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GOOD MORNING

Osteology of
Facial bones
contents
• Introduction
• Maxilla
• Mandible
• Lacrimal bone
• Vomer
• Nasal
• Inferior nasal conchae
• Palatine bone
• Zygomatic bone
 Osteology: The study of the skeletal system.
 Bone is a specialized tissue of mesodermal origin
 Bone formation – endochondral and
intra - membranous
• The human skeleton is divided into ------

a) Axial skeleton consisting of bones of the head ,neck


and trunk
b) Appendicular skeleton consisting of bones of the
limbs

.
• The skull consists of 22 bones
A) Calvaria or braincase consists of 8 bones
B) Facial skeleton is composed of 14 bones
Paired unpaired
1) maxilla 1) mandible
2) zygomatic 2) vomer
3) nasal
4) lacrimal
5) palatine
6) inferior nasal concha
Anterior Aspect of Facial Bones
Maxilla

2 Zygomatic bones

2 Lacrimal bones

2 Nasal bones

2 Inferior nasal conchae

2 Palatine bones (not visualized

1 vomer

1 mandible
• The facial skeleton serves to house and protect the

sense organs of smell, sight, and taste; and provide a

frame on which the soft tissues of the face can act to

facilitate eating, facial expression, breathing, and

speech.
MAXILAE
Ossification

• The maxilla is intramembranely ossified.

• Two centers
one in maxilla proper and
second for the premaxilla
• It is the second largest bone of the face.

Assists in forming
• The boundaries of three cavities--roof of the mouth,
the floor and lateral wall of the nose and the floor of
the orbit
• Two fossa – infratemporal and pterygopalatine
• Two fissures -- inferiororbital and pterygomaxillary
Components
Each half of the fused maxilla consists of:
• The body of the maxilla
• Four processes
 The zygomatic process
 The frontal process of maxilla
 The alveolar process
 The palatine process
• Infraorbital foramen
The Body

• Pyramidal in shape -- large cavity -- maxillary sinus

(antrum of Highmore)

• It has four surfaces—


1. anterior or facial ,
2. posterior or infratemporal ,
3. superior or orbital , and
4. medial or nasal.
Anterior surface

• Directed forward and


laterally
• lower part -- series of
eminences corresponding
to the positions of the
roots of the teeth.
• Above incisor teeth is a depression, the incisive
fossa--- origin to the depressor alae nasi

-- to the alveolar
border below the fossa is
attached a slip of the orbicularis
oris
-- above and a little
lateral to it, the nasalis arises
• Lateral to incisive fossa
-- depression, the canine
fossa, and is separated
from it by a vertical ridge,
the canine eminence,
--origin to the Caninus
• Above canine fossa --
infraorbital foramen,
the end of the
infraorbital canal --
infraorbital vessels and
nerve
• Above the foramen is
the margin of the orbit,
which affords
attachment to part of
.
the Quadratus labii
superioris.
• Medially -- limited by a deep

concavity, the nasal notch,


the margin --Dilatator naris
posterior
• Ends below in a pointed
process, when joined with its
opposite side forms the anterior
nasal spine
• The deepest point in the
midline between anterior nasal
spine and alveolar crest b/w two
centrals
-- POINT A OR SUBSPINALE
posterior surface
• Convex, directed backward and laterally
• Forms anterior wall of infratemporal fossa

• It is separated from the


anterior surface by the
zygomatic process and by a
strong ridge, extending
upward from the socket of
first molar tooth.
• It is pierced about its
center by the apertures of
the alveolar canals, which
transmit the posterior
superior alveolar vessels
and nerves
• lower part -- rounded eminence -- maxillary tuberosity
-- prominent after the growth of the wisdom tooth

• It is rough on its lateral side for

articulation with the pyramidal


process of the palatine bone and
in some cases articulates with the
lateral pterygoid plate of the
sphenoid
•Forms the anterior
boundary of the
pterygopalatine fossa,
and presents a groove,
for the maxillary nerve
superior surface

• smooth and triangular, and forms the greater


part of the floor of the orbit.
• The lowest point on the inferior bony margin
of orbit -- ORBITALE
• Bounded medially by an irregular margin which in
front presents -- the lacrimal notch

• Behind this notch the margin

articulates with the lacrimal,


the lamina papyracea of the
ethmoid and the orbital
process of the palatine.
• continuous --
medially with the frontal process,
laterally -- zyogmatic process
• Near the middle of the
posterior part of the
orbital surface --
infraorbital groove --
infraorbital vessels and
nerve passing forward,
ends in a canal, which
subdivides into two
branches
• One -- anterior
superior alveolar vessels
and nerve to the front
teeth of the maxilla.

