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A journey into gross anatomy
Oral Cavity Proper
| Structures that you should be able to feel or see in your own mouth.
Figure 1.
First, the boundaries of the mouth are:
- superior--hard and soft palates
- inferior--tongue and floor of mouth
- anterolateral--upper and lower teeth
- posterior--palatoglossal fold (5)
Structures to identify:
- vestibule
- hard palate
- soft palate
- uvula
- palatoglossal arch
- palatine tonsil
- palatopharyngeal arch
- posterior wall of oropharynx
- pterygoid hamulus
Figure 2. Tongue elevated.
- frenulum of tongue
- ridge formed by deep lingual vein
- sublingual fold
- sublingual caruncle
- opening of submandibular duct
The sublingual gland forms the sublingual fold and sends multiple small ducts into the mouth along the fold. |
Figure 1
Figure 2
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Surface of the tongue viewed from above.
Note the tip of tongue, epiglottis and soft palate with the uvula as points of reference!
Identify:
- anterior 2/3rd of tongue
- posterior 1/3rd of tongue
- palatogossal fold
- palatine tonsil
- fungiform papillae
- circumvallate papillae
- sulcus terminalis
- foramen cecum
- foliate papillae
Innervation:
Anterior 2/3rd:
- general sensation--lingual nerve (V3)
- taste--chorda tympani (VII)
Posterior 1/3rd:
- general sensation--glossopharyngeal (IX)
- taste--glossopharyngeal (IX)
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Floor of the Mouth
Here is a perfect example of how important it is to orient yourself. In order to show the structures in the floor of the mouth, the tongue must be reflected posteriorly (notice the vertebral column). I always look for the mandible for anterior orientation.
In opening up the floor of the mouth, the mucous membrane is gently incised just above the sublingual gland and the fascia covering the gland (sg) is pulled posteriorly along with the tongue. This reveals:
- mylohyoid muscle (floor)
- geniohyoid muscle just above the mylohyoid
The mylohyoid muscles of the two sides joint in the mid line forming a sling across the floor of the mouth. In the section of the head and neck, the mylohyoid muscle can be seen in cross section. |
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Note where the tip of the tongue is
It has been displaced posteriorly.
Removal of the fascia around the sublingual gland (slg) and the deep part of the submandibular gland (sm) allows you to visualize the remainder of the structures of the mouth.
- styloglossus muscle (sg)
- hyoglossus muscle (hg)
- genioglossus muscle (gg)
- submandibular duct (5)
- lingual nerve (1)
- submandibular ganglion (2)
- hypoglossal nerve (3)
- C1 nerve to geniohyoid (4)
You can also see the genioglossus muscle from the sectioned tongue. |
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| Muscle |
Origin |
Insertion |
Action |
Nerve Supply |
| styloglossus |
styloid process |
merges with hyoglossus and genioglossus muscles in the tongue |
draws tongue up and back to aid swallowing food |
XII |
| hyoglossus |
greater horn of hyoid bone |
merges with styloglossus and genioglossus muscles |
draws side of tongue down |
XII |
| genioglossus |
genial tubercle of mandible |
fans out in the tongue to make up the bulk of the tongue |
pulls tongue forward, sticking the tongue out |
XII |
| intrinsic muscles |
tissues of tongue |
tissues of tongue |
produce small changes in the contour of the surface of tongue |
XII |
| mylohyoid |
mylohyoid line of mandible |
hyoid bone and raphe |
elevates hyoid bone and floor of mouth to aid in swallowing |
nerve to mylohyoid (V3) |
| geniohyoid |
lower genial tubercle of mandible |
body of hyoid bone |
elevate hyoid bone or depress mandible |
C1 |
You will now identify the structures found in the lateral wall of the oropharynx. This is where the palatine tonsil is located. Again, orient yourself: identify the tongue, hard palate, hyoid bone and soft palate.
Identify the palatoglossal arch and the palatopharyngeal arch. Find the palatine tonsil between the two arches, if it is present. Beneath the mucosa of the arches, identify the small palatoglossus (pg) and palatopharyngeus (pp) muscles. You might also see the superior pharyngeal constrictor (SC) and middle pharyngeal constrictor (mc) at this stage. |
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When the tonsil is removed, you can see the structures that make up the tonsillar bed and that could be injured during a tonsilectomy.
