GRISTO Module 3 Anatomy: Infratemporal Fossa

Infratemporal fossa

Anterior: Maxilla

Posterior: Styloid process

Medial: Lateral pterygoid plate

Lateral: Mandibular ramus

Borders of the infratemporal fossa

A. Temporalis

B. Lateral pterygoid muscle

C. Medial pterygoid muscle

Buccal

A. Auriculotemporal nerve

B. Chorda tympani nerve (CN VII)

C. Inferior alveolar nerve

D. Lingual

E. Nerve to mylohyoid

the medial and lateral pterygoid muscles

The lingual and inferior alveolar nn are found between

A. Lateral pterygoid muscle

B. Medial pterygoid m

CN V3 and the maxillary artery

The space between the pterygoid muscles is a hotspot for

LEFT:

A. Lateral pterygoid muscle

B. Infratemporal fossa

C. Medial pterygoid muscle

Right:

A. V3 (and branches)

B. Maxillary artery

C. Sphenomandibular ligament

VASCULATURE OF THE HEAD AND DEEP FACE

VASCULATURE OF THE HEAD AND DEEP FACE

A. Maxillary artery

B. Facial artery

C. Lingual artery

D. External carotid a.

E. Superior thyroid a

F. Superficial temporal a

G. Posterior auricular a

H. Occipital a

I. Internal carotid a

J. Ascending pharyngeal a

K. Common carotid a

angle of the mandible

The facial artery branches near the

mandible (and posterior to the submandibular gland in the neck)

The facial artery runs posterior to the

inferior mandible to enter the face

The facial artery loops around the _____ to enter ____

the bridge of the nose, giving off several branches along the way

The facial artery then runs diagonally from the mandible up to

Facial artery

A. angular a.

B. lateral nasal a.

C. Superior labial a.

D. inferior labial a.

A. Superficial temporal artery

B. Transverse facial artery

C. Supraorbital artery

D. Supratrochlear artery

E. Internal carotid a. branches

A. Maxillary artery

B. Lateral pterygoid m

Portion before lateral pterygoid

- branches run with named V3 branches

Maxillary artery: Part 1

Portion over/under lateral pterygoid

- branches run with V3 muscular nn

- branches go directly to structure (no foramina)

Maxillary artery: Part 2

Portion after lateral pterygoid

- Branches run with V2 branches

Maxillary artery: Part 3

A. Inferior alveolar artery

B. Deep auricular artery

C. Anterior tympanic artery

D. Middle meningeal artery

Follows inferior alveolar nerve (V3) into mandibular foramen

Supplies mandibular teeth, chin

Inferior alveolar artery

Follows auriculotemporal nerve (V3)

Supplies external acoustic meatus

Deep auricular artery

Follows chorda tympani nerve (VII)

Supplies tympanic membrane

Anterior tympanic artery

Enters foramen spinosum

Supplies dura mater

Middle meningeal artery

A. Deep temporal aa

B. Masseteric aa

C. Pterygoid aa

D. Buccal aa

Follow nerve to temporalis m (V3)

Supply temporalis muscle

Deep temporal aa

Follow nerve to masseter m (V3)

Supply masseter muscle

Masseteric aa

Follow nerve to pterygoid mm (V3)

Supply pterygoid muscle

Pterygoid aa

Follow buccal n (V3)

Supply buccinator muscle

Buccal aa

A. Artery of pterygoid canal

B. Sphenopalatine artery

C. Infraorbital artery

D. Posterior superior alveolar artery

F. Descending palatine artery

Follows greater petrosal n (VII)

Supplies pharynx, auditory tube, middle ear

Artery of pterygoid canal

Follows nasopalatine n (V2)

Supplies nasal cavity, anterior palate

Sphenopalatine artery

Follows infraorbital nerve (V2)

Supplies maxillary teeth, maxillary sinus, anterior face

Infraorbital artery

Follows posterior superior alveolar nerve (V2)

Supplies maxillary teeth, maxillary sinus

Posterior superior alveolar artery

Follows greater/lesser nn (V2)

Supplies palate

Descending palatine artery

A. Sphenopalatine

B. Infraorbital

C. Maxillary (3rd part)

D. Posterior superior alveolar

E. Middle superior alveolar

F. Anterior superior alveolar

G. Descending palatine

H. Buccal branch

I. Dental branches

J. Mental branch

K. Maxillary (2nd part)

L. Branch to mylohyoid

M. Pterygoid branch

N. Masseteric branch

O. Inferior alveolar

P. Accessory mingeal

Q. External carotid

R. Middle meningeal

S. Maxillary (1st part)

T. Superior temporal artery

U. Lateral pterygoid muscle

V. Deep auricular

W. Anterior tympanic

X. Artery of pterygoid canal

Y. pharyngeal artery

Z. Deep temporal branches

arterial system

In general venous return follows

pterygoid venous plexus

The __________ is a network of veins in infratemporal fossa

- Down to the internal jugular veins

- Back to Retromandibular veins

- Up to the ophthalmic veins

- Up to the Cavernous sinus (Meningeal blood space)

Pterygoid plexus and facial veins have multiple draining pathways

A. Facial vein

B. Pterygoid venous plexus

C. internal jugular vein

- blood/nutrient supply to the teeth

- Spread of infection

- Vascular injury during anesthetic injection

- Inadvertent intravascular injection of anesthetic

Clinical significance of infratemporal vasculature

Parotid region

Superficial to the infratemporal fossa is the

Parotid gland

Facial nerve

External carotid artery

Retromandibular vein

Structures in the parotid region

A. Facial nerve

B. Retromandibular vein

C. Parotid gland

D. External carotid artery

salivary gland

The parotid gland is a

produces serous secretions

Parotid gland primarily

CN IX

The parotid glands is stimulated by parasympathetics from

Lesser petrosal n (CN IX), Auriculotemporal n (V3)

Preganglionics are carried in the _______ and postganglionics are carried via the

saliva to the oral cavity

The parotid duct conveys

Masseter muscle, buccinator muscle

The parotid duct passes out of the parotid gland superfifcal to ______. Then it dives down through the fibers of the ________ to enter the oral cavity

2nd maxillary molar

The parotid duct enters the oral cavity adjacent to the

infection (E.g mumps)

Clinical note: poor oral hygiene can lead to what spreading through the parotid duct to the parotid gland

infratemporal fossa.

This has important implications when considering anesthetic injections

The Parotid gland often wraps around the posterior mandible, meaning small portions of the gland are located in the