INFRATEMPORAL 1

FOSSA

-
PRESENTED BY:-
V.V.N.S.HARSHITHA
1st year POSTGRADUATE
PUBLIC HEALTH DENTISTRY
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CONTENTS

1. INTRODUCTION
2. BOUNDARIES
3. CONTENTS of INFRATEMPORAL FOSSA-i) Muscles of Mastication
ii) Mandibular Nerve
iii) Maxillary artery
iv) Pterygoid plexus of veins
v) Temporomandibular joint
vi) Otic Ganglion
4. APPLIED ANATOMY
5. REFERENCES

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1. INTRODUCTION
OSTEOLOGY :-

1. It lies below the skull i.e. middle cranial fossa, behind the body of
maxilla, and lateral to the lateral pterygoid plate.

2. It communicates with the pterygopalatine fossa through the

pterygomaxillary fissure.

3. It is a wedge shaped space present deep to masseter muscle and

underlying ramus of the mandible.
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4.Structures that travel between the cranial cavity, neck,

pterygopalatine fossa, floor of the oral cavity, floor of the orbit,
temporal fossa and superficial regions of the head pass through it.
Bones that form the skeletal framework of infratemporal fossa are

→sphenoid bone

→ paired maxilla

→ temporal bones

→ palatine bones

→ mandible
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2. BOUNDARIES
 ANTERIOR:- Posterior surface of body of the maxilla
 POSTERIOR :- Tympanic plate and the mastoid and styloid process of
the temporal bone
 ROOF :- Infratemporal surface of greater wing of sphenoid bone
 FLOOR :- Medial pterygoid muscle.
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 SUPERIOR :- Inferior(infratemporal) surface of the greater wing of

the sphenoid bone

 INFERIOR :- where the medial pterygoid muscle attaches to the

mandible near its angle

 MEDIAL :- Lateral pterygoid plate and pyramidal process of palatine

bone

 LATERAL :- Ramus of the mandible

BOUNDARIES OF INFRATEMPORAL FOSSA
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3. CONTENTS of
INFRATEMPORAL FOSSA
A. Muscles of mastication

B. Mandibular nerve

C. Maxillary artery

D. Pterygoid plexus of veins

E. Temporomandibular joint

F. Otic Ganglion
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MUSCLES OF
MASTICATION
Muscles of Mastication are 4 in number

 Massetter

 Temporalis

 Lateral pterygoid

 Medial pterygoid
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MASSETER
 Quadrilateral in shape

 ORIGIN:- Zygomatic arch and zygomatic process of maxilla.

 INSERTION:- Ramus of the mandible

 It elevates of the mandible.

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TEMPORALIS
 Fan shaped muscle.

 ORIGIN:- Temporal fossa

 INSERTION:- Coronoid process and anterior border of ramus of the

mandible.

 Elevates the mandible.

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LATERAL PTERYGOID
MUSCLE
 Short, conical in shape.

 ORIGIN:- Upper head from infratemporal surface and crest of

greater wing of sphenoid bone.

Lower head from lateral surface of lateral pterygoid plate.

 INSERTION:- Neck of the mandible.

 Depress the mandible.

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MEDIAL PTERYGOID
MUSCLE
 Quadrilateral in shape.

 ORIGIN:- Medial surface of lateral pterygoid plate.

 INSERTION:- Angle of the mandible.

 Elevates the mandible.

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BLOOD SUPPLY:- Muscles of mastication are supplied by

maxillary artery.

NERVE SUPPLY:- They are supplied by their respective divisions

from mandibular nerve.
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APPLIED ANATOMY OF MUSCLES OF

MASTICATION

MYOFASCIAL PAIN: Most commonly reported type of masticatory

muscle disorder. It is characterized by a dull regional ache that

increases during function.

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• MYOSITIS:
 It is primary inflammation of muscle resulting from infection /
trauma.

 It is characterized by constant acute pain in one or more of the

masticatory muscles usually accompanied by swelling, redness of
overlying skin & increase in temperature over the affected area. It
results in jaw dysfunction & limited range of movement.
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• LOCAL MYALGIA:
It refers to a general category of acute muscle pain disorders.

 MYOSPASM / MUSCLE CRAMP:

Acute condition resulting from a sudden, involuntary &

continuous tonic contraction of muscle. It is characterized by

localized acute pain& severely limited range of motion of the

mandible.
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 MYOFIBROTIC CONTRACTURE:

It involves a painless shortening of muscle as a result of fibrosis in &

around the remaining contractile muscle tissue. It follows an

infectious process or trauma. There is limited mouth opening &

unyielding resistance to passive jaw muscle stretch.

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MANDIBULAR NERVE
 This is the largest of the three divisions of trigeminal nerve.

 The main trunk of mandibular nerve lies in the infratemporal

fossa which is formed by sensory and motor roots emerging out
of cranial cavity through foramen ovale.

 After a short course, main trunk divides into small anterior trunk
and large posterior trunk.
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Branches of main trunk

 Meningeal branch- supplies dura mater of the middle cranial fossa.

 Nerve to medial pterygoid- supplies medial pterygoid muscle.

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Branches from anterior trunk

 Sensory – buccal branch supplies the skin and mucous membrane
related to buccinator muscle.

 Motor – masseteric nerve supplies masseter muscle and

temporomandibular joint.

- deep temporal nerves

- nerve to lateral pterygoid supplies lateral pterygoid muscle.

