Surgical Anatomy For Dental Students

OSTEOLOGY OF SKULL
1. The Skull
 composition
 It is composed of 22 flattened or irregular bones which, with one exception (the mandible), are
immovably jointed together.
21 Parietal + temporal + zygomatic + Maxillary + lacrimal + Nasal +
Paired
immobile Palatine + Inferior concha.
bone Unpaired Frontal. + Occipital. + Ethmoidal + Sphenoid + Vomer.
1 mobile bone Mandible
 Parts
 It is divisible into two parts
Cranium Occipital + 2 Parietals + Frontal. + 2 Temporals + Sphenoidal+ Ethmoidal.
2 Nasals + 2 Maxillæ + 2 Lacrimals + 2 Zygomatic + 2 Palatines + Vomer + 2
Face
Inferior Nasal Conchæ + Mandible.
 Special features ( VIP)
1. Foramina of skull & its contents
Contents
Foramina
Vessels Nerves
1 supraorbital f. supraorbital artery & v. supraorbital nerve
2 f. cecum emissary veins to sup. sagittal sinus -
3 f. of cribriform plate - olfactory nerve bundles (I)
4 ant. ethmoidal f. anterior ethmoidal artery &v anterior ethmoidal nerve
5 post. ethmoidal f. posterior ethmoidal a. & v. posterior ethmoidal nerve
6 optic canal ophthalmic artery optic nerve (II)
superior ophthalmic vein 3rd , 4th , 6th cranial ns.
7 sup. orbital fissure
branches of ophthalmic n.
8 foramen rotundum - maxillary nerve (V2)
9 incisive foramen sphenopalatine artery nasopalatine nerve(V2)
10 greater palatine f. greater palatine artery & v. greater palatine nerve
11 lesser palatine f. lesser palatine artery & v. lesser palatine nerve
inferior ophthalmic veins zygomatic nerve
infraorbital artery infraorbital n. of maxillary n.
12 inf.orbital fissure
infraorbital vein orbital branches
of pterygopalatine ganglion
13 infraorbital f. infraorbital artery & v. infraorbital nerve
accessory meningeal artery mandibular nerve (V3)
14 foramen ovale
lesser petrosal nerve.
middle meningeal artery meningeal branch of the
15 foramen spinosum
mandibular nerve (V3)
internal carotid artery , artery of nerve of pterygoid canal
16 foramen lacerum
pterygoid canal
internal acoustic labyrinthine artery facial nerve (VII)
17
meatus vestibulocochlear nerve (VIII)
internal jugular vein , inferior glossopharyngeal nerve (IX)
18 jugular foramen petrosal sinus, sigmoid sinus vagus nerve (X)
accessory nerve (XI)
19 hypoglossal canal - hypoglossal nerve (XII)
anterior and posterior spinal medulla oblongata
20 foramen magnum
arteries,vertebral arteries
21 Stylomastoid f. stylomastoid artery facial nerve
Dr. Ahmed El_Nashar (2013)
 Surgical Anatomy For Dental Students
2.Temporal fossa
 position
- region at the side of the skull & above zygomatic arch.
 Boundaries
- Bounded by a continuous line formed by the foloowing
Front  frontal process of zygomatic bone
Above  temoral lines
Below  supra mastoid crest + zygomatic arch
 Contents
1. temporalis ms + temporal fascia
2. temporal branch of facial + zygomatico-temporal + auriculo-temporal + deep temporal ns.
3. superficial temporal ve. + deep temporal ve.
3. Infra-temporal fossa
 position
- region at side of the skull & below the zygomatic arch & deep to mand..
 boundaries
med. Lat. Ptergoid plate Lat Zygomatic arch + coronoid process + ramus
ant. Back of maxilla post Freely open
sup. Infra termpral surf. of greater wing of Inf. Freely open
sphenoid
 Contents
Ms. Medial & lateral pterygoid. Ns. Mand. + max. + otic ganglion + corda tympani
Joint TMJ Ve. Max. a + pterygoid venous plexuses
Lig. Spheno-mandibular lig.

4. pterygo-mandibular space
 position
- triangular space situated bn ramus of mandible (lat.) & medial pterygoid ms. (med.)
 boundaries
med. Medial pterygoid ms. lat Ramus of mandible
ant. Ptergomand. Raphe + buccinator ms. post Communiates e preparotid space.
sup. Lat. Pterygoid ms. inf. Medial pterygoid ms.

2. The Mandible
 Ligaments attached to the mandible
Lat. temporo-mand. Extend from Tubercle of root of zygoma to Neck of the mandible
Spheno-mand. Extend from Spine of sphenoid bone to lingual
Stylo-mand. Extend from tip of styloid process to angle of mand.
Pterygo-mand. Raphe Extend from pterygoid hamulus to post. Part of mylohoid line.
 Nerves related to the mandible
1. inferior alveolar n. 2. mental nerve. 3. N. to mylohyoid ms.
4. Lingual n. 5. Masseteric n. 6. Auriculotemporal n.
 Arteries related to the mandible
1. Maxillary a. 2. inf. Alveolar a.
3. Mental a. 4. facial a.
 Muscles attached to the mandible
Ramus insertion of all amusles of mastication
receives insertion of platysma ms.
gives origin to 6 ms.
Body
Buccinator + sup. Constrictor + genio hyoid + genioglossus + mylohyoid
+ ant. belly of digastric]

Dr. Ahmed El_Nashar (2013)

Surgical Anatomy For Dental Students

Nerves
1. Tooth Innervations

A) Innervations of maxillary teeth

pulp , alveolar bone & opposite Opposite palatal muco- periosteum ,
Buccal or labial muco- periosteum , supplied by …………………
supplied by ….
Ant. teeth Ant. Sup. alveolar n. Nasopalatine n. (long spheno-palatine n.)
Premolars middle Sup. alveolar n. Greater palatine nerve.
st
post. Sup. alveolar n. # M.B. root of 1 Greater palatine nerve.
Molars
molar , supplied by middle sup. Alveolar n.

B) Innervations of mandibular teeth

pulp , supporting buccal & labial muco- lingual muco-
alveolar bone, supplied periosteum , supplied by periosteum , supplied by
by …. …… …………………
Ant. teeth Incisive n. Mental n. Lingual n.
Premolars Inf. Alveolar n. Mental n. Lingual n.
Molars Inf. Alveolar n. Long buccal n. Lingual n.

