MAXILLA AND MANDIBLE

1. Osteology Of Facial
Bones

2. • Face: Consists of 14 bones
•--(2)Maxilla
•--(2)Zygomatic Bones
•--(2)Lacrimal Bones
•--(2)Palatine Bones
•--(2)Nasal Bones
•--(2)Nasal Conchae
•--(1)vomer
•--(1)Mandible

3. Osteology Of Maxilla
Introduction
•Maxilla is the
second largest bone of
the face, the first being
the mandible
•The two
Maxillae form the
whole of the upper
jaw.

4. Maxilla –central bone; prominent
position where trauma hits face
This structure is analogous to a
matchbox sitting below and anterior
to hard shell containing brain
Act as cushion for trauma directed
towards cranium from anterior or
antero-lateral direction

5. This period extends from the fourteenth day to the fifty sixth day of
intra-uterine life. During this period the major part of the development of the facial &
the cranial region occurs.
Period of the embryo:

6. Period of the fetus:
This phase extends between the fifty sixth day of
intra-uterine life till birth. In this period ,accelerated growth of the
cranio-facial structures occurs resulting in an increase in their size. In
addition, a change in proportion between the various structures also
occurs

7. Development of Maxilla

9. • These are 4 in number
• 5th arch disappears soon after formation.
•Only the first 2 arches are named; the Mandibular arch & Hyoid
arch respectively.

15. The palate is
formed by the
contribution of:
• Maxillary process.
•Palatal shelves given
off by the maxillary
process
• Fronto-nasal process
DEVELOPMENT OF PALATE

16. •By the fusion of the maxillary and nasal processes in the roof of the stomodeum the
primitive palate (or primary palate) is formed, and the olfactory pits extend
backward above it.
• It consists of the maxillary process and medial nasal process.
• The lip and primary palate close during the 4th to 7th weeks of gestation
PRIMARY PALATE

17. Primitive palate of a human embryo of thirty-seven to thirty-eight days.

18. The development of the secondary palate commences in the
sixth week of human embryological development. It is
characterised by the formation of two palatal shelves on the
maxillary prominences.
SECONDARY PALATE

19. •As the palatal shelves grow medially there, their union is prevented by the presence
of tongue.
•Initially the developing palatal shelves grow vertically toward the floor of mouth

20. •During 7th week of intrauterine life, a transformation in the position of the palatine
shelf occurs
• They change from a vertical to a horizontal position

21. •The 2 palatal shelves, by 8 ½ weeks of intra uterine life are in close approximation
to each other
•Initially the 2 palatal shelves are covered by an epithelial lining. As they join the
epithelial cells degenerate
•The connective tissue of the palatal shelves intermingle with each other resulting
in their fusion

22. •The entire palate does not contact and fuse at the same time. Initially the
contact occurs in the central region of the secondary palate posterior to the
premaxilla
• From this point, closure occurs both anteriorly and posteriorly

23. Cleft lip (cheiloschisis) and cleft
palate (palatoschisis), which can also
occur together as cleft lip and palate,
are variations of a type of clefting
congenital deformity caused by
abnormal facial development during
gestation.
APPLIED ANATOMY

24. •Cleft palate is a condition in which the two plates of the skull that form
the hard palate (roof of the mouth) are not completely joined
•Palate cleft can occur as complete or incomplete (a 'hole' in the roof of the
mouth, usually as a cleft soft palate). When cleft palate occurs, the uvula is
usually split. It occurs due to the failure of fusion of the lateral palatine
processes, the nasal septum, and/or the median palatine processes (formation of
the secondary palate
Incomplete cleft palate Unilateral complete lip
and palate
Bilateral complete lip and
palate
CLEFT PALATE

25. Parts of Maxilla
1. Body
a) 4 Surfaces
•Anterior or Facial
•Posterior or
Infratemporal
•Superior or Orbital
•Medial or Nasal
b)Maxillary Sinus
1. 4 Processes
•Frontal
•Zygomatic
•Alveolar
•Palatine

