FACIAL FASCIAS AND TISSUE SPACES

• The Subcutaneous fascia of the face represents a thin loose connective plate
located under the subcutaneous tissue.
• It makes a compartment for the muscles of facial expression and also for
super cial vessels and nerves.
• The location of the muscles of facial expression is not always parallel to the skin
and is not also one layer type, which makes the anatomy of the fascia complex,
especially in the infraorbital region.
• Here are located 4 loose connective fatty layers: Between fascial bed of levator
labi superioris, levator labi superioris alaque nasi levator anguli oris muscle
and periosteum of the maxilla.
• Many fatty layers cause the spread of infections.
• Here may develop phlegmon, which should be complicated by osteomielitis of
inferior margin of orbit and zygomatic bone,maxillary sinusits,from which
infection by anastomoses may spread through the venous sinuses.

H
• The Proper fascia of the face is divided into super cial and deep layers.

ID
• The super cial fascia covers the parotid gland, masseter muscle.

S H
• This fascia is thicker than the deeper one and then passes to the buccal fat pad.
• On the way it makes a compartment for the structures, passes upward, and

AA
attaches to the zygomatic bone and zygomatic arch.
• Inferiorly it is xed to the edge and angle of the mandible.

R
• It surrounds the parotid gland posteriorly and inferiorly and passes to the proper
fascia of the neck.
• The deep layer of the proper fascia or inter pterygoid - muscular fascia
originates from the base of the skull with a line, which passes from the base of
pterygoid process to the spine of sphenoid bone, passes between lateral and
medial pterygoid muscles and attaches with medial pterygoid muscle to the
internal surface of the angle of the mandible.
• On the posterior edge of the ramus of the mandible with super cial layer it is
attached to the periosteum.
• The deep layer of the proper fascia of the face is thickened by sphenomandibular
ligament. (lig spheno-mandibulare).
• Visceral fascia covers the walls of the pharynx externally.

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 • It is separated from the wall of the organ by a thin loose fatty layer, and is xed
on the base of the skull at the level of the attachment of the muscles (on the
bone), sphenomandibular ligament and on the suture of the pharynx (raphe
pharings).
• Prevertebral fascia anteriorly covers the bodies of the vertebra, long muscles of
the head and neck, makes compartment for them.
• It is xed on the base of the skull at the level of the attachment of the muscles
and on the transverse processes of the vertebra.
• The above mentioned fascias make the interfascial spaces, which are bounded

‣ Externally - by the ramus of the mandible

‣ Anteriorly - by tuberosity of the maxilla

‣ Internally - pterygoid process

‣ Superiorly - by the body of a sphenoid bone and greater wing

‣ Inferiorly - medial pterygoid muscle.
• In this space are located interfascial ssures (spaces), which include di erent
thickness of connective tissue and anatomical structures (vessels, nerves, lymph

H
ways).

ID
1. Interfacial-pterygomuscular ssure
• Located between lateral and medial pterygoid muscles covering fascias.

S H
• The third branch of trigeminal nerve (n. mandibularis) passes through this loose
connective tissue, which after leaving the cranial cavity by foramen ovale divides

AA
into branches the thicker ones of which are lingual, inferior alveolar and
auriculotemporal.

R
2. Parotidmasseteric ssure
• It is closed between masseter muscle and ramus of the mandible, with the
membrane located between coronoid process up to condylar process.

‣ Inferiorly and partly posteriorly it is bounded by the area of attachment of

muscle to the mandible.

‣ Superiorly the ssure is opened to the subtemporal connective tissue.

• From parotidmasseteric ssure infection spreads inferiorly to the zygomatic bone
between temporal aponeurouses and temporalis muscle.
3. Pterygo-mandibular or temporo-pterygoid (according to Pirogov) ssure
• It is bounded

‣ Externally - by the ramus of the mandible with temporal muscle

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 ‣ Internally - by the interpterygomuscular fascia with a medial pterygoid
muscle.

‣ Inferiorly - the ssure ends at the level of the attachment of medial pterygoid
muscle - on internal surface of the angle of the mandible.

‣ Superiorly - the ssure spreads to the temporal fossa (the space between a
temporal muscle and periosteum of the temporal bone).

