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The temporal and infratemporal regions lie on the lateral aspect of the skull, housing muscles and neurovascular structures important in mastication (chewing).
The temporal region contains the temporal fossa, while the infratemporal region lies below the zygomatic arch.
These two spaces are continuous through the gap deep to the zygomatic arch and behind the infratemporal crest of sphenoid.
A shallow depression on the side of the skull above the zygomatic arch.
Boundaries:
Superior: Temporal lines (superior and inferior)
Inferior: Zygomatic arch
Anterior: Frontal and zygomatic bones
Floor: Formed by parts of frontal, parietal, temporal, and sphenoid bones
Roof: Temporal fascia
Contents:
Temporalis muscle
Deep temporal arteries and nerves
Middle temporal artery
Zygomaticotemporal nerve
Superficial temporal vessels
Function: Allows powerful elevation and retraction of mandible through temporalis contraction.
A deep, irregular space below the temporal fossa and behind the maxilla.
Communicates with:
Temporal fossa (above)
Pterygopalatine fossa (medially)
Orbit (anterosuperiorly via inferior orbital fissure)
Boundaries:
Roof: Greater wing of sphenoid (with foramen ovale & spinosum)
Medial wall: Lateral pterygoid plate
Lateral wall: Ramus of mandible
Anterior wall: Posterior surface of maxilla
Posterior wall: Tympanic plate and mastoid process
Contents:
Muscles: Lower part of temporalis, lateral and medial pterygoids
Vessels: Maxillary artery and pterygoid venous plexus
Nerves: Mandibular nerve, chorda tympani, otic ganglion
Function:
Acts as a neurovascular hub for mandibular structures and provides space for jaw movements.
Zygomatic arch: palpable landmark separating temporal and infratemporal regions.
Temporal lines: attachment of temporal fascia and boundary of temporalis.
Pterion: junction of frontal, parietal, sphenoid, and temporal bones — weakest point of skull; fracture here may injure middle meningeal artery → extradural hematoma.
There are four main muscles — all supplied by the mandibular division of the trigeminal nerve (V₃) and acting on the temporomandibular joint (TMJ).
Origin: Temporal fossa and fascia
Insertion: Coronoid process and anterior border of ramus of mandible
Nerve supply: Deep temporal branches (V₃)
Action: Elevates and retracts mandible
Origin: Zygomatic arch
Insertion: Lateral surface of ramus and angle of mandible
Nerve supply: Masseteric nerve (V₃)
Action: Elevates mandible and helps in clenching teeth
Origin: Medial surface of lateral pterygoid plate and maxillary tuberosity
Insertion: Medial surface of angle of mandible
Nerve supply: Nerve to medial pterygoid (V₃)
Action: Elevates mandible; with lateral pterygoid → side-to-side grinding movements
Origin:
Upper head → Infratemporal surface of greater wing of sphenoid
Lower head → Lateral surface of lateral pterygoid plate
Insertion: Neck of mandible, capsule, and articular disc of TMJ
Nerve supply: Nerve to lateral pterygoid (V₃)
Action:
Both muscles acting together → protrude mandible
One side acting → produces contralateral side movement (grinding action)
Definition:
A strong fibrous sheet covering the temporalis muscle, forming the roof of the temporal fossa.
Attachments:
Superiorly: To superior temporal line
Inferiorly: Splits into two laminae attached to lateral and medial margins of zygomatic arch
Anteriorly: Continuous with pericranium and deep fascia of face
Relations:
Superficial surface: Covered by skin, superficial fascia, auriculotemporal nerve, and superficial temporal vessels.
Deep surface: Gives attachment to temporalis muscle and contains fat pad between its two laminae.
Function:
Protects the temporalis muscle and maintains its contour.
Provides origin to superior fibers of temporalis.
Transmits tension during mastication.
Reflection of temporal fascia:
Incise and reflect downward from superior temporal line to zygomatic arch.
Identify the superficial temporal vessels and auriculotemporal nerve.
Exposure of temporalis:
Detach fascia and reflect temporalis muscle to observe its deep surface.
Infratemporal region exposure:
Remove the zygomatic arch and mandibular ramus (by sawing through neck of mandible).
Identify:
Lateral and medial pterygoid muscles
Maxillary artery and branches
Pterygoid venous plexus
Mandibular nerve and its branches
Otic ganglion
Note:
The infratemporal crest of sphenoid separates temporal from infratemporal fossa.
All major structures of mastication can be studied here.
Shape: Short, thick, two-headed muscle — upper and lower heads diverge anteriorly.
Upper head: Infratemporal surface and crest of greater wing of sphenoid.
Lower head: Lateral surface of lateral pterygoid plate.
Insertion: Neck of mandible and capsule of temporomandibular joint (TMJ).