27. Anterior Surface
Sadness-levator labii superioris & levator anguli oris
Anger-dilator naris & depressor septi
Whistling-buccinator & orbicularis oris

28. Frontal Process
•Articulates with Frontal,Nasal and
Lacrimal bones
•Lateral surface- Anterior lacrimal crest-
gives attachment to lacrimal facia and
medial palpabral ligament
Anterior smooth surface-origin to orbital
part of orbicularis oculi and levetor labii
superioris alaeque nasi
•Medial surface-part of the lateral wall
of nose

29. Posterior Surface

30. Superior Surface
Features
Anterior border-Forms a
part of infraorbital margin
Posterior border-smooth
and rounded- Anterior margin of
infraorbital fissure
Medial border- anteriorly
there is Lacrimal notch
Surface presents
Infraorbital groove leading forwards
to Infraorbital canal – Infraorbital
foramen
Near the midpoint of the
canal- Lateral branch-
canalis sinuosis- for Anterior
superior alveolar nerve and vessels

31. Medial Surface
Postero superiorly – Large irregular
opening- Maxillary Hiatus
Above the Hiatus- Parts of
air sinuses Below the
Hiatus- Inferior meatus
Behind the Hiatus- surface
articulates with the perpendicular
plate of palatine bone

32. MaxillarySinusDevelopment

33. Maxillary Sinus
•Large cavity in the body of Maxilla
•Pyramidal shape- Base directed medially and
apex laterally
•Sinus opens into Middle meatus
•Height 3.5cm , width 2.5 cm,
anteroposterior depth 3.5cm
•Roof – floor of Orbit, Floor- Alveolar
process of Maxillae
•Reaches full size after the eruption of
permanent
teeth
Arterial supply: Facial infraorbital and
greater palatine arteries
Venous drainage: Facial veins , pterygoid plexus
of
veins
Lymphatic drainage: Submandibular nodes
Nerve supply: infraorbital, anterior , middle ,
and posterior superior alveolar nerves.

34. Palatine Process
•Thick horizontal plate projecting medially
•Inferior surface is concave. Two palatine
processes form anterior three fourths of
bony palate
•Superior surface is concave side to side
•Medial border is thicker in front than
behind
•Posterior border articulates with horizontal
plate of palatine bone
•Lateral border is continuous with the
alveolar process.

35. Zygomatic Process
•Pyramidal lateral projection
on which the anterior ,
posterior and superior
surfaces of maxilla converge.
•Superiorly it is rough for the
articulation with the
zygomatic bone.

36. Alveolar Process
•It bears sockets for roots of
the upper teeth
•Buccinator arises from the
posterior part of its outer
surface up to the first molar
•A rough ridge –Maxillary
torus may be present

37. Muscle Attachments

38. Arterial Supply

39. Clinical Significance of Maxillary Artery and its
Branches : A Cadaver Study and Review of the
Literature. *Ismihan Ilknur Uysal; **Mustafa Buyukmumcu;
*Nadire Unver Dogan; **Muzaffer Seker & **Taner Ziylan
In this study, it was found that
maxillary artery had superficial course by 57.1 % and deep
course by 42.9 % according to the relation of the artery with
inferior part of lateral pterygoid.

40. In this study, it was observed that inferior
alveolar artery branched from origin section of the maxillary
artery by 14.3% , before the middle meningeal artery
by 35.7 % , branched from same localization with
middle meningeal artery by 14.3 % and after the
middle meningeal artery by 35.7 %. In surgical
interventions to be performed in the region, knowledge on
branching variations of the inferior alveolar artery will be
useful for preventing negative influence on mandible supply.

41. It was determined that one accessory middle meningeal
artery passed through the fibers of inferior alveolar nerve.
In our cases, it was reported that distance
between inferior alveolar nerve and middle meningeal artery
was 3.25±1.65cm. Due to this close proximity, it
should be considered that both middle meningeal artery and
particularly superficial maxillary artery will be under higher
influence during the anesthesia of mandibular nerve and its
branches.

