​ Temporal & Infra temporal fossa

​Work done by:

​- Assil Shelig
-Shada ammar
- Mohammed Shadi
Coordination and arrangement:
-Shahd abuaziz
-Roa beau
​Reviewed by: Dr. Mohamed Gabroun
 TEMPORAL FOSSA
● Shallow depression on both sides of skull bounded by temporal lines and terminate
below at level of zygomatic arch.
● It is a ​fan-shaped​ space The temporal fossa is
the floor of the temporal region, it
communicates with the infratemporal fossa
through the zygomatic arch.

-Boundaries:
● Superiorly​: temporal lines(superior temporal
line, and inferior temporal line).
● Inferiorly​: zygomatic arch.
● Anteriorly:​ temporal surface of ​zygomatic bone
● Posterior: ​inferior temporal line & supramastoid crest.
● Medially​(floor): 4 Bones (Frontal bone, Squamous temporal, Greater wing of the
sphenoid, parietal) these ​Bones ​meet at ​pterion​.

Pterion:​ the region of the side of the skull where sutures between the ​sphenoid​,
parietal,​ ​frontal​, and ​temporal bones​ are located, typically arranged in a pattern
resembling the letter​ H​. it’s the surface mark for middle meningeal artery and vein ,its
fracture # leads to extradural hematoma.

1​, ​bregma
2, superior sagittal Sinus
3, sagittal suture
4, coronal suture;
5, lambda
6, inion
7, lambdoid suture;
8, asterion
9, transverse sinus
10, pterion

Superficial temporal artery​ can be felt in front of tragus of

ear ,and it lies in front ​auriculotemporal nerve
 CONTENTS OF THE TEMPORAL FOSSA
● Temporalis muscle
● Temporal fascia
● Middle temporal artery a branch of superficial temporal artery
● Zygomaticotemporal nerve
● Auriculotemporal nerve
● Zygomaticotemporal artery
● Deep temporal nerve
● Deep temporal artery

-​Temporalis muscle:​ (MASTICATION

MUSCLE 1ST PHARYNGEAL ARCH)!!
is one of the muscles of mastication. It is
responsible for both closing the mouth and
retraction.
● Origin: ​the​ ​floor of the temporal fossa and
the deep surface of the temporal fascia.
● Insertion​: the tendon passes deep to the
zygomatic arch to be inserted into all
coronoid process.
● Nerve supply: ​temporal branch from the
anterior division ​of a mandibular nerve​.(ANT,MIDDLE,POST.TEMPORAL N.)
● Action: ​elevation of the mandible, its posterior fibers retract the mandible.

Temporal fascia:
covers the ​temporalis muscle, ​attached above to the sup-temporal line, and below to the
upper border of the zygomatic arch​.

NOTE:
-​Middle temporal artery​(MTA​): is the proximal medial branch of the superficial temporal artery
(STA).enters foramen spinosum
-​Deep temporal nerves:​ ​are two branches of the anterior division of the mandibular nerve, emerge
from the upper border of lateral pterygoid, enter the deep surface of temporalis to supply it.
-Auriculotemporal nerve​: ​arise by 2 roots from the posterior division of the mandibular nerve, it
emerges from the upper border of the parotid gland, it lies behind the superficial temporal artery &
temporomandibular joint AKA (TMJ)
1​.​ ​Greater occipital
2. Auriculotemporal
3. Third occipital
4. Lesser occipital
5. Lesser occipital and
greater auricular
6. Greater auricular
7. Transverse cervical
8. Transverse cervical
9. Mandibular [V3]
10. Buccal
11​. Mental
12. Zygomaticofacial
13. Infra-orbital
14. External nasal
15. Maxillary [V2]
16. Infratrochlear
17. Supra-orbital
18. Supratrochlear
19 .​Zygomaticotemporal
20. Ophthalmic (V1)
 INFRATEMPORAL FOSSA (ITF)
Lies beneath the base of the skull,between the pharynx
(medially) & ramus of mandible (laterally).