Superficial (Upper Head):
Temporal fascia
Masseter muscle
Temporalis insertion
Deep (Lower Head):
Medial pterygoid (inferomedial)
Maxillary artery and buccal nerve cross between the two heads
Medial:
Tensor and levator veli palatini muscles
Pharyngeal wall
Lateral:
Ramus of mandible
Superior:
Foramen ovale (transmitting mandibular nerve)
Foramen spinosum (middle meningeal artery)
Both sides: Protrude mandible
One side: Moves chin to opposite side (grinding movement)
Shape: Quadrangular muscle forming a mirror image of masseter (on the inner side of mandible).
Superficial head: Maxillary tuberosity and pyramidal process of palatine bone.
Deep head: Medial surface of lateral pterygoid plate.
Insertion: Medial surface of ramus and angle of mandible.
Superficial Surface:
Lateral pterygoid muscle (above)
Maxillary artery and its branches
Inferior alveolar and lingual nerves
Deep Surface:
Tensor veli palatini and superior constrictor of pharynx
Styloglossus and stylopharyngeus (posteriorly)
Lateral:
Ramus of mandible (separating it from masseter)
Medial:
Superior constrictor muscle and pharyngeal wall
Elevates mandible
With opposite lateral pterygoid → side-to-side (grinding) movements
Weakest point on skull (junction of frontal, parietal, sphenoid, temporal bones).
Fracture may rupture anterior branch of middle meningeal artery, causing epidural hematoma.
Rapid intracranial bleeding → compression of brain → emergency surgery required.
Painful restriction of mouth opening due to spasm of medial pterygoid.
Common in tetanus, peritonsillar abscess, or after dental infections.
Excessive opening of mouth may cause the head of mandible to slip anterior to articular tubercle of temporal bone.
The lateral pterygoid contributes to this displacement.
May lead to paralysis of muscles of mastication → jaw deviates to the affected side on opening the mouth.
Infratemporal fossa communicates freely with pterygopalatine fossa, orbit, and cranial cavity.
Deep infections here may spread intracranially through venous channels like the pterygoid plexus.
The maxillary artery is the larger terminal branch of the external carotid artery.
It begins behind the neck of the mandible inside the parotid gland, then runs forward through the infratemporal fossa and enters the pterygopalatine fossa via the pterygomaxillary fissure.
It is divided into three parts based on its relation to the lateral pterygoid muscle:
First (mandibular) part – before the muscle
Second (pterygoid) part – superficial or deep to it
Third (pterygopalatine) part – beyond it, in the pterygopalatine fossa
Supplies the ear, meninges, and lower jaw.
Mnemonic: DAM I A Man
Deep auricular artery
Anterior tympanic artery
Middle meningeal artery
Inferior alveolar artery
Accessory meningeal artery
Supplies muscles of mastication.
Deep temporal arteries (anterior and posterior)
Pterygoid branches
Masseteric artery
Buccal artery
Supplies nasal cavity, palate, and pharynx.
Mnemonic: P-DISI
Posterior superior alveolar artery
Descending palatine artery
Infraorbital artery
Sphenopalatine artery (artery of epistaxis)
Artery of the pterygoid canal
Fracture at the pterion may tear the anterior branch of the middle meningeal artery, causing an epidural hemorrhage.
Bleeding from lower teeth occurs from branches of the inferior alveolar artery.
Bleeding from upper teeth arises from posterior superior alveolar or infraorbital arteries.
Sphenopalatine artery forms Kiesselbach’s plexus (Little’s area), the most common site of epistaxis.
A network of veins around the lateral pterygoid muscle.
Tributaries correspond to branches of the maxillary artery.
Drains into the maxillary vein, which joins the superficial temporal vein to form the retromandibular vein.
Communications:
With inferior ophthalmic vein via the inferior orbital fissure
With cavernous sinus via emissary veins
With facial vein via the deep facial vein
Clinical importance:
Infections from the face may spread through these venous connections to the cavernous sinus, leading to cavernous sinus thrombosis and cranial nerve palsies.
Synovial joint of the condylar variety.
Upper: Articular tubercle and anterior part of mandibular fossa (temporal bone).
Lower: Head of the mandible.
Both surfaces are covered by fibrocartilage instead of hyaline cartilage.
Biconcave fibrocartilaginous disc dividing the joint into upper (gliding) and lower (hinge) cavities.
Allows both rotation and translation movements.
Capsular ligament – encloses the joint, loose above, tight below.
Lateral temporomandibular ligament – reinforces the capsule laterally.
Sphenomandibular ligament – runs from spine of sphenoid to lingula of mandible.
Stylomandibular ligament – from styloid process to mandible.
Pterygomandibular raphe – connects buccinator to superior constrictor (functionally related).
Reflect lateral pterygoid muscle near its insertion.
Dislocate the head of mandible to reveal the articular disc and joint cavities.
