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Preauricular Subtemporal-Infratemporal Fossa Approach

Surgical Correlation

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A, The scalp flap has been reflected forward. The flap is positioned so that a neck dissection as well as a frontotemporal craniotomy can be completed. The scalp flap has been reflected forward while protecting the facial nerve and its branches. The neck dissection has been completed below the parotid gland. The facial nerve branches passing deep to the parotid have been preserved. B, The dissection has been carried around the parotid gland to expose the branches of the facial nerve. The internal jugular vein and internal carotid artery are exposed below the gland. C, The parotid gland has been removed to expose the branches of the facial nerve distal to the stylomastoid foramen. D, A segment of the mandibular ramus has been removed, leaving the mandibular condyle in the mandibular fossa, to expose the maxillary artery and pterygoid muscles in the infratemporal fossa. Branches of the third trigeminal division pass between the lateral and medial pterygoid muscles. The inferior alveolar nerve descends to enter the inferior alveolar foramen and canal. (Images courtesy of AL Rhoton, Jr.)

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