Competency-based Medical Bachelor

Program
“CBMBP”
 Lecture 3

Infratemporal region
Prof. Dr. Morsy Abdelfattah Morsy
Professor of Anatomy and Embryology
Tanta Faculty of Medicine
 Semester II

Principles of anatomy
Lecture (3)
Infratemporal region

Time: 1 hour
Type of lecture: interactive lecture.
References :
1. Kaplan step 1.
2. Snell’s clinical anatomy.
 ILOS

1- Determine the site and boundaries of infratemporal region.

2- Recognize the contents of infratemporal regions

3- Interpret and analyze clinical findings in correlation with the

anatomical facts.
 Infratemporal region

 Source:
 USMLE lecture notes Anatomy 2018
 Snell Clinical Anatomy by Regions 2018 pp:1605-1610
Ground Rules
 Infratemporal region

This is an irregularly
shaped area located
inferior and medial to
the zygomatic arch,
between the ramus of
the mandible and the
pharynx.
 Boundaries of the infratemporal region

 Anterior: Posterior surface of

the maxilla
 Posterior: Mandibular fossa,
styloid process, spine of the
sphenoid bone Infratemporal
 Superior: Infratemporal crest crest Zygomatic
arch
 Inferior: Alveolar border of
the maxilla
 Medial: Lateral pterygoid
plate Mandibular
 Lateral: Zygomatic arch and fossa
Maxilla
ramus of the mandible
Lateral Styloid
pterygoid plate process
 Communications of infratemporal fossa

• Temporal fossa deep to the zygomatic

arch
• Cranial cavity via the foramen ovale
and foramen spinosum
• Tympanic cavity via the petrotympanic
fissure
• Maxillary teeth and sinus through the
posterior superior alveolar foramina
• Orbit by way of the inferior orbital
fissure
• Pterygopalatine fossa via the
pterygomaxillary fissure
• Submandibular region deep to the
mandible
 Infratemporal region

 Contents of the infratemporal fossa:

• 1-Muscles:
 Medial pterygoid muscle.
 Lateral pterygoid muscle.
• 2-Nerves:
 Mandibular nerve.
 Maxillary nerve.
 Otic ganglion.
 Chorda tympani.
• 3-Vessels:
 Maxillary artery.
 Pterygoid plexus of veins.
 Medial pterygoid muscles
The medial pterygoid muscle is quadrangular in
shape and has deep and superficial heads .
Deep head:
 Originates from the medial surface of the lateral
plate of the pterygoid process and pyramidal
process of the palatine bone.
 Inserted into the roughened medial surface of
the ramus of mandible near the angle of
mandible.
Superficial head:
 Originates from the tuberosity of the maxilla
and pyramidal process of the palatine bone .
 Joins with the deep head to insert on the
mandible.
 Action:
 The medial pterygoid mainly elevates the
mandible.
 It also assists the lateral pterygoid muscle in
protruding the lower jaw.
 Nerve supply :By the nerve to medial pterygoid
from the mandibular nerve .
 Lateral pterygoid muscle

 The lateral pterygoid is a thick triangular

muscle and has two heads
 Upper head originates from the roof of the
infratemporal fossa (inferior surface of the
greater wing of the sphenoid and the
infratemporal crest)
 Lower head is larger than the upper head and
originates from the lateral surface of the lateral
pterygoid plate.
 It into the pterygoid fovea of the neck of
mandible and capsule of the temporomandibular
joint.
 It is innervated by the nerve to lateral pterygoid
from the mandibular nerve.
 It pulls the articular disc and head of the
mandible forward onto the articular tubercle and
is therefore it is major protruder of the lower jaw.
 When lateral and medial pterygoids contract on
only one side, the 'chin' moves to the opposite
 Maxillary artery

 The maxillary artery is the largest branch

of the external carotid artery in the neck
and is a major source of blood supply for Maxillary artery
nasal cavity, lateral wall and roof of the
oral cavity, all teeth, and the dura mater
in the cranial cavity Lateral
 The maxillary artery originates within pterygoid
the substance of the parotid gland and muscle
then passes forward, between the neck Neck of the
of mandible and Sphenomandibular mandible
ligament, into the infratemporal fossa. Sphenomandibular
 It ascends obliquely through the ligament
infratemporal fossa to enter the External
pterygopalatine fossa by passing carotid
through the pterygomaxillary fissure. artery
This part of the vessel may pass either
lateral or medial to the lower head of
lateral pterygoid.
 Branches of the Maxillary Artery
 Branches in the infratemporal
fossa :
 First part of the maxillary artery (the
part between the neck of mandible
and the Sphenomandibular ligament
gives:
•Middle meningeal.
•Inferior alveolar arteries.
•Deep auricular.
•Anterior tympanic.
•Accessory middle meningeal.
 Second part (the part related to the
lateral pterygoid muscle) gives:
•Deep temporal.
•Masseteric.
•Buccal.
•pterygoid branches.
 Third part is in the pterygopalatine
fossa.
 Pterygoid plexus of vein
 The pterygoid plexus is a
network of veins between the
medial & lateral pterygoid
muscles, and between the
lateral pterygoid & temporalis
• The pterygoid plexus connects:
 Posteriorly, via a short maxillary
vein, with the retromandibular
vein in the neck.
 Anteriorly, via a deep facial
vein, with the facial vein on the
face.
 With cavernous sinus through
emissary vein passing through
foramen ovale and foramen
spinosum.
 Nerves of infratemporal region

