DR Gopinath thilak . p.sDR Gopinath thilak . p.s

11stst year postgraduate year postgraduate

Dept. of Oral & Maxillofacial Dept. of Oral & Maxillofacial surgerysurgery

ContentsContents DevelopmentDevelopment

PrenatalPrenatal

Post natalPost natal

AnomaliesAnomalies

Anatomy of mandibleAnatomy of mandible

Muscle attachmentsMuscle attachments

muscles of masticationmuscles of mastication

Artery, vein ,nerve supply and lymphatic drainageArtery, vein ,nerve supply and lymphatic drainage Applied surgical anatomyApplied surgical anatomy Applied anatomy of surrounding soft tissueApplied anatomy of surrounding soft tissue

Development

PrenatalPrenatal

PostnatalPostnatal

Prenatal DevelopmentPrenatal Development

The cartilages and the bones of the mandibular skeleton The cartilages and the bones of the mandibular skeleton form from embryonic neural crest cells that originate form from embryonic neural crest cells that originate from the mid- and the hindbrain regions of the neural from the mid- and the hindbrain regions of the neural folds.folds.

These cells migrate ventrally to form the mandibular These cells migrate ventrally to form the mandibular facial prominences, where they differentiate into bones facial prominences, where they differentiate into bones and connective tissue and connective tissue

The first structure to develop in the region The first structure to develop in the region of the lower jaw is the mandibular division of the lower jaw is the mandibular division of the trigeminal nerve that precedes the of the trigeminal nerve that precedes the ectomesenchymal condensation forming ectomesenchymal condensation forming the first pharyngeal arch .the first pharyngeal arch .

The mandible is derived from ossification of The mandible is derived from ossification of an osteogenic membrane at 36 to 38 days an osteogenic membrane at 36 to 38 days of development.of development.

Mandibular ectomesenchyme must interact initially with the Mandibular ectomesenchyme must interact initially with the epithelium of mandibular arch before primary ossification can epithelium of mandibular arch before primary ossification can occur; the resulting intramembranous bone lies lateral to occur; the resulting intramembranous bone lies lateral to Meckel,s cartilage of the first pharyngeal arch.Meckel,s cartilage of the first pharyngeal arch.

66thth week post conception week post conception- a single ossification centre for - a single ossification centre for each half of mandible arises in the region of the bifurcation each half of mandible arises in the region of the bifurcation of the inferior alveolar nerve and artery into mental and of the inferior alveolar nerve and artery into mental and incisive branches. incisive branches.

From the primary centre From the primary centre ossification spreads ossification spreads upwards to form a trough upwards to form a trough for the developing teeth for the developing teeth

. . The spread of the intra The spread of the intra

membranous ossification membranous ossification dorsally and ventrally dorsally and ventrally forms the body and forms the body and ramus of the mandible ramus of the mandible

Meckel,s cartilage Meckel,s cartilage becomes surrounded and becomes surrounded and invaded by bone invaded by bone

Ossification stops Ossification stops dorsally at the site dorsally at the site that will become that will become the mandibular the mandibular lingula , where lingula , where meckel,s cartilage meckel,s cartilage continues into the continues into the middle ear . middle ear .

1010thth and 14 and 14thth weeks post conception- secondary weeks post conception- secondary accessory cartilage appear to form the head of the accessory cartilage appear to form the head of the condyle , part of coronoid process , and mental condyle , part of coronoid process , and mental protuberance .protuberance .

1010thth week post conception – the condylar secondary week post conception – the condylar secondary cartilage appears as a cone shaped structure in the cartilage appears as a cone shaped structure in the ramal bone .ramal bone .

1414thth week – the first evidence of endochondral bone week – the first evidence of endochondral bone appears in the condyle region appears in the condyle region

In the mental region , on the either side of In the mental region , on the either side of symphysis , one or two small cartilages symphysis , one or two small cartilages appear and ossify which later forms the appear and ossify which later forms the symphysis menti.symphysis menti.

•The condylar growth rate increases at puberty , peaks between 121/2 and 14 years of age , and normally ceases at 20 years of age .

