tightly adherent to the bony walls. As major branches of the middle meningeal artery pass superiorly up the walls of the cranial cavity, they can be damaged by lateral blows to the head. When the vessels are torn, the leaking blood, which is under arterial pressure, slowly separates the dura mater from its attachment to the bone, resulting in an ______.
periosteal (outer) layer, extradural hematoma
176
The ______ descends from the maxillary artery to enter the mandibular foramen and canal with the inferior alveolar nerve. It is distributed with the inferior alveolar nerve and supplies all lower teeth, and contributes to the supply of the buccal gingivae, chin, and lower lip.
inferior alveolar artery
177
Before entering the mandible, the inferior alveolar artery gives origin to a ______, which accompanies the nerve to the mylohyoid.
small mylohyoid branch
178
The ______, ______, and ______ arteries are small branches from the first part of the maxillary artery and contribute to the blood supply of the external acoustic meatus, deep surface of the tympanic membrane, and cranial dura mater, respectively.
deep auricular, anterior tympanic, accessory meningeal
179
The ______ branch also contributes small branches to surrounding muscles in the infratemporal fossa before ascending through the foramen ovale into the cranial cavity to supply the dura mater.
accessory meningeal
180
______, usually two in number, originate from the second part of the maxillary artery and travel with the deep temporal nerves to supply the temporalis muscle in the temporal fossa.
Deep temporal arteries
181
Numerous ______ also originate from the second part of the maxillary artery and supply the pterygoid muscles.
pterygoid arteries
182
The ______, also from the second part of the maxillary artery, accompanies the masseteric nerve laterally through the mandibular notch to supply the masseter muscle.
masseteric artery
183
The ______ is distributed with the buccal nerve and supplies skin, muscle, and oral mucosa of the cheek.
buccal artery
184
The ______ is a network of veins between the medial and lateral pterygoid muscles, and between the lateral pterygoid and temporalis muscles.
pterygoid plexus
185
Veins that drain regions supplied by arteries branching from the maxillary artery in the infratemporal fossa and pterygopalatine fossa connect with the ______. These tributary veins include those that drain the nasal cavity, roof and lateral wall of the oral cavity, all teeth, muscles of the infratemporal fossa, paranasal sinuses, and nasopharynx. In addition, the ______ from the orbit can drain through the inferior orbital fissure into the pterygoid plexus.
pterygoid plexus, inferior ophthalmic vein
186
Significantly, ______ veins often connect the pterygoid plexus in the infratemporal fossa to the ______ in the cranial cavity. These veins, which pass through the foramen ovale, through the cartilage that fills the foramen lacerum, and through a small sphenoidal foramen on the medial side of the lateral plate of the ptery-goid process at the base of the skull, are a route by which infections can spread into the cranial cavity from structures, such as the teeth, that are drained by the pterygoid plexus. Also, because there are no ______ in veins of the head and neck, anesthetic inadvertently injected under pressure into veins of the pterygoid plexus can backflow into tissues or into the cranial cavity.
small emissary, cavernous sinus, valves
187
The pterygoid plexus connects:
• posteriorly, via a ______ vein, with the retromandibular vein in the neck; and
• anteriorly, via a ______ vein, with the facial vein on the face.
short maxillary, deep facial
188
The ______ is an inverted teardrop-shaped space between bones on the lateral side of the skull immediately posterior to the maxilla.
pterygopalatine fossa
189
Although small in size, the ______ communicates via fissures and foramina in its walls with the:
• middle cranial fossa,
• infratemporal fossa,
• floor of the orbit,
• lateral wall of the nasal cavity,
• oropharynx, and
• roof of the oral cavity.
pterygopalatine fossa
190
Because of its strategic location, the pterygopalatine fossa is a major site of distribution for the ______ and for the terminal part of the ______.
maxillary nerve [V2], maxillary artery
191
The pterygopalatine fossa also contains the ______ where preganglionic parasympathetic fibers originating in the facial nerve [VII] synapse with postganglionic parasympathetic fibers and these fibers, along with sympathetic fibers originating from the T1 spinal cord level join branches of the maxillary nerve [V2].
pterygopalatine ganglion
192
All the upper teeth receive their innervation and blood supply from the ______ and the ______, respectively, that pass through the pterygopalatine fossa.
maxillary nerve [V2], terminal part of the maxillary artery
193
The walls of the pterygopalatine fossa are formed by parts of the ______, ______, and ______:
• The anterior wall is formed by the posterior surface of the ______.
