INFRATEMPORAL FOSSA

DR. EB. KAFUMUKACHE

Definition/Boundaries
• The infratemporal fossa has a roof and anterior, lateral and
medial walls, and is open to the neck posteroinferiorly, i.e. it
has no anatomical floor
Definition/Boundaries:
• Between the infratemporal crest on the greater wing of the
sphenoid and the lateral pterygoid lamina is the
infratemporal fossa
• The infratemporal fossa lies inferior to the zygomatic arch
and the infratemporal surface of the greater wing of the
sphenoid (Roof). and the tympanic plate, mastoid, and
styloid process of the temporal bone posteriorly in the roof
• It is bound by the ramus and angle of the mandible laterally,
the lateral pterygoid plate medially, the posterior aspect of
the maxilla anteriorly,
Communications
It communicates with:
• the temporal fossa superiorly deep to the zygomatic arch
• the orbit anteriorly through the inferior orbital fissure
• and the pterygopalatine fossa medially through the
pterygomaxillary fissure
• with the middle fossa through the foramina ovale and
spinosum.
 Superficial contents of the infratemporal
fossa
• Lateral pterygoid muscle
• Origin: It arises by two heads. The smaller upper head takes
origin from the infratemporal ridge and infratemporal
surface of the greater wing of the sphenoid medial to it. The
lower head takes origin from the lateral surface of the lateral
pterygoid plate.
• Insertion: The muscle narrows, as it passes posteriorly, and is
inserted into the front of the neck of the mandible and the
articular disc of the temporomandibular joint through its
capsule
Nerve supply & Actions
• The mandibular nerve.
• The left and right acting together, the two muscles protrude
the mandible and depress the chin, by drawing the head of
the mandible and the disc forwards onto the articular
tubercle
• When one muscle acts alone, the head of the mandible on
that side is drawn forwards, and the mandible pivots around
the opposite joint so that the chin is swung towards the
opposite side
• Medial pterygoid muscle
• Origin: has two heads of origin which embrace the lower
head of the lateral pterygoid . The superficial head is small
and takes origin from the maxillary tuberosity. The deep
head forms nearly the whole muscle and takes origin from
the medial surface of the lateral pterygoid plate.
• Insertion: The two heads unite inferior to the anterior part of
the lateral pterygoid and pass downwards, backwards, and
laterally, to be inserted into the ramus of the mandible
between the mandibular foramen and the angle of the
mandible.
Nerve supply & Actions
• Nerve: the mandibular nerve through the nerve to the
medial pterygoid
• Actions: (1) raises the mandible; (2) helps in protraction; and
(3) moves the chin to the opposite side. The two medial
pterygoid muscles acting alternatively produce a grinding
movement, similar to the action of the superficial fibres of
the masseter
Deeper contents of the infratemporal fossa
• Maxillary artery
• Venous plexus
• Nerves
Maxillary artery
• The maxillary artery is a branch of the external carotid artery.
• It arises posterior to the neck of the mandible.
• For the sake of description it is divided in to three parts
• The first part (mandibular) of the maxillary artery runs
horizontally forwards between the neck of the mandible and
the sphenomandibular ligament , on the lower border of the
lateral pterygoid muscle.
• The second part(pterygoid) runs anterosuperiorly, superficial
to the lower head of the lateral pterygoid muscle and deep
to the insertion of the temporalis. (often lies between the
two pterygoid muscles)
• The third part(pterygopalatine) turns medially, between the
two heads of the lateral pterygoid, enters the
pterygomaxillary fissure, and ends in the pterygopalatine
fossa in a number of branches.
The first part (mandibular) branches
Has five branches that all enter bone:
1. deep auricular
2. anterior tympanic
3. middle meningeal
4. accessory meningeal
5. inferior alveolar arteries
The second part(pterygoid) branches
The pterygoid part of the maxillary artery has five branches
that do not enter bone but supply muscle:
1. deep temporal
2. Pterygoid
3. masseteric
4. buccal arteries
5. Superior Alveolar
The third part(pterygopalatine) branches
1.the posterior superior alveolar
2.infraorbital arteries
3. the artery of the pterygoid canal (Vidian artery),
and terminal branches
4. sphenopalatine
5. greater palatine arteries
Pterygoid venous plexus and maxillary vein
• The numerous veins of the infratemporal fossa are difficult to
dissect, since they form a dense plexus—the pterygoid
venous plexus—around the lateral pterygoid muscle.
• Veins corresponding to the branches of the maxillary artery
open into this network.
• The pterygoid plexus is drained posteriorly by one or two
short, wide maxillary veins.
• The maxillary veins enter the parotid gland and drain into the
retromandibular vein, posterior to the neck of the mandible
The plexus connects with the facial vein via the deep facial
vein, with the cavernous sinus through veins that pass through
the sphenoidal emissary foramen (of Vesalius), foramen ovale
and foramen lacerum and with the orbit via the inferior
ophthalmic vein(s). Its deep temporal tributaries often
connect with tributaries of the anterior diploic veins and thus
with the middle meningeal veins.
Infectious material from the face can reach the cavernous
sinus through these communication
Mandibular nerve V3
The mandibular branch of the trigeminal nerve arises from the
trigeminal ganglion in the cranium and leaves the skull
through the foramen ovale.
