Prof. Akinola, Ph.D.

• Location:
– side of the skull
•Contents:
– temporalis muscle,
– temporal fascia and
– Neurovascular
structures
•Links:
– Communicates with
infratemporal fossa
deep to the zygomatic
arch
• infratemporal crest
of sphenoid
separates the two
fossae
• Anteriorly:
– frontal process of zygomatic
bone and
– zygomatic process of frontal
bone
• Posteriorly and superiorly:
– temporal lines
• Inferiorly:
– infratemporal crest of
sphenoidal greater wing
• Laterally:
– zygomatic arch
• Medially (the floor):
– four adjoining bones:
• frontal,
• squamous temporal,
• parietal and (greater wing of)
sphenoidal bones
• – these bone meet at the
pterion
 Pterion
• Description:
– a small circular area in the floor of
the temporal fossa
• the bones of this floor meet to form an
H-shaped suture
• Location:
– about 3.5 cm (thumb breadth) behind
the frontozygomatic suture, &
– about 4 cm (two finger breadth)
above the zygomatic arch
• Importance:
– a surgical and anatomical landmark
– overlies the frontal branch of middle
meningeal artery;
• this may rupture in fracture of this
region, causing epidural haematoma,
even death
• Description:
– a strong fibrous sheet
– covers temporalis, and
– forms the roof of temporal fossa
• Attachment:
– attached above to the superior temporal line, &
– below to zygomatic arch
• Description:
– a fan-shaped muscle
•Location:
– in the temporal fossa
•Fibres:
– its anterior fasciculi are directed
almost vertically; while
– its posterior fasciculi are almost
horizontal
•Tendon:
– Forms a thick tendon inferiorly.
– This descends (deep to
zygomatic arch), to its distal
(mandibular) attachment
•Importance:
– a powerful muscle of
mastication
• Proximal attachment:
– Floor of the temporal fossa
– Deep surface of temporal fascia
• Distal attachment:
– Apex and medial aspect of the
coronoid process of the mandible
– Anterior border of mandibular ramus
• Innervation:
– Deep temporal nerves (from the
anterior division of mandibular
nerve)
• Actions:
– Elevates the mandible (and thus
closes the mouth) – a function of its
anterior fibres
– Retracts the mandible (from a
protruded position) – a function of
its posterior fibres
Prof. Akinola
• Description:
– an irregular space
– located behind the maxilla
• Contents:
– several muscles,
• – vessels and
– nerves
• in close interrelationship with
each other
Links:
– Communicates with temporal
fossa
• through the interval between
the zygomatic arch and the
lower part of the temple; and
– with the middle cranial fossa
• through foramina ovale and
spinosum (located in its roof)
• Superiorly (the roof):
– greater wing of sphenoid and
adjacent part of the squamous
temporal bone
• Inferiorly:
– no anatomical structure
• Medially:
– lateral pterygoid plate
• Laterally:
– mandibular ramus
• Anteriorly:
– posterior surface of the maxilla
• Posteriorly:
– mastoid and styloid processes
(of the temporal bone) and the
tympanic plate
• Note:
– numerous structures are crammed
in the infratemporal fossa:
• Muscles
– medial and lateral pterygoid, &
– lower part of temporalis
• Arteries
– maxillary artery and its numerous
branches
• Veins
– pterygoid plexus of veins
• Nerves
– mandibular nv and its branches, &
– chorda tympani
• Ganglion
– otic ganglion
• These include:
– Lower part of
temporalis
– Lateral
pterygoid, and
– Medial
pterygoid
• Location:
– Infratemporal fossa
•Origin:
– two heads of origin:
upper and lower heads
•Insertion:
– Converges posterolaterally
from its sphenoidal origin
to its mandibular insertion
• Relations:
– Is traversed (between
its two heads) by the
buccal nerve,
• as this nerve
descends forwards
through the
infratemporal fossa
– Lateral relation:
• mandibular ramus,
• masseter and
• temporalis
– Medial relation:
• medial pterygoid
(upper part of),
• Sphenomandibular
ligament,
• mandibular nerve and
• middle meningeal
artery
• Maxillary artery
traverses the
infratemporal fossa
either deep or
superficial to lateral
pterygoid
• Lingual and inferior
alveolar nerves
descend through the
infratemporal fossa
close to the lower
border of lateral
pterygoid
• Nerves to masseter
and temporalis
ascend in the fossa
