4.

04

FEBRUARY 15, 2016

TOPIC: Temporal Fossa, Infratemporal Fossa, and TMJ
LECTURER: Dr. Wong

[PS. Fully italicized texts are not in the objectives]

TEMPORAL FOSSA

Temporal fascia
o
o

Boundaries of the temporal fossa
Posterior and superior
Temporal line
Anterior
Frontal and zygomatic bones
Lateral
Zygomatic arch
Inferior
Infratemporal crest

Forms the roof of the temporal fossa
Covers the temporalis, and arches superiorly to the
superior temporal line

Pterion
o
o
o

Forms the floor of the temporal fossa
Significance: weakest area and damage of the blood
vessels present in the area may lead to haemorrhage
Formed by parts of the four bones: frontal, parietal,
temporal and greater wing of the sphenoid.

INFRATEMPORAL FOSSA
Is an irregularly shaped space deep and inferior to the zygomatic
arch, deep to the ramus of the mandible, and posterior to the
maxilla

Fig 1. Lateral view of the temporal fossa

CONTENTS OF THE TEMPORAL FOSSA

It communicates with the temporal fossa through theinterval
between the zygomatic arch and to the cranial bones.

Lateral
Medial
Anterior
Posterior
Superior
Inferior
Fig 2. Temporal Region

Temporalis muscle
o The temporal fossa is occupied primarily by the
upper portion this muscle.
o Fan-shaped muscle from the bony floor and
overlies the temporal fascia
Origin
Insertion
Action

Floor of temporal fascia
Coronoid process and anterior
border of ramus of mandible
Elevates mandible (closing jaws);
posterior, more horizontal fibers
are primary retractors of
mandible

TRANSCRIBED BY: Patty, Ernest, Babes

Boundaries of the Infratemporal Fossa
Ramus of the mandible
Lateral pterygoid plate
Posterior aspect of maxilla
Tympanic plate and the mastoid and styloid
process of the temporal bone
Inferior (infratemporal) surface of the greater
wing of the sphenoid
Medial pterygoid plate attaches to the mandible
near its angle
CONTENTS OF THE TEMPORAL FOSSA
Inferior part of the temporalis muscle
Lateral and medial pterygoidmuscles
Maxillary artery
Pterygoid venous plexus
Mandibular, inferior alveolar, lingual, buccal, and chorda
tympani nerves
Otic ganglion

Page 1 of 9

Ernest. INFRATEMPORAL FOSSA. passes between heads of lateral pterygoidand through pterygomaxillaryfissure into pterygopalatine fossa. deep (medial) to neck of condylar process of mandible and lateral to stylomandibularligament Adjacent (superficial to deep) to lateral pterygoid muscle. ascends obliquely anterosuperiorly.[4. Distal (anteromedial) to lateral pterygoid muscle.04: TEMPORAL FOSSA. runs horizontally. AND TMJ] MAXILLARY ARTERY Maxillary artery is the larger of the two terminal branches of the external carotid artery. but in Moore) 1st (mandibular) division 2nd(pterygoid) division TRANSCRIBED BY: Patty. Babes Page 2 of 9 . Division of maxillary nerve st 1 (mandibular) Division of maxillary nerve st 1 (mandibular) nd 2 (pterygoid) rd 3 (pterygoid-palatine) Course Proximal (posterior) to lateral pterygoid muscle. nd 2 (pterygoid) rd 3 (pterygoid-palatine) Branches Deep auricular artery Anterior tympanic artery Middle meningeal artery Accessory meningeal artery Inferior alveolar artery Masseteric artery Deep temporal arteries Pterygoid branches Buccal artery Posterior superior alveolar artery Infraorbital artery Artery of pterygoid canal Pharyngeal branch Descending palatine artery Sphenopalatine artery DISTRIBUTION OF THE BRANCHES OF MAXILLARY ARTERY (not included in the course objectives. medial to temporalis muscle.