‣ Posteriorly - the pterygo-mandibular ssure is connected to the

retromandibular space by the ssure which is created by the thickened part of
interpterygomuscular fascias and by mandibular synovial process. The
maxillary artery passes through this space.

‣ Anteriorly - the pterygo-mandibular ssure is connected with the buccal

connective tissue by the ssure, which is formed by the anterior edge of the
mandible, body of the maxilla and zygomatic bone.
• The Anterior part of the pterygomandibular space opens in pterygo-palatine
fossa (fossa pterygopalatina) and is connected with the cranial cavity by foramen
ovale.
• The above mentioned spaces provide gates for spreading infections from
pterygomandibular ssure to the connective tissues.

H
• The vessels and nerves of the deep region of the face:

‣ Maxillary Artery
‣ Pterygoid venous plexus

H ID
A
‣ Lingualis nerve S
‣ Inferior alveolar nerve

R A
• All of the above pass through the space of the pterygomandibular ssure
connective tissue.
• All these elemants are wrapped in the interpterygomuscular septas.
• In the Inferior part of the ssure n. alveolaris inferior it moves out of the common
fascia bed with the like-named vessels and passes to the foramen mandibulare.
• The Injection of the anestetic solution near the loose connective tissue of the
foramen mandible causes blocking of the inferior alveolar nerve, whereas the
lingual nerve stays unblocked. In order to block the lingual nerve, anestetic
solution should be injected 1 sm above the mandibular foramen.

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Buccal Region

• The buccal region is bounded

‣ Superiorly - by inferior margin of the orbit

H
‣ Inferiorly - inferior margin of the mandible

H ID
‣ Anteriorly - nasolabial fold

‣ Posteriorly - anterior edge of the masseter muscle.

A S
• The skin is thin, mobile.

R A
• Subcutaneous tissue is well developed.

• Under the skin is located super cial (subcutaneous) fascial laminas, which
covers around located mimic muscles.
• In the connective tissue passes facial artery.
• On anterior margin of the masseter muscle facial artery crosses inferior margin of
the mandible and enters the face region.
• In the face, the artery travels super cially just under the cover of the platysma
muscle.
• It passes via tortuous path deep to the zygomaticus major, risorius and elevator
angulioris muscles to the corner of the mouth.
• Here, it ascends laterally to the nose to terminate as the angular artery at the
medial corner of the eye.
• Branches of the facial artery in the face are the
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 ‣ Inferior labial

‣ Superior labial

‣ Lateral nasal

‣ Angular arteries
• In the face, facial artery by anastomoses is communicated to the transverse
facial artery (branch of super cial temporal artery), infraorbital artery (branch of
maxillary artery) and buccal artery (branch of maxillary artery).
• The projection line of the facial artery on the face-on the line passing from the
intersection point between anterior margin of the masseter muscle and inferior
margin of the mandible to the internal corner of the orbit ssure.
• The facial vein serves as the principal venous vessel of the super cial face.
• It begins in the medial corner of the eye as the angular vein and passes inferiorly,
following the course of the facial artery deep to the zygomaticus major and
zygomaticus minor muscles, from the face it enters submandibular triangle, when
it leaves the triangle connects the posterior retromandibular vein, and in carotid
triangle empty into the internal jugular vein.
• The facial vein in the deep region of the face communicates with ophthalmic

H
veins, both of which present possible passageways to the cavernosus sinus due
to lack of directional valves.

H ID
• Lymph vessels of the buccal region follows facial vein and empties into the
submandibular, parotid, deep cervical lymph nodes.

A S
• The facial nerve branches passes into the deep layer of the subcutaneous tissue
and enter mimic muscles by it's internal surface.

R A
• The skin is innervated by

‣ Infraorbital nerve (Il branch of the trigeminal nerve)

‣ Buccal nerve
‣ Mental nerve (III branch of the trigeminal nerve).
• In the super cial layer, in proper fascial layer, is located buccal fat pad, which
processes are passed to temporal, pterygopalatine and orbit regions.
• Poor vascularization of the buccal fat pad provides it keeping during the body's
general dieting.
• The buccal region is crossed by the branches of the facial nerve.
• On the buccal muscle are located a. buccalis (branch of maxillary artery), buccal
vein and nerve.