Post natal development Post natal development

Fetal mandible Fetal mandible The ascending ramus of The ascending ramus of

the neonatal mandible is the neonatal mandible is low and wide low and wide

The coronoid process is The coronoid process is relatively large and relatively large and projects well above the projects well above the condyle condyle

The body is merely an The body is merely an open shell containing the open shell containing the buds and partial crown of buds and partial crown of the deciduous teeth the deciduous teeth

The mandibular canal runs low in the body The mandibular canal runs low in the body

44thth and 12 and 12thth months after months after birth –birth –

initial seperation of the initial seperation of the right and the left bodies of right and the left bodies of the mandible at the the mandible at the midline symphysis menti midline symphysis menti is gradually eliminated .is gradually eliminated .

As ossification converts As ossification converts the syndesmosis into the syndesmosis into synostosis , uniting the synostosis , uniting the two halves.two halves.

Developmentally and Developmentally and functionally mandible functionally mandible is divided into several is divided into several skeletal subunits .skeletal subunits .

The growth pattern of The growth pattern of each of these skeletal each of these skeletal subunits is influenced subunits is influenced by a functional matrix by a functional matrix that acts upon the that acts upon the bone bone

The main sites of The main sites of postnatal mandibular postnatal mandibular growth are at the growth are at the condylar cartilages , the condylar cartilages , the posterior borders of the posterior borders of the rami, and the alveolar rami, and the alveolar ridges .ridges .

Any damage to the Any damage to the condylar cartilages condylar cartilages restricts the growth restricts the growth potential .potential .

In infant, condyles of the In infant, condyles of the mandible are inclined mandible are inclined almost horizontally, , so almost horizontally, , so that the condylar growth that the condylar growth leads to an increase in leads to an increase in the length of the mandible the length of the mandible rather than to increase in rather than to increase in height. height.

Growth follows a v shape Growth follows a v shape patternpattern

The attachment of the The attachment of the elevating muscles of elevating muscles of mastication to the mastication to the buccal and the lingual buccal and the lingual aspects of the ramus aspects of the ramus and to the mandibular and to the mandibular angle and coronoid angle and coronoid process influences the process influences the ultimate size and ultimate size and proportions of these proportions of these mandibular elements. mandibular elements.

•The forward shift of the growing mandibular body changes the The forward shift of the growing mandibular body changes the direction of the mental foramen during infancy and childhooddirection of the mental foramen during infancy and childhood

Clinical implication : Clinical implication :

In infants and children - the In infants and children - the syringe needle may be syringe needle may be applied at right angles to applied at right angles to the body of the mandible the body of the mandible to enter the mental to enter the mental foramen .foramen .

In adults: needle must be In adults: needle must be applied obliquely from applied obliquely from behind to achieve entry. behind to achieve entry.

The location of the The location of the mental foramen mental foramen also alters its also alters its vertical relationship vertical relationship within the body of within the body of the mandible from the mandible from infancy to old age .infancy to old age .

Age changes mandibular vs maxillaAge changes mandibular vs maxilla

Fetal life : Fetal life : Initially – mandible is considerably larger than maxilla .Initially – mandible is considerably larger than maxilla . Later- greater development of maxilla takes place .Later- greater development of maxilla takes place .

8 weeks of post conception –maxilla overlaps the mandible 8 weeks of post conception –maxilla overlaps the mandible

11 week- relatively greater growth of mandible results in the 11 week- relatively greater growth of mandible results in the approx equal size of the upper and the lower jaws.approx equal size of the upper and the lower jaws.

1313thth and 20 and 20thth weeks- mand growth lags behind max growth due to weeks- mand growth lags behind max growth due to change over from Meckel,s cartilage to condylar secondary change over from Meckel,s cartilage to condylar secondary cartilage .cartilage .

Birth:Birth:

The mandible tend to be retrognatic to the The mandible tend to be retrognatic to the maxilla although the two may be equal size.maxilla although the two may be equal size.

Early post natal life –rapid mand growth and Early post natal life –rapid mand growth and forward displacement to establish an Angles forward displacement to establish an Angles class I maxillomandibular relationship. class I maxillomandibular relationship.

