3D Models Related Images

Left Lateral Exposure of Brain, Infratemporal Fossa, and Carotid Vasculature

Surgical Correlation


Left lateral exposure of brain, infratemporal fossa, and carotid vasculature. 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 maxillary artery, one of the terminal branches of the external carotid artery, traverses this space giving rise to several branches, such as those shown here: inferior alveolar, middle meningeal, posterior superior alveolar, and infraorbital arteries. The sphenopalatine artery continues through the pterygomaxillary fissure into the pterygopalatine fossa where the maxillary nerve can also be seen. 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 carotid sympathetic nerve plexus carrying postganglionic sympathetic fibers. The hypoglossal nerve emerges between the IJV and proximal part of the ECA and courses forward superficial to the hyoglossus muscle on its way to the oral cavity and tongue. The superior root of the ansa cervicalis (containing C1 nerve fibers) leaves the epineurial sheath of the hypoglossal and descends in the neck where it unites with the inferior root to supply motor innervation to most of the infrahyoid muscles. Deep neck musculature has been removed to show portions of the suboccipital muscles: obliquus capitis inferior and superior muscles. Part of the vertebral artery is exposed prior to entering the transverse foramen of the atlas. It is crossed superficially by the ventral ramus of the C2 spinal nerve. The facial artery courses superficial to the hyoglossus and on the deep surface of the submandibular gland (not present) before emerging onto the face. The ECA terminates as the superficial temporal and maxillary arteries near the neck of the mandible. The carotid sinus nerve, a sensory branch of the glossopharyngeal nerve, innervates the baroreceptors of the carotid sinus and the chemoreceptors of the carotid body. (Image courtesy of PA Rubino)

You are leaving the Neurosurgical Atlas

Full 3D Models are available outside the Neurosurgical Atlas through an Atlas Meditech subscription.