- superior pharyngeal constrictor (SC)
- pterygomandibular raphe (PR)
- middle pharyngeal constrictor (MC)
- tonsillar branch of facial artery (1)
- glossopharyngeal nerve (2)
- stylohyoid ligament (3)
You might also be able to see the buccinator muscle (BUC) in this dissection. The pterygomandibular raphe serves as an insertion point for two muscles: superior constrictor and buccinator. |
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Bones of the Nasal Cavity
It is always a good idea to learn the bones of a region before proceeding further. The bones of the nasal septum and other landmarks are:
- nasal
- frontal
- ethmoid
- sphenoid
- vomer
- perpendicular plate of ethmoid
- maxilla
- horizontal process of palatine bone
- medial pterygoid plate
- occipital condyle
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The skeleton of the lateral nasal wall include:
- nasal
- frontal
- ethmoid
- sphenoid
- maxilla
- horizontal process of palatine
- superior concha (ethmoid)
- middle concha (ethmoid)
- inferior concha
- sphenopalatine foramen
- medial pterygoid plate
- pterygoid hamulus of medial plate
Notice that the roof of the nasal cavity is:
- nasal
- frontal
- ethmoid
- sphenoid
and the floor:
- maxilla and its palatine process (5)
- palatine and it horizontal process (6)
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Nasal Septum
Usually when the head is bisected, the nasal septum is either destroyed or left behind on one side.
The nasal septum is made up of the following:
- perpendicular plate of ethmoid
- vomer
- maxilla
- septal cartilage
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The septum and the nasal cavity, in general is highly vascularized. One reason for this might be to warm the air before it reached the bronchi and lungs. The major arteries of the septum are:
- anterior ethmoidal (ophthalmic)
- posterior ethmoidal (opththalmic)
- sphenopalatine (maxillary)
- greater palatine (maxillary)
- branch of superior labial (facial)
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Sensory innervation to the nose is also important in that it provides reflexes (such as the sneeze reflex) to keep foreign particles out of the respiratory system. The sensory nerves to the septum are:
- anterior ethmoidal (V1) (nasociliary)
- nasopalatine (V2) (maxillary)
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Lateral Nasal Wall
ORIENT YOURSELF!
Be sure you know which is front and back and up and down. Look at the lateral wall of the nasal cavity and identify:
- sphenoethmoid recess (arrow above 1)
- superior concha (1)
- superior meatus (tip of arrow)
- middle concha (2)
- middle meatus (tip of arrow)
- inferior concha (3)
- inferior meatus (ti of arrow)
A meatus is a small space under the concha.
The superior and middle conchae are parts of the ethmoid bone.
The inferior concha is a separate bone of the skull. |
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Once the most obvious structures are identified, removal of the middle and inferior conchae reveals other items to be identified:
- cut edges of middle and inferior conchae (1 and 2)
- hiatus semilunaris (3)
- ethmoid bulla (bulge formed by ethmoid air cells (4)
- small bulge formed by the nasolacrimal duct (5) (not always apparent)
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In order to get an idea as to the relationship of the nasal cavity to the air sinuses, a frontal section is shown in the image. Again use familiar structures to orient yourself, like the orbits with the optic foramen (black circle). Identify:
- right and left nasal cavities on either side of the nasal septum made up of the:
- vomer (7) and
- perpendicular plate of ethmoid (1)
- superior, middle and inferior conchae (3-5) with the meatus deep to them
- large maxillary sinus
- ethmoid sinuses
- frontal sinus
Note that the roof of the nasal cavity is made up of the cribriform plate (not labeled) but on each side of (1).
Also note that the floor of the nasal cavity is made up of the palatine processes of the maxilla (6). |
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The paranasal sinuses are lined with a mucous membrane that secretes a fluid to keep the lining moist. Under normal conditions, the sinuses drain into various parts of the nasal cavity.
- sphenoid sinus-->sphenoethmoid recess
- frontal sinus-->infundibulum of middle meatus
- anterior ethmoid sinus-->middle meatus
- middle ethmoid sinus-->ethmoid bulla of middle meatus
- maxillary sinus-->middle meatus
One other structure empties into the nasal cavity and the is (6) the nasolacrimal duct. You can see that this duct is close to the front of the nasal cavity and therefore should realize why your nose runs when you cry. This duct carries away extra tears.
You should also realize that when the drainage pores are closed off due to irritation, the mucous can no longer drain out of the sinuses, they fill up and cause pressure which can then cause headaches (sinus headaches).
Sinus medication reduces the swelling so that the mucous can drain. |
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| Continuing to work you way laterally, you can remove the bone further and open up the maxillary sinus. You can also see the nasopalatine nerve (1) emerging through the sphenopalatine foramen. Once the foramen is identified, you can then see a small bulge formed by the bony greater palatine canal. If this is broken down, you would see the greater palatine nerve and artery in the canal. |
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After more of the lateral nasal wall has been removed, you can see the major nerve coming into this region, the maxillary division of the trigeminal.