Anomalies of DevelopmentAnomalies of Development

AgnathiaAgnathia Micrognathia: Micrognathia:

Pierre robin syndromePierre robin syndrome

cri du chatcri du chat

Treacher collins syndromeTreacher collins syndrome

Progeria Progeria

downs syndrome downs syndrome

Hallermann-streiff syndrome Hallermann-streiff syndrome

Turner syndromeTurner syndrome

Goldenhar syndromeGoldenhar syndrome

MacrognathiaMacrognathia Congenital hemifacial hypertrophyCongenital hemifacial hypertrophy

Unilateral condylar hyperplasiaUnilateral condylar hyperplasia

Pierre Robin syndromePierre Robin syndrome

Treacher collins syndromeTreacher collins syndrome

Parry Romberg syndromeParry Romberg syndrome

Goldenhar SyndromeGoldenhar Syndrome

AgnathiaAgnathia

AnatomyAnatomy

Condylar head

neck

Pterygoid fovea

coronoid

Anterior ramus and coronoid notch

Oblique line

body

Mental foramen

Alveolar part

Mental tubercleMental protuberance

Base of mandible

Unerupted 3rd molar

Coronoid process Mandibular

notch

ramus

angle

ramus

Pulaosterior border of ramus

Mandibular foramen

Mylohyoid groove

Angle

Mylohyoid line

Submandibular fossa

Digastric fossa

Superior and inferior mental spines

Sublingual fossa

lingula

Mandibular notch

angle

Coronoid process

Muscle AttachmentMuscle Attachment

buccinator

platysma

Depressor anguli oris

Depressor labii inferioris

mentalis

masseter

temporalis

Lateral pterygoid

Capsule of the tmj

Medial pterygoid

buccinator

Pmr and Scmp

mylohyoid

Buccinator

Sphenomandibular ligament

Stylomanbular ligament

Medial pterygoid

Anterior belly of digastric

mylohyoid

genioglossus

geniohyoid

Muscle of MasticationMuscle of Mastication

Masseter MuscleMasseter Muscle

Quadrangular in shapeQuadrangular in shape originorigin: : zygomatic arch and zygomatic arch and

maxillary process of zygomatic maxillary process of zygomatic bone bone

InsertionInsertion: : lateral surface of lateral surface of ramus of mandibleramus of mandible

nervesupplynervesupply: : anterior division anterior division of mandibular nerveof mandibular nerve

Temporalis muscle Temporalis muscle

Large fan shaped muscleLarge fan shaped muscle

Origin Origin : : Bone of the temporal Bone of the temporal fossa and temporal fascia.fossa and temporal fascia.

InsertionInsertion : :Coronoid process of Coronoid process of the mandible and anterior the mandible and anterior margin of the ramus of the margin of the ramus of the mandible almost to the last mandible almost to the last molar tooth.molar tooth.

NerveNerve supplysupply::anterior division of mandibular anterior division of mandibular

nervenerve

Medial Pterygoid Medial Pterygoid

Quadrangular in shapeQuadrangular in shape

OriginOrigin Deep Head:Deep Head: Superficial head:Superficial head:

Insertion:Insertion: medial surface of medial surface of mandible near anglemandible near angle

Nerve supplyNerve supply: : main trunk of main trunk of mandibular nerve mandibular nerve

Superficial headDeep head

Lateral PterygoidLateral Pterygoid

Thick Triangular muscleThick Triangular muscle..

Origin:Origin:

upper headupper head::

lower head:lower head:

InsertionInsertion : :Capsule of the TMJ Capsule of the TMJ joint in the region of attachment to joint in the region of attachment to articular disc and pterygoid fovea articular disc and pterygoid fovea on the neck of the mandible .on the neck of the mandible .

Upper head

Lower head

Applied Surgical Applied Surgical anatomyanatomy

The mandible is basically tubular long bone which is bent The mandible is basically tubular long bone which is bent into a blunt “v” –shapeinto a blunt “v” –shape

The cortical bone is thicker The cortical bone is thicker anteriorly and at the lower anteriorly and at the lower border of mandible , while border of mandible , while posteriorly the lower border is posteriorly the lower border is relatively thin.relatively thin.

Thus the mandible is Thus the mandible is strongest anteriorly in the strongest anteriorly in the midline with progressively midline with progressively less strength towards the less strength towards the condyle. condyle.

The teethThe teeth

Restoration of occlusion is the prime aim in the treatment Restoration of occlusion is the prime aim in the treatment of fractures of the mandible . of fractures of the mandible .

