Head

JIGJIGA UNIVERSITY
gross Anatomy
FOR MEDICINE STUDENTS
ANATOMY OF head
Overview Head
The superior part of the body.
Attached to the trunk by the neck.
It is the control and communications center for the
body.
Is the site of our consciousness:
ideas, creativity, memory
Imagination, responses, memory & decision
making
Overview Head cont…
It consists of:
The brain and , its protective coverings (cranial vault
and meninges)
Special sensory receivers (eyes, ears, mouth, and nose),
& face.
Portals for the intake of food, water, and oxygen and the
removal of carbon dioxide.
Cranium (skull)
The skeleton of the head

Formed by two sets of bones
i. Neurocranium and
ii. Viscerocranium
Neurocranium
It is the bony case of the :
Brain and its membranous coverings,
It also contains :
Proximal parts of the cranial nerves and the
vasculature of the brain.
Neurocranium cont…
Formed by a series of eight bones:
Four un paired bones
Frontal
Ethmoidal
Sphenoidal
Occipital
Two paired bones
Temporal and
Parietal
Neurocranium has a dome-
like roof :
– The calvaria (skullcap)
Primarily formed by flat

bones: frontal, parietal, and
Occipital
Most calvarial bones are

united by fibrous interlocking
sutures
Neurocranium also has:
 Floor or cranial base
Primarily making by irregular bones :

Sphenoidal and
Temporal
Ethmoid bone (minor)
 The spinal cord is continuous with
the brain through the foramen magnum.
• A large opening in the cranial base
Viscerocranium (facial skeleton)
Comprises facial skeleton

Forms anterior part of the cranium
Consists of the bones surrounding ,
Mouth.
nose/nasal cavity,
most of the orbits/ orbital cavities
Viscerocranium cont…
Consists of 15 irregular
6 paired bones
bones:
3 un paired bones Maxillae
centered on the midline. Inferior nasal conchae
Mandible, Zygomatic
Ethmoid, and Nasal
Vomer Lacrimal
Palatine bone
Facial Aspect of Cranium
Features of the anterior or facial (frontal) aspect of the

cranium are:
 Frontal bones & Zygomatic bones
 Orbits, Nasal region
 Maxillae
 Mandible bone
Frontal bone
Forms the skeleton of the forehead

Articulating inferiorly with
Nasal and Zygomatic
Lacrimal
Ethmoid
Sphenoids bone
Frontal bone cont…
Consists of:
1. Glabella
Craniometric points
Smooth prominence
2. Metopic suture
• A persistent frontal suture in some adults.
• It is in the middle of the glabella
3. Nasion
The intersection of the frontal and
the nasal bones.
Used radiographically in medicine
to make :
Cranial measurements
Compare and describe the
topography of the cranium, and
Document abnormal variations.

4. Supra-orbital margin
Angular boundary b/n the squamous and the orbital parts
Has a supra-orbital foramen for passage of the supra-orbital
nerve and vessels.
5.Superciliary arch
Superior to the supra-orbital margin
Extends laterally on each side from the glabella.

Zygomatic Bones (cheek bones, malar bones)
Lie on the inferolateral sides of the orbits

Rest on the maxillae
Form anterolateral rims, walls, floor, and much of the
infra-orbital margins of the orbits
Zygomatic Bones cont…
Has a small zygomaticofacial foramen pierces the

lateral aspect of each bone
Articulate with
Frontal
Sphenoid
Temporal
Maxillae bone
Nasal Bones
Join medially to form the bridge of the nose.

Articulate with:
Superiorly - frontal bone
Laterally - maxillary bone
Posteriorly - Perpendicular plate of ethmoid bone
Inferiorly - attaches to the cartilages that form most
of the skeleton of the external nose
Nasal Bones cont…
Consists
Piriform aperture
Inferior to the nasal bones
Nasal septum
dividing the nasal cavity into right and left parts
Nasal conchae
On the lateral wall of each nasal cavity.
Maxillae Bones
Form skeleton of the upper jaw

Supporting bone for the maxillary teeth.
Contribute the greatest part of the upper facial skeleton
Surround most of the piriform aperture
Fixed to the cranial base.
Maxillae Bones cont…
It has
Intermaxillary suture
United the two maxillae in the median plane
Infraorbital foramen
Inferior to each orbit for passage of the infra-orbital
nerve and vessels
Maxillae Bones cont…
Form
Medially -infra-orbital margins
Laterally- broad connection with the zygomatic bones
Consists
Frontal process
Alveolar process
Zygomatic process
Mandible Bones
Forms the skeleton of the lower jaw,

The only movable bone of the skull
Articulates with the cranial base at the
temporomandibular joints.
Largest, strongest bone of the face
Mandible Bones cont…
Has
Alveolar process that supports the mandibular teeth.
Mental foramina Inferior to the second premolar teeth
for the mental nerves and vessels
Mental protuberance, forming the prominence of the chin
On the medial surface of the ramus is a large mandibular
foramen for transmission of the inferior alveolar nerve and
vessels.
Mandible Bones cont…
It consists
Mandibular symphysis, the line of fusion between the two

halves of the mandible
Body (horizontal part)
Ramus (vertical part)
Coronoid and Condylar processes, are separated by the
mandibular notch.
Lateral Aspect of the Cranium
Formed by both the The main features of the
neurocranium and the viscerocranial part are
viscerocranium
Zygomatic arch
The main features of the
lateral aspects of the
neurocranial part are
maxilla and mandible
Temporal fossa
Infratemporal fossa
External acoustic opening
Mastoid process of the
temporal bone.
Temporal Fossa
Bounded:
Superiorly and Posteriorly - by the superior and inferior
temporal lines
Anteriorly -by the frontal and zygomatic bones,
Inferiorly -by the zygomatic arch.
Zygomatic Arch
Formed
By the union of:
The temporal process of the zygomatic bone and
Zygomatic process of the temporal bone.
Pterion
Lie in the anterior part of the temporal fossa
3-4 cm superior to the midpoint of the zygomatic arch
Junction of the frontal, parietal, sphenoid (greater
wing), and squamous temporal bones.
Overlies course of anterior division of middle
meningeal artery
External Acoustic Opening
Entrance to the external acoustic meatus (canal)

Which leads to the tympanic membrane (eardrum)
Has mastoid process of the temporal bone -
posteroinferior
Styloid process of the temporal bone -Anteromedial to
the mastoid process
Posterior or Occipital Aspect of the Cranium
Composed of :
Occipital bone
Parts of the parietal bones
Mastoid parts of the temporal bones.
The external occipital protuberance( inion)
Posterior Aspect of the Cranium cont…
External occipital crest
descends from the protuberance toward the foramen

magnum.
Superior nuchal line
extends laterally from each side of the protuberance
superior limit of the neck
Inferior nuchal line
is less distinct.
Posterior Aspect of the Cranium cont…
lambda
Junction of lambdoid and sagittal sutures
In the center of the occiput sutural bones (accessory

bones)
may be located at lambda or near the mastoid process.

Superior (vertical) Aspect of the Cranium
Oval in form
Broadens posterolaterally at the parietal eminences
and
frontal eminences are also visible, in some people
giving the calvaria an almost square appearance.
Superior Aspect of the Cranium cont…
Consist of:
Coronal Suture
Separates the frontal and parietal bone
Sagittal Suture
Separates the parietal bones
Lambdoid Suture
Separates the parietal and temporal bones from the
occipital bone .
Bregma
Craniometric point
Junction of coronal and sagittal

sutures
Vertex
The most superior point of the

calvaria
Near the midpoint of the sagittal

suture.
Parietal Foramen
Inconstant aperture located posteriorly
in the parietal bone near the sagittal
suture
For the passage of parietal emissary
vein
Emissary Foramina
Most irregular, highly variable
Transmit emissary veins
Connecting scalp veins to the venous

External Surface of Cranial Base
Main features includes:
Alveolar arch of the maxillae
Palatine processes of the maxillae
Palatine, Sphenoid
Vomer, Temporal, and
Occipital bones.
Hard Palate
Formed
Anteriorly
Palatal processes of the maxillae
Posteriorly
Horizontal plates of the palatine bone
Forms both a part of the roof of the mouth and the
floor of the nasal cavity.

Hard Palate cont…
Consist of
Posterior Nasal Spine
In the free posterior border of the hard palate
projects posteriorly in the median plane
Hard Palate cont…
Incisive Fossa
Posterior to the central incisor teeth
In the midline of the bony palate
Into which the incisive canals open
Right and Left Nasopalatine nerves pass from the nose
Greater and Lesser Palatine Foramina.
Posterolaterally to the palate
Transmit greater & lesser palatine vessels and nerve
Choanae (posterior nasal apertures)
Superior to the posterior edge of the palate
Separated from each other by the vomer bone
Sphenoid
Wedged b/n the frontal, temporal, and occipital bones
Consists of a body and three pairs of processes:
Greater wings
Lesser wings
Pterygoid processes
Sphenoid cont…
The greater wings have
Orbital, Temporal, and Infratemporal surfaces

Apparent in facial, lateral, and inferior views of the
exterior of the cranium
Cerebral surfaces in internal views of the cranial

base
Sphenoid cont…
Pterygoid Processes
Consisting of lateral and medial pterygoid plates
Extend inferiorly on each side of the sphenoid -
From the junction of the body and greater wings
Sphenoid cont…
Groove for the cartilaginous part of the pharyngotympanic
(auditory) tube
Lies medial to the spine of the sphenoid,

Inferior to the junction of the greater wing of the
sphenoid and the petrous part of the temporal bone
Temporal Bone
Has
4 Parts
Tympanic
mastoid,
Squamous
Petrous
Styloid process
Zygomatic process
Mastoid process
Temporal Bone cont...
Mandibular fossa- receives condyle of mandible to form

temporomandibular joint
Mastoid foramen- transmit mastoid emissary vein from
sigmoid sinus and meningeal branch of occipital artery
Foramina penetrate the bone
jugular foramen
Transmits – internal jugular veins, CN-IX, X, XI
Carotid canal
Transmits the internal carotid artery
Contain venous plexuses and carotid plexuses of
sympathetic nerves
Internal acoustic meatus –
Entry point for the auditory nerve & CN VII, VIII
Styolomastoid foramen
Exit for facial nerve (CN-VII) & stylomastoid artery
Foramen lacerum - for
Deep petrosal nerve and
Some meningeal arterial branches and small veins
Occipital Bone
Forms most of the posterior wall Consist of
and cranial base Occipital condyles articulate
Articulates with parietal, with atlas

External occipital
temporal and the first cervical
protuberance
vertebrae
External occipital crest
Has 2 parts
Superior nuchal line-
Squamous,
boundary b/n scalp and neck
Basilar
Inferior nuchal line &
Sutures- lambdoid, Foramen Magnum
Internal Surface of Cranial Base
Has three large depressions

Anterior cranial fossae
Middle cranial fossae
Posterior cranial fossae
Form floor of the cranial cavity

Lie at different levels
Anterior Cranial Fossa
The shallowest of the three cranial fossae.

Formed by
Anteriorly: frontal bone(orbital parts )
Middle: ethmoid bone
Posteriorly: the body and lesser wings of the
sphenoid.
Anterior Cranial Fossa cont…
Foramina/Apertures
Foramen cecum (nasal emissary vein)
Cribriform foramina in cribriform plate- (olfactory
nerves)
Anterior and posterior ethmoidal foramina-(Vessels
and nerves with same names)

Middle Cranial Fossae
Posteroinferior to the anterior cranial fossa,

Separated from it by:
• Sharp sphenoidal crests -laterally and
• Sphenoidal limbus - centrally
Middle Cranial Fossae cont…
The boundary b/n the middle and the posterior

cranial fossae is:
Laterally- superior border of the petrous part of
the temporal bone
Medially- dorsum sellae of the sphenoid.
Composed of the Sella turcica on the body of the sphenoid

Which is surrounded anterior and posterior by the clinoid
processes &
Sella turcica composed of three parts

Dorsum Sellae
Tuberculum Sellae
Hypophysial Fossa
Dorsum Sellae
A square plate of bone projecting superiorly from the
body of the sphenoid
It forms the posterior boundary of the sella turcica, &
Its prominent superolateral angles make up the
posterior clinoid processes.
Tuberculum Sellae
Forming the posterior boundary of the prechiasmatic
sulcus and
anterior boundary of the hypophysial fossa.
Hypophysial Fossa
A median depression in the body of the sphenoid that
accommodates the pituitary gland

Foramina/Apertures Foramen rotundum
Optic Canals- Maxillary nerve (CN V2)
Optic nerves (CN II) and Foramen ovale-

Mandibular nerve (CN V3)
ophthalmic arteries
and accessory meningeal
Superior orbital fissure-
artery
Ophthalmic veins
Ophthalmic nerve (CN V1); CN
III, IV, and VI & sympathetic
fibers
Foramen spinosum – Groove or hiatus of greater

Middle meningeal artery petrosal nerve
and vein and Greater petrosal nerve and
Meningeal branch of CN Petrosal branch of middle
V3 meningeal artery
Foramen lacerum
Deep petrosal nerve and
some meningeal arterial
branches and small veins
Posterior Cranial Fossae
The largest and deepest of the three cranial fossae,

Contains the hind brain
Lodges the cerebellum, pons, and medulla oblongata
Formed mostly by the occipital bone.
Posterior Cranial Fossae cont…
Boundaries
Anteriorly
a) superior border of petrous temporal bone
b) Dorsum sellae of sphenoid bone
Posteriorly
c) Squamous part of occipital bone
On each side
d) Mastoid part of the temporal bone
e) Mastoid angle of the parietal bone

Consist of
Clivus
Internal occipital crest
Cerebellar fossae
Internal occipital protuberance
Grooves formed by the dural venous sinuses:
Foramina/Apertures Jugular foramen

Foramen magnum CN IX, X, and XI
Spinal Cord Superior bulb of internal
Meninges of the brain and spinal cord jugular vein
Vertebral arteries
Inferior petrosal and
Dural veins & Medulla
sigmoid sinuses
Anterior and Posterior spinal arteries
Meningeal branches of
Spinal accessory nerve (CN XI).
ascending pharyngeal and
occipital arteries
Hypoglossal canal Mastoid foramen
Hypoglossal nerve (CN Mastoid emissary vein from
XII) sigmoid sinus and meningeal
branch of occipital artery.