42. Last part of the maxillary artery was determined as type “Y”, type
“intermediate-T” and type “M” according to the classification
based on how sphenopalatine artery and descending palatine artery
from the maxillary artery.
Based on the type of branching indicated by last part of the
maxillary artery, type “Y” was found in 50 %, type “Intermediate-
T” in 14.3 % and type “M” in 35.7 %.

43. Maxillary Nerve

44. Branches of Maxillary nerve

45. The infraorbital foramen is usually (90–97%)
single nevertheless several studies have
underlined the presence of two or three
foramina Aziz et al. reported a 15% incidence of
accessory infraorbital foramina. A low
percentage (4.7%) was observed during a study
on 1064 skulls, with a higher
frequency on the left side, both in male and in
female skulls.In addition, an incidence of 1.3%
was found by Gupta. Moreover, a case of bifid
foramina associated with a bifid infraorbital
nerve was found during a cadaver dissection
of a 69-year old man.Normally, the distance from
the infraorbital foramen to the inferior border of
the orbital rim is from 4.6 to 10.4 mm depending
on the landmarks chosen for measurements.
Since the infraorbital nerve block is often used to
achieve regional anaesthesia of the face, the
study of frequency and position of accessory
infraorbital foramen are useful to reduce
anaesthetic and surgical complications,
especially in trunk block of the infraorbital nerve.
Schematic representation of
the maxillary nerve
and its branches. ***Dental
plexus

46. Venous Drainage

47. Facial Buttresses

49. 3D CT
Anterior View
Major structures
are labeled in the
picture.
Nasofrontal suture
Zygomaticofrontal
suture
Zygomaticotemporal
suture
SOF = Superior orbital fissure
IOF = Inferior orbital fissure
Orbital ‘rim’

50. •Do not confuse the suture between nasal bone and
frontal process of maxilla for a fracture
•Look for a piece of fracture in the optic foramen, it is
the true emergency of facial fracture
Key structures
D = Orbit, medial wall
E = Orbit, lateral wall
F = Suture between
sphenoid and
zygomatic bones
= Nasomaxillary
suture
1 = Globe
2 = Ethmoid sinus
3 = Sphenoid sinus
4 = Nasal bone
5 = Maxilla, frontal
process
6 = Orbit, lateral rim
7 = Sphenoid bone
8 = Optic foramen
Axial view

51. Clear maxillary sinuses can almost
rules out certain fractures such as
ZMC, LeFort, blowout fractures
Key structures
F = Groove for
infraorbital nerve
G = Maxillary sinus,
posterolateral wall
5 = Maxilla, frontal process
9 = Maxillary sinus
10 = Zygomatic arch
11 = Pterygoid bone
12 = Nasolacrimal duct
13 = Mandible, condyle
Axial view

52. Key structures
H = Maxillary sinus,
anterior wall
I = Maxillary sinus,
medial wall
J = Medial pterygoid
plate
K = Lateral pterygoid
plate
9 = Maxillary sinus
14 = Mandible, ramus
Fracture of the pterygoid plates may represent
LeFort fracture
Axial view

53. Lucency in midline of the maxilla is a
normal finding seen occasionally
Key structures
J = Medial pterygoid plate
K = Lateral pterygoid plate
L = Maxilla, spine
14 = Mandible, ramus
15 = Maxilla bone/ hard palate
Axial view

54. MANDIBLE
•DEVELOPMENT AND OSTEOLOGY

55. The first structure to develop in the primordium of the lower jaw is the
mandibular division of trigeminal nerve that preceeded the
mesenchymal condensation forming the first arch (mandibular).
The prior presence of nerve has been postulated as being necessary
to induce osteogenesis by the production of neutrotrophic factors

56. MECKEL’S CARTILAGE
Meckel’s cartilage is derived from the first branchial arch
around the 41st-45th day of intra uterine life.
It extends from the cartilaginous otic capsule to the midline
or symphysis and provides a template for guiding the
growth of the mandible.