The presence of the teeth is extremely helpful in the The presence of the teeth is extremely helpful in the reduction and fixation of mandibular fracturesreduction and fixation of mandibular fractures

Complete fracture of the body of the dentate mandible Complete fracture of the body of the dentate mandible will lead to the soft tissue tear over the fracture both will lead to the soft tissue tear over the fracture both bucally and lingually and thus are open into oral cavity bucally and lingually and thus are open into oral cavity and exposed to possible infection . and exposed to possible infection .

The mandible is The mandible is commonly fractured commonly fractured because of their because of their prominent position.prominent position.

Forward falls will result in Forward falls will result in point of chin striking the point of chin striking the ground ground

Chin and body of Chin and body of mandible form an inviting mandible form an inviting landmark in fights.landmark in fights.

Strength of the mandibleStrength of the mandible

Huelke (1961) and Hodgson(1967Huelke (1961) and Hodgson(1967) ) investigated into the resistance of the investigated into the resistance of the mandible to applied forces.mandible to applied forces.

Bones fracture at sites of tensile strain, Bones fracture at sites of tensile strain, since their resistance to compressive since their resistance to compressive forces is greaterforces is greater

Huelke (1961) shown Huelke (1961) shown that isolated mandible that isolated mandible is liable to particular is liable to particular patterns of distribution patterns of distribution of tensile strain when of tensile strain when forces are applied to it forces are applied to it

The mandible is a strong bone , the The mandible is a strong bone , the energy required to fracture it being of the energy required to fracture it being of the order of order of 44.6-74.4 kg/m44.6-74.4 kg/m, which is about the , which is about the same as the zygoma and about half that same as the zygoma and about half that for the frontal bone .(Hodgson 1967)for the frontal bone .(Hodgson 1967)

The inferior dental neurovascular bundleThe inferior dental neurovascular bundle

The fibrous sheath The fibrous sheath provides considerable provides considerable support for the support for the contained vessels contained vessels and nerve ,which and nerve ,which accounts for the low accounts for the low incidence of incidence of permanent nerve permanent nerve damage after fracture.damage after fracture.

The disposition of mandibular fracture lineThe disposition of mandibular fracture line

Hagan and Huelke ,1961 has detailed Hagan and Huelke ,1961 has detailed site of injuring force site of injuring force

1.1. The condylar region- most common The condylar region- most common

2.2. The angle – 2The angle – 2ndnd most most

3.3. Multiple fracture more commonMultiple fracture more common

2120

Condylar region Condylar region

Localisation Localisation

The zygomatic arch gives The zygomatic arch gives some protection to the some protection to the condyle from direct traumacondyle from direct trauma

Condylar injuries are Condylar injuries are usually caused by an usually caused by an indirect impact through indirect impact through the body of the mandiblethe body of the mandible

Fail to cause fracture

Contuse the capsular ligament

Capsulitis

Effusion of Inflammatory exudate or Bleeding into joint

Haemarthrosis

Impact transmitted through the Condylar neck

The articular eminence The articular eminence limits the extent of limits the extent of forward translatory forward translatory movement of condyle movement of condyle

Due to lax capsule Due to lax capsule hypermobility, subluxation hypermobility, subluxation , or dislocation over the , or dislocation over the eminentia occurs.eminentia occurs.

fracturefracture

Extra capsular or sub-Extra capsular or sub-condylar fracture.condylar fracture.

Intracapsular –Head Intracapsular –Head fractured within joint fractured within joint cavity often comminutedcavity often comminuted

Sub condylar Sub condylar fracture:-fracture:-

Result of voilence to Result of voilence to the mental the mental prominence or prominence or contralateral body of contralateral body of the mandible.the mandible.

The line of fracture, very The line of fracture, very significantly ,lies just significantly ,lies just above the posterio-above the posterio-superior insertion of the superior insertion of the masseter muscle.masseter muscle.

Condylar neck is the site of Condylar neck is the site of maximum tensile strain maximum tensile strain with anterior and with anterior and anterolateral applied anterolateral applied forces.forces.

