口腔科学教学课件：Oral and Maxillofacial Anatomy

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1、Key points:positionofthetemporomandibularjoint4.musclesofmastication5.Howtodistinguishtheinternalandexternalcarotid artery?6.pterygoidplexus7.distributionoftrigeminalnerveinoralregion8.branchesoffacialnerve Joints ：temporomandibular joint Oral and Maxillofacial systematic anatomybone Therere totally

2、 fourteen bones making up the maxillofacial bony framework. Oral and Maxillofacial systematic anatomyboneOral and Maxillofacial systematic anatomy maxilla口腔颌面部口腔颌面部系统解剖系统解剖boneOral and Maxillofacial systematic anatomymaxilla口腔颌面部系统解口腔颌面部系统解剖剖boneOral and Maxillofacial systematic anatomymaxilla口腔颌面部系

3、统解口腔颌面部系统解剖剖boneOral and Maxillofacial systematic anatomymaxillaboneOral and Maxillofacial systematic anatomymaxillabonefrontal processfrontal processzygomatic processzygomatic processpalatine processpalatine processalveolar processalveolar processOral and Maxillofacial systematic anatomyThe inferio

4、r wall of The inferior wall of the maxillary sinus the maxillary sinus covers the root covers the root apexes from the apexes from the maxillary second maxillary second premolar to the third premolar to the third molar, and the root molar, and the root apex of the first apex of the first molar is th

5、e nearest molar is the nearest to it.to it.maxillaboneOral and Maxillofacial systematic anatomymaxillaboneOral and Maxillofacial systematic anatomyOral and Maxillofacial systematic anatomyOral and Maxillofacial systematic anatomyMandibleOral and Maxillofacial systematic anatomyOral and Maxillofacial

6、 systematic anatomyMandiblecoronoid processcoronoid process（muscular processmuscular process） Condylar processCondylar process(articular process(articular process）simoid notchsimoid notch(mandibular notch)(mandibular notch)The internal surface of The internal surface of the ramus of mandblethe ramus

7、 of mandblemandibular foramenmandibular lingulaMandibular canal Oral and Maxillofacial systematic anatomyMandibleangle of mandibleangle of mandibleInternal surfaceInternal surface： pterygoid pterygoid tuberositytuberosityExternal surfaceExternal surface：masseteric tuberositymasseteric tuberosityangl

8、e of angle of mandiblemandibleOral and Maxillofacial systematic anatomyMandibleOral and Maxillofacial systematic anatomyMandibleTemporomandibularTemporomandibular joint jointOral and Maxillofacial systematic anatomyOral and Maxillofacial systematic anatomyTemporomandibularTemporomandibular joint joi

9、ntOral and Maxillofacial systematic anatomyTemporomandibularTemporomandibular joint jointTemporomandibularTemporomandibular joint jointOral and Maxillofacial systematic anatomymusclemuscles of muscles of masticationmasticationOral and Maxillofacial systematic anatomymassetermassetertemporalistempora

10、lismedial pterygoid medial pterygoid musclemusclelateral pterygoid lateral pterygoid musclemuscleOral and Maxillofacial systematic anatomymusclemuscles of muscles of masticationmasticationActions:Actions:lelevates the mandibleelevates the mandiblelProtrudes the mandible Protrudes the mandible Oral a

11、nd Maxillofacial systematic anatomymuscle Actions:Actions:lelevates the mandibleelevates the mandiblelRetracts the protruded Retracts the protruded mandible with its mandible with its horizontal posterior horizontal posterior fibersfiberslUnilateral contraction : Unilateral contraction : mastication

12、 mastication Oral and Maxillofacial systematic anatomymuscleActions:elevates Actions:elevates the mandiblethe mandible Oral and Maxillofacial systematic anatomymuscleLateral pterygoid Lateral pterygoid musclemuscleActions:Actions:lBilateral contraction: Bilateral contraction: initiates mouth opening

13、 initiates mouth opening by protruding the by protruding the mandible and moving the mandible and moving the articular disk forwardarticular disk forwardlUnilateral contraction: Unilateral contraction: tract the mandible to the tract the mandible to the opposite side during opposite side during mast