Condylar canal
Internal Acoustic Meatus
Emissary vein that passes
for the facial and
from sigmoid sinus to
vestibulocochlear nerves (CN
vertebral veins in neck
VIII) and
the labyrinthine artery.

Walls of Cranial Cavity
Thinner in females, children and elderly people.

Most bones of the calvaria consist of
Internal and external tables of compact bone.
Separated by diploë (cancellous bone containing red

bone marrow during life) & it contains diploe canal for
diploe vein
Buttresses of cranium
Buttress (stronger pillar) is -
Thickened portions of the cranial bones
Transmit forces by passing the orbits & nasal cavity.
Main buttress includes
Frontonasal buttress
Extend from Canine teeth b/n nasal & orbital cavities
to the central frontal bone

Buttresses of cranium. The buttresses are thicker portions of cranial bone that transmit
forces around weaker regions of the cranium.
Buttresses …
Zygomatic Arch-Lateral Orbital Margin Buttress
Extend from the region of the molars to the lateral
frontal and temporal bones.
Occipital Buttresses
Transmit forces received lateral to the foramen
magnum from the vertebral column.

Regions of Head
Clinical Condition, Head
Fractures of the Maxillae and Associated Bones
Dr. Le Fort classified three common variants of
fractures of the maxillae
Le Fort I fracture:
wide variety of horizontal fractures of the
maxillae,
passing superior to the maxillary alveolar process
(i.e., to the roots of the teeth),
crossing the bony nasal septum and possibly the
pterygoid plates of the sphenoid.

Le Fort II fracture:
Passes from the posterolateral parts of the
maxillary sinuses (cavities in the maxillae)
Superomedially through the infra-orbital
foramina, lacrimals, or ethmoids to the
bridge of the nose.
As a result, the entire central part of the face,
including the hard palate and alveolar
processes, is separated from the rest of the
cranium.
Le Fort III fracture:
• Horizontal fracture that passes through the
superior orbital fissures and the ethmoid

and nasal bones and
extends laterally through the greater wings of
the sphenoid and the frontozygomatic
sutures.
Concurrent fracturing of the zygomatic arches
causes the maxillae and zygomatic bones to
separate from the rest of the cranium.
Fractures of Mandible
Fractures of the coronoid process are uncommon
and usually single
Fractures of the neck of the mandible are often
transverse and may be associated with
dislocation of the temporomandibular joint
(TMJ) on the same side.
Fractures of the angle of the mandible are usually
oblique & may involve the bony socket
or alveolus of the 3rd molar tooth
Fractures of the body of the mandible frequently
pass through the socket of a canine tooth

Fractures of Calvaria
Depressed fractures: a bone fragment is depressed inward,
compressing and/or injuring the brain

Linear calvarial fractures: the most frequent type, usually occur
at the point of impact, but fracture lines often radiate away

from it in two or more directions
Comminuted fractures: the bone is broken into several pieces.
Contrecoup (counterblow) fracture: no fracture occurs at the point
of impact, but one occurs on the opposite side of the cranium.
Anatomy of the SCALP
• The scalp consists of skin and subcutaneous tissue
that covers the neurocranium
It extends from:
• Anteriorly, supra-orbital margin up to superior
nuchal line of the occipital bone (posteriorly)
• Laterally, extend over the temporal fascia up to
zygomatic arch
106
107
Scalp cont…
• It is important clinically because trauma to the scalp
is common in the 4th layer (loose CT).
• The scalp is made of 5 layers:
S = skin
C= dense connective tissue
A = aponeurosis of the occipitofrontalis muscle
L = loose connective tissue
P= periosteum (pericranium)
108
Scalp cont…
 First three are intimately bound together & move as a
unit.
1. Skin
• Thick, hair-bearing; contains numerous sebaceous
glands.
2. Dense connective tissue:
• Thick, dense, richly vascularized, subcutaneous
layer, is well supplied with cutaneous nerves
• The arteries are branches of external & internal
carotid arteries, a free anastomosis takes place b/n
the two.
110
Mengistu A. 111
Scalp cont…
3. Aponeurosis (epicranial):
 Is broad, strong, tendinous sheet
 It covers calvaria
 It unites occipital & frontal bellies of occipitofrontalis
muscle
 Serves as attachment for muscle bellies of:
 Occipitofrontalis
 Superior auricular muscles
112
114
Scalp cont…
4. Loose (areolar) connective tissue
• It has potential spaces that may distend with fluid as a
result of injury or infection.
•This layer allows free movement of the scalp proper
•Contains a few small arteries, and clinically important
emissary veins.
Emissary veins
• Are valveless & connect superficial veins of scalp
with diploic veins of skull bones & with
intracranial venous sinuses
115
Scalp cont…
 The loose (areolar) tissue layer is the danger area of
the scalp because pus or blood spreads easily in it.
 Infection in this layer can pass into cranial cavity thru
emissary veins.
 Which pass thru foramina in the calvaria & reach intracranial
structures such as meninges (dural venous sinuses).
 An infection of scalp cannot pass into the neck because
occipital belly of occipitofrontalis attaches to occipital
bone & mastoid parts of temporal bones.
116
Scalp cont…
 A scalp infection also can not spread laterally beyond
zygomatic arches because epicranial aponeurosis is
continuous with temporalis fascia that attaches to these
arches.
 An infection or fluid (e.g., pus or blood) can enter
eyelids & root of the nose because frontal belly of
occipitofrontalis inserts into skin & dense
subcutaneous tissue & does not attach to the bone.
 Ecchymoses, or purple patches, develop as a result of
extravasation of blood into subcutaneous tissue & skin
of eyelids & surrounding regions.
117
Scalp cont…
• The loose connective tissue layer of scalp will allow
bacteria or fluid to pass freely from posterior aspect
of scalp into eyelids in front.
• Trauma in the back of the head can result in blood
showing up in the eyelids ”black eye” & this should
make you suspect something is going on in the back
of the head.
119
Scalp cont…
5. Pericranium
• The pericranium is the deepest layer of the scalp and is
the periosteum covering on the outer surface of the
calvaria.
• It is attached to the bones of the calvaria.
• But is removable, except in the area of the sutures.
120
Arteries of Scalp:
• Scalp has a rich blood supply.
• Blood vessels anastomose freely with one another.
• Arteries are derived from both internal carotid
(supratrochlear & supraorbital arteries) & external
carotid systems (superficial temporal, posterior
auricular & occipital arteries).
• Blood vessels are located in 2nd layer of scalp,
embedded in the dense connective tissue.
121
Arteries of scalp cont…
• The connective tissue has a special relationship with

arteries in this area:
• When an artery is severed, the connective tissue fibers
around the vessel contract & pull the artery to open
– This results in more hemorrhage than in other places.
• Control of bleeding of the scalp is best done by

application of pressure bandage or compression.
122
123
Veins of Scalp
1. Supra-orbital veins
2. Supratrochlear veins
3. Superficial temporal veins; drain the scalp anterior to
the auricles
4. Posterior auricular veins; drain the scalp posterior to
the auricles.
 The posterior auricular vein often receives a mastoid
emissary vein from the sigmoid sinus.
5. Occipital veins; drain the occipital region of the scalp.
6. Deep temporal veins: drain the deep parts of the scalp
in the temporal region,
– They are tributaries of the pterygoid venous plexus.
Nerves of Scalp:
• Scalp is well supplied with cutaneous nerves –

– Those in front of the ear come from trigeminal (all 3 parts)
&
– Those behind the ear arise from the ventral &

dorsal rami of C2 & C3.
125
Nerves of scalp. The nerves
appear in sequence: CN V1,
CN V2, CN V3, anterior rami of
C2 and C3, and posterior rami
of C2 and C3
Muscles of the Scalp
Occipitofrontalis:
 Consists of four bellies, two occipital & two frontal,
connected by an aponeurosis.
Origin: Each occipital belly arises from the highest nuchal
line of occipital bone & passes forward, to be attached to
the aponeurosis.
 Each frontal belly arises from the aponeurosis & passes
foreward, to be attached to skin & superficial fascia of
the eyebrow
127
Nerve Supply
 Occipital belly is supplied by posterior auricular
branch of facial nerve & Frontal belly by temporal
branch of facial nerve.
Action:
 Frontal bellies raise eyebrows in expressions of
surprise or horror.
128
The Face
 Boundaries
 Superiorly – margins
of hair
 Inferiorly – chin and
base of mandible
 Laterally – auricle
• N.B. the forehead is
common for the scalp and
face
Skin and Fascia of the Face
• Skin
– Connected to underlying bones
– Highly vascular
– Rich in sebaceous and sweat glands
• Superficial fascia
– Contain facial muscles, nerves, vessels and fat (fat
pad in cheeks)
• Deep fascia
– Absent except over parotid gland and over
buccinator muscle
Muscles of the Face & Scalp
A. Muscle of the forehead (1)
1. Occipitofrontalis
B. Muscles around the mouth (11)
1. Orbicularis oris - Sphincter Muscle
2. Zygomaticus major,
3. Levator labii superioris,
4. Levator labii superioris alaeque nasi
5. Levator anguli oris,
6. Zygomaticus minor,
7. Depressor anguli oris
8. Depressor labii inferioris,
9. Mentalis
10. Risorius &
11. Buccinator
Muscles of the Face & Scalp cont…
C. Muscles around the eyelids (2)
1. Orbicularis oculi,
2. Corrugator supercilli &
D. Muscles around the nose (3)
3. Procerus
4. Nasalis (Compressor naris, and Dilator naris) &
5. Depressor septi
• Sensory innervation: by CN V – opthalmic, maxillary,
mandibular
• Motor innervation: by CN VII – the Facial Nerve
Muscles of the Face & Scalp cont…
A. Muscle of the forehead (1) II. Occipital belly
1. Occipitofrontalis O- Lateral two thirds of
I. Frontal belly superior nuchal line
O- Epicranial aponeurosis I- Epicranial aponeurosis
I- Skin and subcutaneous A-Retracts scalp; increasing
tissue of eyebrows and effectiveness of frontal belly
forehead
A- Elevates eyebrows and
wrinkles skin of forehead;
protracts scalp
B. Muscles around the mouth (11)
1. Orbicularis oris
O- Medial maxilla and mandible;
angle of mouth
I- Mucous membrane of the lips
A- Closes oral fissure
B. Muscles around the mouth cont…
 Dilator muscles of the mouth
1. Levator labii superioris alaeque nasi
2. Levator labii superioris
3. Zygomaticus minor
4. Zygomaticus major
5. Levator anguli oris
6. Risorius
7. Depressor anguli oris
8. Depressor labii inferioris
9. Mentalis
O- Bones & fascia around oral aperture
I- Substance of the lips
B. Muscles around the mouth cont…
 Buccinator (cheek muscle)
O- Alveolar processes of maxilla &

mandible, pterygomandibular raphe
I- Angle of mouth; orbicularis oris
A- Presses cheek against molar teeth;
• Works with tongue to keep food b/n
occlusal surfaces and out of oral
vestibule;
• Resists distension (when blowing)
Muscles Around the Eye (2)
1. Orbicularis Oculi
3 parts -
O- Medial orbital margin; medial
palpebral ligament; lacrimal bone
I- Skin around margin of orbit; superior
and inferior tarsal plates
A- Closes eyelids
Orbicularis Oculi cont…
A. Palpebral
O: Medial palpebral lig. &
bones above & below the
lig.
I: Skin of the eyelid passing
anterior to the tarsal plate
A: Gently close the
palpebral fissure (eyelids)
B. Orbital
O: Medial palpebral ligament
and bones above and below
the lig.
I: No lateral attachment b/c
the fibers form concentric
ring
A: Tightly closes the eyelids
C. Lacrimal
O: Two- posterior margin of the fossa &sheath of the
lacrimal sac
I: upper and lower eyelids, upper and lower tarsi
A: Passing tear into lacrimal puncta by drawing the eye
lids medially, dilating the lacrimal fossa

Muscles Around the Eye (2) cont…
2. Corrugators Supercilli
O: Medial part of superciliary arch
I: Skin superior to middle of supraorbital
margin & superciliary arch
A: Draws eyebrow medially & inferiorly,
creating vertical wrinkles above nose
(demonstrating concern or worry)
D. Muscles around the nose (3)
1. Procerus
 Pyramidal muscle
O- Nasal bone and upper part of
lateral nasal cartilage
I- Glabellar skin over lower part of
forehead b/n the eye brows
A-Draws the eyebrow medially and
forms transverse wrinkles on lower
part of fore head
Muscles around the nose cont….
2 . Nasalis - 2 parts
1. Transverse part/ Compressor naris
O- Maxilla just lateral to nose
I- Aponeurosis across dorsum of nose
2. Alar part / Dilator naris posterior
O- Maxilla over lateral incisor
I- Alar cartilage of nose
 Action
 Compression of naris
 Widening of naris & elongation of
noise
Muscles around the nose cont….
3. Depressor Septi
O- Maxilla above medial incisor
I- Mobile part of the nasal septum
Action-
• Pulls the nasal septum & tip of
nose downward
• With alar part of nasalis-
widens the apperture causing
nose to dip on smiling
Muscles of Mastication
1. Masseter
2. Temporalis
3. Lateral pterygoid and Medial pterygoid
 All innervated by- motor fiber of CNV3
Functions
 Stabilize the mandible
 Move the mandible at temporomandibular joint
Muscles of Mastication cont…
1. Masseter
Has superficial and deep layer
O- Zygomatic arch
I- Angle & ramus of mandible
A- Elevates the mandible &
protracts, for chewing
2. Temporalis
O- Temporal fossa
I- Anterior portion of
mandibular ramus and
coronoid process
A- Elevates and retracts
mandible
3. Pterygoids (Medial)
 Has superficial and deep head
O-Superficial head (Maxilla) and deep head (lateral

pterygoid plate and palatine bone)
I- Medial surface mandible
A- Together elevates and protracts the mandible
– Alone- produce grinding motion
4. Pterygoids (Lateral)
O- Lower head (lateral pterygoid plate ) & upper head
(greater wing of sphenoid)
I- condylar process of mandible and articular disk
A- Together depress and protracts mandible
– Alone- side to side movement
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Sensory Innervation of the Face
 Trigeminal nerve (V)-
 Provides sensory innervation to the