close to the upper
border of lateral
pterygoid
• Proximal attachment:
– Upper head – infratemporal surface and crest of greater wing of sphenoid
– Lower head – lateral surface of lateral pterygoid plate
• Distal attachment:
– Fibrous capsule and disc of the temporomandibular joint (TMJ)
– Neck of the mandible
• Innervation:
– Nerve to lateral pterygoid (from anterior division of mandibular nerve)
• Actions:
– Protrudes mandible, thereby opening the mouth (when acting simultaneously with the
opposite muscle)
– Produces side-to-side movements of the mandible (when acting alternately with the
opposite muscle)
• Introduction:
– a thick quadrilateral muscle
– located in the infratemporal fossa
• Two heads of origin:
– superficial and deep heads
– These embrace the (lower part of) lateral pterygoid
• Descends posterolaterally from its pterygoid (and maxillary) origin to its mandibular
insertion
• Lateral relation:
– mandibular ramus,
– lateral pterygoid and
– sphenomandibular ligament
• Medial relation:
– tensor veli palatini
• Proximal attachment:
– Deep head –
• medial surface of lateral pterygoid
plate & pyramidal process of
palatine bone
– Superficial head –
• tuberosity & pyramidal process of
maxilla
• Distal attachment:
– Medial aspects of mandibular
ramus and angle
• behind and below the mylohyoid
groove and mandibular foramen
• Innervation:
– Medial pterygoid nerve,
• from the trunk of mandibular nerve
• Actions:
– Elevates mandible and therefore closes the
mouth
• when acting simultaneously with the
opposite muscle
– Produces grinding movements, i.e. chewing
• when acting alternately with opposite the
medial pterygoid
– Protrudes the mandible
• together with the lateral pterygoids
• These include:
– Maxillary artery and its branches
• Origin:
– larger of the two
terminal branches of
external carotid artery;
– arises within the parotid
gland
– behind the neck of the
mandible
• Course:
– Passes forwards into the
infratemporal fossa
• between the neck of the
mandible laterally, and the
sphenomandibular
ligament medially
• parallel to and below the
auriculotemporal nerve
Course of maxillary artery (cont’d)
• Lies either superficial or deep to the lateral pterygoid muscle
• as it traverses the infratemporal fossa
• Leaves the infratemporal fossa for pterygopalatine fossa
• by passing btw the two heads of lateral pterygoid and then
through the pterygomaxillary fissure
• Termination:
– Ends in the pterygopalatine fossa
• where it becomes sphenopalatine artery
Maxillary artery has 3 parts (each part has 5 branches):
• Mandibular (or first) part
– This extends from its origin to the lower border
of lateral pterygoid
• Pterygoid (or second) part
– This lies in the infratemporal fossa,
• deep or superficial to lateral pterygoid
• Pterygopalatine (or third) part
– This lies in the pterygopalatine fossa
Branches of the 1st part of maxillary artery are 5:
• Deep auricular artery
• Anterior tympanic artery
• Middle meningeal artery
• Accessory meningeal artery, and
• Inferior alveolar artery
• Usually arises with the
anterior tympanic artery
from the 1st part of the
maxillary artery • Ascends behind TMJ,
through parotid
gland,
• Pierces the
cartilaginous (or
bony) part of external
acoustic meatus
• Supplies
– TMJ,
– the lining of the
external acoustic
meatus and
– the external aspect
of the tympanic
membrane
 • Traverse the
Anterior Tympanic Artery petrotympanic
fissure to enter
the middle ear,
Arises from the 1st part of the • Ramifies on the
maxillary artery & ascends behind internal aspect of
tympanic
TMJ membrane;
– here, it
anastomoses
with branches of
stylomastoid
artery
• Also anastomoses
with branches of
artery of the
pterygoid canal
and the
caroticotympanic
branch of internal
carotid
– in the middle
ear
 • Terminates by dividing into two branches –
• Ascends between the – a larger frontal branch and a
roots of the – smaller parietal branch
auriculotemporal nerve,
Supplies the meninges and the skull
– from the 1st part of
maxillary artery
• Traverses the foramen
spinosum to enter
middle cranial fossa;
– here, it is accompanied
by the nervus
spinosum (a branch of
mandibular nerve).