Now identify:
- infraorbital nerve
- posterior superior alveolar nerve
- pterygopalatine ganglion (parasympathetic)
- greater palatine nerve
- lesser palatine nerve
- cut nasopalatine nerve
- nerve of the pharyngeal canal
All of the nerves are sensory branches of V2. The pterygopalatine ganglion is suspended from V2 by two sensory roots. Since the ganglion is parasympathetic, there are preganglionic neurons feeding into it from the facial nerve (greater petrosal branch) that synapse at this point then continue onward as postganglionic neurons. Their destination is the lacrimal nerve and reach there by rejoining the maxillary nerve through a sensory root, hopping onto the zygomatic nerve (V2), running up the lateral side of the orbit to jump onto the lacrimal nerve (V1) and then to the lacrimal gland to produce tears. |
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As you go posterior to the inferior concha, you enter the nasopharynx. The roof is the body of the sphenoid, the floor is the soft palate and it is open to nasal cavity anteriorly and pharynx posteriorly. When the mucous membrane is carefully removed, you can see the small muscles of the soft palate and upper pharynx. Landmarks are the tubal elevation (torus tubarius) and the uvula (u).
The muscles are:
- tensor palati
- levator palati
- palatopharyngeus
- salpingopharyngeus
To identify the tensor, first feel for the medial pterygoid plate and find its posterior border. The muscle is located there. You might see a small artery at this site, the terminal part of the ascending palatine artery (external carotid)
The palato- and salpingopharyngeus muscles join the stylopharyngeus to form the longitudinal muscles of the pharynx. The help elevate the pharynx when you swallow. |
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| The major sensory innervation to the nasal cavity is from branches of the maxillary division of the trigeminal (nasopalatine, infraorbital, greater palatine). Other sensory branches are from the ophthalmic division (anterior ethmoidal nerve). Any secretory glands of the nasal cavity are supplied by branches of the pterygopalatine ganglion. The olfactory epithelium in the roof of the nasal cavity is innervated by the olfactory nerve (I) and receives smell sensations. |
| The major arterial supply to the nasal cavity are from the ophthalmic and maxillary arteries by way of anterior and posterior ethmoidal branches and sphenopalatine branches respectively. |
Table of Muscles
| Muscle |
Origin |
Insertion |
Action |
Nerve supply |
| tensor palati |
scaphoid fossa of pterygoid fossa |
aponeurosis of soft palate |
elevates and tenses soft palate |
V3 |
| levator palati |
apex of petrous temporal bone and auditory tube |
aponeurosis of soft palate |
pulls soft palate up and back |
X |
| palatopharyngeus |
aponeurosis of soft palate |
wall of pharynx |
elevates pharynx |
X |
| salpingopharyngeus |
cartilage of auditory tube |
wall of pharynx |
elevates pharynx |
X |
Items to Remember in this Lesson
| Parts of the pharynx have been identified when the carotid triangle of the neck was discussed. Now that the head and cervical viscera have been separated, you can identify the pharyngeal muscles and the structures that lie lateral to them.
The muscles of the pharynx consists of three pharyngeal constrictors:
and the stylopharyngeus and palatopharyngeus muscles.
The three constrictors are nested within each other from the top down. You might visualize the constrictors as three cone-shaped cups fitting within each other. The superior fits into the middle which fits into the inferior. The only thing wrong with this picture is that the cups are open on one side. These openings are the nasal cavity, oral cavity and the larynx. Now take a look at the pharynx from the back.
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When you first observe the back of the pharynx, you will want to identify the structures that run parallel to its lateral surface:
- glossopharyngeal nerve (IX)
- vagus (X)
- spinal accessory nerve (XI)
- hypoglossal nerve (XII)
- common carotid artery (CC)
- internal jugular vein (IJ)
- carotid sheath (CS)
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| In this image, the carotid sheath and its contents has been removed in order to show the stylopharyngeus muscle (SP). One reason to be able to identify the stylopharyngeus muscle is that the glossopharyngeal nerve (IX) runs along its posterior surface and can always be identified at this point. The stylopharyngeus muscle also extends between the superior and middle pharyngeal constrictors and can be used to separate these two muscles. |
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| Finally, identify the three pharyngeal constrictors. Before identifying the pharyngeal constrictors, you should first memorize their origins and then you won't have trouble picking them out during a dissection or an examination.
The superior pharyngeal constrictor (SC) arises from the hamulus of the medial pterygoid plate and the pterygomandibular raphe which extends from the hamulus to the lingula of the mandible. This origin is not easy to point out so you will usually identify the other two constrictors first.
The middle pharyngeal constrictor (MC) arises from the greater horn of the hyoid bone (GH). This structures can always be seen or felt.
The inferior pharyngeal constrictor (IC) arises from the thyroid and cartilages which are also obvious structures.
The inferior pharyngeal constrictor continues as the esophagus (ES).
The constrictors join in the mid line posteriorly as a seam (pharyngeal raphe) which is suspended form the pharyngeal tubercle on bottom of the occipital bone.