lateral to auditory tube) tensor velipalatini (arises from otic ganglion near the origin of nerve to Pterygoidinternus. Ernest. Babes Page 3 of 9 . INFRATEMPORAL FOSSA.[4. AND TMJ] 3rd(pterygoid-palatine) division Communications maxillary artery (20171D) Receives branches that correspond with the same branches of themaxillary artery Its tributaries eventually converge to form ashort maxillary vein (2017 1D) Anastomoses anteriorlywith the facial vein via the deep facial vein pharyngeal venous plexus (20171D) Superiorly with the cavernous sinus via emissary veinsand ophthalmic veins Snell: Emissary veins are valveless veins which connect the veins of the scalp to the venous sinuses routes for the spread of infection OTIC GANGLION MUSCLES OF THE INFRATEMPORAL FOSSA [Please check appendix for the OINA] PTERYGOID VENOUS PLEXUS venous equivalent of most of the maxillary artery (most of the veins that accompany the branches of the maxillary artery drain into this plexus) Functional classification Relations Roots Branches Distribution (20171D) Relations Parasympathetic ganglion located in the infratemporal fossa inferior to the foramen ovale medial to CN V3 (mandibular nerve) posterior to medial pterygoid muscle o Snell: the otic ganglion is adherent to the nerve to the the medial pterygoid Preganglionic fibers from glossopharyngeal nerve reach the otic ganglion via the lesser petrosal nerve(exits skull via jugular foramen and innervates tympanic plexus) Postganglionic secretomotor fibers reach the parotid gland via the auricotemporal nerve tensor tympani (passes backward. directed forward) located partly between the temporalis and pterygoid muscles nd rd Parallels the 2 and 3 part of the TRANSCRIBED BY: Patty.04: TEMPORAL FOSSA.

Ernest. mental
foramen Internal – head of mandible. lower part of the face. TYPE OF JOINT The temporomandibular joint is synovial. part of auricle. not directly joined the bones have a synovial cavity and are united by the dense irregular connective tissue that forms the articular capsule that is normally associated with accessory ligaments According to mobility: diarthrosis specifically as ginglymoarthrodial joint referring to its dual compartment structure and function (ginglymo. arises from the trigeminal ganglion in the middle cranial fossa Largest of the 3 divisions of the trigeminal nerve. mandibular notch. mandibular foramen. groove for mylohyoid nerve SUMMARY (2017 1D): Bones Involved: Condylar process or condyle of the mandible Mandibular fossa Articular eminence of the temporal bone A. INFRATEMPORAL FOSSA. Inferior attachment– periphery of the mandibular condyle Temporomandibular joint is a complex articulation of the movable mandible and the base of the skull
 TRANSCRIBED BY: Patty. to the condyle of the mandible inferiorly. temporalis. CAPSULE (Snell) The capsule surrounds the joint and is attached above to the articular tubercle and the margins of the mandibular fossa and below to the neck of the mandible. muscles of mastication except buccinators (supplied by facial nerve) Divisions of the Mandibular Nerve the motor root (of the trigeminal nerve) leaves the skull via the foramen ovale to join the sensory root form the trunk of mandibular nerve divides into small anterior (mostly motor) and large posterior division (mostly sensory) Supplies the 4 muscles of mastication (masseter. medial and lateral pterygoids) leaves the trigeminal ganglion and passes out of the skull through the foramen ovale to enter the infratemporal fossa ARTICULATION (Snell) Occurs between the articular tubercle and the anterior portion of the mandibular fossaof the temporal bone above and the head (condyloid process) of the mandible below. The articular disc divides the joint into upper and lower cavities. The articular surfaces are covered with fibrocartilage. temporal region. coronoid process. AND TMJ] MANDIBULAR NERVE (CN V3) Mandible External – ramus.[4. According to morphology: synovial joint Supplies skin of the lower lip. The enclosed space between the articular surfaces is the joint cavity Superior attachment– area surrounding the mandibular fossa and articular eminence of the temporal bone.04: TEMPORAL FOSSA.and arthrodial) freely movable all diarthrosis joints are synovial joints C. Babes Page 4 of 9 . Addt’l notes from 2017 1D: encloses the joint surfaces like a sleeve that runs from the temporal bone superiorly. it is a mixed nerve(small motor and large sensory) Exits the skull via foramen ovale Motor Sensory [Please check appendix for the course and distribution of the branches of CN V3] TEMPOROMANDIBULAR JOINT (Snell) B.

