Anatomic Relations Summary. Done by: Sohayyla Yasin Dababseh

Transcription

1 Anatomic Relations Summary Done by: Sohayyla Yasin Dababseh

2 Anatomic Relations Lecture 1 Part-1 - The medial wall of the nose is the septum. - The vestibule lies directly inside the nostrils (Nares). - The nasal venous plexus is placed on the lateral wall of the nasal cavity. - Superior meatus is located between superior and middle conchae. - Middle meatus is located between middle and inferior conchae. - Inferior meatus is located between inferior concha and floor of nasal cavity. - Nares are the anterior openings of the nasal cavity. - Choanae are the posterior openings of the nasal cavity (they open into the nasopharynx). Now the Prof. emphasized on memorizing the surrounding bones of choanae which are the following: 1- Superiorly; Sphenoidal process of palatine bone and superior to it; lies the Palatovaginal canal. 2- Inferiorly; Horizontal plate of palatine bone. 3- Laterally; Medial pterygoid plate of sphenoid.

3 4- Medialy; Vomer (which actually separates the two openings apart). - All choncae extend medially across the nasal cavity. - Ethmoidal bulla is an elevation of the lateral wall of the middle meatus, inferior to it; lies Hiatus semilunares. - Sphenopalatine artery enters the nasal cavity by passing medially through sphenopalatine foramen. - Anterior ethmoidal artery descends lateral to crista galli. - Alar branches of the superior labial artery pass around the lateral margin of Nares to supply the vestibule. - Apex of the maxillary sinus is directed laterally and the base is deep to the lateral wall of adjacent nasal cavity. - Relations of the maxillary sinuses (Important) 1- Related above to the orbit. 2- Related below to the roots of upper molar and premolar tooth. 3- Related behind to infratemporal fossa. 4- Related medially to the lower part of nasal cavity. - Relations of the sphenoidal sinuse (Important) 1- Related above to the pituitary gland and optic chiasm. 2- Related laterally to the cavernous sinus and its contents which are the following: *Note: The structures that lie within the cavernous sinus are; internal carotid artery, sympathetic fibers and Abducens nerve. The

4 structures that lie within the lateral wall of the cavernous sinus are; Ophthalmic, Trochlear and Oculomotor nerves. So, all of the aforementioned structures are lateral to the sphenoidal sinuses. 3- Below and front of the sinus lies the nasal cavity. - Note: Maxillary air sinuses are the largest and ethmoidal air sinuses are the smallest. Blood supply of the nasal cavity.

5 Artery Sphenopala tine artery Palatine artery Superior labial artery Anterior ethmoidal artery Posterior ethmoidal artery Branches 1-Posterior lateral branch(short sphenopalatine) 2- Posterior sepatal branch(long sphenopalatine) 1-lesser palatine. 2-Greater palatine. 1-Alar branch 2-Septal branch none none Course The major artery passes medially through sphenopalatine forame to enter nasal cavity. The long brach passes over the roof of the nasal cavity and into the septum. The greater palatine enters nasal through the incisive canal. Not mentioned Passes lateral to crista galli through a slit-like foramen. Passes through the cribriform plate. Supply 1-A Large part of the lateral wall (sup.post.quadrant). 2- The nasal septum. 1-Soft palate. 2-Anterior regions of the septum and adjacent floor. (postero-inferior and anteroinferior quadrant). 1-Ala and surrounding nares passing lateral to it to supply the vestibule. 2-Anterior regions of nasal septum. Lateral and medial walls of nasal cavity (Anterior superior quadrant). Upper parts of medial and lateral walls.

6 Notes: - Sphenopalatine and palatine arteries are branches of maxillary artery in pterygopalatine fossa. - Superior labial artery is a branch of facial artery. - Anterior and posterior ethmoidal arteries are branches of ophthalmic artery. Lecture 2: - The pterygopalatine fossa (sphenopalatine) lies on the lateral side of the skull. - Walls of Pterygopalatine fossa: 1- Anterior wall: Posterior surface of maxillary bone. 2- Posterior wall: Lateral pterygoid plate of sphenoid. 3- Medial wall: The lateral surface of palatine bone. 4- Roof (above it): The greater wing of sphenoid. 5- Lateral to it (not an actual wall): The infratemporal fossa. - Foramen rotundum and pterygoid canal open into the superoanterior surface of the ptyregoid process of sphenoid bone. So, foramen rotundum is the lateral and the superior one and pterygoid canal is the medial and inferior one. - The pterygoid canal opens in the middle cranial fossa anteroinferiorly to the internal carotid artery; it also continues superomedially for a short distance in the cartilage that fills foramen lacerum. - The gates ways of pterygopalatine fossa: (Important)

7 1- To the middle cranial fossa via foramen rotundum and pterygoid canal. 2- To the nasopharynx via palatovaginal canal; it opens into the posterior surface of the pterygopalatine fossa and is superior to the foramen rotundum. 3- To the roof of the oral cavity (hard palate) via palatine canal; it opens inferiorly. 4- To the lateral wall of the nasal cavity via sphenopalatine foramen; it is located on the medial wall (palatine bone) of pterygopalatine fossa. 5- Lateral aspect of pterygopalatine fossa communicates with infratemporal fossa via pterygomaxillary fissure. 6- Superior aspect of pterygopalatine fossa communicates with the orbit via inferior orbital fissure. Nerves that arise from the pterygopalatine ganglion

