2021/7021MSC Oral Biology Semester 1 2013

Laboratory Manual Anatomy of the Head and Neck Region Laboratory 2 Temporomandibular Joint, Infratemporal Fossa Muscles of Mastication Muscles of Facial Expression

Laboratory 2: Osteology; Temporomandibular joint; Muscles of mastication; Muscles of facial expression. Learning objectives.
1. 2. 3. 4. 5. 6. 7. Identify the surface projections of major bony landmarks of the skull on a living subject. Locate and identify the temporal and infratemporal fossae and pteryogpalatine fossa Describe the anatomy of the mandible. Describe the anatomy of the temporomandibular joint. Identify the muscles of mastication Describe an overview of the masticatory cycle and specific actions of the key muscles during the masticatory cycle. Identify the muscles of facial expression and state their actions.

Station 1 Surface anatomy

Use a skull model or specimen to locate the following structures. If working with a partner, seek their permission to palpate the structure, or locate and palpate these structures on yourself . external occipital protuberance mastoid process (what is located within this structure?) zygomatic arch (trace along its length to meet the temporal bone) What are the two processes that unite to form this arch? ____________________________________________________________________________ greater wing of sphenoid bone parietal eminences frontal eminences glabella temporomandibular joint angle of the mandible hyoid bone (on yourself! squeeze gently, inferiomedial to the angle of the mandible) spinous process of C3 and C7 Can you palpate the spinous process of C1? clavicle: The medial one third of this bone is the origin for a large neck muscle that performs the actions of flexion (when both left and right sides contract at once) and rotation (when one side only is contracted). Identify (and palpate) the neck muscle described above:_____________________________ manubrium (inferior to sternal notch) This bone is one of the two origins of a major neck muscle (which also forms the boundary for the anterior and posterior triangles of the neck). Which neck muscle originates on the anterior surface of the manubrium?________________

Identify two other neck muscles that connect the posterior surface of the manubrium to the: Hyoid bone _________________________Thyroid ________________________________ Note that these muscles are named for where they originate and insert.

Station 2
The superior temporal line is formed by the origin of the temporalis muscle attachment and the forces generated during temporalis muscle contraction during mastication. Identify the location of the temporal fossa: Which four cranial bones form the floor of this fossa? 1.______________________________ 3.______________________________ 2._____________________________ 4._____________________________

Which muscle occupies most of the temporal fossa? _________________________________________________________________ The inferior boundary of the temporal fossa is often arbitrarily nominated as the zygomatic arch.

Infratemporal fossa: The region deep to the mandible and inferior to the zygomatic arch is identified as the infratemporal fossa. Which bone and structure forms the ANTERIOR wall of the infratemporal fossa? ___________________________________________________________________________ Which bone forms the LATERAL border of the infratemporal fossa? ___________________________________________________________________________ Which feature of the sphenoid bone forms the MEDIAL boundary of the infratemporal fossa? ___________________________________________________________________________ The POSTERIOR boundary is continuous with the styloid process of temporal bone and the carotid sheath and its contents. The SUPERIOR boundary is formed by the infratemporal surface of the greater wing of sphenoid and the infratemporal crest (a bony ridge between the temporal and sphenoid bones). The infratemporal fossa continues inferiorly, travelling lateral to the pharynx, into the neck. The infratemporal fossa contains the medial and lateral pterygoid muscles and the tendon of the temporalis muscle, which contribute to mastication. See pages 35, 102 and 103 of, Head and Neck Anatomy for Dental Medicine (2010) Eric W. Baker Editor Thieme Medical Publishers Inc NY USA

Locate and label the boundaries of the temporal fossa and the infratemporal fossa on this diagram

Fig 1.5 pg 4, Head & Neck Anatomy for Dental Medicine (2010) Eric W. Baker Ed. Thieme Medical Publishers Inc NY USA

The infratemporal fossa is continuous with the pterygopalatine fossa which provides pathways for a number of neurovascular structures which you will explore further in later labs. The major structures are illustrated below and you can review this region at the following website. http://skullanatomy.info/Individ%20Spaces/Ptg_Fossa/PtPFossa.htm See also pages 100-105 of Head & Neck Anatomy for Dental Medicine (2010) Eric W. Baker Ed. Thieme
Medical Publishers Inc NY USA

Fig 1.5 pg 4, Head & Neck Anatomy for Dental Medicine (2010) Eric W. Baker Ed. Thieme Medical Publishers Inc NY USA

Station 3
Mandible Review: Locate and these structures on the bones and label the following diagrams