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• Under the buccal fat pad is located buccopharyngeal fascia, which covers
buccinators muscle and posteriorly passes to the lateral wall of the pharynx.
• The buccinator originates on the maxilla and mandible, speci cally on the buccal
surfaces of the alveolar processes in the vicinity of the three molars, and from the
pterygomandibular raphe, a collagenous tendineus inscription attached to the
pterygoid hamulus and the mylohyoid line of the mandible.
• The raphe is interposed between the buccinators and superior pharyngeal
constrictor muscle.
• The buccinator inserts into the essy corner of the lip in such a fashion that the
upper fascicles and the lower fascicles decussate at the corner of the mouth and
insert into the lower and upper lips, respectively, becoming bers of the
orbicularis oris.
• The highest and lowest fascicles, however, continue without decussation into the
upper and lower lips, respectively.
• The buccinators muscle acts to press the mucosa of the cheek against the teeth,
thus aiding in mastication and deglutition.
• In addition, it assists in distending the oral vestibule and forcefully expelling air,
as in blowing dust particles o a surface.

H
• The buccal branch of the facial nerve innervates the muscle.

Parotidomasseteric region

H ID
A S
R A

• Parotid region is bounded

‣ Superiorly - by zygomatic arch

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 ‣ Inferiorly - inferior edge of body of the mandible

‣ Anteriorly - anterior edge of the masseter muscle

‣ Posteriorly - external acoustic meatus and anterior edge of the

sternocleidmastoid muscle.
• Ramus of the mandible separates it from deep region of the face.
• Anterior part of the region is composed of masseter muscle, posterior part by
parotid gland.
• In the area of the masseter muscle under the skin is located

‣ Buccal branches of the facial nerve

‣ Parotid duct
‣ Transverse artery and vein of the face (which leaves parotid gland and passes
transversly anteriorly).

H
H ID
A S
R A
• Masseter muscle is covered by masseter fascia, which

‣ Anteriorly - connects to the fascial bed of the buccal fat pad

‣ Posteriorly - it passes to the parotid fascia

‣ Superiorly - is attached to the zygomatic arch

‣ Inferiorly - to the angle of the mandible.

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• Masseter muscle originates from zygomatic arch, and inserts upon the angle and
ramus of the mandible.
• Between masseter muscle and ramus of the mandible is located loose
connective tissue space, which superiorly passes to the space located between
temporal fascia and temporalis muscle (Ill temporal connective space), but
medially by incisuramandibularis.
• Incisuramandibularis is communicated to the deep region of the face.
• By incisura mandibularis from deep region of the face in the masseter muscle
passes masseter artery, vein and nerve.

H
H ID
A S
• Parotid gland (glandula parotis) lies in retromandibular fossa, which is bounded

R A‣ Anteriorly - by masseter muscle, posterior edge of the ramus of the mandible

and medial pterygoid muscle.

‣ Superiorly - external acoustic meatus

‣ Posteriorly - mastoid process and sternoocleidmastoideus muscle

‣ Inferiorly - posterior belly of digastric muscle.

• Medially to the fossa is located styloid process (processus styloideus) and from it
originating stylohyoid, styloglossal and stylopharyngeal muscles (mm.
stylohyoideus, styloglossues, stylopharyngeus).
• The parotid gland somewhat extends around the retromandibular fossa.
• Sometimes superiorly it extends above zygomatic arch, inferiorly extends below
the angle of the mandible, anteriorly extends over the masseter muscle and
covers its posterior part.
• Medially it gives of process, which can reach the wall of pharynx.
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• The parotid fascia (fascia parotidea) forms the capsule for the gland.
• At the superior part of the gland fascia is lique ed and sometimes is completely
disappeared, but on medial aspect it has defect, by which process of the gland
passes through the lateral space of the pharynx.
• That's why during purulent parotitis infection may pass around external acoustic
meatus connective space and through the lateral space of the pharynx.
• The capsule of the gland is so closely attached to the gland, that it is technically
impossible intracapsule (subcapsular) excision.
• Structures passing in the parotid gland are

‣ Last part of external carotid artery

‣ Retromandibular vein
‣ Facial nerve
‣ Auricotemporal nerve
• In the gland under the capsule is located lymph nodes.
• In the parotid gland from external carotid artery arises super cial temporal
artery, which passes to the temporal region, and maxillary artery which passes to
the deep region of the face.

