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THEORALREGION
NOSE
PARANASALSINUSES
THEMAXILLARYARTERY
Largerterminalbranchofexternalcaro2dartery.
Itarisesbeneaththetemporomandibularjoint,passeslateraltothe
lateralpterygoidmuscleandramifiesinthepterygopala2nefossa.
THEMAXILLARYARTERY
PARTSANDBRANCHESOFMAXILLARYARTERY
•  FIRST-MANDIBULAR
Proximal(posterior)tolateralpterygoidmuscle;runshorizontally,
deep(medial)toneckofcondylarprocessofmandibleandlateralto
stylomandibularligament
PARTSANDBRANCHESOFMAXILLARYARTERY
•  FIRST-MANDIBULAR
BRANCHES:
•  deepauricularartery
•  anteriortympanicartery
•  middlemeningealartery
•  accessorymeningealartery
•  inferioralveolarartery
THEMAXILLARYARTERY
PARTSANDBRANCHESOFMAXILLARYARTERY
•  SECOND-PTERYGOID
Adjacent(superficialordeep)tolateralpterygoidmuscle;ascends
obliquelyanterosuperiorly,medialtotemporalismuscle
PARTSANDBRANCHESOFMAXILLARYARTERY
•  SECOND-PTERYGOID
BRANCHES:
•  massetericartery
•  deeptemporalarteries
•  pterygoidbranches
•  buccalarteries
THEMAXILLARYARTERY
PARTSANDBRANCHESOFMAXILLARYARTERY
•  THIRD-PTERYGO-PALATINE
Distal(anteromedial)tolateralpterygoidmuscle;passesbetween
headsoflateralpterygoidandthroughpterygomaxillaryfissureinto
pterygopala2nefossa
PARTSANDBRANCHESOFMAXILLARYARTERY
•  THIRD-PTERYGO-PALATINE
BRANCHES:
• 
• 
• 
• 
• 
• 
infra-orbitalartery
descendingpala2neartery
posteriorsuperioralveolarartery
arteryofpterygoidcanal
pharyngealbranch
sphenopala2neartery
THEORALREGION:THEORALCAVITY
THEORALCAVITY
Featuresoftheoralcavityproperinclude:
•  thepalate(hardandsoJ)
•  teeth
•  gums(gingivae)
•  tongue,and
•  salivaryglands
Allofthemajorsalivaryglands:
•  paro2d,
•  submandibular
•  sublingual
drainintotheoralcavity
THEORALREGION:THEORALCAVITY
THELIPS-ARTERIALSUPPLY
•  Superiorlabialbranchofthefacialarteryofftheexternalcaro2da.
•  Inferiorlabialbranchofthefacialarteryofftheexternalcaro2da.
anastomosewitheachotherinthelipstoformanarterialring
THELIPS–LYMPH
Lymphfromtheupperlipandlateralpartsofthelowerlippasses
primarilytothesubmandibularlymphnodes,whereaslymphfromthe
medialpartofthelowerlippassesini2allytothesubmentallymph
nodes.
THEORALREGION:THEORALCAVITY
THELIPS–NERVESUPPLY
MOTORINNERVATION
Allmusclesoffacialexpressionareinnervatedbythefacialn.(ofCNVII)
SENSORYINNERVATION
Theupperlipissuppliedbythesuperiorlabialbranchesoftheinfraorbitalnerves(ofCNV2).
Thelowerlipissuppliedbytheinferiorlabialbranchesofthemental
nerves(ofCNV3).
THEORALREGION:THEORALCAVITY
THECHEEKS
Theparo2dductdrainsintotheoralcavityattheparo2dpapilla,
locatedalongthemucousmembraneofthecheekopposite
the2ndmaxillarymolar
Pterygomandibularrapheislocatedintheposteriorpor2onandserves
asalandmarkforthepterygomandibularspace
Theentrancetothepterygomandibularspace(whichcontainsthe
lingualandinferioralveolarnerves)isthesiteforinjec2onforan
inferioralveolarnerveblock,commonlyusedtoanaesthe2zethe
ipsilaterallowerteethandgums.
THEORALREGION:THEORALCAVITY
THECHEEKS
Superficialtothebuccinatorsareencapsulatedcollec2onsoffat;these
buccalfat-padsarepropor2onatelymuchlargerininfants,toreinforce
thecheeksandkeepthemfromcollapsingduringsucking.
