SURGICAL ANATOMY AND
APPROACHES TO THE
TEMPOROMANDIBULAR JOINT

INDIAN DENTAL ACADEMY
Leader in continuing dental educatio...










INTRODUCTION OF THE TMJ
ARTICULATORY SYSTEM
TMJ CAPSULE
ARTICULAR DISK
LIGAMENTS
BLOOD AND NERVE SUPPLY...
INTRODUCTION


The TMJ is also known as the craniomandibular
joint/articulation.

www.indiandentalacademy.com




The TMJ is a gingylmoarthrodial joint that is freely mobile with superior and
inferior joint cavities separated by t...
ARTICULATORY SYSTEM








The articulatory system comprises of the following :
The TMJ
The masticatory and accesso...
CRANIAL COMPONENT



Mandibular ( glenoid fossa) :
It is an anterior articular area formed by the inferior aspect of
tem...
CRANIAL COMPONENT








Limits are :
Anteriorly – articular
eminence or tubercle
Posteriorly – post glenoid
tuberc...
MANDIBULAR COMPONENT



Mandibular condyle :
The articular part of the
mandible is an ovoid
condylar process (head)
with...
MANDIBULAR COMPONENT








Mediolateral dimension
varies bn. 13 – 25 mm.
Anteroposterior width varies
bn. 5.5 – 16...
TMJ CAPSULE






TMJ capsule is a thin sleeve of
fibrous tissue investing the joint
completely, it defines the
anatomi...
TMJ CAPSULE


Attachments



Anteriorly – ant. border of the
articular eminence.
Posteriorly – lip of
squamotympanic fis...
TMJ CAPSULE








Each part of the joint is surrounded by short capsular fibers
which stretch from the condyle to th...
ARTICULAR DISK






The articular disk, an oval
plate of fibrous tissue shaped
like a tweaked cap,
completely divides ...
ARTICULAR DISK




The disk is biconcave in the sagittal section.
The superior surface is concavoconvex to
match the ana...
ARTICULAR DISK






The disc is a complex
structure.
It has three different zones
(Rees 1954) posterior band,
intermed...
ARTICULAR DISK




The meniscus projects
anteriorly to form a footshaped process the pes
meniscus. This pss. is attached...
ARTICULAR DISK




The posterior meniscus
attachment is the bilaminar
zone, composed if two strata
of fibres separated b...
ARTICULAR DISK




The posterior meniscus
attaches via the superior
stratum (elastic fibers) to
the tympanic plate of th...
SYNOVIAL MEMBRANE


The inside of the TMJ capsule and the nonarticulating surfaces
of the disk ligaments are lined with s...
TEMPOROMANDIBULAR LIGAMENT





TMJ capsule is reinforced by
this main stabilizing ligament.
It extends downward and
bac...
SPHENOMANDIBULAR LIGAMENT




It is a flat, thin band
descending from the spine of
the sphenoid and widening to
reach th...
STYLOMANDIBULAR LIGAMENT


The stylomandibular
ligament, a specialized band
of deep cervical fascia
stretches from the ap...
BLOOD SUPPLY







The lateral aspect is supplied by superficial temporal artery.
Rich vascular supply to the deep an...
NERVE SUPPLY








The mandibular nerve innervates the TMJ.
Three branches from this nerve send terminals to the jo...
MUSCLES OF MASTICATION





MASSETER : Two heads
The superficial head originates
on the anterior zygomatic arch,
runs d...
MUSCLES OF MASTICATION









TEMPORALIS :
Originates from – the lower
temporal line, the temporal fossa,
temporal ...
MUSCLES OF MASTICATION







MEDIAL PTERYGOID :
Superficial head from
tuberosity and adjoining
bone.
Deep head from m...
MUSCLES OF MASTICATION










LATERAL PTRYGOID :
Upper head arises from the
infratemporal sf. and crest of
of the...
ACCESSORY MUSCLES - SUPRAHYOID









DIGASTRIC :
The ant. belly originates near
the mandibular symphysis.
The post...
ACCESSORY MUSCLES - SUPRAHYOID






GENIOHYOID : Originates from
the genial tubercle and runs
backward to insert into ...
ACCESSORY MUSCLES - SUPRAHYOID


STYLOHYOID : Originates from the post. surface of the styloid process.



