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Prof. makarem SUBMANDIBULAR REGION I By Prof. Saeed Makarem 1 TOPICS 2 1. 2. 3. Suprahyoid muscles: origin, insertion, nerve supply and actions. Tongue muscles. Lingual artery: origin, course, parts and branches. Prof. makarem SUPRAHYOID MUSCLES 3 1- Digastric. 2- Stylohyoid 3- Mylohyoid. 4- Geniohyoid. Prof. makarem DIGASTRIC MUSCLE Origin & Insertion: Posterior belly arises from the medial surface of the mastoid process, then it passes downward and forward crossing the carotid sheath, and ends in the intermediate tendon. The intermediate tendon pierces the Stylohyoid insertion and is held in position by a loop of deep fascia, which binds the tendon down to the Prof. makarem 4 hyoid bone. DIGASTRIC MUSCLE DIGASTRIC MUSCLE Anterior belly runs forward and medially and is attached to the digastric fossa in the lower border of the body of the mandible, near the median plane. Nerve supply: posterior belly: facial nerve( 2nd) anterior belly: nerve to the mylohyoid (branch of the mandibular division of the trigeminal nerve)-(1st pharyngeal arch) • Action: elevation of the hyoid bone Prof. makarem 5 STYLOHYOID MUSCLE This is a small muscular slip that passes along the upper border of the posterior belly of digastric muscle. Origin: from the styloid process. Insertion: At the junction of the body & the greater cornu of hyoid. Near its insertion, it is pierced by the intermediate tendon of the digastric muscle. Nerve supply: Facial nerve, (2nd) Action: elevates the hyoid bone. Prof. makarem 6 SUPERFICIAL RELATIONS OF THE DIGASTRIC 5 muscles, 2 glands, one vein & one bone 1. Platysma. 2. Sternomastoid. 3. Splenius capitis. 4. Longissimus capitis. 5. Parotid gland. 6. Submandibular gland. 7. Stylohyoid. 8. Retromandibular vein. 9. Mastoid process. Prof. makarem 7 DEEP RELATIONS Deep to the anterior belly of the digatric is the mylohyoid. Deep to the posterior belly of the digastric are: Obliques superiorius, occipital artery, rectus capitis lateralis, transverse process of atlas, accessory nerve, internal jugular vein, hypoglossal nerve, internal and external carotid arteries. facial and lingual arteries hyoglossus. Prof. makarem 8 MYLOHYOID MUSCLE Flat, triangular muscle Origin: Mylohyoid line of the mandible. Prof. makarem Insertion: Posterior fibers into the body of the hyoid bone. Anterior fibers into the mylohyoid raphe which extends from the symphysis menti to the body of the hyoid bone. Nerve supply: mylohyoid branch of the inferior alveolar nerve. 9 10 Prof. makarem Action: the two mylohyoid muscles form a muscular sheet that supports the tongue and the floor of the mouth. When the mandible is fixed, they elevate the floor of the mouth and the hyoid bone during the first stage of swallowing. When the hyoid bone is fixed, it assists the depression of the mandible and the opening of the mouth. Prof. makarem 11 GENIOHYOID MUSCLE The geniohyoid muscle is a slender muscle, superior to the mylohyoid. Origin: from the inferior mental spine, behind the symphysis menti. Insertion: anterior surface of the body of the hyoid bone. Action: elevates the hyoid bone and draws it forward; or it depresses the mandible. Nerve supply: first cervical nerve through the hypoglossal nerve. Prof. makarem 12 MUSCLES OF THE TONGUE The muscles of the tongue are divided into two types: intrinsic and extrinsic. The intrinsic muscles are confined to the tongue and are not attached to bone. They consist of longitudinal, transverse, and vertical fibers. Nerve supply: Hypoglossal nerve. Action: Alter the shape of the tongue. Prof. makarem 13 Extrinsic Muscles of the Tongue The extrinsic muscles are attached to bones and the soft palate. They are: the genioglossus, the hyoglossus, the styloglossus, and the palatoglossus. Prof. makarem 14 The genioglossus muscle is a fan-shaped muscle, extends backward into the tongue. Insertion: GENIOGLOSSUS MUSCLE – superior fibers to the tip of the tongue Origin: from the superior mental spine, behind the symphysis menti-of mandible. – middle fibers - to the dorsum of the tongue – inferior fibers - to the body of the hyoid bone • Nerve supply: hypoglossal nerve. Action: draws the tongue forward and deflectsProf. themakarem tip of the tongue to the15 opposite side. Simultaneous contraction of the two muscles protrude the tongue in the midline. GENIOGLOSSUS 16 Prof. makarem • • • STYLOGLOSSUS MUSCLE Insertion: – The fibers run downward and forward on the lateral surface of the superior constrictor muscle. The–styloglossus muscle is a long, slender muscle. On reaching the interval between the superior and the middle constrictor muscles, the passes forward Origin:styloglossus from the styloid process.to enter the sides of the tongue. Action: draws the tongue upward and backward. Prof. Nerve supply: hypoglossal nerve. makarem 17 The hyoglossus is a flat, quadrilateral muscle, superficial to the mylohyoid. HYOGLOSSUS MUSCLE Origin: from upper border of the body and greater cornu of the hyoid bone. Insertion: to the side of the tongue. Action: depression of tongue. Nerve supply: hypoglossal nerve. Prof. makarem 18 STRUCTURES ON THE LATERAL SURFACE OF THE HYOGLOSSUS MUSCLE 19 From above downwards: Lingual nerve. Submandibular ganglion. Deep part of the submandibular salivary gland. Submandibular duct. Hypoglossal nerve. Suprahyoid artery. Prof. makarem • • • Branches Dorsal lingualforming branchesanare two or three number and ascend to the dorsum of the tongue. It runs forward, upward loop, inwhich is crossed by the hypoglossal nerve. The sublingual artery supplies sublingual salivary glandtoand neighboring It then proceeds forward deep the to the hyoglossus muscle supply the tip structures. of the tongue. LINGUAL ARTERY Suprahyoid artery :from the beginning of the artery and runs superficial to Hyoglossus Deep lingual artery: runs on the under surface of the tongue under its mucous membrane The lingual artery arises from the external carotid artery opposite the tip of the greater cornu of the hyoid bone. Prof. makarem 20