MOTORINNERVATION
Allmusclesoffacialexpressionareinnervatedbythefacialn.CNVII
•  Buccalbranchofthefacialn.CNVII
•  Mandibularbranchofthefacialn.CNVII
SENSORYINNERVATION
Allsensoryinnerva2ontotheskinofthisregionissuppliedbythe
trigeminaln.CNV
•  Buccalnerveofthemandibulardivisionofthetrigeminal
THISISTOGENTLYREMINDYOU…
ThemusclesofmasTcaTon:
INNERVATION:
•  Masseter
TRIGEMINALNERVE:MANDIBULARN.V3
•  Temporalis
•  Medialpterygoid
•  Lateralpterygoid
Thedigastricmuscle:
•  anteriorbelly–CNV3
•  posteriorbelly–CNVII
THEORALREGION:THETEETH
THETEETH
are:
•  deciduous(primary)
•  permanent(secondary)
Betweentheagesof6and12years,thereisamixedden22on,inwhich
bothprimaryandpermanentteetharepresentintheoralcavityatthe
same2me
THEORALREGION:THETEETH
THETEETH-DECIDUOUSTEETH
Thereare20totaldeciduousteeth:2incisors,1canine,and2molarsin
eachofthe4quadrantsoftheoralcavity
212
Nodeciduousteetharepresentatbirth;however,bythe3rdyearof
life,all20deciduousteethhaveerupted
THEORALREGION:THETEETH
THETEETH-PERMANENT
Thetypesofteethareiden2fiedbytheircharacteris2cs:
•  incisors:thincu`ngedges
•  canines:singleprominentcones
2123
•  premolars(bicuspids):twocusps
•  molars:threeormorecusps
THEORALREGION:THETEETH
THETEETH
Thesurfacesoftheteeth:
•  theves2bularsurface(labialorbuccal)ofeachtoothisdirected
outwardly
•  thelingualsurfaceisdirectedinwardly
Thesurfacesoftheteeth:
Asusedinclinical(dental)prac2ce,themesialsurfaceofatoothis
directedtowardthemedianplaneofthefacialpartofthecranium.
Thedistalsurfaceisdirectedawayfromthisplane.
Thesurfacesoftheteeth:
Bothmesialanddistalsurfacesarecontactsurfaces-thatis,surfaces
thatcontactadjacentteeth.Themas2catorysurfaceistheocclusal
surface.
Thesurfacesoftheteeth:
Themas2catorysurfaceistheocclusalsurface.
THEORALREGION:THETEETH
THETEETH
Atoothhas:
•  acrown
•  neck,and
•  root
Theneckisbetweenthecrownandtheroot.The
rootisfixedinthetoothsocketbythe
periodon2um;thenumberofrootsvaries.
Mostofthetoothiscomposedofden2ne,whichiscoveredbyenamel
overthecrownandcementovertheroot.
Thepulpcavitycontainsconnec2ve2ssue,bloodvessels,andnerves.
Therootcanal(pulpcanal)transmitsthenervesandvesselstoandfrom
thepulpcavitythroughtheapicalforamen.
Therootsoftheteethareconnectedtotheboneofthealveolusbya
specialtypeoffibrousjointcalledadento-alveolarsyndesmosisor
gomphosis.
THEORALREGION:THETEETH
THETEETH-ARTERIES
Thebloodsupplytotheoralregionisprimarilythroughbranchesofthe
externalcaroTdartery
Thesuperior(anteriorandposterior)andinferioralveolararteries,
branchesofthemaxillaryartery,supplythemaxillaryandmandibular
teeth
Alveolarveinswiththesamenamesanddistribu2onaccompanythe
arteries.
THETEETH-LYMPHATICVESSELS
Lympha2cvesselsfromtheteethandgingivaepassmainly
tothesubmandibularlymphnodes
THEORALREGION:THETEETH
THETEETH-INNERVATION
Theteethintheupperjawaresuppliedbythesuperioralveolarnerves
(anterior,middleandposterior),arisefromthemaxillarynerveinthe
pterygopala2nefossa.
Theteethinthelowerjawaresuppliedbytheinferioralveolarnerve
leavesthemaxillarynerveinthepterygopala2nefossa.
Thenamedbranchesofthesuperior(CNV2)andinferior(CNV3)
alveolarnervesgiverisetodentalplexusesthatsupply
themaxillaryandmandibularteeth.
THEORALREGION:THETEETH
THETEETH-INNERVATION
INNERVATIONofthe
mandibularteeth:
incisors(central,lateral)
+
canine
+
2premolars
+
3molars
INFERIORALVEOLAR
NERVE
(CNV3)
mandibularforamen
THEORALREGION:THETEETH
THETEETH-INNERVATION
INNERVATIONofthe
maxillaryteeth:
incisors(central,lateral)
+
canine
ANTERIORSUPERIOR
ALVEOLAR
NERVE
(CNV2–INFRAORBITALNERVE)
INNERVATIONofthe
maxillaryteeth:
2premolars
MIDDLESUPERIOR
ALVEOLAR
NERVE
(CNV2–INFRAORBITALNERVE)
THEORALREGION:THETEETH
THETEETH-INNERVATION
INNERVATIONofthe
maxillaryteeth:
1stmolar
MIDDLESUPERIOR
ALVEOLAR
NERVE
(CNV2–INFRAORBITALNERVE)
+
POSTERIORSUPERIOR
ALVEOLAR
NERVE(CNV2)
INNERVATIONofthe
maxillaryteeth:
2nd&3rdmolars
POSTERIORSUPERIOR
ALVEOLAR
NERVE(CNV2)
THEORALREGION:THEPALATE
THEPALATE
Thepalateforms:
•  thearchedroofofthemouthand
•  thefloorofthenasalcavi2es
Thepalateseparatestheoralcavityfrom:
•  thenasalcavi2esand
•  thenasopharynx
Thepalateconsistsoftworegions:
•  thehardpalateanteriorlyand
•  thesoJpalateposteriorly.