The tendon di...
ACCESSORY MUSCLES - INFRAHYOID




STERNOTHYROID : Originates on the manubrium of the sternum and
inserts at the thyroid...
ACCESSORY MUSCLES - INFRAHYOID




OMOHYOID :Originates on the superior part of the scapula
and inserts at the lateral b...
MOVEMENTS OF THE TMJ


Motions of the TMJ are manifold. It is a ginglimus, diarthrodial
type of joint, as it is capable o...
MOVEMENTS OF THE TMJ


The mandible can be depressed, elevated, protruded or retruded.



Lateral excursions can also be...
MOVEMENTS






Degenerative joint disease state resulting either from local
causes or systemic causes.
Strength, lengt...
www.indiandentalacademy.com
MOVEMENTS (CLOSURE)


It is accomplished by the
simultaneous contraction
of the masseter, medial
pterygoid and temporalis...
MOVEMENTS (DEPRESSION)






Digastric muscle contraction
depresses the body of the
mandible.
This action is assisted b...
MOVEMENTS (PROTRUSION)


Protrusive movement is
brought about by equal
and simultaneous
contracture of the lateral
and me...
MOVEMENTS (RETRUSION)


Retrusion is brought
about by the posterior
fibres of the temporalis
muscle, assisted by the
mass...
MOVEMENTS (RIGHT & LEFT LATERAL)

www.indiandentalacademy.com
FACIAL NERVE




The main trunk of the facial nerve exits from the skull at the
stylomastoid foramen.
Approximately 1.3 ...
FACIAL NERVE






In the classis article by Al-Kayat and Bramley the distance from
the lowest point of the external bo...
FACIAL NERVE




Knowledge of the distances and the range of the facial nerve
branches from fixed bony landmarks within ...
FACIAL NERVE






The temporal branch of the facial nerve emerges from the
parotid gland and crosses the zygoma under ...
AURICULOTEMPORAL NERVE






The auriculotemporal nerve
supplies sensation to parts of the
auricle, the external audito...
AURICULOTEMPORAL NERVE






Damage to this nerve can be prevented during surgery by
incising and dissecting in close a...




The superficial temporal artery one of the terminal branches of
the ECA, begins behind the mandibular condylar neck ...


The transverse facial artery arises form the base of the superficial
temporal artery and runs almost transversely acros...
LAYERS OF THE TEMPOROPARIETAL
REGION


The temporoparietal fascia is the most superficial layer beneath
the subcutaneous ...


The temporalis fascia is the fascia of the temporalis muscle.



This fascia arises from the superior temporal line an...
REFERENCES













GRAY’S ANATOMY – 38 TH EDITIION
COLOR ATLAS OF TMJ SURGERY – PETER D. QUINN
FONSECA ORAL A...
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
POSTERIOR FIBER DRAWS
MANDIBLE BACKWARDS

www.indiandentalacademy.com
ELEVATION OF MANDIBLE

www.indiandentalacademy.com
www.indiandentalacademy.com
The combinded efforts of the Digastrics and Lateral
Pterygoids provide for natural jaw opening.

www.indiandentalacademy.c...
Medial and lateral pterygoid act together to
protrude the mandible

www.indiandentalacademy.com
Thank you
For more details please visit
www.indiandentalacademy.com

www.indiandentalacademy.com
Upcoming SlideShare
Loading in …5
×

Surgical anatomy of the temporomandibular joint and surgical (nx power lite) /certified fixed orthodontic courses by Indian dental academy

