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Muscular and Osseous Relationships

Surgical Correlation

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G, The mandibular condyle and ramus have been removed to expose the styloid process and attached muscles. The pterygoid muscles and some branches of the mandibular nerve have been removed to expose the auriculotemporal nerve, which splits into two roots that surround the middle meningeal artery. The levator veli palatini, which attaches the lower margin of the eustachian tube, is in the medial part of the exposure. The longus capitis is exposed medial to the internal carotid artery in the retropharyngeal area. H, The muscles that attach to the styloid process have been divided at their origin. The facial nerve crosses the lateral surface of the styloid process. The attachment of the tensor veli palatine to the skull base extends between the foramen ovale and the eustachian tube. I, The external auditory canal has been removed, but the tympanic membrane and cavity have been preserved. The levator veli palatine and part of the tensor veli palatine have been removed and the membranous part of the eustachian tube opened. The eustachian tube crosses anterior to and is separated from the petrous carotid by a thin shell of bone. The jugular bulb and lateral bend of the petrous carotid are located below the osseous labyrinth. The pterygopalatine fossa is exposed anteriorly. J, The eustachian tube has been resected and the mandibular nerve divided at the foramen ovale to expose the petrous carotid. This exposes the longus capitis and rectus capitis anterior, both of which are located behind the posterior pharyngeal wall. K, The petrous carotid has been reflected forward out of the carotid canal to expose the petrous apex medial to the carotid canal. L, Petrous apex and upper clivus have been drilled and the dura opened to expose the anterolateral aspect of the pons below the trigeminal nerve. The sigmoid sinus and the jugular bulb have been removed to expose the nerves exiting the jugular foramen. (Images courtesy of AL Rhoton, Jr.)

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