interesting notes about tooth innervations

1. Nerve Communication
Site of communication Nerves communicates
Max. central incisors sphenopalatinr nerve of both sites communicated together
Max. canine & 1st premolar greater palatine nerve communicates e naso platine n.
1. mental n. of both sides communicates together on buccal m.
Mand. incisors
2. lingual n.of both sides communicates together on lingual m.
Mand. 2nd premolar e 1st molar mental nerve communicates e long buccal n.
‫ اﺣﯿﺎﻧ ﺎ ﺗﺒﻘ ﻰ ﻣ ﺪي ﺑ ﻨﺞ ﻛ ﻮﯾﺲ و ﺗﯿﺠ ﻲ ﺗﺨﻠ ﻊ ﺗﻼﻗ ﻲ اﻟﻤ ﺮﯾﺾ‬.. ‫؟؟!!! اﯾ ﻮه ھﺘﻔ ﺮق ﻛﺘﯿ ﺮ‬.. ‫اﻟﻤﻌﻠﻮﻣﺔ دي ھﺘﻔﺮق ﻣﻌﺎك ﻓﻲ ﺣﺎﺟ ﺔ‬
lower ‫ ﻟ ﻮ ﺟ ﺎي ﺗﺨﻠ ﻊ‬، ‫ ھﻀ ﺮﺑﻠﻜﻢ ﻣﺜ ﺎل‬، ‫ ده ھﻮ اﻟﺴ ﺒﺐ‬communication ‫ﺣﺎﺳﺲ و ﺑﯿﺼﻮت و ﻣﻤﻜﻦ ﯾﻜﻮن ﻣﻮﺿﻮع اﻟـ‬
(‫ و ﺑﻌﺪﯾﻦ ﺟﯿﺖ ﺗﺨﻠﻊ ﻟﻘﯿﺖ اﻟﻤﺮﯾﺾ ﺣﺎﺳﺲ ) ﻟﻮ واﺛ ﻖ ان ﺷ ﻐﻠﻚ ﻣﻈﺒ ﻮط‬inf. Alveolr ‫ ﻟﻠـ‬nerve block ‫ و ﻋﻤﻠﺖ‬incisor
.‫ اﻟﻠﻲ ﻗﻮﻟﺘﻠﻜﻮا ﻋﻠﯿﮭﺎ‬communication ‫ﯾﺒﻘﻰ اﻟﻤﺸﻜﻠﺔ دي ﺳﺒﺒﮭﺎ اﻟـ‬
2. Cuteanous clot nerve
 Branch of cervical plexus
 Some times contribute in sensory innervations of mand. Premolars.
‫ و ﺟﯿﺖ ﺗﺨﻠﻊ ﻟﻘﯿﺖ اﻟﻤﺮﯾﺾ ﺣﺎﺳﺲ ﯾﺒﻘﻰ اﺣﺘﻤﺎل ﻛﺒﯿﺮ ان اﻟﻌﺼﺐ‬premolar ‫ﯾﻌﻨﻲ ﻟﻮ ﻟﻘﯿﺖ ﻟﻠﻤﺮﯾﺾ ﺑﻨﺞ ﻣﻈﺒﻮط ﻋﺸﺎن ﺗﺨﻠﻊ‬
.‫ده ھﻮ اﻟﻠﻲ ﻣﺴﺆول ﻋﻦ اﻹﺣﺴﺎس ده‬
3. Superior dental plexuses
 A plexuses formed by union of terminal branches of 3 superior alveolar nerves (ant. , middle
& post.)
 Formed with in bone & gives off dental and gingival branches w supply max. teeth .
4. Inferior dental plexuses
 A plexus formed by union of branches of inf. alveolar n. within the bone & gives off
dental and gingival branches w supply mand. molar and premolar.

Dr. Ahmed El_Nashar (2013)

 Surgical Anatomy For Dental Students
2. Cranial Nerves
No. Name Type
I 1st Olfactory n. Sensory
II 2nd Optic n. Sensory
II 3rd Oculomotor n. Mixed
IV 4th Troclear n. Motor
V 5th Trigeminal n. Mixed
VI 6th Abducent n. Motor
VII 7th Facial n. Mixed
VIII 8th Vestibulo-cochlear n. sensory
IX 9th Glossopharyngeal n. Mixed
X 10th Vagus n. Mixed
XI 11th Accessory n. Motor
XII 12th Hypoglossal n. Motor
3. Trigeminal nerve = 5th cranial nerve
largest cranial n. + great sensory nerve of head and face + motor nerve of ms. of mastication.
 originates by 2 roots…
 arise from pons .
Small motor root  runs in front of & medial to sensory root behind semilunar ganglion.
 Leaves skull through foramen ovale, where it , joins mandibular
n.
Large sensory root  arise from semilunar ganglion
 Divisions
 Has 3 large nerves ophthalmic, maxillary, and mandibular.
 The ophthalmic and maxillary consist exclusively of sensory fibers.
 the mandibular is joined outside the cranium by the motor root.
Semilunar Ganglion (Gasserian ganglion)
 occupies trigeminal impression near the apex of the petrous part of the temporal bone.
 crescentic in shape
 it is in relation with the internal carotid artery and the posterior part of the cavernous sinus.
 Motor root & greater superficial petrosal nerve lies underneath the ganglion.

4. The Ophthalmic Nerve = 1st division of Trigeminal

 It is the smallest of the three divisions of the trigeminal,
 arises from the upper part of the semilunar ganglion
 passes forward along lat. wall of cavernous sinus, below 3rd & 4th cranial n..
 enter the orbit, through sup. orbital fissure,
 just before entering the orbit through sup. orbital fissure it divides into 3 branches, as follows …
Frontal Lacrimal Nasocilary
1. Supratrochlear 1. Palpebral branches 1. Sensory root to the ciliary ganglion..
3. Supraorbital . 2. 2 or 3 long ciliary nerves
Branches

3. Posterior ethmoidal nerve.

4. Anterior ethmoidal nerve .
- 2 internal nasal nerves
- External nasal nerve
5. Infratrochlear nerve

5. The Maxillary nerve = 2nd division of Trigeminal

 Course and relations
 It arises from the trigeminal ganglion in the middle cranial fossa.
 Runs forwards on the floor of the lateral wall of the cavernous sinus.
 leaves the middle cranial fossa through the foramen rotundum to enter the pterygopalatine fossa where,
spheno-palatine ganglion is suspended from the nerve.
 Then it passes out from the fossa through the pterygo-maxillary fissure & crosses the infra-temporal fossa to
enters the orbit through the inferior orbital fissure.
 In the orbit it continues as the infra-orbital n. That runs in the infra-orbital groove and canal.
 The infra-orbital nerve continues forwards & emerges on the face through the infra-orbital foramen.
Dr. Ahmed El_Nashar (2013)
 Surgical Anatomy For Dental Students
 Branches
 Branches divided into 4 groups, according as they are given off in the cranium, in the pterygopalatine fossa, in
the infraorbital canal, or on the face.
In the Cranium…………… Middle meningeal.
In the Pterygopalatine Fossa… Zygomatic. + Sphenopalatine.
In infratemporal Fossa Post. Sup. alveolar.
In the Infraorbital Canal……… Ant. sup. alveolar. + Middle sup. alveolar.
On the Face………………… Inf. palpebral. + Ext. nasal. + Sup. labial.
1.meningeal branch
- it supplies the dura mater of the middle cranial fossa.
2. Ganglionic branches
- 2 branches w connect pterygo-palatine ganglion e maxillary nerve.
3. Zygomatic nerve
- It enters the orbit through the inferior orbital fissure to run on the lateral wall of the orbit where it ends by
dividing into 2 branches….
- enters a canal in the zygomatic bone and appears in the temporal fossa to
1) Zygomatico-temporal supply the skin of the temple.
- enters a canal in the zygomatic bone and appears on the face to supply
2) Zygomatico-facial the skin of the prominence of the cheek.
Zygomatic n. sends a branch w communicates e lacrimal n. .This communication carries
parasympathetic postganglionic fibres from pterygo-palatine ganglion to lacrimal gland.
4. Posterior superior alveolar nerve:
- It runs downwards and forwards on the back of the maxilla to enter the alveolar canals.
- provide sensory innervations of bucal muco- periosteum , pulp , PDL & alveolar bone of max. molars
except MB root of 1st molar .
5. Middle superior alveolar nerve
- provide sensory innervations of….
 MB root of max 1st molar.
 buccal muco periosteum , pulp , PDL & supporting alveolar bone of max. premolars.
6. Anterior superior alveolar nerve
- it supplies max. anterior teeth.
- provide sensory innervations of….
 buccal muco periosteum , pulp , PDL & supporting alveolar bone of max. ant. Teeth.
7. Palpebral branch
- provide sensory innervations of lat. 1/2 of lower eye led.
8. lateral Nasal branch
- provide sensory innervations of lat. Part of nose.
9. sup. Labial branch.
- provide sensory onnervation of upper lip.
6. The Mandibular nerve = 3rd division of Trigeminal
 Origin
- originates by 2 roots ......
1. large sensory root arises from trigeminal ganglion.
2. small motor root  arises from pons , units with sensory root at foramen ovale.
 Course and relations
1. the 2 roots pass through the foramen ovale, and join each other just outside the foramen to form the trunk
of the nerve.
2. The trunk descends in the infratemporal fossa between the following structures ……
 tensor palati and otic ganglion (medially).  lateral pterygoid (laterally).

