Clinical Oral Anatomy

Thomas von Arx • Scott Lozanoff

Clinical Oral Anatomy

A Comprehensive Review for Dental Practitioners and Researchers

Thomas von Arx University of Bern School of Dental Medicine Department of Oral Surgery and Stomatology Bern Switzerland

Scott Lozanoff Department of Anatomy Biochemistry & Physiology John A. Burns School of Medicine Honolulu Hawaii USA

ISBN 978-3-319-41991-6 ISBN 978-3-319-41993-0 (eBook) DOI 10.1007/978-3-319-41993-0

Library of Congress Control Number: 2016958506

© Springer International Publishing Switzerland 2017 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made.

Printed on acid-free paper

This Springer imprint is published by Springer Nature The registered company is Springer International Publishing AG Switzerland

I dedicate this book to my wife Fränzi and our children Yannick , Dennis , and Joya for supporting my academic career and for being such a wonderful family.

Thomas von Arx

I want to dedicate this book to my parents, Paul and Peggy, for instilling within me a passion for knowledge through scientifi c pursuit.

Scott Lozanoff

vii

The authors – Thomas von Arx and Scott Lozanoff – have in their introduction presented a citation that clearly points to the importance of present-day anatomy: namely, its clinical rel-evance. For oral- and maxillofacial surgeons, dentists, and ENT and plastic surgeons, the clini-cal and functional anatomy of the head (and neck) is of prime signifi cance and importance for successful and acceptable outcomes of their surgical procedures. Detailed and fi rm knowledge of orofacial anatomical structures therefore is absolutely mandatory for all those dental and medical specialists who are “active” in the oral cavity and face.

The productive academic partnership of Thomas von Arx, an experienced oral surgeon, and Scott Lozanoff, an authority in orofacial anatomy, is ideal in combining their knowledge and expertise in the fi eld of clinical anatomy.

In 26 chapters, the authors have written down and illustrated clinical anatomical features of musculature, orofacial nerves, facial bones, and other important anatomical structures in an extremely clear and didactic way. The text is precise and to the point. The illustrations includ-ing schematic drawings and photographs of anatomical specimens are easy to understand, informative, and of excellent quality.

The present book is an update of oral anatomy not only for those who have been in their dental and medical profession for a long time but also for medical and dental students.

This book on clinical oral anatomy is a marvel and has great promise!

Charité, Berlin, Germany Peter A. Reichart May 2016

Foreword

ix

Oral anatomy provides the basis for oral diagnosis, treatment, and care. A fi rm understanding of anatomical structures and their spatial relationships is critical for all dental specialists to remedy patient maladies and ensure holistic health. Recent innovations in dental research have provided far greater anatomical resolution and information than was previously available. The dental sciences have witnessed an explosion of scientifi c investigation over the recent years with a dizzying array of new data to improve all aspects of clinical dentistry. With such a dra-matic increase in information, reduction in curricular time for craniofacial anatomy is inevi-table. However, curriculum reduction belies a fundamental fact – to achieve successful diagnosis and treatment, the practitioner must learn and understand basic oral anatomical rela-tionships. An anatomical knowledge base must be portable and translatable in the clinic in spite of reduced instructional time. We believe that there is a need for an oral anatomy textbook that provides fundamental information in a descriptive fashion but also utilizes a presentation style that enables the interested reader to effectively obtain anatomical information required to understand clinical intervention. Thus, we have written a textbook that focuses on fundamental anatomical relationships presented in a concise fashion so that the most relevant information can be found rapidly and reliably. We have endeavored to address the most important anatomi-cal information in various presentation styles, enabling the interested reader to either read sequentially or utilize the book as a reference and identify information for a specifi c purpose.

Clinical Oral Anatomy: A Comprehensive Review for Dental Practitioners and Researchers concentrates on the oral cavity and structures that are directly contiguous. Detailed descrip-tions are provided, focusing on spatial relationships among anatomical structures that are par-ticularly compelling for the clinician. The descriptions are written to be direct and informative, ensuring that the reader comprehends the information as effi ciently as possible.

The written descriptions of oral anatomy are accompanied by elegantly simple illustrations that are designed to refl ect critical relationships in a visual fashion that emphasizes ease of use and understanding. The illustrations and captions have been devised in a manner that should enable the reader to understand the corresponding anatomical relationship without necessarily reading the full text. Additionally, detailed cadaveric dissections were undertaken to empha-size anatomical relationships in situ. In addition to the information provided in textual form, this book also is intended to serve as an anatomical atlas.

