Connections of the skull bones. Temporomandibular joint.

Masticatory muscles, mimic muscles andtheir innervation.

Veronika Němcová, CSc.

Connections of the skull bones

• Synchondroses cranii• Syndesmoses - suturae cranii, gomphosis

• Synostoses• Articulatio temporomandibularis

Cartilaginousconnections

Synchondrosissphenopetrosa(foramen lacerum)

Synchondrosispetrooccipitalis(fissurapetrooccipitalis)

Synchondrosisintraoccipitalisposterior

Symphysis menti

Synchondrosis sphenooccipitalisFonticulusmastoideus

Cartilaginous and fibrous connection on the newborn skull

Synchondrosisintraoccipitalisanterior

Sutura lambdoidea

Sutura squamosa Sutura coronalis

Sutura sagittalis

Sutures

newborn

Articulatiotemporomandibularis

complex– discushead: caput mandibulaefossa: fossa mandibularis,

tuberculum articulareArticular surfices are coveredby fibrous cartilage

Movements : depressionelevationprotractionretractionlateropulsion

Ligaments of thetemporomandibularjoint – lateral aspect

Ligamentum laterale- it prevents posterior displacement of theresting condyle

Ligamentum stylomandibulare

Ligaments of the temporomandibular joint- medial aspect

Lig. pterygomandibulare(raphe buccopharyngea)

Lig.stylomandibulare

Lig.pterygospinale

Lig.sphenomandibulare

Lig. sphenomandibulare

Lig. pterygospinale

Lig. stylomandibulare

Ligaments of thetemporomandibular joint

Articulatio temporomandibularissagittal section (after Frick)

Discus articularisMeatus acusticusexternus

Retroarticular plastic pad(Zenker)(veins and fatty connectivetissue)

Caput mandibulae

A P

Position of the caput mandibulae to the external acoustic meatus

MR of the temporomandibular joint

m-discusC-caput mandibulaeE-tuberculum articulareAC-meatus acusticus externus

MR of the temporomandibular joint- anterior displacement of the disc

Normal

Anterior disc displacement

Communication of both parts of the jointcavity – rupture of the disc or in eldery

Arthrography of the temporomandibular joint

Artrocentesis (lavage ) of the temporomandibular joint

Temporomandibular joint and m. pterygoideus lateralis

m. pterygoideus lat(depression, lateropulsion)

Elevation: m.masseterm.temporalism. pterygoideus medialis

M

T

PM

PL

Lateropulsion: m.pterygoideus med.m.pterygoideus lat.

Protraction: mm. pterygoideim. temporalism. masseter

Retraction: m. temporalism. masseter (newborn)

Depression: suprahyoid musclesm.pterygoideus lat.

Injury of Karel IV.

Úraz Karla IV.Karel IV. Normalmandible

X-ray picture of the mandible ofKarel IV.

thick corticalis

healed fractures

Karel IV.

Masticatory muscles• From the first branchial arch• Nerve supplying – mandibular nerve (V/3)• Blood supplying – branches of maxillary artery (pars infratemporalis),• plexus pterygoideus, • Fascia parotideomasseterica

temporalisinterpterygoidea

Fce: elevation - m.masseter, m.temporalis, m.pterygoideus med.protraction - m.pterygoideus lat., m.masseter (superficial fibres)retraction- m.temporalis (posterior part), m.masseter (deep fibres)lateropulsion – m.pterygoiei, unilateral action

M.temporalis

M.masseter

M.pterygoideusmedialis

M.pterygoideuslateralis

Fossa infratemporalisA.maxillarisV/3

A.meningeamedia

N.auriculotemporalis

N.alveolaris inf

N.lingualis

Raphe pterygomandibularis(Raphe buccopharyngea)

V/3

Ductusparotideus

M.buccinator

M.pterygoideuslateralis

M.pterygoideusmedialis

M.constrictor pharyngis sup

lingual nerve

inferior alveolar nerve

Corpus adiposum

Frontal section of temporal andinfratemporal region

A.facialis

A.temporalis superficialis

A.occipitalis

A.auricularisposterior

A.maxillaris

A.maxillaris

A.meningea media

A.carotis externa

A.carotis int.

A.temporalis spf.

A.alveolaris inf.

Pars pterygopalatina Pars pterygoideaMaxillary artery: Pars mandibularis

Maxillary artery

APTA

A.alveolaris inferior

A.meningea media

Pars mandibularisPars pterygoidea

R. temporales profundi

Pars pterygopalatina

A.sphenopalatinaA.infraorbitalis

Aa.alveolaressup.post.