8 Nerve 1-Orbital nerve 2-Pharyngeal nerve 3-Greater palatine (anaterior palatine) Course Passes through inferior orbital fissure. Passes posteriorly from the pterygopalatine ganglion & leaves it through palatovaginal canal. Passes through palatine canal and passes forward on the roof of the oral cavity through greater palatine foramen. Supply Orbital wall lacrimal gland and sphenoidal sinus. Mucosa and glands of the nasopharynx. Mucosa and glands of hard palate, adjacent gingiva asfar forward as the incisor teeth and the mucosa over the middle and lower part of the lateral wall of the nasal cavity.

9 4-Lesser palatine (middle and posterior palatine 5-Short spheno-palatine 6-Nasopalatine nerve (long Sphenopalatine Passes through palatine canal The soft palate and passes posteriorly through lesser palatine foramen. Passes medially through the sphenopalatine foramen to enter the nasal cavity. The mucosa of the posterior superior quadrant of the nasal cavity. Passes medially through the sphenopalatine foramen to enter the nasal cavity and then passes anteriorly grooving down the nasal septum and then hrough the incisive canal and fossa in the hard palate. mucosa, gingiva, and glands adjacent to the incisor teeth.

10 Branches of the Maxillary nerve: **The table is on the last page 1- Meningeal ; before it enters the pterygopalatine fossa 2- Two ganglionic branches that carry sensory fibers to the pterygopalatine ganglion. 3- Zygomatic nerve 4- Posterior superior alveolar nerve. 5- Infra-orbital nerve. Maxillary artery - Is the major branch of the external carotid artery in the neck, originating adjacent to the neck of mandible within the substance of the parotid gland. It passes forward through the infratemporal fossa and enters the pterygopalatine fossa through the pterygomaxillary fissure (the third part) - The maxillary artery is divided into three parts: Relations of the first part: Laterally; the neck of mandible Medially; sphenomandibular ligament Above it: auriculo-temporal nerve Below it: maxillary vein It gives origin to two major branches: 1) The middle meningeal artery which passes through foramen spinosum. 2) Inferior alveolar artery which supplies teeth of the lower jaw.

11 Smaller branches: - Deep auricular and anterior tympanic arteries which supply the auricle. - Accessory meningeal artery which passes through foramen ovale to the middle cranial fossa. Relations of the second part: (Muscular part) It's related to the lateral pterygoid muscle. - Gives origin to deep temporal, masseteric, buccal, and pterygoid branches (muscles of mastication). - Courses with branches of the mandibular nerve. Relations of the third part: - Arises in the pterygopalatine fossa anterior to the pterygopalatine ganglion. - It Gives origin to branches that accompany branches of the maxillary nerve [V2] and the pterygopalatine ganglion. Branches of the third part: 1. The posterior superior alveolar artery 2. Infra-orbital artery 3. Greater palatine artery 4. Pharyngeal artery 5. Sphenopalatine arteries. 6. The artery of the pterygoid canal Note: check the relations of the branches from slides. Besides, this summary wasn't corrected by anyone so please if you find any wrong information, contact Raghad Abu-Jebbeh as soon as you can to have it corrected and excuse my typos btw.

12 Nerve Zygomatic Nerve Posterior superior alveolar nerve Infraorbital nerve Course Originates directly from the maxillary nerve in the pterygopalatine fossa and enter the orbit through the inferior orbital fissure. Passes laterally out of the fossa through the pterygomaxillary fissure the enters the posterior surface of the maxilla approximately midway between the last molar tooth and the inferior orbital fissure It s the anterior continuation of the maxillary nerve; it leaves the pterygopalatine fossa through the inferior orbital fissure. Then in the infra-orbital groove in the floor of the orbit and then continues forward in the Infra-orbital canal. It exits the infraorbital canal through the infra-orbital foramen and divides into nasal, palpebral, and superior labial branches Branches 1-Zygomatico-temporal branch enter thetemporal fossa and passes superficially 2-The Zygomatico-facial branch opens on the anterolateral surface of the zygomatic bone In the infra-orbital canal it gives the following two branches: middle and anterior superior alveolar nerves Supply 1-The skin over the temple and carriest parasympathetic and sympathetic fibers to lacrimal gland. 2-The adjacent skin of the zygomatic bone Molar teeth and adjacent buccal gingivae. It also contributes to the supply of the maxillary sinus The two branches Join the superior alveolar plexus to supply the upper teeth Middle superior alveolar nerve also supplies the maxillary sinus. Anterior superior alveolar nerve also gives origin to a small nasal branch. Nasal branches supply skin over the lateral aspect of the external nose and part of the nasal septum. Palpebral branches supply skin of the lower eyelid. Superior labial branches supply skin over the cheek and upper lip, and the related oral mucosa