We will cover the nerve supply of the pharynx later.
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| Along the lateral sides of the pharynx, you will find four gaps associated with the superior, middle and inferior constrictors. Specific structures pass through each of these gaps.
Above the superior pharyngeal constrictor:
- auditory tube (AT)
- levator palati (LP)
- ascending palatine artery (APA)
Between the superior and middle constrictors:
- stylopharyngeus muscle (SP)
- glossopharyngeal nerve (IX)
Between the middle and inferior constrictors:
- internal laryngeal branch of the superior laryngeal nerve (IL)
- superior laryngeal artery from the superior thyroid artery (SLA)
Below the inferior constrictor:
- inferior laryngeal nerve ( ILN) (recurrent laryngeal branch of the vagus)
- inferior laryngeal artery (ILA) (inferior thyroid)
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Pharyngeal Cavity as Viewed From the Back
After the pharynx has been cleaned from the back and the pharyngeal constrictors are identified, the pharynx can be opened and the anterior relationships exposed.
What you should be able to identify are:
- nasopharynx (arrow)
- oral pharynx (where tongue is seen)
- laryngeal pharynx (larynx).
If you inserted you finger into each one of these, you would enter the nasal cavity, oral cavity and larynx from behind. To have another view of this same relationship, see the following section. |
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Sagittal Section of the Head and Neck
There comes a point in the anatomy laboratory when the body must be divided into strange sections in order to study its innermost parts. One of these divisions is the sagittal section of the had and neck. This will aid in the visualization of the nasal cavity, oral cavity and the larynx. Once smaller pieces of the head and neck are produced, it becomes difficult to know what is anterior, posterior, up or down. You should make it a habit to pick out a structure that you can always identify (such as the mandible, tip of nose, tip of tongue, etc.) and use this to give you the proper orientation. Every time you walk up to a cadaver, or look at an image, the first thing to do is orient yourself. Orientation is very important!!!
Once the head and neck have been separated into left and right halves, you can see relationships of the nasal cavity, oral cavity and larynx to the pharynx. These cavities function as part of the respiratory and gastrointestinal systems. You will notice in the diagram that the two systems merge. I am sure that most of you have experienced choking after inhaling fluid or food instead of swallowing it.
Air flows through both the nasal cavity and oral cavity to travel through the nasopharynx and oropharynx respectively before entering the larynx.
Food travels through the oropharynx, down the laryngopharynx and into the esophagus. The innervation to this area, both motor and sensory, is important in keeping the pathways functioning properly. We will cover the nerve supply in future sessions. |
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Remember to orient yourself when you look at these images.
I usually use the mandible (M) or maxilla (Mx) as a starting point. Then I look for the tip of the tongue or tip of the nose.
Once oriented with the sagittal section, identify the nasal cavity, the oral cavity with the tongue, the epiglottis and larynx.
The borders of the naso-, oro-, and laryngopharynges are arbitrary and shown as red dotted lines in the diagram. Classically, the anterior border of the opening of the auditory tube and tip of uvula for the nasopharynx, the palatoglossal fold and upper border of epiglottis for the oropharynx and the opening of the larynx for the laryngopharynx. Nasopharynx (np), oropharynx (op), and laryngopharynx (lp).
Posterior to the pharynx, you can identify the atlas (C1), axis (C2) and the remaining cervical vertebrae. You can also see the spinal cord passing through the vertebral canal (yellow). |
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Innervation of the Pharynx
Motor Innervation
- glossopharyngeal (IX)
- vagus (X) and allied spinal accessory (XI)
- recurrent laryngeal
Sensory Innervation
- glossopharyngeal (IX to oropharynx region
- vagus (X) to remainder of pharynx
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Another point to consider!
The parotid region is actually part of the neck but it extends into the facial region as well. It also must be studied before the infratemporal region can be examined. We will examine the parotid region from superficial to deep pointing out the gland itself and the structures running through it.
