Anatomy

Submandibular triangle
Inferior border of the mandible
Anterior and posterior digastric muscle
Contains:
 Submandibular gland
 Submandibular lymph nodes
 Lingual and facial arteries
 Hypoglossal nerve
 Nerve to mylohyoid

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Submental triangle
Inferior border of chin
Right and left anterior digastric muscles

Venous drainage
Anterior portion of the face drained by facial vein
Posterior portion of the face drained by retromandibular vein
Divides into posterior and anterior divisions
Both leave the face the drain into neck
Anterior division of retromandibular joins with facial vein forms
common facial vein, drains into internal jugular
Posterior vein joins with posterior auricular vein, unite to form
external jugular vein

Superficial nerves of neck

Transverse cervical nerve, supplies skin overlying anterior triangle
Cervical branch of facial nerve passes from parotid down to
platsyma muscle

Contents of the anterior triangle

Muscles of anterior triangle
 Suprahyoid
o Above hyoid bone
 Posterior digastric
(cervical branch of facial
nerve)
 Anterior digastric (nerve
to mylohyoid br of V3)
 Mylohyoid (nerve to
mylohyoid br of V3)
 Geniohyoid (C1)
 Stylohyoid (cervical
branch of facial nerve)
 Infrahyoid (strap)
o Below hyoid bone
o Supplied by C1, C2, C3
 Omohyoid
 Sternohyoid
 Thyrohyoid
 Sternothyroid

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Arteries of anterior triangle
Boundaries: anterior border sternocleidomastoid, midline
 Common carotid
 Internal carotid: gives off no branches, enters skull
 External carotid:
o Superior thyroid
o Lingual artery
o Facial artery
o Ascending pharyngeal artery
o Occipital artery
o Posterior auricular artery

Veins of anterior triangle

Internal jugular vein from jugular
foramen in carotid sheath
Picks up tributaries:
 Veins of pharyngeal plexus
 Facial vein
 Lingual vein
 Superior thyroid vein
 Middle thyroid vein

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Nerves of anterior triangle
 Accessory nerve
o Also from jugular foramen
o Pierces sternocleidomastoid
o Then trapezius
 Hypoglossal
o Hypoglossal canal
o Anterior triangle, then loops into submandibular triangle
o Between mylohyoid and hyoglossus to supply tongue
 Cervical plexus
o C1-C4
 Vagus
o Jugular foramen
o Also in carotid sheath
o Forms pharyngeal plexus with CN9, CN11

Contents of the submandibular region

Floor: mylohyoid and hyoglossus
Submandibular gland:
 Mixed mucous and serous saliva
 Superficial and deep portion
 Between mylohyoid and submandibular fossa of mandible:
superficial
 Wraps around posterior border of mylohyoid as deep portion
in floor of mouth
 Submandibular duct continues anteriorly and empties under
tongue
Submandibular lymph glands
 Nodes found in this region
Hypoglossal nerve
 Enters from anterior triangle to submandibular triangle
 Travels between mylohyois and hyoglossus to tongue
Mylohyoid nerve
 Branch of V3 (inferior alveolar)
 Descends medial aspect of ramus
Facial artery
 After leaving external carotid enters submandibular region
 Pushed upwards by submandibular gland onto medial aspect
of mandible

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  Loops down and anteriorly appearing in antegonial notch of
mandible
Lingual artery
 Forward from external carotid artery
 Passes deep to posterior belly of digastric
 Enters submandibular region
 Leaves by passing deep to hyoglossus
 Enters FOM
 Supples fom and tongue

Lingual and facial veins follow lingual and facial artery

Posterior triangle
Posterior border of sternocleidomastoid
Anterior border of trapezius
Inferior border of mandible
Middle third of clavicle

