HEAD, NECK & TMJ ANATOMY & CONDITIONS

HEAD
SCALP- Layers: Skin- thick, hair-bearing layer, contains a sebaceous gland, the outermost layer of the scalp
Connective Tissue- “Epicranium”, fibrofatty layer, major arteries & veins found
Aponeurosis- tendinous sheath that connects 2 muscles (occipitofrontalis); “Galea Aponeurotica”
Loose Areolar Tissue- emissary veins (valveless); “Dangerous layer”
Periosteum/Pericranium- innermost layer of scalp; Outermost layer of skull; Provides nutrition to the scalp

> Axial Skeleton (80 bones)- skull, vertebral column, hyoid bone, sternum, ribs, ear ossicles (malleus/hammer, incus/anvil,
stapes/stirrup)
> Appendicular Skeleton (126 bones)- SH girdle (scapula, GH jt, clavicle), pelvic girdle, UE & LE bones
SKULL (22)- upper: vault, lower: base
Cranial bones- 8 bones “PTFOES” Facial bones- 14 bones “NILaPaZVMaMa”
Parietal (2) Nasal (2) Maxilla (2)
Temporal (2) Inferior Nasal Conchae (2) Mandible (1)
Frontal (1) Lacrimal (2)
Occipital (1) Palatine (2)
Ethmoid (1)- 2nd most difficult to visualize Zygomatic (2)
Sphenoid (1)- most diff to visualize & # of articulations Vomer (1) “VoMan= One”

Sutures- synarthrodial joint

Fontanelles- “soft spots”
1) Anterior Fontanelle- closes 18-24 mos., diamond shape
Frontal - Bregma: coronal & sagittal sutures intersect
2) Posterior Fontanelle- closes 9-12 mos., triangular shape
Coronal - Lambda: lambdoidal & sagittal suture meets
suture- *Depressed- dehydrated, Bulging- ↑ICP
frontal + Landmarks
parietal Bregma
1) Nasion- depression at the root of the nose
2) Nasolabial folds- creases at the lat. part of the mouth
Sagittal 3) Philtrum- depression/groove between the mouth & nose
Parietal suture- 4) Pterion- thinnest portion of the lateral skull
parietal - middle meningeal artery lies beneath this often
5) Inion- small eminence at the post. skull
- landmark for head circumference measurement
Lambdoidal Squamosal
- “External Occipital Protuberance”, “Bump of Knowledge”
suture- parietal suture-parietal 6) Glabella- area/skin between the eyebrows
+ occipital + temporal - used for Glabellar Tap Reflezx = (+) persistent blinking/
Lambda
Myerson’s sign
Facial Muscles- innervated by CN 7
1) Occipitofrontalis- raises the eyebrows; “surprise” 11) Mentalis- protrusion of lower lip; “doubting, pouting”
2) Corrugator Supercilii- pulls the eyebrows medially; “frowning” 12) Platysma- depress the angle of mouth; “EGAD muscle”
3) Procerus- wrinkles the bridge of the nose; “distaste/disgust”
4) Zygomaticus Major- “smiling” Muscles for Eye Opening
5) Zygomaticus Minor- “sadness” 1) Levator Palpebrae Superioris- innervated by CN 3 (80%)
6) Risorius- “grimace”/”fake smile” 2) Mueller’s Muscle- sympathetic nerve (20%)
7) Orbicularis Oris- closes the lips; “kissing”
8) Buccinator- “blowing, sucking, whistling” Muscle for Eye Closing
9) Levator Labii Superioris- elevates the upper lip 1) Orbicularis Oculi- innervated by CN 7
10) Levator Anguli Oris- elevates the angle of the mouth; “sneezing”

Extraocular Muscles “IO Mr. So”

1) Superior Rectus- upward & downward
2) Inferior Rectus- downward & outward
3) Lateral Rectus- abducts
4) Medial Rectus- adducts
5) Superior Oblique- downward & inward
6) Inferior Oblique- upward & inward
 Exit Points
1) Cribriform Plate-CN 1
2) Optic Canal- CN 2
3) Superior Orbital Fissure- CN 3, 4, 5VI (ophthalmic) & 6
4) Foramen Rotundum- CN 5V2 (maxillary) “RoMax”
5) Foramen Ovale- CN 5V3 (mandibular) “Oman”
6) Internal Auditory Meatus- CN 7 & 8
7) Jugular Foramen- CN 9, 10 & 11
8) Hypoglossal Canal- CN 12
9) Foramen Lacerum- Internal Carotid artery
10) Foramen Spinosum- Middle Meningeal artery
11) Foramen Magnum- spinal part of CN 11, (L) & (R) vertebral arteries, SC, Medulla oblongata sits