| The parotid gland is a superficial structure located in the upper neck above the posterior belly of the digastric muscle. It is a salivary gland that has a large duct (pd) which crosses the masseter muscle to pierce the buccinator muscle opposite the upper 2nd molar tooth. The duct can frequently be rolled between the finger and the masseter muscle. The skin overlying the lower pole of the gland is supplied by the greater auricular nerve (ga), a branch of the cervical plexus. You have already identified the branches of the facial nerve appearing at the upper and anterior edges of the gland (yellow). |
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If the parotid gland is carefully removed, you can identify the structures located within it. The first plane is the venous plane and consists of the retromandibular vein (rm) and its tributaries and branches:
- st--superficial temporal
- rm--retromandibular vein
- m--maxillary vein
- ad--anterior division
- f--facial
- cf--common facial
- pd--posterior division
- pa--posterior auricular
- ej--external jugular
The common facial vein empties into the internal jugular vein and the external jugular into the subclavian vein near its junction with the internal jugular. |
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When the venous plane is removed we reach the important nervous plane. The importance of this plane is the presence of the facial (VII) nerve. The facial nerve leaves the skull through the stylomastoid foramen and immediately enters the deep part of the parotid gland where it gives off its branches:
- posterior auricular (pa)
- motor branch to posterior belly of digastric (db)
- temporal branch (t)
- zygomatic branch (z)
- buccal branches (b)
- mandibular branch (m)
- cervical branch (c)
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Deep to the nerves lies the arterial plane which includes terminal parts of the external carotid artery and its branches:
- external carotid artery (EC)
- occipital artery (oc)
- maxillary artery (m)
- transverse facial artery (tf)
- superficial temporal artery
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The deepest part of the parotid region is the parotid bed and houses the deep part of the gland which fills the small space between the neck of the condyle of the mandible (nc) and the mastoid process (m). Other structures forming the floor of this space are the :
- styloid process (sp)
- stylohyoid muscle (sh)
- stylopharyngeus muscle (sph)
- posterior belly of the digastric muscle (pbd)
The gland becomes infected and swollen in mumps. If you have had the mumps, you will realize just how difficult it is to open your mouth. Now, you can see why this is so. When you open the mouth, you narrow the parotid bed space and compress the deep parotid gland between the neck of the condyle and the mastoid process. |
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The Infratemporal Fossa and Muscles of Mastication
The infratemporal fossa is a small space between the ramus of the mandible and the lateral pterygoid plate of the sphenoid. On a skull, it is big enough for maybe 1 1/2 fingers but it has many things in it. Following is a tabulation of the infratemporal fossa and all of its contents.
The lateral wall of the infratemporal fossa is noted in the 1st image and consists of the
- ramus (4)
- coronoid process (1)
- head of condyle (2)
- neck of condyle (3)
- body (5)
- angle (6)
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Medial wall:
lateral pterygoid plate (1)
Roof;
greater wing of sphenoid (3)
includes foramen ovale & foramen
spinosum
Posteriorly:
styloid process (4)  |
There are four muscles of mastication on each side that control the movement of the mandible:
- masseter
- medial pterygoid
- lateral pterygoid
- temporalis
The lateral pterygoid is the main muscle that opens the mouth. It is helped from gravity and a couple of neck muscles. It opens the jaw by pulling forward on the neck of the mandible and causing the jaw to drop. |
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The artery entering the infratemporal fossa is the maxillary branch of the external carotid artery. As can be seen, it has many branches (11 in all). You will probably not be responsible for all of them but I have included them all for completeness.
Maxillary artery
- deep auricular (da)
- anterior tympanic (at)
- middle meningeal (mm)
- accessory middle meningeal (amm)
- inferior alveolar (ia)
- buccal (b)
- deep temporal (dt)
- posterior superior alveolar (psa)
- descending palatine (dp)
- infraorbital (io)
- sphenopalatine (sp)
External carotid artery (ec)
- occipital (oc)
- transverse facial (tf)
- superficial temporal (st)
The sphenopalatine and descending palatine arteries pass through a small space between the pterygoid process of the sphenoid and the maxilla, the pterygomaxillary fissure.
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The mandibular nerve (V3) is the nerve of the infratemporal fossa and is responsible for supplying the muscles of mastication plus two tensor muscles: 1) tensor palati and 2) tensor tympani. The branches are as follows:
- deep temporal (dt)
- auriculotemporal (at)
- inferior alveolar (ia)
- nerve to the mylohyoid (nmh)
- lingual (l)
- buccal (b)
- branches to lateral pterygoid (not labeled)
Not shown:
- meningeal branch
- nerve to masseter
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The Temporomandibular Joint (TMJ)
| The temporomandibular joint (tmj) is a synovial type joint separated by an interarticular disc. The disc splits the joint into two separate joints. The upper joint (ujc) is between the mandibular (articular) fossa of the temporal bone and the articular disk and provides a sliding motion when the lateral pterygoid contracts and pulls the condyle and disc forward.
The lower joint (ljc) is between the articular disc and the head of the condyle of the mandible. The action here is a hinge-like action, in which the mandible drops, thereby opening the mouth.
When dentition or muscle action is not in proper alignment, the joint can be secondarily affected and pain can ensue. This is TMJ disease and requires dental specialists to correct the problem.