H
ID
• In the parotid gland from super cial temporal artery arises transverse facial
artery.

H
• The Retromandibular vein is located with external carotid artery in the gland.

S
A
• It is formed by junction of parotid, maxillary, transverse facial, super cial
temporal, middle and deep veins.

R A
• Retromandibular vein connects the facial vein at the area of angle of the
mandible.
• The facial nerve exits from the cranial cavity through the stylomastoid foramen
and passes through the parotid gland and divides into the branches which
connects one another and form plexus - plexus parotideus.
• It is located 1-2 cm deeply the gland.
• There are ve group branches of the facial nerve:
1. Temporal branches (rami temporales) passes anteriorly and superiorly to the
frontal belly of calvaria.
2. Zygomatic branch (rami zygomatici) innervates zygomatic and muscle around
the eye.

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3. Buccal branches (rami buccales) passes inferiorly to the zygomatic arch- to
the muscles around the mouth.
4. Marginal mandibular branch (ramus marginalis mandibulae) passes
anteriorly-along the edge of the mandible, to the muscles of the chin.
5. Cervical branch (ramus colli) passes to the neck region.
• Disorder of the facial nerve cause paralysis of the muscles of facial expression.
• Auricotemporal nerve arises from mandibular nerve below foramen ovale (in the
deep region of the face), where it divides into two branches, surrounds the
middle meningial artery and again becomes as one branch.
• Then nerve passes posteriorly to the condyle process of the mandible and in the
parotid gland connects the facial nerve by the branch, gives branches to the
external acoustic meatus and parotid gland, then with super cial temporal artery
it enters the temporal region.
• The skin of the lateral region of the face is innervated by branches of the
ophthalmic, maxillary and mandibular nerves.
• The parotid duct (ductus parotideus) passes anteriorly, super cial to the
masseter muscle to dive medially into the buccal fat pad: it pierces the
buccinator muscle on it's way to the oral vestibule.

H
• It delivers the parotid salivary secretions at the opening of the parotid papilla

ID
located opposite the second maxillary molar.

H
• Projection point of the parotid duct on the skin is in the midpoint of line which
passes from tragus of ear to the nasal wing.

S
AA
The Deep region of face

R
• The base of the deep face are

‣ Maxilla
‣ Mandible
‣ Pterygoid process of sphenoid bone
‣ Pterygoid muscles (Medial and lateral pterygoid muscles)
• Deep face is the portion of the side of the head located deep to the mandible
and zygomatic arch in infratemporal fossa, which is bounded

• Laterally - by the ramus and coronoid process of the mandible

• Medially - by the lateral pterygoid plate of the sphenoid bone and lateral wall
of the pharynx

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 • Superiorly - limited by the greater wing of the sphenoid bone

• Anteriorly - maxilla

• Posteriorly - capsule of the parotid gland

• Inferiorly - passes to the angle of the mandible.

H
H ID
A S
• Medially the region is communicated to the pterygopalatine fossa, Superiorly - to
the temporal fossa, inferiorly - to the medial triangle of the neck.

R A
• The temporal fossa is the region on the side of the head 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 attached to the bones of the
temporal fossa.
• Superiorly, this fossa is bounded by the superior temporal line, wheras its inferior
boundary is arbitrarily designated to be the zygomatic arch even though the
temporalis muscle extendes inferiorly below this arch into the infratemporal
fossa.
• The oor of the temporal fossa is formed by the bones of the side of the head -
portions of the frontal, sphenoid, temporal, and parietal bones.

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 • The superior-must extent of the origin of the temporalis muscle and its fascia
marks these bones with the inferior and superior temporal lines, respectively.
• These 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 processs of this bone.
• There are two connective tissue spaces in the deep face.

‣ Between temporal muscle and lateral pterygoid muscle (spatium temporo

pterygoideum)

‣ Between lateral and medial pterygoid muscles. (spatium interpterygoideum).

• In rst passes maxillary artery and pterygoid venous plexus
• In second the inferior alveolar and lingual nerves (branches of the mandibular
nerve)

Vascular Supply
• Structures of the deep face receive their vascular supply from branches of the
maxillary artery.

H
• The vascular supply to the entire region of the deep face is provided by branches

ID
of the maxillary artery along with a small contribution from the middle temporal
artery to the superior surface of the temporalis muscle.

