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Left Lateral Pharyngeal Wall and Skull Base Dissection

Surgical Correlation

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Left lateral pharyngeal wall and skull base dissection. The ramus of the mandible and zygomatic arch have been removed along with the pterygoid muscles to provide a view of the lateral pharyngeal wall and skull base. The lateral pterygoid plate is exposed. The tensor veli palatini muscle descends deep to this plate and along the lateral surface of the medial pterygoid plate. Just deep and slightly posterior to the tensor muscle is the levator veli palatini. It is overlapped inferiorly by the upper border of the superior pharyngeal constrictor muscle (partially cut). Overlying this portion of the constrictor muscle are the ascending palatine branch of the facial artery and the ascending pharyngeal artery, a medial branch of the external carotid. The mandibular nerve emerges from the foramen ovale and gives rise to several branches, including the inferior alveolar, lingual, buccal, deep temporals, nerves to the tensor veli palatini and lateral pterygoid muscles, and auriculotemporal nerve whose roots enclose the middle meningeal artery. The styloid process gives rise to three muscles: stylohyoid, styloglossus, and stylopharyngeus. The internal jugular vein is seen descending in the neck and is crossed proximally by the spinal accessory nerve to the sternocleidomastoid and trapezius muscles. Deep to the vein is the internal carotid artery. The glossopharyngeal nerve after passing through the jugular foramen descends in the neck in relation to the stylopharyngeus into the pharyngeal wall. The external carotid artery  is shown giving off facial and occipital branches. The hypoglossal nerve is shown descending in the neck and bending forward near the origin of the occipital artery to course on the superficial surface of the hyoglossus muscle to the floor of the mouth. At this junction, C1 fibers enclosed in its epineurium leave the hypoglossal nerve as the superior root of the ansa cervicalis to supply strap (infrahyoid) muscles.  Posterior to the internal jugular vein and deep within the neck portions of the suboccipital muscles, obliquus capitis inferior and obliquus capitis superior, are in view. (Image courtesy of AL Rhoton, Jr.)

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