Lecture note 12: deep face, infratemporal fossa

13.3.2011

Done by: Nurul kauthar, wan Muhammad najib, zulkhairi, kamal

(Min 4.00)

Ok, we learned previously about the superficial face and today’s lecture
is about the Deep Face including both Temporal and Infratemporal Fossa. So,
this is lateral view of the skull showing you Temporal Fossa.

As you could see, The Temporal fossa is bounded by the Zygomatic

process of the Frontal Bone and the Frontal process of Zygomatic bone
(Anteriorly), Temporal line (superiorly); both Superior line & Inferior line.
And those lines are also bounding the Temporal fossa (posteriorly).

Now, the medial wall of Temporal Fossa forms the floor of Temporal
Fossa. It is formed by Frontal Bone, Parietal Bone, Temporal Bone (the
squamos part of Temporal Bone) as well as Great Wing of Sphenoid Bone. And
if you remember the circular area (which is circled in the picture) which is the
junction for all those 4 bones are called Pterion (P is silent).

Now, inferiorly, the Temporal Fossa is bounded by Infratemporal

surface of Greater wing of Sphenoid bone medially and Zygomatic process
laterally. The lateral wall of Temporal fossa is open but in fact it is formed by
temporal fascia which is the fascia that covers the Temporal fossa.

The temporal fascia is attached superiorly to the Temporal line

(Superior Temporal Line), inferiorly to the Zygomatic arch. In fact, it is
attached to Zygomatic arch by 2 layers; the inner layer is attached to the Inner
surface of the Zygomatic arch and the outer layer is attached to the outer
surface of the Zygomatic arch.

So, Temporal fossa contains the Temporalis muscle, and its covering
Temporal fascia in addition to the nerves and blood supply to the Temporalis
muscle. Of course there is some pad between the {two layers of temporal
fascia} the Temporal fascia.
 Temporalis muscle is one of the muscles of mastication. There are 4
muscles of mastication. The temporalis muscle arises from the Floor of
Temporal fossa; its action is to close the mouth by elevating the mandible. SO
remember that you have different orientation of fibres in Temporalis muscle
so that you have the ones that are anterior and superior they are almost
vertical and therefore they elevate the mandible. Whereas the postertior ones
are almost horizontal so they act on retracting the mandible.

Temporalis muscle is inserted on the anterior border. Here is Coronoid

process, near to the Masetter muscle, and it (Temporalis muscle) inserts on
the anterior border and the Deep surface of Coronoid process.

Temporalis muscle is innervated by anterior and posterior deep

temporal nerves which are branches of Mandibular division of Trigerminal
nerve that you will see in a few minutes.

Now the Infratemporal fossa: If you remember, the Infratemporal fossa is

located inferior to Temporal fossa. Going back to the skull, this here (Lateral
view of skull) is Infratemporal fossa. It is medial to Ramus and Coronoid
process. In fact, you have to break this Zygomatic arch down and remove the
ramus of the mandible to see the view of Infratemporal fossa.

Now, the infratemporal fossa is bounded Anteriorly by Posterior

surface of Maxilla, posteriorly by Tympanic plate, Styloid process and
Mastoid process of Temporal Bone, Superiorly by Infratemporal surface of
Greater wing of Sphenoid, Laterally by Ramus of Mandible and Coronoid
process. Inferiorly is bounded by level of Medial Pterygoid Muscle
attachment to the medial aspect of the Angle of Mandible.

10.42

As you can see, there are those muscles in the infratemporal fossa, so
those who are the two heads of the lateral pterygoid muscle and this is the
medial pterygoid muscle. Now remember that the medial pterygoid muscle
lies on the medial surface or deep to the ramus of the mandible and the angle
of the mandible in fact it lies opposite to the masseter muscle which lies on the
lateral surface of the ramus of the mandible.
 So, this is lateral pterygoid muscle, it has two heads of ‘region’, the
superior head arises from infratemporal surface of greater wing of the
sphenoid bone whereas the inferior surface arises from lateral surface of the
lateral pterygoid plate and both heads join to insert on to the articular disk of
temporamandibular joint and the neck of the mandible. Lateral pterygoid
muscle asses in opening the mouth, not closing the mouth.