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Table of Muscles
| Muscle |
Origin |
Insertion |
Action |
Nerve Supply |
| masseter |
zygomatic arch |
ramus & angle of mandible |
closes mouth |
muscular branch (V3) |
| medial pterygoid |
medial surface of lateral pterygoid plate and maxillary tuberosity |
medial surface of ramus and angle of mandible |
closes mouth and helps protrude mandible |
muscular branch (V3) |
| lateral pterygoid |
upper head: greater wing of sphenoid
lower head: lateral surface of lateral pterygoid plate |
upper head: articular disc
lower head: neck of condyle |
open and protrudes mandible, moves mandible side to side |
muscular branch (V3) |
| temporalis |
temporal fossa |
coronoid process and anterior border of ramus |
closes and retracts mandible |
muscular branch (V3) |
Summary of Items in This Lesson
please try your hands on this quiz!
Head and Neck Questions
For each question, select the one BEST answer. Hold mouse cursor over the button to see the correct answer.
| 1. When trying to locate the parotid duct, a physician would consider each of the following relationships EXCEPT: |
- its opening can be seen in the vestibule of the mouth opposite the upper 2nd premolar tooth
- it extends from the anterior border of the parotid gland
- it can be palpated as it crosses the face, superficial to the masseter muscle
- it is inferior to the zygomatic arch
- it is superior to the zygomatic arch
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| 2. Which of the following statements best describes the facial vein? |
- it is located within the substance of the parotid gland
- it communicates superiorly with the ophthalmic vein
- it is more tortuous than the facial artery
- it lies anterior to the facial artery as it passes through the face
- it usually empties into the external jugular vein
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| 3. The tickling sensation felt in the nasal cavity, just prior to a sneeze is probably carried in which of the following nerves? |
- facial
- maxillary division of trigeminal
- mandibular division of the trigeminal
- glossopharyngeal
- none of the above
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| 4. Which muscle is innervated by the external branch of the superior laryngeal nerve? |
- lateral cricoarytenoid
- cricothyroid
- posterior cricoarytenoid
- transverse arytenoid
- thyroarytenoid
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| 5. Tumors of the head may grow from one region of the head to another by passing through fissures and foramina. Knowing this, if you found a tumor in the pterygopalatine fossa, it may have developed there primarily or it may have grown into the fossa from any of the following EXCEPT: |
- infratemporal fossa
- cranial cavity by way of the foramen ovale
- cranial cavity by way of the foramen rotundum
- nasal cavity
- oral cavity by way of the greater palatine canal
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| 6. The 4th cranial nerve (trochlear) innervates: |
- the lacrimal caruncle
- a muscle that turns the eyeball superiorly and laterally
- the lacrimal gland
- the medial part of the lower eyelid
- a muscle that turns the eyeball inferiorly and laterally
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| 7. During a physical examination, you have a patient stick out his/her tongue and say AAH. The muscle that is responsible for this movement is the: |
- geniohyoid
- styloglossus
- palatoglossus
- genioglossus
- hyoglossus
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| 8. The coronoid process belongs to which bone in the head? |
- maxillary
- mandible
- sphenoid
- occipital
- temporal
|
| 9. In order to locate the approximate position of the bifurcation of the common carotid artery, you would feel for its pulse at or above which of the following? |
- at the level of the cricothyoid membrane
- at the level of the hyoid bone
- at the level of the upper border of the cricoid cartilage
- at the level of the upper border of the thyroid cartilage
- at the level of the first tracheal ring
|
| 10. The muscles of mastication, their nerves and their vessels are located primarily in which part of the head? |
- pterygopalatine fossa
- jugular fossa
- incisive fossa
- infratemporal fossa
- temporal fossa
|
| 11. The thyroid gland can be examined in which of the following triangles of the neck? |
- submental
- glandular
- carotid
- submandibular (or digastric)
- muscular (or visceral)
|
| 12. During a sinus attack, painful sensation from the ethmoid cells is carried in which nerve? |
- meningeal
- greater petrosal
- pterygoid
- nasociliary
- frontal
|
| 13. The pharyngeal plexus of nerves contains both motor and sensory components. The motor nerves are believed to come from which of the following? |
- hypoglossal nerve