fascia and skin Medially: maxillary artery and vein and the auriculotemporal nerve DISLOCATION OF TMJ (LOCKED JAW) In this movement. the head of the mandible might slide forward in front of the mandibular joint (slide outside the mandibular fossa). Posterior thickening – sits atop the condyle and fills the mandibular fossa above when the mandible is at rest. leads to laxity and instability of the TMJ. 2. 1. Moore: In this position.04: TEMPORAL FOSSA. all boxes mean addt’l/alternative info] is a lateral thickening of the joint capsule and is similar to the collateral ligaments of other joints prevents posterior and inferior displacement of the condyle but allows limited anterior movements of the condyle fibers run downward and backward from the tubercle on the root of the zygoma to the lateral surface of the neck of the mandible 2. BLOOD SUPPLY OF TEMPOROMANDIBULAR JOINT 1. and lymphatics within the LIGAMENTS(Snell) looseconnective tissue matrix. as in laughing or yawning. Intermediate zone– lies between the two previous zones. Babes G. the neck of the mandible fractures before dislocation occurs. Superficial temporal artery Muscular branch of the maxillary artery I. being resisted by the presence of the postglenoid tubercle and the strong intrin. SYNOVIAL MEMBRANE a layer of synovium lines the inner aspects of the joint capsule does not line the actual articular surfaces of the joints because synovial joints are generally weight-bearing joints synovium secretes synovial fluids for lubrication and nourishment of the opposing articular surfaces 2 layers of the synovial membrane 1. a sideways blow to the chin by a clenched hand (fist) when the mouth is open dislocates the TMJ on the side that received the blow. the mandible remains depressed and the person is unable to close his or her mouth. intervening between the condyle and the mandibular fossa biconcave disc that serves to provide reciprocal articular surfaces between its inferior surface and the condyle. Because of the close relationship of the facial and auriculotemporal nerves to the TMJ. care must be taken during surgical procedures to preserve both the branches of the facial nerve overlying it and the articular branches of the auriculo. sliding outside of the mandibular fossa (opening of mouth)
o result in displacement of condyle anterior to the articular eminence of the temporal bone. Branches of temporalis nerve Branches of auriculotemporal nerve Branches of masseteric nerve H.[4. Page 5 of 9 . 
 c. When the mandible is depressed or if the mouth is widely opened. Dislocation of the TMJ may also accompany fractures of the mandible. Usually in falls on or direct blows to the chin.sic lateral ligament. SPHENOMANDIBULAR LIGAMENT thin band that is attached above to the spine of the sphenoid bone and below to the lingula of the mandibular foramen represents the remains of the first pharyngeal arch in this region lies on the medial side of the joint 
 STYLOMANDIBULAR LIGAMENT lies behind and medial to the joint and some distance from it merely a band of thickened deep cervical fascia that extends from the apex of the styloid process to the angle of the mandible E. 2. INFRATEMPORAL FOSSA. Ernest. and type B cells which synthesize hyaluronate found in synovial fluid. D. Common dislocation is anterior type characterized by the forward movement of the head of the mandible. An intimal cellular layer contains type A cells which are phagocytic. RELATIONS OF TEMPOROMANDIBULAR JOINT Anteriorly: mandibular notch and the masseteric nerve and artery Posteriorly: tympanic plate of the external auditor meatus and the glenoid process of the parotid gland Laterally: parotid gland. Posterior dislocation is uncommon. Anterior thickening– lies just below the posterior slope of the articular eminence. TRANSCRIBED BY: Patty. associated with traumatic dislocation and rupture of the articular capsule and lateral ligament. Most common. A vascular subintimal layer contains blood vessels. ARTICULAR DISC 2018 1C: divides the joint into upper and lower cavities an oval plate of fibrocartilage that is attached circumferentially to the capsule attached in front to the tendon of the lateral pterygoid muscle and by fibrous bands to the head of the mandible (ensure that the disc moves forward and backward with the head of the mandible during protraction and retraction of the mandible) 2017 1D: composed of dense fibrous tissues and lies within the joint capsule. AND TMJ] F. 2. Injury to articular branches of the auriculotemporal nerve supplying the TMJ. LATERAL TEMPOROMANDIBULAR LIGAMENT strengthens the lateral aspect of the capsule limits the movement of the mandible in a posterior direction and thus protects the external auditory meatus 2017 1D: [From here onwards. 3. and its superior surface and the mandibular fossa and eminence Three zones of the articular disc: a. the head of the mandible and the articular disc both move forward until they reach the summit of the articular tubercle. NERVE SUPPLY OF TEMPOROMANDIBULAR JOINT 1.temporal nerve that enter the posterior part of the joint. b. 3.

and injury to the jaw. de Jesus) 2017 1D Temporal Fossa. and opening and closing the jaw can be painful. and masseter TRANSCRIBED BY: Patty. Locked jaw or limited jaw movement is often a result of a bad-bite. chronic recurrent or chronic. INFRATEMPORAL FOSSA. 
 References: 2018 1C Temporal Fossa. These dislocations can be both unilateral and bilateral. Infratemporal Fossa and Temporomandibular Joint (lecture by Dr. The masseter and temporalis muscles elevate the mandible before the lateral pterygoid muscle relaxes resulting in the mandibular condyle being pulled anterior to the bony eminence and out of the temporal fossa.04: TEMPORAL FOSSA. Ernest. Anterior dislocations are usually secondary to an interruption in the normal sequence of muscle action when the mouth closes from extreme opening. Spasm of the masseter. headaches develop. Causes may include clenching teeth during sleep. facial muscles and TMJ are out of alignment. When the teeth. 
 ANTERIOR DISLOCATION Most common and result in displacement of the condyle anterior to the articular eminence of the temporal bone. Infratemporal Fossa and Temporomandibular Joint (lecture by Dr. it causes a problem in the jaw joint (TMJ). arthritis. AND TMJ] 2017 1D: Dislocation sometimes occurs when mandible is depressed.[4. Chewing is difficult. temporalis. masseter. If the bite is not aligned correctly. Babes Page 6 of 9 . the jaw joint and muscles become locked. stress.Celaje) Clinical Anatomy by Regions 9th edition by Richard Snell Clinically Oriented Anatomy 7th edition by Keith Moore Gray’s Anatomy Movements of the Temporomandibular joint Movements of Mandible Muscles Temporal. and Protrusion (protrude chin) medial pterygoid Retrusion (retrude chin) Temporal (posterior oblique and near horizontal fibers) and masseter Lateral movements (grinding
and chewing) Temporal of same side. These dislocations are classified as acute. pterygoids of opposite side. masseter and medial Elevation (close mouth) pterygoid Lateral pterygoid and suprahyoid and Depression (open mouth) infrahyoid muscles Lateral pterygoid. and pterygoid muscles causes trismus and keeps the condyle from returning into the temporal fossa.

