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