• second -- middle
alveolar nerve to the
premolar teeth
MEDIAL SURFACE

• Presents a large,
irregular opening
leading into the
maxillary sinus.

.
• At the upper border
of this aperture are
some broken air cells,
which, in the
articulated skull, are
closed in by the
ethmoid and lacrimal
bones.
• Below the aperture is a smooth concavity which forms
part of the inferior meatus of the nasal cavity, and
behind it is a rough surface for articulation with the
perpendicular part of the palatine bone
• Near the middle of
the posterior border -
--running obliquely
downward and
forward the
pterygopalatine canal
• In front of the opening of the
sinus is a deep groove, the
lacrimal groove, which is
converted into the nasolacrimal
canal, by the lacrimal bone and
inferior nasal concha; this canal
opens into the inferior meatus of
the nose and transmits the
nasolacrimal duct
Maxillary Sinus or Antrum of Highmore
• sinus opens into the middle meatus of the nose
roof -- floor of the orbit,and is traversed by
the infraorbital canal.
floor -- alveolar process of the maxilla

• On the posterior wall are the alveolar canals,


transmitting the posterior superior alveolar vessels
and nerves to the molar teeth.
• Projecting into the floor of the antrum are several
conical processes, corresponding to the roots of the
first and second molar teeth; 38 in some cases the floor
is perforated by the fangs of the teeth.
Zygomatic Process

• A rough triangular
eminence, situated at the
angle of separation of the
anterior, zygomatic, and
orbital surfaces.
•In front it forms part of the
anterior surface

• Behind, it is concave, and


forms part of the
infratemporal fossa

•Above, it is rough and


serrated for articulation with
the zygomatic bone
Frontal Process

• The upper border articulates with the frontal bone


and the anterior with the nasal
• Its lateral surface is
smooth, continuous with
the anterior surface of the
body, and gives
attachment to the
Quadratus labii superioris,
the Orbicularis oculi, and
the medial palpebral
ligament.
Palatine Process

• It forms a considerable

part of the floor of the nose

and the roof of the mouth

and is much thicker in front

than behind.
• Forms the anterior three-
fourths of the hard plate with
the palatine process of the
opposite bone.

• The posterior border is


serrated for articulation with
the horizontal part of the
palatine bone
• Occasionally two
additional canals are
present in the middle line --
- foramina of scarpa, and
when present transmit the
nasopalatine nerves
• When the two maxilla
are articulated, a funnel-
shaped opening, the
incisive foramen -- behind
the incisor teeth --

Nasopalatine nerve
Alveolar Process

• Excavated into deep cavities for the reception of the


teeth
• The Buccinator arises from the outer surface of this
process, as far forward as the first molar tooth.
• When the maxilla are articulated with each other,
their alveolar processes together form the alveolar
arch.
• The lowest and most anterior point on the
alveolar bone in the midline between the centarals
-- PROSTHION OR SUPRADENTALE
Articulations

• The maxilla articulates with nine bones:

 Two of the cranium --- frontal and ethmoid


 Seven of the face --- nasal, zygomatic, lacrimal
Inferior nasal concha,
palatine, vomer,
.

and with the opposite side.


Changes Produced in the Maxilla by Age

• At birth the transverse and antero-posterior


diameters of the bone are each greater than the
vertical.
• The frontal process is well-marked and the body
of the bone consists of little more than the alveolar
process, the teeth sockets reaching almost to the
floor of the orbit.
• Adult -- vertical diameter is the greatest, owing to
the development of the alveolar process and the
increase in size of the sinus.

