Dr.

Kiryowa Haruna
 Outline of the presentation
• Definition of temporal and infratemporal
fossa
• Contents of the temporal and
infratemporal fossae
• Structure, relations, nerve supply and
blood supply of the parotid gland
TEMPORAL FOSSA
TEMPORAL FOSSA
INFRATEMPORAL FOSSA
 Temporal fossa
• Located on the side of the head
• Extends from the superior temporal lines
to the zygomatic arch.
• Communicates with the infratemporal
fossa deep to the zygomatic arch.
• Contains a numbers of structures that
include a muscle, nerves, blood vessels
 TEMPORAL FOSSA
BOUNDARIES:
• Anterior: Zygomatic process of
frontal bone + zygomatic bone
• Superior & Posterior: Temporal
lines
• Inferior: Zygomatic arch
 TEMPORAL FOSSA
CONTENTS:
1. Temporalis muscle and fascia
2. Deep temporal nerve & vessels
3. Superficial temporal vessels
4. Auriculotemporal nerve
 Zygomatic arch
• Separates the temporal and infratemporal
fossae
• Formed by the squamous part of the
temporal bone, the zygomatic bone and the
zygomatic process of the maxilla
• Crossed by the auriculotemporal nerve, and
the zygomatic branches of the facial nerve.
• These can be injured in fractures of the arch.
Temporalis muscle
 TEMPORALIS
• ORIGIN: floor of temporal fossa & deep surface of
temporal fascia
• INSERTION: the tendon passes deep to zygomatic
arch to be inserted to all coronoid process
(except its lateral surface) and ramus of the
mandible
• NERVE SUPPLY: 2 deep temporal nerves from
anterior division of mandibular nerve
• ACTION:
1. Anterior and posterior fibers elevate the mandible
2. Its posterior fibers retract the mandible
 Temporal fascia
• Covers the temporalis muscle above the
zygomatic arch
• Attached above to the superior temporal
line and below to the upper margin of the
zygomatic arch.
• Deep surface is site of origin for temporalis
muscle.
• The superficial temporal vessels and
auriculotemporal nerve lie upon it
• It is perforated by the deep temporal artery
and vein
 Deep temporal nerves
• Are two in number and arise from the
anterior division of mandibular nerve,
emerge from the upper border of lateral
pterygoid to enter the the deep surface of .
temporalis muscle.
• Accompanied by deep temporal arteries,
branches of the maxillary artery
 Auriculotemporal nerve
• Arises from the post root of trigerminal by 2
roots encircling middle meningeal artery
• Runs backward, deep to neck of mandible,
behind TMJ
• Moves upwards, crossing root of zygomatic
arch between the auricle and the superficial
temporal artery
• Gives sensory branches to skin of auricle,
external auditory meatus, TMJ & parotid gland
• Carries postganglionic parasympathetic
secretomotor fibers from otic ganglion to
parotid gland
MANDIBULAR NERVE
 Superficial temporal artery
• A smaller terminal branch of the external
carotid in the parotid gland.
• Emerges from the upper part of the parotid