Knowledge of anatomical variation of the oral region is critical for understanding symp-toms, interpreting images, planning treatment, and providing operative management. A signifi -cant number of malpractice cases have resulted directly from a misunderstanding of anatomical variation. Sadly, near fatal and in some cases fatal complications arise due to a lack of appre-ciation of atypical anatomy. There are likely genetic and ethnic components to the preponder-ance of certain variations in specifi c populations. We have attempted to incorporate reports of anatomical variation patterns and occurrence with the intention of providing a reference source for the student and practicing clinician. In addition to qualitative descriptions of reported varia-tions, we have painstakingly delineated quantitative descriptions of variants so that the reader has access to the most complete information regarding possible variations within their own clinical context.

Pref ace

x

The operational fi eld for dental clinicians is miniature in scale where the difference between success and failure is literally measured in millimeters. Precision is imperative, and to this end, we have meticulously reported quantitative assessments of anatomical relationships directly from the publications in the primary literature. These values as well as their derivative citations are summarized in tabular form. The tables provide a quick reference for the interested reader and refl ect a novel perspective of anatomical variation.

Among the numerous and varied research breakthroughs in basic and clinical dental sci-ences in recent years, dramatic progress has occurred in dental imaging. In particular, image procurement using cone beam computed tomography (CBCT) has become a critical tool in various dental specialties for assessment and treatment paradigms. We have incorporated as many of these studies as possible and assessed the usefulness of CBCT in various settings for recognizing anatomical spatial relationships. Imaging with CBCT is compared to anatomical resolution utilizing other visualization methods whenever possible. Several original clinical and radiological images are included from the Department of Oral Surgery and Stomatology at the University of Bern School of Dental Medicine.

Cadaveric dissection provides one of the most direct and dynamic approaches to test hypotheses concerning anatomical spatial relationships. Several meticulous dissections were undertaken and included in this book. In many cases, the photographs provide direct evidence for oral anatomical features that are described in the text. Many of these photographs are unique and were included because they have not been available, to our knowledge, in the litera-ture. They provide novel perspectives of complex features and should serve to illuminate previ-ously unappreciated anatomical arrangements.

The anatomical information presented in this text ultimately is intended to improve clinical problem-solving skills. Thus, all chapters include a “clinical relevance” section highlighting the importance of the anatomical topic within a clinical context. These sections largely refl ect the considerable clinical and anatomical experience of the authors and underscore the impor-tance of a solid foundation in anatomy.

It may seem unusual to write an orofacial anatomy book without including teeth. After signifi cant consideration and discussion, it was decided to leave this complex and broad topic to other textbooks. However, we frequently refer to the many aspects of tooth morphology and their relationship to the tissue and structures described in the text.

With all of these factors in mind, we have compiled a comprehensive guide to oral anatomy emphasizing the most recent fi ndings regarding quantitative assessment, advanced imaging, and anatomical variations. We have attempted to maximize new research relevancy so the lit-erature cited covers the period from 1990 to 2015 with some earlier landmark articles cited where appropriate. We are hopeful that this book will provide a valuable reference guide for dental practitioners, clinical researchers, orofacial research scientists, and craniofacial anat-omy instructors among others eventually serving to improve oral anatomical problem solving within a clinical context.

Bern , Switzerland Thomas von Arx Honolulu , HI , USA Scott Lozanoff

Preface

xi

Anatomy has played a critically important role in our 30-year experience in oral surgery (TvA) and basic oral biology research (SL). The lack of continuing education courses focus-ing specifi cally on clinical oral anatomy has triggered our interest in writing a book on oral anatomy. Furthermore, the introduction of CBCT in dentistry has increased the need for understanding detailed spatial relationships between anatomically relevant structures. Taken together, complimentary interests have deepened our curiosity to learn and teach collaboratively.

Cadaveric dissections of the orofacial region serve as possibly the most direct and dynamic method to test hypothesis concerning anatomical spatial relationships. This philosophy pro-vided the primary motivation to write this book. TvA undertook a sabbatical at the University of Hawai’i School of Medicine. The main objective was to benefi t from mutual and comple-mentary academic interests as well as to undertake comprehensive orofacial cadaveric dissec-tions in preparation for this book. Many of these dissections are included in this book. Faculty, staff, and students of the Department of Anatomy, Biochemistry and Physiology at JABSOM are thanked for their helpfulness and hospitality (the famous aloha spirit of Hawai’i). In par-ticular, Steven Labrash is thanked for providing outstanding assistance as well as outstanding anatomical specimens, Beth Lozanoff for graphical ideas, and Tricia Yamaguchi for adminis-trative support.