External surface Head Neck Condylar process (head & neck) Body Ramus Angle Coronoid process Mandibular (sigmoid) notch Pterygoid fovea Lingula Mandibular foramen Mylohyoid groove Temporal crest (internal oblique line) Retromolar fossa

Coronoid notch Mental foramen Mental protuberance Mental tubercle Alveolar Process External oblique line (ridge) Groove for the facial artery Internal surface Mylohyoid ridge (what attaches here?) Submandibular fossa (what sits here?) Sublingual fossa (what sits here?) Genial tubercles (mental spines) (attached?) Digastric fossa (what attaches here?) Angle - attachment of medial pterygoid

Use the diagrams above to illustrate the origins and insertions of the major masticatory muscles you observe in Station 4 Hyoid bone: Locate and identify the following features on the diagrams below:

Fig 1.40 pg22, Head & Neck Anatomy for Dental Medicine (2010) Eric W. Baker Ed. Thieme Medical Publishers Inc NY USA

Body of the hyoid, Lesser cornu, Greater cornu

Try to find the names of all the muscles that insert onto the hyoid bone. (think infrahyoid and suprahyoid muscles)

Gently palpate your hyoid bone. Now swallow. Which direction does the hyoid bone move initially?_______________________________________ Where would you expect to locate the muscles responsible for this movement? _________________________________________________________________________________ Which direction does the hyoid bone then move? _________________________________________ Where would you expect to locate the muscles responsible for this movement? _________________________________________________________________________________

Station 4
Temporomandibular joint The name of this joint describes the two bones which articulate together to permit opening, closing and chewing movements. Overview of Temporomandibular joint (TMJ) and its movement. The TMJ is a diarthrotic joint that is formed by the opposition of two convex structures with a fibrocartilaginous articular cartilage in between them. The structure of the joint provides two different types of movement: ginglymus (hinge) and arthrodial or gliding movement (thus ginglymoarthrodial joint). Fig 2.21 pg37, Head & Neck Anatomy for Dental Medicine (2010) Eric W. Baker Ed. Thieme
Medical Publishers Inc NY USA

Identify the bony features that form the temporomandibular joint (be specific) 1.____________________________ _____________________________

2.____________________________ What is meant by the upper and lower joint cavities of the temporomandibular joint? ___________________________________________ ____________________________________________ Identify the mandibular and articular fossae. What is the role of the articular disc in TMJ function? ____________________________________________ ____________________________________________ ____________________________________________ _____________________________ what is it attached to? _____________________________ Identify the fibrocartilage structure in the temporomandibular joint

Ligaments supporting the Temporomandibular Joint

First: orientate yourself with this image. What view is shown here?

Now, identify three ligaments that provide support to the TMJ.

What do you notice about their names?

Fig 2.20 pg37, Head & Neck Anatomy for Dental Medicine (2010) Eric W. Baker Ed. Thieme Medical Publishers Inc NY USA

Note the location and attachment of the sphenomandibular ligament. What is the clinical significance of this ligament? _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________

Fig 2.22 pg37, Head & Neck Anatomy for Dental Medicine (2010) Eric W. Baker Ed. Thieme Medical Publishers Inc NY USA

Write a brief description of the clinical disorder of the TMJ illustrated above:

Identify which of these three diagrams represents the following stages: mouth closed

mouth starting to open

mouth wide open.

For each of these stages, indicate two characteristic features you observed in the diagram.
Fig 2.16 pg35, Head & Neck Anatomy for Dental Medicine (2010) Eric W. Baker Ed. Thieme Medical Publishers Inc NY USA

What is meant by the clinical term crepitis when describing the TMJ?

TMJ Dysfunction syndrome:

Station 5
Use the following diagrams to help you identify the masticatory muscles on the cadaveric specimens Fig 2.12 pg32, Head & Neck Anatomy for Dental Medicine (2010) Eric W. Baker Ed. Thieme Medical Publishers Inc
NY USA

Although the TMJ movements are complex, the three primary movements are: Rotation occurs around an axis through the head of each mandibular condyle and is demonstrated during the initial opening of the mouth (first 15 of opening) where the mandible head remains within the glenoid (mandibular) fossa of the temporal bone (if you call it the glenoid fossa then also state it is the temporal bone as there is a glenoid fossa on your scapula too!). As the mouth opens more than 15 of opening, the head of the mandible glides forward with the articular disk on to the articular tubercle which results in shifting the joint axis forward. The movement of the articular disk is aided by the lateral pterygoid muscle (superior fibres), whilst the mandibular head translates anteriorly due to the pull of the inferior part of the same muscle. Further depression of the mandible (or opening of the mouth) is the result of synergistic actions of the digastric, geniohyoid and mylohyoid muscles contracting against a fixed hyoid bone. Fixation of the position of the hyoid bone occurs through infrahyoid muscle action. Mastication is initiated consciously however the movements, their sequence and rhythm are controlled by the central nervous system. An individuals masticatory pattern changes over the lifespan and can adapt to changes of the stomatognathic system. Overview of Mastication: Review the mandibular movements from your initial laboratory notes. Closure of the jaw (including biting) is synergistically actioned by two large (paired) muscles which elevate the jaw. Identify these two large superficial muscles: Muscle 1: Prime mover for mandibular elevation: _______________________________________________________________________________ Muscle 2: A fan- shaped muscle that elevates AND retracts mandible _______________________________________________________________________________

