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Left Lateral Pharyngeal Wall and Skull Base Dissection

Surgical Correlation


Left lateral pharyngeal wall and skull base dissection. The ramus of the mandible and zygomatic arch have been removed along with the pterygoid, lateral and posterior neck 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 temporal, 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 (cut): 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 external carotid artery is shown giving off the occipital branch that is directed posteriorly within a groove deep to the mastoid tip enroute to supplying the posterior scalp. Posterior to the internal jugular vein are exposed portions of the atlas and axis vertebrae. Emerging above the posterior arch of the atlas and inferior to the vertebral artery is the suboccipital nerve, a dorsal ramus of C1, and motor to the suboccipital muscles. The greater occipital nerve, the dorsal ramus of C2, emerges inferior this arch and supplies sensation to the occipital area. (Image courtesy of AL Rhoton, Jr.)