Importance of Meniscus in TMJ InjuryImportance of Meniscus in TMJ Injury

Meniscus:- intervening Meniscus:- intervening disc divides articular disc divides articular space into space into

Temporodiscal or Temporodiscal or superior compartmentsuperior compartment

Condylodiscal or Condylodiscal or inferior compartmentinferior compartment

ImportanceImportance Loss of Meniscus leads to eventual Loss of Meniscus leads to eventual degenerativedegenerative

changeschanges in condylar articulation. Sprintz (1966) in condylar articulation. Sprintz (1966) Tearing or displacement of the meniscus may be an imp Tearing or displacement of the meniscus may be an imp

requirement for requirement for ankylosisankylosis after condylar fracture . Laskin after condylar fracture . Laskin (1977)(1977)

Trauma may initiate Trauma may initiate clicking or locking in the TMJclicking or locking in the TMJ due to due to inco-ordination of translatory movement of condyle and inco-ordination of translatory movement of condyle and meniscus under influence of lateral pterygoid muscle , meniscus under influence of lateral pterygoid muscle , particularly if a tear is created in the meniscal particularly if a tear is created in the meniscal attachments to capsule .Toller(1974)attachments to capsule .Toller(1974)

Ramus and the Coronoid processRamus and the Coronoid process

Fracture causes minimal displacement Fracture causes minimal displacement

Ramus of mandible Ramus of mandible - splinted by masseter - splinted by masseter muscle on lateral aspect and medial pterygoid on muscle on lateral aspect and medial pterygoid on deep aspect.deep aspect.

Coronoid process- splinted by tendinous Coronoid process- splinted by tendinous insertion of temporalis muscle. insertion of temporalis muscle.

The angle of MandibleThe angle of Mandible

22ndnd common site of fracture common site of fracture

Clinical angleClinical angle

Surgical angle Surgical angle

Anatomical angleAnatomical angle

Factors responsibleFactors responsible

1.1. Shape of the bone Shape of the bone

Weakness of the angle produced by abrupt change in direction between body and ascending ramus

2. A partly erupted or 2. A partly erupted or unerupted wisdom unerupted wisdom teethteeth

3. The insertions of the 3. The insertions of the masseter and medial masseter and medial pterygoid muscles and pterygoid muscles and the anterior limit of their the anterior limit of their insertion which just lie insertion which just lie behind 3behind 3rdrd molar molar

A

B

C

Favourable and unfavourable FracturesFavourable and unfavourable Fractures

Vertically favourable Vertically favourable fracturefracture

Vertically Vertically unfavourable fracture unfavourable fracture

Buccal plate

Lingual plate

Horizontally Favourable Horizontally Favourable fracturefracture

Horizontally unfavourable Horizontally unfavourable fracturesfractures

Displacement of the Displacement of the posterior fragment is only posterior fragment is only marked if the fracture line marked if the fracture line is unfavourable in both is unfavourable in both the planes .the planes .

Horizontally and vertically favour

Horizontally and

Vertically unfavourable

Fracture of the body of the mandibleFracture of the body of the mandible

Result from direct violence .Result from direct violence .

concentrated in the 1st molar or the canine regions.concentrated in the 1st molar or the canine regions.

Forward the site of fracture , the more is the upward Forward the site of fracture , the more is the upward displacement of the elevators counteracted by the displacement of the elevators counteracted by the downward pull of mylohyoid muscle attached to downward pull of mylohyoid muscle attached to mylohyoid ridge on the lingual aspect of mandible. mylohyoid ridge on the lingual aspect of mandible.

Multiple fractures of the mandibleMultiple fractures of the mandible

Fracture of the Body and Fracture of the Body and opposite angle or condyleopposite angle or condyle

Bilateral sub-condylar Bilateral sub-condylar fracturesfractures

Antero-medial deviation or dislocation Antero-medial deviation or dislocation of condyle.of condyle.

Gross anterior open bite.Gross anterior open bite.

Bilateral angle Bilateral angle fractures- fractures- Two posterior Two posterior fragments are drawn upwards and fragments are drawn upwards and forwards and anterior tooth bearing forwards and anterior tooth bearing fragment is rotated downwards by infra fragment is rotated downwards by infra mandibular musculature.mandibular musculature.

Bilateral body Bilateral body fracturesfractures

Applied anatomy of the surrounding Applied anatomy of the surrounding soft tissuesoft tissue

The condylar region

Condyle and its capsule Condyle and its capsule are covered by the are covered by the Parotid gland----Parotid gland----glenoid lobeglenoid lobe

Gland Enclosed in a capsule Gland Enclosed in a capsule derived from the investing derived from the investing layer of the deep cervical layer of the deep cervical fasciafascia

The fasia fuses with the The fasia fuses with the pericondrium and periosteum pericondrium and periosteum of the external auditory of the external auditory meatus, and also the temporal meatus, and also the temporal fascia behind the joint capsule fascia behind the joint capsule at the root of the zygomatic at the root of the zygomatic arch .arch .

