Muscles acting on the Temporomandibular Joint

• Movements of the temporomandibular joint are chiefly from the action of the muscles of mastication.
• The temporalis, masseter, and medial pterygoid muscles produce biting movements.
• The lateral pterygoid muscles protrude the mandible with the help from the medial pterygoid muscles and retruded largely by the posterior fibres of the temporalis muscle.
• Gravity is sufficient to depress the mandible, but if there is resistance, the lateral pterygoid, suprahyoid and infrahyoid, mylohyoid and anterior digastric muscles are activated.

Extrinsic Muscles of the Tongue (p. 746)

The Genioglossus Muscle

• This is a bulky, fan-shaped muscle that contributes to most of the bulk of the tongue.
• It arises from a short tendon from the genial tubercle (mental spine) of the mandible.
• It fans out as it enters the tongue inferiorly and its fibres attach to the entire dorsum of the tongue.
• Its most inferior fibres insert into the body of the hyoid bone.
• The genioglossus muscle depresses the tongue and its posterior part protrudes it.

The Hyoglossus Muscle

• This is a thin, quadrilateral muscle.
• It arises from the body and greater horn of the hyoid bone and passes superoanteriorly to insert into the side and inferior aspect of the tongue.
• It depresses the tongue, pulling its sides inferiorly; it also aids in retrusion of the tongue.

The Styloglossus Muscle

• This small, short muscle arises from the anterior border of the styloid process near its tip and from the stylohyoid ligament.
• It passes inferoanteriorly to insert into the side and inferior aspect of the tongue.
• The styloglossus retrudes the tongue and curls its sides to create a trough during swallowing.

The Palatoglossus Muscle 

• Superior attachment: palatine aponeurosis.
• Inferior attachment: side of tongue.
• Innervation: cranial part of accessory nerve (CN XI) through the pharyngeal branch of vagus (CN X) via the pharyngeal plexus.

• This muscle, covered by mucous membrane, forms the palatoglossal arch.

• The palatoglossus elevates the posterior part of the tongue and draws the soft palate inferiorly onto the tongue.

The Meatus of the Nose

Sphenopalatine Recess

• This space is posterosuperior to the superior concha.
• The sphenoidal sinus opens into this recess.

Superior Meatus

• This is a narrow passageway between the superior and middle nasal conchae.
• The posterior ethmoidal sinuses open into it by one or more orifices.

Middle Meatus

• This is longer and wider than the superior one.

• The anterosuperior part of this meatus lead into a funnel-shaped opening, called the infundibulum, through which the frontonasal duct leads to the frontal sinus.
• There is one duct for each frontal sinus and since there may be several, there may be several frontonasal ducts.

• When the middle concha is removed, rounded elevation called the ethmoidal bulla (L. bubble), is visible
• The middle ethmoidal air cells open on the surface of the ethmoidal bulla.

• Inferior to this bulla is a semicircular groove called the hiatus semilunaris.
• The frontal sinus opens into this hiatus anterosuperiorly.
• Near the hiatus are the openings of the anterior ethmoid air cells.
• The maxillary sinus also opens into the middle meatus.

Inferior Meatus

• This is a horizontal passage, inferolateral to the inferior nasal concha.
• The nasolacrimal duct opens into the anterior part of this meatus.
• Usually, the orifice of this duct is wide and circular.

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.

​​​​​​​The Tongue

• The tongue (L. lingua; G. glossa) is a highly mobile muscular organ that can vary greatly in shape.
• It consists of three parts, a root, body, and tip.
• The tongue is concerned with mastication, taste, deglutition (swallowing), articulation (speech), and oral cleansing.
• Its main functions are squeezing food into the pharynx when swallowing, and forming words during speech.

Muscles of the Soft Palate

The Levator Veli Palatini (Levator Palati)

• Superior attachment: cartilage of the auditory tube and petrous part of temporal bone.
• Inferior attachment: palatine aponeurosis.
• Innervation: pharyngeal branch of vagus via pharyngeal plexus.
• This cylindrical muscle runs inferoanteriorly, spreading out in the soft palate, where it attaches to the superior surface of the palatine aponeurosis.
• It elevates the soft palate, drawing it superiorly and posteriorly.
• It also opens the auditory tube to equalise air pressure in the middle ear and pharynx.

The Tensor Veli Palatini (Tensor Palati)

• Superior attachment: scaphoid fossa of medial pterygoid plate, spine of sphenoid bone, and cartilage of auditory tube.
• Inferior attachment: palatine aponeurosis.
• Innervation: medial pterygoid nerve (a branch of the mandibular nerve).
• This thin, triangular muscle passes inferiorly, and hooks around the hamulus of the medial pterygoid plate.
• It then inserts into the palatine aponeurosis.
• This muscle tenses the soft palate by using the hamulus as a pulley.
• It also pulls the membranous portion of the auditory tube open to equalise air pressure of the middle ear and pharynx.

The Palatoglossus Muscle

• Superior attachment: palatine aponeurosis.
• Inferior attachment: side of tongue.
• Innervation: cranial part of accessory nerve (CN XI) through the pharyngeal branch of vagus (CN X) via the pharyngeal plexus.
• This muscle, covered by mucous membrane, forms the palatoglossal arch.
• The palatoglossus elevates the posterior part of the tongue and draws the soft palate inferiorly onto the tongue.

The Palatopharyngeus Muscle

• Superior attachment: hard palate and palatine aponeurosis.
• Inferior attachment: lateral wall of pharynx.
• Innervation: cranial part of accessory nerve (CN XI) through the pharyngeal branch of vagus (CN X) via the pharyngeal plexus.
• This thin, flat muscle is covered with mucous membrane to form the palatopharyngeal arch.
• It passes posteroinferiorly in this arch.
• This muscle tenses the soft palate and pulls the walls of the pharynx superiorly, anteriorly and medially during swallowing.

The Musculus Uvulae

• Superior attachment: posterior nasal spine and palatine aponeurosis.
• Inferior attachment: mucosa of uvula.
• Innervation: cranial part of accessory through the pharyngeal branch of vagus, via the pharyngeal plexus.
• It passes posteriorly on each side of the median plane and inserts into the mucosa of the uvula.
• When the muscle contracts, it shortens the uvula and pulls it superiorly.