• In old age the bone reverts in some measure to the


infantile condition; its height is diminished, and after
the loss of the teeth the alveolar process is absorbed
Clinical applications

• Transverse maxillary deficiency -- narrow palatal vault


– corrected by opening the suture -- which widens roof
of mouth ,floor of nose

 Removable or fixed palatal expanders


• In cases of maxillary excessive growth -- orthopaedic
appliance headgear
• Center of resistance
 for maxilla -- posterosuperior aspect of
zygomaticomaxillary suture
 for dentition –
Tanne and Hiroto -- between roots of premolars
• Staggers et al -- at the level of the zygomatic buttress
• Miki -- between the first and second premolars in the
postero-anterior direction and between the orbit and the
distal root apex of first molars vertically
• Hata et al -- resistance of the maxilla is located 5 mm
above the nasal floor
• To produce no tipping of the molar, force should be
thruogh the trifurcation
• Forces passing via center of resistance causes
translation of maxilla in distal direction
 Above or below - rotation

• When anterior protraction force is required --


protraction headgear is used
• To study the growth – implants are placed
 Hard palate behind the deciduos canines(prior to
eruption of maxillary permenant incisors)
 Below anterior nasal spine (after max incisors eruption)
 Zygomatic process of maxilla
 Junction—hardpalate and alveolar process medial to 1st
Molar
For correction of dentofacial deformaties

1) Segmental osteotomy
 single tooth dentoosseous osteotomy
 anterior maxillary osteotomy – bimaxillary
protrusion
 posterior maxillary osteotomy—cross bite
,reposition supra erupted posteriors , close posterior open
bite by placing it inferiorly
2) Total maxillary surgery – lefort 1 osteotomy

• Repositioning of entire dentoalveolar segment of


maxilla superiorly , inferiorly ,and posteriorly with
simulteneous wideninig ,narrowing , and improving
arch symmetry
Sites for implant placement
MANDIBLE
Ossification

• Develops from the 1st pharyngeal arch

• Ossified in the fibrous membrane covering the outer


surfaces of Meckel’s cartilages.

• Each half of the bone is formed from a single center


--near the mental foramen -- sixth week of fetal life.
• At birth the bone consists of two parts, united by a
fibrous symphysis, in which ossification takes place
during the first year.

• Endochondrial bone formation -- 3 regions –condylar,


coronoid process and mental region

• Largest and strongest bone of the face.


• Parts:
1. Horse-shoe shaped body which lodges the teeth
2. Pair of rami which provide attachment to muscles.
Body

• The body is curved -- horseshoe


two surfaces
two borders.
surfaces

1) external surface

• Marked in the median line by a faint ridge,


indicating the symphysis or line

of junction of the two pieces


which the bone is composed at
an early period of life.
• This ridge divides below
and encloses a triangular
eminence, the mental
protuberance, the base of
which is depressed in the
center but raised on either
side to form the mental
tubercle.
• The deepest point in the midline between the
alveolar crest of mandible and the mental process
-- POINT B OR SUPRAMENTALE

• Most anterior point on the


bony chin -- POGONION
• Most inferior midline point
– MENTON
• Anterio inferior point on
symphysis -- GNATHION
•On either side of the symphysis, just below the incisor
teeth, is a depression, the incisive fossa, which gives
origin to the
Mentalis and a small
portion of the
Orbicularis oris
• Below the second premolar -- mental foramen --
mental vessels and nerve.

• Running backward and upward from


each mental tubercle is a faint ridge, the
oblique line -- continuous with the
anterior border of the R it affords
attachment to the Quadratus labii
inferioris and Triangularis; the
Platysma is attached below it.
Internal surface

• concave from side to side


• Near the lower part of the
symphysis are a pair of
mental spines -- origin to
the Genioglossi
• Immediately below --
second pair of spines --
origin of the Geniohyoidus
• Below the mental
spines, on either side
of the middle line, is
an oval depression for
the attachment of the
anterior belly of the
. Digastricus.
• Extending upward and backward from the lower part
of the symphysis -- mylohyoid line -- origin to the
Mylohyoidus
•Above the mylohyoid
line -- sublingual gland

• below --oval fossa --


submaxillary gland.
Borders

1) superior or alveolar border

• Wider behind than in front, is hollowed into cavities,

for the reception of the teeth – sixteen -- vary in depth


and size according to the teeth which they contain

• To the outer lip of the superior border, on either side,


the Buccinator is attached as far forward as the first
molar tooth
• The highest and most
anterior point on the
alveolar bone in the
midline between the
mandibular centrals --
INRADENTALE
Inferior border
• Rounded, longer than the superior, and thicker in
front than behind; at the point where it joins the lower
border of the ramus a shallow groove; for the external
maxillary artery, may be present.