Then, it
• Ascends in a groove on
the inner aspect of the
squamous temporal
bone
•
Branches of middle meningeal artery
Petrosal branch,
– traverses the hiatus for the greater petrosal nerve to supply the genicular ganglion, facial nerve and
middle ear. It anastomoses with the stylomastoid artery
• Ganglionic branches
– to the trigeminal ganglion and nerve
• Superior tympanic branch
– to the tensor tympani and its canal
• Temporal branches to temporalis
• Anastomotic branch,
– traverses the superior orbital fissure to anastomose with the recurrent branch of lacrimal artery
• Frontal branch,
– ascends deep to the pterion, to supply the anterior part of the dura matter and cranium, and
• Parietal branch,
– passes backward to supply the posterior part of the dura matter and cranium
• Origin:
– Usually arises from
the 1st part of the
maxillary artery.
– However, it may arise
from middle
meningeal artery
• Course:
– Ascends through the
foramen ovale to
enter cranial cavity
• Distribution:
– Supplies the dura
mater and cranium
– Gives numerous
branches to
pterygoid muscles,
mandibular nerve
and otic ganglion
• Origin: from the 1st part of the maxillary artery
• Gives rise to a lingual branch near its origin
– This accompanies the lingual nerve to the buccal mucosa
•Descends through the infratemporal fossa
– behind the inferior alveolar nerve
•Enters the mandibular canal through the mandibular
foramen
•Gives rise to a mylohyoid branch
– just before it enters the mandibular foramen;
– this branch accompanies mylohyoid nerve through the mylohyoid
groove (to supply mylohyoid muscle)

•Supplies mandible,
mandibular teeth and
their sockets
•Anastomoses with its
fellow across the
midline via its incisor
branch
•Gives a mental branch
– This emerges from the
mental foramen of the
mandible to supply the chin.
– It anastomoses with the
inferior labial branch of the
facial artery
These supply muscles of mastication; and include:
• Anterior and posterior deep temporal arteries;
– these ascend deep to temporalis, which they supply
•Pterygoid branches,
– to medial and lateral pterygoid muscles
•Masseteric branch,
– which traverses the mandibular notch (behind temporalis) to reach the deep aspect of
the masseter, which it supplies, and
•Buccal branch,
– which accompanies the buccal nerve to supply buccinator and mucosa of the cheek
These include:
• Posterior superior alveolar artery
• Infraorbital artery
• Descending palatine artery
• Artery of the pterygoid canal
• Pharyngeal artery, and
• Sphenopalatine artery
 The posterior superior alveolar artery
• Arises from the 3rd part of maxillary artery
(as this enters pterygopalatine fossa)
• Descends on the posterior surface of maxilla
• Supplies maxillary (upper) molar and premolar
teeth, maxillary sinus and gum
• Origin:
– Often arises with the posterior superior alveolar artery from the 3rd part of
the maxillary artery
• Course:
– Enters the orbit through the inferior orbital fissure
– Passes forwards in the infraorbital groove and canal (beneath the eyeball)
– Emerges through the infraorbital foramen to enter the face
• Distribution:
– Gives rise to the anterior superior alveolar arteries
• To the maxillary (upper) incisor and canine teeth and the mucosa of the maxillary
sinus
– Also gives rise to orbital branches that supply the lacrimal sac, inferior rectus
and inferior oblique
– Give branches to the lower eyelid, external nose, cheek and upper lip (in the
face)
 The descending palatine artery
• Passes downwards through the greater palatine canal
(accompanied by its nerve)
• Gives rise to 2–3 lesser palatine arteries; these
descend through the lesser palatine canal to supply
the soft palate and palatine tonsil. Then, it
• Continues downwards, through the greater palatine
foramen, as the greater palatine artery; this emerges
on the oral aspect of the hard palate
