Lecture 4 – Head, (part 2)

viscerocranium, muscles of mastication,

temporomandibular joint
chapter 7

Clinically Oriented Anatomy

Keith L. Moore, Seventh Edition

Tamar Chichinadze MD
599 55 45 05
 Lecture 4 – Head, part 2
Objectives Main literature: Moore, clinically oriented anatomy,
7th edition, K.L. Moore, A.F. Dalley, A.M.R. Agur;

• Orbit, • p.: 889-891; 909, 916-921; 922, 923,

• Temporal Region, infratemporal fossa, 927, 951, 952, 953, 955-965.
• temporomandibular joint,
• Muscles of mastication,
• Dislocation of TMJ, Arthritis of TMJ,
• Pterygopalatine fossa,
• Skeleton of External Nose; Nasal
Cavity; Paranasal Sinuses
 889-891

Orbits and placement of eyeballs within them

 889-891
Bony walls of the orbit - anterolateral view
 916-921
Temporal fossa

• Boundaries:
• Posteriorly and superiorly by the
temporal lines.
• Anteriorly by the frontal and
zygomatic bones.
• Laterally by the zygomatic arch.
• Inferiorly by the infratemporal crest

• Floor of the temporal fossa - pterion:

frontal, parietal, temporal, and
greater wing of the sphenoid
 916-921

Temporal and
infratemporal fossae
 916-921

Temporal and
infratemporal
fossae
 916-921

Temporal fossa
• Boundaries:
• Medial: frontal bone, parietal
bone, temporal bone, and sphenoid
bone
• Lateral: Temporal fascia
• Anterior:
– Posterior surface of the frontal process
of the zygomatic bone
– posterior surface of the zygomatic
process of the frontal bone.
• Superior:
– superior and inferior temporal lines
– Anteriorly - zygomatic process of the
frontal bone
– Posteriorly - supramastoid crest of the
temporal bone
• Inferior:
– Zygomatic arch laterally
– infratemporal crest of the greater wing Gray`s anatomy for students, third
of the sphenoid medially
edition © 2015 by Elsevier
 916-921
Infratemporal
fossa

• Laterally: the ramus of the

mandible.
• Medially: the lateral pterygoid
plate.
• Anteriorly: the posterior aspect
of the maxilla.
• Posteriorly: the tympanic plate
and the mastoid and styloid
processes of the temporal bone.
• Superiorly: the inferior
(infratemporal) surface of the
greater wing of the sphenoid.
• Inferiorly: where the medial
pterygoid muscle attaches to the
mandible near its angle
 916-921

Infratemporal fossa
• Boundaries:
• roof:
– inferior surfaces of the
greater wing of the
sphenoid and the
temporal bone
– infratemporal crest of
the greater wing of the
sphenoid
• Lateral:
– ramus of mandible
• Medial:
– pterygoid process
• Anterior:
– posterior surface of the
maxilla
Gray`s anatomy for students, third edition © 2015
by Elsevier
Mandible
 916-921
Temporomandibular joint (TMJ)
• Type – synovial, modified hinge
• Movements: flexion (elevation) and extension (depression), gliding and a
small degree of rotation (pivoting)
• Articular surfaces: mandibular fossa and articular tubercle of the temporal
bone superiorly, and the head of the mandible inferiorly
• articular disc
• Separate superior and inferior articular cavities
 916-921
Temporomandibular joint
 916-921
Ligaments of • lateral ligament of the TMJ
Temporomandibular • stylomandibular ligament,
joint (TMJ) • Sphenomandibular ligament
 Ligaments of the
temporomandibular
joint
 916-921

Temporomandibular joint (TMJ)

 916-921

Movements of
Temporomandibular
joint
• To enable more than a small
amount of depression of the
mandible—that is, to open the
mouth wider than just to
separate the upper and lower
teeth—the head of the
mandible and articular disc
must move anteriorly on the
articular surface until the head
lies inferior to the articular
tubercle (a movement
referred to as “translation” by
dentists)
 Movements of the
temporomandibular
joint
 916-921