2,039 views
1,731 views

Published on



The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078

0 Comments
5 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
2,039
On SlideShare
0
From Embeds
0
Number of Embeds
5
Actions
Shares
0
Downloads
60
Comments
0
Likes
5
Embeds 0
No embeds

No notes for slide

Surgical anatomy of the temporomandibular joint and surgical (nx power lite) /certified fixed orthodontic courses by Indian dental academy

  1. 1. SURGICAL ANATOMY AND APPROACHES TO THE TEMPOROMANDIBULAR JOINT INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2.          INTRODUCTION OF THE TMJ ARTICULATORY SYSTEM TMJ CAPSULE ARTICULAR DISK LIGAMENTS BLOOD AND NERVE SUPPLY MUSCLES MOVEMENTS OF THE TMJ SURGICAL ANATOMY www.indiandentalacademy.com
  3. 3. INTRODUCTION  The TMJ is also known as the craniomandibular joint/articulation. www.indiandentalacademy.com
  4. 4.   The TMJ is a gingylmoarthrodial joint that is freely mobile with superior and inferior joint cavities separated by the meniscus (articular disc). It is considered as a complex joint because it involves two separate joints (rt. & lt.) in which there is presence of intracapsular disc and both joints have to function in coordination. www.indiandentalacademy.com
  5. 5. ARTICULATORY SYSTEM       The articulatory system comprises of the following : The TMJ The masticatory and accessory muscles The occlusion of the teeth. The function is governed by sensory and motor branches of he third division of the trigeminal nerve (mandibular) and a few fibers of the facial nerve. The occlusion of the teeth plays an imp. role in he function of the TMJ. Normally, the greatest part of the force of mastication is borne by the dentition of the jaws, but in case of occlusal disharmony, a great deal of force can be shifted to the joint itself. www.indiandentalacademy.com
  6. 6. CRANIAL COMPONENT   Mandibular ( glenoid fossa) : It is an anterior articular area formed by the inferior aspect of temporal squama. It’s surface is smooth, oval and deeply hollow and the bone is very thin at the depth of the fossa. The fossa is lined by dense avascular fibrocartilage. www.indiandentalacademy.com
  7. 7. CRANIAL COMPONENT       Limits are : Anteriorly – articular eminence or tubercle Posteriorly – post glenoid tubercle Medially – spine of he sphenoid bone Laterally – root of the zygomatic process of temporal bone Superiorly – separated from MCF by thin plate of bone at apex www.indiandentalacademy.com
  8. 8. MANDIBULAR COMPONENT   Mandibular condyle : The articular part of the mandible is an ovoid condylar process (head) with narrow mandibular neck. It is broad laterally and narrower medially. The articular part of the condyle is covered by fibrocartilage. www.indiandentalacademy.com
  9. 9. MANDIBULAR COMPONENT       Mediolateral dimension varies bn. 13 – 25 mm. Anteroposterior width varies bn. 5.5 – 16 mm. Majority of the human condyles (58%) are slightly convex superiorly. 25% of the condyles may be flat superiorly. 12% are pointed or angular in shape. 3% are bulbous or rounded in shape. www.indiandentalacademy.com
  10. 10. TMJ CAPSULE    TMJ capsule is a thin sleeve of fibrous tissue investing the joint completely, it defines the anatomic and functional boundaries of the TMJ. It is a funnel shaped capsule, which blends with the periosteum of the mandibular neck and it envelops the articular disc. On the temporal bone, the articular capsule surrounds the articular surfaces of the eminence and fossa. www.indiandentalacademy.com
  11. 11. TMJ CAPSULE  Attachments  Anteriorly – ant. border of the articular eminence. Posteriorly – lip of squamotympanic fissure and ant. sf. of postglenoid pss. Laterally – edge of the eminence and glenoid fossa. Medially – along the sphenosquamosal suture. Below – neck of the condyle medially and laterally.     www.indiandentalacademy.com