THEORALREGION:THEPALATE
THEHARDPALATE
Theanteriortwothirdsofthepalatehasabonyskeletonformedbythe
pala2neprocessesofthemaxillaeandthehorizontalplatesofthe
pala2nebones
Thenasopala2nenervespassfromthenosethroughavariablenumber
ofincisivecanalsandforaminathatopenintotheincisivefossa.
Medialtothe3rdmolartooth,thegreaterpala2neforamenpiercesthe
lateralborderofthebonypalate.
Thegreaterpala2nevesselsandnerveemergefromthegreater
pala2neforamen
Thelesserpala2neforaminaposteriortothegreaterpala2neforamen
transmitsthelesserpala2nenervesandvesselstothesoJpalate.
THEORALREGION:THEPALATE
THESOFTPALATE
Theso[palateissuspendedfromtheposterioredgeofthehardpalate
andmovesposteriorlyagainstthepharynxduringswallowingtoprevent
materialenteringthenasalcavity.
ThesoJpalatehasnobonyskeleton.
Thethickpala2neaponeurosisformsthefounda2onofthesoJpalate.
Posteroinferiorly,thesoJpalatehasacurvedfreemarginfrom
whichhangsaconicalprocess,theuvula.
Theuvulahangsinthecenteroftheposteriorfreemargin
Laterally,thesoJpalateiscon2nuouswiththewallofthepharynxand
isjoinedtothetongueandpharynxbythepalatoglossaland
palatopharyngealarches.
THEORALREGION:THEPALATE
THESOFTPALATE
ThepalaTnetonsilsareinatonsillarfossa(sinus),boundedbythe
palatoglossalandpalatopharyngealarchesandthetongue.
Theso[palateiscomposedof5muscles:
•  musculusuvulae
•  tensorvelipala2ni
•  levatorvelipala2ni
•  palatopharyngeus
•  palatoglossus
The5musclesofthesoJ
palatearisefromthe
baseofthecraniumand
descendtothepalate.
THEORALREGION:THEPALATE
THEPALATE-INNERVATION
SENSORYINNERVATION
Thesensorynervesofthehardpalatearethegreaterpala2neand
nasopala2nebranchesofthemaxillarynerve(CNV2),whichallpass
throughthepterygopala2neganglion.
Itsuppliesthegumsandthemucosaandglandsofthehardpalate.
Thenasopala2nenervesuppliesthemucousmembraneoftheanterior
partofthehardpalate.
Thelesserpala2nenervessupplythesoJpalate.
THEORALREGION:THEPALATE
THEPALATE-INNERVATION
MUSCLEINNERVATION
AllmusclesofthesoJpalateareinnervatedbythevagusnerve[X],
exceptforthetensorvelipala2ni,whichisinnervatedbyabranchfrom
themandibularnerve[V3].
THEORALREGION:THEPALATE
THEPALATE-INNERVATION
SENSEINNERVATION(TASTE)
Fibresconveyingtasteimpulsesfromthepalateprobablypassviathe
pala2nenervestothepterygopala2neganglion,andtravelthroughit
withoutsynapsingtojointhenerveofthepterygoidcanalandthe
greaterpetrosalnervetothefacialganglion,wheretheircellbodiesare
situated.
SENSEINNERVATION(TASTE)
Thecentralprocessesoftheseneuronestraversethesensoryrootof
thefacialnerve(nervusintermedius)topasstothegustatorynucleus
inthenucleusofthetractussolitarius.Parasympathe2c
postganglionicsecretomotorfibresfromthepterygopala2neganglion
runwiththenervestosupplythepala2nemucousglands.
THEORALREGION:THETONGUE
THETONGUE
ThedorsumofthetongueischaracterizedbyaV-shapedgroove,the
terminalsulcus,theangleofwhichpointsposteriorlytotheforamen
cecum.
Theterminalsulcusdividesthedorsumofthetongueinto
•  anteriorpartintheoralcavityproperand
•  posteriorpartintheoropharynx.
THEORALREGION:THETONGUE
THETONGUE
Thelingualpapillae:
•  vallatepapillae
•  foliatepapillae
•  filiformpapillae
•  fungiformpapillae
VALLATEPAPILLAE
arelargepapillaearrangedinaVattherearofthetongue.
Eachissurroundedbyadeepcirculartrench.Thereareonly7to12of
them.
FOLIATEPAPILLAE
arepoorlydevelopedinhumans.Theyformparallelridgesonthesides
ofthetongueabouttwo-thirdsofthewaybackfrom
THEORALREGION:THETONGUE
THETONGUE
FILIFORMPAPILLAE
containafferentnerveendingsthataresensi2vetotouch,withouttaste
buds.Theyaresmallandplaynogustatoryrole.