14、icationmasticationOral and Maxillofacial systematic anatomymuscleBloodBlood vessel vesselOral and Maxillofacial systematic anatomyarteryarteryInternal carotid arteryInternal carotid arteryExternal carotid arteryExternal carotid arteryDistinguish the two arteriesDistinguish the two arteries（locationl

15、ocation、branchbranch、pulsationpulsation）veinveinSuperficial veinSuperficial veinDeep veinDeep veinBloodBlood vessel vesselOral and Maxillofacial systematic anatomycommon carotid arterycommon carotid artery Internal carotid arteryInternal carotid artery frontonasal partfrontonasal part intra-orbitint

16、ra-orbit encephalonencephalonExternal carotid arteryExternal carotid artery superior thyroid arterysuperior thyroid artery lingual arterylingual artery facial artery (external facial artery (external maxillary artery) maxillary artery) maxillary artery (internal maxillary artery (internal maxillary

17、artery )maxillary artery ) superficial temporal arterysuperficial temporal arteryBloodBlood vessel vesselOral and Maxillofacial systematic anatomythe internal is at the internal is at the post-lateral side of the the post-lateral side of the external first and then at its external first and then at

18、its post-intra side post-intra side the internal has no the internal has no branch at thebranch at the cervical partcervical partexternal maxillary external maxillary a r t e r y a n d s u p e r f i c i a l a r t e r y a n d s u p e r f i c i a l temporal artery have no temporal artery have no pulsa

19、tion whenpulsation when blocking the blocking the external carotid arteryexternal carotid arteryarterydistinguishingdistinguishingBloodBlood vessel vesselOral and Maxillofacial systematic anatomyfacialveinsuperficialtemporalveinpterygoidplexusmaxillaryveinretromandibularveincommonfacialveinBloodBloo

20、d vessel vesselOral and Maxillofacial systematic anatomypterygoid plexus:Isavenousnetworksituatedbehindthemandibularramusbetweenthemusclesofmastication.Ithasextensiveconnectionswiththeadjacentveinswhichareclinicallyimportantbecausetheymayallowinfectiousorganismstoenterthecranialcavity.BloodBlood ves

21、sel vesselOral and Maxillofacial systematic anatomyOral and Maxillofacial systematic anatomyolfactory nerveolfactory nerveoptic nerveoptic nerveoculomotor nerveoculomotor nervetrochlear nervetrochlear nerveV.V.trigeminal nervetrigeminal nervebranchbranch、distributiondistributionabducent nerveabducen

22、t nerveVIIVII.facial nerve.facial nervebranchbranch、distributiondistributionvestibulocochlear nervevestibulocochlear nerveIXIX.glossopharyngeal nerve.glossopharyngeal nervedistributiondistributionvagus nervevagus nerveaccessory nerveaccessory nerveXIIXII.hypoglossal nerve.hypoglossal nervedistributi

23、ondistributionCranialCranial nerves nervesOral and Maxillofacial systematic anatomytrigeminal nervetrigeminal nerveOral and Maxillofacial systematic anatomytouch-pressure sensationtrigeminal trigeminal nervenerveOral and Maxillofacial systematic anatomyCranialCranial nerves nerveslacrimal glandlacri

24、mal glandOral and Maxillofacial systematic anatomyCranialCranial nerves nervestrigeminal trigeminal nervenerveCranialCranial nerves nervesOral and Maxillofacial systematic anatomytrigeminal trigeminal nervenerveFacial Facial sectionsectionOral and Maxillofacial systematic anatomyMaxillary nervetrige

25、minal trigeminal nervenerveauriculotemauriculotemporal nerveporal nervelingual lingual nervenerveinferior inferior alveolar alveolar nervenerveCranialCranial nerves nervesOral and Maxillofacial systematic anatomytrigeminal trigeminal nervenerveMandibular nerveMandibular nerveMotor branches:Motor bra

26、nches: for the for the muscles of mastication muscles of mastication Sensory branches:Sensory branches: Buccal nerveBuccal nerveAuriculotemporal nerveAuriculotemporal nerveLingual nerveLingual nerveInferior alveolar nerve Inferior alveolar nerve CranialCranial nerves nervesOral and Maxillofacial sys