• Junction of the ramal and


the mandibular plane --
GONION
Ramus

• Quadrilateral in shape
• Two surfaces,
• Four borders, and
• Two processes.
Surfaces

lateral surface

• Flat and marked by oblique


ridges at its lower part; it
gives attachment throughout
nearly the whole of its extent
to the masseter.
Medial surface

• Presents about its center


the oblique mandibular
foramen, for the entrance
of the inferior alveolar
vessels and nerve.
• Foramen -- presents in front a prominent ridge,
surounded by a sharp spine, the lingula mandibule --
attachment to the sphenomandibular ligament; at its
lower and back part is a notch from which the
mylohyoid groove runs obliquely downward and
forward, and lodges the mylohyoid vessels and nerve.
• Behind this groove is a rough surface, for the insertion
of the Pterygoideus internus

• Median pterygoid inserted –


median surface of the angle and
adjoining ramus
Mandibular canal

• Obliquely downward and forward in the ramus

• Horizontally forward in the body, where it is placed


under the alveoli and communicates with them by
small openings
• On arriving at the incisor teeth, it turns back to
communicate with the mental foramen, giving off
two small canals which run to the cavities
containing the incisor teeth
• posterior two-thirds of the bone the canal is situated
nearer the internal surface of the mandible
anterior third -- external surface.

• It contains the inferior alveolar vessels and nerve, from


which branches are distributed to the teeth.

•The lower border of the ramus is thick, straight, and


continuous with the inferior border of the body of the bone
• Junction -- angle --
attachment of the masseter
laterally, and the
pterygoideus internus
medially
Stylomandibular ligament
is attached to the angle
between these muscles.
• The anterior border is thin above, thicker

below, and continuous with


the oblique line.

• Posterior border is thick,


smooth, rounded, and
covered by the parotid
gland.
• The upper border is thin, and is surounded by two
processes, the coronoid in front and the condyloid
behind, separated by a deep concavity, the mandibular
notch.
Coronoid Process

• Thin, triangular eminence -- flattened


from side to side ----- varies in shape
and size.

• Anterior border -- convex --


continuous below with the anterior
border of the ramus
• Posterior border --- concave
and forms the anterior boundary
of the mandibular notch –
maseetric nerves n vessels.

• Lateral surface is smooth --


insertion to the temporalis and
masseter
Condyloid Process

• Thicker than the coronoid, and consists of two


portions: the condyle, and the constricted portion
which supports it, the neck.

• Most superior point on the head


of the condyle --CONDYLION

• Lateral pterygoid inserted –


fovea on anterior aspect of neck
• Condyle presents an articular surface for articulation
with the articular disk of the temporomandibular joint

• At the lateral extremity


of the condyle is a small
tubercle for the
attachment of the
temporomandibular
ligament.
• Its posterior surface is
convex; its anterior
presents a depression for
the attachment of the
Pterygoideus externus
Changes Produced in the Mandible with age

• Birth --- The angle is obtuse (175°), and the condyloid


portion is nearly in line with the body. The coronoid
process is of comparatively large size, and projects above
the level of the condyle.
• After birth the two segments of the bone become
joined at the symphysis, from below upward, in the first
year; but a trace of separation may be visible in the
beginning of the second year, near the alveolar margin.