CONTENTS OF THE INFRATEMPORAL FOSSA

● Lateral & Medial pterygoid muscles, ​masseter
muscle, temporalis muscle (​muscles of mastication)
● Branches of the mandibular nerve
● Otic ganglion
● Chorda tympani
● Maxillary artery
● Pterygoid venous plexus
-Boundaries: ​Roof​ ​(Superior​):: the infratemporal surface of the greater wing of the
sphenoid with the foramen ovale and foramen spinosum.
● Medial​: Lateral pterygoid plate of the sphenoid, the superior constrictor muscle,
● Lateral:​ Ramus of the mandible and coronoid process of the mandible
● Anterior​: Posterior portion of the maxilla
● Posterior:​ Styloid process, carotid sheath
 -​ The Pterygomaxillary fissure:
a vertical gap between the lateral pterygoid plate
of the pterygoid process and the maxilla that
descends at right angles to the medial end of the
inferior orbital fissure and gives passage to part of
the maxillary artery and vein

NOTE:>​Upper part of​ ​Pterygomaxillary fissure leads to

pterygopalatine fossa.
-MASSETER MUSCLE​ ​(MASTICATION MUSCLE 1ST PHARYNGEAL ARCH)!!
a superficial part​ of the masseter originates from the maxillary process of the zygomatic bone
and the anterior two-thirds of the zygomatic process of the maxilla.•It inserts into the angle of
the mandible and related posterior part of the lateral surface of the ramus of the mandible.
The deep part​ of the masseter originates from the medial aspect of the zygomatic arch and the
posterior part of its inferior margin and inserts into the central and upper part of the ramus of
the mandible as high as the coronoid process.

-​Medial pterygoid muscle:

(MASTICATION MUSCLE 1ST PHARYNGEAL ARCH)!!
ORIGIN:
1. Superficial head: tuberosity of maxilla
2. Deep head: medial surface of lateral pterygoid plat​e
• INSERTION​: medial ramus & angle of
mandible
• ​NERVE SUPPLY​: from trunk of mandibular
nerve
-​Lateral pterygoid muscle
(MASTICATION MUSCLE 1ST PHARYNGEAL ​ARCH)!!
ORIGIN:
​
1. Upper head: infratemporal surface of greater wing of sphenoid
2. Lower head: lateral surface of lateral pterygoid plate
• ​INSERTION:​ pterygoid fovea (in front of neck of mandible) + capsule & articular disc of
TMJ
• ​NERVE SUPPLY:​ from anterior division of mandibular nerve
RELATIONS OF LATERAL PTERYGOID
• Superficial: temporalis, masseter, ramus of mandible, maxillary artery, buccal nerve
• Deep: medial pterygoid, mandibular nerve, middle meningeal artery, otic ganglion
• Emerging through its upper border: deep temporal & masseteric nerves
• Emerging through its lower border: lingual & inferior alveolar nerves + maxillary artery
• Emerging between its 2 heads: buccal nerve,
 Maxillary artery

It arises posterior to the neck of the mandible and is divided into three parts based
on its relation to the lateral pterygoid muscle.
● 1st (mandibular) part: Deep to the condyle of mandible
● 2nd (pterygoid) part: Neighbourhood of lateral pterygoid muscle
● 3rd (pterygopalatine) part: into the pterygopalatine fossa​ through the
pterygomaxillary fissure,​:
● 1st part​ ​(mandibular) between neck of the mandible and sphenomandibular
ligament:
​Mnemonic​ ​(MAID ​with double a​)
A) Anterior tympanic artery: ​enters the squamotympanic fissure
B)Middle meningeal artery(MMA):​ ​courses between the tensor veli
palatine muscle and lateral pterygoid muscle to enter the foramen spinosum
into the middle cranial cavity
C) Accessory meningeal artery​:​ ​enters the foramen ovale
D) Inferior alveolar artery​:​ ​enters the mandibular foramen
E) Deep auricular artery​: e​ nters the squamotympanic fissure
 2nd part​(Pterygoid)it travels between the two heads of the
lateral pterygoid muscle:

​Mnemonic​ ​ALL MUSCULAR ​,​(Make Dinner Before Party)

A)Masseteric artery: ​ ​passes laterally through the mandibular notch to the deep
surface of the masseter muscle, which it supplies
B)pterygoid artery: ​it supplies the lateral pterygoid muscle and medial pterygoid
muscle.
C) deep temporal artery(anterior, middle & posterior)​: ​They ascend
between the temporalis muscle and the pericranium supplying the overlying
muscle
D) buccal or buccinator artery:​ ​the outer surface of the buccinator
muscles, to which it supplies

