Anatomy of orofacial structures

for C-II Medical students

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contents
• The skull and it’s foramina
• Neurovascular supply of the face
• Anatomy Temporomandibular joint
• Parts of the oral cavity
• Tooth numbering systems
• References

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 skull
• The skull, excluding the three pairs of ossicles of the ear, is composed
of 22 bones, some of which are paired, whereas the others are single.
• Twenty-one of these bones are firmly attached to each other via
sutures and are immovable. The only movable bone is the tooth-
bearing mandible, which articulates with the paired temporal bones
by a combined hinge and gliding, the temporomandibularjoint

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Bones of the Skull

• The cranium consists of the following bones, two of which are paired

• Frontal bone: 1
• Parietal bones: 2
• Occipital bone: 1
• Temporal bones: 2
• Sphenoid bone: 1
• Ethmoid bone: 1

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cont’d
• The facial bones consist of the following, two of which are single:
• Zygomatic bones: 2
• Maxillae: 2
• Nasal bones: 2
• Lacrimal bones: 2
• Vomer: 1
• Palatine bones: 2
• Inferior conchae: 2
• Mandible: 1
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MAXILLARY BONE

• Forms upper jaw and central portion of facial skeleton

• Surround anterior nasal aperture and unite in medial plane
• Articulates with all facial bones except mandible
• Forms upper dentition
• Surfaces - nasal, orbital, infratemporal, and anterior
• Parts – Body and Four processes - frontal, alveolar, zygomatic and
palatine
• Body – houses maxillary sinus
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Mandible

• Forms the lower jaw

• Largest, strongest bone of the face
• the only movable bone of the skull
• Houses lower dentition

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Foramina and Fissures of the Skull
• Olfactory foramina 
• Optic canal 
• Superior orbital fissure
• Foramen rotundum
• Foramen ovale
• Foramen spinosum
• Foramen lacerum
• Carotid canal

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• Internal acoustic meatus
• Jugular foramen
• Hypoglossal canal
• Foramen magnum

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Cranial nerves
I: Olfactory nerve VII: Facial nerve
II: Optic nerve VIII: Vestibulocochlear nerve
III: Oculomotor nerve IX: Glossopharyngeal nerve
IV: Trochlear nerve X: Vagus nerve
V: Trigeminal nerve XI: Spinal accessory nerve
VI: Abducens nerve XII: Hypoglossal nerve

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SENSORY NERVES OF THE FACE

• Two sources
•Skin around the angle of the mandible – greater auricular nerve (C 2, 3 )
•The rest of the face- trigeminal branches

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 Trigeminal nerve
• The largest cranial nerve
• It is mixed nerve ( sensory and motor )
• Sensory to – Skin of face
-Mucosa of cranial viscera Except base of tongue and pharynx
• Motor to – Muscles of Mastication
-Tensor ville palatini,Tensor tympany
-Anterior belly of digastric
-Mylohyoid

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Trigeminal nerve
• Motor root arises separately from sensory root, originating
in main nucleus with pons and medulla oblongata.
• Its fibers (as a small nerve root), travel anteriorly along with, but
separately, the sensory root to the region of semilunar ganglion.
• Sensory root fibers of trigeminal nerve comprises of the central
processes of ganglion cells located in trigeminal ganglion.
• Sensory root fibers enter the concave portion of each crescent and
the three sensory divisions of trigeminal nerve exit from the
convexity.

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Ophthalmic Nerve (V1)
• The ophthalmic nerve transmits sensory innervation from eyeballs,
skin of upper face and anterior scalp, the lining of upper part of nasal
cavity and air cells and the meninges of anterior cranial fossa.
• Its branches also convey parasympathetic fibers to the ciliary and iris
muscles for accommodation and pupillary constriction and to the
lacrimal gland.
• It passes anteriorly through lateral wall of cavernous sinus. It divides
into three branches:
• 1. Frontal
• 2. Nasociliary
• 3. Lacrimal.
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Maxillary Nerve (V2)
• The maxillary nerve transmits sensory fibers from the skin of face
between the lower eyelid and the mouth from the nasal cavity and
sinuses, from the maxillary teeth.
• it contains only sensory fibers some of its branches receive
postganglionic parasympathetic fibers from pterygopalatine ganglion
which pass to the lacrimal, nasal and palatine glands, and others
convey taste (visceral sensory) fibers from the palate to the nucleus of
the solitary tract.

