The Infratemporal Fossa

The infratemporal fossa is an irregularly shaped cavity, situated Below And Medial to the Zygomatic Arch. It is bounded by: Anteriorly (In front), by the Infratemporal Surface Of The Maxilla and the ridge which descends from its zygomatic process. Posteriorly (behind), by the Articular Tubercle Of The Temporal Bone and the spinal Part of the sphenoid Superiorly (above), by the Great Wing Of The Sphenoid below the infratemporal crest, and by the under surface of the Temporal Squama;.

Temporal fossa

Infratemporal fossa

Greater wing of sphenoid Pterygomandibular fossa

Lateral pterygoid plate

The Infratemporal Fossa

Inferiorly (below): by the Alveolar Border Of The Maxilla. Medially, by the Lateral Pterygoid Plate.

Contents
It contains: 1. The lower part of the Temporalis. 2. The Medial and Lateral Pterygoid Muscles. 3. Maxillary Vessels. 4. Mandibular And Maxillary Nerves.

The Infratemporal Fossa

Foramen ovale and Foramen Spinosum open on its roof, and The Alveolar Canals on its anterior wall. At its upper and medial part are Two Fissures, which together form a Tshaped fissure, the horizontal limb being named the Inferior Orbital, and the vertical one the Pterygomaxillary.

Rotundum f.

Ovale f.

Spinosum f.

Sphenoid bone

Pterygopalatine fossa

Pterygopalatine fossa

Sphenoid

Rotundum f.

Palatine Maxilla

Alveolar foramen

Muscles of Mastication
1. Temporalis 2. Masseter
1. Medial pterygoid 2. Lateral pterygoid

Muscles of Mastication

Masseter

Origin: Temporal fossa and temporalis fascia Insertion: Coronoid

process and anterior border of mandible

Temporalis m.

Deep part

Superficial part

Origin: Zygomatic arch Insertion: Ramus and angle of mandible

Masseter m.

Lateral Pterygoid
Upper head: Origin from infratemporal crest of sphenoid bone Lower head: Origin from lateral side of lateral pterygoid

plate

Insertion: Articular capsule of TMJ and mandibular neck

Upper head

Lower head

Lateral pterygoid muscle

Deep head of medial pterygoid m. Superficial head of MPG m.

Medial pterygoid m.

Action of Muscles of Mastication

1.Temporaris: Anterior and middle fiber: elevate
Temporalis

Posterior fiber:

Retract

2. Masseter: Super fiber: Elevate Deep fiber:

Action of Masticatory Muscle

3.Medial pterygoid: Elevate 4. Lateral pterygoid: Protract (protrude)

Maxillary Artery
The Larger of the Two Terminal Branches of the External Carotid, Arises behind the Neck Of The Mandible, and is at first imbedded in the substance of the parotid gland; it passes forward between the ramus of the mandible and the sphenomandibular ligament, and then runs, either superficial or deep to the Pterygoid, to the pterygopalatine fossa. It supplies the deep structures of the face, and may be divided into mandibular, pterygoid, and pterygopalatine portions.

Branches
Inferior Alveolar: Anterior Tympanic: Tympanic Membrane. Middle Meningeal: Is the largest of the branches which supply the dura mater through Foramen Spinosum.

Maxillary Artery
It is the terminal part of the
External carotid artery. The maxillary artery is divided into four parts

3.
4.

1. 2.

Mandibular part Muscular part.

Infraorbital part. Sphenopalatine(pterygopalatine)

1.The Mandibular Part Of Maxillary

Artery
There are four branches from this part 1. Deep Auricular And Anterior Tympanic Arteries 2. Middle Meningeal Artery 3. Accessory Meningeal Artery. 4. Inferior Alveolar Artery

Deep temporal a. Middle meningeal a. Auriculotemporal n.

