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Left Lateral Infratemporal Fossa and Exposure of the Pharynx

Surgical Correlation


Left lateral infratemporal fossa and exposure of the pharynx. 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 been removed to expose the interior of the pharynx.   The maxillary artery, one of the terminal branches of the external carotid artery (ECA), traverses this space giving rise to several branches, such as those shown here: inferior alveolar, middle meningeal, anterior deep temporal, posterior superior alveolar, and infraorbital arteries. The sphenopalatine artery continues through the pterygomaxillary fissure into the pterygopalatine fossa. 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 (ICA) and internal jugular vein (IJV) run parallel with each other. Coursing between them 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. (Image courtesy of PA Rubino)