 The medial pterygoid (anteriorly).  middle meningeal artery (posteriorly).

 Branches
Branches from trunk (2 nerves 1 sensory & 1 motor)
1. nervous spinosus
 - It is a sensory branch which passes through the foramen spinosus to supply the dura mater of the
middle cranial fossa
2. N. to medial pterygoid
 - it supplies the medial pterygoid muscle.
 - it gives off a branch which traverses the otic ganglion without interruption to supply tensor palati and
tensor tympani.

Dr. Ahmed El_Nashar (2013)

Surgical Anatomy For Dental Students
Branches of ant division (all branches are motor except long buccal n.)
1. long buccal n. (sensory)
 - runs downward & forward. - supplies the Skin of the cheek.
2. N. to masseter (motor)
3. Deep temporal nerves (motor)
4. N. to lateral pterygoid. (motor)
Branches of post. Division ( all branches are sensory except mylohyoid n.)
1.auriculo- temporal nerve. (pure sensory )
 It arises by 2 roots that encircles the middle meningeal artery.
 It runs backwards deep to the neck of the mandible and enter the parotid gland.
 It then ascends behind the T.M.J. & crosses over the root of the zygomatic arch just in front of the tragus
of the ear.
 Has 3 types of fibers…
1. Sensory fibers
1. ext. auditaory meatus. 2. T.M.J. 3. Parotid gland
4. Skin of post. 1/2 of temporal region.
2. Post ganglionic para sympathetic fibers to parotid gland
3. Post ganglionic sympathetic fibers to parotid gland
2. lingual nerve. (pure sensory)
 It arises from the posterior division of the mandibular nerve just behind the lateral ptergoid muscle.
 It appear at the lower border of the lateral ptergoid muscle.
 Runs superficial to the medial petrgoid muscle where it joins the corda tympani nerve in an acute angle.
 Runs on the inner surface of the mandible close to the medial root of the mand. 3rd molar.
 Then, it runs on the lateral surface of hyoglossus muscle where, submandibular ganglion is suspended.
 At the anterior border of hyoglossus muscle it has a triple relation with the submandibular duct and run
medial to it till reach apex of the tongue.
 Contain 2 types of fibers….
1. fibers of lingual itself , carries general sensation to m.m. of ant 2/3 of tongue.
2. fibers of corda tympani, w caries ….
- taste sensation ant. 2/3 of tongue.
- preganglionic parasympathetic f. to submand. SG.
3. inferior alveolar nerve. (mixed n.)
 It arises from the posterior division of the mandibular nerve just behind the lateral ptergoid muscle.
 It appear at the lower border of the lateral ptergoid muscle.
 Runs superficial to the medial petrgoid muscle.
 Runs on the inner surface of the mandible.
 It runs in mandibular canal where it gives its terminal branches.
 Branches……..
1. Branches to bone , pulp , PDL related to mand.molars & premolars.
2. Mylohyoid nerve (motor)
- arises just above mand. foramen and run in the mylohyoid groove.
- It supplies mylohyoid ms. and anterior belly of digastric.
3. Mental branch
- emerges from mental foramen..
- it supplies buccal muco-periosteium related to mand. Ant. & premolars + labial mucsa + chin.
4. Incisive branch
- it supplies Pulp, PDL , supporting bone of mand. Ant. teeth.
Mandibular nerve supplies 8 muscles
4 ms of mastication + tensor palate + tensor tympani + mylohoid ms. + ant. belly of digastric

Dr. Ahmed El_Nashar (2013)

Surgical Anatomy For Dental Students
7. Nerve supply of the face
Sensory innervation of face Motor innervation of face
Trigeminal nerve. Great auricular nerve Facial nerve
1) sensory innervation of face
1. trigeminal nerve
supplies the skin of the most of the face, through its branches, as follows…..

Ophthalmic nerve Maxillary nerve Mandibular nerve

Supplies the Upper 1/3 of the face Supplies the Middle 1/3 of the face Supplies the Lower 1/3 of the face
forehead + upper eye lid + ant. part of side of nose cheek + lower eye lid + post. part of side of nose + upper lip. = temporal region + mandible + lower lip.
• Branches of ophth. in face (= Cutaneous B.) • Branches of max. in face = (Cutaneous B.) • Branches of mand. In face = (Cutaneous B.)
1. supra orbital (from frontal) 1. palpebral (from inf. Orbital) 1. mental
- medial 1/3 of upper eye lid & middle part of - lateral part of lower eye lid. - skin of lower lip & chin.
forehead. 2. nasal (from inf. Orbital) 2. buccal
2. supra trochlear (from frontal) - Posterior part of side of nose. - skin over buccinator ms.
- central 1/3 of upper eye lid &forehead. 3. labial (from inf. Orbital) 3. auriculo-temporal.
3. infra tochlear (from nasociliary) - Upper lip. - Post. 1/2 of temple.
- cartilaginous (= upper) part of nose & skin of lwer 4. zygomatico-temporal (from zygomatic)
1/2 of lower eye lid. - ant. 1/2 of the temple.
4. ext. nasal (from nasociliary) 5. zygomatico-faci al (from zygomatic)
- bony (= lower) part of nose. - skin on check peomienence.
5. palpebral ( from lacrimal)
- lateral 1/3 of upper eye lid.
2. Great auricular nerve
(discussed before in scalp)
2) motor innervation of face
Facial nerve
• Course and relations
1. it emerges from the skull through the stylo-mastoid foramen. 2. Runs forward on the lateral side of the base of the styloid process.
3. Enters parotid gland through its postero-medial surface. 4. divides into 5 terminal branches that emerges from its ant. Border.
• Branches
Branches in middle ear Branches as it comes out from skull Terminal branches = branches of facial n. in face
1. greater superficial petrosal 3. post. Auricular nerve. All are emerges from ant. Border of parotid
- leave middle ear through itd foramen - supplies occipitalis ms. 6. temporal n.
- caries preganglionic parasympathetic fibers to 4. muscular branch to post. Belly of digasrtic ms. - supllies frontalis + obricularis oculi ms.
sphenopalatine ganglion & lacrimal gland. 5. muscular branch to stylohyoid ms. 7. zygomatic n.
2. corda tympani nerve - supplies orbicularis oculi ms.
- leave middle era through squamotympanic fissure & 8. buccal n.
join lingual n. - supplies buccinator ms. + ms of both lips.
- carries taste fibers from ant. 2/3 of tongue & 9. mandibular n.
preganglionic parasympathetic fibers ro submand.
- supplies ms. Of lower lip.
Ganglion & gland.
10. cervical n.
3. nerve to stapidus ms.
- supplies platysma ms.