Muscles of mastication
 916-921

Tempiralis
Origin - Triangular muscle with broad
attachment to floor of temporal fossa
and deep surface of temporal fascia

Insertion – Narrow attachment to tip

and medial surface of coronoid
process and anterior border of ramus
of mandible

Action - Elevates mandible, closing jaws;

posterior, more horizontal fibers are
1° retractors of mandible
Temporalis muscle
 916-921
Masseter

Origin - Quadrate muscle

attaching to inferior border and
medial surface of maxillary
process of zygomatic bone and
the zygomatic arch
Insertion - Angle and lateral
surface of ramus of mandible
Action - Elevates mandible, closing
jaws; superficial fibers make
limited contribution to
protrusion of mandible
Masseter muscle
 916-921

Muscles of mastication
medial and lateral pterigoids
 Medial
pterygoid
muscle
Lateral pterygoid
muscle
 922

Muscles of mastication
medial and lateral pterigoids
 916-921

Muscles of mastication
medial pterigoid

• Origin – Quadrangular two headed muscle from

• (1) medial surface of lateral pterygoid plate and pyramidal process of
palatine bone and
• (2) tuberosity of maxilla

• Insertion – Medial surface of ramus of mandible, inferior to mandibular

foramen; in essence, a “mirror image” of ipsilateral masseter, two muscles
fl anking ramus

• Action –
– elevate mandible;
– contributes to protrusion;
– alternate unilateral activity produces smaller grinding movements
 916-921

Muscles of mastication
lateral pterigoid
Origin – Triangular two-headed
muscle from
(1) infratemporal surface and
crest of greater wing of
sphenoid and
(2) (2) lateral surface of lateral
pterygoid plate

Insertion –
Upper head attaches primarily to
joint capsule and articular disc
of TMJ;
inferior head attaches primarily to
pterygoid fovea on
anteromedial aspect of neck of
condyloid process of mandible

Action -Acting bilaterally, protracts

mandible and depresses chin;
acting unilaterally, swings jaw
toward contralateral side;
alternate unilateral
contraction produces larger
lateral chewing movements
Pterigoid muscles
923
Infrahyoid and suprahyoid Muscles acting on
mandible/TMJ
Infrahyoid and suprahyoid Muscles acting on mandible/TMJ
Clinical correlations

Temporomandibular
joint
⚫ Dislocation of TMJ - Sometimes
during yawning or taking a large
bite, excessive contraction of the
lateral pterygoids may cause the
heads of the mandible to
dislocate anteriorly (pass anterior
to the articular tubercles)
⚫ Arthritis of TMJ
 Pterygopalatine fossa
• Located deep in the infratemporal
fossa, deep to the pterygomaxilary
fissure
• The bony boundaries of the
pterygopalatine fossa
– superiorly, the apex of the orbit;
greater wing of sphenoid
– anteriorly, the tubercle of maxilla
– posteriorly, pterygoid process
sphenoid bone;
– laterally, the pterygomaxillary fissure;
– medially, the vertical plate of the
palatine bone
Pterygopalatine fossa
 Pterygopalatine
fossa p. 951-952
• Boundaries:
• Posteriorly - pterygoid process of
the sphenoid
• Anteriorly – maxilla
• Medially - perpendicular plate of
the palatine bone
• Roof – infratemporal surface of
the greater wing of the sphenoid

• Openings:
• inferior orbital fissure – to orbit
• greater and lesser palatine canals – to oral cavity
• Sphenopalatine foramen – to nasal cavity
• Pterygoid canal – base of the skull
• Foramen rotundum – cranial cavity
 Pterygopalatine
fossa
• Connections of the
Pterygopalatine fossa