Another two pairs of smaller muscles contract synergistically to protrude the mandible and promote lateral or side to side movement for grinding. Identify these two muscles: Muscle 1: Orientation of this muscles fibres permits it to work synergistically (together) with the two large muscles above in elevation of the mandible. It forms a masticatory muscle sling with the Masseter muscle. __________________________________________________________ Muscle 2: Located more laterally than the muscle above and has a primary role in initiating depression of the mandible which is continued by the suprahyoid and infrahyoid muscles and gravity. Contraction of this muscle and its paired muscle on the other side of skull are considered to guide the TMJ movement. Its superior head also attaches to the articular disk. __________________________________________________________ If the two muscles identified above contract together, protrusion of the mandible occurs. It is important to recognise that unilateral contraction by these muscles contribute to lateral excursion or grinding . In addition to the four paired muscles above (ie there are two muscles, one on each side of the skull/mandible), the buccinator muscle compresses the cheek to ensure food remains between the occlusal surfaces of the teeth. See pages 30-35 Head & Neck Anatomy for Dental Medicine (2010) Eric W. Baker Ed. Thieme Medical Publishers Inc NY USA and Chapter 13 pages 208-215 Textbook of Head & Neck Anatomy 4th Edn Hiat JL and Gartner LP Wolters Kluwer Lippincott Williams and Wilkins Philadelphia PA.

Muscles of mastication: Identify the following muscles in the cadaver and the models.
Muscle Masseter Origin Insertion Action

Temporalis

Medial pterygoid

Lateral pterygoid

What is the embryological origin of these muscles? (see last page of these notes) Muscle Masseter Embryological origin Innervation Action

Temporalis

Medial pterygoid

Lateral pterygoid

What do you notice about the innervation? Identify the suprahyoid muscles. Which of these muscles affects mandibular movement. What is their action? Muscle Digastric Action

Mylohyoid

Geniohyoid

Stylohyoid

Fig 2.24b pg38, Head & Neck Anatomy for Dental Medicine (2010) Eric W. Baker Ed. Thieme Medical Publishers Inc NY USA

Identify the infrahyoid muscles that also affect mandibular movements. Muscle Sternohyoid Action

Sternothyroid

Thyrohyoid

Omohyoid

Identify the origins and insertions of the muscles on the hemi mandible diagram below.

Fig 2.24b pg38, Head & Neck Anatomy for Dental Medicine (2010) Eric W. Baker Ed. Thieme Medical Publishers Inc NY USA

On the diagram below, identify the origins and insertions for the muscles of MASTICATION only

Fig 2.24a pg38, Head & Neck Anatomy for Dental Medicine (2010) Eric W. Baker Ed. Thieme Medical Publishers Inc NY USA

Use the diagram below to assist your identification of the superficial facial muscles on the cadaveric specimens.

Fig 2.1 pg24, Head & Neck Anatomy for Dental Medicine (2010) Eric W. Baker Ed. Thieme Medical Publishers Inc NY USA

By looking at the locations of these muscles and the direction of their fibres, predict what their general action would be when each is contracted individually (or in combination if paired muscles).

Now label the muscles of facial expression on the following diagram.

Fig 2.2 pg25, Head & Neck Anatomy for Dental Medicine (2010) Eric W. Baker Ed. Thieme Medical Publishers Inc NY USA

Identify the innervation (motor nerve supply to the muscles of mastication), the muscles of facial expression (eg cranial nerve and division)

Embryology revisited: This diagram illustrates the why you are exploring embryology. You can see that the adult structures derived from each arch, share common features (eg groups of muscles with common functions, all supplied by specific nerves as illustrated here and blood supply not illustrated here)

http://classconnection.s3.amazonaws.com/519/flashcards/2297519/jpg/bbmapasset13541543839 41.jpg accessed March 1st, 2013

See also pages 60-61, particularly figure 4.13 which illustrates the four pharyngeal pouches, their migration to their final position and the muscles derived from each arch. Table 4.6 on page 61 is also of assistance.