A.palatina desc.

FOI CPFSP

A.massetericaRr.pterygoidei

A.buccalis

Pterygopalatine fossa – lateral aspect - schema

Maxilla

PrPt

FOIForamen sphenopalatinum

Canalis pterygoideus

Maxillary artery branches in the pars pterygopalatina

M

Aa.alveolares sup.post

A.alveolares sup.ant.

A.sphenopalatinaRr. nasales post.lat.+septi

A.palatina descendens

A.palatina major +minor

A.infraorbitalis

A.canalis pterygoidei

Maxillary artery branches in the pars pterygopalatina

Plexus pterygoideus

V.jugularis externa

V.jugularis interna

V.temporalis spf.

Vv.diploicae

V.angularis

V.facialis

V.retromandibularis

N.auriculotemporalis

N.VII

N.alveolaris inf.

R.mylohyoideus

N.lingualis

N.buccalis

Nn. temporalesprofundi

n.massetericus

Infratemporal fossa - repetition

http://anat.lf1.cuni.cz/muzeum/alb3

http://anat.lf1.cuni.cz/muzeum/alb3

Transverse section throughthe palatine tonsille

Section through the neck - C1/2Spatium parapharyngeumSpatium retropharyngeum

Section through the neck - C1/2 ductus parotideuscorpus adiposum buccae

m.massetern.+vasa alveolaria inf.

m. pterygoideus medialis

n.XIm. digastricus (v.p.)SH

a.carotis ext., n.VII,v.retromandibularis

n.IX, n.XII

m.trapezius

m.sternocleidomastoideus

SG,SPh

m.buccinatorn.lingualisconstrictor pharyngis sup.

tonsilla palatinaa.palatina ascendens

a.pharyngea ascendensa.carotis int., n.X., v. jugularis int.

truncus sympaticus

nodi lymphaticiretropharyngei

Section throughthe neck - C1/2repetition

Section throughthe neck - C1/2repetition

Mimetic muscles• From the 2. branchial arch• Nerve supplying facial nerve (VII.n)• No fascia• m.buccinator – fascia buccopharyngeaGroups: a)muscles of the scalp

b) muscles of the auriclec) muscles in the region of eyelidsd) muscles of the nasal regione) muscles of the mouth region

Galea aponeurotica

1

2

3 4

56

7

8

910

1112

13 1415

16

17

Mimetic muscles

a) muscles of the scalpb) muscles of the auriclec) muscles in the region of eyelidsd) muscles of the nasal regione) muscles of the mouth region

Nerve supplying ofmimetic muscles -facial nerve (VII.)

Foramen stylomastoideum

Porus acusticus int

Plexus parotideus

Regio parotidomasseterica(plexus parotideus)

Rr.temporales

Rr.zygomatici

Rr.buccales

R.marginalis mandibulae

R.colli

Ductus parotideus

A.transversa faciei

V.retromandibularis

N.auricularis magnus(pl.cervicalis)

Vasa temporalia superficialiaN.auriculotemporalis(V/3)

N.auricularis post.(VII)

Vasa auricularia post.

Duchenne and an assistant faradize the mimetic muscles of a live subjectto demonstrate the mechanics of facial expression.

M.epicranius, venter frontalis

M.depressor anguli oris

M.zygomaticus major

M occipitofrontalis, venter frontalis

M.orbicularis oculi

M.zygomaticus major

M.corrugator supercilii

Peripherial facial nerve palsy

Mimetic muscles lateral aspect

Mimetic musclesanterior aspect

Superfitial face structures – parotid gland is partially removed

Superfitial head structures

Projection of the importantstructures on the face surface

Face transplantation

• Isabelle Dinoire, the world's first face transplant recipient, is beginning to recover much of her facial function

Sources• Čihák, Anatomie 1• Petrovický a spol., Anatomie 1• Grim, Záklagdy anatomie• Sobotta , Atlas anatomie člověka• Bertolini/Leutert, Atlas der Anatomie des Menschen• Grayś Anatomy• http://en.wikipedia.org/wiki/Guillaume_Benjamin_Amand

_Duchenne• http://www.newscientist.com/article/dn8688--face-

transplant-recipient-faces-world-press.html• Ramba, Slavné české lebky• Personal archive