Then, the medial pterygoid plate arises from the medial surface of
lateral pterygoid plate of the sphenoid bone and it has a small origin from the
tubercle of the maxilla. It inserts on the medial surface of the angle of the
mandible. It lies opposite to the masseter muscle superficial to the ramus of
the mandible. Of course this here is buccinators muscle which has been
reflected in order to be able to see the medial pterygoid muscle.

And this is part of the table! containing the muscle of mastication who have
the origin insertion, innervations and the action.

The doctor repeats what she has just said…

The infratemporal fossa also contains the temporomandibular joint.

Temporomandibular joint is very important for you and it is formed by three
bones which are first the condyle / head of the mandible which is the
superior part of the condylar process of the mandible and then you have
mandibular fossa of the temporal bone and anterior to the mandibular is
the articular tubercle which is also a part of temporal bone.

Temporomandibular joint, as another joint is supported by ligament.

Now, remember that first, temporomandibular has the articular disk which is
a fibrocartilagenous disk separating this cavity. Now temporomandibular joint
is a synovial joint and it has synovial cavity. That is divided by this articular
disk into two compartments; superior one and inferior one.

This joint is surrounded by a capsule. This capsule is thickened or

strengthened laterally by additional bundles of collagen forming ligament
called the lateral temporomandibular ligament. There are also two
accessory ligaments supporting this temporomandibular joint. So, here you
have the capsule and here you have the lateral temporomandibular ligament.

The accessory ligaments supporting the temporomandibular joint are

spinomandibular ligament and the stylomandibular ligament. The
spinomandibular ligament arises from the spine of sphenoid bone and it
inserts on the lingula of the mandible (the medial projection that medial to the
mandibular foramen on the medial aspect to the ramus of the mandible). So,
this is the spinomandibular ligament.

Remember that between the spinomandibular ligament and the neck of

the mandible you have the maxilliary artery passing. It’s passing in that space
form between spinomandibular ligament and the neck of the mandible.
Remember that spinomandibular ligament is the thickening of investing fascia
that covers pterygoid muscle.

Regarding the stylomandibular ligament, as the name indicate, it

extends from the styloid process of the temporal bone to the angle of the
mandible. It’s a thickening of the fascia of carotid gland. The
stylomandibular ligament separates the submandibular gland from sublingual
gland.

This is lateral view, and this is medial view. So this is where the lingula of the
mandible is, and here the spine of the sphenoid form. So this is the
sphenomandibular ligament against stylomandibular ligament. You have
Styloid process and angle of the mandible [17.10].

Look here, you have stylomandibular ligament, neck of the mandible, in

between is maxilliary artery.

This is here foramen ovale through which mandibular division of trigeminal

nerve passes to leave the middle cranial fossa and enter the infratemporal
fossa. Just below the foramen ovale on the medial surface / aspect of the
mandibular division of the trigemninal nerve, you have the otic ganglion. Otic
ganglion is parasympathetic ganglion containing postganglionic
paraympathetic neurons.

Do you remember the parasympathetic system? How many neurons are

involved in parasympathetic system? How do they differ from the motor
neurons?

The parasympathetic system involves two neurons; the first set of

neuron is called 'pre-ganglionic parasympathetic’ neurons and then you have
post-ganglionic parasympathetic neurons. The fibers that project from pre-
ganglionic parasympathetic neurons are called pre-ganglionic
parasympathetic fibers and they have to synapse on post-ganglionic
parasympathetic fibers to give rise to the post-ganglionic parasympathetic
fibers which are just the axons of post-ganglionic parasympathetic neurons
and similarly pre-ganglionic parasympathetic fibers are the axons of pre-
ganglionic parasympathetic neurons.