Dr. Ahmed El_Nashar (2013)

Surgical Anatomy For Dental Students
Buccinator ms.
- Upper fibers
alveolar process of max.
Origin
- Middle fibers
Pterygo-madibular raphe.
- Lower fibers
alveolar process of mand.
- Upper fibers  Upper lip
Insertion
- Middle fibers , decussate wh,.
- upper fibers  lower lip.
- lower fibers  upper lip.
- Lower fibers Lower lip
• Buccal branch of facial n.
N.S.
1. compresses cheek & lip
against the teeth  prevent
accumulation of food in the
Action
vestibule  food remains
under action of teeth.
2. help in blowing and
whistling.
Covered by ….
1. Bucaal salivary glands.
2. Buccal lympn node.
3. Buccal bad of fat.
4. Bucco-pharyngeal fascia.
5. Skin
Crossed by …..
Relations
1. Facial vessels.
2. Parotid duct.
3. Buccal branch of facial n.
Pierced by …..
- Parotid duct.
Masster muscle
- superficial head
lower border of ant. part
of zygomatic arch.
- Deep head
inner surface of post. Part
of zygomatic arch.
- Fibers inserted into….
Lat. surface of ramus of
mand.
• Masseteric of ant. division
of mand n.
- Whole ms.
Elevate () the mand.
- Deep head
Retract () the mand.
- superficial head
Protrude () the mand.
Superficial
= relations of ant border of
parotid g. (= 7 structure)
Deep
1. ramus of mandible and
coronoid process.
2. tendon of temporalis.
3. buccinator ms.
Muscles
1) Ms of Head
Temporalis muscle
Fan-like ms
1. floor of temporal fossa.
2. deep surface of temporal
fascia.
- Fibers inserted into….
1. ant. border and medial
surface of coronoid process.
2. ant. border of ramus of mand.
• Deep temporal of ant.
division of mand n.
- Whole ms.
Elevate () the mand.
- Post fibers
Retract () the mand.
Superficial
1. masseter ms.
2. Zygomatic arch
3. temporal fascia
4. superficial temporal ve.
5. temporal branch of facial n.
6. auriculo-temporal n.
7. zygomatico-temporal n.
Deep
1. temporal fossa.
2. lat. Ptergoid ms.
3. max. a.
4. Ptrygoid venous plexuses
5. deep temporal n. & a.
6. buccal n. & ve.
Lateral pterygoid ms.
- Upper head
infra-temporal surface of
grater wing of sphenoid.
- Lower head
lat. surface of lat.
pterygoid plate.
- Fibers inserted into….
1. articular disk.
2. pterygoid fovea.
3. neck of the mand.
• Branch of ant. division of
mand n..
Ms of both sides
1. acting together
 &  the mand.
2. acting alternatively
protrude the mand.
Ms of 1 side act alone
1. pull mand. to opposite side.
2.  &  the mand.
Superficial
1. ramus & coronoid processes
2. masseter & temporalis ms.
3. max. a.
4. pterygoid venous plexus.
Deep
1. medial pterygoid ms.
2. mand. n.
3. middle meningeal a.
4. spheno-mandibular ligament.
Along the upper border
Deep temporal n.+ masseteric n.
Along the lower border
Lingual n. + inf. Alveolar n.
Bn two heads = above lwer head
Buccal n. + max. a.
Dr. Ahmed El_Nashar (2013)
Medial pterygoid ms.
- superficial head
max. tuberosity.
- Deep head
deep surface of lat.
pterygoid plate.
- Fibers inserted into….
med. surface of angle of
mand.
• Branch of trunk of mand. n.
Ms of both sides
1. acting together
 &  the mand.
2. acting alternatively
protrude the mand.
Ms of 1 side act alone
1. pull mand. to opposite side.
2.  &  the mand.
Superficial
1. ramus of mandible.
2. lat. Pteygoid ms.
3. lingual & inf. Alveolar n.
4. spheno-mandibular ligamnet.
Deep
1. post. Belly of digastric ms.
3. stylo hyoid
pharyngeus
glossus
Surgical Anatomy For Dental Students
2) Ms of Neck
Sternomastoid ms. Mylohyoid ms. Digastric ms. Hyoglossus ms.
- Sternal head 1. Mylohyoid line - Ant. belly • Upper border of body & greater horn
Upper part ant. Surf. of manubrium on inner surf. of Digastric fossa.
Origin

of hyoid bone.
sterni mand. - Post. belly
- Clavicular head Medial surface of mastoid process.
Upper surf. medial 1/3 of clavicle.
- Fibers inserted into…. - Post. fibers  body of hyoid bone. - Fibers of 2 bellies inserted into…. - Fibers inserted into….
Insertion

1. Lat. Surf. of mastoid process.
2. Lat. part of sup. Nuchal line.
- motor fibers
Spinal part of accessory
N.S.
- Rest fibers  median raphe.
• N. to mylohyoid ms. (mand. nerve)
common tendon attached to junction Post. 1/5 of the side of the tongue.
bn body & greater horn of hyoid bone
by a sling of fascia.
- Ant. belly • Hypoglossal n.
N. to mylohyoid ms. (mand. nerve)

- properioceptive fibers - Post. belly

Ant. Rami of 2nd & 3rd cervical ns. Mascular branch from facial n.
Ms of both sides • Elevate the hyoid or Depress the - Ant. belly • Depress the tongue.
1. draw head forward on the thorax. mand. elevate hyoid bone (during
Action

2. elevate thorax during forced swallowing)

inspiration. - Post. belly
Ms of 1 side act alone depress the mand.
Bend head to shoulder of the same
side  rotate face to opposite side.
Superficial Superficial - Ant. belly Superficial
1. ‫الثوابت‬ 2. parotid gland. Roof & the contents of the submental  Superficial 1. stylohyoid ms.
3. great auricular n. 4. ext. jugular v. Deep ‫األربعة الثوابت‬ 2. lingual n.
5. tr. Cervical n. 1. hyoglossus ms. Deep 3. submandibular ganglion.
Deep 2. genio-hyoid ms. Mylohyoid ms.+ submental ve. 4. submandibular salivary gland& duct.
Muscles 3. genio-glossus ms. - Post. belly 5. post. belly of digastric ms.
1. Splenius capitis 2. levator scapula. 4. sublingual salivary gland. Superficial 6. stylohyoid ms.
3. scalenus medius. 4. scalenus ant. 5. submandibular salivary gland. 1. ‫الثوابت‬ 2. sterno mastoid ms. 7. hypoglossal n
Realations