57. A major portion of the Meckel’s carlitage disappears during
growth and the remaining part develop into the following
structures:-
•
•
•
The mental ossicles
Incus and malleus
Spine of sphenoid bone
•
•
Anteriorligament of malleus
Spheno mandibular ligament

58.  The mandible is derived from
the ossification of an
osteogenic memberane formed
from ectomesenchymal
condensation at around 36- 38
days IU.
 The resulting intramemberanous
bone lies lateral to meckel’s
cartilage of the first arch.
 A single ossification centre for each
half of the mandible arises in the 6th
week IU, in the region of the
bifurcation of the inferior alveolar
nerve and artery into the mental
and incisive branches.

59.  As a result mandibular length increases, the external auditory meatus
appears to move posteriorly.
 Bone begins to develop lateral to Meckel’s cartilage during the 7th week
and continues until the posterior aspect is covered with bone.
 This is the marked acceleration of the mandibular growth between the 8th
and 12th week IU

60. ENDOCHONDRAL BONE FORMATION
Endochondral bone formation is seen in 3 areas of mandible-
1) The condylar process
2) The coronoid process
3) The mental process

61. •At fifth week of intrauterine life , an area of
mesenchymal condensation is seen above the
ventral part of developing mandible.
• At about tenth week it develops in cone shaped
cartilage.
•It migrate inferior & fuses with mandibular
ramus at about 4 month.

62. THE CORONOID PROCESS-
Secondary accessory cartilage appear in region of
coronoid process at about 10- 14 week of intrauterine life.
This cartilage become incorporated into expanding
intramembranous bone of ramus & dissappear before birth.

63. THE MENTAL REGION-
In mental region , on either side of symphysis , one or two
small cartilage appear and ossify in seventh week of
intrauterine life to become mental ossicles.
These ossicles become incorporated into intramembranous
bone when symphysis ossify completely.

64. ANTEROLATERAL SUPERIOR VIEW

65. MENTAL FORAMEN
The MF was most frequently located
between the first and second mandibular
premolar teeth (43.5%) or below the second
premolar (34.3%). The mean horizontal
dimension of the MF was 3.1 mm, the
vertical dimension was 2.8 mm, and the
mean vertical distance from the alveolar
crest was 14.2 mm. An AMF was observed
in 12.8% of cases with a mean distance
of 4.1 mm from the MF. An AL was present
in 47.2% of cases with a mean loop length
of 3.38 mm. An LLF was present in 20.4%
of cases, predominantly below the first
premolar (27.3%) with a mean angle of
entry of 148. The LLC always
communicated with the MC and generally
not with the tooth apex. A statistically
significant association existed between the
presence of the LLF and AMF.
A Limited Field Cone-beam Computed Tomography–based Evaluation of the MentalForamen, Accessory Mental Foramina, Anterior Loop, Lateral
Lingual Foramen, and Lateral Lingual Canal
Unni Krishnan, MDS, MSc, FRACDS, FRACDS (Endo),* Paul Monsour, BDSc (Hons), MDSc, PhD,* Khaleel Thaha, MDS,† Ratilal Lalloo, BChD,
BSc Med (Hons), MChD, PhD,* and Alex Moule, BDSc, PhD*

66. Superior Genial Foramen:
 Occasionally, periapical or panoramic films may indicate
an anterior extension to the IAN.
 Some of these foramina can have a diameter of up to 2
mm, indicating a substantial neurovascular component
exiting to supply the chin
 Reports of substantial bleeding in the symphysis after
raising may be attributable to these larger vessels
 Following block graft harvesting, paresthesia of the
midline chin area has been reported and may be the
result of transection of these anterior neurovascular
components
 Injury to these vessels can be avoided by limiting the
apical extension of flaps during implant placement and
by harvesting block grafts closer to the midline
Fig.: Cross
section of
superior
genial
foramen
at the
cuspid
position
Fig.: Reconstructed 3-
dimensional image
showing positions and
relative sizes of the
superior genial and
mental foramina
Prevalence and location of accessory foramina in the
human mandible
Carmen Salinas-Goodier1A ´ ngel Mancho´n
Rosa Rojo Michael Coquerelle Gilberto Sammartino Juan
Carlos Prados-Frutos