From a broader perspective, several current and former faculty and students at the University of Hawai’i School of Medicine provided intellectual input serving to expand our anatomical knowledge base necessary for writing this book. Faculty include Dr. Chris Stickley, Dr. Kaori Tamura, Dr. Yukiya Oba, Dr. Takashi Matsui, Dr. Vernadeth Alarcon, Dr. Cadie Buckley, Dr. Selcuk Tunali, Dr. Julie Rosenheimer, Dr. Beth Jones, Dr. Sara Doll, Dr. Marita Nelson, and the late Dr. Vince DeFeo, while vital medical students include Ms. Trudy Hong, Mr. Greg Atkinson, Mr. Chih-wei Chang, and Dr. Niket Ghandi.

Back in Bern, the most important persons to get this book on track were Bernadette Rawyler who provided all the fantastic illustrations and Ines Badertscher who provided critical assis-tance with image preparation that is greatly appreciated. We would also like to thank TvA’s personal assistant, Lena Dänzer, for patient management in order to obtain clinical pictures and for assisting literature searches and obtaining selected articles. We also greatly acknowl-edge the staff of the University of Bern Dental Radiology Section for taking and providing the two- and three-dimensional radiographs used in this book.

Special thanks go to Prof. Dr. Daniel Buser, Chair of the Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Switzerland, for mentor-ing the academic career of TvA and supporting TvA’s interest in orofacial anatomy; special thanks also to Prof. Dr. Michael Bornstein, Associate Professor, Section of Radiology, Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Switzerland, for intellectual input and collaboration in many radiographic-anatomi-cal studies.

We thank the staff of Springer for bringing this book to life, especially Mrs. Tanja Maihöfer and Mrs. Wilma McHugh for their assistance and patience.

Acknowledgments

xii

Last but not least, our thoughts are with the thousands of people who donate their bodies annually for health education and research. Their contribution to the study of anatomy forms the foundation of medicine and dentistry underscoring the maxim – Anatomy: The Oldest Child of Mother Medicine (Tubbs S, Editorial, Clinical Anatomy 2014;27:805).

Thomas von Arx, Bern Scott Lozanoff, Honolulu

May 2016

Acknowledgments

xiii

1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

2 Oral Fissure and Lips . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Smile Line . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Clinical Relevance of the Oral Fissure and Lips . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

3 Vestibule and Cheeks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Clinical Relevance of the Vestibule and Cheeks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

4 Parotid Glands. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Facial Nerve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Auriculotemporal Nerve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 External Carotid Artery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Retromandibular Vein . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Clinical Relevance of the Parotid Gland and the Facial Nerve . . . . . . . . . . . . . . . . . . . 43 Literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

5 Anterior Maxilla . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Clinical Relevance of the Anterior Maxilla . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 Literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70

6 Infraorbital Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 Infraorbital Canal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 Infraorbital Foramen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76

Shape . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 Location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 Size . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 Distances . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84

Multiple Foramina . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 Infraorbital Nerve and Artery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 Canalis Sinuosus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 Anterior Superior Alveolar Nerve and Artery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 Middle Superior Alveolar Nerve and Artery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 Clinical Relevance of the Infraorbital Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 Literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101

7 Nasopalatine Canal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 Radiography of the Nasopalatine Canal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 Morphology of the Nasopalatine Canal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 Angulation of the Nasopalatine Canal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114 Width and Length of the Nasopalatine Canal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114 Distances from the Nasopalatine Canal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117 Content of the Nasopalatine Canal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118

Contents

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Nasopalatine Duct . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120 Clinical Relevance of the Nasopalatine Canal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 Literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130