• The medial wall is formed by the lateral surface of the ______.
• The posterior wall and roof are formed by parts of the ______.
palatine, maxilla, sphenoid bones, maxilla, palatine bone, sphenoid bone
194
The part of the sphenoid bone that contributes to the formation of the pterygopalatine fossa is the anterosuperior surface of the ______. Opening onto this surface are two large foramina:
• The maxillary nerve [V2] passes through the most lateral and superior of these—the ______—which communicates posteriorly with the middle cranial fossa.
• The greater petrosal nerve from the facial nerve [VII] and sympathetic fibers from the internal carotid plexus join to form the nerve of the pterygoid canal that passes forward into the pterygopalatine fossa through the more medial and inferior foramen—the ______.
pterygoid process, foramen rotundum, anterior opening of the pterygoid canal
195
The ______ is a bony canal running horizontally through the root of the pterygoid process of the sphenoid bone. It opens anteriorly into the pterygopalatine fossa. Posteriorly it continues through the cartilage filling the foramen lacerum and opens into the middle cranial fossa just anteroinferior to the internal carotid artery as the vessel enters the cranial cavity through the carotid canal.
pterygoid canal
196
______ foramina and fissures provide apertures through which structures enter and leave the pterygopalatine fossa.
Seven
197
Seven foramina and fissures provide apertures through which structures enter and leave the pterygopalatine fossa:
• The ______ and ______ communicate with the middle cranial fossa and open onto the posterior wall.
foramen rotundum, pterygoid canal
198
Seven foramina and fissures provide apertures through which structures enter and leave the pterygopalatine fossa:
• A small ______ opens onto the posterior wall and leads to the nasopharynx.
palatovaginal canal
199
Seven foramina and fissures provide apertures through which structures enter and leave the pterygopalatine fossa:
• The ______ leads to the roof of the oral cavity (hard palate) and opens inferiorly.
palatine canal
200
Seven foramina and fissures provide apertures through which structures enter and leave the pterygopalatine fossa:
• The ______ opens onto the lateral wall of the nasal cavity and is in the medial wall.
sphenopalatine foramen
201
Seven foramina and fissures provide apertures through which structures enter and leave the pterygopalatine fossa:
• The lateral aspect of the pterygopalatine fossa is continuous with the infratemporal fossa via a large gap (the ______) between the posterior surface of the maxilla and pterygoid process of the sphenoid bone.
pterygomaxillary fissure
202
Seven foramina and fissures provide apertures through which structures enter and leave the pterygopalatine fossa:
• The superior aspect of the anterior wall of the fossa opens into the floor of the orbit via the ______.
inferior orbital fissure
203
The ______ and terminal part of the ______ enter and branch within the pterygopalatine fossa. In addition, the nerve of the pterygoid canal enters the fossa carrying:
• ______ from the greater petrosal branch of the facial nerve [VII], and
• ______ from the deep petrosal branch of the carotid plexus.
maxillary nerve [V2], maxillary artery, preganglionic parasympathetic fibers, postganglionic sympathetic fibers
204
In addition to nerves and arteries, ______ and ______ also pass through the pterygopalatine fossa.
veins, lymphatics
205
The ______ is purely sensory. It originates from the trigeminal ganglion in the cranial cavity, exits the middle cranial fossa, and enters the pterygopalatine fossa through the foramen rotundum. It passes anteriorly through the fossa and exits as the infraorbital nerve through the inferior orbital fissure.
maxillary nerve [V2]
206
While passing through the pterygopalatine fossa, the maxillary nerve [V2] gives rise to the ______, the ______, and two ______. The two ganglionic branches originate from its inferior surface and pass through the pterygopalatine ganglion.
zygomatic nerve, posterior superior alveolar nerve, ganglionic branches
207
Postganglionic parasympathetic fibers, arising in the pterygopalatine ganglion, join the general sensory branches of the maxillary nerve [V2] in the ______, as do postganglionic sympathetic fibers from the carotid plexus. The three types of fibers leave the ganglion as ______, ______, ______, and ______ branches.