- glossopharyngeal nerve
- vagus nerve
- trigeminal nerve
- spinal accessory nerve
|
| 14. The facial artery gives rise to branches that supply each of the regions listed below EXCEPT for the: |
- medial angle of the orbit
- lateral nose
- region of the eyebrow
- upper lip
- lower lip
|
| 15. Which of the following meningeal structures is located between the cerebral hemispheres? |
- diaphragma selli
- falx cerebelli
- tentorium cerebelli
- falx cerebri
- none of the above
|
| 16. The cough reflex, as do all reflexes, has a sensory and a motor part to it. What nerve carries the sensory part of the cough reflex? |
- internal laryngeal nerve
- external laryngeal nerve
- trigeminal nerve
- facial nerve
- maxillary nerve
|
| 17. All of the following structures are located within the walls or cavity of the cavernous sinus EXCEPT for the: |
- oculomotor nerve
- internal carotid artery
- ophthalmic division of the trigeminal nerve
- mandibular division of the trigeminal nerve
- abducens nerve
|
| 18. The lateral wall of the ethmoid sinus is also part of the medial wall of the: |
- nasal cavity
- orbit
- anterior cranial fossa
- oropharynx
- nasopharynx
|
| 19. The facial nerve: |
- exits the cranium through the foramen ovale
- provides the primary parasympathetic supply to the parotid gland
- supplies taste fibers to the posterior 1/3 of the tongue
- supplies motor fibers to the medial pterygoid muscle
- supplies motor fibers to the stapedius muscle
|
| 20. The superior sagittal sinus: |
- drains into the straight sinus
- is attached to the petrous temporal bone
- receives emissary veins from the scalp
- communicates with the cavernous sinus
- receives the superior petrosal sinus
|
| 21. The tympanic plexus of nerves is found on the: |
- floor of the middle ear cavity
- pyramid of the middle ear
- medial surface of the tympanic membrane
- promontory of the middle ear cavity
- mucous membrane lining the vestibule of the inner ear
|
| 22. The chorda tympani nerve: |
- is part of the nerve of the pterygoid canal
- contains postganglionic parasympathetic fibers for the parotid gland
- contains sensory fibers from the tympanic membrane
- joins the auriculotemporal nerve
- carries parasympathetic fibers to the submandibular ganglion
|
| 23. The foramen spinosum: |
- is closed by a cartilaginous disc in life
- is found in the petrous temporal bone
- usually transmits the maxillary nerve
- is located in the posterior cranial fossa
- transmits the middle meningeal artery
|
| 24. Loss of lacrimation (dry eye) can be due to an injury to which nerve? |
- nasociliary
- greater petrosal
- supraorbital
- anterior ethmoid
- lesser petrosal
|
| 25. Upon examining a sick child, you notice pus draining from the middle meatus of the nose. You might suspect and look for further evidence of an infection originating from the: |
- nasolacrimal duct
- sphenoid sinus
- maxillary sinus
- mastoid sinus
- posterior ethmoidal air cells
|
| 26. A structure that can easily be injured during ligation of the superior thyroid artery is the: |
- inferior laryngeal branch of the recurrent laryngeal nerve
- ascending pharyngeal artery
- superior parathyroid gland
- transverse colli nerve
- external branch of the superior laryngeal
|
| 27. The thyrohyoid membrane is pierced by the: |
- hypoglossal nerve
- internal branch of the superior laryngeal nerve
- external branch of the recurrent laryngeal nerve
- ansa cervicalis
- inferior larygneal artery
|
| 28. Destruction of which of the following would result in loss of pain from the anterior 2/3 of the tongue? |
- pterygopalatine ganglion
- otic ganglion
- trigeminal ganglion
- geniculate ganglion
- inferior ganglion of the glossopharyngeal nerve
|
| 29. Which of the following muscles is innervated by the glossopharyngeal nerve? |
- tensor tympani
- superior constrictor of the pharynx
- tensor veli palatine
- stylopharyngeus
- palatopharyngeus
|
| 30. Which of the following does not open into the middle cranial fossa? |
- foramen lacerum
- foramen ovale
- foramen rotundum
- superior orbital fissure
- inferior orbital fissure
|
Match the most appropriate opening on the right with the numbered description on the left:
31. It is located within the petrous part of the temporal bone.
32. It allows for the exit of the spinal accessory nerve from the cranial cavity.
33. The vertebral artery enters the cranial cavity through it.
34. The lesser petrosal nerve usually leaves the cranial cavity through it.
35. The abducens nerve enters the orbit by passing through it. |
- foramen ovale
- superior orbital fissure
- internal acoustic meatus
- foramen magnum
- jugular foramen
|
Below are a list of numbered symptoms that occur after a particular nerve lesion. Select the lettered item that corresponds to the lesioned nerve. A letter may be used more than once.