FUNGIFORMPAPILLAE
areshapedsomewhatlikemushrooms.Eachhasaboutthreetaste
buds,locatedmainlyontheapex.Mostnumerousattheapexand
marginsofthetongue.
THEORALREGION:THETONGUE
THETONGUE
Thevallate,foliate,andmostofthefungiformpapillaecontain
tastereceptorsinthetastebuds.
Asublingualcaruncle(papilla)ispresentoneachsideofthebaseofthe
lingualfrenulumthatincludestheopeningofthesubmandibularduct
fromthesubmandibularsalivarygland.
VALLATEPAPILLAE:largeandflattoppedpapillaearrangedinaV.
Numeroustastebudsandsmallserousglands.
FOLIATEPAPILLAE:poorlydeveloped,lateralfoldsofthelingual
mucosa.Numeroustastebuds.
FILIFORMPAPILLAE:aresensi2vetotouch,withouttastebuds.
FUNGIFORMPAPILLAE:likemushrooms,attheapexandmarginsof
thetongue,aboutthreetastebuds.
THEORALREGION:THETONGUE
THETONGUE-MUSCLES
Thefourintrinsicandfourextrinsicmusclesineachhalfofthetongue
areseparatedbyamedianfibrouslingualseptum
Theextrinsicmusclesaltertheposi2onofthetongue
Theintrinsicmusclesalteritsshape
EXTRINSICMUSCLESOFTONGUE:
•  genioglossus
•  hyoglossus
•  styloglossus,and
•  palatoglossus
originateoutsidethetongueand
akachtoit.
INTRINSICMUSCLESOFTONGUE:
•  superiorandinferiorlongitudinal
•  transverse,and
•  ver2cal
muscles.
THEORALREGION:THETONGUE
THETONGUE-INNERVATION
MOTORINNERVATION
Allmusclesofthetongue,exceptthepalatoglossus(accessorynerveXI
viavagusX)receivemotorinnerva2onfromthehypoglossalnerve
(CNXII)
GENERALSENSORYINNERVATION
•  trigeminalV3(vialingual),
•  glossopharyngealIX,and
•  vagusX(viainternallaryngeal),
toinnervatetheepitheliumandmucosa.
GENERALSENSORYINNERVATION
Thesensoryinnerva2onofthetonguereflectsitsembryological
development:theanteriortwo-thirdsisderivedfromfirstarch
mesenchymeandtheposteriorthirdfromthirdarchmesenchyme.
THEORALREGION:THETONGUE
THETONGUE-INNERVATION
GENERALSENSORYINNERVATION
Thenerveofgeneralsensa2ontotheanteriortwo-thirdsisthelingual
nerve.Thenervesupplyinggeneralsensa2ontotheposteriorthirdis
theglossopharyngealnerve.
Tastebudss2mulate:
•  thefacialnerve(VII)intheanteriortwo-thirdsofthetongue,
•  theglossopharyngealnerve(IX)intheposteriorone-third,and
•  thevagusnerve(X)inthepalate,pharynx,andepiglo`s.
Forspecialsensa2on(taste),thisanterior2/3ofthetongue,exceptfor
thevallatepapillae,issuppliedthroughthechordatympaninerve,a
branchofCNVII.
THEORALREGION:THETONGUE
THETASTE
Chordatympanipassesanteriorlytoenterthetympaniccavityandlies
alongthetympanicmembraneandmalleusun2lexi2ngthe
petrotympanicfissure.
Chordatympanijoinstheposteriorborderofthelingualnerveinthe
infratemporalfossaandrunsanteriorlyinitssheath.
Lingualnerveisdistributedtotheanterior2/3ofthetongue,andthe
specialtastefibersfromthechordatympanitraveltothetastebudsin
thisregion
Theposterior1/3ofthetongue(generalandspecialsensa2on)is
suppliedbythelingualbranchoftheglossopharyngealnerve(CNIX).
THEORALREGION:THETONGUE
THETASTE
Twigsoftheinternallaryngealnerve,abranchofthevagusnerveCNX,
supplymostlygeneralbutsomespecialsensa2ontoasmallareaofthe
tonguejustanteriortotheepiglo`s.
THEORALREGION:THETONGUE
THETONGUE-PARASYMPATHETIC
These:facial(viachordatympani),glossopharyngeal,andvagus(via
internallaryngeal)nervesalsocarryparasympathe2csecretomotor
fiberstoserousglandsinthetongue.
THEORALREGION:THETONGUE
THETONGUE-ARTERIES
Thelingualarteryarisesfromtheexternalcaro2dartery
Thesubmentalartery,abranchofthefacialarteryfromtheexternal
caro2dartery
Thebranchesofthelingualartery:
•  thedorsallingualarteriessupplytherootofthetongue;
•  thedeeplingualarteriessupplythebody.
Onlythedeeplingualarteriescommunicatewitheachothernear
theapexofthetongue.Thedorsallingualarteriescannot,becauseof
thelingualseptum.