pterygopalatine ganglion, orbital, palatine, nasal, pharyngeal
208
The ______ branches are small and pass through the inferior orbital fissure to contribute to the supply of the orbital wall and of the sphenoidal and ethmoidal sinuses.
orbital
209
The ______ and ______ nerves pass inferiorly from the pterygopalatine ganglion, enter and pass through the palatine canal, and enter the oral surface of the palate through the greater and lesser palatine foramina.
greater, lesser palatine
210
The ______ nerve passes forward on the roof of the oral cavity to innervate mucosa and glands of the hard palate and the adjacent gingiva, almost as far forward as the incisor teeth.
greater palatine
211
In the palatine canal, the greater palatine nerve gives origin to ______ nerves, which pass medially through small foramina in the perpendicular plate of the palatine bone and contribute to the innervation of the lateral nasal wall.
posterior inferior nasal
212
After passing through the lesser palatine foramen, the ______ nerve passes posteriorly to supply the soft palate.
lesser palatine
213
The ______ nerves, approximately seven in number, pass medially through the sphenopalatine foramen to enter the nasal cavity. Most pass anteriorly to supply the lateral wall of the nasal cavity, while others pass across the roof to supply the medial wall.
nasal
214
One of the nerves passing across the roof to supply the medial wall of the nasal cavity (the ______ nerve) is the largest of the nasal nerves and passes anteriorly down the nasal septum, through the incisive canal and fossa in the hard palate to enter the roof of the oral cavity and supply mucosa, gingiva, and glands adjacent to the incisor teeth.
nasopalatine
215
The ______ nerve passes posteriorly from the pterygopalatine ganglion, and leaves the fossa through the palatovaginal canal, which it then exits to supply the mucosa and glands of the nasopharynx.
pharyngeal
216
The ______ nerve originates directly from the maxillary nerve [V2] in the pterygopalatine fossa, which it leaves to enter the orbit through the inferior orbital fissure.
zygomatic
217
The zygomatic nerve passes forward on the lateral orbital wall and divides into ______ and ______ branches:
• The ______ branch continues forward at the base of the lateral orbital wall, passes through a small bony canal in the zygomatic bone to enter the temporal fossa through a small foramen in the lateral orbital margin on the posterior surface of the frontal process of the zygomatic bone, and passes superficially to supply skin over the temple.
• The ______ branch also passes forward at the base of the lateral orbital wall and leaves through a small bony canal, in the orbital margin, which opens via multiple small foramina on the anterolateral surface of the zygomatic bone, and its branches supply the adjacent skin.
zygomaticotemporal, zygomaticofacial, zygomaticotemporal, zygomaticofacial
218
The ______ nerve originates from the maxillary nerve [V2] in the pterygopalatine fossa and passes laterally out of the fossa through the pterygomaxillary fissure to enter the infratemporal fossa. It continues laterally and inferiorly to enter the posterior surface of the maxilla through a small alveolar foramen approximately midway between the last molar tooth and the inferior orbital fissure. It then passes inferiorly just deep to the mucosa of the maxillary sinus to join the ______ plexus.
posterior superior alveolar, superior dental
219
The ______ nerve supplies the molar teeth and adjacent buccal gingivae, and contributes to the supply of the maxillary sinus.
posterior superior alveolar
220
The ______ nerve is the anterior continuation of the maxillary nerve [V2] that leaves the pterygopalatine fossa through the inferior orbital fissure. It lies first in the infra-orbital groove in the floor of the orbit and then continues forward in the infra-orbital canal.
infra-orbital
221
While in the infra-orbital groove and canal, the infra-orbital nerve gives origin to ______ and ______ nerves, respectively, which ultimately join the ______ plexus to supply the upper teeth:
• The ______ nerve also supplies the maxillary sinus.
• The ______ nerve also gives origin to a small nasal branch, which passes medially through the lateral wall of the nasal cavity to supply parts of the areas of the nasal floor and walls.
middle, anterior superior alveolar, superior alveolar, middle superior alveolar, anterior superior alveolar
222
The ______ nerve exits the infra-orbital canal through the infra-orbital foramen inferior to the orbital margin and divides into ______, ______, and ______ branches:
• ______ branches supply skin over the lateral aspect of the external nose and part of the nasal septum.