● 3rd part​(Pterygopalatine)6 branches in pterygopalatine

fossa to nasal cavity ​Mnemonic​ ​(​P​epp​A​ ​PIGS​)
A) Pharyngeal artery:​ ​enters the palatovaginal canal.
B) Greater palatine artery​:​ e​ nters the greater palatine foramen.
C) Artery of pterygoid canal​: r​ uns into the pterygoid canal
D) Sphenopalatine artery​:​ e​ nters the sphenopalatine foramen.
E) Posterior superior alveolar artery:​It branches off within the
pterygopalatine fossa and exits via the pterygomaxillary fissure on its way to
the maxillary tuberosity
​ F)​ ​ Infraorbital artery​:​ ​enters inferior orbital fissure
 Mandibular nerve
Third branch of trigeminal nerve(V3), enters the ITF via the foramen ovale,
giving rise to motor and sensory branches

1. Auriculotemporal nerve 2. Petrotympanic fissure

3. Chorda tympani nerve 4. Inferior alveolar nerve
5. Nerve to mylohyoid 6. Mental nerve
7. Incisive nerve 8. Lingual nerve

Note: before entrance to mandibular foramen gives nerve to mylohyoid

1) Branches arising from the trunk
Spinous nerve
Medial pterygoid nerve:​ ​innervates the medial pterygoid muscle,tensor veli palatini
muscle and the tensor tympani muscle

2) Anterior branches
Buccal nerve:​ ​is sensory and innervates the inner surface of the cheek.
Masseteric nerve
Deep temporal nerves
 Lateral pterygoid nerve

3) Posterior branches
Auriculotemporal nerve
Lingual nerve:​ ​sensory to the anterior two thirds of the tongue, the floor of the
mouth, and the lingual gingivae.
Inferior alveolar nerve: ​enters the mandibular foramen and passes through the mandibular
canal, forming the inferior dental plexus, which sends branches to all mandibular teeth on its side,
TERMINATES AS mental nerve

NOTE:
● The inferior alveolar nerve is sensory to all lower teeth and
to gingiva associated with the ​buccal​ side of the incisor, canine,
and premolars.
● The ​buccal​ gingiva of the molars is innervated by the buccal
nerve
● The lingual nerve is, in general, sensory to the tongue and
the lingual​ gingiva of all the lower teeth​.
 Otic ganglion
connected to the mandibular nerve but functionally to glossopharyngeal
nerve, 2-3 mm in size,it lies immediately below the foramen ovale & medial
to the mandibular division of the trigeminal nerve

Roots:
A) parasympathetic root:​ from the inferior salivary nucleus via the
glossopharyngeal nerve and branch off the tympanic nerve
(Jacobson's nerve) to form the tympanic plexus in the middle ear and
then exit as the lesser petrosal nerve. The lesser petrosal nerve then
 passes from the foramen ovale to the ganglion and then fibres reach
the parotid gland as the auriculotemporal nerve

B) sympathetic root: ​via the middle meningeal artery, vasomotor

fibres from the superior cervical ganglion pass through the ganglion
without synapsing and course though the auriculotemporal nerve
and supply the parotid gland
C) sensory root:​via the auriculotemporal nerve is sensory to the
parotid gland
-Chorda tympani:​ is a nerve that arises from the mastoid segment of the
facial nerve, carrying ​afferent special sensation​ from the anterior two-thirds
of the tongue via the lingual nerve, as well as ​efferent parasympathetic
secretomotor innervation to the submandibular and sublingual glands

-Pterygoid venous plexus:

is a small intercommunicating cluster of venules that is intimately related to
the lateral pterygoid muscle, all veins accompanies maxillary artery branches
empties in this plexus !!

The pterygoid plexus connects: (​routes for spread of infection​)

● 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.
● Superiorly, via emissary vein ( F. spinosum) to cavernous sinus.
Note​:​ ​Lymphatic drainage of the infratemporal fossa (and the temporal fossa)
is to the superior deep cervical nodes.
● The infratemporal fossa is an irregular, post maxillary space deep to
the ramus of the mandible.
● The infratemporal fossa communicates with the pterygopalatine fossa
through the pterygomaxillary fissure.