H+N Exam 3

temporomandibular, stylomandibular, splenomandibular

3 paired ligaments associated with TMJ

Internal derangement and degenerative joint disease

50% of TMJ cases are due to

masticatory myalgias (acute muscle/joint strain)

50% of all TMJ cases are due to

Artery

A blood vessel that carries blood away from the heart

Vein

A blood vessel that carries blood back to the heart.

TMJ

A joint on either side of the head. Allows for movement of the mandible for mastication, speech, and respiration

Pathology

A patient may have ________ with TMJ (tenderness, swelling, painful spasms)

cavernous sinus

A sinus containing venous blood located on each side of the body of the sphenoid bone, near the base of the brain, behind the bridge of the nose

Capillary

A tiny blood vessel where substances are exchanged between the blood and the body cells.

elevation

Action of masseter

Head could tip back or turn away

Action of sternocleidomastoid

Elevates anterior 2/3 of mandible and retracts posterior 1/3 of jaw

Action of temporalis muscle

Pharyngeal constrictor

Action: raise pharynx and larynx to help move food down esophagus

Ethmoid bone

Another name for this bone is the cribriform plate

anteroposterior; mediolaterally

Articulating surface of condyle is strongly convex in the ______ direction and slightly convex ________.

Rotational movement

Between disc and mandibular condyle in lower synovial cavity. Axis of rotation and condyle is transverse. Movements are depression or elevation

Gliding

Between disc/articular eminence of temporal bone in upper synovial cavity

Protrusion

Bilateral contraction of both lateral pterygoid muscles

Branches of external carotid artery (superficial temporal branch)

Blood supply of TMJ

Sphenoid bone

Bone that joins all of the bones of the cranium together

Sphenoid bone

Center has sella turcica and houses pituitary gland

Trismus

Condylar heads can't move posteriorly because muscles of mastication spasm. Can occur with odontogenic infections

infratemporal fossa

Contains mandibular division V3 of trigeminal nerve, enters through foramen ovale. Contains pterygoid plexus of veins and pterygoid muscles

Lateral deviation

Contraction of contralateral lateral pterygoid muscles is involved

Hyoglossus

Depresses tongue

Anterior suprahyoid

Depression muscles

lowers

Depressor

Hard palate

Descending palatine artery and greater palatine artery serves ______

depresses mandible

Digastric

zygomatic major

Draws angles of mouth upward and backward, as in laughing

masseter, temporalis, medial pterygoid

Elevation muscles

Inferior alveolar artery

Enters mandible through mandibular foramen

Maxillary artery

Enters maxilla through posterior superior alveolar foramina

Nasal, lacrimal, zygomatic, inferior nasal conchae, vomer, maxilla, mandible, palatine

Facial bones

extrinsic tongue muscles

Genioglossus Hyoglossus Styloglossus Palatoglossus

Arteries

High pressure, no valves required. Thicker walls, no valves

Pterygoid plexus of veins

If local anesthesia is injected here, it causes hematomas

Inferior

Inferioris

Anterior displacement of disc (TMD)

Initial opening: limited gliding as disc is pushed. Full opening: "click" as disc slips to position

Infrahyoid muscles

Insert into thyroid cartilage, depression of hyoid bone

Clavicle, lateral third and scapula

Insertion of Trapezius

Pterygoid fovea of mandible

Insertion of lateral pterygoid

angle and ramus of mandible

Insertion of masseter muscle

angle of mandible

Insertion of medial pterygoid

Mastoid process of temporal bone

Insertion of sternocleidomastoid

coronoid process of mandible

Insertion of temporal muscle

B

Is the ethmoid bone A. Paired B. Single

B

Is the frontal bone A. Paired B. Single

A.

Is the inferior nasal conchae A. Paired B. Single

A.

Is the lacrimal bone A. Paired B. Single

B.

Is the mandible A. Paired B. Single

A.

Is the maxillae A. Paired B. Single

B

Is the occipital bone A. Paired B. Single

A.

Is the parietal bone A. Paired B. Single

B.

Is the sphenoid bone A. Paired B. Single

A.

Is the temporal bone A. Paired B. Single

B.

Is the vomer A. Paired B. Single

A.

Is the zygomatic A. Paired B. Single

Gliding (sliding) and Rotational (hinge)

Jaw movements

Protrusion of mandible

Lateral pterygoid

temporomandibular joint (TMJ)

Lateral side of each joint. Restricts overextension or excessive retraction

Transverse/vertical

Lengthen and narrow the tongue

raises

Levator

Trapezius

Lifts clavicle and scapula as when shoulders are shrugged

Depression

Lowering of jaw

Drained deeply into superior deep cervical nodes

Lymph of TMJ

Larger

Major

TMJ ligaments

Mandible is joined to cranium by ___

elevation

Medial pterygoid action

Smaller

Minor

Mastication, swallowing, and speech

Mobility of the hyoid allows for

Muscles of mastication

Motor function of TMJ

Insertion

Moveable attachment of a muscle

Palatopharyngeus

Moves soft palate toward posterior pharyngeal wall

Risorius muscle

Muscle of the mouth that draws the corner of the mouth out and back, as in grinning.