5. post. Belly of digastric ms. 6. submandibular duct. 3. mastoid process 4. parotid gland Deep
6. infrahyoid ms. 7. lingual n. 5. angle of mand. 6. submand. S. G. 1. genioglossus ms.
Vessles 8. hypoglossal n. Deep 2. stylohyoid ligament.
1. common , int. & ext. carotid a. 9. 3rd part of lingual a. 1. internal jugular v. 3. middle constrictor ms.
2. int. & ant. Jugular v. 2. accessory n. (11th cr. n.) 4. sup. Constrictor ms.
3. supra scapular ve. 3. vagus n. (10th cr. n.) 5. 2nd part of lingual a.
4. transverse cervical ve. 4. hypoglossal n.( 12th cr n.)
Nerves 5. internal carotid a.
1. vagus n. 2. cervical plexus. 6. stylopharyngeus ms.
3. spinal part of accessory n. 7. external carotid a.
4. trunks of brachial plexus. 8. hyoglossus ms

Dr. Ahmed El_Nashar (2013)

 Surgical Anatomy For Dental Students

GANGLIONS
1. Spheno-palatine ganglion
parasympathetic ganglion + situated in pterygopalatine fossa + Hanging from maxillary & related functionally to facial n.
 Roots
1. Sympathetic root (passes eout relay)
Preganglionic f.  arises from lat. horn cells of 1st thoracic segment.
Relay in  superior cervical sympathetic ganglion.
 form plexus around Int. carotid a.
Post ganglionic f.  deep petrosal nerve arises from this plexus
 joins greater superficial petrosal n. to form vidian n.
2. Para-sympathetic root (relay in ganglion)
 arised from lacrimatory nucleus. ●Join facial nerve ( 7th cranial nerve).
Preganglionic f.  leave it as its geniculate ganglion. ●become greater superficial petrosal n.
 runs ein ptrygoid canal where , it joins the deep petrosal nerve to form vidian n.
Relay in  sphenopalatine ganglion
Post ganglionic f.  joins zygomatic nerve to reach to lacrimal gland.
3. Sensory root (passes eout relay)
 come from max. n. & passes eout relay.
 Branches
1. Orbital supplies the perosteium of the orbit.
2. Pharyngeal supplies mucous membrane of the naso pharynx.
3. greater palatine supplies m. m. of H. palate&palatal mucosa opposite to max. post. teeth.
4. Lesser palatine Supplies m. m. of soft palate.
5. long sphenopalatine supplies m. m. of nasal septum&palatal mucosa opposite max. ant. teeth.
6. short sphenopalatine Supplies m. m. of the lateral wall of the nose.
2. Otic ganglion
para-sympathetic ganglion , situated ein infratemporal fossa + deep to trunk of mand. Nerve.
 Roots
1. Sympathetic root (passes eout relay)
Preganglionic f.  Arises from lat. horn cells of 1st thoracic segment.
Relay in  superior cervical sympathetic ganglion.
Post ganglionic f.  form plexus around ext. carotid a. & its branches.
2. Para-sympathetic root (relay in ganglion)
 arises from the inf. salivatory nucleus. ● joins glossopharyngeal n. (9th cr. n.).
 leaves 9th cr. n. as its tympanic branch. ● joins tympanic plexus.
Preganglionic f.
 lesser superficial petrosal n. arises from tympanic plexus.
 leaves skull through f. ovale.
Relay  Otic ganglion
Post ganglionic f.  Reach gland by joining auriculo-temporal nerve.
3. motor root (passes eout relay)
 Nerve to medial pterygoid ms.
3. Submandibular ganglion
 Roots
1. Sympathetic root (passes eout relay)
Preganglionic f.  arises from lat. horn cells of 1st thoracic segment.
Relay in  superior cervical sympathetic ganglion.
Post ganglionic f.  Reach the gland as a plexus around the facial & lingual a.
2. Para-sympathetic root (relay in ganglion)
 arises from the sup. salivatory nucleus.  joins the facial n. (7th cr. n.).
Preganglionic f.
 leaves facial n as its corda tympani n. w joins lingual n. in infratemporal fossa.
Relay in  submandibular ganglion
Post ganglionic f.  Reach submandibular & sublingualr S.G. directely.
Dr. Ahmed El_Nashar (2013)
 Surgical Anatomy For Dental Students

VESSLES

1. Branches of External carotid artery

 Ext. ca. a. has 8 branches ….
(3)From Ant. aspect (2)From Post. aspect (1)From Medial aspect (2)Terminal branches
1. sup. Thyroid a. 4. occipital a. 6. ascending pharyngeal 7. maxillary a.
2. lingual a. 3. facial a. 5. post. Auricular a. 8. superficial temporal a.

2. Facial artery
 Course
- in the neck
 arises from the ext. ac. a. just above the tip of greater horn of hyoid bone.
 Runs upward deep to the post. Belly of digastric.
 Ascends upward grooving post. aspect of the submand s.g. where, it becomes deep to mand.
 It runs forward & downward between the mandible & the gland.
- in the face
 enters the face by curving around the base of mand at the antero-inferior angle of masseter ms.
 runs in a wavy manner till reach angle of the mouth.
 Runs upward in the naso-labial sulcus to end close to medial angle of the eye as the angular a.
 Branches
- in the neck
1. submental a. 2.glandullar branches 3.ascending palatine. 4. tonsillar a.
-in the face
1. inferior labial a 2. superior labial a 3.lateral nasal a. 4.angular a.
3. Lingual artery
 Course
1. arises from the ext. ac. a. just above the tip of greater horn of hyoid bone.
2. Runs Forward deep to the hyoglossus ms above the hyoid bone.
3. Then, it ascends along the ant. Border of the hyoglossus ms. to the tip of the tongue.
 Parts
- it divides into 3 parts, according to its relaion with the hyoglossus ms. , as follows…..
1st part 2nd part 3rd part = deep lingual a. = profunda a.
 Proximal to ms.  Deep to the ms.  Distal to the ms.
 Branches
1. supra hyoid a.  From 1st part, w runs along the upper border of the hyoid bone.
2. dorsal lingual a.  from the 2nd part, ascend to the dorsum of the tongue.
3. sublingual a.  from 3rd part, ascend upward & forward on genioglossus ms to supplysublingual S.G.
4. Superficial temporal artery
 Course
- the smallest terminal branch of ext. carotid artery. - begins in parotid bhind the neck of mand.
- Ascend upward crossing root of zygoma , infront of auricle
- Ends above zygomatic arch by about 2 inchs, by giving its ant. & post. Terminal branches.
 Branches &
1) transverse facial artery . 2) middle temporal artery. 3) ant. & post. Terminal branches.
Dr. Ahmed El_Nashar (2013)
 Surgical Anatomy For Dental Students
6. Venous drainage of Face
1. anterior facial vein
- formed at the medial angle of the eye by the union of supra trochlear and supra orbital veins.
- descends downward and backward behind the facial a.
- ends by joining the ant. division of the post. facial vein to from the common facial v. which drains
into the internal jugular v.
- connection :
- connects with the cavernous sinus by 2 routes .....
1) sup. Ophthalmic v. through superior orbital fissure.
2) Deep facial vein, that connects it with pterygoid venous plexus, from which an emissary
vein passes to cavernous sinus through foramen ovale
2. posterior facial vein
- formed by union superficial temporal v. with maxillary v. within the parotid gland.
- at the lower end of the gland it divides into….
1. Ant. division that unites with the ant. facial vein to form Common facial v. which
drains into the internal jugular v.
2. Post. Division unites with the post. auricular v. to from the external jugular v.
3. occipital vein
- drains the occipital venous plexus.
- communicates with …….
1) suboccipital venous plexus. 2) dural venous sinuses.
- ends into vertebral & deep cervical nerves.
7. ptrygoid venous plexus
Site  around the lateral pterygoid ms.
Tributaries  correspond to branches 2nd & 3rd parts of max. a.
Drainage  drains into maxillary vein.
1. inf. Ophthalmic vein  through the inferior orbital fissure.
Communications 2. ant. facial vein  by the deep facial vein.
3. Cavernous sinus  by an emissary vein that passes throught the foramen ovale.