  12. 12. TMJ CAPSULE     Each part of the joint is surrounded by short capsular fibers which stretch from the condyle to the disc, and from the disc to the temporal bone forming two joint capsules. Longer bands extending from the condyle to the temporal bone may be regarded as reinforcing fibers. Capsular fibers passing bn. the mandible and temporal bone are present only on the lateral side. The cavities are lined with synovial tissue with villi extending from anterior and posterior part of the articular disk to the attachments to the temporal bone and mandibular condyle. www.indiandentalacademy.com
  13. 13. ARTICULAR DISK    The articular disk, an oval plate of fibrous tissue shaped like a tweaked cap, completely divides the articular space into two compartments: The inferior compartment – condylodiscal complex between the condyle and the disc. The superior compartment – temporodiscal complex between the disc and the glenoid fossa. www.indiandentalacademy.com
  14. 14. ARTICULAR DISK   The disk is biconcave in the sagittal section. The superior surface is concavoconvex to match the anatomy of the glenoid fossa and the inferior surface is concave to fit over the condylar head. Histologically the disk is a meshwork of firmly woven avascular fibrous connective tissue. www.indiandentalacademy.com
  15. 15. ARTICULAR DISK    The disc is a complex structure. It has three different zones (Rees 1954) posterior band, intermediate band and anterior band. The disk blends medially and laterally with the capsule, which is attached to the medial and lateral poles of the condyle. www.indiandentalacademy.com
  16. 16. ARTICULAR DISK   The meniscus projects anteriorly to form a footshaped process the pes meniscus. This pss. is attached superiorly to the articular eminence and superior belly of the lat. pterygoid muscle. Inferiorly the pes meniscus is attached to the articular margin of the condyle. www.indiandentalacademy.com
  17. 17. ARTICULAR DISK   The posterior meniscus attachment is the bilaminar zone, composed if two strata of fibres separated by a central zone composed of loose areolar connective tissue. The meniscus is highly vascular in this region and is called the genu vasculosa. ( sensory branches of the auriculotemporal n.) www.indiandentalacademy.com
  18. 18. ARTICULAR DISK   The posterior meniscus attaches via the superior stratum (elastic fibers) to the tympanic plate of the temporal bone. The inferior stratum (inelastic collagen) attaches to the neck of the condyle. www.indiandentalacademy.com
  19. 19. SYNOVIAL MEMBRANE  The inside of the TMJ capsule and the nonarticulating surfaces of the disk ligaments are lined with synovial membrane.  It has been estimated that the volume of synovial fluid in the superior joint compartment is 1.2ml and in the posterior compartment is 0.9ml.  The synovial fluid contains a glycoprotein known as lubricin, which serves to lubricate and minimize friction between articular surfaces of the joint. www.indiandentalacademy.com
  20. 20. TEMPOROMANDIBULAR LIGAMENT   TMJ capsule is reinforced by this main stabilizing ligament. It extends downward and backward from the lat. aspect of the articular eminence to the external and posterior aspect of the condylar neck. This ligament functions like a pendulum, which allows translation but resists abnormal lateral condyle displacement. www.indiandentalacademy.com
  21. 21. SPHENOMANDIBULAR LIGAMENT   It is a flat, thin band descending from the spine of the sphenoid and widening to reach the lingula of the mandibular foramen. It is imp. landmark during surgery as the maxillary artery and the auriculotemporal n. lies between it and the mandibule. www.indiandentalacademy.com
  22. 22. STYLOMANDIBULAR LIGAMENT  The stylomandibular ligament, a specialized band of deep cervical fascia stretches from the apex and adjacent anterior aspect of the styloid process to the mandible’s angle and posterior border. www.indiandentalacademy.com