8 Posterior Maxilla . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133 The Posterior Alveolar Process: Horizontal Dimensions . . . . . . . . . . . . . . . . . . . . . . 135 The Posterior Alveolar Process: Vertical Dimensions . . . . . . . . . . . . . . . . . . . . . . . . 137 Root Positions Within the Posterior Alveolar Process . . . . . . . . . . . . . . . . . . . . . . . . 139 Maxillary Tuberosity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140 The Posterior Superior Alveolar Nerve and Artery . . . . . . . . . . . . . . . . . . . . . . . . . . 141 Posterior Superior Alveolar Nerve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142 Posterior Superior Alveolar Artery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142 Frequency of Vascular Anastomosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149 Size of the Vascular Anastomosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149 Location of the Vascular Anastomosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149 The Os Zygomaticum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149 Pyramidal Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158 Pterygoid Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158 Clinical Relevance of the Posterior Maxilla . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159 Literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161

9 Maxillary Sinus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163 Radiography of the Maxillary Sinus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169 Volume and Size of the Maxillary Sinus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170 Hypoplasia of the Maxillary Sinus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173 Pneumatization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175 Dimensions of the Maxillary Sinus: Walls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177 Angle of Sinus Walls. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178 Ostium and Semilunar Hiatus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178 Root Positions Related to Maxillary Sinus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180 Schneiderian Membrane . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184 Sinus Septa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186 Clinical Relevance of the Maxillary Sinus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193 Literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195

10 Hard and Soft Palate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199 Vault of the Hard Palate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201 Length, Width, and Thickness of the Hard Palate . . . . . . . . . . . . . . . . . . . . . . . . . . . 202 Posterior Nasal Spine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203 The Pterygopalatine Canal (Palatine Canal) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204 Greater Palatine Foramina: Location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208 Greater Palatine Foramina: Shape . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212 Greater Palatine Foramina: Direction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212 Lesser Palatine Foramina . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212 Sulcus Palatinus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213 Greater Palatine Artery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 216 Greater Palatine Nerves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 218 Lesser Palatine Nerves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 218 Palatal Mucosa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219 Palatal Mucosa Thickness: Assessment with Bone Sounding . . . . . . . . . . . . . . . . . . 222 Palatal Mucosa Thickness: Assessment with CT/CBCT . . . . . . . . . . . . . . . . . . . . . . 222 Palatal Mucosa Thickness: Assessment with Histomorphometry . . . . . . . . . . . . . . . 222 The Soft Palate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223 Clinical Relevance of the Palate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 226 Literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 226

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11 Infratemporal Fossa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229 Mandibular Nerve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233 Mandibular Nerve: Anterior Trunk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 236 Mandibular Nerve: Posterior Trunk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237 Auriculotemporal Nerve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 238 Inferior Alveolar Nerve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239 Lingual Nerve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239 Otic Ganglion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239 Maxillary Artery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 240 Middle Meningeal Artery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243 Accessory Meningeal Artery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 244 Pterygoid Plexus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 244 Clinical Relevance of the Infratemporal Fossa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 244 Literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249

12 Pterygopalatine Fossa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251 Osseous Components of Pterygopalatine Fossa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253 Compartments of Pterygopalatine Fossa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 256 Size and Dimensions of the Pterygopalatine Fossa . . . . . . . . . . . . . . . . . . . . . . . . . . 256 Communication Structures of the Pterygopalatine Fossa . . . . . . . . . . . . . . . . . . . . . . 256 Foramen Rotundum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257 Pterygoid (Vidian) Canal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 260 Inferior Orbital Fissure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 261 Sphenopalatine Foramen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 262 Palatovaginal Canal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 264 Vomerovaginal Canal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 264 Pterygopalatine Canal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 264 Pterygomaxillary Fissure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265 Arteries of the Pterygopalatine Fossa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265

Maxillary Artery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265 Posterior Superior Alveolar Artery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265 Infraorbital Artery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265 Artery of the Pterygoid Canal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267 Descending Palatine Artery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267 Sphenopalatine Artery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267

Neural Structures of Pterygopalatine Fossa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267 Maxillary Nerve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267 Pterygopalatine Ganglion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267 Sympathetic Distribution Within the Pterygopalatine Fossa . . . . . . . . . . . . . . . . . 268 Parasympathetic Distribution Within the Pterygopalatine Fossa . . . . . . . . . . . . . . 268 Clinical Relevance of the Pterygopalatine Fossa . . . . . . . . . . . . . . . . . . . . . . . . . . 269

Literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 269

13 Retromandibular Area . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 271 Styloid Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 272 Muscles Originating from the Styloid Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 280 Ligaments Originating from the Styloid Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . 280 Internal (ICA) and External Carotid Arteries (ECA) . . . . . . . . . . . . . . . . . . . . . . . . . 282 Parapharyngeal Space . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 283 Clinical Relevance of Retromandibular Area . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 283 Literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 283