skin of the face, except the area over
the angle of mandible & parotid
gland, which is supplied by great
auricular nerve.
 sensory root – supplies the face
 Motor root - muscles of mastication
 It has 3 divisions
Branches of Trigeminal Nerve (V)
1. Ophthalmic Nerve
 It has 3 branches :
a-Lacrimal N. : skin & conjunctiva of lateral part of upper
eyelid.
b- Frontal nerve
1. Supraorbital N.: skin & conjunctiva on the central part
of upper eyelid + skin of forehead.
2. Supratrochlear N. : Skin & conjunctiva on medial part
of upper eyelid + skin of forehead.
Ophthalmic Nerve cont…
c. Nasociliary nerve: Supplies branches to the eyeball and

divides within the orbit into:
1. Posterior ethmoidal
2. Anterior ethmoidal
3. Infratrochlear N.: Skin & conjunctiva on the medial
part of upper eyelid + skin of adjoining part of the side
of the nose.
4. External Nasal N- Skin on the side of the nose
2. Maxillary Nerve
 It has 2 branches :
a-Infraorbital N- supply skin of lower eyelid & cheek,
side of nose, & the upper lip.
b. Zygomatic nerve
i-Zygomaticofacial N.: supply skin over the cheek.
ii-Zygomaticotemporal N.: supply skin of temple.
3. Mandibular Nerve
 It has 3 branches
1-Mental N.: supply skin of lower lip & chin.
2-Buccal N.: It supplies skin & muscles of cheek.
3. Auriculotemporal N.: supply skin of auricle,
external auditory meatus, outer surface of tympanic
membrane & skin of scalp above auricle.
Motor Innervation of the Face
Facial Nerve
 Has posterior auricular nerve & 5 terminal branches:
1. Temporal branch : supply anterior + superior
auricular muscles, frontal belly, orbicularis oculi and
corrugator supercillii
2. Zygomatic branch : supply orbicularis oculi & facial
muscles inferior to the orbit
Facial Nerve…
3. Buccal branch: supply buccinator, muscles of upper

lip (parts of orbicularis oris and inferior fibers of
levator labii superioris) & nostril.
4. Marginal mandibular branch: supply risorius,
muscles of lower lip and chin
5. Cervical branch: supply platysma muscle &
depressor anguli oris muscle.
Arterial Supply of the Face
1. External carotid artery
 Facial artery
 Superficial temporal artery
 Transverse facial artery
 Branches of the maxillary artery
 Occipital artery
 Posterior auricular artery
2. Internal carotid artery
 Branches of the ophthalmic artery
 Supraorbital artery
 Supratrochlear artery
 Zygomaticofacial artery
 Dorsal nasal artery
External Carotid Artery
 Branches of Facial Artery
1. Inferior labial artery: supplies the lower lip
2. Superior labial artery: Supply- the upper lip,
provides a branch to the nasal septum
3. Lateral nasal artery: supplies the lateral surface
and dorsum of the nose
4. Angular artery: supply the superior part of cheek
and inferior eyelid
5. Submental artery: arises from the facial artery
 supply skin of chin + lower lip.
External Carotid Artery cont…
 Superficial temporal artery-

supply Facial muscles & skin of frontal and
temporal regions
• Transverse facial artery- arises within the parotid
gland.
Supply- muscles and skin of face, the skin of the
forehead
External Carotid Artery cont…
 Branches of Maxillary Artery
1. Infra-orbital artery- Infra-orbital foramen
 supplies the lower eyelid, upper lip, and the area
between these structures.
2. Buccal artery- Buccinator muscle
 supplies structures in buccinator area
3. Mental artery- mental foramen
 supplies the chin.
Internal Carotid Artery
 Branches of Ophthalmic Artery
1. Zygomaticofacial artery- enters the face through the

zygomaticofacial foramen
 supplies the area of the face over the zygomatic bone
2. Dorsal nasal artery- exits the orbit in the medial corner

 supplies the dorsum of the nose.
3. Supraorbital artery
4. Supratrochlear artery
Venous Drainage of Face
1. Facial vein
• Are valveless veins that provide the primary superficial
drainage of the face.
Facial vein connects to:
 superior ophthalmic vein through supraorbital vein
 cavernous sinus through superior ophthalmic vein
 pterygoid venous plexus through deep facial vein
 Join the anterior division of retromandibular vein to
form the common facial vein draining to the internal
jugular vein
Venous Drainage of Face cont…
2. Deep facial vein
 drain forehead and scalp
3. Cavernous sinus
4. Pterigoid venous plexues
5. Retromandibular vein
 Formed by union of superficial temporal and
maxillary veins
 Descend within parotid gland & divide to anterior
and posterior divisions
Lymph Drainage of the Face
 Lymph from the face drains to superficial
ring of lymph nodes
1. Submental nodes - drain from the medial
part of the lower lip and chin bilaterally;
2. Submandibular nodes - drain from the
medial corner of the orbit, most of external
nose, medial part of the cheek, upper lip &
lateral part of the lower lip
3. Pre-auricular & parotid node- drain from
most of the eyelids, a part of the external
nose, and lateral part of the cheek.
Clinical Condition
Injuries to Facial Nerve
 Injury to branches of the facial nerve causes paralysis
of the facial muscles (Bell palsy).
– Zygomatic branch- paralysis of orbicularis oculi
(inferior eyelid).
– Buccal branch- paralysis of buccinator and superior
portion of the orbicularis oris and upper lip muscles.
– Marginal mandibular branch- paralysis of inferior
portion of the orbicularis oris and lower lip muscles.
Trigeminal neuralgia (tic douloureux):
• It is a sensory disorder of the sensory root of CN V.
• Common in middle-aged and elderly persons.
• It is characterized by sudden attacks of excruciating,
lightening like jabs of facial pain.
• A paroxysm (sudden sharp pain) can last for 15
minutes or more.
• CN V2 is most frequently involved, then CN V3, and
least frequently, CN V1.
Danger triangle of the face
• The facial vein makes clinically
important connections with the
cavernous sinus through the
– Superior ophthalmic vein, and
– The pterygoid venous plexus
through the inferior ophthalmic
and deep facial veins.
• Because of these connections,
an infection of the face may
spread to the cavernous sinus
and pterygoid venous plexus.
Danger triangle of the face cont…
• Normally, blood from the medial angle of the eye,
nose, and lips usually drains inferiorly through the
facial vein, especially when a person is erect.
• Because the facial vein has no valves, blood may pass
through it in the opposite direction.
• Consequently, venous blood from the face may enter
the cavernous sinus.
• Consequently, the triangular area from the upper
lip to the bridge of the nose is considered the danger
triangle of the face
Eye, Orbit, Orbital Region and
Eyeball
Introduction
• The eye is the organ of vision and consists of the

eyeball and the optic nerve.
• The orbit contains the eyeball and its accessory
visual structures (L., adnexa oculi).
• The orbital region is the area of the face overlying
the orbit and eyeball and includes:
– The upper and lower eyelids and lacrimal apparatus
189
The Orbit
 Bilateral structures in the upper half of the face.
 Below the anterior cranial fossa
 Anterior to the middle cranial fossa.
Contains:
 Eyeball
 Optic nerve
 Extraocular muscles
 Lacrimal apparatus
 Adipose tissue
 Fascia
 Nerves and vessels supplying these structures.
190
Bony orbit
 Composed of Seven bones.
 The maxilla, zygomatic, frontal, ethmoid, lacrimal,
sphenoid, and palatine bones.

 The orbit has a base, four walls, and an apex
191
The base (the orbital rim) is formed:
Outlined by the orbital margin, which surrounds
the orbital opening.
Superiorly by: frontal bone
Medially by: frontal process of maxilla
Inferiorly by: zygomatic process of maxilla and
zygomatic bone
Laterally by: zygomatic bone, frontal process of
zygomatic bone, and zygomatic process of frontal
bone.
193
• The apex of the orbit: is at the optic canal in
the lesser wing of the sphenoid
– Just medial to the superior orbital fissure
Roof (superior wall)
Made of orbital part of frontal (mainly) & the lesser
wing of sphenoid bone.

 Anterolaterally: lacrimal fossa for lacrimal gland.
196
Medial wall
 Primarily by the orbital plate of ethmoid bone, along
with contributions from the frontal process of the
maxilla, lacrimal, and sphenoid bones
 Anteriorly, the medial wall is indented by the lacrimal
groove and fossa for lacrimal sac.
 Much of the bone forming the medial wall is paper
thin.
198
Floor (inferior wall)
 The floor of the bony orbit is also the roof of the
maxillary sinus.
 It consists the orbital surface of maxilla (mainly)
with zygomatic and palatine bones.
 The inferior wall is demarcated from the lateral
wall of the orbit by the inferior orbital fissure
.
199
Lateral wall
 Formed by the frontal process of the zygomatic bone
and the greater wing of the sphenoid.
 This is the strongest and thickest wall.
Which is important because it is most exposed and
vulnerable to direct trauma.
200
201
Eyelids
 The eyelids are moveable folds that cover the eyeball anteriorly
when closed.
 Protecting it from injury and excessive light.
 They also keep the cornea moist by spreading the lacrimal fluid.
 The eyelids are covered externally by thin skin and internally by
transparent mucous membrane, the palpebral conjunctiva.
 This part of the conjunctiva is reflected onto the eyeball, where it is
continuous with the bulbar conjunctiva
202
Eyelids cont…
• The lines of reflection of the palpebral conjunctiva
onto the eyeball form deep recesses, the superior and
inferior conjunctival fornices.
• The conjunctival sac is the space bound by the
palpebral and bulbar conjunctivae.
• It is a closed space when the eyelids are closed, but
opens via an anterior aperture, the palpebral
fissure (the gap between the eyelids)
Tarsus
• The superior (upper) and inferior (lower) eyelids are
strengthened by dense bands of connective tissue:
– The superior and inferior tarsi, which form the “skeleton”
of the eyelids.
– The palpebral portion of the orbicularis oculi are
superficial to the tarsi.
• Embedded in the tarsi are tarsal glands that produce a
lipid secretion.
– Lubricates the edges of the eyelids and prevents
them from sticking together when they close.
Eyelashes
• Found in the margins of the eyelids.
• The large sebaceous glands associated with the
eyelashes are ciliary glands.
• Between the nose and the medial angle of the eye is
the medial palpebral ligament:
– Which connects the tarsi to the medial margin of the orbit.
– The orbicularis oculi originates and inserts onto this
ligament.
• A similar lateral palpebral ligament attaches the tarsi
to the lateral margin of the orbit
– But it does not provide for direct muscle attachment
Orbital septum(palpebral fascia)
Located deep to palpebral part of orbicularis oculi
It is an extension of periosteum into upper and lower
eyelids from margin of the orbit.
Attaches to tendon of levator palpebrae superioris
muscle in upper eyelid and tarsus in lower eyelid .
209
Vessels
Arterial supply to eyelids is from:
 Supratrochlear: Tb. ophthalmic artery
 Supra-orbital: Tb. ophthalmic artery
 Lacrimal: ophthalmic artery
 Dorsal nasal arteries: from ophthalmic artery
 Angular artery: from facial artery
 Transverse facial artery: from superficial temporal artery
 Branches from the superficial temporal artery itself .

210
Venous drainage:
 Follows the various arteries.
Lymphatic drainage:
 Drain to parotid nodes mainly
 Some from medial corner of eye to submandibular
nodes.
212
Innervation:
 The sensory nerves are all branches of the trigeminal nerve [V].
 Palpebral branches arise from:
 Supra-orbital, supratrochlear, infratrochlear, and lacrimal branches
of the ophthalmic nerve [V1];
 Infra-orbital branch of the maxillary nerve [V2].
 Motor innervation from:
 Facial nerve [VII]:To palpebral part of orbicularis oculi
 Oculomotor nerve [III]:To levator palpebrae Superioris
 Sympathetic fibers: To superior tarsal muscle 213

The lacrimal apparatus
The lacrimal apparatus comprises:

1. The lacrimal gland: located in superolateral portion of
the orbit.
– in the fossa for the lacrimal gland;
– Secretes lacrimal fluid, a watery physiological saline
containing the bactericidal enzyme lysozyme.
– The fluid moistens and lubricates the surfaces of
the conjunctiva and cornea
– Provides some nutrients and dissolved oxygen to the cornea;
215
The lacrimal apparatus cont…
2. Lacrimal ducts convey lacrimal fluid from the

lacrimal glands to the conjunctival sac.
3. The lacrimal canaliculi, convey lacrimal fluid from
lacrimal lake to lacrimal sac, (dilated superior part of
nasolacrimal duct).
4. The nasolacrimal duct which extends from the
lacrimal sac and conveys the lacrimal fluid to the
inferior meatus of the nasal cavity.
216
Lacrimal Apparatus
• Surface projection of lacrimal apparatus:
 Tears, secreted by the lacrimal gland in the
superolateral angle of the bony orbit, pass across the
eyeball  enter the lacus lacrimalis (lacrimal lake)
at the medial angle of the eye:  from here they drain
thru the lacrimal puncta & lacrimal canaliculi to the
lacrimal sac.
The lacrimal sac drains into the nasolacrimal duct,
which empties into the inferior meatus of nose.
218
Lacrimal Gland
219
Nerve supply of the lacrimal gland
Parasympathetic: secretomotor fibers are
conveyed from the facial nerve by
– the greater petrosal nerve.
Sympathetic fibers: Vasoconstrictive, brought
from the superior cervical ganglion
Fissures and foramina
 Numerous structures enter and leave the orbit through
a variety of openings
Optic canal
Round opening at apex of pyramidal-shaped orbit.
Opens into middle cranial fossa
Bounded:
Medially by body of sphenoid
Laterally by lesser wing of sphenoid.
 Passage for optic nerve & ophthalmic artery
221
Superior orbital fissure
A triangular-shaped gap between roof and lateral wall
of the bony orbit.
Lies lateral to optic canal
Allow passage of structures b/n orbit and middle
cranial fossa.
Passage for:
Superior and inferior branches of oculomotor nerve
[III]
Trochlear nerve [IV]
Abducent nerve [VI]
Lacrimal, frontal, and nasociliary branches of
ophthalmic nerve [V1]
Superior ophthalmic vein.
223
Inferior orbital fissure
 Separates lateral wall of orbit from floor of orbit
Allows communication between:
 Orbit and pterygopalatine fossa posteriorly
 Orbit and infratemporal fossa in middle
 Orbit and temporal fossa anteriorly.
Passage for:
 Maxillary nerve [V2] and its zygomatic branch.
 infra-orbital vessels, and a vein communicating
with pterygoid plexus of veins.
224
Infra-orbital foramen
Passages for:
 Infra-orbital nerve, a branch of the maxillary nerve
[V2]
Anterior and posterior ethmoidal foramina:

Passages for:
 Anterior & posterior ethmoidal vessels & nerve
225
Muscles of the eyeball
Two groups of muscles within the orbit:
Extrinsic muscles of eyeball
 Involved in movements of the eyeball
 Raise upper eyelids
 Extrinsic muscles are: levator palpebrae superioris,
superior rectus, inferior rectus, medial rectus, lateral
rectus, superior oblique, and inferior oblique.
Intrinsic muscles within the eyeball
 Control the shape of the lens and size of the pupil.
 Intrinsic muscles are: ciliary muscle, sphincter
pupillae, and dilator pupillae.
226
Extrinsic muscles
 Only levator palpebrae superioris, raises the eyelids,
others move eyeball.
Movements of eyeball, 3 dimensions are: Moving pupil
Elevation: superiorly
Depression: inferiorly
Abduction: laterally
Adduction: medially
Internal rotation: rotating the upper part of the pupil
medially (towards the nose)
External rotation: rotating the upper part of the pupil
laterally (towards the temple).
228
229
Extrinsic (extra-ocular) muscles
Muscles Innervation Function
levator palpebrae superioris Oculomotor nerve [III]- Elevation of upper

superior branch eyelid
Superior rectus Oculomotor nerve [III]- Elevation, adduction,

superior branch medial rotation of
eyeball
Inferior rectus Oculomotor nerve [III]- Depression, adduction,

inferior branch lateral rotation of
eyeball 230
Medial rectus Oculomotor nerve [III]- Adduction of eyeball
inferior branch
Lateral rectus Abducent nerve [VI] Abduction of eyeball
Superior oblique Trochlear nerve [IV] Depression, abduction,

medial rotation of eyeball
Inferior oblique Oculomotor nerve [III]- Elevation, abduction,

inferior branch lateral rotation of eyeball
231
232
Rectus muscles
 Four rectus muscles occupy medial, lateral, inferior,
and superior positions .
 Originate as a group from a common tendinous ring at
the apex of the orbit.
 Attached on the eyeball
233
Superior and inferior rectus muscles
 Contraction of the superior rectus elevates, adducts,
and internally rotates the eyeball
 contraction of the inferior rectus depresses, adducts,
and externally rotates the eyeball .
234
Medial and lateral rectus muscles
 Contraction of each medial rectus adducts the eyeball
 Contraction of each lateral rectus abducts the eyeball.
 Medial rectus: inferior branch of oculomotor nerve [III]
 Lateral rectus: abducent nerve [VI]
235
Superior oblique
Action: Its Contraction directs the pupil down and
out.
Innervation: trochlear nerve [IV]
Inferior oblique
 Action: Its Contraction directs the pupil up and out.
 Innervation: Inferior branch of oculomotor nerve.
237
Arterial supply of orbit
Ophthalmic artery
A branch of internal carotid artery
Supply structures in orbit and eyeball
Passes into orbit via optic canal with optic nerve.
238
Branches ophthalmic artery in orbit:
Lacrimal artery
 To lacrimal gland, muscles, anterior ciliary branch to
eyeball, and lateral sides of eyelid
Central retinal a.: To retina
Long & short posterior ciliary a.:
 To structures inside eyeball
240
Muscular a.
 To intrinsic muscles of eyeball
Supra-orbital a.
 To forehead and scalp
Posterior ethmoidal a.
 To ethmoidal air cells & nasal cavity.
241
Anterior ethmoidal artery
 Gives off anterior meningeal branch
 Supply: septum and lateral wall,
Medial palpebral arteries

 To Medial area of upper and lower eyelids
Dorsal nasal artery

 To upper surface of nose
Supratrochlear artery
 Leaves orbit with supratrochlear nerve
 To forehead
242
Veins
Two venous channels in orbit
Superior ophthalmic vein
Begins in anterior area of orbit.
Receive tributaries from companion veins to branches of
ophthalmic artery and veins draining posterior part of
eyeball.
Communicate with facial vein
End in cavernous sinus.

243
Inferior ophthalmic
 Begins on floor of orbit
 receives tributaries from muscles and posterior part of
eyeball.
 Join superior ophthalmic vein
 passes via superior orbital fissure & join cavernous
sinus
 Communicate with pterygoid venous plexus in
infratemporal fossa.
 Ends in superior ophthalmic or cavernous sinus
 So, act as a route by which infections can spread from
outside to inside the cranial cavity.
245
Innervation
Orbit structures are innervated by:
 Optic nerve [II]
 Oculomotor nerve [III]
 Trochlear nerve [IV]
 Abducent nerve [VI]
 Autonomic nerves
 Ophthalmic nerve [V1]
246
Optic nerve[II]
 Extension of the brain carrying afferent fibers from
retina of eyeball to visual centers of brain.
 Surrounded by cranial meninges
 Leaves the orbit through the optic canal.
 Accompanied in optic canal by the ophthalmic artery.
 Provides vision
 Damage causes blindness in visual field
248
Oculomotor nerve[III]
 Leaves the anterior surface of brainstem b/n midbrain

and pons.
 Passes forward in lateral wall of cavernous sinus.
 Before entering the orbit divides into superior and

inferior branches.
 The branches enter the orbit through the superior

orbital fissure, lying within the common tendinous ring.
250
251
Trochlear nerve[IV]
 Arises from posterior surface of midbrain
 Enter the edge of the tentorium cerebelli.
 Enters the orbit through superior orbital fissure above the
common tendinous ring
 Cross above the levator palpebrae superioris muscle .
 Then enter the upper border of superior oblique muscle.

 Eye movement (superior oblique muscle)
 Damage causes double vision and inability to rotate eye
inferolaterally
252
253
Abducent nerve[VI]
arises from brainstem b/n pons and medulla.
enters the orbit through the superior orbital fissure
within the common tendinous ring
supply the lateral rectus muscle.
 Provides eye movement (lateral rectus m.)
 Damage results in inability to rotate eye laterally and
at rest eye rotates medially
254
Ophthalmic nerve [V1]:
 Purely sensory nerve receives input from structures in the orbit
and from branches on face and scalp.
 Before it enters orbit divides into 3 branches- nasociliary,
lacrimal, and frontal nerve
 Its branches enter orbit through superior orbital fissure.
256
Lacrimal nerve
 Smallest of the 3 branches of ophthalmic nerve [V 1].
 It receives a branch from zygomaticotemporal nerve,
which carries parasympathetic and sympathetic
postganglionic fibers for distribution to lacrimal gland.
Supply: lacrimal gland, conjunctiva, and lateral part of

upper eyelid.
258
Frontal nerve
 Largest branch of ophthalmic nerve [V1]
 Receives sensory input from areas outside orbit.
 Has 2 terminal branches:
1.Supra-orbital nerve
Supply: upper eyelid and conjunctiva, forehead up to middle of
scalp.
2.Supratrochlear nerve
supply: conjunctiva and skin of upper eyelid and skin on the
lower medial part of forehead.
260
Nasociliary nerve
 b/n frontal and lacrimal nerve
 First branch from ophthalmic nerve.
 It is most deeply placed in the orbit.
261
Branches of nasociliary nerve
Long ciliary nerves:
 sensory to eyeball
 Contain sympathetic fibers for pupillary dilation
Posterior ethmoidal nerve:
 To posterior ethmoidal air cells and sphenoidal sinus
Infratrochlear nerve:
 To medial part of upper and lower eyelids, lacrimal sac, and
skin of the upper half of the nose.
Anterior ethmoidal nerve:
 To anterior cranial fossa, nasal cavity, and skin of lower
half of nose.
262
Ciliary ganglion
 a parasympathetic ganglion of occulomotor nerve
[III].
 Associated with nasociliary branch of ophthalmic
nerve [V1]
 site where preganglionic and postganglionic
parasympathetic neurons synapse
 Receive at least 2 or 3, branches in orbit.

263
Parasympathetic root
 From inferior branch of the oculomotor nerve [III]
 In eyeball parasympathetic fibers innervate:
 Sphincter pupillae muscle
 Ciliary muscle
Sensory root
Passes from nasociliary nerve to ganglion.
Carries sensory fibers, to all parts of the eyeball.

265
Sympathetic root
 Most variable
 Contains postganglionic sympathetic fibers from
superior cervical ganglion
 Enter the orbit through common tendinous ring.
 Postganglionic sympathetic fibers reach the eyeball and
innervate the dilator pupillae muscle.
266
Clinical conditions
Horner's syndrome
 Caused by a lesion in the sympathetic trunk in the neck that results in
sympathetic dysfunction.
 It is characterized by:
 Pupillary constriction due to paralysis of the dilator pupillae muscle
 Partial ptosis (drooping of the upper eyelid) due to paralysis of the superior
tarsal muscle associated with levator palpebra superioris.
 Absence of sweating on the ipsilateral side of the face and neck due to
absence of innervation of sweat glands.
267
Horner's syndrome cont…
 Ipsilateral vasodilation due to loss of the normal
sympathetic control of the subcutaneous blood
vessels
 Enophthalmos (sinking of the eye).
 Cause for Horner's syndrome is a tumor eroding the
cervicothoracic ganglion, which is typically an apical
lung tumor.
268
Clinical conditions of Orbital Cavity
Fractures of the Orbit:

 Fractures of the medial wall may involve ethmoidal &
sphenoidal sinuses
 Fractures in the inferior wall may involve maxillary
sinus.
Orbital fractures result in intraorbital bleeding, which
exerts pressure on eyeball, causing exophthalmos
(protrusion of the eyeball).
269
Tumors of Orbit
 A malignant tumor in sphenoidal and posterior

ethmoidal sinuses may:
 Erode the bony walls of the orbit
 compress the optic nerve and orbital contents.
 The tumor may produce exophthalmos.
270
Paralysis of Muscles and Nerves of the Orbit
Ptosis
 Loss of innervation of the levator palpebrae
superioris by oculomotor nerve [III]
 Damage causes an inability of the superior eyelid to
elevate.
 Loss of innervation of the superior tarsal muscle by
sympathetic fibers
271
Oculomotor nerve paralysis:
 Resulted in dilated pupil, ptosis
Trochlear nerve paralysis:
 Diplopia on looking down
 Patient has difficulty in descending stairs.
 The head is tilted as a compensatory adjustment.
Abducent nerve paralysis:
 Inability to rotate eye laterally
273
Glaucoma
 Intraocular pressure will rise if the normal cycle of
aqueous humor fluid production and absorption is
disturbed so that the amount of fluid increases.
 This condition is glaucoma.
 May leads to blindness, which results from
compression of the retina and its blood supply.
274
Cataracts
 With increasing age and in certain disease states the
lens of the eye becomes opaque.
 Increasing opacity results in increasing visual
impairment.
 A common operation is excision of the 'cloudy' lens
and replacement with a new manmade lens.
275
Parotid Region
• It is the posterolateral part of the facial region.

– bounded :
Superiorly: by zygomatic arch.
Posteriorly: by external ear and anterior border of the
sternocleidomastoid.
Medially: by ramus of the mandible
Anteriorly: by anterior border of the masseter muscle.
Inferiorly: by angle and inferior border of the mandible.
Content of the Parotid Region
• The parotid gland and duct
• The parotid plexus of the facial nerve (CN VII)
• The retromandibular vein
• The external carotid artery, and
• The masseter muscle.
The parotid gland
• The parotid gland is the largest of three paired salivary
glands.
• Lies in the hollow b/n sternomastoid & ramus of
mandible known as parotid space.
• Enclosed within a tough fascial capsule, the parotid
sheath, from investing layer of deep cervical fascia.
The gland has:
• The parotid bed, is b/n the ramus of mandible &
mastoid process.
• Apex of the gland is posterior to the angle of the
mandible,
• Its base is related to the zygomatic arch.
278
The parotid gland
• Embedded within the substance of the parotid gland,
from superficial to deep, are:
• Parotid plexus of the facial nerve (CN VII) and its
branches,
• Retromandibular vein
• External carotid artery.
• Parotid lymph nodes on the parotid sheath .
280
The parotid duct
•The parotid duct (Stenson’s duct) runs forward over

the masseter, pierces baccinator m &
 Turns inward to open into the inside of the cheek
at the level of upper 2nd molar tooth.
•It forms a small swelling (papilla) inside the oral cavity
that can be easily seen.
•The transverse facial artery runs just above the parotid
duct & is a branch of the superficial temporal artery.
282
283
Innervation of parotid gland
• Great auricular nerve (C2 and C3), branch of
cervical plexus, innervates the parotid sheath and
the overlying skin
• Auriculotemporal nerve, a branch of CN V3, closely
related to the parotid, gives general sensory
innervation to the gland
284
Innervation of parotid gland cont…
• Parasympathetic component of CN IX supplies
secretory fibers to the parotid gland;
 postsynaptic fibers are conveyed from the otic
ganglion to the gland by the auriculotemporal nerve.
• Sympathetic fibers are derived from cervical ganglia
thru the external carotid nerve plexus on external
carotid artery.
 Vasomotor activity of Sympathetic fibers reduces
secretion of parotid gland.
285
286
Clinical Considerations, Mumps
• The most common inflammatory condition of the
parotid gland is parotiditis due to mumps.
• Infection of the gland causes inflammation
(parotiditis) & swelling.
• Severe pain occurs because the parotid sheath
limits swelling.
• Often the pain is worse during chewing because the
enlarged gland is wrapped around the posterior
border of the ramus of the mandible and
– It is compressed against the mastoid process of the temporal
bone when the mouth is opened.
287
Clinical Considerations cont…
• Because the pain produced by mumps may be
confused with a toothache:
 redness of the papilla (opening of the parotid duct)
is often an early sign that the disease involves the gland
and not a tooth.
• Parotid gland disease often causes Referred Pain in
the auricle, external acoustic meatus, temporal
region & temporomandibular joint (TMJ) because:
– The auriculotemporal nerve, sensory nerve of parotid
gland, also supplies sensory fibers to the skin over the
temporal fossa and auricle.
288
Clinical Considerations, Mixed tumors
• Mixed tumors form the most common neoplasms of

salivary glands, & the parotid.
• It is the site of 85-90% of the mixed tumors.
 Tumor may involve either the superficial or deep

lobe or both lobes of parotid.
289
Treatment of mixed tumors
 Treatment consists of excision of tumor