gland behind the TMJ
• Crosses root of zygomatic arch infront of the
auricle and the auriculotemporal nerve.
• Ascends onto the scalp and divides into ant
and post divisions.
• Supplies the lateral aspect of the scalp.
 Infra temporal fossa
• Lies deep to the base of the skull.
• Located between the ascending ramus of
the mandible and the side wall of the
pharynx
• Contains the two pterygoid muscles, the
otic ganglion, the mandibular nerve, the
chorda tympani, the pterygoid venous
plexus and the maxillary artery
 INFRATEMPORAL FOSSA
BOUNDARIES:
• Superficial (lateral): Ramus of mandible
• Deep (medial): Lateral pterygoid plate
• Superior: Infratemporal surface of greater
wing of sphenoid
• Anterior: Tuberosity (posterior wall) of
maxilla
• Posteriorly: styloid apparatus and carotid
sheath
• It has no anatomical floor and is continous
with the tissue spaces of the neck
alongside the pharynx and esophagus.
• Contnues thro the posterior and inferior
mediastinum
 INFRATEMPORAL FOSSA
COMMUNICATIONS:
1. With temporal fossa: through a gap deep
to zygomatic arch
2. With cranial cavity: through foramen
ovale, foramen spinosum, foramen
lacerum
3. With orbit: through inferior orbital fissure
4. With pterygopalatine fossa: through
pterygomaxillary fissure
 INFRATEMPORAL FOSSA
CONTENTS:
1. Lateral & medial pterygoid muscles
2. Mandibular nerve & its branches
3. A part of maxillary nerve & 2 of its
branches
4. Otic ganglion
5. Chorda tympani
6. Pterygoid plexus of veins
 MUSCLES OF MASTICATION
1. TEMPORALIS
2. MASSETER
3. LATERAL PTERYGOID
4. MEDIAL PTERYGOID
• They are derived from mesoderm of 1st
branchial arch
• They originate from temporal or
infratemporal fossa
• They are inserted into ramus of mandible
• They are supplied, through their deep
surfaces by branches of mandibular nerve
• They act on temporomandibular joint
MUSCLES OF MASTICATION
MUSCLES OF MASTICATION
 LATERAL PTERYGOID
• ORIGIN:
1. Upper head: infratemporal surface of greater wing of
sphenoid
2. Lower head: lateral surface of lateral pterygoid plate
• INSERTION: pterygoid fovea (in front of neck of mandible)
+ capsule & articular disc of TMJ
• NERVE SUPPLY: from anterior division of mandibular
nerve
• ACTION:
1. Pulls the condylar process forward to depress the
mandible
2. Protrusion of mandible (when muscles on both sides act
together)
3. Side-to-side movement (when muscles on both sides act
alternatively)
 MEDIAL PTERYGOID
• ORIGIN:
1. Superficial head: tuberosity of maxilla
2. Deep head: medial surface of lateral pterygoid plate
• INSERTION: medial surface of ramus & angle of
mandible
• NERVE SUPPLY: from trunk of mandibular nerve
• ACTION:
1. Elevation of mandible
2. Protrusion of mandible (when muscles on both sides
act together)
3. Side-to-side movement (when muscles on both sides
act alternatively)
 ALL MUSCLES OF
MASTICATION
Elevate mandible EXCEPT
• Lateral pterygoid