• ______ branches supply skin of the lower eyelid.
• ______ branches supply skin over the cheek and upper lip, and the related oral mucosa.
infra-orbital, nasal, palpebral, superior labial, Nasal, Palpebral, Superior labial
223
The nerve of the pterygoid canal is formed in the middle cranial fossa by the union of:
• the ______ nerve (a branch of the facial nerve [VII], and
• the ______ nerve (a branch of the internal carotid plexus).
greater petrosal, deep petrosal
224
The nerve of the ______ passes into the pterygopalatine fossa and joins the pterygopalatine ganglion. It carries mainly preganglionic parasympathetic and postganglionic sympathetic fibers.
pterygoid canal
225
The ______ nerve, which originates from the geniculate ganglion of the facial nerve [VII] in the temporal bone, exits the temporal bone through a small canal that opens via a fissure onto the anterior surface of the petrous part of the temporal bone. It passes anteromedially along the posterior margin of the middle cranial fossa and then under the internal carotid artery to reach the superior surface of the cartilage filling the foramen lacerum.
greater petrosal
226
As the greater petrosal nerve passes under the internal carotid artery, it is joined by the deep petrosal nerve to form the nerve of the ______.
pterygoid canal
227
The greater petrosal nerve carries parasympathetic innervation to all glands above the oral fissure, including:
• ______ glands in the nasal cavity,
• ______ glands in the upper half of the oral cavity, and
• the ______ gland in the orbit.
mucous, salivary, lacrimal
228
The greater petrosal nerve also carries some ______ from the soft palate in the lesser palatine nerve.
taste (SA) fibers
229
The deep petrosal nerve is formed by postganglionic sympathetic fibers that originate in the ______ in the neck and leave the ganglion as the ______.
superior cervical sympathetic ganglion, internal carotid nerve
230
The internal carotid nerve forms the ______ plexus around the internal carotid artery as the internal carotid artery passes through the skull and into the cranial cavity. Some of the fibers from the ______ plexus converge to form the deep petrosal nerve, which leaves the ______ plexus in the middle cranial fossa and joins the greater petrosal branch of the facial nerve [VII].
internal carotid
231
The nerve of the ______ enters the superior surface of the cartilage that fills the foramen lacerum and passes anteriorly through the cartilage to enter the pterygoid canal in the root of the pterygoid process of the sphenoid bone. It passes through the canal and into the pterygopalatine fossa where it joins the pterygopalatine ganglion formed around the branches of the maxillary nerve [V2].
pterygoid canal
232
The ______ is the largest of the four parasympathetic ganglia in the head and is formed by the cell bodies of the postganglionic neurons associated with preganglionic parasympathetic fibers of the facial nerve [VII] carried by the greater petrosal nerve and the nerve of the pterygoid canal.
pterygopalatine ganglion
233
The postganglionic parasympathetic fibers that originate in the pterygopalatine ganglion, together with post-ganglionic sympathetic fibers passing through the ganglion, join fibers from the ganglionic branches of the maxillary nerve [V2] to form ______, ______, ______, and ______ branches, which leave the ganglion.
orbital, palatine, nasal, pharyngeal
234
Other postganglionic parasympathetic and sympathetic fibers pass superiorly through the ganglionic branches of the maxillary nerve [V2] to enter the main trunk of the maxillary nerve and be distributed with the ______, ______, and ______ nerves. Of these, the postganglionic parasympathetic and sympathetic fibers that pass into the orbit with the zygomatic nerve are particularly important because they ultimately innervate the lacrimal gland.
zygomatic, posterior superior alveolar, infra-orbital
235
Approximately midway along the orbital wall, the postganglionic parasympathetic and sympathetic fibers leave the zygomaticotemporal branch of the zygomatic nerve and form a special autonomic nerve, which travels up the lateral orbital wall to join the ______ nerve.
lacrimal
236
The ______ is a major general sensory branch of the ophthalmic nerve [V1], which passes forward in the orbit at the margin between the lateral wall and roof.
lacrimal nerve
237
The postganglionic parasympathetic and sympathetic fibers pass with the lacrimal nerve to the ______.
lacrimal gland
238
The postganglionic parasympathetic and sympathetic fibers pass with the lacrimal nerve to the ______.
