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Left Temporal Lobe, Infratemporal Fossa, and Lateral Neck Dissection

Surgical Correlation


Left temporal lobe, infratemporal fossa, and lateral neck dissection. The dura mater and arachnoid layers of the meninges have been removed to expose part of the brain (temporal lobe). The lateral surface of the temporal lobe is in view with the superior, middle, and inferior temporal gyri separated by the superior and middle temporal sulci. The lateral sulcus separates the temporal lobe from the frontal and parietal lobes. The tentorium cerebelli (not labeled) separates the cerebrum from the brainstem and cerebellum. The superior petrosal vein is in view. It drains the anterior and lateral surfaces of the brainstem and parts of suboccipital and tentorial surfaces and empties into the superior petrosal sinus. In the infratemporal fossa the lateral and medial pterygoid muscles have been removed. The maxillary artery, one of the terminal branches of the external carotid artery, traverses the infratemporal fossa 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 is also seen. The buccal and auriculotemporal branches of the mandibular nerve are in view along with anterior and posterior deep temporal nerves to the temporalis muscle. The inferior alveolar and lingual nerves normally descend on the surface of the medial pterygoid muscle 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 common carotid artery divides into its external and internal carotid branches. The cervical segment of the ICA 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. The hypoglossal nerve emerges between the IJV and proximal part of the ECA and courses forward superficial to the hyoglossus muscle. It then passes deep to the mylohyoid muscle to supply motor innervation to the intrinsic and extrinsic muscles of the tongue, except palatoglossus. 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. The facial artery courses superficial to the hyoglossus and on the deep surface of the submandibular gland (not present) before emerging onto the face. Deep neck musculature has been removed to show the suboccipital muscles: obliquus capitis inferior and superior, which have common attachments to the transverse process of the atlas vertebra. 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 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)