14 Posterior Mandible . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 285 Dimensions of the Posterior Mandible . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 290 Submandibular Fossa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 295

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Innervation of Posterior Mandible . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 300 Retromolar Bone Harvesting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 301 Clinical Relevance of the Posterior Mandible . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 302 Literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 302

15 Mandibular Foramen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 305 Anatomy of the Mandibular Foramen and Surrounding Structures . . . . . . . . . . . . . . 307 Size and Distances of the Mandibular Foramen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 309 Relative Position of the Mandibular Foramen Within Ramus . . . . . . . . . . . . . . . . . . 314 Vertical Distance from the Mandibular Foramen to the Occlusal Plane . . . . . . . . . . . 315 Spatial Relationship of Neurovascular Structures at the Foramen . . . . . . . . . . . . . . . 317 Accessory Mandibular Foramen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 318 The Lingula . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 318 The Antilingula . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 320 Clinical Relevance of the Mandibular Foramen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 321 Literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 321

16 Mandibular Canal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 323 Radiographic Identifi cation of Mandibular Canal . . . . . . . . . . . . . . . . . . . . . . . . . . . 324 Course of Mandibular Canal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 330 Size of Mandibular Canal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 334 Distances from Mandibular Canal to Adjacent Root Apices . . . . . . . . . . . . . . . . . . . 335 Distances from Mandibular Canal to Bone Surfaces . . . . . . . . . . . . . . . . . . . . . . . . . 337 Components of Mandibular Canal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 340 Bifi d Mandibular Canal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 342 Mandibular Canal and Third Molars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 350 Mandibular Canal and Dental Implants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 360 Mandibular Canal and Endodontic Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 362 Clinical Relevance of the Mandibular Canal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 365 Literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 366

17 Retromolar Canal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 369 Presence of Retromolar Canal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 371 Course and Types of Retromolar Canals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 374 Size and Height of Retromolar Canal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 377 Location of Retromolar Foramen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 378 Neurovascular Content of Retromolar Canal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 379 Clinical Relevance of Retromolar Canal. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 382 Literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 382

18 Mental Foramen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 385 Position of Mental Foramen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 388 Size of Mental Foramen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 396 Radiographic Visibility of Mental Foramen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 398 Number of Mental Foramina . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 398 Mental Canal and “Anterior Loop” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 403 Mental Nerve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 406 Clinical Relevance of the Mental Foramen and Related Structures . . . . . . . . . . . . . . 408 Literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 408

19 Lingual and Mylohyoid Nerves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 413 Lingual Nerve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 413 Patterns of Lingual Nerve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 416 Communications of Lingual Nerve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 416 Chorda Tympani . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 417

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Position of Lingual Nerve Relative to Mandible . . . . . . . . . . . . . . . . . . . . . . . . . . . . 417 Risk of Lingual Nerve Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 418 Risk Factors of Lingual Nerve Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 418 Nonsurgical Lingual Nerve Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 421 Clinical Relevance of Lingual Nerve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 422 Mylohyoid Nerve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 423 Clinical Relevance of Mylohyoid Nerve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 425 Literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 425

20 Anterior Mandible . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 429 Alveolar Ridge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 433 Dimensions of the Anterior Mandible . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 435 Genial Tubercles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 436 Sublingual Fossa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 438 Bone Harvesting from Symphysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 439 Sequelae of Bone Harvesting in the Chin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 440 Clinical Relevance of the Anterior Mandible . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 441 Literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 442

21 Mandibular Incisive Canal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 445 Presence of the Mandibular Incisive Canal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 447 Length and Diameter of the Mandibular Incisive Canal . . . . . . . . . . . . . . . . . . . . . . . 449 Distances from the Mandibular Incisive Canal to Adjacent Structures . . . . . . . . . . . 452 Course of the Mandibular Incisive Canal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 454 Mandibular Incisive Nerve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 456 Clinical Relevance of the Mandibular Incisive Canal and Nerve . . . . . . . . . . . . . . . . 457 Literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 460

22 Lingual Foramina and Canals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 463 Frequency and Location of the Lingual Foramina . . . . . . . . . . . . . . . . . . . . . . . . . . . 470 Radiographic Detection of the Lingual Foramina. . . . . . . . . . . . . . . . . . . . . . . . . . . . 472 Size and Distances of the Lingual Foramina . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 472 Canals of Lingual Foramina . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 477 Neurovascular Components of the Lingual Foramina and Canals . . . . . . . . . . . . . . . 480 Clinical Relevance of the Lingual Foramina . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 482 Literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 486