27、tematic anatomytrigeminal trigeminal nervenerveMandibular nerveMandibular nerveOral and Maxillofacial systematic anatomyMandibular nerveCranialCranial nerves nervesOral and Maxillofacial systematic anatomytrigeminal trigeminal nervenerveP PmA APalatal/lingualPalatal/lingualLingual n.Lingual n.Buccal

28、 n./Buccal n./Mental n.Mental n./Inferior alveolar n./Inferior alveolar n.L-B/teethL-B/teethNasopalatine Nasopalatine n.n.anter. anter. pala.n.pala.n.Distribution of n. in oral region Distribution of n. in oral region Oral and Maxillofacial systematic anatomyCranialCranial nerves nervesOral and Maxi

29、llofacial systematic anatomyOral and Maxillofacial systematic anatomyCommen trunk of the facial nerveCommen trunk of the facial nerveCranialCranial nerves nervesOral and Maxillofacial systematic anatomyCranialCranial nerves nervesOral and Maxillofacial systematic anatomyCentral paralysis and Central

30、 paralysis and peripheral paralysisperipheral paralysisLoss of the upper neurpns, in this case on the left side.presents clinically with paralysis of the contralateral muscles of the facial expression in the lower half of the face , while the contralateral forehead and extra-ocular muscles remain fu

31、nctional. Thus, the corner of the mouth sags on the right (contralateral) side, but the patient can still wrinkle the forehead and close the eyes on both sides. Speech articulation is impaired.CranialCranial nerves nervesOral and Maxillofacial systematic anatomy (Loss of the lower neurpns, in this c

32、ase on the right side).is characterized by complete paralysis of the ipsilateral muscles. The patient cannot wrinkle the forehead, the corner of the mouth sags, articulation is impaired, and the eyelid cannot be fully closed. A Bell phenomenon is present (the eyeball turns upward and outward, exposi

33、ng the sclera, when the patient attempts to close the eyelids), and the eyelids closure reflex is abolished. Depending on the site of the lesion, additional deficits may be present such as decreased lacrimation and salivation or loss of taste sensation in the anterior two-thirds of the tongue.Crania

34、lCranial nerves nervesOral and Maxillofacial systematic anatomyglossopharyngeal nerveglossopharyngeal nerve Sensory fiber:Sensory fiber: GlossopharyngealGlossopharyngeal nerve nerveCranialCranial nerves nervesOral and Maxillofacial systematic anatomyCranialCranial nerves nervesOral and Maxillofacial

35、 systematic anatomyL-1L-1Have a breakKey points1.local anatomy of the oral cavityBoundary of theBoundary of the oral cavity oral cavityoral vestibular grooveoral vestibular groovefrenulum of the upper and frenulum of the upper and lower liplower lipbuccal frenumbuccal frenumopening of the Stensens o

36、pening of the Stensens ductParotid glandductParotid glandretromolar area retromolar area Pterygonmandibular foldPterygonmandibular foldlingual frenulumlingual frenulumlocal anatomy of the oral cavitylocal anatomy of the oral cavityanatomic landmarkanatomic landmarklocal anatomy of the oral cavityloc

37、al anatomy of the oral cavitylocal anatomy of the oral cavityboundaryboundaryinferior margin of the inferior margin of the zygomatic bone is the upper zygomatic bone is the upper boundboundinferior border of mandible is inferior border of mandible is the lower boundthe lower boundanterior border of

38、masseter is anterior border of masseter is its posterior borderits posterior borderlayerlayerskinskinhypodermishypodermis：buccal pad, buccal pad, vascular nervevascular nerveBuccinatorBuccinator，fascia buccinatorfascia buccinatorsubmucosasubmucosa：contain mucous contain mucous glandglandmucosamucosa

39、：have thw opening of have thw opening of the Stensens ductthe Stensens ductlocal anatomy of the oral cavitylocal anatomy of the oral cavity Anatomic landmarkAnatomic landmarkPalatine raphePalatine rapheIncisive papillaIncisive papillaPalatine foldsPalatine foldsHard palate Hard palate Greater palati

40、ne Greater palatine foramenforamenPterygoid hamulusPterygoid hamulusFoveola palatinaFoveola palatinalocal anatomy of the oral cavitythere are no glands in the anterior part，and a lot of mucous glands in the posterior part.Periosteum adhere to mucosa and submucosa more tightly than to bone surfaceMuc