THEORALREGION:THETONGUE
THETONGUE-VEINS
Theveinsofthetongueare:
•  thedorsallingualveins
•  thedeeplingualveins
joiningtoformalingualveinanddrainintotheinternaljugularvein.
THEORALREGION:THETONGUE
THETONGUE-LYMPHATICDRAINAGE
Lymphfromtherootdrainsbilaterallyintothesuperiordeepcervical
lymphnodes.
Lymphfromthemedialpartofthebodydrainsbilaterallyanddirectly
totheinferiordeepcervicallymphnodes.
Lymphfromtherightandle[lateralpartsofbodydrainstothe
submandibularlymphnodesontheipsilateralside.
Theapexandfrenulumdraintothesubmentallymphnodes,
themedialpor2ondrainingbilaterally.
THEORALREGION:THESALIVARYGLANDS
THESALIVARYGLANDS
Thesalivaryglandsare:
•  paro2d
•  submandibular,and
•  sublingual
glands
Thesubmandibularglandsliealongthebodyofthemandible
Thesubmandibularductarisesfromthegland,passingfromlateralto
medialandopeningbyonetothreeorificesonasmallsublingualpapilla
besidethebaseofthelingualfrenulum
Thesublingualglandisdeeptothesublingualmucosaandsecretes
salivadirectlyintothefloorofthemouth.
THEORALREGION:THESALIVARYGLANDS
THESUBMANDIBULARANDSUBLINGUALGLANDS
Thesubmandibularandsublingualglandsareinnervatedby
postganglionicsympathe2cfibersthatarisefromthesuperiorcervical
ganglionandrunalongsidethelingualandfacialarteries.
Parasympathe2cinnerva2onisfromthechordatympani,whicharises
fromthefacialnerve.Thesepreganglionicfiberssynapseinthe
submandibularganglion.Postganglionicsinnervatethesubmandibular
andsublingualglands.
THEORALREGION:THESALIVARYGLANDS
THESUBMANDIBULARANDSUBLINGUALGLANDS
Venousdrainageistothelingualandfacialveins,andlympha2c
drainageistosmallvesselsthatemptyintothesubmandibularnodes.
THEORALREGION:THETEMPORALREGION
THETEMPORALFOSSA
Thetemporalfossaisbounded:
•  posteriorlyandsuperiorlybythetemporallines.
•  anteriorlybythefrontalandzygoma2cbones.
•  laterallybythezygoma2carch.
•  inferiorlybytheinfratemporalcrest
isoccupiedprimarilybytheupperpor2onofthetemporalismuscle
Thespace:
•  deepandinferiortothezygoma2carch,
•  deeptotheramusofthemandibleand
•  posteriortothemaxilla.
THEORALREGION:THEINFRATEMPORALFOSSA
THEINFRATEMPORALFOSSA
Theboundariesoftheinfratemporalfossaare:
•  laterally:theramusofthemandible.
•  medially:thelateralpterygoidplate.
•  anteriorly:theposterioraspectofthemaxilla.
•  posteriorly:thetympanicplateandthemastoidandstyloid
processesofthetemporalbone.
•  superiorly:theinferior(infratemporal)surfaceofthegreater
wingofthesphenoid.
•  inferiorly:wherethemedialpterygoidmuscleakachestothe
mandiblenearitsangle.
THEORALREGION:THEINFRATEMPORALFOSSA
THEINFRATEMPORALFOSSA
Theinfratemporalfossacontains:
•  inferiorpartofthetemporalismuscle
•  lateralandmedialpterygoidmuscles
•  maxillaryartery
•  pterygoidvenousplexus
•  mandibular,inferioralveolar,lingual,buccal,andchordatympani
nerves
•  o2cganglion
THETEMPOROMANDIBULARJOINT
Thetemporomandibularjoint(TMJ)isamodifiedhingetypeof
synovialjoint,permi`nggliding(transla2on)andasmalldegreeof
rota2on(pivo2ng)inaddi2ontoflexion(eleva2on)andextension
(depression)movementstypicalforhingejoints.
Thebonyar2cularsurfacesinvolvedare:
•  themandibularfossaand
•  ar2culartubercleofthetemporalbonesuperiorly,and
•  theheadofthemandibleinferiorly
Thetwobonyar2cularsurfacesarecompletelyseparatedby
interveningfibrocar2lage,thear2culardiscoftheTMJ,akachedatits
peripherytotheinternalaspectofthefibrouscapsule
THETEMPOROMANDIBULARJOINT
Thiscreatesseparatesuperiorandinferiorar2cularcavi2es
TheligamentsofTMJ:
TheintrinsiclateralligamentoftheTMJ,formedbyapartofthejoint
capsule
Thestylomandibularligament,whichisactuallyathickeningofthe
fibrouscapsuleoftheparo2dgland,runsfromthestyloidprocessto
theangleofthemandible
Thesphenomandibularligamentrunsfromthespineofthesphenoid
tothelingulaofthemandible
THETEMPOROMANDIBULARJOINT
ThemusclesofmasTcaTon:
•  Masseter
•  Temporalis
INNERVATION:V3
•  Medialpterygoid
•  Lateralpterygoid
Thelateralpterygoidistheonlymuscleofmas2ca2onthatassistsin
depressingthemandible(openingthejaw).