For the otic ganglion it contains the post ganglionic parasympathetic

neurons and therefore it is receiving the pre-ganglionic parasympathetic
neurons. In fact, those fibres are originating from the glossopharyngeal nerve
and linking the Otic ganglion through Lesser Petrosal nerve. The lesser
petrosal nerve is a branch from glyssopharyngeal nerve that contains pre-
ganglionic parasympathetic fibres innervating or synapsing on the neuron of
optic ganglion. Now, the axons of the post-ganglionic parasympathetic
neurons present in otic ganglion travel via auriculartemporal nerve (one of
mandibular division of trigimenal nerve) and those fibers distant to the
parotid gland.

Now remember that the parasympathetic fibers or system provides

innervations to salivary glands and smooth muscles. Whereas the skeletal
muscles are innervated by somatic motor neurons and fibers. (important!)
So again, the post ganglionic parasympathetic fibers arising from otic ganglion
travel to the parotid gland via auriculartemporal nerve. Therefore
auriculartemporal nerve has two types of fibers; sensory to the skin in front of
the ear and scalp, and now post-ganglionic parasympathetic fibres to the
parotid gland. In addition, it innervates the the posterior medial part of the
temporalmandibular joint.

So remember again … just below the foramen ovale, medial aspect of the
mandibular division of the trigeminal nerve is the Otic gangilion.

Now, the maxillary artery. As you already know, maxillary artery is one of the
terminal branches of the external carotid artery it travels deep to the neck of
the mandible. The maxillary artery can be divided into three branches or
portions based on its relationship with lateral pterygoid muscle. So, from its
origin to the lateral pterygoid muscle, it is called as mandibular portion, and
from that point to the pterygoid maxillary fissure, it is called as pterygoid
portion, and by that point, when it exists the pterygoid maxillary fissure it is
called as pterygopalatine portion.

Again, external carotid artery gives its terminal branches which are superficial
temporal artery and maxillary artery. And from its point of origin to the lateral
pterygoid muscle, this is called as mandibular portion. And then from the
beginning of lateral pterygoid muscle to the pterygoid maxillary fissure, we
call it as pterygoid portion. And branches of mandibular portion are, there are
two small branches supplying the ear, they are called deep auricular artery and
anterior tympanic artery.

And here you have medial meningeal artery. It travels between the two
roots of the auriculotemporal nerve as it arises from the mandibular division
of trigimenal nerve. So here is the mandibular division of trigimenal nerve
leaving the foramen ovale giving up this auriculartemporal nerve by two roots
separated by this middle meningeal artery. In fact the middle meningel artery
enters the middle cranial fossa through foramen spinosom. Foramen
spinosum is posterior to foramen ovale. Another branch that travels to the
middle cranial fossa is the accessory meningeal artery. And In fact it goes to
the middle cranial fossa via foramen ovale.

Then you have mandibular portion. Mandibular portion gives off you the
muscular artery. Those arteries supply muscles of mastification. So you have
… artery to masseter muscle or known as massetric artery. So it travels in
mandibular notch to go to the masseter muscle. And then you have here artery
to the lateral pterygoid, and opposite to it you have artery to the medial
pterygoid. Those two arteries are the ones that enter the deep surface of
temporalis muscle to supply it. They are anterior and posterior deep temporal
arteries. Then you have this buccal artery which goes to the buccinators
muscle to supply it.

Then you have, this is called the pterygoid plexus of vein, which is
associated with the 2 pterygoid muscles, the medial & lateral pterygoid
muscles. Remember that the pterygoid plexus empties into the maxillary
artery. In fact it communicates with the inferior ophthalmic artery through
the inferior orbital fissure and it also communicates with the facial vein
through the deep facial vein. The pterygoid plexus of veins is very important
bcoz it can be away of infection spreading due to its communications with the
other veins likes the facial vein for example.

Ok, finally, there is the mandibular division of the trigeminal nerve. Of course
you know that the trigeminal nerve is the cranial nerve no 5 (V). It arises from
mid pons and it divides into 3 divisions (Ophthalmic, maxillary & mandibular).

Now the mandibular division is that division that leaves the middle
cranial fossa through foramen ovale to enter the infratemporal fossa.