• Runs forwards, on the oral aspect of the hard palate
(close to the alveolar process of the maxilla), to the
incisive canal; it then
• Ascends through the incisive canal to anastomose with
a branch of the sphenopalatine artery
• Supplies the palatine mucosa and gum
 The pharyngeal artery
• Passes backwards, through the pharyngeal
(palatovaginal) canal, to the roof of the
pharynx
• Is accompanied by the pharyngeal branch
of pterygopalatine ganglion
• Supplies the nasopharynx, roof of the nasal
cavity, auditory tube and sphenoidal sinus
 The artery of the pterygoid canal
• Passes backwards through the pterygoid
canal
• Is accompanied by nerve of the pterygoid
canal
• Supplies the pharynx, middle ear, auditory
tube and soft palate
 The sphenopalatine artery
• Origin:
– Is the terminal branch of the maxillary artery
• Course:
– Traverses the sphenopalatine foramen to reach the
nasal cavity
• Distribution:
– Gives rise to posterior lateral nasal branches (to
the lateral wall of the nasal cavity)
– Also gives rise to posterior septal nasal branches,
which supply the nasal septum
• One of these descends towards the incisive canal to
anastomose with the greater palatine artery
Pterygoid Plexus of Veins
• Location:
– In the infratemporal fossa
• between the medial and lateral
pterygoid muscles, and also
• between lateral pterygoid and
temporalis
• Tributaries:
– Receives tributaries that
drain, to a larger extent, the
territories of branches of the
maxillary artery
• Links:
– Communicates with the
facial vein
• through the deep facial vein
– Also communicates with the
cavernous sinus
• through emissary veins that
traverse foramina ovale and
lacerum and the sphenoidal
emissary foramen
• Is drained by maxillary vein
 Maxillary Vein
• Drains the pterygoid plexus of veins
• Is accompanied by the 1st part of the
maxillary artery
– as this passes backwards from its
origin
• between mandibular neck laterally and
sphenomandibular ligament medially
• Termination:
– Unites with the superficial temporal
vein behind the neck of mandible
– to form the retromandibular vein
 Nerves of Infratemporal Fossa
These include:
• Mandibular nerve, its numerous branches, &
• Chorda tympani branch of facial nerve
• Largest of the 3 divisions of trigeminal
nerve
•2 roots:
– large sensory root and
– small motor root;
• Motor root lies beneath the trigeminal
ganglion as it passes towards the
foramen ovale
•Course:
– Traverses foramen ovale as two
separate roots (sensory and motor),
– These roots then unite just beyond
the foramen to form the trunk of this
nerve
•2 divisions:
– In the infratemporal fossa, mandibular
nerve divides into:
• a larger posterior division and
• a smaller anterior division
Branches of the Mandibular Nerve
• Branches of the mandibular nerve arise from
– the trunk of this nerve
– its anterior division, and
– its posterior division
Nerves from the main trunk of mandibular
nerve include:
•Meningeal branch (nervus spinosus), and
•Nerve to medial pterygoid
• Arises from the medial
aspect of mandibular
nerve
– in the infratemporal fossa
•Ascends through the
foramen spinosum to
middle cranial fossa
– with the middle
meningeal artery
•Distribution:
– Gives sensory branches
• dura of the middle fossa
• dura of the anterior
cranial fossa
• dura of the calvaria, as
well as
• mucosa of the mastoid air
cells
• Also arises from the medial aspect of the trunk of
the mandibular nerve,
– in the infratemporal fossa
•Innervates medial pterygoid muscle
•Also sends branches to the tensor tympani and tensor
veli palatini;
– these branches traverse the otic ganglion (without synapsing)
 Branches of Anterior Division of
Mandibular Nerve
• Branches of the anterior division of
mandibular nerve are largely motor;
• they include:
– Masseteric nerve
– Deep temporal nerves
– Nerve to lateral pterygoid, and
– Buccal nerve
• Origin:
– Mandibular nv, anterior
div.
