Topographical anatomy of the facial skeleton, spaces and contents.

Orbit, nasal cavity oral cavity, and pterygopalatine fossa

Dr Gallatz Katalin

ORBIT

Walls of the orbit Superior wall - orbital plate of the frontal bone - lesser wing of the sphenoid Lateral wall - greater wing of the sphenoid - orbital surface of the zygomatic bone Medial wall - frontal process of the maxilla - lacrimal bone - orbital plate of the ethmoid - body of the sphenoid Inferior wall - orbital surface of the body of the maxilla - orbital process of the palatine bone

Connections of the orbit

1. optic canal 2. superior orbital fissure 3. inferior orbital fissure 4. anterior ethmoidal foramen 5. posterior ethmoidal foramen 6. nasolacrimal canal 7. infraorbital canal 8. supraorbital foramen 9. frontal notch 10. zygomaticotemporal for. 11. zygomaticofacial for.

middle cranial fossa middle cranial fossa pterygopalatine fossa anterior cranial fossa ethmoidal cells inferior nasal meatus canine fossa frontal region frontal region temporal fossa lat. surface of the face

optic nerve and ophth. art. III., IV., VI., V/1., ophth.v. infraorbital a.,v., n. ant. ethmoidal nerve, a. post. ethmoidal a., n. nasolacrimal duct infraorbital a.,v., n. lat. supraorbital a., v., n. med. supraorb. a., v., n. zygomaticotemp. n. zygomaticofacial n.

septum orbitale superior and inferior tarsus

Superficial layer of the orbit

trochlear neve, frontal nerve,

lacrimal nerve and artery,

superior obligue muscle,

levator palpebrae superior, superior rectus,

lateral rectus and abducens n.

Middle layer of the orbit

- nasociliary nerve and artery cross the optic nerve from medial to lateral,

- medial rectus muscle

Branches of the ophthalmic artery Contents - central retinal artery - lacrimal artery - ciliary arteries - long and short posterior and anterior ciliary arteries

- muscular branches
- supraorbital artery - ant., post. ethmoidal arteries - medial palpebral artery

Branches of the ophthalmic nerve

- nasociliary nerve
- posterior ethmoidal nerve - anterior ethmoidal nerve - long ciliary nerves - infratrochlear nerve

- lacrimal nerve

- frontal nerve supratrochlear nerve supraorbital nerve

deep layer of the orbit

- inferior branch of the oculomotor n., - inferior rectus muscle,

- medial rectus muscle

- infraorbital artery and nerve,

CILIARY GANGLION: - can be found between the lateral rectus and optic nerve

- parasympathetic ganglion of the oculomotor nerve,

- it gets preganglionic fibers from the Edinger-Westfal nucl.,

- postganglionic fibers are called short ciliary nerves, - they innervate the sphincter of the pupil and ciliary muscles

Lateral wall of the orbit

Communicating branch of the zygomatic nerve (V/2) carries postganglionic parasympathetic fibers from the pterygopalatine ganglion

(VII.) to the lacrimal nerve (V/1)

Nasal cavity

WALLS OF THE NASAL CAVITY Superior:

nasal bone, frontal bone, cribriform plate of ethmoid, body of the sphenoid

Inferior: hard palate (palatine process of the maxilla, horizontal plate of palatine bone Medial: nasal septum Lateral: maxilla, the perpendicular plate of the palatine bone, the medial pterygoid plate, the labyrinth of the ethmoid and the inferior concha.

NASAL SEPTUM
Bony nasal septum - perpendicilar plate of the ethmoid - vomer Cartilagineous nasal septum

inferior nasal meatus middle nasal meatus

nasolacrimal duct semilunar hiatus (frontal sinus, anterior and middle ethmoidal cells, maxillary sinus)

superior nasal meatus

posterior ethmoidal cells

BLOOD SUPPLY OF THE NASAL CAVITY - sphenopalatine artery - anterior and posterior ethmoidal artery (branches of the ophthalmic artery),

- superior labial arteries (branches of facial artery supplying the vestibule of nasal cavity

Kiesselbach's area, (also Kiesselbach's plexus, and Little's area)

is a region in the anteroinferior part of the nasal septum, where arteries anastomose to form a vascular plexus called Kiesselbach's plexus. 90% percent of nose bleeds (epistaxis) occur in this area