41、operiosteum is not easy to move,and can tolerate scrape and masticatory pressurelocal anatomy of the oral cavitytensor veli palatinilevator veli palatinipalatoglossuspalatopharyngeusuvular musclelocal anatomy of the oral cavitylocal anatomy of the oral cavitylocal anatomy of the oral cavitylocal ana

42、tomy of the oral cavitylocal anatomy of the oral cavitylocal anatomy of the oral cavityapex of tongue lymphatic vesselsubmental lymph nodesnodi lymphaticus juguloomohyoideusante- lateral tongueSubmaxillary L.Nlymphonodi cervicales profundi cranialescenter of tonguelymphonodi cervicales profundi cran

43、ialessubmaxillary L.Nsubmaxillary L.Npart cross to opposite sideposterior tonguelymphonodi cervicales profundi cranialeslocal anatomy of the oral cavitylingual frenulumlingual frenulumfimbriated foldfimbriated foldsublingual carunclesublingual carunclesublingual foldsublingual foldlocal anatomy of t

44、he oral cavitylocal anatomy of the oral cavitylocal anatomy of the oral cavitylocal anatomy of the oral cavitylocal anatomy of the oral cavitylocal anatomy of the oral cavitylocal anatomy of the oral cavityUnder the tongue and Under the tongue and mucous membrane of oral mucous membrane of oral floo

45、rfloorBeyond the Mylohyoid and Beyond the Mylohyoid and hyoglossushyoglossusGo ahead to reach the Go ahead to reach the medial surface of the body medial surface of the body of mandibleof mandibleRoot of tongue is the post Root of tongue is the post wallwallGenioglossus and Genioglossus and geniohyo

46、id divide it into geniohyoid divide it into two halvestwo halvesAnatomic Anatomic landmarklandmarklocal anatomy of the oral cavitySublingual gland and Sublingual gland and the the deep partdeep part of the of the submandibular glandsubmandibular glandSubmandibular duct and Submandibular duct and lin

47、gual nervelingual nerveHypoglossal nerve and Hypoglossal nerve and its accompanying veinits accompanying veinSublingual arterySublingual arterycontentscontentslocal anatomy of the oral cavityKmunicationbetweenthecellulitespacesnasal columellanasal columellaBase of the noseBase of the noseNasofacial

48、sulcusNasofacial sulcusLabiofacial sulcusLabiofacial sulcusmentonmentoninfraorbital forameninfraorbital foramensurface projection of the surface projection of the Stensens ductStensens ductthe position of the facial the position of the facial nerve nerve efferensefferens stylomastoid stylomastoid fo

49、ramenforamenLocal anatomy of theLocal anatomy of the maxillofacial region maxillofacial regionSkin is thin and soft and has Skin is thin and soft and has wrinkle whose strike is regular. wrinkle whose strike is regular. Subcutaneous tissue is curmbly.Subcutaneous tissue is curmbly.Abundant of sebace

50、ous glands, hair Abundant of sebaceous glands, hair follicle and sweat glandfollicle and sweat glandBlood vessels are intensive, and Blood vessels are intensive, and blood is plentiful.blood is plentiful.Expression musclesExpression musclesLocal anatomy of theLocal anatomy of the maxillofacial regio

51、n maxillofacial regionparotideomasseteric regionparotideomasseteric regionLocal anatomy of theLocal anatomy of the maxillofacial region maxillofacial regionLocal anatomy of theLocal anatomy of the maxillofacial region maxillofacial regionParotideomassetericParotideomasseteric region regionparotid gl

52、and and its parotid gland and its contentscontentsperpendicular teamperpendicular teamsuperficial temporal superficial temporal artery and veinartery and veinauriculotemporal nerveauriculotemporal nervevena facialis posteriorvena facialis posteriorexternal carotid arteryexternal carotid arteryLatero

53、pulsion teamLateropulsion teamFacial nerveFacial nerveMaxillary artery and Maxillary artery and veinveintransverse facial arterytransverse facial arterymassetermasseterLocal anatomy of theLocal anatomy of the maxillofacial region maxillofacial regionParotideomassetericParotideomasseteric region regi