8. Lingual veins
1. dorsal lingual veins  Drains into the lingual v.
2. lingual veins  Drains into the int. jugular v.
3. sublingual veins  Drains sublingual s.g. & join deep lingual veins.
4. deep lingual veins  Runs on under surface of tongue where it join sublingual v.
 Formed by union of deep lingual e sublingual veins.
5. vena comitans of hypoglossal n.
 Drains into facial vein or internal jugular vein.
9.External jugular vein
 Origin & course
- begins by the union of post. Division of post. Facial v. & post. Auricular v.
- it descends obliquely crosses the sterno-mastoid ms.
- about 1 inch above the middle of the clavicle it pierces the deep fascia
- end in the sub-clavian vein.
 Tributaries
1) post. auricular vein. 2) post. Division of post. Facial v. 3) post. Ext. jugular v.
4) Transverse cervical vein. 5) supra scapular vein. 6) anterior jugular vein.

Dr. Ahmed El_Nashar (2013)

 Surgical Anatomy For Dental Students

GLANDS
1. Parotid gland
 Relations of the gland.
1. Relations of superior concave base
1. Zygomatic arch. 2. Ext. auditory meatus. 3. auriculo-temporal n. 4. superficial temporal ve.
2. Relations of inferior apex
1. post. belly of digastric. 2. cervical branch of facial n. 3. ant. & post. divisions of post. facial v.
3. Relations of anterior border " from above downwards"
1. temporal branch of facial n. 2. zygomatic branch of facial. 3. tr. Facial a.
4. accessory lobe. 5. parotid duct. 6. buccal branch of facial n.
7. mandibular branch of facial n
4. Relations of medial border
1. styloid apparatus ( = styloid process + 3 ms. + 2 ligament).
2. carotid sheath & its contents (internal carotid a. + internal jugular v. + vagus n.)
Styloid process separates the medial border of the gland from the carotid sheath
5. Relations of surfaces of the gland
Antero-medial surface Postero-medial surface Lateral surface
- Bone sandwiched bn 2 ms. - Bone sandwiched bn 2 ms. 1. skin. 2. superficial fascia.
1. masseter ms. (lateral). 1. sterno-mastoid ms. (lateral) 3. deep fascia. 4. platysma ms.
2. ramus of mandible. 2. mastoid process. 5. great auricular n.
3. medial pterygoid ms.(medial) 3. post. belly of digastric ms. (med.) 6. superficial parotid L.N.

 structures within the gland "from superficial to deep"

1. deep parotid lymph nodes.
2. facial nerve.
- It enters the postero-medial surface of the gland , where it divides into 5 terminal branches
that emerges out from the ant. border of the gland.
3. posterior facial vein.
- formed within the gland by the union of superficial temporal and maxillary veins.
- it divides within the gland into ……
a) ant. division  unites with ant, facial v. to from common facial v.
b) post. division  unites with post. auricular to from ext. jugular v.
4. External carotid artery.
- it divides within the gland into … …superficial temporal a. & maxillary a.
 parotid duct
- about 5 cm long.
- appears at ant. border of gland at level of lobule of ear.
- lies bn 2 branches of facial n…..a) Zygomatic branch. b) Buccal branch.
- open in a small papilla in the buccal vestibule opposite maxillary 2nd molar (upper 7.
- It pierces the following structures to open in mouth….. " from superficial to deep"
1. Buccal pad of fat. 2. Buccopharyngeal fascia
3. Buccinator muscle 4. Buccal mucous membrane.
 Nerve supply of the gland
1. Sympathetic fibers = sympathetic root of otic ganglion.
2. Parasympathetic fibers (Secreto-motor fibers) = parasympathetic root of otic ganglion.
3. Sensory fibers a) auriculo-temporal nerve. b) great auricular nerve.
 parotid capsule (sheath or fascia).
- Derived from the investing layer of the deep cervical fascia which splits into 2 layers……
Superficial layer Deep layer
 thick, covers lateral surface of the gland  Thin, Covers medial surfaces of the gland
 Attachment :  Attachment :
1. Zygomatic arch 1. Tympanic plate. 2. Styloid process.
2. Ext. auditory meatus 3. Angle of the mandible.

Stylomandibular ligament = thickned part of deep layer of parotid capsule that

extended from tip of styloid process to angle of mand.
Dr. Ahmed El_Nashar (2013)
 Surgical Anatomy For Dental Students
2. Submandibular salivary gland
consists of 2 parts continuous around post. free border of mylohyoid ms.
 Superficial part
- lies in the digastric .
- wedge in shape has 3 surfaces , as folloiws …..
Medial
Inferior Lateral
Ant. part Post. part
Under the skin In contact e the mand. In contact e mylohyoid ms. In contact e hyoglossus ms.
1. ‫اﻷرﺑﻌﺔ اﻟﺜﻮاﺑﺖ‬ Separated from the mylohyoid Separated from the hyoglossus
1. sub-mand fossa.
2. ant. Facial v. ms by… ms by…
2. facial a.
3. cervical branch of 1. submental a. 1. lingual n.
3. med. Pterygoid ms.
facial n. 2. n.to mylohyoid. 2. hypoglossal n.
 Deep part
- Relations…
Medially Hyoglossus ms.
Laterally 1. mylohyoid ms. 2. superficial part of the gland.
Superiorly lingual n.
Inferiorly Hypoglossal n.
Anteriorly 1. Submandibular duct. 2. sublingual gland
Posteriorly 1. post. Belly of digastric. 2. stylohyoid ms.
 Sub-mandibular duct
 About 5 cm long.
 Runs forward on hyoglossus & genioglossus ms. To open on the floor of the mouth on the summit of the
sublingual papilla at the sides of the lingual frenum.
 It hasa triple relation with the lingual n. at the ant.border of the hyoglossus ms. Where, thelingual n. passes …..
Laterally  inferiorly  mediallly
 Nerve supply
1. Sympathetic fibers = sympathetic root of submandibular ganglion.
2. Parasympathetic fibers (Secreto-motor fibers) = parasympathetic roots of submandibular ganglion
3. Sensory fibers
- lingual nerve.
 The capsule of the gland.
- the gland as a whole is surrounding by a capsule of a C.T. [ true capsule].
- while, the superficial part is surrounding by a fibrous capsule [false capsule] derived from the investing layer
of deep cervical fascia.
- this fibrous capsule consists of 2 layers, as follows….
Superficial layer Deep layer
- Cover the inferior surface - Cover the lateral surface.
- Attached to …. - Attached to …….
Inf. hyoid bone. Inf.  hyoid bone.
Sup.  base of the mand. Sup.  mylohyoid line.