• The bony boundaries of the pterygopalatine fossa

• • superiorly, the apex of the orbit;
• • anteriorly, the maxilla
• • posteriorly, sphenoid bone;
• • laterally, the pterygomaxillary fissure;
• • medially, the vertical plate of the palatine bone
Connections of the Pterygopalatine fossa
 Openings of • inferior orbital fissure – to orbit
• greater and lesser palatine canals – to oral cavity
Pterygopalatine • Sphenopalatine foramen – to nasal cavity
• Pterygoid canal – base of the skull
fossa • Foramen rotundum – cranial cavity
 955-965

SKELETON OF EXTERNAL NOSE

 Major compartments of head
• cranial cavity
• two ears
• two orbits
• two nasal cavities
• oral cavity
 Nasal cavities
• Floor
• Roof
• Medial wall
• Lateral wall
• Naris (anterior opening)
• Choane (posterior
opening)
Regions of the
nasal cavities
 Nasal
cavities
Nasal cavities
Paranasal
sinuses
nasolacrimal
duct
 Paranasal sinuses
Posteroanterior skull radiograph
 955-965

Nasal Cavities
• Respiratory area
• Olfactory area

• BOUNDARIES:
• Roof - frontonasal,
ethmoidal, and sphenoidal
• Floor - palatine processes
of the maxilla and the
horizontal plates of the
palatine bone
• medial wall – septum
• lateral wall - nasal
conchae
 Nasal cavities
• Floor
• Roof
• Medial wall
• Lateral wall
 Nasal cavities
• Floor - hard palate
– palatine process of the maxilla
– horizontal plate of the palatine
bone
 Nasal cavities

• Roof :
• cribriform plate of the ethmoid
bone
• frontal bone
• nasal bones
• sphenoid bone
• vomer
• palatine bone
 Nasal cavities

• Medial wall -nasal septum

consists of:
• septal nasal cartilage
• vomer
• perpendicular plate of the
ethmoid bone
• small contributions by frontal,
palatine, sphenoid and maxillry
bones.
 Nasal cavities
• Lateral wall
• The inferior, middle,
and superior conchae
• ethmoid
• palatine bone
• Inferior nasal concha
• Sphenoid
• Lacrimal bone
• Maxila
• Nasalbone
• Cartilages
Choanae
 Meatuses of the nasal cavity

• Superior meatus – bellow the superior

concha (open - posterior ethmoidal
cells)
• Middle meatus – bellow the middle
concha (open - anterior and middle
ethmoidal cells, frontal sinus, maxilary
sinus)
• Inferior meatus – bellow the inferior
concha (opens - naso-lacrimal duct)
• Sphenoethmoidal recess - above the
superior concha ( opens sphenoid
sinus)
 Ethmoid bone

• Perpendicular
plate
• Crista gali
• Cribriform plate
• Orbital plate
• Ethmoid air
cells – air-filled
cavities
• Superior and
middle concha
 Meatuses of nasal
cavity and paranasal
synuses
 Meatuses of nasal
cavity and paranasal
sinuses
 Meatuses of nasal
cavity and paranasal
sinuses
 Paranasal sinuses
Posteroanterior skull radiograph
Paranasal sinuses
Paranasal sinuses
Gateways to the nasal cavities
Clinical correlations

Nasal Fractures - Deviation of Nasal Septum

The deviation can be corrected surgically
Clinical correlations

Nasal Fractures -
Deviation of Nasal
Septum
Clinical correlations

Paranasal sinuses
⚫ Sinusitis:
⚫ Infection of Ethmoidal Cells
⚫ Infection of Maxillary Sinuses

⚫ Relationship of Teeth to Maxillary Sinus - A communication may be created

between the oral cavity and the maxillary sinus as a result, and an infection
may occur.
Clinical correlations

Transillumination of Sinuses
References
⚫ Clinically Oriented Anatomy Keith L. Moore sixth edition
⚫ Gray`s anatomy for students, third edition © 2015 by Elsevier