Ernest. Temporalis is in the temporal fossa TRANSCRIBED BY: Patty.04: TEMPORAL FOSSA. 9 ed) [Moore also has a table but medj different from Snell’s] **20171D: only lower part of the temporalis muscle is in the infratemporal fossa. OINA: Infratemporal Muscles (Snell.[4. Babes Page 7 of 9 . INFRATEMPORAL FOSSA. AND TMJ] APPENDIX th Table 1.

conveys postganglionic parasympathetic secretomotorfibersfrom the otic ganglion to the parotid. joined by the chorda tympani nerve supplies the mucous membrane of the anterior two thirds of the tongue and the floor of the mouth. and the scalp. gives off preganglionic parasympatheticsecretomotorfibersto the submandibular ganglion Inferior alveolar nerve enters the mandibular canal to supply the teeth of the lower jaw emerges through the mental foramen (mental nerve) to supply the skin of the chin Before entering the canal. the temporomandibular joint. Ernest. 9 ed) DIVISION Main Trunk of the Mandibular Nerve Anterior *All branches of the anterior division are motor except the buccal nerve (sensory) Branches Meningeal branch Nerve to medial pterygoid muscle Masseteric Nerve Deep temporal nerves Nerve to lateral pterygoid Buccal nerve Auricotemporal nerve Lingual nerve Posterior *All branches of the posterior division are sensory (except the nerve to mylohyoid) TRANSCRIBED BY: Patty. it gives off the mylohyoid nerve which supplies the mylohyoid muscle and the anterior belly of the digastric muscle. AND TMJ] Table 2. descends in front of the inferior alveolar nerve enters the mouth runs forward on the side of the tongue and crosses the submandibular duct. external auditory meatus. Communicating branch frequently runs from the inferior alveolar nerve to the lingual nerve Page 8 of 9 . INFRATEMPORAL FOSSA.th [4. Babes Course Supplies medial pterygoid and tensor velipalatini Masseter Temporalis Lateral pterygoid Skin and mucous membrane of the cheek (does not innervate the buccinators muscle) supplies the skin of the auricle.04: TEMPORAL FOSSA. Branches of the Divisions of the Mandibular Nerve (Snell.

Ernest. Babes Page 9 of 9 . and the vestibular gingiva of the mandibular incisorteeth lies anterior to the inferior alveolarnerve sensory to the anterior two thirds of the tongue. the largest of which passes posteriorly. medial to the neck of mandible supplies sensory fibers to the auricle and temporal region sends articular (sensory) fibers to the TMJ conveys postsynapticparasympathetic secretomotorfibers from the otic ganglionto the parotid gland.[4. Another branch of the plexus. Branches. Course and Distribution of The branches of the Sensory Division (Lifted from 2017 1D) TRANSCRIBED BY: Patty.04: TEMPORAL FOSSA. enters mandibular foramen passes through the mandibular canal forms theinferior dental plexus. the mental nerve passes through the mental foramen and supplies theskin and mucous membrane of the lower lip. medial and inferiorto the 3rd molar tooth. AND TMJ] Table 3. and the lingual gingivae enters the mouth between the medial pterygoidmuscle and the ramus of the mandible passes anteriorly under cover of the oral mucosa. which sends branches to all mandibular teeth on its side. the skin of thechin. joins the lingual nerve in theinfratemporal fossa Table 4. the floor of the mouth. Couse and Distribution of the Sensory Division of the Mandibular Nerve (Moore) Branch Auricotemporal nerve Inferior alveolar nerve Lingual nerve Course and distribution Encircles the middle meningeal artery divides into numerous branches. the chorda tympani nerve(from CN VII) carrying taste fibers from the anteriortwo thirds of the tongue. INFRATEMPORAL FOSSA.