3. Thyroid gland
 .Arterial supply
1. sup. Thyroid a. , from ext. ca. a.
2. inf. Thyroid a. , from thyrocervical trunk from 1st part of subclavian.
3. thyroida ima ertery , from arch of aorta "if present"
 Venous drainage
1. sup thyroid v.  drains into int. jugular v.
2. middle thyroid v  drains into int. jugular v.
3. inf. Thyroid v.  drains into lt. innominate v.
 Lymphatic drainage
- Thyroid gland drains into …
1. deep cervical lymph node. 2. pre-laryngeal lymph node.
3. pre-tracheal lymph node. 4. paratracheal lymph node.
Dr. Ahmed El_Nashar (2013)
 Surgical Anatomy For Dental Students

COLLECTION
1. Mouth cavity
 Sensory innervations of mouth
Roof Greater palatine + nasoplatine
Floor Lingual n. + corda tympani n.
cheek Buccal nerve of mandibular.
 Sublingual region
1. lingual frenum
2. sublingual papilla , on each side of the frenum , receives the opening of sub-mandibular duct.
3. sublingual fold , elevation produced by sublingual salivary gland , receives opening of sublingual ducts.
2. Nasal cavity
 Boundaries
Roof - Body of sphenoid  cribriform plate of ethoid  frontal bone  nasal bone
Floor - Palate = palatine process of max. bone + horizontal plate of platine bone
Med. wall Septal cartilage (ant.) Vomer (post.) Vertical plate of ethmoid.(sup.)
 spheno-ethmoidal recess = depression above & post. To sup conchae
 sup. Conchea.
 sup. Meatus.
 middle conchae.
Lat. wall  middle meatus.
1. bulla ethmoidalis rounded emeinnce produced by middle ethoidal air sinus.
2. hiatus semilunaris curved ceft present ant. & below to bulla ethmoidalis
3. infundibulum funnel shaped channel at the ant. End of hiatus semilunaris
 Inf. Chonchae.
 Inf. Meatus.
 opening of paranasal sinuses
Paranasal sinuses open in Sup. Meatus 1. Post. Ethmoidal.
2. Middle ethmoidal  open in bulla ethmoidalis
3. Ant. Ethmoidal  open in hiatus semilunaris infron of bulla
Paranasal sinuses open in Middle meatus
4. Maxillary  open in hiatus semilunaris below the bulla
5. Frontal  open in infundibulum.
Paranasal sinuses open in Inf. Meatus 6. Nasolacrimal duct
Little's area = most common site of bleeding of nose
At ant. Inf. Angle of nasal septum & formed by anastomosing bn the following 4 arteries ……
1) ant. Ethmoidal a. 2) septal branch of sup. Labial a. of facial a.
3) sphenopalatine a. 4) greater palatine a.

3. Larynx
 Cartilages of the larynx (= skeleton of larynx)
1. Thyroid cartilage . 2. cricoid cartilage. 3. artynoid cartilage.
4. coniculate cartilage. 5. cuniform cartilage. 6. epiglottis.
 Nerve supply
Sensory innervations
Motor innervations
Above vocal cord Below vocal cords
All ms supplied by recurrent laryngeal except cricothyroid Int. laryngeal n. Recurrent laryngeal
supplied by ext. laryngeal n.
 Blood supply
- branch of sup. Thyroid a. w is branch of ext. ca. a.
1. sup laryngeal a.
- enter larynx through thyrohoid membrane.
- branch of inf. Thyroid a. w is branch of thyrocervical trunk.
2. inf. Laryngeal a.
- enter larynx by ascending deep to lower biorder of inf. Constrictor.
Dr. Ahmed El_Nashar (2013)
 Surgical Anatomy For Dental Students
7. Tempro-mandibular joint
Synovial joint of condyloid variety
 ligaments
Lat. tempro-mand. Lig. Spheno-mand. Lig. Stylo-mand. Lig.
Site Lat. aspect of T.M.J Med. aspect of T.M.J Behind and med. to T.M.J
Attac

Above Tubercle at root of zygoma Spine of sphenoid bone Tip of styloid process
h

below Neck of mand. Lingual Angle of mand.

 movements
MOVEMENT Ms. Produce the movement
1. lateral pterygoid ms. 2. geniohyoid ms.
1. Depression 3. mylohoid ms. 4. digastric ms.
2. Elevation 1. med. pterygoid ms . 2. masseter ms. 3. temporalis ms.
3. Protrusion 1. med. pterygoid ms. 2. lat. ptergoid ms. 3. Superficial head of masseter
4. Retraction 1. deep head of masster. 2. post. Fibers of temporalis.
5. Side –to-side 1. med. pterygoid ms. 2. lat. ptergoid ms.
 nerve supply
1) auriculo-temporal n. 2) masseteric n.
 arterial supply
1)superficial temporal a. 2) maxillary a.
 relations
Anteriorly 1. insertion of lat. pterygoid. 2. mandibular notch. 3.masseteric n. & a.
Posteriorly 1. parotid gland. 2. auriculo-temporal n. 3. tympanic plate.
medially 1. max. A. & v. 2. auriculo-temporal n.

8. styloid apparatus = structures attached to styloid process.

3 muscles 2 ligament
Stylohoid ms + styloglossus ms. + stylopharyngeous ms. Stylohoid lig. + stylomandibular lig.

9.Infra hyoid – supra hyoid ms.

Supra hyoid ms. Digastric + Geniohyoid + Stylohyoid + Mylohyoid
Infra hyoid ms. sternothyroid + sternohyoid + thyrohyoid + omohyoid.