• The most important step in doing parotidectomy is
identification, dissection, isolation & preservation
of the facial nerve:
 In malignant tumor of the parotid it may be
necessary to sacrifice the facial nerve & its branches.
290
Temporal & Infratemporal Fossa
• Are interconnected spaces on the lateral side of the
head.
• Their boundaries are formed by bone and soft tissues.
• The temporal fossa is superior to infratemporal fossa,
above zygomatic arch.
• Communicates with the infratemporal fossa below.
• The infratemporal fossa is a wedge-shaped space deep
to the masseter muscle and the underlying ramus of
the mandible.
291
292
Temporal & Infratemporal Fossa cont…
• Structures that travel b/n the cranial cavity, neck,
pterygopalatine fossa, floor of the oral cavity, floor of
the orbit, temporal fossa, and superficial regions of
the head pass thru the infratemporal fossa.
• Of the four muscles of mastication:
– One (masseter) is lateral to the infratemporal fossa
– Two (medial & lateral pterygoid) are in the infratemporal
fossa &
– One (temporalis) fills the temporal fossa.
293
Temporal & Infratemporal Fossa cont…
• Zygomatic process of the temporal bone is the

boundary b/n the temporal fossa & the infratemporal
fossa.
• Deeply, the infratemporal crest separates temporal &
infratemporal fossae.
294
The Temporal Fossa
The Temporal Fossa: bounded by:

• Superiorly & posteriorly : superior temporal line on the
side of the skull
• Inferiorly: zygomatic arch & infratemporal crest
• Anteriorly: frontal bone & zygomatic bone.
296
The Temporal Fossa cont…
Contents:
• Temporalis muscle & its covering fascia (temporal
fascia: attached to sup. temporal line; crossed by sup
temporal vessels & auriculotemporal n. & enclose
zygomatico-orbital a & zygomatico-temporal n)
• Deep temporal nerves & vessels
• Auriculotemporal nerve
• Superficial temporal artery
297
The Temporal Fossa
298
Boundaries of Infratemporal Fossa
Lateral wall of
infratemporal- fossa is
consists of the:
 ramus of
Mandible(4):
Medial wall:
-lateral pterygoid plate of
sphenoid bone
299
Boundaries of Infratemporal Fossa cont…
Roof:
-greater wing of sphenoid:-
includes foramen ovale & foramen
spinosum
Anteriorly:
-posterior surface of maxilla
Posteriorly:
-styloid process
300
301
Contents of Infratemporal Fossa
1. Mandibular nerve & its branches: (buccal, lingual,

inferior alveolar & auriculotemporal)
2. Maxillary artery & its branches
3. Medial & lateral pterygoid muscles
4. Otic ganglion
5. Chorda tympani
6. Pterygoid venous plexus
302
303
Infratemporal Fossa: Contents
304
Maxillary artery
•The maxillary artery arises at the neck of the mandible &

is divided into three parts by the lateral pterygoid m:
1. The first or retromandibular part
2. Second or pterygoid part (directly related to the
lateral pterygoid)
3. The third (pterygopalatine) part
305
Branches of the first part of Maxillary artery
•Branches of the first part (pass thru foramina or

canals):
1. Deep auricular (da)to external acoustic meatus,
2. Anterior tympanic (at) to the tympanic cavity,
3. Middle meningeal (mm) to the cranial cavity
4. Accessory meningeal (amm) to the cranial cavity, &
5. Inferior alveolar (ia) to the mandible & teeth.
306
307
Branches of the 2nd part of Maxillary artery
1. Deep temporal (dt)
2. Buccal (b)
3. Masseteric artery
4. Pterygoid branch
308
Branches of the 3rd part of Maxillary artery
1. Posterior superior alveolar (psa),

2. Descending palatine (dp),
3. Infraorbital (io), &
4. Sphenopalatine arteries (spa) arise within the
pterygopalatine fossa.
5. Artery of pterygoid canal
6. Pharyngeal branch
309
Pterygoid venous plexus:
• Occupies most of the infratemporal fossa.
• It is located partly b/n temporal & pterygoid muscles.
• Receives venous blood from areas supplied by
branches of maxillary artery
• Receives tributaries from deep facial & inferior
ophthalmic v.
• It communicates with cavernous sinus via emissary v.
• Drains anteriorly to facial vein via deep facial vein but
mainly drains posteriorly via the maxillary & then the
retromandibular veins.
310
311
Mandibular Nerve
•The mandibular nerve (V3) is nerve of the

infratemporal fossa & responsible for supplying:
•The muscles of mastication plus
•Two tensor muscles:
1) Tensor palati &
2) tensor tympani.
312
Branches of the mandibular nerve (V3):
• Temporal (dt)
• Auriculotemporal (at)
• Inferior alveolar (ia)
nerve to the mylohyoid (nmh)
• Lingual (l)
• Buccal (b)
• Branches to lateral pterygoid (not labeled)
• Meningeal branch (not labeled)
• Nerve to masseter (not labeled)
Mandibular nerve block
• To perform a mandibular nerve block, an
anesthetic agent is injected near the
mandibular nerve where it enters the
infratemporal fossa.
 This block usually anesthetizes the
auriculotemporal, inferior alveolar, lingual, and
buccal branches of the mandibular nerve.
315
Alveolar nerve block
• An alveolar nerve block commonly used by dentists
when repairing mandibular teeth anesthetizes the
inferior alveolar nerve, a branch of CN V3 .
• Anesthetic agent is injected around mandibular
foramen, on medial aspect of ramus of mandible.
This canal gives passage to inferior alveolar nerve,
artery & vein.
316
Alveolar nerve block cont…
• When this nerve block is successful, all mandibular

teeth are anesthetized.
• The skin & mucous membrane of the lower lip, the
labial alveolar mucosa & gingiva, & the skin of the
chin are also anesthetized because they are supplied by
the mental branch of inferior alveolar nerve.
317
Temporomandibular Joint
•The temporomandibular joint (TMJ) is a modified
hinge type of synovial joint
•The bony articular surfaces involved are the mandibular
fossa and articular tubercle of the temporal bone
superiorly, and the head of the mandible inferiorly
•An articular disc separates the joint cavity into 2
cavities (into two separate joints), an upper & lower
compartments.
 Each lined by a separate synovial membrane. 318
319
Temporomandibular Joint cont…
•Upper (temporomeniscal) joint (ujc): is b/n

mandibular (articular) fossa of the temporal bone & the
articular disc
 It provides a sliding motion:
Protrusion & retraction movements take place here.
321
•Lower (meniscomandibular) joint (ljc): is b/n

articular disc & head of the condyle of mandible:
the action here is a hinge-like action :
 depression & elevation movements
• Side to side or chewing or grinding movements
occur at both joints
322
324
• Movements of the TM joint are produced by muscles of

mastication.
• In resting position, there is a small space b/n upper and
lower teeth.
a). Opening mouth — lateral pterygoid (mainly), helped by

anterior belly of digastic, mylohyoid, geniohyoid, gravity.
b). Closing mouth - masseter, temporalis, medial pterygoid
325
c). Protraction - lateral pterygoid mainly (& also masseter &

medial pterygoid)
d). Retraction - posterior fibers of temporalis
e). Lateral movement (grinding) – contralateral Lateral &
medial pterygoids & ipsilateral temporalis.
N.B: Although buccinator muscle is a muscle of facial
expression, its main function is in chewing
 Its contraction press cheeks against the teeth to prevent food
from collecting in the vestibule.
326
Nerve Supply to Temporomandibular Joint
1. Auriculotemporal n. of V3
2. Maseteric branch of V3
Arterial Supply:
• Branches from Maxillary & superficial temporal
artery
327
Ligaments of Temporomandibular joint
• Lateral (temporomandibular) ligament strengthens the

lateral aspect of the joint & prevents backward (posterior)
displacement of TMJ.
• The strong sphenomandibular ligament: run from the
spine of the sphenoid to the lingula of the mandible; serve
as a “swinging hinge” for the mandible
• The weaker stylomandibular ligament: joins the styloid
process to angle of the mandible.
328
Factors for stability of TMJ
1. Position of mandible: occluded position stabilizes the
joint
2. Lateral (temporomandibular) ligament: prevents
backward (posterior) displacement of TMJ.
3. Bones: forward displacement prevented by articular
eminence & backward displacement prevented by
pterygoid tubercle.
4. Muscles: tendon of temporalis m. prevents over-
protrusion & lateral pterygoid prevents over-retraction.
330
Dislocation of TMJ
Usually an anterior dislocation:
During yawning or a blow or when taking large bites,
excessive contraction of the lateral pterygoids can cause
the head of the mandible to dislocate (pass anterior to the
articular tubercle):
 The mouth remains wide open & the person cannot close
it without manual distraction.
Treatment: Press down on molar teeth with thumbs and at
same time pull up chin.
331
Pterygopalatine Fossa
• The pterygopalatine fossa is an inverted 'tear-drop'
shaped space b/n:
– lateral pterygoid plate (posteriorly) & posterior to the
maxilla (anteriorly)
• The pterygopalatine fossa communicates via fissures
and foramina in its walls with:
1. The middle cranial fossa;
2. Infratemporal fossa;
3. Floor of the orbit;
4. Lateral wall of the nasal cavity;
5. Nasopharynx;
6. Roof of the oral cavity.
332
333
Pterygopalatine Fossa cont…
• The pterygopalatine fossa communicates:

• Laterally with the infratemporal fossa, thru the
pterygomaxillary fissure.
• Medially with the nasal cavity thru sphenopalatine foramen.
• Anterosuperiorly with the orbit thru the inferior orbital
fissure.
• Posterosuperiorly with the middle cranial fossa thru foramen
rotundum & pterygoid canal.
334
Communications of Pterygopalatine Fossa
• Seven foramina and fissures provide apertures thru
which structures enter & leave the pterygopalatine
fossa:
1. Foramen rotundum & pterygoid canal
communicate with the middle cranial fossa;
2. A small palatovaginal canal leads to the
nasopharynx;
3. Palatine canal leads to roof of oral cavity (hard
palate);
336
Communications of Pterygopalatine Fossa
4. Sphenopalatine foramen opens onto the lateral wall

of the nasal cavity;
5. Pterygomaxillary- fissure) is continuous with the
infratemporal fossa
6. Inferior orbital fissure opens into the floor of the
orbit.
337
Contents of the Pterygopalatine Fossa:
1. The maxillary nerve [V2] & terminal part (3rd part) of the
maxillary artery.
2. Nerve of the pterygoid canal enters the fossa carrying:
• preganglionic parasympathetic fibers from greater petrosal
branch of the facial nerve [VII];
• postganglionic sympathetic fibers from the deep petrosal branch
of the internal carotid plexus of superior cervical ganglia.
3. The pterygopalatine ganglion;  contains cell bodies for the
postganglionic parasympathetic fibers in the greater petrosal
branch of facial nerve [VII], is formed in the fossa.
4. Arteries, veins & lymphatics also pass thru the pterygopalatine
fossa.
338
Pterygopalatine fossa: Nerves
339
Pterygopalatine fossa: Vessels & nerves
• The pterygopalatine (3rd) part of the maxillary artery, passes thru
the pterygomaxillary fissure & enters the pterygopalatine fossa.
• Branches of pterygopalatine part of maxillary artery are :
1. Posterior superior alveolar artery.
2. Descending palatine artery, divides into greater & lesser
palatine art.
3. Sphenopalatine artery, which divides into posterior lateral nasal
branches to the lateral wall of the nasal cavity & its associated
paranasal sinuses, and the posterior septal branches.
4. Infraorbital artery, which gives rise to the anterior superior
alveolar artery and terminates as branches to the inferior eyelid,
nose, and upper lip.
340
Pterygopalatine fossa: Vessels & nerves
341
The Oral Region
• The oral region includes the oral cavity (mouth), teeth,

gingivae (gums), tongue, palate, and the region of the
palatine tonsils.
Oral Cavity:
• Extends from oral fissure to oropharynx
Contents:
1. Teeth & gums
2. Tongue
342
Boundaries of oral cavity
boundaries of oral cavity are:
• Superior--hard & soft palates
• Inferior--tongue & floor of mouth
• Anterolateral--upper & lower teeth
• Posterior--palatoglossal fold
Oral Cavity cont…
• Main functions include:
1. Salivation, biting, drinking, sucking, & mastication

2. Articulation, speech
• The oral cavity consists of two parts:
– The oral vestibule &
– Oral cavity proper.
344
The oral vestibule:
• It is the slit-like space b/n the lips & cheeks
superficially & teeth & gingivae deeply.
• Communicates with the exterior through the mouth.
The oral cavity proper:
• It is the space posterior & medial to upper & lower
dental arches.
• Limited laterally & anteriorly by the maxillary &
mandibular alveolar arches housing the teeth.
• The roof is formed by the palate & floor by the
tongue.
• Posteriorly, the oral cavity communicates with the
oropharynx.
345
The lips:
• They are covered externally by skin and internally by
mucous membrane.
• The upper lip is supplied by superior labial branches
of the facial & infraorbital arteries.
• The lower lip is supplied by inferior labial branches of
facial & mental arteries.
• The upper lip is supplied by the superior labial
branches of the infraorbital nerves (CN V2), and
• The lower lip by the inferior labial branches of mental
nerves (CN V3).
346
Nerves of the oral Cavity
• Multiple nerves innervate the oral cavity:
• General sensory innervation: mainly by branches of
trigeminal nerve [V]:
– The upper parts of the cavity, including the palate and the
upper teeth, are innervated by branches of the maxillary
nerve [V2];
– The lower parts, including the teeth and oral part of the
tongue, are innervated by branches of the mandibular nerve
[V3];
347
Nerves of the oral Cavity cont…
• Taste (special afferent-SA) from the oral part or
anterior two-thirds of the tongue is carried by branches
of the facial nerve [VII] & from post one-third by CN
IX.
• Parasympathetic fibers to the glands within the oral
cavity: by branches of CN VII,
• Sympathetic fibers: come from T1 spinal cord,
synapse in the superior cervical sympathetic ganglion.
348
Nerves of the oral Cavity cont…
• All muscles of the tongue are innervated by the
hypoglossal nerve [XII], except the palatoglossus,
which is innervated by the vagus nerve [X].
• All muscles of the soft palate are innervated by the
vagus nerve [X] except for the tensor veli palatini,
which is innervated by a branch from the mandibular
nerve [V3].
• The muscle (mylohyoid) that forms the floor of the oral
cavity is also innervated by the mandibular nerve [V 3].
349
Oral Cavity
350
• Structures that you should be able to
feel or see in your own mouth.
Structures to identify:
1. vestibule
2. hard palate
3. soft palate
4. uvula
5. palatoglossal arch
6. palatine tonsil
7. palatopharyngeal arch
8. posterior wall of oropharynx
9. pterygoid hamulus
Hard palate formed by:

•Palatine process of
maxilla
•Horizontal plate of
palatine bone
351
Oral Cavity Proper
Skeletal framework:
• Bones contributing to skeletal framework of oral
cavity include:
paired maxillae & palatine & temporal bones;
 unpaired mandible, sphenoid, & hyoid bone.
352
354
Oral Cavity Proper: Palate
Soft Palate
• Has two surfaces
1. Nasal surface: -ciliated columnar epithelium
2. Oral surface: -stratified squamous epithelium
• Is composed of mucous membrane containing:
• Aponeurosis
• Muscular fibers
• Vessels
• Nerves
• Lymphoid tissue
• Mucous glands
355
Oral Cavity Proper: Palate
Soft Palate:
• The muscles of soft palate:
1. tensor veli palati
2. levator veli palati
3. palatopharyngeus
4. Musculus uvulae
Innervation:
• all except tensor veli palati
Are supplied by pharyngeal
plexus via vagus nerve.
356
Oral Cavity Proper
357
Muscles of Soft Palate
Tensor veli palatini :
Origin; Scaphoid fossa of sphenoid bone; fibrous part of
pharyngotympanic tube; spine of sphenoid
Insertion; Palatine aponeurosis
Innervation; Mandibular nerve [V3] via the branch to medial

pterygoid muscle
Function: Tenses the soft palate; opens the pharyngotympanic tube
358
Muscles of Soft Palate cont…
Levator veli palatini:
Origin; Petrous part of temporal bone anterior to
opening for carotid canal
Insertion; Superior surface of palatine aponeurosis
Innervation; Vagus nerve [X] via pharyngeal branch to
pharyngeal plexus
Function; Only muscle to elevate the soft palate above
the neutral position
359
Muscles of Soft Palate cont…
Palatopharyngeus:
Origin; Superior surface of palatine aponeurosis
Insertion: Pharyngeal wall
Innervation; Vagus nerve [X] via pharyngeal branch to pharyngeal
plexus
Function; Depresses soft palate; elevates pharynx
Musculus uvulae:
Origin: from Posterior nasal spine of hard palate
Insertion: Connective tissue of uvula
Innervation; Vagus nerve [X]
Function; Elevates and retracts uvula; thickens central region of
soft palate
360
361
Nerve supply of the Palate:
• The palate is supplied by greater & lesser palatine
nerves and nasopalatine nerve.
• General sensory fibers carried in all these nerves
originate in the pterygopalatine fossa from the
maxillary nerve.
• Parasympathetic (to glands) & special sensation
of taste fibers are from facial nerve
• Sympathetics (mainly to blood vessels-
vasoconstriction): come from T1 spinal cord level.
362
The Palate: Nerves & Arteries
363
Innervation of the Palate
• Greater & lesser palatine nerves descend thru the
pterygopalatine fossa & palatine canal to reach the
palate:
• Greater palatine nerve travels thru greater palatine
foramen & turns anteriorly to supply the hard palate &
gingiva as far as the first premolar;
• Lesser palatine nerve passes posteromedially to supply
the soft palate.
• Nasopalatine nerve also originates in the
pterygopalatine fossa, but passes medially into the nasal
cavity.
• Nasopalatine nerve supplies gingiva & mucosa adjacent
to the incisors and canine. 364
Clinical condition
• The nasopalatine nerves can be anesthetized by
injecting anesthetic into the incisive fossa in the hard
palate:  The anesthetized tissues are the palatal
mucosa, the lingual gingivae, the six anterior
maxillary teeth, and associated alveolar bone.
• The greater palatine nerve can be anesthetized by
injecting anesthetic into the greater palatine foramen.
• The nerve emerges b/n 2nd & 3rd maxillary molar teeth.
 This nerve block anesthetizes the palatal mucosa
and lingual gingivae posterior to the maxillary
canine teeth, and the underlying bone of the palate.
365
Blood supply of the Palate:
Arteries
1. Greater palatine a. (maxillary a.): hard palate
2. Ascending palatine (facial a.):  soft palate
3. Palatine a. (ascending pharyngeal branch of ECA)
 supply soft palate
4. Lesser palatine a. (maxillary a.): soft palate
Veins:
• Drain into pterygoid plexus & tonsillar plexus
Lymphatic drainage: Drain into deep cervical LN
366
Floor Oral Cavity
• The floor of the oral cavity proper is formed mainly
by:
1. Paired mylohyoid muscles, a muscular diaphragm,
2. Two cord-like geniohyoid muscles above the
diaphragm,
3. The tongue, which is superior to the geniohyoid
muscles.
4. Also present are salivary glands & their ducts:
sublingual gland & oral part of the submandibular
gland.
367
The Floor of the Mouth
368
Mylohyoid muscles
• The two thin mylohyoid muscles, form a muscular
diaphragm that defines inferior limit of floor of oral
cavity.
• Each muscle is triangular in shape with its apex
pointed forward.
• Lateral margin of the muscle is attached to mylohyoid
line of the mandible.
369
370
Tongue
• The tongue (L. lingua; G. glossa) is a mobile
muscular organ covered with mucous membrane
• It is partly in the oral cavity and partly in
the oropharynx.
• The tongue has a root, body, and apex
• The tongue features two surfaces.
– the dorsum of the tongue (“top” of the tongue).
– The inferior surface of the tongue (“underside”)
371
Muscles of the Tongue
a. Intrinsic muscles of the tongue
• The intrinsic muscles of the tongue originate and
insert within the substance of the tongue.
• They are divided into superior longitudinal, inferior
longitudinal, transverse, and vertical muscles, and
they alter the shape of the tongue by:
– lengthening and shortening it;
– curling and uncurling its apex and edges;
– flattening and rounding its surface
373
b. Extrinsic muscles of the tongue
• Extrinsic muscles of the tongue originate from
structures outside the tongue and insert into the
tongue.
• There are four major extrinsic muscles on each side:
genioglossus, hyoglossus, styloglossus, &
palatoglossus.
• They protrude, retract, depress, & elevate the
tongue.
374
Genioglossus: CN - XII
O: Superior part of mental spine of mandible
I: Dorsum of tongue and body of hyoid bone
A: Depresses tongue; its posterior part pulls tongue
anteriorly for protrusion (as in “Aaahh”/sticking the
tongue out).
375
Hyoglossus: (CN-XII) is an important landmark in the
floor of oral cavity:
Lingual artery in the neck enters the tongue deep to
the hyoglossus,
 CN – XII & lingual nerve [V3] & lingual vein enter
the tongue superficial to hyoglossus.
Origin: Body and greater horn of hyoid bone
Insertion: Side and inferior aspect of tongue
Action: Depresses and retracts tongue
377
Styloglossus: CN - XII
O: Styloid process of temporal bone and stylohyoid
ligament
I: Side and inferior aspect of tongue
A: Retracts tongue and draws it up to facilitate
swallowing.
Palatoglossus: CN - X
O: Palatine aponeurosis of soft palate
I: Side of tongue
A: Elevates posterior part of tongue
378
The Tongue: Structures Entering
379
Innervation of the Tongue:
• All muscles of the tongue, except the palatoglossus,
receive motor innervation from CN XII, (hypoglossal
nerve).
• Palatoglossus is a palatine muscle supplied by the
pharyngeal plexus (CN X)
(i). Anterior 2/3rd:
• General sensation lingual nerve (V3)
• Taste (special sensation) chorda tympani (VII)
(ii). Posterior 1/3rd:
• General sensation glossopharyngeal (IX)
• Taste (special sensation) glossopharyngeal (IX)
380
The Tongue: Muscles
381
Blood Supply to the Tongue
Arteries
1). Lingual artery
2). Tonsilar branch of Facial artery &
3). Ascending pharyngeal artery.
Veins:
• Lingual vein drain into Internal Jugular Vein
382
Lymphatic Drainage
 Tip of the tongue drains into Submental LN.
 Medial & Lateral parts of anterior two-thirds
drains into Inf. Deep Cervical LN &
Submandibular, respectively.
 Posterior one-thirds drains into Sup Deep
Cervical LN.
385
The Tongue: Clinical Conditions
• Malignant tumors in the posterior part of tongue

metastasize to the superior deep cervical lymph
nodes on both sides.
• Tumors in the apex of tongue to submental lymph
nodes;
• Tumors in the medial & lateral parts of the body
the tongue  to the inferior deep cervical nodes &
to submandibular lymph nodes, respectively.
387
The Tongue: Clinical Conditions cont…
• One may touch the anterior part of the tongue without

feeling discomfort; however, when the posterior part
is touched, one usually gags  Gag Reflex.
• CN- IX & CN- X are responsible for the muscular
contraction of each side of the pharynx.
• CN- IX provide the afferent limb of the gag reflex.
388
• When genioglossus is paralyzed, tongue mass has a
tendency to shift posteriorly, obstructing the airway &
presenting the risk of suffocation.
• Total relaxation of the genioglossus muscles occurs
during general anesthesia;
• Thus, the tongue of an anesthetized patient must be
prevented from relapsing by inserting an airway.
389
• In clinical examination, when a patient is asked to say
“Aaahh”, (Asking a patient to 'stick the tongue
out‘), the muscle & nerve being tested are the
genioglossus & hypoglossal nerves [XII],
respectively.
• If the nerves are functioning normally, the tongue
should protrude evenly in the midline.
• If the nerve on one side is not fully functional, the tip
of the tongue will point to the affected side.
390
The submandibular glands
• Lie along body of mandible, partly superior & partly

inferior to posterior half of mandible & partly
superficial & partly deep to mylohyoid muscle
• The submandibular duct, approximately 5 cm long,
arises from the portion of the gland that lies
between the mylohyoid and hyoglossus muscles
391
The submandibular glands cont…
Arterial supply: is from the submental arteries.
Venous drainage: veins accompany the arteries.
Innervation: supplied by:
• Presynaptic parasympathetic secretomotor fibers 
chorda tympani nerve
• Vasoconstrictive postsynaptic sympathetic fibers
from the superior cervical ganglion.
Lymphatic drainage: drain into submandibular &
deep cervical LN, particularly the jugulo-omohyoid
LN.
392
Sublingual Glands:
• Are the smallest and most deeply situated.
• Each almond-shaped gland lies in the floor of the mouth
b/n mandible & genioglossus me.
• The glands from each side unite to form a horseshoe-
shaped mass around the lingual frenulum.
Sublingual duct: 8-20 in number; open individually on
summit of sublingual papilla; some join to form a single
orifice; or a few open into submandibular duct.
Arterial supply: is from sublingual & submental arteries,
branches of lingual & facial arteries, respectively.
Innervation: is same as that of submandibular gld.
394
Submandibular & Sublingual Gland: Nerves
395
Submandibular Gland: Clinical Note
• Excision of a submandibular gland because of
a calculus (stone) in its duct or a tumor in
the gland is common.
• Risks to the mandibular branch of the facial
nerve may be avoided by making the skin
incision at least 2.5 cm inferior to the angle
of the mandible.
396
Teeth and gingivae
• The teeth are attached to sockets (alveoli) in two
elevated arches of bone on the mandible below and
the maxillae above.
• If the teeth are removed, the alveolar bone is resorbed
and the arches disappear.
• The gingivae (gums) are specialized regions of the
oral mucosa that surround the teeth and cover adjacent
regions of the alveolar bone.
397
The Teeth
• Two successive sets of teeth develop in humans:
– Deciduous teeth ('baby' teeth) &
– Permanent teeth ('adult' teeth).
• The deciduous teeth emerge at b/n six months & two
years of age.
• There are 20 primary (deciduous) teeth.
• They are named central incisor, lateral incisor,
canine, 1st molar (M1) , and 2nd molar (M2).
398
The Teeth cont…
• Primary teeth differ from permanent teeth in that:
– The primary teeth are smaller & whiter;
– The molars also have more bulbous crowns & more
divergent roots.
Permanent teeth
• Begin to emerge & replace the deciduous teeth at
around age six years &
• Can continue to emerge into adulthood.
399
400
Innervation of the Teeth
• All nerves that innervate the teeth and gingivae are
branches of the trigeminal nerve [V]
The lower teeth
• All innervated by branches from the inferior alveolar
nerve, which originates in the infratemporal fossa from
the mandibular nerve.
• Inferior alveolar nerve & its accompanying vessels
enter the mandibular foramen.
401
The lower Teeth cont…
• Adjacent to the first premolar tooth, the inferior
alveolar nerve divides into incisive & mental
branches.
• The incisive branch innervates the first premolar, the
canine, and the incisor teeth, together with associated
vestibular (buccal) gingiva.
• The mental nerve exits the mandible thru mental
foramen & innervates the chin & lower lip.
402
Innervation of the upper teeth
• All upper teeth are innervated by anterior, middle & posterior
superior alveolar nerves.
• The posterior superior alveolar nerve originates directly from
the maxillary nerve [V2]: innervates the molar teeth.
• The middle & anterior superior alveolar nerves originate from
the infra-orbital branch of maxillary nerve [V2] :
• Middle superior alveolar nerve innervates the premolar teeth.
• Anterior superior alveolar nerve, supplies the canine & incisor