S H
• The maxillary artery, a terminal of the external carotid artery, courses deep to
the mandible and passes through the parotid gland.

AA
• The artery is described as consisting of three portions and terminates as several
branches within the pterygopalatine fossa.

R
• The Maxillary artery, the larger of two terminals of the external carotid artery,
arises from that artery deep to the neck of the mandible embeded within the
subastence of the parotid gland.
• The artery immediately turns anteriorly, passing between the mandibular ramus
and the sphenomandibular ligament on its way to the pterygopalatine fossa,
where it subsequently divides into terminal branches.
• Along its course to that fossa, it provides branches to the ear, TMJ, meninges,
muscles of mastication, teeth and supporting structures of the mandible,
buccinator muscle, cheek, and mucous membrane of the mouth.
• Terminals, branching from the artery while it as within the pterygopalatine fossa,
serve the teeth and supporting tissues of the maxilla, the nasal cavity, and the
palate.

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• The major terminal enters the oor of the orbit as the infraorbital artery, which
eventually exits upon the face.
• The following discussing is con ned mostly to descriptions of the artery and its
branches supplying the structures of the deep face.
• Excluding a few exceptions, the terminal branches have been or will be detailed
in the appropriate chapters.
• The maxillary artery is described as consisting of three segments as it courses
through the

‣ Mandibular region

‣ Pterygoid region

‣ Pterygopalatine region
• The mandibular portion of the maxillary artery (located deep to the mandibule)
sends branches to the meninges, to the mandibular teeth, mylohyoid muscle,
and supporting tissues, and to the lower lips as well as to the chin to
anastomose with branches from other sources.
• The mandibular portion runs behind the mandible between the ramus and the
sphenomandibular ligament.

H
• Branches arising from this portion include the deep auricular and anterior

ID
tympanic arteries.

H
• Arising also from this portion are the middle and accessory meningeal
arteries.

A S
• Both of these arteries ascend to enter the skull via the foramin spinosum and
foramen ovale, respectively.

R A
• Another artery arising from this portion of the maxillary artery is the inferior
alveolar artery, which gives rise to the mylohyoid artery just before entering the
mandibuar foramen.
• The mylohyoid artery courses along the mylohyoid groove to the mylohyoid
muscle, supplies.
• Within the mandibular canal, the inferior alveolar artery supplies the bone,
teeth, and adjacent supporting structures as far anteriorly as the rst premolar
tooth, where it divides no an incisive branch and a mental branch.
• The incisive branch continues on to vascularize the anterior teeth and supporting
structures.
• The mental branch exists the mandible through the mental foramen onto the face
to anastomose with the inferior labial and submental arteries vascularizing the
area of the chin.

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 • Occasionally, a lingual artery may arise from the inferior alveolar artery near its
origin from the mandibular portion of the maxillary artery.
• When present, this artery will descend to assist in vascularizing the mucous
membrane of the mouth.
• The pterygoid portion of the maxillary artery vascularizes the muscles of
mastication and the buccinators muscle.
• The course of this portion of the artery is not constant, since it may pass either
super cial of deep to the lateral pterygoid muscle.
• The masseteric artery, arising from this portion of the maxillary artery, passes
through the mandibular notch to enter the masseter muscle.
• The anterior and posterior deep temporal arteries accompany the like-named
nerves to enter the deep surface of the temporalis muscle, anastomosing with
the middle temporal branch of the super cial temporal artery.
• The pterygopalatine portion of the maxillary artery enters the pterygopalatine
fossa via the pterygomaxillary ssure.
• As the vessel enters the fossa to terminate into several arteries, the posterior
superior alveolar artery arises from it and descendes over the maxillary
tuberosity to enter the posterior superior alveolar foramen with the like-named
nerve.
H
ID
• This artery vascularizes the molar and premolar teeth, adjacent supporting
tissues, and the maxillary sinus.