Muscles of the floor of the posterior triangle

 Splenis capitis
 Scalenus posterior
 Scalenus medius
 Scalenus anterior

Contents of the posterior triangle

External jugular vein
Suprascapula vein
Anterior jugular vein

Cutaneous nerves
 Lesser occipital
 Greater auricular
 Transverse cervical nerve
 Supraclavicular nerve
Motor nerves
 Accessory
 Phrenic
Subclavian artery and vein (to
limbs)

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Skull

Bones of skull: cranium

 Frontal
 Parietal
 Temporal
 Occipital
 Sphenoid
 Ethmoid

Bones of skull: face

 Maxilla
 Nasal
 Zygomatic
 Palatine
 Lacrimal
 Inferior conchae
 Vomer
 Mandible
Zygomatric buttress: keystone between temporal, frontal and
maxillary bones

Orbital openings
 Supraorbital notch/ foramen
o Supreorbital vessels and nerves
 Infraorbital foramen
o Infraorbital vessels and nerves
 Optic canal
o Optic nerve and opthalamic artery
 Superior orbital fissure
o Opthalamic veins
o CNS: 3, 4, V1, 6 (oculomotor, trochlear, abducens,
opthalamic division of trigeminal)
 Inferior orbital fissure
o Infraorbital nerve and vessels via groove

Pterion: junction of frontal, parietal and greater wing of sphenoid

Infratemporal fossa

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Lateral wall: medial aspect of ramus
Medial wall: lateral pterygoid plate
Superior roof: greater wing of sphenoid and temporal bone
No inferior boundary
Summary of foramina

Foramen Contents
Supraorbital Supra orbital nerve
foramen artery and vein
Infraorbital foramen Infraorbital nerve
artery and vein
Mental foramen Mental nerve, artery
and vein
Foramen ovale Mandibular nerve
(V3)
Foramen spinosum Middle meningeal
artery
Foramen lacerum Internal carotid
artery
Pterygoid canal Nerve and artery of
pterygoid canal
Petrotympanic Chorda tympani
fissue
Carotid canal Internal carotid
artery and
sympathetic plexus
Jugular foramen Internal jugular vein,
cranial nerves 9,10,
11
Stylomastoid Facial nerve
foramen
Hypoglossal canal CN12
Foramen magnum Spinal cord,
vertebral arteries
Olfactory foramina Olfactory nerve
CN1
Optic foramen and Optic nerve,
canal opthalamic artery
Superior orbital Cranial nerves 3, 4,
fissure 6, V1
Foramen rotundum V2
Superior petrosal Greater Superior
petrosal nerve of
CN7
Inferior petrosal Lesser superior
nerve of CN9
Internal auditory Vestibulocohlear,
meatus facial nerve internal

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auditory artery

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9
Palate
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Incisive canal
Used to be nasopalatine duct (remember cyst!)
Nasopalatine nerves and vessels
Greater palatine canal
Greater palatine nerves and vessels

Cribriform plate: skull base olfactory nerve

Sensory nerves of the face

Sensory nerves of the face
Trigeminal
Opthalamic division
Maxillary division
Mandibular division

Mandibular division only branch with motor also: to muscles of

mastication

Facial branches of the opthalamic nerve (v1)

 Supraorbital nerve
Supraorbital foramen
Supples small portion of frontal sinus, upper eyelid, forehead
and scalp
 Supratrochlear nerve
Medial portion of eyelid
 Infratrochlear nerve
Medial aspect of upper lid and lacrimal sac
 Lacrimal nerve
Small lateral portion of upper eyelid
 External nasal nerve
Median strip of external nose

Facial branches of maxillary nerve (V2)

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  Infraorbital nerve
Passes through bony canal in orbit floor
Emerges onto face through infraorbital foramen
o Inferior palpebral br: skin and conjunctivum
o Lateral nasal branch: lateral aspect of nose
o Superior labial branch: skin of upper lip
 Zygomaticofacial nerve
Zygomaticofacial foramen
Supply skin of zygomatic area
 Zygomaticotemporal nerve
Zygomaticotemporal foramen
Skin of anterior temporal fossa and scalp