lacrimal gland
239
The postganglionic parasympathetic and sympathetic fibers pass with the lacrimal nerve to the ______.
lacrimal gland
240
A lesion anywhere along the course of parasympathetic fibers that leave the brain as part of the facial nerve [VII] and are ultimately carried to the lacrimal gland along branches of the ophthalmic nerve [V1] results in "______" and can eventually lead to loss of vision in the affected eye.
dry eye
241
The ______ is a major branch of the external carotid artery in the neck. It originates adjacent to the neck of the mandible, passes forward through the infratemporal fossa, and then enters the pterygopalatine fossa through the pterygomaxillary fissure.
maxillary artery
242
The part of the ______ artery in the pterygopalatine fossa (the third part) is anterior to the pterygopalatine ganglion and gives origin to branches that accompany branches of the maxillary nerve [V2] and the pterygopalatine ganglion.
maxillary
243
Branches of the maxillary artery include the ______, ______, ______, ______, and ______ arteries, and the artery of the ______. Collectively, these branches supply much of the nasal cavity, the roof of the oral cavity, and all upper teeth. In addition, they contribute to the blood supply of the sinuses, oropharynx, and floor of the orbit.
posterior superior alveolar, infra-orbital, greater palatine, pharyngeal, sphenopalatine, pterygoid canal
244
The ______ artery originates from the maxillary artery as it passes through the pterygomaxillary fissure. It meets the posterior superior alveolar nerve, accompanies it through the alveolar foramen on the infratemporal surface of the maxilla, and supplies the molar and premolar teeth, adjacent gingiva, and the maxillary sinus.
posterior superior alveolar
245
The ______ artery passes forward with the infra-orbital nerve and leaves the pterygopalatine fossa through the inferior orbital fissure. With the infra-orbital nerve, it lies in the infra-orbital groove and infra-orbital canal, and emerges through the infra-orbital foramen to supply parts of the face.
infra-orbital
246
Within the infra-orbital canal, the infra-orbital artery gives origin to:
• branches that contribute to the blood supply of structures near the floor of the orbit—the ______ and ______ muscles, and the ______; and
• ______ arteries, which supply the incisor and canine teeth and the maxillary sinus.
inferior rectus, inferior oblique, lacrimal sac, anterior superior alveolar
247
The ______ artery passes inferiorly with the palatine nerves into the palatine canal. It gives origin to a ______ branch, which passes through the lesser palatine foramen to supply the soft palate, and then continues through the greater palatine foramen to supply the hard palate. The latter vessel passes forward on the inferior surface of the palate to enter the incisive fossa and pass superiorly through the incisive canal to supply the anterior aspect of the septal wall of the nasal cavity.
greater palatine, lesser palatine
248
The ______ branch of the maxillary artery travels posteriorly and leaves the pterygopalatine fossa through the palatovaginal canal with the pharyngeal nerve. It supplies the posterior aspect of the roof of the nasal cavity, the sphenoidal sinus, and the pharyngotympanic tube.
pharyngeal
249
The ______ artery is the terminal branch of the maxillary artery. It leaves the pterygopalatine fossa medially through the sphenopalatine foramen and accompanies the nasal nerves, giving off:
• ______ arteries, which supply the lateral wall of the nasal cavity and contribute to the supply of the paranasal sinuses; and
• ______ branches, which travel medially across the roof to supply the nasal septum—the largest of these branches passes anteriorly down the septum to anastomose with the end of the greater palatine artery.
sphenopalatine, posterior lateral nasal, posterior septal
250
The artery of the ______ passes posteriorly into the pterygoid canal. It supplies surrounding tissues and terminates, after passing inferiorly through cartilage filling the foramen lacerum, in the mucosa of the nasopharynx.
pterygoid canal
251
Veins that drain areas supplied by branches of the terminal part of the maxillary artery generally travel with these branches back into the ______.
pterygopalatine fossa
252
The veins coalesce in the pterygopalatine fossa and then pass laterally through the pterygomaxillary fissure to join the pterygoid plexus of veins in the ______.
infratemporal fossa
253
The ______ vein, which drains the inferior aspect of the orbit, may pass directly into the infratemporal fossa through the lateral aspect of the inferior orbital fissure, so bypassing the pterygopalatine fossa.
infra-orbital