23 Tongue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 489 Size of the Tongue. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 492 Tongue Muscles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 492

Extrinsic Tongue Muscles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 494 Intrinsic Tongue Muscles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 499

Lingual Nerve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 500 Hypoglossal Nerve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 503 Glossopharyngeal Nerve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 503 Vagus Nerve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 504 Vasculature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 504 Lingual Veins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 504 Lymphatics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 505 Clinical Relevance of the Tongue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 505 Literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 505

24 Floor of Mouth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 507 Mylohyoid Muscle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 509 Geniohyoid Muscle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 512

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Sublingual Gland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 514 Submandibular Gland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 516 Blood Vessels of the Floor of the Mouth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 518 Clinical Relevance of the Floor of the Mouth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 520 Literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 524

25 Temporomandibular Joint . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 525 Bony Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 528 Articular Disk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 531 Capsule and Synovial Membrane . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 532 Ligaments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 533 Temporomandibular Joint Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 533 Clinical Relevance of the Temporomandibular Joint . . . . . . . . . . . . . . . . . . . . . . . . . 534 Literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 534

26 Masticatory Muscles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 535 Masseter Muscle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 537 Temporalis Muscle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 541 Medial Pterygoid Muscle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 546 Lateral Pterygoid Muscle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 549 Imaging of the Masticatory Muscles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 552 Clinical Relevance of the Masticatory Muscles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 553 Literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 553

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 555

Contents

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AA Angular artery AbN Abducens nerve AC Alveolar crest AD Articular disk AE Articular eminence AEA Anterior ethmoidal artery AIOF Accessory infraorbital foramen ALa Antilingula ALN Ala of nose AMA Accessory meningeal artery AMC Accessory maxillary canal AMF Accessory mental foramen AN Anastomosis ANe Anastomosis (extraosseous) ANi Anastomosis (intraosseous) ANS Anterior nasal spine AOM Angulus oculi medialis APA Ascending pharyngeal artery APalA Ascending palatine artery APC Adipocytes APG Accessory parotid gland ARF Anastomosis between RMV and FV ASAA Anterior superior alveolar artery ASAN Anterior superior alveolar nerve AT Articular tubercle ATN Auriculotemporal nerve AV Angular vein BA Buccal artery BBP Buccal bone plate BF Buccal frenum BFe Bone fenestration BFP Bichat’ fat pad BiMC Bifi d mandibular canal BM Buccinator muscle BMc Buccal mucosa BMlp Buccinator muscle (lower part) BMup Buccinator muscle (upper part) BV Blood vessel C Canine CaNF Canaliculus to nasal fl oor (from CSin) CBCT Cone beam computed tomography CC Carotid canal

Abbreviations

xx

CCA Common carotid artery CEC Crista endocoronoidea CEJ Cementoenamel junction CFo Canine fossa CH Choana ChT Chorda tympani Ci Canine (impacted) CI Central incisor CIa Central incisor (alveolus of) CM Condyle of mandible CN Cranial nerve CP Coronoid process CR Canine ridge CS Cavernous sinus CSc Corrugator supercilii muscle CSin Canalis sinuosus CT Computed tomography CvP Circumvallate papillae DAO Depressor anguli oris muscle DgM Digastricus muscle DgMab Digastricus muscle, anterior belly DgMpb Digastricus muscle, posterior belly DLA Deep lingual artery DLI Depressor labii inferioris muscle DPA Descending palatine artery DPN Deep petrosal nerve DTA Deep temporal artery EAC External auditory canal EC Ethmoid cell ECA External carotid artery EJV External jugular vein EOL External oblique line Ep Epiglottis EX External nasal branch (of ION) FA Facial artery FC Foramen cecum FLc Foramen lacerum FN Facial nerve FNb Facial nerve (buccal branch) FNc Facial nerve (cervical branch) FNm Facial nerve (marginal mandibular branch) FNt Facial nerve (temporal branch) FNz Facial nerve (zygomatic branch) FOv Foramen ovale FR Foramen rotundum FS Frontal sinus FSm Foramen stylomastoideum FSp Foramen spinosum FV Facial vein g Greek GGM Genioglossus muscle GHM Geniohyoid muscle GPA Greater palatine artery