• Course:
– passes laterally through
the infratemporal fossa,
• above lateral pterygoid,
and just anterior to the
capsule of TMJ
– Continues laterally
through mandibular notch
• behind temporalis tendon
• Distribution:
– Innervates masseter
• (through the deep surface
of this muscle)
– Supplies TMJ
• Is accompanied by
masseteric artery
• Usually occur as anterior
and posterior deep
temporal nerves; Deep Temporal
– an intermediate one may
be present Nerves
•Course:
– Pass laterally through
the infratemporal fossa,
above the lateral
pterygoid
– Turn upwards, to enter
the temporal fossa
• where they innervate
temporalis (via the deep
surface of this muscle)
 Nerve to lateral pterygoid
• Supplies lateral pterygoid
– Via the deep surface of this muscle
• May share a common stem with buccal nerve
• Is the sensory branch of the
anterior division of the
mandibular nerve
• Course:
– Passes initially between the two
heads of lateral pterygoid; then
– Descends to the cheek, deep to
(or through) the lower part of
temporalis, masseter and
mandibular ramus
• Distribution:
– Innervates the skin and mucosa
over the anterior part of
buccinator
– Also innervates the gums
– May give rise to the anterior deep
temporal nerve
• Is joined by the buccal branch
of facial nerve (a motor ramus)
• Branches of posterior trunk of mandibular nerve
are largely sensory; they include:
– Auriculotemporal nerve
– Lingual nerve, and
– Inferior alveolar nerve
• Origin:
– arises from the posterior
division of mandibular nerve,
• via two roots that encircle the
middle meningeal artery
• in the infratemporal fossa
• Course:
– passes backwards to enter
the parotid region,
• first between lateral pterygoid
and tensor veli palatini, and
• then between the neck of the
mandible and sphenomandibular
ligament
• Ascends behind the superficial
temporal vessels to enter the
temporal region
– anterior to the auricle
 • Parotid branches,
– These convey postganglionic
parasympathetic fibres (from
otic ganglion) and
postganglionic sympathetic
fibres (from external carotid
Auriculotemporal nerve gives rise plexus) to the parotid gland
to: • Superficial temporal
•Paired anterior auricular branches
branches, – to the skin of the temple and
– which innervate the tragus of scalp;
the auricle – these accompany branches
•Two branches to the external of superficial temporal artery
acoustic meatus;
– these pass between the bony
and cartilaginous parts of the
meatus
– to supply its skin, and the
tympanic membrane
•An articular branch to TMJ
– this enters the joint from
behind
• Origin:
– Arises from the posterior
trunk of the mandibular
nerve,
– in the infratemporal fossa
• Course:
– Descends first between tensor
veli palatini medially and
lateral pterygoid laterally;
then, it
– Continues downwards and
forwards between medial
pterygoid medially and
mandibular ramus laterally
– anterior to the inferior
alveolar nerve
– Lies on the mandible near the
3rd molar tooth (below the
inferior margin of the superior
pharyngeal constrictor);
• here, it is covered by buccal
mucosa and
• can be felt by a finger in the
mouth
– Continues forwards on the
stylohyoid and the lateral
aspects of hyoglossus and
genioglossus
• deep to mylohyoid, and above
the deep part of
submandibular gland
– Crosses the submandibular
duct, first laterally, inferiorly
and then medially, before
ascending on the lateral aspect
of genioglossus
• Distribution:
– Innervates mucosa of the anterior
2/3 of the tongue (general
sensations)
• Is joined by chorda tympani (in
the infratemporal fossa);
– this branch of facial nerve conveys
presynaptic parasympathetic fibres
to the submandibular ganglion
• Is also joined by fibres that arise
from the submandibular
ganglion;
– these contain secretomotor
(postganglionic parasympathetic)
fibres to the sublingual and
anterior lingual glands
Branches of the lingual nerve include:
• Sensory fibres, to:
– mucosa of the floor of the mouth
– lingual aspect of the lower
gingivae (gums)
– lower premolar and 1st molar
teeth
– mucosa of the oral part (anterior
2/3 or presulcal part) of the
tongue
• Secretomotor fibres to:
– sublingual and anterior lingual
glands
– These fibres arise from the
submandibular ganglion
• Communicating rami to
branches of the hypoglossal
nerve (at the apex of the
tongue).