• The maxillary nerve, a one

of three division of the
trigeminal nerve, runs
through the foramen
rotundum and enters the
pterygopalatine fossa.
• All branches in the
pterygopalatine fossa.
 Nerves of infratemporal region

• The mandibular nerve is

the largest of the three
divisions of the trigeminal
nerve .
• The mandibular nerve,
passes through the
foramen ovale and enters
the upper part of the
infratemporal fossa.
• It immediately sends many
motor and sensory
branches to the cranium,
infratemporal fossa,
temporal fossa, lower jaw,
oral cavity, and lower face.
 Nerves of infratemporal region

Branches of mandibular nerve:

From the trunk:
1. Meningeal (spinous) nerve
2. Nerve to medial pterygoid muscle and Auriculotemporal
tensor veli palatini, and tensor tympani
From anterior division: Motor branches
1. Motor branches to other muscles of
mastication. Buccal nerve
2. Buccal nerve. Inferior
From posterior division: alveolar
1. Lingual nerve it carries general and taste nerve Lingual nerve
sensations from anterior 2/3 of the tongue
2. Inferior alveolar nerve gives all lower
Mylohyoid
teeth and much of the associated gingivae
nerve
and It has one motor branch, which
innervates the mylohyoid muscle and the
anterior belly of the digastric muscle.
3. Auriculotemporal nerve
 Nerves of infratemporal region

• Chorda tympani nerve is a branch of

the facial nerve within the temporal
bone.
• It carries parasympathetic root for
submandibular and sublingual
salivary glands and taste fibers from
anterior 2/3 of the tongue.
• The chorda tympani joins the lingual
nerve deep in the infratemporal
fossa by acute angle and distributes
its fibers into the oral floor and
anterior 2/3 of the tongue.
 Nerves of infratemporal region

• The lesser petrosal nerve is a

parasympathetic component of the
glossopharyngeal nerve.
• It runs from the middle ear into the
infratemporal fossa, where it joins
the Otic ganglion. Postganglionic
fibers join the auriculotemporal
branch of the mandibular nerve.
• The lesser petrosal nerve provides
the secretomotor fibers to the
parotid gland.
Otic ganglion:
It is small parasympathetic Foramen ovale
ganglion. Mandibular nerve
It is present just below the Otic ganglion
foramen ovale medial to the
trunk of the mandibular nerve
between it and tensor palati
muscle. Tensor palati muscle
It is functionally related to
glossopharyngeal nerve.
 Otic ganglion:

Otic
ganglion
 Roots of the Otic ganglion:
Parasympathetic
root
1-Parasympathetic root : It relays
in the ganglion which consists of Motor root
preganglionic fibers from the lesser
petrosal nerve.
2-Sympathetic root : It derived
from the plexus around the middle Sympathetic
meningeal artery. root
3-Motor root : The ganglion is
traversed by a branch from the
nerve to medial pterygoid on its way
to supply the tensor palati and
tensor tympani muscles.
 Parasympathetic root of Otic ganglion:

 The lesser petrosal nerve carries

mainly parasympathetic fibers to
the parotid gland .
 The pre-ganglionic
parasympathetic fibers from the
glossopharyngeal nerve [IX] after
exits the jugular foramen at the
base of the skull is tympanic
nerve.
 The tympanic nerve re-enters the
temporal bone through a small
foramen on the ridge of bone
separating the jugular foramen
from the carotid canal(tympanic
canaliculi) and forms tympanic
plexus. The lesser petrosal nerve
is a branch of this plexus.
 Clinical notes

1-Lingual nerve injury

 A lingual nerve injury proximal to where the chorda tympani joins it in the
infratemporal fossa will produce loss of general sensation from the anterior two-thirds
of the tongue.
 If a lingual nerve lesion is distal to the site where it is joined by the chorda tympani,
secretion from the salivary glands below the oral fissure and taste from the anterior
two-thirds of the tongue will be lost.
2-Dental anesthesia
 Anesthesia of the inferior alveolar nerve is widely practiced by most dentists.
 The inferior alveolar nerve is one of the largest branches of the mandibular nerve
carries the sensory branches from the teeth and mandible and receives sensory
information from the skin over the mandible.
 Multiple-Choice Questions and case scenario.

1-A 24-year-old man had a third molar (wisdom tooth) extracted from his
lower jaw. This resulted in the loss of general sense and taste sensation
from the anterior two thirds of the tongue. This loss was most likely due
to injury of which of the following nerves?
A. Auriculotemporal
B. Lingual
C. Mental
D. Inferior alveolar

2-A 38-year-old woman is admitted to the dental clinic with acute dental
pain. The attending dentist found penetrating dental caries affecting one
of the mandibular molar teeth. Which of the following nerves would be
anesthetize to treat the caries in that tooth?
A. Lingual
B. Inferior alveolar
C. Buccal
D. Mental
3-About the contents of infratemporal fossa one is
wrong.
A- Otic ganglion.
B- Temporalis muscle.
C- Mandibular nerve.
D- Maxillary artery.

4-Which one of the following arteries is present in the

infratemporal fossa?
A- Occipital.
B- Facial.
C- Maxillary.
D- Superficial temporal.
5- Which one of the following statement regarding
Otic ganglion is true?
A. It is large parasympathetic ganglion.
B. It lies medial to trunk of mandibular nerve.
C. Its parasympathetic root is corda tympani
D. It is present in the pterygopalatine fossa.

6- Which one of the following veins connected

between pterygoid plexus and facial veins?
A. Deep facial.
B. Maxillary.
C. Ophthalmic.
D. Common facial.