Observe the fibrocartilage lining and ligaments.
TMJ dislocation: Mouth opened too wide → head of mandible moves anterior to the articular tubercle.
Subluxation: Partial dislocation due to loose capsule.
Arthritis and clicking jaw: Degeneration or malalignment of articular disc.
Trismus (lockjaw): Spasm of masticatory muscles, often due to infection or tetanus.
Fracture neck of mandible: May injure the auriculotemporal nerve, producing pain and gustatory sweating (Frey’s syndrome).
Largest mixed branch of the trigeminal nerve (V₃).
Nerve of the first branchial arch, supplying all its derivatives.
Associated with otic and submandibular ganglia.
Arises from the trigeminal ganglion by two roots:
Large sensory root
Small motor root
Both roots pass through the foramen ovale and unite just below it.
Lies in the infratemporal fossa, on tensor veli palatini and deep to lateral pterygoid.
Quickly divides into:
Small anterior trunk (mainly motor)
Large posterior trunk (mainly sensory)
Meningeal branch – passes through foramen spinosum with middle meningeal artery.
Nerve to medial pterygoid – gives branches to:
Medial pterygoid
Tensor tympani
Tensor veli palatini
Masseteric nerve – to masseter.
Deep temporal nerves – to temporalis.
Nerve to lateral pterygoid.
Buccal nerve – only sensory branch here; supplies cheek mucosa and skin.
Auriculotemporal nerve – supplies TMJ, auricle, and parotid gland; carries postganglionic parasympathetic fibres from otic ganglion.
Lingual nerve – supplies anterior two-thirds of tongue (general sensation); joined by chorda tympani for taste and secretomotor fibres to submandibular/sublingual glands.
Inferior alveolar nerve – enters mandibular foramen → mandibular canal → supplies lower teeth.
Mylohyoid branch (motor): to mylohyoid and anterior belly of digastric.
Mental branch: to skin and mucosa of lower lip and chin.
Identify middle meningeal artery arising from maxillary artery and follow it up to foramen spinosum.
Note auriculotemporal nerve roots looping around the artery.
Trace lingual and inferior alveolar nerves anterior to the lower part of lateral pterygoid.
Observe chorda tympani joining the lingual nerve.
Lift the main trunk of the mandibular nerve laterally to identify the otic ganglion situated just below the foramen ovale.
Trace all ganglionic connections to auriculotemporal, lesser petrosal, and medial pterygoid nerves.
A small (2–3 mm) parasympathetic ganglion.
Lies in the infratemporal fossa, just below the foramen ovale.
Medial to mandibular nerve, lateral to tensor veli palatini.
Functionally part of the glossopharyngeal nerve, though topographically attached to V₃.
Parasympathetic (secretomotor) root:
From lesser petrosal nerve (branch of glossopharyngeal).
Synapses in the otic ganglion → postganglionic fibres travel via auriculotemporal nerve to the parotid gland.
Sympathetic root:
From plexus on middle meningeal artery (superior cervical ganglion).
Passes through without synapse → vasomotor to parotid.
Sensory root:
From auriculotemporal nerve → sensory to the parotid gland.
Motor root:
From nerve to medial pterygoid → passes through ganglion to supply:
Tensor tympani
Tensor veli palatini
Other communications:
With chorda tympani and nerve of pterygoid canal, allowing an alternative taste pathway from the anterior two-thirds of the tongue.
Testing of mandibular nerve (motor part):
Ask patient to clench teeth → palpate temporalis and masseter.
Paralysis → jaw deviates to the affected side on opening due to unopposed action of opposite lateral pterygoid.
Test pterygoid activity by asking patient to move chin side to side.
Referred pain:
In carcinoma of tongue, pain radiates to ear and temple along the auriculotemporal nerve (branch of V₃).
Since lingual and auriculotemporal nerves are both branches of V₃, irritation of one may cause referred sensation in the other.
Surgical significance:
The lingual nerve may be cut (neurectomy) below and behind the last molar to relieve intractable tongue pain.
Great care is needed to preserve auriculotemporal and facial nerves during operations near TMJ.
“La” → Lateral pterygoid opens mouth (jaw open).
“Me” → Medial pterygoid closes mouth (jaw closed).
Mnemonic: “Buccaneers Are Inferior Linguists”
B – Buccal nerve
A – Auriculotemporal nerve
I – Inferior alveolar nerve
L – Lingual nerve
Mnemonic: “DAM I AM Piss Drunk But Stupid Drunk”
D – Deep auricular
A – Anterior tympanic
M – Middle meningeal
I – Inferior alveolar
A – Accessory meningeal
The mandibular nerve is the only mixed branch of the trigeminal nerve.
It is associated with two parasympathetic ganglia — the otic and submandibular ganglia.