  23. 23. BLOOD SUPPLY     The lateral aspect is supplied by superficial temporal artery. Rich vascular supply to the deep and posterior aspect of the retrodiscal capsular part by deep auricular, posterior auricular and the masseteric artery. Vascular supply to the lateral pterygoid muscle also supplies the head of the condyle by penetration of numerous nutrient foramina vessels. The venous pattern is more diffuse forming a plentiful plexus all around the capsule. www.indiandentalacademy.com
  24. 24. NERVE SUPPLY      The mandibular nerve innervates the TMJ. Three branches from this nerve send terminals to the joint capsule: Largest – Auriculotemporal n. – posterior, medial and lateral parts of the joint. Massseteric nerve. Branch from the posterior deep temporal nerve supplies the anterior parts of the joint. www.indiandentalacademy.com
  25. 25. MUSCLES OF MASTICATION    MASSETER : Two heads The superficial head originates on the anterior zygomatic arch, runs downward and backward and inserts on the angle and the ramus. The deep head originates from the posterior part of the zygoma, runs vertically downwards and inserts on the ramus and the coronoid process. www.indiandentalacademy.com
  26. 26. MUSCLES OF MASTICATION      TEMPORALIS : Originates from – the lower temporal line, the temporal fossa, temporal fascia. Fibers converge into a tendinous band which then divides into 2 parts. Superficial group of fibers inserts on the superolateral sf. of the coronoid pss. Deeper larger fibers form a band along the inner coronoid pss. extending inferiorly to the ant. border of the ramus. www.indiandentalacademy.com
  27. 27. MUSCLES OF MASTICATION     MEDIAL PTERYGOID : Superficial head from tuberosity and adjoining bone. Deep head from medial sf. of lat. Pterygoid plate and palatine bone. Fibers run posteroinferiorly inserting on the medial surface of the ramus and the angle. www.indiandentalacademy.com
  28. 28. MUSCLES OF MASTICATION       LATERAL PTRYGOID : Upper head arises from the infratemporal sf. and crest of of the greater wing of the sphenoid. Lower head arises from lat. Pterygoid plate. Fibers run posterolaterally and converge to insert onto: Pterygoid fovea Ant. margin of the articular disc and capsule of the TMJ. www.indiandentalacademy.com
  29. 29. ACCESSORY MUSCLES - SUPRAHYOID      DIGASTRIC : The ant. belly originates near the mandibular symphysis. The post. belly originates on the mastoid notch. The ant. belly runs downwards and backward and post. belly forwards to meet the intermediate tendon. This tendon is held by a fibrous pulley attached to the hyoid bone www.indiandentalacademy.com
  30. 30. ACCESSORY MUSCLES - SUPRAHYOID    GENIOHYOID : Originates from the genial tubercle and runs backward to insert into anterior surfacef of body of the hyoid. MYLOHYOID : Originates from the mylohyoid line. Fibers run medially and slightly downwards. Post. Fibers insert into body of hyoid. Middle & ant. fibers insert into the median raphe that unites the rt. & lt. muscles. www.indiandentalacademy.com
  31. 31. ACCESSORY MUSCLES - SUPRAHYOID  STYLOHYOID : Originates from the post. surface of the styloid process.  The tendon divides into two slips that pass on either sides of the digastric tendon to insert into the hyoid bone. www.indiandentalacademy.com
  32. 32. ACCESSORY MUSCLES - INFRAHYOID   STERNOTHYROID : Originates on the manubrium of the sternum and inserts at the thyroid cartilage. THYROHYOID :Originates on the thyroid cartilage and inserts on the hyoid bone. www.indiandentalacademy.com
  33. 33. ACCESSORY MUSCLES - INFRAHYOID   OMOHYOID :Originates on the superior part of the scapula and inserts at the lateral border of the hyoid bone. STERNOHYOID : Originates on the manubrium of the sternum and inserts on the body of the hyoid bone. www.indiandentalacademy.com