– Via these rami, sensory fibres may
be distributed to the tongue
• Origin:
– from the posterior division of
mandibular nerve,
– in the infratemporal fossa
• Course:
– Descends deep to lateral
pterygoid (behind the lingual
nerve)
– Passes between
sphenomandibular ligament
medially and mandibular ramus
laterally as it enters the
mandibular canal through the
mandibular foramen
• Is accompanied by
inferior alveolar artery
– from the 1st part of maxillary
artery
• mylohyoid nerve:
– Arises from inferior alveolar
nerve just before this nerve
enters mandibular foramen;
– innervates mylohyoid
• Inferior dental plexus:
– Formed from numerous
branches of inferior alveolar nv
(that arise in the mandibular
canal);
– this plexus innervates
mandibular teeth, gums and
alveolar processes
• Distribution:
– Innervates mandibular teeth,
gums and skin of the chin
• These include:
– Mylohyoid nerve,
• This pierces sphenomandibular
ligament, and traverses the
mylohyoid groove, to supply
mylohyoid
• It is accompanied by mylohyoid
artery
– Nerves to the lower molar and
premolar teeth;
• these fibres also supply the gums
and alveolar processes of the
mandible
– Incisive nerve,
• innervates lower incisor and
canine teeth
– Mental nerve,
• emerges from the mental foramen
• innervate the skin of the chin and
that of the lower lip (and its
mucosa)
• How?
– by injecting an anesthetic around the mandibular
foramen;
– this largely abolishes sensations in the lower teeth.
• Limitation:
– Inferior alveolar nerve block usually does not
completely abolish sensations in the lower teeth;
• this is owing to the fact that sensory nerve fibres also
reach mandibular teeth from nerves of muscles attached
to the mandible, etc
• Mandibular nerve
block anesthetizes
mandibular nerve
and its branches
– in the infratemporal
fossa;
•How?
– the needle is
passed into
infratemporal fossa
through the
mandibular notch
• Origin:
– from the facial nerve (CN VII), about 6
mm above the stylomastoid foramen;
• Course:
– it then passes forwards and upwards
into the middle ear
– Crosses the tympanic membrane
from behind forwards (between the
fibrous layer and mucous lining of this
membrane),
• in the lateral wall of the tympanic
cavity
– Leaves the middle ear to enter the
infratemporal fossa
• where it joins the lingual nerve at an
acute angle
• Importance:
– Conveys preganglionic parasympathetic
fibres to the submandibular ganglion
(via the lingual nerve);
• these fibres arise from the superior salivatory
nucleus (in the lower pontine tegmentum)
• From this gng, postganglionic fibres reach the
subm./subl .glds
– Also conveys taste fibres from antr 2/3
of the tongue
• A small reddish oval body (2-3 mm)
located just below foramen ovale
– medial to the mandibular nerve
– in the infratemporal fossa
• Is one of the peripheral
parasympathetic ganglia
• Receives preganglionic
parasympathetic fibres from the
glossopharyngeal nerve
– via the lesser petrosal nerve;
– these fibres arise from the inferior -
salivatory nucleus
• located in the upper medullary
tegmentum
• Is the source of postganglionic
parasympathetic fibres to the
parotid gland
– These fibres are conveyed to the gland
by auriculotemporal nerve
• Is traversed by nerves to tensor
tympani and tensor veli palatini
(though these do not synapse in
it)