Protrude mandible EXCEPT

• Temporalis

Are supplied by anterior division of

mandibular nerve EXCEPT
• Medial pterygoid
MANDIBULAR NERVE
INFRATEMPORAL FOSSA
Mandibular nerve
 MANDIBULAR NERVE
• COMPOSITION:
• Formed of 2 roots:
roots motor & sensory

• ORIGIN:
• Sensory root: peripheral processes
of cells of trigeminal ganglion in the
middle cranial fossa
• Motor root: axons of cells of motor
nucleus of trigeminal nerve in pons
 MANDIBULAR NERVE
• COURSE:
• Both roots emerge separately through
foramen ovale to infratemporal fossa
• The 2 roots unite, below foramen ovale
• The nerve soon divides into a small
anterior & a large posterior division
 MANDIBULAR NERVE
• RELATIONS:
1. Superficial: lateral pterygoid
2. Deep: otic ganglion separated from it
by tensor veli palatini muscle
3. Posterior: middle meningeal artery
 BRANCHES FROM TRUNK
OF MANDIBULAR NERVE
• One motor: Nerve to medial pterygoid:
supplies medial pterygoid & gives off 2
branches that pass through otic
ganglion (without relay) & supply
tensor palati & tensor tympani muscles
• One sensory: meningeal branch
(nervus spinosus) passing through
foramen spinosum to supply meninges
of middle cranial fossa
 BRANCHES FROM ANTERIOR
DIVISION OF MANDIBULAR NERVE
Four branches
Three motor:
• Masseteric nerve: emerges through upper
border of lateral pterygoid & turns along
mandibular notch to reach masseter
• Deep temporal nerves: emerge through upper
border of lateral pterygoid
• Nerve to lateral pterygoid
One sensory:
• Buccal nerve: emerges between the 2 heads of
lateral pterygoid, supplies skin & mucous
membrane overlying buccinator
 BRANCHES FROM POSTERIOR
DIVISION OF MANDIBULAR NERVE
Four branches
Three sensory:
Auriculotemporal nerve:
• Arises by 2 roots encircling middle
meningeal artery
• Runs backward, deep to neck of mandible
• Gives sensory branches to skin of auricle,
temple, TMJ & parotid gland
• Carries postganglionic parasympathetic
secretomotor fibers from otic ganglion to
parotid gland
 BRANCHES FROM POSTERIOR
DIVISION OF MANDIBULAR NERVE
Lingual nerve:
• Emerges through lower border of lateral
pterygoid then superficial to medial pterygoid
• Joins chorda tympani
• Runs just below 3rd molar tooth (dangerous
position because it is only covered by muscous
membrane)
• Runs superficial to hyoglossus & is connected
to submandibular ganglion by 2 roots
• Carries general sensations from anterior 2/3 of
tongue
 BRANCHES FROM POSTERIOR
DIVISION OF MANDIBULAR NERVE
Inferior alveolar nerve:
• Emerges through lower border of
lateral pterygoid then superficial to
medial pterygoid, behind lingual nerve
• Passes through mandibular foramen &
canal to supply lower teeth
• Emerges through mental foramen as
mental nerve supplying skin of lower
lip & chin
 BRANCHES FROM POSTERIOR
DIVISION OF MANDIBULAR NERVE
One motor:
Mylohyoid nerve:
• A branch of inferior alveolar nerve just above
mandibular foramen, pierces
sphenomandibular ligament, runs on the
mandible above insertion of medial pterygoid.
• Passes in mylohyoid groove of mandible
• Supplies mylohyoid & anterior belly of
digastric muscles
RELATIONS OF LATERAL
PTERYGOID
 RELATIONS OF LATERAL
PTERYGOID
• Superficial: temporalis, masseter, ramus of
mandible, maxillary artery, buccal nerve
• Deep: medial pterygoid, mandibular nerve,
middle meningeal artery, otic ganglion
• Emerging through its upper border: deep
temporal & masseteric nerves
• Emerging through its lower border: lingual &
inferior alveolar nerves + maxillary artery
• Emerging between its 2 heads: buccal nerve,
maxillary artery
 Otic ganglion
• A small parasympathetic ganglion, anatomically
associated with the trigerminal nerve but functionally
associated with the glossopharyngeal nerve
• Located just below foramen ovale, medial to the
mundibular nerve and lateral to tensor veli palatini,
fixed to the nerve to medial pterygoid
• Preganglionic fibers from inferior salivatory nucleus
carried by lesser petrosal nerve
• Post ganglionic fibers reach parotid gland via
auriculotemporal nerve
 Maxillary artery
• Larger terminal branch of external carotid in
the parotid gland
• Runs between the neck of mandible and
spenomandibular ligament. Here the
auriculotemporal nerve lies above it, and
the maxillary vein below it. It runs either
superficial or deep to lateral pterygoid,
leaves infratemporal fossa to enter
pterygopalatine fossa.
• Has three parts, each with five branches
• 1st part is below lateral pterygoid, 2nd part
behind lateral pterygoid and 3rd part above
lateral pterygoid.
 Branches of the 1 part st

All bony namely;

• Inferior alveolar artery: enters mandibular foramen to
supply lower teeth, lips and chin
• Middle meningeal artery: enters foramen spinosum to
supply meninges
• Accessory meningeal artery: enters foramen ovale to
supply dura in middle cranial fossa
• Deep auricular temporal artery: supplies external
acoustic meatus
• Anterior tympanic artery: supplies tympanic membrane.
 2 part of maxillary artery
nd

5 in number
• All supply soft tissues
• Are distributed to medial pterygoid, lateral
pterygoid and temporalis muscle
• The other two accompany the lingual
nerve and the long buccal nerve.
 3 part
rd