H
A S
R A
Pterygoid Plexus and Maxillary Vein
• The pterygoid venous plexus lying on the surfaces of pterygoid muscles and
within spaces of the deep face receives tributaries from a number of sources,
including all of the venous branches that accompany the named branches of the
maxillary artery.
• The pterygoid plexus of veins is a massive network of venous channels lying on
and about the surfaces of the lateral and medial pterygoid muscles and
extending into the spaces of the deep face within the infratemporal fossa.
• The plexus receives venous tributaries from vessels corresponding to the named
arteries branching from the maxillary artery.
• This plexus is in direct or indirect communication with a vast area, including the

‣ Cranial cavity and cavernous sinus

‣ Nasal cavity
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 ‣ Orbit
‣ Paranasal sinuses
‣ Facial vein
‣ Deep facial veins
‣ Angular veins
• The maxillary vein is the short venous trunk that accompanies the maxillary
artery as it lies behind the mandible.
• This vein serves to connect the pterygoid venous plexus with the super cial
temporal vein, thus forming the retromandibular vein.

Innervation
• Most of the sensory innervations and all of the motor innervations to the
structures of the deep face are supplied by branches of the mandibular division
of the trigeminal nerve.
• Trigeminal Nerve (cranial nerve V) has three divisions:

H
‣ Ophthalmic

ID
‣ Maxillary
‣ Mandibular

S H
• Most of the structures of the deep face are supplied by branches of the
mandibular division, with only a small contribution from the maxillary division.

AA
• The mandibular division of the trigeminal nerve is the only division that contains
both sensory and motor components.

R
• The two unite outside the foramen ovale to form the trunk of the mandibular
nerve.
• The mandibular division of the trigeminal nerve exits the cranium via the foramen
ovale.
• Motor and sensory roots pass individually through the foramen before uniting
into a trunk within the infratemporal fossa.
• The trunk is very short and it divides into two major divisions.

‣ Anterior division
‣ Posterior division
• The anterior division is mostly motor with some sensory branches, wheres the
posterior division is mainly sensory with some motor branches.
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• Two branches arises from the trunk: the meningeal branch and the medial
pterygoid nerve.
• The meningeal branch re-enters the cranial cavity through the foramen
spinosum in company with the middle meningeal artery.
• Within the cranial cavity, it provides sensory innervations to the dura mater.
• The medial pterygoid nerve arises from the medial aspect of the trunk, passing
through the adjacent otic ganglion on its way to the medial pterygoid muscle.
• Two small branches arises from the medial pterygoid nerve close to its origin and
are named; The nerve to the tensor tympani and the nerve to the tensor veli
palatine.
• The former passes to the auditory tube and on to the same-named muscle in the
middle ear cavity.
• The latter nerve enters the tensor veli palatine muscle near its origin.

Anterior Division
• The anterior division of the mandibular nerves (mostly motor) innervates all of the

H
muscles of mastication except the medial pterygoid muscle.

ID
• It also contains sensory nerves to the skin and mucous membranes of the cheek.
• The anterior division of the mandibular nerve provides motor innervations to all

S H
the remaining muscles of mastication (with the possible exception of the
sphenomandibulars muscle).

AA
• Arising from this division are
1. The masseteric nerve passes superior to the lateral pterygoid muscle and

R then laterally to the mandibular notch, sending a twig to the TMJ before gaining
access to the deep portion of the masseter muscle.
2. The deep temporal nerves, usually an anterior and posterior (sometimes an
intermediate also), ascend between the two heads of the lateral pterygoid
muscle to enter the deep surface of the temporalis muscle. Occasionally, these
nerves may arise from either the masseteric of buccal nerves.
3. The lateral pterygoid nerve enters the deep surface of the muscle lying over
it.
4. The buccal nerve passes between the two heads of the lateral pterygoid
muscle and then continues anteriorly beyond the border of the massseter
muscle as it forms a plexus on the surface of the buccinator muscle. Here it
freely communicates with the facial nerve, sending sensory branches with the
facial nerve to supply the skin over the cheek. The nerve then pierces the

Page 16 of 20
 muscle to provide sensory innervations to the mucous membrane of the cheek
and adjacent gingiva.

Posterior Division
• The posterior division of the mandibular nerve possesses only one motor nerve -
mylohyoid nerve, which serves the mylohyoid muscle and anterior belly of the
digastric muscle.
• Sensory components serve the meninges, the TMJ, mandibular teeth and
supporting tissues, skin of the temple region, ear and tympanic membrane, and
anterior two thirds of the tongue.
• It also communicates with the facial and glossopharyngeal nerves.
• Arising from this division are
1. The auriculotemporal nerve arises from the posterior division of the
mandibular nerve, usually as two roots that join after encircling the middie
meningeal artery just before that artery enters the foramen spinosum.
• The auriculotemporal nerve then courses deep to the lateral pterygoid muscle as
it passes posteriorly deep to the parotid gland.