  34. 34. MOVEMENTS OF THE TMJ  Motions of the TMJ are manifold. It is a ginglimus, diarthrodial type of joint, as it is capable of rotating around more than one axis and is capable of hinge/rotatory movement and also capable of gliding/translatory movement.  A hinge type of movement takes place in the lower compartment between inferior aspect of the stationary disc and the moving condyle.  Gliding type of movement takes place in the upper compartment between the superior surface of the disc, which moves with the condyle ,and the stationary mandibular fossa and eminence. www.indiandentalacademy.com
  35. 35. MOVEMENTS OF THE TMJ  The mandible can be depressed, elevated, protruded or retruded.  Lateral excursions can also be carried out.  There is a variation of normal patterns of motion in different individuals, which are caused by many factors, including the following:  Condyle head size, shape and inclinaiton.  Glenoid fossa depth and angulation.  Articular eminence height and degree of inclination.  Length and laxity of ligaments comprising the joint capsule. www.indiandentalacademy.com
  36. 36. MOVEMENTS    Degenerative joint disease state resulting either from local causes or systemic causes. Strength, length, position and tonicity of muscles of mastication and the suprahyoid musculature. Neuromuscular control of the muscles. www.indiandentalacademy.com
  37. 37. www.indiandentalacademy.com
  38. 38. MOVEMENTS (CLOSURE)  It is accomplished by the simultaneous contraction of the masseter, medial pterygoid and temporalis muscle of both the sides. www.indiandentalacademy.com
  39. 39. MOVEMENTS (DEPRESSION)    Digastric muscle contraction depresses the body of the mandible. This action is assisted by the suprahyoid, sternohyoid, and geniohyoid muscles. The lateral pterygoid is the trigger and contracts to pull the condylar head downward and forward on the articular eminence. www.indiandentalacademy.com
  40. 40. MOVEMENTS (PROTRUSION)  Protrusive movement is brought about by equal and simultaneous contracture of the lateral and medial pterygoid muscles. www.indiandentalacademy.com
  41. 41. MOVEMENTS (RETRUSION)  Retrusion is brought about by the posterior fibres of the temporalis muscle, assisted by the masseter, digastric and geniohyoid muscles. www.indiandentalacademy.com
  42. 42. MOVEMENTS (RIGHT & LEFT LATERAL) www.indiandentalacademy.com
  43. 43. FACIAL NERVE   The main trunk of the facial nerve exits from the skull at the stylomastoid foramen. Approximately 1.3 cm of the nerve is visible before it divides into temporofacial and cervicofacial branches. www.indiandentalacademy.com
  44. 44. FACIAL NERVE    In the classis article by Al-Kayat and Bramley the distance from the lowest point of the external bony auditory canal to the bifurcation was found to be 1.5 cm to 2.8 cm (mean 2.3 cm) Distance from the post-glenoid tubercle to the bifurcation was 2.4 to 3.5 cm (mean 3.0 cm) The distance from the most anterior concavity of the bony external auditory canal to the most posterior significant temporal branch of the facial nerve was 0.8 to 3.5 cm (mean 2.0 cm) www.indiandentalacademy.com
  45. 45. FACIAL NERVE   Knowledge of the distances and the range of the facial nerve branches from fixed bony landmarks within the surgical field alerts the surgeon to the areas of highest risk. During surgery by incising the superficial layer of the temporalis fascia and the periosteum over the arch inside the 8 mm boundary, damage to the branches of the upper trunk can be prevented. www.indiandentalacademy.com
  46. 46. FACIAL NERVE    The temporal branch of the facial nerve emerges from the parotid gland and crosses the zygoma under the temporoparietal fascia to innervate the frontalis, the corrugator, the procerus and occasionally a portion of he orbicularis oculi muscle. Post surgical palsy manifests as an inability to raise the eyebrow or wrinkle the forehead and ptosis of the brow. Damage to the zygomatic branch results in temporary or permanent paresis to the orbicularis oculi. (may require temporary patching of the eye to prevent corneal dessication) www.indiandentalacademy.com