THENOSE
THENOSE-SKELETONOFEXTERNALNOSE
3pairsofbonesformtherootofthenose:
•  frontal(nasalprocess)
•  maxilla(frontalprocess)
•  nasal
Becausetherootofthenoseismadeofbone,itisfixed3different
car*lagesformthedorsumandapexofthenose:
•  septal
•  lateralnasal
•  alar
THENOSE
THENOSE-NASALSEPTUM
Themaincomponentsofthenasalseptumare:
•  theperpendicularplateoftheethmoid,
•  thevomer,and
•  theseptalcar2lage
Thenasalcavityisenteredanteriorlythroughthenares.
Itopensposteriorlyintothenasopharynxthroughthechoanae.
ThesphenopalaTneforamen
(forthesphenopala2neartery,abranchofthemaxillarya.),
locatedintheposteriorpor2onofthelateralwalls,connectsthenasal
cavitytothepterygopala2nefossa.
THENOSE
THENASALCAVITY-BOUNDARIES
•  SUPERIOR-nasal,frontal,cribriformplateoftheethmoid,bodyofthe
sphenoid
•  INFERIOR-pala2neprocessofthemaxilla,horizontalplateofthe
pala2ne
•  ANTERIOR-externalnose
•  POSTERIOR-choanae •  SEPTUM-ethmoid(perpendicularplate),vomer,septalcar2lage •  LATERAL-maxilla,ethmoid,pala2ne,sphenoid(medialpterygoid
plate),andinferiornasalconcha,lacrimal
THENOSE
THENASALCAVITY-RELATIONS
Superior:frontalsinus,sphenoidsinus,anteriorcranialfossawith
frontallobeofthebrain Inferior:palate,oralcavity Medial:otherhalfofnasalcavity
Lateral:maxillarysinus,ethmoidsinuses,orbit,andpterygopala2ne
fossa THENOSE
THENASALCAVITY-CONCHAE
SUPERIORCONCHA
•  throughsphenoethmoidalrecessconnectswithsphenoidalsinus •  throughsuperiormeatusconnectswithposteriorethmoidsinus
MIDDLECONCHA
connectsthroughmiddlemeatuswith:
•  middleethmoidalsinus
•  maxillarysinus
•  frontalsinus INFERIORCONCHA
•  connectsthroughinferiormeatuswithnasolacrimalduct
THENOSE
THENASALCAVITY-ARTERIES
Thebloodsupplytothenasalcavityarisesfrom3majorarteries:
•  ophthalmic
•  maxillary
•  facial
These3vesselsarederivedfromtheexternalandinternalcaro2d
arteriesandgenerallyfollowthepathsofthenerves
These3vessels(ophthalmic,maxillary,facial)arederivedfromthe
externalandinternalcaro2darteriesandgenerallyfollowthepathsof
thenerves
Awell-developedcavernousplexusliesdeeptothemucousmembrane.
THENOSE
THENASALCAVITY-VEINS
EMISSARY:
Veinfromthecavernousplexusinthenasalcavitypassesthroughthe
foramencecumtodrainintothesuperiorsagikalsinus SPHENOPALATINE
Bloodfromthevenousplexusalongtheposteriorpor2onofthenasal
cavitydrainstothesphenopala2nev.
Travelsthroughthesphenopala2neforamentoenterthepterygoid
plexus ETHMOIDALBRANCHES
Bloodfromthevenousplexusintheanteriorpor2onofthenasalcavity
drainsintoethmoidbranches,whichfollowtheethmoidaa.to
terminateintheophthalmicv.and/orfacialv. THENOSE
THENASALCAVITY-NERVESUPPLY
GENERALSENSATION
•  ophthalmicdivisionV1ofthetrigeminal
•  maxillarydivisionV2ofthetrigeminal
Thenervesupplyoftheanterosuperiorpor2onisfromtheophthalmic
nerve(CNV1)bywayoftheanteriorandposteriorethmoidalnerves,
branchesofthenasociliarynerve.
Mostoftheexternalnose(dorsumandapex)isalsosuppliedbyCNV1
Thealaeofthenosearesuppliedbythenasalbranchesofthe
infraorbitalnerve(CNV2).
THENOSE
THENASALCAVITY-NERVESUPPLY
SENSORYINNERVATION-OLFACTION
Theolfactoryepitheliumisfoundintheroofofthenasalcavity
includingtheadjacentsuperiorpor2onsofthelateralwallofthenasal
cavityandthenasalseptum
SENSORYINNERVATION-OLFACTION
Roughly20to25smallolfactoryn.fibers,whichcollec2velyformthe
olfactorynervesperside,travelsuperiorlythroughthecribriformplate
intotheanteriorcranialfossatojointheolfactorybulb
THEPARANASALSINUSES
THEPARANASALSINUSES
Theair-filledextensionsoftherespiratorypartofthenasalcavityinto
thefollowingcranialbones:
•  frontal
•  ethmoid
•  sphenoid,and
•  maxilla
TherightandleJfrontalsinuses.Frontalsinusesareusuallydetectable
inchildrenby7yearsofage.
