2nd year

2022 Temporal fossa

The temporal fossa is the region on the side of the head (the space on side of
calvaria) above the external ear canal, which is covered by the temporalis
muscle. The side of the head anterior and superior to the ear is commonly
called the temple. The skin, fascia, and portions of the extrinsic muscles of the
ear in this region overlie the deeper fan-shaped temporalis muscle that
L8 H. ANATOMY
attached to the bones of the temporal fossa. Superiorly, this fossa is bounded
DR. Natheer Ayed by the superior temporal line, whereas its inferior boundary is the zygomatic
arch, even though the temporalis muscle extends inferiorly below this arch
into the infratemporal fossa.fig.1

FIGURE 1: Temporal fossa

The floor of the temporal fossa is formed by the bones of the side of the head that is portions of the frontal,
sphenoid, temporal, and parietal bones.
The inferior and superior temporal lines begin at the Zygomatic process of the frontal bone and arch
posteriorly over the parietal bone before descending to the temporal bone and blending into the zygomatic
process of temporal bone.
The tough fascia covers the temporalis muscle is called temporalis fascia attaching superiorly to the superior
temporal line. Inferiorly, the fascia splits into two layers, which attach to the lateral and medial surfaces of
the zygomatic arch. The temporal fascia also tethers the zygomatic arch superiorly.
When the powerful masseter muscle, which is attached to the inferior border of the arch, contracts and exerts
a strong downward pull on the zygomatic arch, the temporal fascia provides resistance. Fig.2
Boundaries: fig.3
a. Posterosuperiorly: superior temporal line.
b. Inferiorly: infratemporal crest.
c. Anteriorly: frontal process of zygomatic bone and zygoma.
d. Laterally: zygomatic arch.
e. Floor: formed by 4 bones: frontal, parietal, temporal, and sphenoid forming pterion which is thinnest
part of the lateral wall of the skull where the anteroinferior corner of the parietal bone articulates with
the greater wing of the sphenoid. Clinically, the pterion is an important area because it overlies the
anterior division of the middle meningeal artery and vein.
Contents:
Temporalis muscle, deep temporal nerves and vessels, auriculotemporal nerve, superficial temporal
vessels. And temporalis fascia which have important clinical significantFig.4
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 FIGURE 2: layers of temporal fossa

FIGURE 3: Boundaries of temporal fossa

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 FGURE 4:

Infratemporal fossa fig.5

o The infratemporal fossa is an irregularly shaped space deep and inferior to the Zygomatic arch, deep
to the ramus of the mandible and posterior to the maxilla (Deep lateral region of face).
o The pterygomaxillary fissure is a vertical fissure that lies within the fossa between the pterygoid
process of the sphenoid bone and back of the maxilla. It leads medially into the pterygopalatine fossa.
o The inferior orbital fissure is a horizontal fissure between the greater wing of the sphenoid bone and
the maxilla. It leads forward into the orbit.
o Superiorly, the fossa is limited by the infratemporal surface of the greater wing of the sphenoid bone
and the very anteroinferior-most portion of the squamous part of temporal bone. The bony ridge
extending across these two bones, known as the infratemporal crest, delineates the superior-most
extent of the roof of the fossa.

FIGURE 5: infratemporal fossa

The Boundaries: fig.6
• Laterally: the ramus of the mandible.
• Medially: the lateral pterygoid plate.
• Anteriorly: the posterior aspect of the maxilla.

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 • Posteriorly: the tympanic plate and the mastoid and styloid processes of the temporal bone.
• Superiorly: the inferior (infratemporal) surface of the greater wing of the sphenoid.
• Inferiorly: where the medial pterygoid muscle attaches to the mandible near its angle.

FIGURE 6: boundaries of infratemporal

fossa

Communications:
The infratemporal fossa communicates with the temporal fossa as the temporalis muscle descends from
its origin in the temporal fossa to be inserted onto the coronoid process of the mandible.
Nerves and vessels supplying the temporalis muscle pass from the infratemporal fossa to the temporal
fossa to pierce the deep surface of this muscle. Fig.7
Two foramina open onto its roof on the medial aspect of the infratemporal region of the greater wing of
the sphenoid:
1- The larger of the two, the foramen ovale, transmits the mandibular division of the trigeminal nerve
exiting from the cranial vault and the accessory meningeal artery proceeding to the cranium.
2- The smaller foramen, the foramen spinosum, lies between the foramen ovale and the spine of the
sphenoid. It transmits the middle meningeal artery and the recurrent meningeal nerve from the fossa
into the cranium.