54、onLocal anatomy of theLocal anatomy of the maxillofacial region maxillofacial regionProzone- the posterior Prozone- the posterior surface of the maxilla.surface of the maxilla.Postzone-the parotid Postzone-the parotid gland sheath.gland sheath.Extra-zone-the ramus of Extra-zone-the ramus of mandible

55、.mandible.Intra-zone- the lamina Intra-zone- the lamina lateralis processus lateralis processus pterygoidei.pterygoidei.equal to the range of equal to the range of pteryomandibular space pteryomandibular space and temporal spaceand temporal spaceLocal anatomy of theLocal anatomy of the maxillofacial

56、 region maxillofacial regionPterygoid plexusPterygoid plexus：located located between the temporalis and between the temporalis and lateral pterygoid M., also lateral pterygoid M., also between the medial and between the medial and lateral pterygoid M.lateral pterygoid M.Maxillary arteryMaxillary art

57、ery：go along go along the deep part of the the deep part of the neck neck of condyleof condyleMandibular nerve and its Mandibular nerve and its branchesbranchesLateral pterygoid M.Lateral pterygoid M.Local anatomy of theLocal anatomy of the maxillofacial region maxillofacial regionLocal anatomy of t

58、heLocal anatomy of the maxillofacial region maxillofacial regionLocal anatomy of theLocal anatomy of the maxillofacial region maxillofacial regionLocal anatomy of theLocal anatomy of the maxillofacial region maxillofacial regionLocal anatomy of theLocal anatomy of the maxillofacial region maxillofac

59、ial regionLocal anatomy of theLocal anatomy of the maxillofacial region maxillofacial regionLocal anatomy of theLocal anatomy of the maxillofacial region maxillofacial regionLocal anatomy of theLocal anatomy of the maxillofacial region maxillofacial regionLocal anatomy of theLocal anatomy of the max

60、illofacial region maxillofacial regionLocal anatomy of theLocal anatomy of the maxillofacial region maxillofacial regionsubmental submental spacespaceinfratemporal spaceinfratemporal spacePterygomandibuPterygomandibular spacelar spaceparotid spacesparotid spacespterygopalatine spacespterygopalatine

61、spacesCranium cavityCranium cavitytemporal temporal spacespacebuccal buccal spacespaceinfraorbital spaceinfraorbital spaceMasseteric Masseteric spacespacesublingual spacesublingual spaceparapharyngparapharyngeal spaceeal spaceviscera viscera spacespaceGenioglossus Genioglossus spacespacepretracheal

62、pretracheal spacespacemediastimediastinumnumretroretroesophagealesophageal space spaceRetropharyngeRetropharyngeal spaceal spaceKey points:1.Submandibularregion2.CervicalsectionofthetracheaLocal anatomy of Local anatomy of the cervical partthe cervical partsubmandibular submandibular triangletriangl

63、eBoundary Boundary ：upper bound -the inferior upper bound -the inferior border of mandibleborder of mandibleAnte-lower bound - the Ante-lower bound - the anterior belly of digastricanterior belly of digastricPost-lower bound - the Post-lower bound - the posterior belly of digastric posterior belly o

64、f digastric Its basic floor - Its basic floor - constituded of mylohyoid, constituded of mylohyoid, hyoglossushyoglossus, superior , superior constrictor of pharynx and constrictor of pharynx and so on.so on.Local anatomy of Local anatomy of the cervical partthe cervical partsubmandibular submandibu

65、lar triangletriangleContents Contents ：Submandibular glandSubmandibular glandsubmandibular lymph submandibular lymph nodesnodesexternal maxillary external maxillary arteryarteryvena facialis anteriovena facialis anteriolingual nervelingual nerve Wharton Wharton ductducthypoglossal nervehypoglossal n

66、erveLocal anatomy of Local anatomy of the cervical partthe cervical partsubmandibular submandibular triangletriangleLocal anatomy of Local anatomy of the cervical partthe cervical partsubmandibular submandibular triangletriangleCervical section Cervical section of the tracheaof the tracheaLocal anatomy of Local anatomy of the cervical partthe cervical partadjacentadjacent：linea alba linea alba cervicaliscervicalisthyroid glandthyroid glandcommon carotid common carotid arteryarteryEsophagusEsopha