Veins

No direct pressure from heart, valves (prevent backflow). Very few valves in H+N region. They are thin and flexible and have valves.

splenomandibular ligament (TMJ related)

Not strictly considered part of TMJ. Located on medial side of mandible

Occipital bone and cervical/thoracic midline

Origin of Trapezius

Superior head: Infratemporal crest of greater wing of sphenoid bone Inferior head: Lateral surface of lateral pterygoid plate of sphenoid bone

Origin of lateral pterygoid

zygomatic arch

Origin of masseter muscle

pterygoid fossa of sphenoid bone

Origin of medial pterygoid

sternum and clavicle

Origin of sternocleidomastoid

temporal fossa

Origin of temporalis muscle

Heart Aorta Branchicephalic artery common carotid artery external carotid artery

Origins of Blood supply

squamous, petrous, tympanic, zygomatic process, articular eminence, articular fossa, postglenoid process

Parts of temporal bone

Infraorbital artery

Passes through pterygopalatine fossa

Route of local anesthesia

Posterior superior alveolar vein Inferior alveolar veins Pterygoid plexus Maxillary vein Retromandibular External jugular Branchiocephalic superior vena cava heart

Genioglossus

Protrudes/partially depresses tongue

Palatoglossus

Pulls tongue and soft palate together to separate oral cavity from pharynx

occiptofrontalis

Raises forehead, pulls scalp backward

Platysma

Raises skin of neck and lowers corner of mouth

Elevation

Raising jaw

styloglossus

Retracts tongue

mental artery

Serves anterior mandibular labial mucosa and lip. Exits through mental foramen

Alveolar branches

Serves periodontium

Joint

Site/junction between 2 or more bones

Involuntary positioning (swallowing)

Soft palate elevated blocking nasopharynx larynx elevated and closed pharyngeal constrictor sequentially contract

Risorius

Stretching lips

Acute TMD

Subluxation: causes maximal depression/protrusion of mandible. Happens when each condyle moves too far anteriorly on articular eminence

Superior

Superioris

Maxillary artery

Supplies all teeth

External carotid artery

Supplies lingual mucosa, tongue, floor of mouth

Voluntary positioning Involuntary positioning

Swallowing steps

limited or deviated mandibular opening.

TMJ may include

retracts mandible

Temporalis

Retraction

Temporalis function

Origin

The fixed attachment of a muscle

temporalis, masseter, medial and lateral pterygoid

These muscles always insert in mandible

Voluntary positioning (swallowing)

Tongue pushes food back to oropharynx Suprahyoid muscles elevate hyoid bone palatopharyngeal muscles close to form bolus

Lingual artery

Tongue, floor of mouth. Branches off to sublingual artery, branches to lingual gingiva.

Veins

Usually larger than arteries. More numerous, frequently anastomose, more variable, uniquely have sinuses.

Stylomandibular ligament of TMJ

Variable ligament, becomes taut when mandible protrudes

Superficial temporal, maxillary, and pterygoid plexus of veins

Venous return of TMJ

Night guard, muscle relaxants, tylenol, grinding

What can you do to help patients with clenching?

Foramen magnum and Lambdoid suture

What connects to occipital bone?

Stylohyoid ligament

What does the styloid process connect to?

Fibrous joint capsule

What encloses the TMJ?

Omohyoid

What muscle has a superior and inferior belly?

Mandibular nerve

What nerve travels through foramen ovale

Maxillary nerve

What nerve travels through foramen rotundum

Sagittal suture

What separates parietal bones

joint disc

What's located between the temporal bone and mandibular condyle

Infratemporal fossa, pterygopalatine fossa

Where does the maxillary artery pass through

Temporal bone (zygomatic process)

Which bone connects to "everything"

Cranial bones

Which bones are behind the eyes?

Frontal bones

Which bones are in front of the eyes?

Cranial bones

Which bones support the brain?

Facial bones

Which bones support the face?

Lateral pterygoid

Which muscle is painful when you grind your teeth?

temporal and maxillary processes

Which two processes does the zygomatic arch have

For control the direction of blood flow and implications for the spread of infection

Why are arteries and veins different?

Temporal bones

Zygomatic process, mandibular fossa, auditory meatus, mastoid process, styloid process

levator labii superioris muscle

a muscle of facial expression which elevates and extends the upper lip

Arteriole

the smallest kind of artery

Venule

the smallest kind of vein

Direction of blood flow

artery, arteriole, capillary, venule, plexus, venule, vein

TMJ

articulation of mandible and temporal bone

Depressor anguli oris

depresses corner of mouth

depressor labii inferioris

depresses lower lip

Hyoid bone

doesn't articulate with any other bone. Forms base of tongue and larynx

corrugator supercilli

draws eyebrows medially and inferiorly

Levator anguli oris

elevates angle of mouth

zygomatic minor

elevates upper lip

levator labii superioris alaque nasi muscle

eleveates the superior lip, dilates the nostrils

Superior belly of omohyoid

insertion at hyoid bone

depressor anguli oris

lowers angle of mouth

Buccinator

moves bolus of food

encircles

obicularis

Inferior belly of omohyoid

origin at scapula

anterior faucial pillar

palatoglossus

posterior faucial pillar

palatopharyngeus

mentalis

raises chin, protrudes lower lip, decreases depth of lower vestibule

TMJ

sensory innervation (mandibular (trigeminal) nerve)

Sternocleidomastoid

serves to locate lymphnodes.

Superior/inferior longitudinal

shorten, thicken, curl the tongue

Intrinsic muscles of the tongue

superior longitudinal, inferior longitudinal, transverse, vertical

Epicranial muscle

surprise

suprahyoid muscles

swallowing- elevation of hyoid bone and larynx. Help with opening jaw/depress mandible

Pterygoidpalatine fossa

contains maxillary artery, mandibular divison V2 of trigeminal nerve, enters through foramen rotundum

Ligament

band of fibrous tissue that connects bones

Pterygoid fossa

between lateral and medial pterygoid plates

Venous plexus

capillary return deep to the papillary plexus

orbiculoris oculi

closes eyelids

orbicularis oris

closes lips