FIGURE 7: 7 opening of infratemporal fossa

The fossa communicates with the orbit at its most superoanterior aspect via the inferior orbital fissure
between the maxilla and the greater wing of the sphenoid. Through this fissure pass the maxillary division

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of the trigeminal nerve, on its way to the floor of the orbit, as well as the zygomatic branch which arises from
it.
The cleft between the maxilla and the lateral pterygoid plate is the pterygomaxillary fissure communicating
with the pterygopalatine fossa, medially. It is through this fissure that the maxillary artery distributes to the
fossa, eventually to reach the nasal cavity via the sphenopalatine foramen.
Foramina opened in the infratemporal fossa: (summary) fig.7
i. Foramen spinosum: for middle meningeal artery into middle cranial fossa.
ii. Foramen ovale: for mandibular nerve (CN V3) and accessory meningeal artery.
iii. Pterygomaxillary fissure: medial cleft leading into pterygopalatine fossa; for terminal part of maxillary
artery.
iv. Inferior orbital fissure: leads anteriorly into orbit; for zygomatic and infraorbital branches of maxillary
nerve (CN V2), infraorbital artery, and communication between pterygoid plexus and inferior ophthalmic
vein.
Contents fig.8
1. Muscles of mastication (masseter and most of temporalis lie outside of infratemporal fossa)
i. Lower portion of temporalis muscle: passes medial to zygomatic arch to insert on coronoid
process and anterior border of ramus of mandible
ii. Lateral pterygoid muscle: from lateral pterygoid plate and greater wing of sphenoid to
neck of mandible and articular disc of TMJ
iii. Medial pterygoid muscle: from medial surface of lateral pterygoid plate and tuberosity of
maxilla to medial surface of ramus and angle of mandible
2. Mandibular nerve (CN V3) and its branches, chorda tympani, and otic ganglion
3. Maxillary artery
4. Pterygoid plexus

FIGURE 8: content of infratemporal fossa

Muscles of Mastication fig.9

Temporalis
1. Origin: from temporal fascia and temporal fossa from temporal lines to infratemporal crest
2. Insertion: coronoid process and anterior border of ramus of mandible
3. Action: closes jaw, posteroinferior part retracts jaw
4. Innervation: anterior and posterior deep temporal branches of mandibular nerve (CN V3), which curve
around infratemporal crest to pass beneath temporalis
Masseter fig.10
1. Origin:
a. Superficial part: anterior 2/3 of lower border of zygomatic arch.
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 b. Deep part: posterior and medial side of zygomatic arch.
2. Insertion
a. Superficial part: angle and lower lateral surface of ramus of mandible.
b. Deep part: upper lateral surface of ramus.
3. Action: closes the jaw
4. Innervation: masseteric nerve from mandibular nerve (CN V3), which passes over mandibular notch to enter
muscle

Medial pterygoid (internal pterygoid) fig.11

1. Origin: medial surface of lateral pterygoid plate of sphenoid, pyramidal process of palatine and tuberosity of
maxilla
2. Insertion: lower and posterior part of angle and medial surface of ramus of mandible
3. Action: closes jaw with bilateral contraction; helps grinding movements with 1-sided contraction (moving
jaw side to side)
4. Innervation: nerve to medial pterygoid from mandibular nerve (CN V3), which also sends branches to
innervate tensor tympani and tensor veli palatine.

Lateral pterygoid (external pterygoid) fig11

1. Origin
a. Superior head: from inferior surface of greater wing of sphenoid
b. Inferior head: from lateral surface of lateral pterygoid plate
2. Insertion
a. Superior head: articular disc of TMJ
b. Inferior head: pterygoid fovea on neck of mandibular condyle
3. Action: protrudes mandible, opening mouth by drawing mandible and articular disc forward onto articular
tubercle; unilateral contraction moves mandible from side to side, assisting in grinding motion (Note: anterior
belly of digastric, geniohyoid, mylohyoid, and platysma help in opening mouth)
4. Innervation: nerve to lateral pterygoid from mandibular nerve (CN V3)

FIGURE 9: muscle of mastication

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 FIGURE 10: masseter

FIGURE 11: lateral and medial pterygoid muscle posterior view

Clinical significance
• The temporalis muscle can be used as a flap for various deformities. The primary indications for the
temporalis muscle flap are for intraoral, cranial base, and orbital reconstructions. The use of split
temporalis muscle as a sling for the lower eyelid and lip in facial paralysis is another common
indication: some dynamic movement is possible through the V3 branch of the trigeminal nerve. (Also
masseter muscle can be used in patient with facial paralysis). Less common indications are for palate
and maxillary reconstruction.
• TRAUMA TO THE TEMPORAL REGION The bone of calvarium is thinnest in the temporal fossa.
Strong blows to the side of the head may cause a depressed fracture, in which a fragment of bone is
depressed inward to compress or injure the brain. At the pterion, the middle meningeal artery is
easily ruptured following such an injury CAUSING EXTRA DURAL HEMATOMA that compress
the brain and could be fatal if untreated.

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• Benign Masseteric Hypertrophy is a relatively uncommon condition that can occur unilaterally or
bilaterally. Pain may be a symptom, but most frequently a clinician is consulted for cosmetic reasons.
Although it is tempting to point to Malocclusion, Bruxism, clenching, or Temporomandibular joint
disorders, the etiology in the majority of cases is unclear. Diagnosis is based on awareness of the
condition, clinical and radiographic findings, and exclusion of more serious Pathology such as Benign
and Malignant Parotid Disease.

Temporalis muscle flap