• Divides in the pterygopalatine fossa

• Gives off five branches that accompany
the branches of the pterygopalatine
ganglion. These are: nasopalatine,
anterior palatine, pharyngeal, middle and
posterior palatine arteries.
• These are distributed to the nose and the
palate.
 Pterygoid venous plexus
• A venous plexus associated with the
pterygoid muscles
• Receives veins that correspond to
branches of the maxillary artery
• Its posterior end is drained by the
maxillary vein
• Communicates with the facial vein through
the deep facial vein.
 Chorda tympani
• A branch of the facial nerve in the temporal
bone.
• Enters temporal fossa through the
pterygotympanic fissure, runs downwards
and forwards to join the lingual nerve
• Carries parasymapathetics to the sublingual
and submandibular salivary glands
• Carries taste fibers to ant 2/3 of the tongue.
 Parotid gland
• Largest of the three paired glands.
• Triangular in shape with the apex posterior
to the angle of the mandible..
• Between mandible and
sternocleidomastoid muscle.
• Wrapped in fibrous capsule.
• Posseses a parotid duct which is about
5cm long and 5mm in diameter.
• The duct passes horizontally to the
anterior edge of the gland , turns medially
at the anterior border of the masseter
muscle, it then pierces the buccinator
muscle to enter the oal cavity opposite the
second maxillary molar.
 Histology of the gland
• Consists exclusively of serous cells which
produce a thin watery secretion rich in
enzymes and antibodies.
• These cells are grouped into secretory units
( clusters of cells) known as serous acini.
• Acini are lined by luminal cells, which are
enclosed by myoepithelial cells .
• Acini are then grouped into lobules which are
bounded by connective tissue.
Histology
1-serous secretory units (acini), 2-intercalated excretory duct, 3-striated
excretory duct, 4-interlobular excretory duct, 5-inter lobular connective

tissue .
Duct system
 Relations
• Superficial: Parotid lymph nodes, fascia,
greater auricular nerve and skin.
• Superiorly: external auditory meatus,
temporal mandibular joint.
• Posteromedially: mastoid process,
sternocleidomastoid, posterior belly of
digastric muscle,styloid process, carotid
sheath(internal jugular vien, internal carotid
artery,vagus nerve,facial nerve, accessro
and hypoglossal nerve).
 Relations contd
• Anteromedial: posterior border of ramus of
mandible, pharynx, masseter and
pterygiod muscles.
 Parts of the gland
• Divided into superficial and deep parts by facial
nerve
• In addition has a glenoid process, facial process
and pterygoid process
• Glenoid process extends posterior to TMJ in the
mandibular fossa
• Facial process extends anteriorly infront of the
masseter
• Pterygoid process extends forward btn medial
pterygoid and mandibular ramus.
 Structures in the parotid gland
• From superficial to deep
1)The facial nerve
2)The retromandibular vein
3)The external carotid artery
 Facial nerve
• Emerges from the stylomastoid process
and enters the posteromedial part of the
gland
• Gives off a muscular branch to the post
belly of digastric, and the post auricular
nerve before entering the gland.
• Divides the gland into a superficial and
deep part.
• Lies superficial to the retromandibular vein
and external carotid artery
• Ends by giving off the five branches to
supply the muscles of facial expression;
frontal, zygomatic, buccal, mandibular and
cervical nerves
• Pathologies of the parotid gland are a
common cause of facial nerve palsy
 Retromandibular vein
• Formed in substance of the gland as a
union of the maxillary vein and the
superficial temporal vein. Divides into an
anterior and posterior division.
• Anterior division joins facial vein
• Posterior division joins posterior auricular
vein to form the external jugular vein.
 External carotid artery
• Enters the gland deep to the posterior
belly of digastric.
• At the level of the neck of the mandible,
divides into the maxillary artery and the
superficial temporal artery
Blood supply, nerve supply and
lymphatic drainage
• External carotid artery and its terminal
branches.Veins drain into retromandibular
vein and in-turn to the internal jugular.
• Lymphatics; parotid nodes and in-turn to
deep cervical nodes.
• Nerve supply; parasympathetics (secretor
motor) through glossalpharyngeal nerve.
• Sympathetics reach the gland along the
external carotid.
 Clinical correlates
• Parotid gland surgery causing damage to
the facial nerve.
• Can be infected through blood stream
(mumps/ epidemic parotiditis) which is a
viral infection. Viral inflammation causes
swelling which is resusted by the
inextensible capsule which is worse during
chewing. The duct can also be infected.
• Stones (calcus): bolus of infections or
inflamed tissue can block duct and dilate it
causing infection of gland.
Sialolithiasis
Parotitis
THE END