In the foramen ovale, it is joined by the motor root of the
trigeminal nerve.
Immediately below the skull, it lies between the lateral
pterygoid muscle and the tensor palati which separates it from
the auditory tube. It divides almost immediately into anterior
(predominantly motor) and posterior (predominantly sensory)
divisions
Branches of the trunk
• The meningeal branch (nervous spinosus) arises from the
trunk of the nerve and enters the skull through the foramen
spinosum. It supplies the dura mater and skull and sends a
filament to the middle ear.
• The nerve to the medial pterygoid arises from the trunk and
runs forwards into the deep surface of the muscle. At its
origin, it lies close to the otic ganglion. It supplies one or two
filaments that pass through the otic ganglion without
interruption to supply tensor tympani and tensor veli palatini
Branches of the anterior division
• Buccal nerve
• Nerve to the masseter
• Deep temporal nerves
• Nerve to the lateral pterygoid
Posterior trunk of mandibular nerve
• The posterior trunk of the mandibular nerve is larger than
the anterior and is mainly sensory, although it receives fibres
from the motor root for the nerve to mylohyoid.
It divides into:
• Auriculotemporal nerve
• Lingual neve
• Inferior alveolar (dental) nerves
Auriculotemporal nerve
• The nerve carries post-ganglionic parasympathetic secretomotor
fibres from the otic ganglion to the parotid gland. (Preganglionic
fibres reach the otic ganglion through the lesser petrosal branch of
the glossopharyngeal nerve.)
The auriculotemporal nerve gives the following branches:
• slender filaments to the posterior part of the capsule of the
temporomandibular joint;
• one or two thick branches to the parotid gland—these sensory nerves
mingle with branches of the facial nerve in the substance of the
gland;
• cutaneous branches to the auricle and temple
Inferior alveolar nerve
• The inferior alveolar nerve is the largest branch of the
posterior division. It runs vertically downwards with the
inferior alveolar artery between the medial and lateral
pterygoid muscles.
• The nerve and artery each give off a mylohyoid branch and
then enter the mandibular foramen.
• In the body of the mandible, the inferior alveolar nerve and
artery give branches to the teeth and gums, and send a
branch (the mental nerve and artery) through the mental
foramen to supply the skin of the chin and the mucous
membrane of the lower lip
• The mylohyoid nerve contains the only motor fibres present
in the posterior division.
• It pierces the sphenomandibular ligament and runs antero-
inferiorly in a groove on the medial aspect of the mandible to
the digastric triangle, inferior to the mylohyoid muscle.
• In the triangle, it is joined by the submental artery and
supplies the mylohyoid muscle and the anterior belly of the
digastric
Lingual nerve
• The lingual nerve is sensory to the mucous membrane of the
anterior two-thirds of the tongue and to the adjacent part of
the floor of the mouth and gum.
• The lingual nerve gives no branches in the infratemporal
fossa but is joined by the chorda tympani branch of the facial
nerve, deep to the lateral pterygoid muscle
Chorda tympani
• The chorda tympani is a slender branch of the facial nerve.
• It arises from the facial nerve on the posterior wall of the
middle ear cavity, runs anteriorly across the lateral wall of
that cavity (on the tympanic membrane), and leaves the
tympanic cavity through the petrotympanic fissure.
• It then grooves the medial side of the spine of the sphenoid,
running anteroinferiorly to join the posterior surface of the
lingual nerve
 It contains special sensory(SVA)and preganglionic
parasympathetic fibres(SVE). The sensory fibres arise from
the taste buds on the anterior two-thirds of the tongue. The
preganglionic fibres synapse in the submandibular ganglion
and supply the submandibular and sublingual gland
Otic ganglion
• The otic ganglion is a minute collection of parasympathetic
nerve cells which lies between mandibular nerve and the
tensor palati, immediately below the foramen ovale
• It is one of the four parasympathetic ganglia of the head.
• A number of different fibres pass through the otic ganglion,
but only the preganglionic parasympathetic fibres synapse in
the ganglion
Connections of the otic ganglion
• The preganglionic parasympathetic fibres to the otic ganglion run in the
lesser petrosal nerve, a branch of the glossopharyngeal nerve.
• Post-ganglionic parasympathetic fibres (secretomotor fibres) arise from the
cells of the ganglion and pass to the parotid gland in the auriculotemporal
nerve.
• Other nerves traverse the ganglion but have no functional connection with
it. They are:
(1) motor fibres to the tensor palati and tensor tympani muscles from the
nerve to the medial pterygoid muscle;
(2) sympathetic fibres from the plexus on the middle meningeal artery, for
distribution through the branches of the ganglion; and
(3) sensory fibres from the glossopharyngeal and trigeminal nerves for
distribution through the branches of the ganglion
Tensor palati (tensor veli palatini)
• The tensor palati is a thin, triangular muscle which takes origin from
the scaphoid fossa at the root of the medial pterygoid lamina, and the
posteromedial margin of the greater wing of the sphenoid as far
posteriorly as the spine of the sphenoid and the auditory tube .
• It lies immediately medial to the foramina ovale and spinosum in the
uppermost part of the lateral wall of the pharynx and will be seen
later
• It is inserted in the soft palate
END OF THE LECTURE
ZIKOMO