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Branches from posterior trunk

 Auriculotemporal nerve –

a) auricular part-skin of the tragus,

upper parts of the pinna,

the external acoustic meatus

the tympanic membrane.

b) temporal part- skin of temple.

-- It supplies the parotid gland and temporomandibular joint.

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 Lingual nerve – sensory to anterior two-thirds of the tongue and to
floor of the mouth.

 Inferior alveolar nerve –

a) Mylohyoid branch- supplies mylohyoid muscle and the anterior

belly of digastric.

b) Supplies to lower teeth and gums.

c) Mental nerve- supplies skin of the chin, and the skin and mucous
membrane of the lower lip.

d) Incisive branch-labial aspect of gums of canine and incisor tooth.

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 Applied anatomy of 29

mandibular nerve
 The motor part of mandibular nerve is tested clinically by asking the
patient to clench his/her own teeth and then feeling for contracting
masseter and temporalis muscles on two sides.

 If one masseter is paralysed ,jaw deviates to one side, on opening

mouth by action of normal lateral pterygoid of opposite side.
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 The activity of pterygoid muscles is tested by asking the patient to

move his chin from side to side.

 REFERRED PAIN:- In cases with cancer of tongue, pain radiates to

the ear and to the temporal fossa, over the distribution of
auriculotemporal nerve.
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 MANDIBULAR NEURALGIA

 LINGUAL NERVE:- In extraction of malplaced wisdom tooth care

must be taken not to injure the lingual nerve.
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MAXILLARY ARTERY
 This is the largest terminal branch of the external carotid artery at
the neck of the mandible.

 It is divide into 3 parts by the lateral pterygoid muscle.

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FIRST PART

1. Deep auricular Skin of external acoustic

meatus
Outer surface of tympanic
membrane
TMJ
2.Anterior tympanic Inner surface of tympanic
membrane
3.Middle meningeal 5th and 7th cranial nerves
Middle ear and tensor tympani

4.Accessory meningeal Extracranial to pterygoids

5.Inferior alveolar Lower teeth and mylohyoid
muscle
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SECOND PART

1.Deep temporal Temporalis

2.Pterygoid Lateral and medial pterygoid

muscles

3.Masseteric Masseter

4.Buccal Buccinator
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THIRD PART
1.Posterior superior alveolar Upper molar and premolar
teeth and gums
Maxillary sinus
2.Infraorbital Upper incisor and canine
teeth,lower orbital
muscles,lacrimal sac,maxillary
sinus
3.Greater palatine Soft palate,tonsil,palatine
glands and mucosa,upper gums
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4.Pharyngeal Roof of nose and pharynx

Auditory tube
Sphenoidal sinus

5.Artery of pterygoid canal Auditory tube,upper pharynx

and middle ear

6.Sphenopalatine Lateral and medial walls of

nose and air sinuses
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PTERYGOID PLEXUS OF
VEINS
 It lies around and within lateral pterygoid muscle.

 This plexus is drained by maxillary vein which begins at the end of

plexus and unites with the superficial temporal vein to form
retromandibular vein.
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TEMPOROMANDIBULAR
JOINT
 This is a synovial joint of the condylar variety.
 The area where mandible articulates with cranium.
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 TMJ constitues

 Cranial component– formed by the following parts of temporal

bone such as articular eminence and anterior part of mandibular
fossa.

 Mandibular component– head of the mandible forms inferior

articular surface.

 Ligaments—a)fibrous capsule

b) lateral ligament

c) sphenomandibular ligament

d) stylomandibular ligament
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 Articular disc– oval fibrous plate that divides joint into upper and
lower compartments which permits gliding and rotatory
movements.

 BLOOD SUPPLY:-

Superficial temporal and maxillary arteries and respective veins.

 NERVE SUPPLY:-

Auriculotemporal and masseteric nerves.

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TMJ
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Applied anatomy of TMJ

1) DISLOCATION OF MANDIBLE:-

During excessive opening of the mouth,or during a convulsion,the

head of the mandible of one or both sides may slip anteriorly into
the infratemporal fossa which leads to inability to close the
mouth.

2) DERANGEMENT OF THE ARTICULAR DISC:-

This may result from any injury,overclosure or malocclusion.this

give rise to clicking and pain during movements of the jaw.
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OTIC GANGLION

 It is a peripheral parasympathetic ganglion which relays

secretomotor fibres to the parotid gland.

 It is structurally related to the mandibular nerve and

functionally related to glossopharyngeal nerve.
 LOCATION:-

 It is situated just below the foramen ovale situated in the

infratemporal fossa.

 Medial to mandibular nerve

 Lateral to the tensor veli palatini

 Surrounds the origin of the nerve to medial pterygoid.

 PARASYMPATHETIC ROOT:-

It is formed by lesser petrosal nerve.

Preganglionic fibres:-

inferior salivary nucleus-9th cranial nerve, its tympanic

branch, tympanic plexus-the lesser petrosal nerveotic
ganglion.

Postganglionic fibres:-

auriculotemporal nerve-parotid gland.

 SYMPATHETIC ROOT:-

Superior cervical ganglionauriculotemporal nerve-parotid

gland

 SENSORY ROOT:-

Comrs from auriculotemporal nerve and is sensory to parotid gland.

 Other fibres passing through nerve to medial pterygoid and

chordatympanic nerve.
 REFERENCES

1) B D Chaurasia’s Human Anatomy vol 3

2) Gray’s anatomy

3) Netter’s atlas of Anatomy