• Mandibular canal -- just above

the level of the mylohyoid line


• Mental foramen ~ adult.
• Angle becomes less obtuse --
140°.
Adult --- alveolar and subdental portions of the body
are usually of equal depth.
• Mental foramen -- midway between the upper and
lower borders of the bone
• Mandibular canal runs nearly // with the mylohyoid
line.
• Ramus -- almost vertical in directn
• Angle -- 110° to 120°.
Old age -- greatly reduced in size -- loss of the teeth
the alveolar process resorbed
• Mental foramen -- close to the alveolar border.
• Ramus -- oblique in direction, angle --140°, neck of
the condyle -- more or less bent backward.
Anomalies of developement

Agnathia – deficiency of neural crest tissue in lower


part of face
• Micrognathia — pierre robin ,cats cry,
mandibulofacial dysostosis,downs, turners syndrome
•Macrognathia – inherited condition,
hyperpituitarism
Clinical applications
• To study growth -- implants –
 Anterior aspect of
symphysis in midline below the
root tips
 Right --under 1st pm and
another below 2nd pm or 1st m
 Right ramus – level of
occlusal surface of molars
Clinical applications

• In mandibular excess -- chincup – to restrict forward


and downward growth
•To corect dentofacial deformaties , mandibular
osteotomy procedures are done

1) Mandibular body osteotomy -- class III ,cross bites


Anterior -- anterior to mental foramen
Posterior
Mid symphysis – to widen or narrow the anterior
maxillary width
2) Subapical mandibular ostetomy– anterior, posterior
and total
3) Genioplasty – augment,reduce straighten or
lengthen the chin
Sites for implant placement
LACRIMAL BONES
Ossification

• The lacrimal bone is ossified from a single center,


• Twelfth week in the membrane covering the
cartilaginous nasal capsule.
• Smallest and most
fragile bone of the
face, is situated at the
front part of the medial
wall of the orbit.

• Two surfaces and


four borders.
Surfaces
Lateral or orbital surface
• Divided by a vertical ridge, the
posterior lacrimal crest, into two
parts.

• In front of this crest is a


longitudinal groove, the lacrimal
sulcus the inner margin of which
unites with the frontal process of
the maxilla, and the lacrimal fossa
is thus completed.

•The upper part of this fossa lodges


the lacrimal sac, the lower part,
the nasolacrimal duct
Medial or nasal surface

• Presents a longitudinal furrow, corresponding to the


crest on the lateral surface.
• The area in front of this furrow forms part of the
middle meatus of the nose
that behind it articulates with the ethmoid, and
completes some of the anterior ethmoidal cells
Borders

• Anterior articulates with


frontal process of the maxilla

• Posterior -- lamina papyracea


of the ethmoid

• Superior -- frontal bone


Inferior

• divided by the lower edge


of the posterior lacrimal
crest

• Posterior part articulates


with the orbital plate of the
maxilla
Articulations

• With four bones

• 2 cranium --frontal and ethmoid


• 2 face -- maxilla and the inferior
nasal concha.
VOMER
• Situated in the median plane, but its anterior portion is
frequently bent to one or other side.

• Thin -- quadrilateral -- and forms the lower part of the


nasal septum

• It has two surfaces


four borders.
• The surfaces are marked by small furrows for blood
vessels, and on each is the nasopalatine groove, which
runs obliquely downward and forward, and lodges the
nasopalatine nerve and vessels.
Borders -- superior border

• thickest -- presents a deep

furrow, bounded on either


side by a horizontal
projecting ala of bone; the
furrow receives the
rostrum of the sphenoid
while the margins of the ala
articulate with the medial pterygoid plates of
the sphenoid behind, and
with the sphenoidal
processes of the palatine
bones in front.

Inferior border
•articulates with the crest
formed by the maxilla and
palatine bones
anterior border

• longest and slopes downward and forward


• upper half is fused with the perpendicular plate of
the ethmoid
• lower half is grooved for
the inferior margin of the
septal cartilage of the nose
posterior border
• Free, concave
Articulations

Six bones:

2 cranium – sphenoid
ethmoid.

4 face -- two maxillae


two palatine

• Also articulates with the


septal cartilage of the
nose
NASAL BONES
Ossification

• Each bone is ossified from one center

• Appears at the beginning of the third month of fetal

life in the membrane overlying the front part of the

cartilaginous nasal capsule.