The arteries are

Anterior ethmoidal artery

Sphenopalatine artery Greater palatine artery Septal branch of the superior labial artery

INNERVATION OF THE NASAL CAVITY General sensory innervation is by branches of the trigeminal nerve (V1 & V2):

- nasociliary nerve (V1) anterior and posterior ethmoidal branches

- posterior nasal branches of maxillary nerve (V2) - infraorbital nerve external nasal branch vestibule of the nasal cavity

PARANASAL SINUSES

PARANASAL SINUSES
- the maxillary sinus, the largest of the paranasal sinus, are under the eyes, in maxillary bones. It opens into the posterior part of the semilunar hiatus

-the frontal sinus, superior to the eyes, in the frontal bone, it opens into the anterior part of the semilunar hiatus through the ethmoidal infundibulum

- the ethmoid sinuses, which are formed from several air cells within the ethmoid. Anterior and middle group open into the middle part of the semilunar hiatus, posterior group open into the superior nasal meatus.

- the sphenoid sinus, in the sphenoid bone at the center of the skull base under the pituitary gland. It opens into the sphenoethmoidal recess.

The paranasal air sinuses are lined with respiratory epithelium

(ciliated pseudostratified columnar epithelium)

Borders of the semilunar hiatus

- ethmoid bulla - uncinate process

MAXILLARY SINUS

Recesses of the maxillary sinus

1. infraorbital recess
2. zygomatic recess 3. alveolar recess

MAXILLARY SINUS Structures narrowing the maxillary hiatus - ethmoidal bulla - uncinate process - inferior nasal concha, - perpendicular plate of the palatine bone - lacrimal bone
Maxillary sinus opens into the posterior part of the semilunar hiatus (middle nasal meatus)

Maxillary sinus

OLFACTORY EPITHELIUM

RESPIRATORY EPITHELIUM

RESPIRATORY EPITHELIUM

Walls of the pterygopalatine fossa

anterior: maxilla post.surface

posterior: ant. surface of the greater wing,

and pterygoid process

medial:

perpendicular plate of palatine bone

The pterygopalatine fossa contains

- the pterygopalatine ganglion suspended by nerve roots from the maxillary nerve - the terminal third of the maxillary artery

- the maxillary nerve (CN V2, the second division of the trigeminal nerve),
- the nerve of the pterygoid canal, a combination of the greater petrosal nerve (preganglionic parasympathetic) and the deep petrosal nerve (postganglionic sympathetic).

To obtain block anesthesia of the entire second division of the trigeminal nerve,

an intraoral injection can be administered

into this area through the greater palatine foramen.

Contents of the pterygopalatine fossa

maxillary artery, maxillary nerve (V.), pterygopalatine ganglion (VII.)

Connections of the pterygopalatine fossa

infraorbital fissure foramen rotundum sphenopalatine foramen

orbit middle cranial fossa nasal cavity

infraorbital a.,v., n. maxillary nerve sphenopalatine a.,

post. nasal nerves.

greater and lesser palatine canal oral cavity palatine nerves, desc.palatine artery pterygoid canal base of the skull greater petrosal nerve deep petrosal nerve pterygomaxillary fissure infratemporal fossa maxillary artery

Parts of the oral cavity

Vestibule of the oral cavity Oral cavity proper

ISTHMUS OF THE FAUCES

Borders:
superior: soft palate inferior: root of the tonque lateral: palatoglossal and palatopharngeal arch

Structure of the hard palate

Hard and soft palate

Muscles of the soft palate
Levator veli palatini
Tensor veli palatini Palatoglossus m. Palatopharyngeus m. M. uvulae

The hard and soft palate

Blood supply and innervetion of the hard and soft palate

SUBLINGUAL REGION

FEATURES OF THE FLOOR - frenulum of tongue - ridge formed by deep lingual vein - sublingual fold - sublingual caruncle (papilla) opening of submandibular and sublingual duct

ORAL DIAPHRAGMA MYLOHYOID M.

Lateral groove (sulcus) of the tongue

Borders: medial: lateral: hyoglossus m. mylohyoid m. Content: lingual nerve submandibular duct hypoglossal nerve

superior: sublingual mucous membrane

Medial groove (sulcus) of the tongue

Borders: medial: genioglossus m.

lateral:

hyoglossus m. Content: lingual artery

(glossopharyngeal nerve)

Thank you for your attention!