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Anatomy

Superior Constrictor Muscle

  • Origin: Hamulus, pterygo-mandibular raphe, and mylohyoid line of the mandible.
  • Insertion: Median raphe of the pharynx.
  • Nerve Supply: Vagus nerve via the pharyngeal plexus.
  • Arterial Supply: Ascending pharyngeal artery, ascending palatine artery, tonsillar branch of the facial artery, and dorsal branch of the lingual artery.
  • Action: Constricts the wall of the pharynx during swallowing.

The Masseter Muscle

  • This is a quadrangular muscle that covers the lateral aspect of the ramus and the coronoid process of the mandible.
  • Origin: inferior border and medial surface of zygomatic arch.
  • Insertion: lateral surface of ramus of mandible and its coronoid process.
  • Innervation: mandibular nerve via masseteric nerve that enters its deep surface.
  • It elevates and protrudes the mandible, closes the jaws and the deep fibres retrude it.

Walls of the Tympanic Cavity or Middle Ear

  • This cavity is shaped like a narrow six-sided box that has convex medial and lateral walls.
  • It has the shape of the biconcave lens in cross-section (like a red blood cell).

 

The Roof or Tegmental Wall

  • This is formed by a thin plate of bone, called the tegmen tympani (L. tegmen, roof).
  • It separates the tympanic cavity from the dura on the floor of middle cranial fossa.
  • The tegmen tympani also covers the aditus ad antrum.

 

The Floor or Jugular Wall

  • This wall is thicker than the roof.
  • It separates the tympanic cavity from the superior bulb of the internal jugular vein. The internal jugular vein and the internal carotid artery diverge at the floor of the tympanic cavity.
  • The tympanic nerve, a branch of the glossopharyngeal nerve (CN IX), passes through an aperture in the floor of the tympanic cavity and its branches form the tympanic plexus.

The Lateral or Membranous Wall

  • This is formed almost entirely by the tympanic membrane.
  • Superiorly it is formed by the lateral bony wall of the epitympanic recess.
  • The handle of the malleus is incorporated in the tympanic membrane, and its head extends into the epitympanic recess.

The Medial or Labyrinthine Wall

  • This separates the middle ear from the membranous labyrinth (semicircular ducts and cochlear duct) encased in the bony labyrinth.
  • The medial wall of the tympanic cavity exhibits several important features.
  • Centrally, opposite the tympanic membrane, there is a rounded promontory (L. eminence) formed by the first turn of the cochlea.
  • The tympanic plexus of nerves, lying on the promontory, is formed by fibres of the facial and glossopharyngeal nerves.
  • The medial wall of the tympanic cavity also has two small apertures or windows.
  • The fenestra vestibuli (oval window) is closed by the base of the stapes, which is bound to its margins by an annular ligament.
  • Through this window, vibrations of the stapes are transmitted to the perilymph window within the bony labyrinth of the inner ear.
  • The fenestra cochleae (round window) is inferior to the fenestra vestibuli.
  • This is closed by a second tympanic membrane.

 

The Posterior or Mastoid Wall

  • This wall has several openings in it.
  • In its superior part is the aditus ad antrum (mastoid antrum), which leads posteriorly from the epitympanic recess to the mastoid cells.
  • Inferiorly is a pinpoint aperture on the apex of a tiny, hollow projection of bone, called the pyramidal eminence (pyramid).
  • This eminence contains the stapedius muscle.
  • Its aperture transmits the tendon of the stapedius, which enters the tympanic cavity and inserts into the stapes.
  • Lateral to the pyramid, there is an aperture through which the chorda tympani nerve, a branch of the facial nerve (CN VII), enters the tympanic cavity.

The Anterior Wall or Carotid Wall

  • This wall is a narrow as the medial and lateral walls converge anteriorly.
  • There are two openings in the anterior wall.
  • The superior opening communicates with a canal occupied by the tensor tympani muscle.
  • Its tendon inserts into the handle of the malleus and keeps the tympanic membrane tense.
  • Inferiorly, the tympanic cavity communicates with the nasopharynx through the auditory tube.

 
Anterior 2/3 of tongue Posterior 1/3 of tongue
Motor Innervation All muscles by hypoglossal nerve (CN XII) except palatoglossus muscle (by the pharyngeal plexus)
General Sensory Innervation
Lingual nerve (branch of mandibular nerve CN V3) Glossopharyngeal nerve (CN IX)
Special Sensory Innervation
Chorda tympani nerve (branch of facial nerve) Glossopharyngeal nerve (CN IX)

Movements of the Temporomandibular Joint

  • The two movements that occur at this joint are anterior gliding and a hinge-like rotation.
  • When the mandible is depressed during opening of the mouth, the head of the mandible and articular disc move anteriorly on the articular surface until the head lies inferior to the articular tubercle.
  • As this anterior gliding occurs, the head of the mandible rotates on the inferior surface of the articular disc.
  • This permits simple chewing or grinding movements over a small range.
  • Movements that are seen in this joint are: depression, elevation, protrusion, retraction and grinding

CARTILAGE

There are 3 types:

Hyaline cartilage
Elastic cartilage
Fibrocartilage

Matrix is made up by: Hyaluronic acid

Proteoglycans

 

- In cartilage the protein core of the proteoglycan molecule binds through a linking protein to hyaluronic acid to form a proteoglycan aggregate which binds to the fibres

- In the matrix there are spaces, lacunae in which one to three of the cells of cartilage, chondrocytes, are found

- The matrix around the lacuna is the territorial matrix

- Type II collagen fibrils are embedded in the matrix

- The type of fiber depends on the type of cartilage

- Cartilage is surrounded by perichondrium which is a dense CT

- Apositional growth takes place in the perichondrium

- The fibroblasts of the perichondrium change to elliptic chondroblasts which later change to round chondrocytes

- Interstitial growth takes place around the lacunae

- Nutrients diffuse through the matrix to get to the chondrocytes   this limits the thickness of cartilage

Hyaline cartilage

Found: Rib cartilage,  articulating surfaces,  nose,  larynx, trachea, embryonic skeleton, Articulating cartilage has no perichondrium

 Bluish-white and translucent

Contains type II collagen that is not visible

 

Elastic cartilage

Found:  external auditory canal,  epiglottis

Similar to hyaline except that it contains many elastic fibres ,Yellow in colour,  Can be continuous with hyaline

Fibrocartilage

Found: Intervertebral disk, symphysis pubis

Always associated with dense CT,  Many collagen fibres in the matrix, No perichondrium

- Chondrocytes tend to lie in rows, Can withstand strong forces

Nerves of the Palate

  • The sensory nerves of the palate, which are branches of the pterygopalatine ganglion, are the greater and lesser palatine nerves.
  • They accompany the arteries through the greater and lesser palatine foramina, respectively.
  • The greater palatine nerve supplies the gingivae, mucous membrane, and glands of the hard palate.
  • The lesser palatine nerve supplies the soft palate.
  • Another branch of the pterygopalatine ganglion, the nasopalatine nerve, emerges from the incisive foramen and supplies the mucous membrane of the anterior part of the hard palate.

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