Abbreviations

xxi

GPC Greater palatine canal GPF Greater palatine foramen GPH Glossopharyngeal nerve GPN Greater palatine nerve GPT Greater petrosal nerve GT Genial tubercle GTin Genial tubercle, inferior GTsu Genial tubercle, superior Ham Hamulus HB Hyoid bone HGM Hyoglossus muscle HGN Hypoglossal nerve HP Hard palate IAA Inferior alveolar artery IAN Inferior alveolar nerve IAV Inferior alveolar vein IC Inferior concha ICA Internal carotid artery IF Incisive foramen IFo Incisor fossa IFS Inferior orbital fi ssure IJV Internal jugular vein ILA Inferior labial artery ILM Inferior longitudinal muscle IM Inferior meatus IMA Inner mandibular angle IMS Intermaxillary suture IN Internal nasal branch (of ION) IOA Infraorbital artery IOC Infraorbital canal IOF Infraorbital foramen IOG Infraorbital groove IOM Infraorbital margin ION Infraorbital nerve IOphV Inferior ophthalmic vein IOR Infraorbital rim IOV Infraorbital vein IP Inferior palpebral branch (of ION) ITF Infratemporal fossa l Latin LA Lingual artery La Lingula LAO Levator anguli oris muscle LBN Long buccal nerve LcA Lacrimal artery LD Lacrimal duct LF Lingual foramen LI Lateral incisor LIa Lateral incisor (alveolus) LL Lower lip LLC Lateral lingual canal LLF Lateral lingual foramen LLS Levator labii superioris muscle

Abbreviations

xxii

LLSAN Levator labii superioris alaeque nasi muscle LMA Labiomental artery LN Lingual nerve LNW Lateral nasal wall LPC Lesser palatine canal LPE Ethmoid bone (lamina perpendicularis) LPF Lesser palatine foramen LPM Lateral pterygoid muscle LPMih Lateral pterygoid muscle (inferior head) LPMsh Lateral pterygoid muscle (superior head) LPN Lesser palatine nerve LRM Lateral rectus muscle LT Lingual torus LVP Levator veli palatini muscle M1 Molar (fi rst) M2 Molar (second) M3 Molar (third) MA Maxillary artery MC Mandibular canal MeA Mental artery MeC Mental canal MeF Mental foramen MeM Mentalis muscle MeN Mental nerve MeP Mental protuberance MF Mandibular foramen MHG Mylohyoid groove MHM Mylohyoid muscle MHN Mylohyoid nerve MHR Mylohyoid ridge (line) MIC Mandibular incisive canal MidC Middle concha MiM Middle meatus MIN Mandibular incisive nerve ML Masticatory line MLC Median lingual canal MLCin Median lingual canal, inferior MLCmi Median lingual canal, middle MLCsu Median lingual canal, superior MLF Median lingual foramen MLFin Median lingual foramen, inferior MLFmi Median lingual foramen, middle MLFsu Median lingual foramen, superior MM Masseter muscle MMA Middle meningeal artery MN Mandibular nerve MO Maxillary ostium MO Modiolus MP Mastoid process MPM Medial pterygoid muscle MPS Median palatine suture MS Maxillary sinus MSa Maxillary sinus (anterior extension)

Abbreviations

xxiii

MSAN Middle superior alveolar nerve MSar Maxillary sinus (alveolar recess) MSaw Maxillary sinus (anterior wall) MSlw Maxillary sinus (lateral wall) MSmw Maxillary sinus (medial wall) MSor Maxillary sinus (orbital recess) MSpw Maxillary sinus (posterior wall) MSzr Maxillary sinus (zygomatic recess) MT Maxillary tuberosity MTu Masseteric tuberosity MV Maxillary vein MX Maxillary nerve NA Not available NaM Nasalis muscle NAp Nasal aperture NApb Nasal aperture (border) NC Nasal cavity NClw Nasal cavity (lateral wall) NF Nerve fascicle NFl Nasal fl oor NPA Nasopalatine artery NPC Nasopalatine canal NPClc Nasopalatine canal (larger canal) NPCno Nasopalatine canal (nasal opening) NPCsc Nasopalatine canal (smaller canal) NPD Nasopalatine duct NPN Nasopalatine nerve NS Nasal septum NVB Neurovascular bundle OA Occipital artery OcF Occipitofrontalis muscle OcN Oculomotor nerve OF Orbital fl oor OFm Orbital fl oor (medial part) OG Otic ganglion OM Os maxilla OMa Os maxilla (alveolar process) OMf Os maxilla (frontal process) OMp Os maxilla (palatal process) OMz Os maxilla (zygomatic process) ON Ophthalmic nerve OO Orbicularis oris muscle OOc Orbicularis oculi muscle OOlp Orbicularis oris muscle (lower part) OOup Orbicularis oris muscle (upper part) OP Os palatinum OpA Ophthalmic artery OPC Optic canal OpV Ophthalmic vein PAA Posterior auricular artery PB Perforating branch Pc Procerus muscle PD Parotid duct