THEPARANASALSINUSES
THEFRONTALSINUSES
RELATIONSOFTHEFRONTALSINUS:
Superior:anteriorcranialfossaandcontents
Inferior:orbit,anteriorethmoidalsinuses,nasalcavity
Anterior:forehead,superciliaryarches
Posterior:anteriorcranialfossaandcontents
Medial:otherfrontalsinus
TherightandleJsinuseseachdrainthroughafrontonasalductintothe
ethmoidalinfundibulum,whichopensintothesemilunarhiatusofthe
middlenasalmeatus.
Innerva2on-thesupraorbitalandsupratrochlearnerves(CNV1).
THEPARANASALSINUSES
THEETHMOIDALCELLS
Mayfind3to18ethmoidaircellsoneachside
RELATIONSOFTHEETHMOIDALSINUS:
Superior:anteriorcranialfossaandcontents,frontalbonewithsinus
Medial:nasalcavity
Lateral:orbit
Theethmoidalcellsaresuppliedbytheanteriorandposterior
ethmoidalbranchesofthenasociliarynerves(CNV1)
Theanteriorethmoidalcellsdraindirectlyorindirectlyintothemiddle
nasalmeatusthroughtheethmoidalinfundibulum.
Themiddleethmoidalcellsopendirectlyintothemiddlemeatus.
Theposteriorethmoidalcellsopendirectlyintothesuperiormeatus.
THEPARANASALSINUSES
THEETHMOIDALCELLS
Theanteriorethmoidalcellsdraindirectlyorindirectlyintothemiddle
nasalmeatusthroughtheethmoidalinfundibulum.
Themiddleethmoidalcellsopendirectlyintothemiddlemeatus.
Theposteriorethmoidalcellsopendirectlyintothesuperiormeatus.
THEPARANASALSINUSES
THESPHENOIDALSINUSES
Thesphenoidalsinusesarelocatedinthebodyofthesphenoid.Two
large,irregularlyshapedcavi2es.Separatedbyanirregularseptum.
RELATIONSOFTHESPHENOIDSINUS:
Superior:hypophysealfossa,pituitarygland,op2cchiasm
Inferior:nasopharynx,pterygoidcanal
Medial:othersphenoidbone
RELATIONSOFTHESPHENOIDSINUS:
Lateral:cavernoussinus,internalcaro2dartery,cranialnervesIII,IV,
V1,V2,andVI
Anterior:nasalcavity
THEPARANASALSINUSES
THESPHENOIDALSINUSES
Theposteriorethmoidalarteries(fromophthalmica.fromtheinternal
caro2da.)andtheposteriorethmoidalnerves(fromophthalmicdivision
ofthetrigeminaln.)thataccompanythearteriessupplythesphenoidal
sinuses.
Thespheno-ethmoidalrecess,lyingsuperoposteriortothesuperior
concha,receivestheopeningofthesphenoidalsinus
THEPARANASALSINUSES
THEMAXILLARYSINUSES
•  Largepyramidalcavity
•  Thinwalls
•  Primarylympha2cdrainageistothesubmandibularlymphnodes
RELATIONSOFTHEMAXILLARYSINUS
Superior:orbit,infraorbitalnerveandvessels
Inferior:rootsofmolarsandpremolars
Medial:nasalcavity
Lateralandanterior:cheek
Posterior:infratemporalfossa,pterygopala2nefossa
THEPARANASALSINUSES
THEMAXILLARYSINUSES
Eachmaxillarysinusdrainsbyoneormoreopenings,themaxillary
os2um(os2a),intothemiddlenasalmeatusofthenasalcavitybyway
ofthesemilunarhiatus.
Thearterialsupplyofthemaxillarysinusismainlyfromsuperior
alveolarbranchesofthemaxillaryartery.
Innerva2onofthemaxillarysinusisfromthesuperioralveolarnerves,
whicharebranchesofthemaxillarynerveV2
THEOLFACTORYNERVECNI
THEOLFACTORYNERVECNI
Func2on:Specialsensory-thespecialsenseofsmell.
Theolfactorynerveisformedbyabout20smallbundlesof
nonmyelinatedaxonsfromtheolfactorycells.Itpassesthroughthe
cribriformplateoftheethmoidintotheolfactorybulb.
Theolfactorynervefiberssynapsewithmitralcellsintheolfactory
bulb.Theaxonsofthesesecondaryneuronsformtheolfactorytract.
Theolfactorybulbsandtractsareanteriorextensionsoftheforebrain.
THEGLOSSOPHARYNGEALNERVECNIX
THEGLOSSOPHARYNGEALNERVECNIX
Func2ons:
Sensory-soma2c(general)sensory,specialsensory(taste),andvisceral
sensory.