Now, you have to know branches from each part of mandibular divisions. So,
there are branches giving off the main trunk, and there are branches giving
off the anterior division of the mandibular nerve & other branches giving
off the posterior division of the mandibular nerve. Now regarding the
nerves that are giving off the main trunk, this is here called the mentalic
branch and it is travel with the middle meningeal artery through the cranial
spinosum to innervate the dura mater. Another branches that are coming
from main trunks is called nerve to medial pterygoid and as it is indicated, it
innervate the medial pterygoid muscle, in addition it innervate 2 muscles,
these are called tensor veli palatine & tensor veli tympani.

Then branches from the anterior divisions of mandibular nerves are,

you have those temporal nerves, both anterior & posterior deep temporal
nerves which innervate the temporalis muscle. Then, you have nerve to lateral
pterygoid which innervates the lateral pterygoid muscle. Then, you also have
nerve to massetter muscle. There is the nerve which innervates the messectric
muscle and in fact it is a mixed nerve, its motor to the mastoid musles & it’s
sensory to the anterior & lateral part of the temporamandibular joint. Then,
you have the buccal nerve. The buccal nerve travels between the 2 heads of
lateral pterygoid muscle going to the cheek. At the anterior edge of the
mastoid muscle, it becomes subcutaneous.

Now remember, buccal nerve travels with the buccal artery and buccal
nerve is a sensory. It doesn’t innervate the buccinator muscle.

Which nerve innervates the buccinators muscle?

So, remember the buccal of the mandibular is sensory. It does not innervate
the buccinators muscle. Buccinator muscle is innervated by buccal of facial
nerve.

Now, the branches of the posterior division include:

1) You have this, auriculotemporal nerve which again arises by 2 roots

created by the middle meningeal artery and as you already know the
auriculotemporal nerve receives the post-ganglionic parasympathetic fibers
from the aortic ganglion to innervate the parotid gland. It is sensory to the
skin in front of the ear & the skull. It is also sensory to the posterior medial
part of the temporomandibular joint. So, the temporomandibular joint is
innervated by 2 nerves:

1) Massetter nerve

2) Auriculotemporal nerve

Then, you have the inferior alveolar nerve which enters the mandibular
foramen, so that it supplies the lower teeth. Before it rained the mandibular
foramen, the inferior alveolar nerve gives off the mylohyoid nerve or the
nerve to the mylohyoid. If you remember, nerve to mylohyoid innervates
mylohyoid muscles and the anterior belly of the gastric.

Finally, you have this nerve here is the lingual nerve. If you can see, the lingual
nerve receives this nerve here which is called chorda tympani .Chorda tympani
is a branch of the facial nerve. It has 2 types of fibers:

1) Special sensory fibers for taste … from the taste buds of the anterior 2/3s of
the tongue.
2) Pre-ganglionic parasympathetic fibres. Distant to the submandibular
ganglion.

Now, so you have chorda tympani is a branch of the facial nerve. It joins the
lingual nerve… since it has pre-ganglionic parasympathetic fibers, those fibers
need to synapse on post-ganglionic parasympathetic neurons which are
present in the submandibular ganglion, hanged up by this lingual nerve. So,
the fibers innervate here synapse on post-ganglionic parasympathetic
neurons, then post-ganglionic parasympathetic fibers synapse on the
submandibular ganglion and travel by/with lingual nerve to the sublingual
salivary gland. Therefore, the lingual nerve contains here, the pre-ganglionic
parasympathetic fibers, taste fibers or special sensory fibers & somatic
sensory fibers. Here, the lingual nerve contains post-ganglionic
parasympathetic fibers, somatic sensory fibers & special sensory fibers.

Here, the somatic is sensory to the mucosa of the anterior 2/3s of the tongue
& the oral cavity over the mandible. Of course remember that the inferior
alveolar nerve enters into the mandibular foramen & it exits to the external
surface of the mandible as the mantel nerve. It innervates the skin on the chin.

That’s all

Good luck ^^;

Prayers …