1. TMJ, Face, Skull

2. TMJ Mandibular fossa of temporal bone with condyle of mandible
Incongruent surfaces
Two joint cavities with articular disc interposed
Lower cavity = hinge joint
Upper joint = gliding

3. TMJ

4. TMJ

5. Mandible

6. Mandible

7. TMJ Capsule Surrounds the joint Encloses the disc
Attaches above the margins of the mandibular fossa
To the neck of the mandible
Inner aspect of capsule attaches to disc
Above disc – capsule loose
Below disc - taut

8. TMJ Capsule

9. TMJ Capsule

10. TMJ Ligaments Lateral ligament - AKA TMJ ligament Sphenomandibular
From zygomatic bone to run inferiorly and posteriorly to blend with the joint capsule to attach to lateral and posterior parts of the neck of the mandible
Sphenomandibular
Strong thin flat band lying on medial aspect of the joint
Passes inferiorly and forwards from the spine of the sphenoid to the lingula
Stylomandibular
Extends from the apex of the styloid process to the lower part of the posterior border of the ramus of the mandible, near the angle

11. TMJ Capsule

12. TMJ Innervated by CN V, Mandibular branch Movements
Elevation, depression, retraction, protraction, side to side
Elevation and depression involves the hinge like rotation of the condyle against the disc in the lower compartment
Protraction and retraction – actions whereby the condyle and disc move as one unit against the mandibular fossa. In protraction the condyle and disc glide forwards so that the condyle rides on the articular eminence – retraction = opposite

13. CN V Trigeminal

14. TMJ Motions

15. TMJ Motions

16. TMJ Side to side – grinding movements
Mandible is alternately protracted and retracted with the two sides moving in opposite directions so that one side is protracted while the other is retracted
Actions combined with elevation and depression, rhythmically and alternately

17. Muscles of Mastication
Masseter
Temporalis
Lateral pterygoid
Medial pterygoid
All innervated by CNV
Opening of jaw (depression) primarily passive or gravity assist

18. Masseter

19. Temporalis

20. Pterygoids

21. Pterygoids

22. Pterygoids

23. Nerve Supply to Face
Sensory by three divisions of CN V – opthalmic, maxillary, mandibular
Innervation of muscles of facial carried out by CN VII – the Facial Nerve
Origin, branches, motor functions, sensory functions, parasympatheric functions

24. CN V

25. CN V

26. Sensory to Face

27. Sensory

28. Scalp Three Layers This allows scalp to move over the skull
Outer = skin
Beneath that – subcutaneous layer with many nerves and vessels running through here, binds skin to inner layer
Galea Aponeurotica – AKA epicranial aponeurosis
Galea attaches to pericranium via loose CT
This allows scalp to move over the skull
Most muscles of face attach to skin, this arrangement allows them to be more mobile.

29. Scalp

30. Scalp

31. CN VII – The Facial Nerve
Motor nerve to muscles of facial expression with one notable exception
Origin = lower pons
Branches – common nerve enters face
Temporal
Zygomatic
Buccal
Mandibular
Cervical

32. Motor to Face CNVII

33. CN VII Motor Functions Sensory functions Parasympathetic
Muscles of facial expression
External ear
Sensory functions
Ant. 2/3 of tongue
Soft palate
Pharynx
Parasympathetic
Gland stimulation

34. CN VII

35. Muscles of Facial Expression
Primary action is to act as either a sphincter or dilator of the orifices of the face
Facial expression is a by-product
Orifices
Lips = labia
Nose = nares; Nostrils, Septum, Ala, Apex, Root
Eyelids = palpebrae
External Ear = auricle, lobule = soft portion

36. Selected Muscles of Facial Expression * = learn
Orbicularis Oculi
Levator Palpebrae Superioris*
O: Root of Orbital Cavity
I: Skin of upper eyelid
A: Raises upper eyelid
N: Note Well, Nerve = CN III
Ptosis is a condition of denervation to this muscle causing drooping of the eyelid, a clinical symptom indicating more loss

37. Facial MM

38. Facial MM

39. Facial MM

40. Facial MM

41. Muscles Continued Occipitofrontalis Corrugator
Auricular muscles of the ear – ant., post., sup.
Nose
Nasalis
Procerus
Depressor Septi

42. Facial MM

43. Facial MM

44. Ear MM

45. Nose MM

46. Nose MM

47. Muscles Mouth Depressor anguli oris Depressor labii inferior Mentalis
Risorius
Orbicularis oris
Buccinator*
Zygomaticus major
Zygomaticus minor
Levator labii superioris
Platysma

48. Platysma

49. Mouth

50. Facial MM

51. Extra Occular Muscles of the Eye
Muscles that move the eyeball
Innervated by: CN III (most), CN IV (1),CN VI (1)
Many have an origin from the annulus tendinous, a common tendon ring attached around the optic canal
Most attach to the sclera of the eyeball

52. Eye MM

53. Muscles *
Superior Rectus – rotates eyeball upward and medially –CN III
Medial Rectus – rotates medially (ADD) – CN III
Lateral Rectus – rotates eyeball laterally (ABD) – CN VI
Inferior Rectus – rotates eyeball downward and medially – CN III

54. Eye MM

55. Eye MM

56. Eye MM

57. Eye MM

58. Muscles *
Superior Oblique – rotates eyeball downward and lateral – CN IV
Inferior Oblique – rotates eyeball upward and lateral – CN III
Combined motions
Up and medial = sup.rectus
Up and lateral = inferior oblique
Straight up = sup. rectus and inf. oblique
Straight down = inf. rectus and sup. oblique
Down and medial = inferior rectus
Down and lateral = superior oblique
Lateral Gaze = ABD of one eye with ADD of the other

59. Eye Movements

60. Eye Movments

61. Eye Movements