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Anatomic Basis of the Postauricular Transtemporal Approach

Surgical Correlation

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E, A segment of the mandibular ramus has been removed to expose the upper and lower head of the lateral pterygoid and the maxillary artery in the infratemporal fossa. The inferior alveolar canal and nerve have been exposed. F, The mandibular ramus, in front of the inferior alveolar canal, has been removed to provide a wider exposure of the inferotemporal fossa. The upper head of the lateral pterygoid muscle passes backward from the inferotemporal surface of the greater sphenoid wing and the lower head passes upward from the lateral pterygoid plate. Both heads insert on the mandibular neck and the joint capsule. The superficial head of the medial pterygoid muscle passes from the maxillary tuberosity and pterygoid plate to the mandibular angle. The deep head of the medial pterygoid arises from the pterygoid fossa between the pterygoid plates. G, Enlarged view of the infratemporal area after removal of the mandibular condyle and lateral pterygoid muscles. The branches of the mandibular nerve are exposed below the foramen ovale. The largest branches are the lingual and superior alveolar nerves, which are predominantly sensory. The auriculotemporal nerve arises as two roots, which often pass around the middle meningeal artery before joining. H, The pterygoid muscles, a segment of the maxillary artery, and the mandibular and facial nerve branches have been reflected or removed to expose the internal jugular vein exiting the jugular foramen on the medial side of the stylomastoid foramen, the internal carotid artery ascending to enter the carotid canal, the tensor and levator veli palatini descending from their origin bordering the eustachian tube, and the terminal segment of the maxillary artery entering the pterygopalatine fossa. (Images courtesy of AL Rhoton, Jr.)

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