Maxillary artery

2.The muscular part of maxillary artery

The Branches Are; 1. Deep Temporal Arteries 2. Massetric And Pterygoid Arteries 3. Buccal artery

Superficial temporal artery Deep temporal nerve

Deep temporal artery Mandibular nerve(V3)

External carotid artery Maxillary artery Nerve and artery of temporal fossa

3.Infraorbital part
It give off the Superior Alveolar Arteries
and traverse infraorbital canal to exit the infraorbital foramen becoming infraorbital artery

which supply the cheek . Inferior palpebral part. Superior labial, and External nasal

4. Spheopalatine part of the maxillary artery

This part gives off the branches which supply 1.The nasal cavity 2.The palate of oral cavity

 It is the venous plexus which is located around the pterygoid muscle. Moreover, it has connection to the following veins;

1. The maxillary vein 2. Deep facial vein 3. Inferior ophthalmic vein 4. Cavernous sinus (in the cranial cavity)

Therefore, the infection could invade from external region to Cranial Cavity

Inferior ophthalmic v.

Emissary vein connect to cavernous sinus in brain

Maxillary v.

Deep facial v.

Pterygoid venous plexus of vein

Cavernous sinus

Pterygoid venous plexus

Intracranial venous connection

Maxillary Vein
Is a short trunk which accompanies the First Part Of The Maxillary Artery. It is formed by a confluence of the veins of the Pterygoid Plexus, and Unites With The Temporal Vein To Form The Posterior Facial Vein. It joins to Retromandibular vein Pterygoid plexus: Drains area of pterygoid muscles & drain into Maxillary Vein

The Maxillary Nerve

Second division of the trigeminal, is Pure Sensory Nerve & Intermediate in Size (Ophthalmic & Mandibular). It arises from Trigeminal ganglia in the Middle Cranial fossa & leaves the skull through the Foramen Rotundum, and enters the orbit through The Inferior Orbital Fissure; It traverses the infraorbital groove and canal in the Floor Of The Orbit, and appears upon the face at the Infraorbital Foramen.

Maxillary Nerve: Alveolar Branches to supply:

Gums and neighboring parts of the Mucous Membrane Of The Cheek. Two premolar teeth (Nerves runs in a canal in the Lateral Wall Of The Maxillary Sinus). Incisor And Canine Teeth, Mucous Membrane Of The Anterior Part Of The Inferior Nasal Meatus and the Floor Of The Nasal Cavity (Nerves runs in a canal in the anterior wall of the maxillary sinus).

5. The maxillary nerve (V2)

It is pure sensory nerve and divided into three Parts as follows:

1.External (Zygomatic n.): They are zygomaticofacial and zygomaticotemporal nerves

2. Intermediate Part: It is infraorbital nerve which gives off branches.

2.1. Posterior, middle and superior alveolar nerves which supply alveolar and upper teeth
2.2. Infraorbital nerve which traverses infraorbital foramen to supply cheek and lower eyelid.

Zygomatic n.
Zygomaticotemporal n.

Nasal n.(sphenopalatine Sphenopalatine f.

Zygomatic n

Zygomaticofacial n.

Infraorbital n.

Infraorbital n.

V2

Lesser palatine

Greater palatine

Pterygopalatine ganglion Palatine n.

Anterior,middle and posterior superior alveolar n.

A.Maxillary n.branches B.Pterygopalatine ganglion

Maxillary Nerve
3. Internal Part (Pterygopalatine Or Sphenopalatine N.): It Supplies Nasal Cavity And Palate. The Branches Are The Following. 3.1. Sphenopalatine Nerve: It Enters The Sphenopalatine Foramen To Supply Nasal Cavity. Its Terminal Branch Is Incisor Nerve Which Supplies Upper Incisor. 3.2. Descending Palatine Nerve: After Descending It Ramifies To Give These Branches. 3.2.1. Greater Palatine N. Which Supplies Hard Palate. 3.2.2. Lesser Palatine N. Which Supplies Soft Palate.

Maxillary Nerve
The greater petrosal n. (preganlionic fiber) of CN.VII (facial n.) come to synapse with this ganglion. The postganglionic fibers merged with internal ramus branches to supply seromucous gland in palate and nasal cavity. There was some postganglionic fiber running with zygomaticotemporal n. to meet the lacrimal n.(sensory)of V1. It pass along with this nerve to supply lacrimal gland for gland secretion.

Zygomatic n.
Zygomaticotemporal n.

Nasal n.(sphenopalatine Sphenopalatine f.

Zygomatic n

Zygomaticofacial n.

Infraorbital n.

Infraorbital n.

V2

Lesser palatine

Greater palatine

Pterygopalatine ganglion Palatine n.