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Cont’d
Maxillary nerve innervates:
1. Skin of:
i. Middle portion of face
ii. Lower eyelid
iii. Side of nose
iv. Upper lip.
2. Mucous membrane of:
i. Nasopharynx
ii. Maxillary sinus
iii. Soft palate
iv. Tonsil
v. Hard palate.
3. Maxillary teeth and periodontal tissues.
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 Cont’d
Maxillary nerve gives off branches in four regions:
1. Within the cranium; Middle Meningeal Nerve
2. In the pterygopalatine ganglion; Pterygopalatine, Zygomatic and
Posterosuperior alveolar nerves.
3. In the infraorbital canal; MSAN and ASAN
4. On the face; palpebral, nasal and labial branch

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Mandibular Nerve (V3)
• It transmits sensory fibers from;
the skin over the mandible,
side of the cheek and temple,
the oral cavity and its contents,
external ear, tympanic membrane
Temporo mandibular joint
meninges of cranial vault.

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• It is motor supply to the muscles derived from first branchial arch:
 muscles of mastication
 Mylohyoid and anterior belly of digastric
 Tensor tympani and tensor palati.
• Some of its distal branches also convey parasympathic secretomotor
fibers to salivary glands and taste fibers from anterior portion of
tongue.

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• In infratemporal fossa, it gives branches in three areas:
1. From undivided nerve
2. From anterior trunk
3. From posterior trunk.

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Facial Nerve
• It is the nerve of second branchial arch
• Facial nerve possesses a motor and a sensory root.
• Secretomotor to submandibular and sublingual glands
• Emerge through stylomastoid foramen and enter parotid and gives five branches

 Temporal
Zygomatic
Buccal
Mandibular
Cervical

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MUSCLES OF facial expression

• THE FACE
• Lie in subcutaneous tissue
• May originate from bones
• Insert in to the skin
• Named as muscles of facial expression
• Arranged in groups around the orbit, nose, mouth and auricles
• functionally considered as regulators of openings
• Supplied from branches of facial nerve
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BLOOD VESSELS OF THE FACE

1. From ophthalmic artery

Supratrochlear
Supraorbital
2. External carotid artery
Facial artery
Transverse facial
Infraorbital
Mental artery
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Veins

• Supratrochlear veins

• Supraorbital veins

• Facial vein

• Superficial temporal

• Retromandibular vein
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Temporomandibular joint
Articulating surfaces
•Head of mandible
•Mandibular fossa and articular tubercle of the temporal bone
• Articular Capsule
•surround the joint
•thickened laterally to form ligaments
Articular disc
•dividing joint cavity into a lower compartment & upper compartment
• Major supportive elements of the TMJ
•muscles of mastication
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 Ligaments of TMJ; Minor supportive of TMJ
Temporomandibular ligament - thickening of the joint capsule
Stylomandibular ligament - behind and medial
Sphenomandibular ligament - medially attached to the sphenoid and
mandible
Synovial membrane – lines the capsule in the upper and lower parts the
joint cavity
Nerve supply – Auriclotemporal and nerve to masseter
Arterial
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Musculature
• Muscles influencing mandibular motion may be divided into two
groups by anatomic position.
• supramandibular muscle group
• inframandibular group

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Muscles of Mastication
• The temporalis muscle
 elevate the mandible for closure
 retrusive movements of the mandible
 assists in deviation of the mandible to the ipsilateral side.
• The masseter muscle
 most powerful elevator of the mandible
 protrusion and retrusion of the mandible

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• The medial pterygoid muscle
 elevation of the mandible
 unilateral protrusion
The lateral pterygoid muscle
primary function of the inferior head is protrusive and contralateral
movement.
• it has also involved in closing movements of the jaw and with
retrusion and ipsilateral movement.

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Medial pterygoid
Lateral pterygoid (inferior head)
Lateral pterygoid (superior head)
Masseter, superficial layer
Masseter, deep layer
Temporalis, anterior portion
Temporalis, posterior portion
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Closure, protrusion
Protrusion, opening contralateral
Retrusion, closure, ipsilateral
Protrusion, closure contralateral
Retrusion, closure, ipsilateral
closure
Retrusion, closure ipsilateral
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ORAL CAVITY

• Two parts ; vestibule and oral cavity proper

• Vestibule
•Bounded by lips and cheeks and teeth and gums
•The parotid duct opens in the superior vestibule, opposite the 2nd
upper molar tooth

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• Oral cavity proper
•Boundaries
 Roof - hard and soft palates with the midline uvula
 Floor - tongue and sub lingual region
 Anteriorly and laterally – the gums and the teeth
The posterior border - oropharyngeal isthmus

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Muscles of the tongue

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The teeth
• The primary or deciduous dentition consists of 20 teeth: 8 incisors, 4
canines, and 8 molars.
• The normal adult dentition consists of 32 permanent teeth.