teeth.
403
Innervation of gingivae
• Like the teeth, the gingivae are innervated by
branches of trigeminal nerve [V]:
• Gingiva of upper teeth is innervated by branches of
maxillary nerve [V2];
• Gingiva of lower teeth: by branches of the
mandibular nerve.
404
Innervation of gingivae of upper teeth
• Gingiva on the buccal side of the upper teeth: by
anterior, middle, & superior alveolar nerves, which
also innervate the adjacent teeth.
• Gingiva on the palatal (lingual) side of upper teeth:
by the nasopalatine & greater palatine nerves.
• Nasopalatine nerve innervates gingiva associated
with the incisor & canine teeth;
• Greater palatine nerve supplies gingiva associated
with the remaining teeth.
405
Innervation of gingivae of lower teeth
• Gingiva associated with the buccal side of the
mandibular incisor, canine, & premolar teeth is
innervated by the mental branch of the inferior
alveolar nerve.
• Gingiva on the buccal side of mandibular molar teeth
is innervated by the buccal nerve, which originates in
the infratemporal fossa from mandibular nerve [V3].
• Gingiva adjacent to lingual surface of all lower teeth:
by lingual nerve.
406
Vessels of the lower Teeth
• All lower teeth are supplied by the inferior alveolar
artery, branch of maxillary artery.
• The vessel enters the mandibular canal, &
– Divides opposite the first premolar into incisor & mental
branches.
• Mental branch leaves the mental foramen to supply
the chin, while the
• Incisor branch continues in bone to supply the anterior
teeth & adjacent structures.
407
Vessels of the upper Teeth
• All upper teeth are supplied by anterior & posterior
superior alveolar aa.
• Posterior superior alveolar artery originates from
maxillary artery & enters small canals in the bone to
supply the molar & premolar teeth.
• Anterior superior alveolar artery originates from
infra-orbital artery, which arises from maxillary
artery in the pterygopalatine fossa.
• It passes thru bone & branches to supply incisor &
canine teeth.
408
Vessels of the gingiva
• Buccal gingiva of the lower teeth is supplied by
branches from the inferior alveolar artery whereas
• The lingual side is supplied by branches from the
lingual artery of the tongue;
• Buccal gingiva of the upper teeth is supplied by
branches of the anterior and posterior superior
alveolar arteries;
• Palatal gingiva is supplied by branches from the
nasopalatine (incisor & canine teeth) & greater
palatine (premolar & molar teeth) arteries.
409
Vessels of the Teeth cont…
• Veins from the upper and lower teeth generally

follow the arteries.
• Inferior alveolar veins from the lower teeth, and
superior alveolar veins from the upper teeth drain
mainly into the pterygoid plexus of veins in the
infratemporal fossa;
• Some drainage from the anterior teeth may be via
tributaries of the facial v.
410
• The pterygoid plexus drains mainly into the maxillary vein
and ultimately into the retromandibular vein and jugular
system of veins.
• In addition, small communicating vessels pass superiorly,
from the plexus, and pass through small emissary foramina
in the base of the skull to connect with the cavernous sinus
in the cranial cavity:
• Infection originating in the teeth can track into the cranial
cavity thru these small emissary veins.
411
• Veins from the gingivae also follow the arteries and

ultimately drain into the facial vein or into the
pterygoid plexus of veins.
• Lymphatic vessels from the teeth & gingivae drain
mainly into:
– Submandibular cervical nodes,
– Submental cervical nodes &
– Deep cervical nodes
412
Pharynx
The pharynx: is a musculofascial half-cylinder that links
oral & nasal cavities in the head to the larynx &
esophagus in the neck.
• The pharyngeal cavity is a common pathway for air and
'food'.
Superiorly: attached to base of the skull
Inferiorly: is continuous with esophagus, at about level of C-
VI vertebra.
Laterally: carotid artery; styloid process
Posteriorly: bodies of Cervical vertebral; retropharyngeal
space
Anteriorly: its walls are deficient & are attached to margins
of nasal cavities, oral cavity & larynx.
413
Pharynx cont…
• Based on its anterior relationships, pharynx is
subdivided into 3 regions:
 Nasopharynx, oropharynx, & laryngopharynx:
• Posterior apertures (choanae) of nasal cavities:
open into nasopharynx;
• Posterior opening of the oral cavity (oropharyngeal
isthmus): opens into the oropharynx;
• Superior aperture of larynx (laryngeal inlet): opens
into laryngopharynx.
415
Pharynx cont…
• Pharyngeal cavity is also related anteriorly to posterior
one-third of the tongue & to posterior aspect of the
larynx.
• The pharyngotympanic tubes open into the lateral walls
of the nasopharynx.
• Lingual, pharyngeal, & palatine tonsils are on deep
surfaces of pharyngeal walls.
• Pharynx is separated from the vertebral column behind
by a thin retropharyngeal space containing loose
connective tissue.
• Pharyngeal wall is formed by skeletal muscles & fascia.
416
Characteristic Features of Nasopharynx:
• Most prominent features on lateral wall of
nasopharynx are:
1. The opening of the pharyngotympanic tube
2. Salpingopharyngeal fold: It covers the
salpingopharyngeus muscle.
3. Pharyngeal tonsil: Enlargement of this tonsil, known
as adenoids, can occlude nasopharynx so that
breathing is only possible thru oral cavity.
417
418
Characteristic Features of Oropharynx:
• The oropharynx has a digestive function.
• It is bounded by:
– The soft palate superiorly,
– The base of the tongue inferiorly, and
– The palatoglossal and palatopharyngeal arches
laterally
• The palatine tonsils found on each side of the
oropharynx.
• The tonsil does not fill the tonsillar sinus (fossa).
420
Characteristic Features of Laryngopharynx
• Posteriorly, the laryngopharynx is related to the bodies

of the C4–C6 vertebrae.
• Its posterior and lateral walls are formed by the middle
and inferior pharyngeal constrictor muscles.
• Internally, the wall is formed by the palatopharyngeus
and stylopharyngeus muscles.
• The laryngopharynx communicates with the larynx
through the laryngeal inlet on its anterior wall
Laryngopharynx cont…
• Piriform fossae (recess): is a small depression of the
laryngopharyngeal cavity on either side of the
laryngeal inlet.
• It is separated from the laryngeal inlet by the ary-
epiglottic fold
• Recurrent laryngeal n. & internal laryngeal n.
branches found here.
422
Muscles of the Pharynx
• The muscles of the pharynx consists of:
1. Three pharyngeal constrictors (fibers oriented

circularly):
• The external circular layer of pharyngeal muscles
consists of three pharyngeal constrictors: Superior,
middle & inferior constrictors
424
Muscles of the Pharynx cont…
2. Longitudinal muscles (fibers oriented vertically):

• The internal longitudinal muscles consists of the
palatopharyngeus, stylopharyngeus, and
salpingopharyngeus.
• These muscles elevate the larynx and shorten the
pharynx during swallowing and speaking
425
The Pharynx cont…
•The overlapping of the pharyngeal constrictor muscles

leaves four gaps in the musculature for structures to
enter or leave the pharynx
1. Above the superior pharyngeal constrictor:
•Auditory tube
•Levator veli palatini
•Ascending palatine artery
428
The Pharynx cont…
2. Between the superior and middle constrictors:
•Stylopharyngeus muscle
•Glossopharyngeal nerve (IX)
•Stylohyoid ligament
3. Between the middle and inferior constrictors:
•Internal laryngeal nerve
•Superior laryngeal artery and vein
4. Below the inferior constrictor:
•Recurrent laryngeal nerve.
•Inferior laryngeal artery
429
Vessels of the Pharynx
Arteries that supply upper parts of the pharynx include:

• Ascending pharyngeal artery;
• Ascending palatine and tonsillar branches of the facial
artery;
• Numerous branches of the maxillary and the lingual
arteries.
 All these vessels are from the external carotid artery.
430
Arteries that supply the lower parts of the pharynx include:
• Pharyngeal branches from inferior thyroid artery
• Major blood supply to palatine tonsil is from tonsillar branch
of facial a.
• Veins of the pharynx form a plexus, which drains superiorly
into pterygoid plexus in infratemporal fossa, & inferiorly into
facial & internal jugular veins
• Lymphatic vessels: from pharynx drain into retropharyngeal,
paratracheal, & infrahyoid nodes
• Palatine tonsils drain into jugulodigastric nodes
431
Innervation of the Pharynx
1. Motor Innervation :
• All muscles of the pharynx, except the stylopharyngeus,
receive motor innervation from pharyngeal plexus (CN X)
 Pharyngeal Plexus: is composed of glossopharyngeal (IX),
vagus (X) and Sympathetic nerves.
• Stylopharyngeus supplied by glossopharyngeal nerve (CN IX)
2. Sensory Innervation:
• Glossopharyngeal (IX): to oropharynx region
• Vagus (X) to remainder of pharynx
3. Palatine tonsil: CN IX (tonsillar branch)Referred pain to
middle ear.
432
The nose
• The nose is the part of the respiratory tract superior to
the hard palate and contains the peripheral organ of
smell.
• It includes the external nose and nasal cavity, which
is divided into right and left cavities by the nasal
septum.
• The functions of the nose include
– Olfaction (smelling), respiration (breathing), filtration of
dust, humidification of inspired air, and reception and
elimination of secretions from the paranasal sinuses and
nasolacrimal ducts
Skeleton of External Nose
• The supporting skeleton of the nose is

composed of bone and hyaline cartilage.
• The bony part of the nose consists of:
– The nasal bones
– Frontal processes of the maxillae,
– The nasal part of the frontal bone, and
– The bony parts of the nasal septum
Skeleton of External Nose cont…
• The cartilaginous part of the nose consists of
five main cartilages:
– Two lateral cartilages,
– Two alar cartilages, and
– One septal cartilage.
• The U-shaped alar cartilages are free and
movable;
• They dilate or constrict the nares when the
muscles acting on the nose contract
Nasal Septum
• The nasal septum divides the chamber of the
nose into two nasal cavities.
• The septum has a bony part and a soft mobile
cartilaginous part.
• The main components of the nasal septum are:
– The perpendicular plate of the ethmoid,
– Maxilla
– The vomer, and
– The septal cartilage
Nasal Cavity cont…
• The nasal cavity is entered anteriorly through the
nares (nostrils).
• It opens posteriorly into the nasopharynx through
the choanae
• Nasal Mucosa: composed of respiratory epithelium &
is continuous with paranasal sinuses & pharynx.
Contains
• Respiratory area  inferior 2/3 of cavities &
• Olfactory area  superior 1/3 of cavities.
439
Boundaries of Nasal Cavities
Has roof, floor, medial wall & lateral wall.
1. Roof of nasal cavity: is composed of:
• Nasal
• Frontal
• Ethmoid (Cribriform Plate)
• Sphenoid
2. The floor:
• Maxilla & its palatine process
• Palatine bone & its horizontal process
440
Boundaries of Nasal Cavities cont…
3. Medial Nasal Wall: is the

Nasal Septum
• Medial Nasal Wall or Nasal-
Septum is made up of the
following:
•Perpendicular plate of ethmoid
•Vomer
•Maxilla
•Septal cartilage
441
Boundaries of Nasal Cavities cont…
4. Lateral wall of nasal cavity: is

composed of:
•Superior concha (1)
•Superior meatus (tip of arrow)
•Middle concha (2)
•Middle meatus (tip of arrow)
•Inferior concha (3)
•Inferior meatus (tip of arrow)
 The superior & middle conchae
are parts of the ethmoid bone.
442
Vasculature and Innervation of Nose
• The nasal septum & nasal cavity is highly vascularized.
One reason for vascularity might be to warm the air before
it reached the bronchi & lungs.
The arterial supply of the medial and lateral walls of the nasal
cavity is from five source:
1. Anterior ethmoidal (ophthalmic)
2. Posterior ethmoidal (opththalmic)
3. Sphenopalatine (maxillary)
4. Greater palatine (maxillary)
5. Septal branch of superior labial (facial) 446
Vasculature and Innervation of Nose cont…
• Anterior part of nasal septum: is an area rich in
capillaries (Kiesselbach area) where all five arteries
supplying the septum anastomose.
• This area is site of profuse bleeding.
• Epistaxis (nose bleeding): relatively common because
of the rich blood supply to nasal mucosa.
• bleeding is from an area in the anterior third of the nose
(Kiesselbach area):  supplied by five anastomosing
artery.
• A rich plexus of veins from the nose drains into
sphenopalatine, facial & ophthalmic veins.
448
Vasculature and Innervation of Nose cont…
• Sensory innervation: important in reflexes (such as

the sneeze reflex) to keep foreign particles out of
the respiratory system.
1. Anterior & posterior ethmoidal (V1) (nasociliary):
supply anterosuperior part.
2. Nasopalatine (V2): supply nasal septum
3. Branch of greater palatine n: supply lateral nasal
wall
449
Rhinitis
• The nasal mucosa becomes swollen and inflamed
(rhinitis) during severe upper respiratory infections
and allergic reactions.
• Infections of the nasal cavities may spread to the:
1. Anterior cranial fossa thru cribriform plate.
2. Nasopharynx & retropharyngeal soft tissues thru
choanea.
3. Middle ear thru pharyngotympanic (auditory) tube.
4. Paranasal sinuses.
5. Lacrimal apparatus and conjunctiva.
451
Cerebrospinal Fluid Rhinorrhea
• It is leakage of CSF from nose.
• Nasal discharge after a head injury may be CSF.
• CSF rhinorrhea results from fracture of cribriform plate
& tearing of cranial meninges,
452
Paranasal Sinuses
• Several of the bones of the skull have developed air
spaces that are lined with mucous membrane.
• It is this mucous membrane that becomes infected in
severe cases of sinusitis.
• Since these sinuses are embedded in bone, they cannot
be seen easily on regular skull preparations.
• function of the sinuses are twofold:
1). make the skull lighter to carry around and
2). serve as resonating chambers during speech.
453
Paranasal Sinuses cont…
•Frontal
•Maxillary
•Sphenoid
•Ethmoid
454
1. Sphenoid Sinus:
• Related to: cavernous sinus (laterally)

• To optic n., optic chiasma, Pituitary gland &
body of sphenoid (superiorly).
• Drains into: sphenoethmoidal recess.
Innervation: Posterior Ethmoidal n.
Arteries: Post. Ethmoidal a.
455
2. Frontal Sinus:
• In frontal bone, deep & medial to superciliary
arches.
• Drains into: infundibulum of semilunar hiatus of
middle meatus.
Innervation:
• Supraorbital nerve
Arterial supply:
• Branches of Anterior Ethmoidal artery
457
3. Ethmoidal sinuses:
• Contain many small air cells, grouped into: Anterior,
Middle & Posterior E S.
Drainage:
• Anterior: into middle meatus
• Middle: into bulla ethmoidalis of middle meatus
• Posterior: to superior meatus.
Innervation: Ant & post ethmoidal nerve
Arterial supply:
• Ant & Post Ethmoidal artery 458
4. Maxillary Sinus:
• Largest & deepest; in body of maxilla;

• Pyramidal in shape: with apex, base, roof & floor.
• Drains into: semilunar hiatus of middle meatus.
Innervation:
• Ant, Mid & Post Superior Alveolar nerve.
Arterial supply:
• Superior alveolar artery
460
Sinusitis is an inflammation of the mucous membrane of
one or more paranasal sinuses.
• It may be caused by a microbial infection (virus,
bacterium, or fungus) and allergic reactions,.
• If the inflammation or an obstruction blocks the
drainage of mucus into the nasal cavity, fluid pressure
builds up in the paranasal sinuses, and a sinus headache
may develop.
461
Nasolacrimal duct
•Nasolacrimal duct empties into nasal cavity.

