THE INFRATEMPORAL FOSSA

1 Borders
1.1 Clinical Relevance Surface Anatomy of the Infratemporal Fossa

2 Contents

2.1 Clinical Relevance: Fractures of the Pterion

The infratemporal fossa is a complex and irregularly shaped space, located deep to
the masseter muscle. It acts as a conduit for many neurovascular structures that
travel between the cranial cavity and other structures of the head.
In this article we shall look at the anatomy of the infratemporal fossa its
boundaries, contents, and clinical significance.

Borders
The infratemporal fossa can be said to have a wedge shape. It is located deep to the
masseter muscle and zygomatic arch (to which the masseter attaches). The
fossa is connected to the pterygopalatine fossa by the pterygomaxillary fissure and
also communicates with the temporal fossa superiorly.
The boundaries of the infratemporal fossa are formed by bone and soft tissue:

Lateral ramus of the mandible.

Medial lateral pterygoid plate of the sphenoid.
Anterior posterior surface of the maxilla.
Posterior carotid sheath.

The floor of the infratemporal fossa is comprised of the medial pterygoid muscle,
while the roof is formed by the greater wing of the sphenoid bone. Two foramina
open out on the roof the foramen ovale and foramen spinosum. They provide a
connection with the cranial cavity.

Clinical Relevance Surface Anatomy of the Infratemporal Fossa

Location- The easiest method is this clench your jaw, and feel for the ridge of
the massetermuscle in your cheek. Youre basically right above the fossa. Trace
posteriorly over the muscle until you reach the anterior edge of the jaw, and youre in
line with the posterior of the fossa. Now relax your jaw, and trace your fingers
forwards across your cheek, along the lower edge of the zygomatic process of your
temporal bone, followed by the zygomatic bone, and finally to the zygomatic process
of the mandible. This is anterior border. At this point, you need to start using your
imagination a bit.
The lateral border of the fossa is actually quite deep the ramus of the mandible
meaning were on the inside face of the jawbone. To get to the medial border, we go
even deeper, to the lateral edge of the sphenoid bone, in an area called the lateral
pterygoid plate. You can think of this as being roughly in line with the molars of your
upper jaw. The sphenoid bone also contributes to the superior border, this time its
the greater wing.
The inferior border is the medial pterygoid muscle, which stretches to the posterior
inferior border of the ramus of the mandible.

Contents
The infratemporal fossa acts as a pathway for neurovascular structures passing
between the cranial cavity, pterygopalatine fossa and temporal fossa. It also contains
some of the muscles of mastication.
Muscles

The infratemporal fossa is associated with the muscles of mastication.

The medial and lateral pterygoids are located within the fossa itself, whilst the
masseter and temporalis muscles insert and originate into the borders of the fossa.

Nerves
There are numerous nervous structures located within the infratemporal fossa:

Mandibular nerve a branch of the trigeminal nerve (CN V). It enters the
fossa via the foramen ovale, giving rise to motor and sensory branches. The
sensory branches continue inferiorly to provide innervation to some of the
cutaneous structures of the face.
Auriculotemporal, buccal, lingual and inferior alveolar nerves sensory
branches of the trigeminal nerve.
Chorda tympani a branch of the facial nerve (CN VII). It follows the
anatomical course of the lingual nerve and provides taste innervation to the
anterior 2/3 of the tongue.
Otic ganglion a parasympathetic collection of neurone cell bodies. Nerve
fibres leaving this ganglion hitchhike along the auriculotemporal nerve to reach
the parotid gland.

Vasculature
The maxillary artery (terminal branch of the external carotid artery) travels through
the infratemporal fossa. Within the fossa, it gives rise to the middle meningeal
artery, which travels into the cranial cavity via the foramen spinosum. Clinically this
is important as a site of traumatic bleed as the middle meningeal passes underneath
the pterion.
The pterygoid venous plexus is directly connected to the cavernous sinus, and
drains the eye and its locality. Infections of the skin and eye socket are able to track
back into the plexus, and on up into the cavernous sinus where meningitis is a
substantial risk. Other veins in the fossa include the maxillary vein and middle
meningeal vein, both of which you might expect.

Clinical Relevance: Fractures of the Pterion

Where the temporal, parietal, frontal and sphenoid bones meet, the skull is at its
weakest, and susceptible to fracture. This point is known as the pterion.
The middle meningeal artery (MMA) supplies the skull and the dura mater (the
outer membranous layer covering the brain). It travels underneath the pterion, thus a
fracture of the skull at the pterion can injure or completely lacerate the MMA.
Blood will then collect in between the dura mater and the skull, causing a dangerous
increase in intra-cranial pressure. This is known as an extradural haematoma.
The increase in intra-cranial pressure causes a variety of
symptoms; nausea, vomiting, seizures, bradycardia and limb weakness. It is treated
by diuretics in minor cases, and drilling burr holes into the skull in the more
extreme hemorrhages.