Motor-soma2c(branchial)motor,andvisceral(parasympathe2c)
motorforderiva2vesofthe3rdpharyngealarch.
Theglossopharyngealnerve(CNIX)emergesfromthelateralaspectof
themedullaandpassesanterolaterallytoleavethecraniumthrough
theanterioraspectofthejugularforamen
CNIXfollowsthestylopharyngeus,theonlymusclethenervesupplies
THEGLOSSOPHARYNGEALNERVECNIX
THEGLOSSOPHARYNGEALNERVECNIX
SOMATICMOTOR
Motorfiberspasstoonemuscle,thestylopharyngeus,derivedfromthe
3rdpharyngealarch.
PARASYMPATHETICMOTOR
Presynap2cparasympathe2cfibersareprovidedtotheo2cganglionfor
innerva2onoftheparo2dgland.Theo2cganglionisassociatedwiththe
mandibularnerve(CNV3),branchesofwhichconveythepostsynap2c
parasympathe2cfiberstotheparo2dgland.
THEGLOSSOPHARYNGEALNERVECNIX
THEGLOSSOPHARYNGEALNERVECNIX
GENERALSENSORY
ThegeneralsensorybranchesofCNIXareasfollows:
•  thetympanicnerve
•  thecaro2dsinusnervetothecaro2dsinus,abaro-(presso-)receptor
sensi2vetochangesinbloodpressure,andthecaro2dbody,a
chemoreceptorsensi2vetobloodgas(oxygenandcarbondioxide
levels).
•  thepharyngeal,tonsillar,andlingualnervestothemucosaofthe
oropharynxandisthmusofthefauces
THEGLOSSOPHARYNGEALNERVECNIX
THEGLOSSOPHARYNGEALNERVECNIX
SPECIALSENSORY-TASTE
Tastefibersareconveyedfromtheposteriorthirdofthetonguetothe
sensoryganglia,thesuperiorandinferiorgangliaofCNIX
OTICGANGLION
Parasympathe2cganglionlocatedmedialtothemandibularnerve
belowtheforamenovale.
Itreceivespreganglionicfibersfromtheglossopharyngealnerveviathe
lesserpetrosalnerveandsendspostganglionicsecretoryfiberstothe
paro2dgland
THEVAGUSNERVECNX
THEVAGUSNERVECNX
FuncTons:Sensory-soma2c(general)sensory,specialsensory(taste),
visceralsensory.
Motor-soma2c(brachial)motorandvisceral(parasympathe2c)motor.
TogetherwiththeIXnerve,itexitsthebrainintheposterolateralsulcus
andpassesthroughthejugularforamen.Itssupplyregionextendsinto
thethoracicandabdominalcavi2es.
SomaTc(general)sensoryfromtheinferiorpharynx,andlarynx.
Visceralsensoryfromthethoracicandabdominalorgans.
TasteandsomaTc(general)sensaTonfromtherootofthetongueand
tastebudsontheepiglo`s.Branchesoftheinternallaryngealnerve(a
branchofCNX)supplyasmallarea,mostlysoma2c(general)sensory
butalsosomespecialsensa2on(taste).
THEVAGUSNERVECNX
THEVAGUSNERVECNX
SomaTc(branchial)motorto:
•  thesoJpalate;
•  pharynx;
•  intrinsiclaryngealmuscles(phona2on);and
•  anominalextrinsictonguemuscle,
•  thepalatoglossus,whichisactuallyapala2ne
musclebasedonitsderiva2onand
innerva2on.
Propriocep2vetothemuscleslistedabove.
Visceral(parasympathe2c)motortothoracicandabdominalviscera.
THEVAGUSNERVECNX
THEVAGUSNERVECNX
•  Soma2c(general)sensoryfromtheinferiorpharynx,andlarynx.
•  Visceralsensoryfromthethoracicandabdominalorgans.
•  Tasteandsoma2c(general)sensa2onfromtherootofthetongue
andtastebudsontheepiglo`s.Branchesoftheinternallaryngeal
nerve(abranchofCNX)supplyasmallarea,mostlysoma2c
(general)sensorybutalsosomespecialsensa2on(taste).
•  Soma2c(branchial)motortothesoJpalate;pharynx;intrinsic
laryngealmuscles(phona2on);andanominalextrinsictongue
muscle,thepalatoglossus,whichisactuallyapala2nemusclebased
onitsderiva2onandinnerva2on.
•  Propriocep2vetothemuscleslistedabove.
•  Visceral(parasympathe2c)motortothoracicandabdominalviscera.
THEVAGUSNERVECNX
THEVAGUSNERVECNX
Thevagusnerve(CNX)hasthelongestcourseandmostextensive
distribu2onofallthecranialnerves,mostofwhichisoutsideof(inferior
to)thehead.
ThenervesgiverisetorightandleJrecurrentnervesandthen,from
theesophagealplexus,reformasanteriorandposteriorvagaltrunks,
whichcon2nueintotheabdomen.