67. Location, shape and anatomic relations of the mandibular foramen and the mandibular lingula:
a contribution to surgical procedures in the ramus of the mandible
F. J. C. Lima1 & O. B. Oliveira Neto1 & F. T. Barbosa2 & C. F. Sousa-Rodrigues3

68. Radiographic localization of mandibular anesthesia
landmarks

69. Anatomic study of the mandibular foramen, lingula and antilingula
in dry mandibles, and its statistical relationship between the true
lingula and the antilingula.
Int. J. Oral Maxillofac. Surg. 2012; 41: 74–78
The mandibular foramen is on average 5.82 mm below the lingula. Regarding the
statistical comparison between the mandibular foramen entrance and the antilingula
position, there is no correlation between the position of those two structures in the
studied sample. The mandibular foramen is slightly posterior in relation to the centre of
the ramus. The lingula is an important anatomic landmark for ramus surgery, and for
determining the distance to the mandibular foramen entrance. The use of the antilingula
as a landmark for the position of the vertical ramus osteotomy is not recommended.

70. CORONOID PROCESS
The shape of coronoid process was hooked in 54.5%, triangular in 23.5% and rounded in 18.5% of the
mandibles. Variant shapes were also observed like square (0.5%), hook & round (3%). The width of
coronoid process on right side ranged from 13 to 28 mm with a mean of 19.30 +_ 2.9 mm and on left
side ranged from 10 to 28 mm with a mean of 19.1 +_ 3.08 mm. The height of coronoid process on
right side ranged from 11 to 27 mm with a mean of 18.2+_ 3.44 mm and on left side ranged from 11 to
27 mm with a mean of 18.0 +_ 3.36 mm. Coronoid process was higher than condylar process bilaterally
in 3 mandibles.

71. CONDYLAR PROCESS
The total mediolateral length of the condyle is
between 18 and 23 mm, and the anteroposterior
width is between 8 and10mm.

72. Applied Anatomy Of Facial Nerve In
View Of Surgeries In Region of Condyle
Or TMJ Surgeries
 Exits skull at stylomastoid formen
 Incise the superficial layer of
temporalis fascia & periosteum
over arch within 8mm boundary,
prevent damage to branches of
upper trunk
Kreutziger KL. Surgery of the temporomandibular joint. I. Surgical
anatomy and surgical incisions. Oral surgery, oral medicine, oral
pathology. 1984 Dec 1;58(6):637-46.

73. Prevalence of bifid mandibular canal according to
gender, type and side
1) Forward canal: the branch
emerging from the upper border of
the main canal.
A. Forward canal without confluence:
It separates from the mandibular
canal in the mandibular ramus and
then extends to the second molar
area.
B. Forward canal with confluence: It
separates from the mandibular canal
in the mandibular ramus, extends
anteriorly and then rejoins to the
main mandibular canal.
2) Buccolingual canal: the branch
emerging from the buccal or lingual
side of the main canal.
3) Dental canal: the end of the
separated canal reaches the root
apex of the first, second and third
molar.
4) Retromolar canal: the branch
emerging from the main canal
reaches the retromolar region.

74. MUSCLES ATTACHMENT
GRIEF – DEPRESSOR ANGULI ORIS
HORROR ,TERROR AND FIGHT – PLATYSMA
DOUBT - MENTALIS

75. Role of muscles in fracture
mandible :
Masseter – Contributes to superior displacement
of proximal fragment of angle fracture.
Temporalis – Contributes to open bite in fracture
condyle, body & angle.
Medial & lateral pterygoid – Contributes to
antero medial displacement.
Suprahyroid & infrahyroid group of muscles –
Contributes to infero-medial displacement of bi-
lateral parasymphysis fractures.