Abbreviations

xxiv

PEA Posterior ethmoidal artery PF Pterygoid fovea PG Parotid gland PGA Palatoglossal arch PGM Palatoglossus muscle PLB Posterior lateral branch (of SPA) PM1 Premolar (fi rst) PM2 Premolar (second) PMC Palatal mucosa PMF Pterygomaxillary fi ssure PMS Pterygomaxillary suture PNS Posterior nasal spine PP Parotid papilla PPA Parapharyngeal arch PPC Pterygopalatine canal PPF Pterygopalatine fossa PPG Pterygopalatine ganglion PPM Palatopharyngeus muscle PPP Pyramid process of palatine bone PPS Parapharyngeal space PPW Posterior pharyngeal wall PR Palatal ridge PSAA Posterior superior alveolar artery PSAF Posterior superior alveolar foramen PSAN Posterior superior alveolar nerve PSB Posterior septal branch (of SPA) PTC Pterygoid canal PTP Pterygoid process of sphenoid bone PtT Palatine tonsil PTT Pharyngotympanic tube PTu Pterygoid tuberosity PVM Prevertebral muscle PVP Pterygoid venous plexus R Ramus RiM Risorius muscle RMC Retromolar canal RMF Retromolar foramen RMT Retromolar trigone RMV Retromandibular vein SA Septal artery SC Septal cartilage (of medial nasal wall) SCA Small communicating artery SchM Schneiderian membrane SCM Sternocleidomastoid muscle SCmc Septal cartilage (mucosa) SEF Sinus fl oor elevation SFD Sublingual fold SGG Submandibular ganglion SGM Styloglossus muscle SHM Stylohyoid muscle SL Superior labial branch (of ION) SLA Sublingual artery SLA Superior labial artery

Abbreviations

xxv

SLC Sublingual caruncle SLF Sublingual fossa SLG Sublingual gland SLl Superior labial branch (lateral portion) SLm Superior labial branch (medial portion) SLM Superior longitudinal muscle SMA Submental artery SMD Submandibular duct SMF Submandibular fossa SMG Submandibular gland SMGup Submandibular gland, uncinate process SML Sphenomandibular ligament SMV Submental vein SN Sigmoid notch SOF Superior orbital fi ssure SON Supraorbital notch SOphV Superior ophthalmic vein SPA Sphenopalatine artery SPCM Superior pharyngeal constrictor muscle SPF Sphenopalatine foramen SPM Stylopharyngeus muscle SPS Sphenoid sinus SR Sinus recessus SSP Sphenoidal spine STA Superfi cial temporal artery STB Soft-tissue bundle STh Superior thyroid artery StHL Stylohyoid ligament StML Stylomandibular ligament StP Styloid process STV Superfi cial temporal vein SuC Sulcus colli SuP Sulcus palatinus SVA Small vertical arterial branches SYM Symphysis TB Temporal bone TBz Temporal bone (zygomatic process) TFA Transverse facial artery TGG Trigeminal ganglion TM Temporalis muscle TMJ Temporomandibular joint TML Temporomandibular ligament TMt Temporalis muscle (tendon) TN Trochlear nerve TVM Transverse/vertical muscles TVP Tensor veli palatini muscle UL Upper lip UP Uncinate process Uv Uvula UvM Uvular muscle VA Vascular anastomosis VC Vascular canal VO Vomer

Abbreviations

xxvi

ZA Zygomatic arch ZB Zygomatic bone ZFF Zygomaticofacial foramen ZFS Zygomaticofrontal suture ZMA Zygomaticomaxillary arch ZMa Zygomaticus major muscle ZMi Zygomaticus minor muscle ZMS Zygomaticomaxillary suture ZN Zygomatic nerve ZTS Zygomaticotemporal suture

Abbreviations