The maxillary artery gives off many branches; some accompany branches of the maxillary nerve, others follow branches of the mandibular nerve, since there is no separate mandibular artery.
The lateral pterygoid is the only muscle of mastication that depresses (opens) the temporomandibular joint.
The spine of sphenoid is related to the chorda tympani and auriculotemporal nerves — injury here affects secretion from three salivary glands (parotid, submandibular, sublingual).
The auriculotemporal nerve and branches of the facial nerve are closely related to the temporomandibular joint.
A patient with carcinoma involving the anterior two-thirds of the tongue complains of pain in the lower teeth, temporal region, and temporomandibular joint.
Why is the pain of the tongue referred to the lower teeth?
Which are the other areas of referred pain?
Sensations from the anterior two-thirds of the tongue are carried by the lingual nerve, a branch of the mandibular nerve (V₃).
In carcinoma, excessive pain impulses travel through the lingual nerve and may get diverted into other branches of the same mandibular nerve, causing referred pain.
The lower teeth are supplied by the inferior alveolar nerve, another branch of V₃, so pain from the tongue is often perceived there.
The mandibular nerve also carries sensory fibers from the temporomandibular joint and temporal region, hence the pain is also referred to these regions.
Referred pain through branches of the mandibular nerve explains why tongue cancers can cause discomfort not only in the tongue but also in jaw, teeth, and temple, misleading early diagnosis unless nerve pathways are understood.
Q1. What is the functional component of the mandibular nerve?
→ It is a mixed nerve, carrying both motor and sensory fibers.
Q2. Which muscles are supplied by the mandibular nerve?
→ All muscles of mastication, plus:
Mylohyoid
Anterior belly of digastric
Tensor tympani
Tensor veli palatini
Q3. What is the only sensory branch in the anterior division of the mandibular nerve?
→ The buccal nerve.
Q4. Which branch of the mandibular nerve carries parasympathetic fibers to the parotid gland?
→ The auriculotemporal nerve (via the otic ganglion).
Q5. What is the nerve supply of the anterior two-thirds of the tongue?
→ Lingual nerve – for general sensation.
→ Chorda tympani (via lingual nerve) – for taste sensation.
Q6. What is the applied importance of the mandibular nerve in tongue carcinoma?
→ Pain from the tongue is referred to lower teeth, temple, and ear due to common sensory pathways through V₃ branches.
Q7. What are the effects of mandibular nerve paralysis?
→ Paralysis of masticatory muscles, causing:
Deviation of jaw toward the affected side on opening.
Weakness in chewing and clenching.
Q8. Which muscle of mastication opens the mouth?
→ Lateral pterygoid.
Q9. What is the location of the otic ganglion?
→ In the infratemporal fossa, just below the foramen ovale, medial to V₃ and lateral to tensor veli palatini.
Q10. Which nerve gives motor supply to the tensor tympani?
→ Nerve to medial pterygoid, through the otic ganglion.
1. The mandibular nerve is:
A. Purely sensory
B. Purely motor
C. Mixed
D. None of the above
→ Answer: C. Mixed
2. The only sensory branch of the anterior division of the mandibular nerve is:
A. Buccal nerve
B. Lingual nerve
C. Auriculotemporal nerve
D. Inferior alveolar nerve
→ Answer: A. Buccal nerve
3. The otic ganglion is functionally associated with:
A. Facial nerve
B. Glossopharyngeal nerve
C. Mandibular nerve
D. Vagus nerve
→ Answer: B. Glossopharyngeal nerve
4. The nerve that carries secretomotor fibers to the parotid gland is:
A. Auriculotemporal nerve
B. Buccal nerve
C. Lingual nerve
D. Inferior alveolar nerve
→ Answer: A. Auriculotemporal nerve
5. The muscle responsible for opening the mouth is:
A. Masseter
B. Medial pterygoid
C. Lateral pterygoid
D. Temporalis
→ Answer: C. Lateral pterygoid
Q1. What is the only mixed division of the trigeminal nerve?
→ Mandibular nerve (V₃).
Q2. Name the parasympathetic ganglia related to the mandibular nerve.
→ Otic ganglion and submandibular ganglion.
Q3. Name the nerve supplying the anterior two-thirds of the tongue.
→ Lingual nerve (for general sensation); chorda tympani via lingual nerve (for taste).
Q4. What happens if the lingual nerve is injured during molar extraction?
→ Loss of all sensations (touch, temperature, taste) from the anterior two-thirds of the tongue.
Q5. What is the jaw-jerk reflex and which nerve mediates it?
→ Stretch reflex of the masseter and pterygoids; both afferent and efferent limbs through the mandibular nerve.
Q6. What happens if there is a lesion at the foramen ovale?
→ Paraesthesia along the mandible, tongue, temporal region, and paralysis of muscles of mastication with loss of jaw-jerk reflex.
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