76. Applied Anatomy Of Masseteric Artery
A careful dissection of 16 intact human
cadaveric head specimens revealed the
location of the masseteric artery in relation
to 3 points:
1)the anterior-superior aspect of the
condylar neck = 10.3 mm;
2) the most inferior aspect of the articular
tubercle = 11.4 mm;
3) the inferior aspect of the sigmoid notch =
3mm
Journal of Oral and Maxillofacial Surgery.
2009;67 (2) : 369–371

77. Applied Anatomy Of Facial Artery In View
Of Surgeries In The Region Of Angle Of
Mandible
 When performing operative procedures
on the lower premolars and molars the
facial artery can be severed
accidentally if an instrument enters the
buccal region.
 Deep incisions may endanger the facial
artery.
 Precaution : The incision should be
made downward and outward instead
of straight downward.

78. Triangle of Marginal Mandibular Branch
(MMB)
The advantages of MMB landmark triangle:
1.Locate the marginal mandibular branch
using palpable reference points, reliable and
easy to identify by clinical examination and
surgical exploration.
2.Make precise measurements to facilitate
the approach of the upper and lateral region
of the neck.
3. Specify the position of the furthest MMB
below the lower border of the mandible.
4.Guide the surgeon to avoid or locate the
MMB.
5. Determine the location of the incision.
AB = The distance between the angle of the
mandible and the intersection of MMB with LBM.
AX = The distance between the angle of the
mandible and the intersection of the facial vein
with LBM.
AY = The distance between the angle of the
mandible and the projection of point C which is
the position of the MMB farthest from LBM.
CY = The distance where the MMB is farthest
down LBM.
El Ayoubi Ali, Laamarti Sara, El Ayoubi Said, Bjijou Younes, Bouchikhi Mohamed.
Triangle of Marginal Mandibular Branch (MMB): Anatomical Zone, Constant
Reference of the MMB in Cervical Surgical Position. International Annals of
Medicine. 2017;1(5).

79. MANDIBULAR NERVE

80. A review of the mandibular and maxillary nerve supplies
and their clinical relevance
L.F. Rodella *, B. Buffoli, M. Labanca, R. Rezzani
Schematic representation of the
mandibular nerve
and its branches. Some anatomical
variations are
reported: (1) additional branches of
the long buccal nerve;
(2) additional branches of the inferior
alveolar nerve; (3)
communication between the
mylohyoid nerve and the
lingual nerve; (4) communication
between the inferior
alveolar nerve and the
auriculotemporal nerve; (5)
innervation of the incisor teeth by the
mylohyoid nerve; (6)
communication between the inferior
alveolar nerve and
the lingual nerve.

81. Applied aspect in view of inferior alveolar nerve & incisivenerve
 two-thirds of the inferior alveolar nerve (IAN) exits at the mental foramen
while remaining one-third continues through the incisive canal and
anastomoses with the contralateral side & is the neurovascular supply to
all anterior teeth and the chin closer to the midline
 Clinicians performing autogenous block graft procedures often prefer
symphyseal bone for the shape and volume of the graft needed
 in this block harvesting procedure incisive nerve is inadvertently resected
causing altered sensation in the affected anterior teeth even after healing
Robert J. Miller, Warren C. Edwards, Jonathan H. Cohen; maxillofacial anatomy: the mandibular
symphysis; J of Oral Implantology 2011.37:745-753

82. AGE CHANGES IN MANDIBLE
I. Children:
• Body of mandible is more like a
shell consisting of sockets for both
deciduous & permanent teeth
• Angle of mandible measures around
140º
• Coronoid process is above the level
of the condylar process
• Mandibular canal & mental foramen
are close to lower border of body

83. II. Adult:
• Alveolar & subalveolar parts of
body are of equal depths
• Angle of mandible measures
110º
• Condylar process projects
above level of condylar
process
• Mandibular canal runs parallel
to mylohyoid line
• Mental foramen is at midway
between upper & lower
borders of body

84. III. Old Age:
• Resorbed alveolar part
• Angle of mandible
measures about 140º
• Neck of mandible is
bent backwards making
level of coronoid
process higher than
level of condylar process
• Mandibular canal and
mental foramen are
closer to upper border
of body