Facial branches of mandibular nerve (V3)

 Auriculotemporal nerve
Between TMJ and ragus of ear
Supplies skin of external ear, ear canal and temporal region,
lateral aspect of scalp
 Buccal branch of V3
Appears from under ramus
Sensation to cheek
Buccal gingivae of mandibular molars
 Mental nerve
Mental branch: skin of chin
Inferior labial: skin of lower lip
Gingival: gingivae of anterior teeth

Arteries of the face

Opthalamic
 Supraorbital
 Supratrochlear
 Dorsal nasal
 Lacrimal
 External nasal
 Zygomatic
Maxillary
 Infraorbital
 Buccal
Mandibular artery
 Buccal artery
 Mental artery
Facial artery
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Branches from external carotid, leaves submandibular region
ascends over anterior border of mandible through antegonial notch
Torturous route towards medial aspect of eye
Branches of facial artery
 Superior and inferior labial branches
 Lateral nasal
 Angular

Superficial temporal artery

Gives off Transverse facial artery

Muscles of the face: FACIAL NERVE (7)

 Orbicularis oris: pout, closes mouth
 Levator anguli oris: Smile
 Depressor anguli oris: Pulls angles of mouth down
 Zygomaticus major: laughing
 Risorius: Grinning
 Levator labii superioris: Raise upper lip
 Depressor labii inferioris: depress lower lip
 Buccinator: Pushes cheek against vestibular aspect of
molars
 Orbicularis oculi: shutting eyelid
 Mentalis: Puckers chin
 Nasalis: Flare nostrils
 Depressor septi (part of nasalis): Pull down on septus during
nostril dilation
 Procerus: Transverse wrinkling of forehead
 Corrugator supercilii: Vertical wrinkles over glabella
 Frontalis: Raising eyebrows

Motor branches of facial nerve:

To Zanzibar by Motor car probably
 Temporal: muscles of facial expression of head, orbicularis
oculi
 Zygomatic: Inf portion of orbicularis oris, zygomaticus major,
LLS, LAO, Nasalis, orbicularis oris
 Buccal: Buccinator , orbicularis oris, inferior portion of above
nerves
 Mandubular: chin lower lip muscles
 Cervical, Platysma, posterior belly of digastric, stylohyoid

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Parotid region (bed)
Borders:
 Anterior: posterior border of ramus of mandible, posterior
borders of masseter and medial pterygoid muscles
 Posterior: Anterior aspect of mastoid process and
sternocleidomastoid muscle
 Inferior: posterior belly of digastric and stylohyoid muscles
 Medial: styloid process of the skull and sttached musculature
and ligaments
Contents of the parotid region
 Facial nerve and it’s branches
 Retromandibular vein
 External carotid artery and two terminal branches
 Parotid gland (ALL above structures within parotid gland)
Facial nerve
Stylomastoid foramen into parotid gland
Within gland gives off its five branches above spread onto face via
anterior and inferior border of gland
Retromandibular vein
Union of superficial temporal vein and maxillary vein
Drains temporal area
Passes through parotid gland to anterior triangle
External carotid artery
Mostly in anterior triangle but extends within gland giving off two
terminal arteries
 Maxillary artery
Passes anteriorly from gland deep to condyle and enters
infratemporal region
 Superficial temporal artery
Leaves superior aspect of parotid travels over root of
zygoma branches off:
o Transverse facial artery: to parotid, masseter, skin
o Articular branches: posterior portion of TMJ
o Anterior auricular: External auditory meatus
o Zygomaticoorbital: Skin and orbiculari oculi
o Frontal
o Middle temporal
o Parietal
Parotid gland
Lobulated exocrine gland
Fibrous capsule continuous with deep investing fascia of neck
Stylomandibular ligament is a thickening of the capsule
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Spreads to fill entire parotid bed
Parotid duct
5cm in length, 3mm diameter
Travels anteriorly, one finger width below zygomatic arch over
lateral aspect of masseter, pierces buccal fat pad and enters oral
cavity opposite crown of second maxillary molar

