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Deep View of Left Infratemporal Fossa, Temporal Lobe, and Deep Neck Structures

Surgical Correlation


Deep view of left infratemporal fossa, temporal lobe, and deep neck structures. The mandibular ramus, zygomatic arch, and portion of lateral skull and meninges have been removed. The lateral surface of the temporal lobe is in view with the superior, middle, and inferior temporal gyri separated by the superior and middle temporal sulci. The lateral sulcus separates the temporal lobe from the frontal and parietal lobes. The lateral pterygoid muscle has been removed and only the medial pterygoid remains within the infratemporal fossa. Posterior to the ramus of the mandible is the external carotid artery and its terminal branches, the superficial temporal and the maxillary arteries, The maxillary artery crosses the center of the image where it normally courses superficial to the lateral pterygoid. Branches in view here are the inferior alveolar, the middle meningeal, anterior deep temporal, posterior superior alveolar arteries, the infraorbital, and the sphenopalatine artery entering the pterygopalatine fossa through the pterygomaxillary fissure. The maxillary nerve can be seen emerging from the foiramen rotundum and traversing the upper portion of the pterygopalatine fossa. The mandibular nerve emerges from the foramen ovale into the infratemporal fossa before dividing into branches. The auriculotemporal (unlabeled) and buccal nerves lie posterior to the lateral pterygoid while the inferior alveolar and lingual nerves emerge between this muscle and the medial pterygoid to course toward the mandibular canal and floor of the mouth, respectively. The inferior alveolar nerve and artery gives rise to mylohyoid branches that supply the mylohyoid and anterior digastric muscles. Deep to the mandibular ramus are the internal carotid artery and internal jugular vein. The cervical segment of the artery continues as the petrous segment as it passes into and through the carotid canal. The internal jugular vein emerges from the nearby jugular foramen. Sandwiched between these vessels more inferiorly is the tip of the superior cervical sympathetic ganglion from which arises the internal carotid nerve carrying postganglionic sympathetic fibers. This nerve courses on the external surface of ICA, but has been pulled inferiorly out of position in this view. The transverse process of the atlas vertebra can be seen and is the common site of attachment of the obliquus capitis inferior and superior muscles of the suboccipital group. (Image courtesy of PA Rubino)