Anterior,middle and posterior superior alveolar n.

A.Maxillary n.branches B.Pterygopalatine ganglion

Lacrimal gland Lacrimal n.

Zygomaticotemporal n. Zygomaticofacial n.
Maxillary n.(V2)

Zygomatic n.

Greater petrosal n.
Pterygopalatine ganglion

Innervation of lacrimal gland

Landmarks / Area of Insertion

Mucobuccal fold above second premolar Apex of second Premolar The practitioner must find the Greater Palatine Foramen And Pass The Needle Through The Greater Palatine Canal. This is difficult, and occasionally the canal is impassable. The other technique described by Malamed is easier and calls for Advancing The Needle Posterior And Superior To The Maxillary Tuberosity. There is a Higher Risk Of Puncturing The Pterygoid Venous Plexus Or Maxillary Artery in the pterygomaxillary fossa. In

Mandibular Nerve
It is the largest of the three divisions of the fifth, and is made up of Two Roots: a Large, Sensory Root and a small motor root. Both unite just after its exit through the Foramen Ovale., and then Divides Into Two Trunks: Anterior and Posterior. Supplies The Teeth And Gums Of The Mandible Skin of the temporal region, Auricula, the lower lip, The lower part of the face, and the Muscles Of Mastication; it also supplies the Mucous Membrane Of The Anterior Two-thirds Of The Tongue.

Ophthalmic n.(V1)

Maxillary n.(V2)

Mandibular n.(V3)

Trigeminal nerve(V) leaving the skull

Mandibular(V3) nerve branches

Branches of Mandibular Nerve

From Main Trunk: Meningeal branch Passes Via foramen spinosum supply the durra matter & mucous lining of the mastoid cells Nerve to Medial Pterygoid. Branches of Anterior Division: All branches of this division are motor nerve except buccal nerve. Nerve to Masseter & Lateral Pterygoid. Buccal Nerve To skin of Cheek (NO Supply to Buccinator) .

Mandibular N: Posterior Division Branches

All branches are sensory nerve except mylohyoid nerve Auriculotemporal: Gives Sensory Branches to Skin of Auricle ear opening & Temperomandibular joint. Lingual: Supplies Ant-2/3 of Mucous Membrane of Tongue & Joined by Chrdae Tympani ( Of Facial N Secteromotor fibers to Submandibular & Sublingual Glands). Otic Ganglion: Branch of Glossopharyngeal Carry Secret motor Fibers to Parotid Gland.

Auriculotemporal n.

M MA

Lingual n.

Chorda tympani n. Inferior alveolar n.

Mylohyoid n.

Posterior division of mandibular nerve

Posterior Division of Mandibular

Ch Ty

IA

MH

Mandibular Nerve Block

It is the procedure for dentist to anesthetize nerve supply of lower teeth and gum before dental treatment. Landmark: Internal and external oblique ridge, retromolar triangle. Space: Pterygomandibular space (locate between medial mandibular ramus and medial pterygoid m.)
Nerves block: 1.Inferior alveolar n.,2.Lingual n. and 3.buccal n.

Mandibular Nerve Block

An injection used to anesthetize the anterior two-thirds portion of the tongue, the pulp tissue of the mandibular teeth, the floor of the mouth, the facial periodontium of the mandibular first premolar and anterior teeth, the lingual periodontium of all mandibular teeth, the skin on the chin, and the lower portion of the lip. Gow-Gates Procedure: Injection delivered at the neck of the condyle just under the insertion of the lateral pterygoid muscle

Inferior Alveolar
Both Motor & Sensory Teeth of Lower Jaw far as the mental foramen, where it divides into two terminal branches, Incisive And Mental. Moreover, it receive additional branch from CN.VII(facial n.) which is called Chorda Tympani Nerve. The dental branches supply the molar and premolar teeth. The incisive branch is continued onward within the bone, and supplies the canine and incisor teeth. skin of the chin, and two ascend to the skin and mucous membrane of the lower lip Mylohyoid Nerve: Branch of Inferior Alveolar & Supplies Mylohopid Muiscle.

Lesser petrosal n.of CN.IX

Chorda tympani

Auriculotemporal n. Lingual n.

Parotid gland

Submandibular ganglion Submandibular gland

Sublingual gland