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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.