Dr. Ahmed El_Nashar (2013)

Surgical Anatomy For Dental Students
4. The Tongue
Covering mucous membrane Striated muscular mass

Upper surface Lower surface Extrinisc Intrinsic

Ant. 2/3 Post. 2/3 Hyoglossus Genioglossus Styloglossus Palatoglossus

Show 3 types of - devoid of - smooth. Upper border & Sup. genial Tip of styloid Palatine Longitudinal ,

origin
papillae…. papillae. - show the following… greater horn of tubercle. process. aponeurosis transverse &
1) vallate - irregular due to 1) lingual frenulum hyoid bone. vertical fibers.
- 10- 12 in no. presence of connect this surface to Post. 1/5 of the Whole length of Whole length of Side of the
- arranged in a lingual tonsils. the floor of the mouth. side of the the under surface the side of the tongue.

n.s Ins.
raw infront of 2) deep lingual v. tongue. of the tongue tongue.
sulcus terminalis under the m. m.on each Hypoglossal n. Hypoglossal n. Hypoglossal n. Pharyngeal Hypoglossal n.
- have taste buds side of the frenulum. plexus.
2) fungiform 3) plica fimbriata Depress the pull the tongue Draws the tongue Pulls the root of Change the
- on sides & fringed fold of m. m. tongue. forward . upwards & tongue upwards. shape of the
apex of tongue. lateral to the vein. backwards. tongue.

action
3) filliform
- scattered on
rest of dorsal
(upper) surface.

N.B Mucous membrane divided into ant.(2/3) & post. (1/3) by a V-shaped groove (sulcus terminalis)its apex directed posteriorly & show a blind pit called (foramen cecum).

• Ne rve supply
Motor Innervations Sensory Innervations
Ant. 2/3 Post. 1/3 Root of tongue
All intrinsic & extrinsic ms. are supplied by hypoglossal n. 1) lingual n. (general). Glossopharyngeal n Internal laryngeal n.
Except palatoglossus ms. Is supplied by cranial root of accessory n. 2) corda tympani n. (taste). (general & taste) (branch of vagus)
• Arterial supply
1) Lingual a. 2) Ascending pharyngeal a. 3) Tonsillar branch of facial a.
• Ve nous drainage
1) Deep lingual vein , lies superficial to hyoglossus ms. & accompany the hypoglossal n.
2) Dorsal lingual veins , lies deep to the hyoglossus ms & accompany lingual a.
• Lymphatic drainage
Tip Submental L.N.
Ant. 2/3
sides Submand. L.N.
Post. 1/3 Deep cervical L.N.
Dr. Ahmed El_Nashar (2013)
Surgical Anatomy For Dental Students
5. The palate

Hard palate Soft palate

- formed by - Attached to the post. Border of the hard palate
1) palatine process of max. - Its free border showwhat is known as “uvula”
2) horizontal plate of palatine bone. - From uvula 2 mucosal folds extending laterally & down ward…..
- Surfaces 1) palatoglossal arch (ant.) 2) palatopharyngeal arch (post.)
1) sup. Surface - formed of ……..
- toward the nasal cavity. 1. Palatine muscles 2. Palatine apoeurosis
- covered by ciliated columnar palatopharynge Musculus 1) fibrous sheath.
epith. Tensor palati Levator palati palatoglossus
us uvulae 2) attached to post.
2) inf. Surface 1) scaphoid Lower surface Palatine Palatine Post. Border of Border of hard
- toward the oral cavity fossa of the petrous aponeurosis aponeurosis hard palate palate.
- covered by st. sq. epith. 2) spine of bone. 3) receives the
sphenoid insertion of palatine
1)Palatine Palatine Side of the Post. Border of m. m. of uvula. ms.
aponeurosis. aponeurosis. tongue. thyroid cartilage
2) palatine crest.
n. to med. Pharyngeal plexus
pterygoid
Tighten the soft Elevates the soft Pulls the root of Elevates the Elevates the
palate. palate. tongue upwards. wall of the uvula.
pharynx.
• Ne rve supply
Motor Sensory
All intrinsic & extrinsic ms. are supplied by pharyngeal plexus Except 1) glossopharyngeal n. (9th cr. n.) 2) lesser palatine n.
tensor palati ms. supplied by mandibular n. 3) greater palatine n. 4) sphenopalatine n.
• Arterial supply
1) ascending palatine a. 2) Ascending pharyngeal a. 3) lesser, greater, spheno palatine arteries.
• Ve nous drainage
1) pharyngeal venous plexus. 2) ptrygoid venous plexus.
• Lymphatic drainage
1) Deep cervical lymph node. 2) Retropharyngeal lymph node.

Dr. Ahmed El_Nashar (2013)

Surgical Anatomy For Dental Students
6. Pharynx
• Walls = layers of pharynx ( From within outwards)
1. pharyngeal mucosa (mucous coat) lined e st. sq. epith. 2. inner fibrous coat (pharyngo-basilar fascia)
3. muscular coat, consists of 2 layers (outer constrictor & inner longitudinal ) 4. outer fibrous coat ( bucco pharyngeal fascia).
• N.B . longitudinal muscles of pharynx  1) palatopharyngeus ms. 2) stylopharyngeus ms. 3) salpingopharyngeus ms.
• Interior of the pharynx
Naso-pharynx Oro-pharynx laryngopharynx
Position • Lies behind the nasal cavity • Lies behind the oral cavity • Lies behind the larynx
From • Base of the skull • Soft palate • Upper border of epiglottis
to • Soft palate • Upper border of epiglottis • Level of 6th C.V.
• Post. Nasal opening - Upper part 1. inlet of the larynx.
- communicates with the oral cavity through the - bounded by aryepiglottic fold.
Ant. oropharyngeal ismuth. 2. pyriform fossa
- Lower part - on each side of the inlet.
- post. 1/3 of the tongue. 3. post. Surface of arytenoids & cricoid cartilages.
Sup.
(roof & post. Wall together) • Communicate with the nasopharynx through the • Communicate with the oropharynx at the upper
1. basilar part of occipital bone. pharyngeal ismuth. border of epiglottis.
2. ant. Arch of atlas(1st C.V.)
Boundaries

Post. 3. nasopharyngeal tonsils (adenoids). • 2nd ,3rd C.V. • 4th ,5th,6th C.V.

Inf. • Communicate with the oropharynx through the • Communicate with the laryngopharynx at the • Communicate with the esophagus at the level of
pharyngeal ismuth. upper border of epiglottis. 6th C.V. (cricoid cartilage)
1. opening of auditory tube 1. palatoglossal arch.
2. tubal elevation 2. palatopharyngeal arch.
- on the sup.&post. Margins of the opening. 3. tonsillar sinus (fossa)
3. salpingo-pharyngeal fold - between the 2 arches.
Lat. - vertical fold of mucous membrane which runs 4. palatine tonsils.
downward from the tubal elevation. - in the tonsillar sinus.
4. pharyngeal recess
- depression behind the tubal elevation.
• Ne rve supply
Sensory innervations
Motor innervations
nasopharynx oropharynx Laryngopharynx
All ms. Are supplied by pharyngeal plexus. Except stylopharyngeus ms. supplied by Pharyngeal branch of Glossopharyngeal n. 1. recurrent laryngeal n.
glossopharyngeal n. sphenopalatine ganglion. 2. internal laryngeal n.
• Arterial supply
Ext. ca. a. facial Maxillary Lingual
1.Ascending pharyngeal 2. Ascending platine 3. tonsillar branch 4. artery of pterygoid canal 5. pharyngeal branch 6. greater palatine 7. Dorsal lingual branch
• Ve nous drainage " pharyngeal venous plexus. "
• Lymphatic drainage 1) Deep cervical lymph node. 2) Retropharyngeal lymph node.
Dr. Ahmed El_Nashar (2013)