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Functions of Teeth
1- Mastication
2- Appearance
3- Speech
4- Growth of jaws

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 Dental Anatomy and Physiology

Enamel
The Dental Tissues: Dentin

• Enamel (hard tissue)

• Dentin (hard tissue) Odontoblast Layer Gingiva

• Pulp Chamber (soft tissue)

• Gingiva (soft tissue) Periodontal Ligament
• Periodontal Ligament (soft tissue) Pulp
• Cementum (hard tissue) Chamber
Cementum
• Alveolar Bone (hard tissue)
• Pulp Canals Alveolar Bone
• Apical Foramen
Apical Foramen

Pulp Canals

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 Dental Anatomy and Physiology

Enamel

The 4 main dental tissues: Dental Pulp

Dentin
•Enamel
•Dentin
•Dental Pulp
•Cementum

Cementum

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Dental Tissues—
Enamel
• Structure
• Highly calcified and hardest
tissue in the body
• Crystalline in nature
• Insensitive—no nerves
• Acid-soluble—will
demineralize at a pH of 5.5 and
lower
• Cannot be renewed
• Darkens with age as enamel is
lost
• Fluoride and saliva can help
with remineralization

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Dental Tissues—Dentin2

• Softer than enamel

• Susceptible to tooth wear
(physical or chemical)
• Does not have a nerve
supply but can be sensitive
• Is produced throughout life
• Will demineralize at a pH
of 6.5 and lower

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Dental Tissue—Cementum2
• Thin layer of mineralized
tissue covering the dentin
• Softer than enamel and
dentin
• Anchors the tooth to the
alveolar bone along with the
periodontal ligament
• Not sensitive

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 Dental Anatomy and Physiology

Dental Tissue—Dental Pulp

• Innermost part of the tooth
• A soft tissue rich with blood
vessels and nerves
• Responsible for nourishing
the tooth
• The pulp in the crown of the
tooth is known as the coronal
pulp
• Pulp canals traverse the root
of the tooth
• Typically sensitive to extreme
thermal stimulation (hot or
cold)

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Periodontal Tissues
• Gingiva
• Alveolar Bone Gingiva
• Periodontal
Ligament
Periodontal Ligament
• Cementum
Alveolar bone

Cementum

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• Gingiva: The part of the oral
mucosa overlying the crowns of
unerupted teeth and encircling the
necks of erupted teeth, serving as
support structure for subadjacent
Gingiva
tissues.

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• Alveolar Bone: Also called the
“alveolar process”; the thickened
ridge of bone containing the tooth
sockets in the mandible and
maxilla.

Alveolar bone

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• Periodontal Ligament: Connects
the cementum of the tooth root to
the alveolar bone of the socket.

Periodontal Ligament

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 Dental Anatomy and Physiology
Dental Tissue—Dental Tissue6

• Cementum: Bonelike, rigid

connective tissue covering the root
of a tooth from the cementoenamel
junction to the apex and lining the
apex of the root canal.
• It also serves as an attachment
structure for the periodontal
ligament, thus assisting in tooth
support.
Cementum

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Anatomical Crown & Clinical Crown

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Numbering or Coding Systems
1.Palmer Notation System
2.Universal System
3.International FDI System (two digit system)

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• American Dental Association in 1947
• Palmer – difficulty in keyboard typing
• Tooth is represented by a number 1 – 8 (permanent) or a letter A – E (deciduous)
• Two lines; indicates which quadrant the tooth belongs to
• a horizontal representing the occlusal plane and
• a vertical representing the midline
• Examples: 1
• Maxillary right central incisor
• Mandibular left second deciduous molar E

EDCBA ABCDE 8 7 6 5 4 3 2 1 1 2 3 4 5 6 7 8

EDCBA ABCDE
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Universal numbering system
• ADA adopted the universal system in 1968
• Uppercase letters for deciduous teeth
• Consecutive from A to T
• Following a clockwise order from maxillary right second molar to mandibular right second
molar
• Numbers for permanent teeth
• Consecutive from 1 to 32
• Following a clockwise order from maxillary right third molar to mandibular right third molar

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 FDI numbering system
• Proposed by FDI & adopted by WHO
• Each tooth is allocated a two-digit number; the left designates the
quadrant and the right designates the tooth order
• Examples
• Mandibular right permanent canine 43
• Maxillary left deciduous lateral incisor 62

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References
• Neelima animalik maxillofacial surgery 3rdedition
• Peterson’s Principles of Oral and Maxillofacial Surgery 2ndedition
• Netter’s Head and Neck Anatomy for Dentistry 2nd edition
• Art and science of operative dentistry 4th edition

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