  47. 47. AURICULOTEMPORAL NERVE    The auriculotemporal nerve supplies sensation to parts of the auricle, the external auditory meatus, the tympanic membrane, and skin in the temporal area. It courses form the medial side of the posterior neck of the condyle and turns superiorly, running over the zygomatic root of the temporal bone. Just anterior to the auricle, the nerve divides into its terminal branches in the skin of the temporal area. www.indiandentalacademy.com
  48. 48. AURICULOTEMPORAL NERVE    Damage to this nerve can be prevented during surgery by incising and dissecting in close apposition to the cartilaginous portion of the external auditory meatus. The nerve runs somewhat anteriorly as it courses from lateral to medial. Temporal extension of the skin incision should be located posteriorly so that the main distribution of the nerve is dissected and retracted forward with the flap. www.indiandentalacademy.com
  49. 49.   The superficial temporal artery one of the terminal branches of the ECA, begins behind the mandibular condylar neck deep to the parotid gland as it emerges from behind the parotid gland. It crosses over the posterior root of the zygomatic process of the temporal bone and enters the temporal region of the scalp. www.indiandentalacademy.com
  50. 50.  The transverse facial artery arises form the base of the superficial temporal artery and runs almost transversely across the face, lying upon the outer surface of the masseter muscle about 1.5 cm below the zygomatic arch but above the parotid duct. www.indiandentalacademy.com
  51. 51. LAYERS OF THE TEMPOROPARIETAL REGION  The temporoparietal fascia is the most superficial layer beneath the subcutaneous fat.  This fascia is the lateral extension of the galea and is continuous with the superficial musculoaponeurotic layer (SMAS).  The blood vessels of the scalp run along its superficial aspect closely related to the subcutaneous fat.  The motor nerves run on the deep surface of the temporoparietal fascia. www.indiandentalacademy.com
  52. 52.  The temporalis fascia is the fascia of the temporalis muscle.  This fascia arises from the superior temporal line and fuses with the pericranium.  Inferiorly at the level of the superior orbital rim, the temporalis fascia splits into the superficial layer attaching to the lateral border and the deep layer attaching to the medial border of the zygomatic arch.  A small quantity of fat is found in between these two layers and it is sometimes referred to as the superficial temporal fat pad. www.indiandentalacademy.com
  53. 53. REFERENCES         GRAY’S ANATOMY – 38 TH EDITIION COLOR ATLAS OF TMJ SURGERY – PETER D. QUINN FONSECA ORAL AND MAXILLOFACIAL SURGERY VOL. 4 – BAYS and QUINN THE TMJ AND RELATED OROFACIAL DISORDERS – BUSH and DOLWICK SURGICAL APPROACHES TO THE FACIAL SKELETON – EDWARD ELLIS THE ANATOMICAL BASIS OF DENTISTRY – LEIBGOTT SURGERY OF THE TMJ. SURGICAL ANATOMY AND SURGICAL INCISIONS – KREUTZIGER (ORAL SURGERY. 58; 637-646, 1984) CLINICALLY ORIENTED ANATOMY – KEITH L. www.indiandentalacademy.com MOORE
  54. 54. www.indiandentalacademy.com
  55. 55. www.indiandentalacademy.com
  56. 56. www.indiandentalacademy.com
  57. 57. www.indiandentalacademy.com
  58. 58. www.indiandentalacademy.com
  59. 59. www.indiandentalacademy.com
  60. 60. www.indiandentalacademy.com
  61. 61. www.indiandentalacademy.com
  62. 62. POSTERIOR FIBER DRAWS MANDIBLE BACKWARDS www.indiandentalacademy.com
  63. 63. ELEVATION OF MANDIBLE www.indiandentalacademy.com
  64. 64. www.indiandentalacademy.com
  65. 65. The combinded efforts of the Digastrics and Lateral Pterygoids provide for natural jaw opening. www.indiandentalacademy.com
  66. 66. Medial and lateral pterygoid act together to protrude the mandible www.indiandentalacademy.com
  67. 67. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com

×