Blood supply to parotid: glandular branches from external carotid

and superficial temporal arteries
Nerve supply: Facial nerve passes through but doesn’t carry
parasympathetic fibres
Actually parasympathetic fibres from glossopharyngeal

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Temporomandibular joint

See tmd notes

Articular capsule
Fibrous capsule
Encloses joint surfaces in a sleeve
Runs from temporal bone superiorly (Area surrounding mandibular
fossa and articular eminance) to the condyle of the mandible
inferiorly (neck)
Enclosed space is the joint cavity
Lateral thickening of capsule: temporomandibular ligament
Opposite ligament acts as medial collateral ligament
Lateral aspect of articular eminance to posterior aspect of neck of
mandible

Articular disk
Dense fibrous tissue
Biconcave disk
Avascular
Only peripheal attachment has vessels
Divides cavity into two for two different types of movement
Hinge lower, translation upper

Articular surfaces
Not hyaline
Dense fibrous tissue

Muscles of mastication
 Masseter
o Lateral aspect of ramus of mandible
o Superficial to masseter is a portion of submandibular
gland: facial process of parotid, also parotid duct,
transverse facial artery, branches of facial nerve
o Arises from zygomatic arch and zygomatic process of
maxilla
o Insert into angle of the mandible and the lower portion
of the lateral aspect of the ramus
o Acts to elevate the mandible, retrude mandible, and
unilateral excursions- ipsilateral

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 Temporalis muscle
o Fan shaped
o Covered by thick membranous sheet of fascia
o Attatches to superior temporal line
o Origin of muscle: inferior temporal line, temporal fossa
o Travels deep to zygomatic arch
o Inserts into medial aspect of coronoid process and
anteromedial wall of ramus
o Causes elevation of the mandible, retrusion, ipsilateral
excursion

 Medial pterygoid
o Infratemporal fossa
o Mirror image of masseter but on medial aspect of
ramus
o Origin: medial aspect of lateral pterygoid plate, few
fibres from maxillary tuberosity
o Insertion: Run down, back and medial to insert into
medial aspect of mandibular ramus
o Tendinous insertion at angle of the mandible forms
common sling
o Acts to elevate, protrusion, contralateral excursion
(unilateral)
 Lateral pterygoid
o Triangle shape two heads
o Inferior head arises form lateral aspect of lateral
pterygoid plate (sphenoid)
o Superior head from from the inferior aspect of the
greater wing of sphenoid (roof of temporal fossa)
o Inferior head inserts backward into pterygoid fovea on
lateral aspect of condylar neck
o Superior head inserts into the articular capsule, and
articular disk, and anterior part of condyler neck
o Act to: protrude, Depress the mandible, Contralateral
excursion
 Suprahyoids
 Infrahyoids

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Summary
Elevators:
o R+L Masseter
o R+L Temporals
o R+L Medial pterygoids
Depressors:
o Inferior heads of right and left lateral pterygoids
o Right and left suprahyoids of neck
o Right and left infrahyoids of neck
Protrusion:
o R+L lateral pterygoid
o R+L medial pterygoids
o Right and left masseter
Retrusion:
o Posterior fibres of R+L temporalis
o R+L masseter (deep heads)
Right lateral excursion:
o Right masseter
o Right temporalis
o Left medial pterygoid
o Left lateral pterygoid muscles
Left lateral excursion:
o Left masseter
o Left temporalis
o Right medial pterygoid process
o Right lateral pterygoid muscles

All receive motor supply from V3

Mandibular division of trigeminal nerve

Nerve from mandibular process of first pharyngeal arch
Arises in middle cranial fossa
Large sensory component (most of face)
Small motor component (muscles of mastication)
Merge as a single trunk after leaving the trigeminal ganglion
Drops through foramen ovale, enters infratemporal region
Deep to lateral pterygoid muscle
Divides to form anterior and posterior portion