NECK
Cervical Vertebrae- 1 triangular shaped foramen; small body; Short & bifid spinous process
 C1- “atlas”, no body & no spinous process; Jefferson’s Fracture
 C2- “axis”, has dens/odontoid process; Peg; “Epistropheus”; Hangman’s Fx (C2), Teardrop Fx (dens)
 C3- Hyoid bone
 C4- Thyroid bone *TYPICAL: C3-C6
 C6- Cricoid *ATYPICAL: C1, C2 & C7
 C7- “Vertebral prominens”; Long & non-bifid spinous process; Clay Shoveler’s Fx

Hyoid Bone- u-shape, no articulations; Stylohyoid ligament- connects the hyoid bone to the skull
Suprahyoid Muscles “DMSG” Infrahyoid Muscles “TOSS”
Digastrics- ant. belly (CN 5), post. belly (CN 7) Thyrohyoid- 1st cervical nerve
Mylohyoid- CN 5 Omohyoid- ansa cervicalis
Stylohyoid- CN7 Sternohyoid- ansa cervicalis
Geniohyoid- CN 12 Sternothyroid- ansa cervicalis
*Suprahyoid & Infrahyoid ms- 2° muscles for mastication *Ansa cervicalis- loop of nerves arising from the cervical plexus

Triangles of the Neck “ALI SAP SAP SIP API SAI”

Anterior Triangle
Submental ∆
Anterior- Ant. neck line
Lateral- Ant. belly digastrics
Inferior- Hyoid bone
POST
Submandibular ∆ Muscular ∆
Superior- Mandible Superior- Sup. fibers omohyoid
Anterior- Ant. belly digastrics Anterior- Ant. neck line
Posterior- Post. belly digastrics Posterior- Ant. border of SCM
MANDIBLE ANT. BELLY of DIGASTRICS ANT HYOID BONE

Carotid ∆
POST. BELLY of DIGASTRICS Superior- Post. belly digastrics
Inferior- Sup. fibers omohyoid
Posterior- Ant. border of SCM

SCM SUP. FIBERS of OMOHYOID

ANTERIOR NECK LINE

TRAPEZIUS

Posterior Triangle
Occipital ∆
Anterior- Post. border of SCM
Posterior- Trapezius
Inferior- Inf. fibers of omohyoid
Supraclavicular ∆
Superior- Inf. fibers of omohyoid
Anterior- Post. border of SCM
INF. FIBERS of OMOHYOID
Inferior- Clavicle
6

CLAVICLE

TMJ
Temporomandibular joint-
1. synovial jt
2. modified hinge jt
3. ginglymoarthrodial
“STIR”- superior jt (translation), inferior jt (rotation)
Open packed position- mouth slightly open, lips together & teeth not in contact
Closed packed position- tightly clenched teeth
Capsular pattern- limitation in mouth opening

TMJ Arthrokinematics
1) Mandibular depression/Mouth opening- at the 1st 26mm of mouth opening, (B) ant. rotation occurs followed by (B) translation
(N) value: 35-55mm
Functional mouth opening: 25mm
Minimum required for mastication: 18mm
2) Mandibular elevation/Mouth closure- (B) post. translation then (B) post. rotation
3) Mandibular protrusion- (B) ant. translation
(N): 3-6mm (old), >7mm (new)
4) Mandibular retrusion- (B) post. translation, (N): 3-4mm
5) Mandibular excursion/Lateral deviation- ipsi rotation, contralateral deviation, (N): 10-15mm

Muscles of Mastication “TIME”- CN 5

Temporalis- post. fibers (mandibular retrusion)
- ant. fibers
- sup. fibers mouth closing
Internal Pterygoid
Masseter mandibular protrusion “IME”
External Pterygoid - mouth opening
*Magee: Lateral deviation/Mandibular excursion- ipsilateral lateral/ external pterygoid
- contralateral medial/ internal pterygoid
Dentition
1) Deciduous Teeth- “milk teeth”, 6mos-2y/o; 20 (4 incisors, 2 canine, 4 molars)
2) Permanent Teeth- 17-30y/o; 32 (4 incisors, 2 canine/cuspids, 4 premolars/bicuspids, 6 molars)
*1st tooth to erupt: lower central incisors
*Last tooth to erupt: 3rd molar

Tongue Muscles “PGHS” Branches of CN 7 “The Zebra Bump My Car”

1) Palatoglossus- CN 10 via palatopharyngeus plexus - elevation Temporal
2) Genioglossus - CN 12 - protrusion Zygomatic
3) Hyoglossus - CN 12 - depression Buccal
4) Styloglossus - CN 12 - retraction Mandibular
Cervical
TMJ Conditions
1) TMJ Disc Displacement- (+) click upon mouth opening
2) TMJ Displacement- (+) click upon mouth closing
3) TMJ Capsulitis- (+) pain upon mouth opening
- limitation on mouth opening, limitation on contralateral deviation
4) TMJ Synovitis- same manifestation c TMJ capsulitis but (+) swelling
5) TMJ Hypomobility- limitation in mouth opening & contra deviation
6) TMJ Hypermobility- excessive mouth opening & contra deviation
*MOST COMMON direction of dislocation- ANTERIOR