Applied Anatomy

Oral Diagnosis Dent423

Dr.Reem Azzam BDs, MSc. Oral Medicine, Jordan Board

Scope of the Lecture
• • • • • • • Mandible TMJ Muscles of mastication Salivary glands Neck Triangles of the neck Lymph Nodes of the Head and Neck


Temporo-Mandibular Joint TMJ



Articulation • Above – Mandibular (glenoid) fossa of temporal bone – Articular tubercle (eminence) • Below – Condyloid process of the mandible *Articular surfaces covered by fibrocartilage *Synovial joint ‫ → زاللي‬Capsule *Articular disc dividing the joint into upper & lower cavities .

Capsule • Attached above to the articular tubercle & margins of mandibular fossa • Attached below to the neck of the mandible .

Relations of the joint • Anteriorly – Mandibular notch – Massetric artery & nerve • Posteriorly – External auditory meatus – Glenoid process of parotid gland ( Remember those for the referred pain) .

fascia & skin • Medially – Auriculotemporal nerve – Maxillary artery & vein .Relations of the joint • Laterally – Parotid gland.

Ligaments • Lateral temporomandibular ligament • Sphenomandibular ligament • Stylomandibular ligament .

Articular disc • Divides the joint into upper & lower cavities • Oval-shaped fibrocartilage • Attachments – Circumferentially to the capsule – In front to the tendon of the lateral pterygoid muscle • Movement with the condyloid process of the mandible • Upper surface is concavoconvex anteroposteriorly • Lower surface is concave .

Nerve supply • Auriculotemporal nerve • Massetric nerve .

Movements • • • • • Depression of the mandible (to open the mouth) Elevation of the mandible (to close the mouth) Protrusion of the mandible Retraction of the mandible Lateral chewing .

Muscles of Mastication .

Masseter Muscles ‫العضلة الماضغة‬ .Muscles of Mastication 1.

Messeter Origin Direction of fibers Insertion Action Enervation Zygomatic arch (medial +lower surfaces) ↙ Downwards &backwards Lateral surface of the ramus &angle of the mandible •Elevates the mandible upwards •Assists in protrusion Masseteric branch of the anterior trunk of mandibular nerve .

Temporalis Muscle ‫العضلة الصدغية‬ .Muscles of Mastication 2.

medial aspect. anterior border as far as the retromolar fossa •Elevates mandible •Posteriour fibers: retract mandible Deep temporal nerve (branch of mandibular nerve) Insertion Action Enervation .Origin Direction of fibers Temporalis ← Most posterior fibers: run • Side wall of the braincase from an area bounded by the inferior temporal line horizontally forward •↙ Posterior fibers: run downwards & forwards • ↓ Middle fibers: run downwards • ↓↘Anterior fibers: run downwards & slightly backwards Coronoid process of the mandible Apex. anterior & posterior margins.

Muscles of Mastication 3.Medial Pterygoid Muscle .

Medial Pterygoid Origin •Major head: medial surface of lateral pterygoid plate •Superficial minor head: maxillary tuberosity ↘ Downwards &backwards &laterally Medial surface of the ramus & angle of the mandible •Elevation of the mandible (closes the jaw) •Minor contribution to protrusion of the mandible •Contralateral excursion of the mandible Branch from mandibular nerve Direction of fibers Insertion Action Enervation .

Lateral Pterygoid Muscle .Muscles of Mastication 4.

Lateral Pterygoid Origin •Upper head: IT surface of the GWS •Lower head: lateral surface of lateral pterygoid plate Backwards &laterally Anteriour aspect of •Neck of the condyle •TMJ capsule •Disc •Pulls mandible forward (protrusion) •Contralateral excursion •Helps depressing the mandible (opening) mandibular nerve Direction of fibers Insertion Action Enervation .


Lymph Nodes of the Head and Neck .



Submandibular LN • Superficial to submandibular gland • Covered by inferior border of the mandible • Receives lymph from – – – – – – – – – Central part of the forehead Anterior part of nasal cavity Sides of the nose Maxillary &frontal sinuses Teeth and their supporting strutures (except lower anterior teeth) Floor of the mouth Anterior 2/3’s of the tongue (except the tip) Upper lip Sides of the lower lip • Drains into deep cervical nodes .

Submental LN • On the superficial surface of mylohyoid • Behind the inferior border of the mandible in the mental protuberance region • Receive lymph from – – – – Tip of the tongue Floor of the mouth Mandibular incisor teeth & associated alveolar process Central part of the lower lip • Drain into – Submandibular nodes or – JO node (Deep cervical LN) .

draining lymph from – Anterior part of the face and lower eyelid. into – Submandibular nodes .Buccal (facial) LN Scattered along the course of the vessels (on buccinator).

Pre-auricular (parotid) LN • Superficial parotid nodes – Situated on the lateral surface of parotid gland – Receives lymph from • • • • Forehead Temple Eyelids External ear • Deep parotid nodes – Located within the gland – Receives lymph from • Eyelids • Middle ear • Parotid nodes drain into upper deep cervical nodes .

mastoid) LN • Superficial to attachment of SCM to mastoid process • Receives lymph from scalp behind external ear • Drains into upper cervical nodes .Post-auricular (retro-auricular.

Occipital LN • Lie at the apex of the posterior triangle of the neck • Receive lymph from posterior part of scalp .

Cervical LN .


Neck .



Triangles of the Neck .



Salivary Glands .

Salivary Glands 1.Parotid Gland ‫الغدة النكفية‬ kelenjar parotid .

Parotid gland • Position – Below the external acoustic meatus (EAM) – Wedged between the mandibular ramus in front & the mastoid process & SCM behind – Superior surface is related to the EAM & TMJ capsule .

a small part that projects medially between TMJ & meatus – Anteromedial surface abuts on posterior border of • Mandibular ramus • Masseter muscle – Posteromedial surface is related to the mastoid process & SCM muscle – The superficial part • Extends anteriorly to overlap the masseter in front & SCM behind • Accessory part is the anterior extension that is separated from the main gland (can be absent) • Enervation: Auriculo-temporal nerve .Parotid gland • Shape & position – Glenoid lobe .

Parotid duct • Starts within the anterior part of the gland • Runs across the masseter • Pierces the buccinator at the front edge of the masseter • Opens opposite crown of upper second molar .

Structures within the parotid gland • Facial nerve • Auriculotemporal nerve • External carotid artery • Retromandibular vein .

Submandibular Gland .Salivary Glands 3.

Submandibular gland • Superficial lobe • Deep lobe (Continuous with superficial lobe around the free edge of mylohyoid) .

Sublingual Gland .Salivary Glands 3.

3.Sublingual gland • In front of deep lobe of submandibular gland • Lateral surface comes into contact with sublingual fossa on the medial surface of the mandible • Medial surface is crossed by lingual nerve & submandibular duct .

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