•Nasolacrimal duct is close to the front of nasal cavity
& thus, this is why your nose runs when you cry:
 This duct carries away extra tears.
•When drainage pores are closed off due to irritation,
mucous can no longer drain out of sinuses  sinuses
fill up & cause pressure  causes headaches (sinus
headaches).
462
The Ear
• The ear is the organ of hearing & balance
• Divided into three parts:
– The external ear,
– The middle ear, and
– The internal ear
463
External ear
• It is the part attached to lateral aspect of the head &
the canal leading inward; it captures sound.
• Consists of:
– Auricle (pinna), which collects sound
– External acoustic meatus (ear canal), which
conducts sound to the tympanic membrane.
1. Auricle (pinna)
• The part of the ear projecting from side of the head
• It consists of cartilage covered with skin & assists in
capturing sound.
Consists of;
• Concha of auricle (hollow center): The external
acoustic meatus leaves from the depths of this area
• Helix/antihelix
• Tragus/antitragus
465
Sensory innervation of the auricle
• Outer more superficial surfaces by:
– Great auricular and lesser occipital nerves from the
cervical plexus &
– Auriculotemporal branch of [V3].
• Deeper parts supplied by:
– Branches of facial CN VII & CN X.
Arterial supply: posterior auricular artery, superficial
temporal artery & occipital artery
• Veins follow arteries.
• Lymphatic drainage into parotid nodes & mastoid LN.
467
2. External acoustic meatus (ear canal)
• S-shaped canal leading inward; about 2.5 cm long
• Extends from deepest part of the concha to tympanic
membrane (eardrum).
• Consist of cartilage and bone:
• Lateral 1/3rd is cartilaginous & medial 2/3rd bony
tunnel in temporal bone.
• It is covered with skin, containing hair & cerumenous
glands, modified sweat glands, producing cerumen
(earwax).
• Tympanic membrane separates external acoustic
meatus from middle ear
468
469
Innervation external acoustic meatus
• Sensory innervation comes from;
– Auriculotemporal, a branch of [V3],
– Auricular branch of vagus nerve [X] &

– A branch of facial nerve
470
The Middle Ear/Tympanic Cavity
• An air-filled, mucous membrane-lined space in petrous part of
temporal bone
• Lies b/n tympanic membrane laterally & lateral wall of internal
ear medially.
• It consists of:
(1). Tympanic cavity proper: The space directly internal to the
tympanic membrane &
(2). Epitympanic recess: the space superior to the membrane
• Middle ear communicates with:
– Nasopharynx (anteriorly) by the pharyngotympanic tube &
– With mastoid air cells (posteriorly) by mastoid antrum.
471
Contents of the middle ear cavity
a. 3 auditory ossicles:
Malleus (connected to the tympanic membrane),
Incus (connected to the malleus), &
Stapes (connected to the incus & lateral wall of the
internal ear at the oval window).
b. Two muscles: tensor tympany & stapedius
c. Chorda tympany &
d. Tympanic plexus of nerves
472
Middle ear cavity & its walls
• The middle ear cavity is like a small box with

lateral, medial, anterior & posterior walls, a floor
& a roof.
•This box is located inside the temporal bone.
473
1. Roof (tegmental wall):
•Formed by tegmen tympani of petrous temporal bone

(ptb).
•Separates tympanic cavity from dura mater on floor of
middle cranial fossa.
•Unossified at petrosquamus suture in the young child.
•Thus, otitis- media infection to meninges 
meningitis.
474
2. Jugular wall (Floor )
• Formed by a layer of bone that separates tympanic

cavity from superior bulb of IJV.
• Contains sulcus for internal jugular vein (not
shown);
475
3. Medial wall (labyrinthine- wall):
separates tympanic cavity from internal ear; it is
also lateral wall of inner ear.
•It also features:
promontory (1st - turn) of cochlea & tympanic plexus
of nerves
 oval (vestibular) & round (cochlear) windows,
 prominence of facial canal, &
 Prominence of lateral semicircular canal.
476
4. Lateral wall (membranous wall)
• Formed by tympanic membrane (tm); & epitympanic
recess.
• Tympanic membrane has a flaccid & tense part.
Innervation of tympanic memb:
•External surface: by auriculotemporal nerve (V3)
mainly, & also by auricular branch of CN - X.
•Internal surface: by CN - IX.
478
5. Anterior wall (carotid wall):
•Separates tympanic cavity from carotid canal;

•Superiorly, contains opening of pharyngotympanic
tube (at) & canal for tensor tympani muscle.
480
6. Posterior wall (mastoid wall):
•Has an opening, aditus (access) to mastoid antrum

(superiorly),
 Mastoid antrum connects tympanic cavity to
mastoid air cells.
•Stapedius m. contained in pyramidal bony-eminence.
•Chorda tympani enter middle ear thru its posterior wall.
•Relations with facial nerve canal.
481
Auditory (Pharyngotympanic) Tube
• Connects the tympanic cavity to the nasopharynx.
• The function to equalize pressure in the middle
ear with the atmospheric pressure
• Length: 3.6 cm; “J”-shaped
• Parts: bony part (1.2 cm) & cartilagenous part (2.4
cm)
• Lumen: in apposition except when we swallow or yawn;
• Tube closed by: cartilage pressure, tissue turgidity &
tension of salpingopharyngeus m
• Tube opened by: contraction of salpingopharyngeus &
tensor velli palatini. (dilator tube)
482
Neurovasculature of Auditory Tube
4. Vessels: 1. branches of Ascending Pharyngeal a. (ECA)

2. branches of Middle Meningeal a. (maxillary a)
3. artery of pterygoid canal (maxillary a)
 Veins drain into Pterygoid Plexus & LN into Deep Cervical
5. Nerves:
• Bony Part: Tympanic Plexus; formed by fibers of the
glossopharyngeal nerve (CN IX
• Cartilagenos Part: pharyngeal br. of Pterygopalatine Gang.
The Middle Ear: Muscles
1. Tensor tympani:
O:Cartilaginous part of pharyngotympanic tube, greater
wing of sphenoid, its own bony canal
I: Upper part of handle of malleus
Inn: Branch from mandibular nerve [V3]
A: Pulls handle of malleus medially, tensing tympanic

membrane to reduce force of vibrations in response to
loud noises
484
The Middle Ear Muscles cont…
2. Stapedius:
• Originates from inside of pyramidal eminence
• Inserted into neck of stapes;
• Innervated by Branch of CN – VII.
• Contraction, usually in response to loud noises, pulls
the stapes posteriorly & prevents excessive oscillation
485
Internal (inner) ear
• Consists of a series of cavities within the petrous part of
the temporal bone: b/n middle ear laterally & internal
acoustic meatus medially.
• It converts mechanical signals from middle ear into
electrical signals  transferred to the brain.
• Internal ear also contains receptors that detect motion
and position
• Consists of:
– Osseous (bony) labyrinth
– Membranous labyrinth
486
The Internal Ear cont…
•The bony labyrinth includes:

•The vestibule & semicircular canals (for equilibrium) &
•The cochlea (for sound).
•The membranous labyninth includes:
• Utricle & Sacule (in bony vestibule);
• Three- semicircular ducts (within the bony
semicircular canals) &
• Duct of cochlea (within bony cochlea)
487
Bony Labyrinth:
• Bony Labyrinth consists of the vestibule, three
semicircular canals, & cochlea.
• Bony cavities are lined with periosteum & contain a
clear fluid (the perilymph).
• Suspended within the perilymph is membranous
labyrinth, which consists of semicircular ducts,
cochlear duct, & two sacs (utricle & saccule).
• These membranous spaces are filled with endolymph.
488
Bony Labyrinth:
1. Vestibule: which contains oval window, is the central

part of bony labyrinth
• Vestibule communicates anteriorly with cochlea &
posterosuperiorly with the semicircular canals
• A narrow canal (the vestibular aqueduct) leaves the
vestibule, and passes through the temporal bone to
open on to internal auditory meatus.
489
Bony Labyrinth cont…
2. Semicircular Canals:
• Projecting from vestibule are anterior, posterior, &
lateral semicircular canals.
• Each canal forms 2/3rd of a circle, connected at both
ends to the vestibule & with one end dilated to form
the ampulla.
491
Bony Labyrinth cont…
3. Cochlea:
• Projects anteriorly from vestibule
• It is a bony structure that twists on itself 2 ½ times
around a central column of bone ( modiolus).
• Circling around modiolus & held in a central position
is cochlear duct, a component of membranous
labyrinth.
492
3. Cochlea cont…
• Cochlear duct, attached to outer wall of cochlea,
creates two canals (scala vestibuli & scala tympani),
which are continuous with each other at apex thru a
narrow slit (helicotrema).
• Scala tympani is separated from middle ear by
secondary tympanic membrane covering round
window.
493
494
Membranous labyrinth:
• It is a continuous system of ducts & sacs within the
bony labyrinth.
• It is filled with endolymph & separated from
periosteum of bony labyrinth by perilymph.
• Consisting of two sacs (utricle & saccule) & four
ducts (three semicircular ducts & cochlear duct)
• Has unique functions related to balance & hearing:
• Utricle, saccule, & three semicircular ducts are part
of vestibular apparatus (i.e. organs of balance);
• Cochlear duct organ of hearing.
495
Organization of parts of membranous labyrinth:
• Cochlear duct within cochlea of bony labyrinth,

anteriorly;
• The three semicircular ducts within the three
semicircular canals, posteriorly;
• Saccule & utricle within the vestibule of bony
labyrinth, in the middle.
• Five of the six components of membranous labyrinth
are concerned with balance:
• These are: two sacs (utricle & saccule) & three ducts
(anterior, posterior, & lateral semicircular ducts).
497
Organization of parts of membranous labyrinth cont…
• The three semicircular ducts empty into utricle &

cochlear duct empties into saccule.
• Sensory receptors are: macula of utricle (in utricle),
macula of saccule (in saccule), & crista (in ampulla
of each semicircular ducts).
498
The Internal Ear: Vessels
• Bony Labyrinth: is supplied by:
1. anterior tympanic branch from the maxillary

artery,
2. A stylomastoid branch from the posterior auricular
artery, and
3. A petrosal branch from the middle meningeal
artery.
500
Membranous Labyrinth:
• It is supplied by labyrinthine artery
 Labyrinthine artery divides into: a cochlear
branch, which supplies the cochlear duct; &
vestibular branches, which supply vestibular
apparatus.
• Venous drainage of membranous labyrinth: thru
vestibular & cochlear veins.
•  These unite to form a labyrinthine vein, which
empties into either inferior petrosal sinus or
sigmoid sinus.
501
The Internal Ear: Nerves
• Vestibulocochlear nerve [VIII] carries special afferent
fibers for hearing (the cochlear component) and
balance (the vestibular component).
• Inside temporal bone, at distal end of internal acoustic
meatus, CN - VIII divides to form: cochlear nerve &
vestibular nerve.
• Vestibular nerve enlarges to form the vestibular
ganglion, distributed to the three semicircular ducts &
utricle & saccule.
• Ganglion cells of cochlear nerve are in the spiral
ganglion at the base of lamina of modiolus.
• Branches of cochlear nerve pass thru lamina of modiolus
to innervate the receptors in the spiral organ. 502
Thank You!!!

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JIGJIGA UNIVERSITY

FOR MEDICINE STUDENTS

The skeleton of the head

Primarily formed by flat

Most calvarial bones are

Primarily making by irregular bones :

Comprises facial skeleton

Features of the anterior or facial (frontal) aspect of the

Forms the skeleton of the forehead

The intersection of the frontal and

the nasal bones.

Used radiographically in medicine

Compare and describe the

topography of the cranium, and

Document abnormal variations.

Angular boundary b/n the squamous and the orbital parts

Has a supra-orbital foramen for passage of the supra-orbital

nerve and vessels.

Superior to the supra-orbital margin

Extends laterally on each side from the glabella.

Lie on the inferolateral sides of the orbits

Has a small zygomaticofacial foramen pierces the

Join medially to form the bridge of the nose.

Form skeleton of the upper jaw

Forms the skeleton of the lower jaw,

Alveolar process that supports the mandibular teeth.

Mental foramina Inferior to the second premolar teeth

for the mental nerves and vessels

Mental protuberance, forming the prominence of the chin

On the medial surface of the ramus is a large mandibular

foramen for transmission of the inferior alveolar nerve and

Mandibular symphysis, the line of fusion between the two

Body (horizontal part)

Ramus (vertical part)

Coronoid and Condylar processes, are separated by the

Lie in the anterior part of the temporal fossa

3-4 cm superior to the midpoint of the zygomatic arch

Junction of the frontal, parietal, sphenoid (greater

wing), and squamous temporal bones.

Overlies course of anterior division of middle

Entrance to the external acoustic meatus (canal)

External occipital crest

descends from the protuberance toward the foramen

Superior nuchal line

extends laterally from each side of the protuberance

superior limit of the neck

Inferior nuchal line

Junction of lambdoid and sagittal sutures

In the center of the occiput sutural bones (accessory

may be located at lambda or near the mastoid process.

Separates the frontal and parietal bone

Separates the parietal bones

Separates the parietal and temporal bones from the

Junction of coronal and sagittal

The most superior point of the

Near the midpoint of the sagittal

Inconstant aperture located posteriorly

in the parietal bone near the sagittal

For the passage of parietal emissary

Most irregular, highly variable

Transmit emissary veins

Connecting scalp veins to the venous

Palatal processes of the maxillae

Horizontal plates of the palatine bone