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Branches come from stem, anterior and posterior divisions of V3

Branches of the stem

o Nerve to medial pterygoid (motor)
o Nerve to tensor tympani (motor)
o Nerve to tensor veli palatini of palate (motor)
Branches of the anterior division
o Nerve to masseter (motor)
o Nerve to temporalis (motor)
o Nerve to lateral pterygoid (motor)
o Long buccal nerve (sensory) to mandibular buccal gingivae
posterior
Branches of the posterior division
o Auriculotemporal nerve (sensory)
o Auricular branch: sensory to external auditory meatus
o Articular branches: sensory to TMJ
o Secretory fibres: parasympathetic fibres to parotid
o Temproal branches: Skin of scalp
o Lingual nerve (sensory
o Chorda tympani pasrt of lingual nerve but comes from
CN7
o General sensory afferent: mucosa of FOM, anterior two
thirds of tongue, mandibular lingual gingivae
o Parasympathetic efferent: parasympathetic fibres of
chorda tympani carried with lingual nerve to floor of
mouth, synapse with submandibular ganglion.
Stimulate submandibular, sublingual and minor glands
of floor of mouth
o Special sensory taste: Chorda tympani distributed by
lingual nerve to anterior two thirds of tongue
o Inferior alveolar nerve (sensory and motor)
o Down to mandibular foramen (centrepoint of internal
ramus)
o Gives off nerve to mylohyoid before entering
mandibular foramen
 Nerve to mylohyoid (motor to mylohyoid and
anterior digastric

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  Intramandibular portion sends small branches to
teeth of molars and premolars and incisors as
incisive nerve
(sensory)
 Mental nerve: branches off IAN to face through
mental foramen
o Otic ganglion: parasympathetic fibre synapse from
glossopharyngeal nerve
Maxillary artery
Terminal branch of external carotis like superficial temporal, middle
meningeal one of many brs

Maxillary division of the trigeminal

Sensory only
Passes through foramen rotundum
Meningeal branches to duramater
Enters pterygopalatine fossa
Heads to infraorbiatl groove of maxilla
Gives off:
o Ganglionic branches
o Zygomatic nerve
o Posterior superior alveolar nerve
o Pass through canal and foramina to maxillary sinus,
then teeth
o Maxillary molars
o Maxillary sinus
o Gingival branches
Enters infraorbital canal, becomes infraorbital nerve
o Middle superior alveolar nerve
o Passes through max sinus also
o Dental branches to premolar teeth
o Maxillary sinus branches
o Gingival branches
o Anterior superior alveolar nerve
o Also enters sinus
o Dental branch to anteriors
o Sinus branch
o Gingival branch
o Nasal branch
Three terminal branches
o Lateral nasal

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 o Superior labial branch
o Inferior palpebral branch

Pterygopalatine ganglion
Gives off greater palatine nerves (hard palate), lesser palatine
nerves (Mucous membrane and glands of soft palate)
Nasopalatine nerve (travels in incisive canal supplys palatal
mucosa anterior to maxillary canines)

Paranasal air sinuses

Development mucosa invades bones
Drain to nasal cavities through ostia openings
Middle meatus
Maxillary sinuses: Bodies of right and left maxillae. Pyramidal
(base lateral wall of nose, apex underneath maxilla)
Small channels in bone of posterior wall lead from the foramina,
down towards the floor of the sinus overlying the maxillary molar
root apices
Carry posterior superior alveolar nerve
Roof: infraorbital canal
Anterior wall has anterior superior alveolar nerves running through
Roots of first and second molars may be inclose proximity to sinus
floor
Canines and third molars also
Roots of maxillary molars may pierce floor only separated from
sinus by thin mucosa

Oral cavity:
Posteriorly pharynx and soft palate
Floor supported by
mylohyoid
Adjacent to
second maxillary
molar: parotid duct
opening

