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Deep Dissection of Left Lateral Exposure of Infratemporal Fossa, Brain, and Suboccipital Area

Surgical Correlation


Deep dissection of left lateral exposure of infratemporal fossa, brain, and suboccipital area. The mandibular ramus, zygomatic arch, and portion of lateral skull and dura mater and arachnoid layers of the meninges have been removed to expose the brain. In the infratemporal fossa the lateral pterygoid and medial pterygoid muscles have been removed. The tensor veli palatini and part of the superior pharyngeal constrictor have also been removed to expose the interior of the pharynx. The maxillary artery, one of the terminal branches of the external carotid artery, traverses the infratemporal fossa giving rise to several branches, such as those shown here: inferior alveolar, middle meningeal, anterior deep temporal, posterior superior alveolar, and sphenopalatine arteries. The sphenopalatine artery continues through the pterygomaxillary fissure into the pterygopalatine fossa. Pharyngeal branches of the ascending pharyngeal artery are visible deep along the lateral pharyngeal wall. The buccal and auriculotemporal branches of the mandibular nerve are also visible as well as the inferior alveolar and lingual nerves that normally descend on the medial pterygoid to the mandibular canal and floor of the mouth, respectively. The inferior alveolar nerve gives rise to the mylohyoid nerve, motor to the mylohyoid and anterior digastric muscles. In the lateral neck, the cervical segment of the internal carotid artery continues as the petrous segment once it enters the carotid canal. The internal jugular vein emerges from the nearby jugular foramen and descends in the neck. Coursing on the external surface of the ICA is the internal carotid nerve consisting of postganglionic sympathetic fibers. Deep neck musculature has been removed to show portions of the suboccipital muscles: obliquus capitis inferior and superior, which have common attachments to the transverse process of the atlas vertebra. (Image courtesy of PA Rubino)