• Two small oblong bones varying in size and form in
different individuals

• They are placed side by side at the middle and upper


part of the face and form, by their junction, "the
bridge" of the nose

• Two surfaces
four borders
Surfaces

Outer surface

• Covered by the procerus


18
and compressor naris
• Perforated about its center
by a foramen, for the
transmission of a small vein
Inner surface

• Concave from side to side,


and is traversed from above
downward, by a groove for
the passage of a branch of
the nasociliary nerve
Articulations

• Two of the cranium –frontal and ethmoid


• Two of the face -- opposite nasal and the maxilla
•The most anterior point midway between the
frontal and nasal bones on the fronto-nasal suture
-- NASION
INFERIOR NASAL CONCHA
• The two small bones which form the inferior lateral

wall of the nasal cavity

• One of the turbinates in the nose

• It extends horizontally along the lateral wall of the


nasal cavity and consists of a lamina of spongy bone
curled upon itself like a scroll.
• Each inferior nasal concha is considered a facial pair
of bones since they arise from the maxilla bones and
projects horizontally into the nasal cavity.

• Also termed “inferior nasal turbinates “ because they


function similar to that of a turbine
• As the air passes through the turbinates, the air is
churned against these mucosa-lined bones in order to
receive warmth, moisture and cleansing.

• Superior to inferior nasal


concha -- middle and
superior nasal concha which
arise from the cranial
portion of the skull
• Hence, these two are considered as a part of the

cranial bones.

• It has two surfaces

two borders

two extremities
Surfaces

medial surface
• convex perforated by numerous apertures, and
traversed by longitudinal grooves for the lodgement of
vessels.
lateral surface
• concave and forms part of the inferior meatus
Borders

Upper border

• Thin, irregular, and connected to various bones along

the lateral wall of the nasal cavity.

• It may be divided into three portions


• Of these,
 Anterior articulates with the
conchal crest of the maxilla
 Posterior -- conchal crest of
the palatine
Middle portion presents 3
well-marked processes which
vary much in their size and form
• Of these
 anterior or lacrimal
process
--small and pointed
articulates, by its apex,
with the descending
process of the lacrimal
bone
• Behind this process a broad,
thin plate, the ethmoidal process
ascends to join the uncinate
process of the ethmoid

Inferior border
• Free, thick, and cellular in
structure, more especially in the
middle of the bone
PALATINE BONE
• Resembles the letter L

• Consists --- horizontal plate

perpendicular plate

• 3 processes -- pyramidal
Orbital
sphenoidal
• articulates with -- sphenoid
ethmoid
maxilla
inferior nasal concha
vomer and
opposite palatine
ZYGOMATIC BONE
Ossification

• Three centers — one for the malar and


Two -- orbital portion

• Eighth week and fuse about the fifth month of fetal life.
• small and quadrangular
• situated at the upper and
lateral part of the face
• forms --prominence of the
cheek
-- part of the lateral wall
and floor of the orbit
-- parts of the temporal
and infratemporal fossae
It presents
• Two surfaces
Malar and temporal
Four processes,
Frontosphenoidal, orbital, maxillary, and
temporal
• Four borders.
Surfaces
malar surface
• convex -- perforated near its
center by zygomaticofacial
foramen -- zygomaticofacial
nerve and vessels; below this
foramen is a slight elevation,
which gives origin to the
Zygomaticus
Temporal surface
• Directed posteriorly and medially -- concave rough, triangular
area, for articulation with the maxilla

• laterally a smooth, concave surface


--upper part of which forms the
anterior boundary of the temporal fossa
--lower a part of the infratemporal
fossa

• Near the center of this surface is the


zygomaticotemporal foramen for the
transmission of the zygomaticotemporal
nerve
Borders

antero-superior or orbital
• smooth, concave, and forms a
considerable part of the
circumference of the orbit.

antero-inferior or maxillary
• rough, and bevelled at the
expense of its inner table, to
articulate with the maxilla;
near the margin it gives origin
to the Quadratus labii
superioris
postero-superior or temporal
• curved -- is continuous above with the
commencement of the temporal line, and below with
the upper border of the zygomatic arch ,the temporal
fascia is attached to it.

postero-inferior or zygomatic
• Affords attachment by its rough edge to the Masseter
Articulations

• four bones
-- frontal,
sphenoidal,
temporal, and
maxilla.
REFRENCES

• Grays anatomy
• Inderbir singh – osteology
• Bd chaurasia -- anatomy
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