Dissection to expose the joint Dissection to expose the joint carried out in close contact and carried out in close contact and direction with pericondrium and direction with pericondrium and periosteum covering the periosteum covering the anterior wall of external anterior wall of external auditory meatusauditory meatus

A surgical cleft is thus created A surgical cleft is thus created along an almost avascular along an almost avascular plane which leads naturally to plane which leads naturally to the posterior aspect of the joint the posterior aspect of the joint capsule behind and beneath capsule behind and beneath the glenoid lobe and its the glenoid lobe and its contained arteries , veins and contained arteries , veins and nerves nerves

Incision should follow general direction of the Incision should follow general direction of the meatus downward , forward and inwards and not in meatus downward , forward and inwards and not in right angle to the surface right angle to the surface

Failure to appreciate this fact Result in transection Failure to appreciate this fact Result in transection of the cartilaginous anterior wall of the meatus and of the cartilaginous anterior wall of the meatus and might injure tympanum .(Rowe 1982)might injure tympanum .(Rowe 1982)

The temporal fascia blends with the periosteum overlying The temporal fascia blends with the periosteum overlying the upper border of zygomatic archthe upper border of zygomatic arch

The zygomatic branches of the facial nerve crossing the The zygomatic branches of the facial nerve crossing the arch lie immediately superficial to the periosteum.arch lie immediately superficial to the periosteum.

hence dissection must proceed superficial to the bone and hence dissection must proceed superficial to the bone and deep to the periosteum if injury to nerves to is to be deep to the periosteum if injury to nerves to is to be avoided .avoided .

Superficial temporal artery and vein

Temp and zyg branch of facial nerve

The maxillary artery will The maxillary artery will be in close medial be in close medial proximity to the condylar proximity to the condylar neck neck

Important in case of Important in case of ankylosis characterised ankylosis characterised by massive bone by massive bone

formation in relation to formation in relation to the the

medial poles of the medial poles of the condyle.condyle.

Maxillary artery

Inferior alveolar nerve

Inferior alveolar artery

Lingual nerve

The angle and bodyThe angle and body

Natural skin creases of neck run in a Natural skin creases of neck run in a correct direction for avoiding the correct direction for avoiding the important underlying anatomical important underlying anatomical structurestructure

Subcutaneous fat and superficial fascia

Platysma muscle(care taken to avoid external jugular vein)

Superficial layer of deep cervical fasciaSuperficial layer of deep cervical fascia

Marginal mandibular branch of facial nerve( nerve stimulator used)

Facial artery lies immediately beneath the deep cervical fascia and can be observed pulsating beneath this layer

20% cases mandibular branch of 20% cases mandibular branch of facial nerve turns upwards and facial nerve turns upwards and accompanies the vessel, anterior accompanies the vessel, anterior branch of the posterior facial vein branch of the posterior facial vein may also be seen transversing may also be seen transversing this areathis area

Disected away and retracted if not Disected away and retracted if not possible divided and ligatedpossible divided and ligated

Dissection contiued beneath the fascia to the inferior border of mandibleDissection contiued beneath the fascia to the inferior border of mandible

Submandibular gland and its Submandibular gland and its capsule becomes evidentcapsule becomes evident

Lower pole of the parotid may be encountered

Dissection carried out taking care to retract nerve fibres superiorly to reach the masseter muscle

Masseter muscle sharply divided at the inferior border to expose the bone

Books of ReferenceBooks of Reference

Craniofacial development, Craniofacial development, SperberSperber

Rowe and Williams, maxillofacial injuriesRowe and Williams, maxillofacial injuries

second edition.second edition. Mc Minns colour atlas of head and neck Mc Minns colour atlas of head and neck

anatomy, anatomy, Logan Bari MLogan Bari M Oral and Maxillofacial Trauma, Oral and Maxillofacial Trauma, Raymond j. Raymond j.

FonsecaFonseca Gray,s Anatomy for students, Gray,s Anatomy for students, Richard L.DrakeRichard L.Drake

Internet sourceInternet source