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Hard palate
Palatine processes of maxillae
Three foramen
Incisive: transmits nasopalatine nerves and vessels: supply
anterior palatal mucosa. Midline, distal to maxillary central incisors
Greater palatine foramen: greater palatine nerves: supples rest
mucosa of hard palate. Opens medially to roots of third molars
Lesser palatine foramen: transmits lesser palatine nerves and
vessels to soft palate. Open medially to maxillary tuberosity

Palatal gingivae and mucosa

Closely adapted adjacent to teeth: lingual gingivae, joined to
vestibular gingivae by interdental papillae
Palatal mucosa thicker and spongier than gingivae
Distinct layers of lamina propria, submucosa, periosteum
Strong bands of connective tissue bing the mucosa to the
periosteum
Palate packed with mucous glands and fat globules

Muscles of the soft palate

 Palatopharyngeus: from aponeurosis to lateral wall of
pharynx: posterior palatal arch
 Palatoglossus: from aponeurosis to tongue
 Levator veli palatini palatine aponeurosis to auditory tube
 Tensor veli palatini: Lateral aspect of auditory tube to
aponeurosis, hooks under hamulus
 Uvular: from PNS to uvula
All supplied by cranial nerve 11 and 10
Accessory and vagus
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Except tensor veli palatini: V3 motor supply

Also greater and lesser palatine arteries supplying hard palate and
soft palate

Tongue
Sulcus terminalis separates anterior two thirds from posterior two
thirds
Foramen cecum in middle of sulcus terminalis: embryological
artefact
Circumvallate papillae line it
Fungiform and filiform (mostly) papillae sit on anterior two thirds
dorsum
Lingual tonsils on lateral aspects
Dorsum: superior and posterior roughened surfaces of the tongue

Muscles of tongue
Extrinsic:
 Genioglossus
 Hyoglossus
 Styloglossus
Intrinsic muscles:
 Longitudinal
 Transverse
 Vertical

Nerve supply of the tongue

Motor: hypoglossal
General sensory:
 General sensation to anterior two thirds: lingual nerve
(branch of v3)
 General sensation to posterior two thirds: Glossopharyngeal
nerve

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  Area around epiglottis: vagus
Taste sensory:
 Taste sensation to anterior two thirds of tongue: Facial nerve
via chorda tympani:
 Taste sensation from posterior two thirds of the tongue:
Glossopharyngeal

Floor of mouth contents

From mylohyoid line on medial mandible to tongue base
 Lingual nerve
 Hypoglossal nerve
 Glossopharyngeal nerve
 Submandibular ganglion
 Submandibular gland
o Mixed serous mucus
o Wraps around free border of mylohyoid to enter floor of
mouth as deep portion in submandibular fossa
o Duct just lateral to midline lingual frenum
 Sublingual gland
o Primarily mucus
o Entirely in floor of mouth
o Sublingual fossa superior and anterior to
submandibular fossa
o R and L glands meet anteriorly forming horseshoe
around base of tongue
o Sublingual fold in floor of mouth
o 12 mini ducts join and drain at submandibular duct

Dental nerve supply

Maxilla
Anterior superior alveolar nerve: midline to canine teeth
Vestibular gingivae of anteriors (labial branches of infraorbital
nerve also)
Middle superior alveolar nerve: premolars and mesiobuccal root
of first molar
Vestibular gingivae of premolars
Posterior superior alveolar nerve: molars
And vestibulargingivae of posteriors
Nasopalatine nerve: anterior palatal gingivae
Greater palatine nerve: rest of palatal gingivae

Mandible
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All teeth supplied by inferior alveolar nerve
Lingual gingivae supplied by lingual nerve
Anterior labial gingivae supplied by mental nerve (branch of IDN)
Rest of gingivae supplied by long buccal nerve

General systemic anatomy

Arteries supplying head and neck arise from common carotid and
subclavian vein
These arise from arch of aorta on LHS and brachiocephalic vein
on RHS
Drainage: External jugular which joins subclavian
Internal jugular drains inside skull

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