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Dissection Through Superficial Branches of the Facial Nerve

Surgical Correlation

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F, The coronoid process and lower part of the temporalis muscle have been removed to expose the deep temporal branches of both the maxillary artery and mandibular nerve passing upward along the greater sphenoid wing and temporal squama to enter the deep side of the temporalis muscle. The lateral pterygoid muscles extend backward from the pterygoid process and greater wing of the sphenoid to insert along the mandibular condyle and temporomandibular joint. G, Craniotomy has been performed to expose the floor of the middle fossa, and the lateral wall of the orbital has been removed to expose the extraocular muscles. The mandibular condyle has been removed and the pterygoid muscles reflected to expose the mandibular nerve at the foramen ovale. The pterygopalatine fossa is located behind the maxilla. The floor of the orbit and the upper part of the maxilla have been removed to expose the nasal cavity. H, Enlarged view after resection of the floor of the middle fossa and the external auditory canal to expose the tympanic membrane and the mandibular nerve below the foramen ovale. The mastoid segment of the facial nerve has been preserved. The greater petrosal nerve crosses above the petrous carotid. The tensor tympani muscle and eustachian tube are layered along the anterior margin of the petrous carotid. I, The eustachian tube and tensor tympani have been resected to expose the upper cervical and petrous carotid. The nasopharyngeal mucosa has been opened to expose the longus capitis and rectus capitis anterior muscles. J, The carotid artery has been reflected forward out of the carotid canal. This exposes the petrous apex in front of the jugular foramen on the medial side of the internal carotid artery. K, The petrous apex has been drilled and the dura opened below the trigeminal nerve to expose the upper anterior part of the posterior cranial fossa. A segment of the internal jugular vein and jugular bulb have been resected to expose the IXth through XIIth cranial nerves below the jugular foramen and hypoglossal canal. (Images courtesy of AL Rhoton, Jr.)

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