36. An upper eyelid that droops (ptosis)
37. Loss of tears over the eyeball (dry eye)
38. A pupil that is small in diameter with no light reflex
39. On protrusion, the tongue deviates to one side. |
- trochlear nerve
- oculomotor nerve
- facial nerve
- hypoglossal nerve
- none of the above
|
| 40. Pulsations felt just above the zygomatic arch and in front of the ear are from which vessel? |
- facial
- internal jugular vein
- superficial temporal artery
- retromandibular vein
- maxillary artery
|
| 41. The floor of the sella turcica is also the: |
- diaphragma sella
- roof of the sphenoid sinus
- medial wall of the temporal fossa
- roof of the nasal cavity
- site of attachment of the superior pharyngeal constrictor muscle
|
| 42. Which of the following accompanies the optic nerve through the optic canal? |
- cranial nerves III, IV and VI
- ophthalmic nerve
- meninges and opthalmic artery
- ophthalmic veins
- none of the above
|
| 43. The sensory supply to the skin over the lower eyelid comes from the: |
- mental nerve
- maxillary division of the trigeminal
- auriculotemporal nerve
- buccal branch of the trigeminal nerve
- ophthalmic division of the trigeminal
|
| 44. The pterygomandibular raphe serves as a point of attachment for two important muscles. They are: |
- superior constrictor and buccinator
- masseter and inferior constrictor
- medial pterygoid and lateral pterygoid
- lateral pterygoid and superior constrictor
-
|
| 45. The opening from the pterygopalatine fossa to the nasal cavity is the: |
- pterygoid canal
- pterygomaxillary fissure
- foramen rotundum
- sphenopalatine foramen
- pharyngeal canal
|
| 46. Impaired function of which of the following muscles would result in difficulty in protruding the lower jaw? |
- digastric
- lateral pterygoid
- medial pterygoid
- masseter
- temporalis
|
| 47. Which nerve innervates the muscle for tight closure of the eyelids? |
- facial
- oculomotor
- sympathetic
- trigeminal
- vagus
|
| 48. An acoustic neuroma is a tumor involving the vestibulocochlear nerve as it exits the cranial cavity. Because this tumor compresses surrounding structures or invades nearby tissues, in addition to hearing loss and equilibrium problems, a patient would most likely also demonstrate ipsilateral (same sided): |
- loss of general sensation to the face
- facial paralysis
- paralysis of the lateral rectus muscle
- tongue paralysis
- ptosis
|
| 49. A gag reflex overcomes your patient as you lightly swab an area of the oropharynx. What nerve carries the sensory fibers of this reflex? |
- mandibular
- maxillary
- facial
- glossopharyngeal
- vagus
|
| 50. Each of the following is characteristic of the maxillary sinus EXCEPT that: |
- it is lined with mucous membrane.
- it drains through an opening under the superior concha (turbinate).
- it may become infected from an abscessed tooth.
- its roof is the floor of the orbit.
- its lining is innervated by the trigeminal nerve.
|
| 51. All of the following paranasal sinuses drain into the middle meatus, EXCEPT the: |
- frontal
- maxillary
- sphenoid
- anterior ethmoid
- middle ethmoid
|
| 52. The submandibular ganglion contains preganglionic parasympathetic axons from which cranial nerve? |
- III (oculomotor)
- V (trigeminal)
- VII (facial)
- IX (glossopharyngeal)
- X (vagus)
|
| 53. A nosebleed (epistaxis) frequently occurs because of picking of the nose with the finger at the anterior inferior portion of the nasal septum. Branches of which arteries may be involved? |
- maxillary
- facial
- ophthalmic
- A and B
- B and C
|
| 54. A lesion of the facial nerve just after it exits from stylomastoid foramen would result in: |
- an ipsilateral (same side) loss of taste to the anterior tongue
- a decrease in saliva production in the floor of the mouth
- a sensory loss to the tongue
- an ipsilateral paralysis of facial muscles
- a contralateral (opposite side) paralysis of facial muscles
|
| 55. The vertical depression in the midline of the upper lip is called the: |
- uvula
- frenulum
- philtrum
- torus
- mentum
|
| 56. The sella turcica (turks saddle) is a part of which bone: |
- temporal
- sphenoid
- ethmoid
- occipital
- lacrimal
|
57. Arrange the following foramina from anterior to posterior:
- internal auditory meatus
- jugular foramen
- foramen ovale
- foramen rotundum
- foramen spinosum
|
- 4 5 3 1 2
- 4 3 5 1 2
- 3 4 5 1 2
- 5 4 3 2 1
- 4 3 5 2 1
|
| 58. Depression of the jaw (opening the mouth) is accomplished by contraction of which of the following muscles and gravity? |
- lateral pterygoids
- geniohyoids
- mylohyoid
- digastrics
- all of the above
|
59. Arrange the following from lateral to medial:
- infratemporal fossa
- nasal cavity
- pterygo-maxillary fissure
- pterygo-palatine fossa
- sphenopalatine foramen
|
- 1 4 5 2 3
- 4 1 5 3 2
- 1 3 4 5 2
- 5 a 3 2 4
- 1 3 5 4 2
|
| 60. Herniation of the intervertebral disc between the fifth and sixth cervical vertebrae will compress the: |
- 4th cervical nerve root
- 5th cervical nerve root
- 6th cervical nerve root
- 7th and 8th cervical nerve roots
- 7th cervical nerve root
|
|
|
mandible 
Mandible 