H
• The nerve then surfaces between the auricular and the temporomandibular joint

ID
below the zygomatic arch.
• It subsequently passes super cial to the zygmomatic arch, along with the

S H
super cial temporal artery, to be distributed to the side of the head.
• Near its origin, the auriculotermporal nerve receives communication from the otic

AA
ganglion.
• These are postganglionic parasympathetic bers to be distributed to the parotid

R gland via the auriculotemporal nerve.

• As the nerve passes through the gland, these bers will leave it to provide
secretomotor innervations to the gland.
• The preganglionic bers are a part of the glossopharyngeal nerve and reach the
otic gangilion via the lesser petrosal nerve.
• The auriculotemporal nerve communicates also with the facial nerve within the
substance of the parotid gland.
• These sensory bers are communicated to the facial nerve for further distribution
over the face.
• As the auriculotemporal nerve passes by the ear and the TMJ, it provides the
anterior auricular branches to the skin of the anterior portion of the ear and the
external acoustic meatus and articular branches to the joint.

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• Superior to the zygomatic arch, the nerve branches into super cial temporal
nerves which distribute to the skin of the side of the head.
2. The lingual nerve arises deep to the lateral pterygoid muscle and descends to
pass super cially over the medial pterygoid muscle as it courses anteriorly to
enter the submandibular region.
• The lingual nerve is joined by the chorda tympani nerve while it is under the
cover of the lateral pterygoid muscle.
• The chorda tympani nerve, a branch of the facial nerve, makes its appearances
in the deep face at the spine of the sphenoid.
• The nerve carries special sensory bers for taste and preganglionic
parasympathetic bers destined for the submandibular ganglion.
• The lingual nerve provides general sensation to the anterior two thirds of the
tongue, adjacent areas of the mouth, and the lingual gingiva.
• Special sensory taste bers from the chorda tympani are distributed to the
anterior two thirds of the tongue by the lingual nerve.
• Preganglionic parasympathetic bers leave the nerve at the submanidibular
ganglion, where they synapse on postganglionic parasympathetic cell bodies
whose secretomotor bers are distributed to the submandibular, sublingual, and

H
minor salivary glands in the oor of the mouth.

ID
3. The inferior alveolar nerve originates deep to the lateral pterygoid muscle and
lateral to the lingual nerve.

S H
• This nerve passes between the sphenomandibular ligament and the ramus of the
mandibule to enter the mandibular foramen.

AA
• Inside the mandibular canal, the nerve distributes to the mandibular teeth,
supporting structures, and gingiva.

R
• A branch of the inferior alveolar nerve, the mental nerve, emerges from the
mental foramen to provide sensory innervations to the skin of the chin and lower
lip.
• Incisive branches continues anterior in the mandibular canal to innervate the
canine and incisor teeth, supporting structures, and gingiva.
• Just before the inferior alveolar nerve enters the mandibular foramen, it gives o
the mylohoid nerve, the only motor component of the posterior division.
• This motor nerve courses along the groove for the mylohyoid nerve before it
enters the mylohyoid muscle.
• Upon crossing its super cial surface, the nerve also provides motor innervations
to the anterior belly of the digastric muscle.

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 • The maxillary division of the trigeminal nerve may be observed in the deep face
as it passes through the pterygopalatine fossa.
• Here a small branch leaves the nerve and courses along the maxillary tuberosity
to provide sensory innervations to the mucous membranes of the cheek.
• A division of this branch enters the posterior superior alveolar foramen to supply
the maxillary sinus, gingiva, supporting tissues, and the three molars.
• A small contribution from the maxillary division of the trigeminal nerve is
observed in the deep face.
• As the maxillary nerve passes through the pterygopalatine fossa, a small branch
arises from it and passes laterally into the deep face via the pterygomaxillary
ssure.
• This posterior superior alveolar nerve descends over the maxillary tuberosity to
enter the posterior superior alveolar foramen; some twigs continue on to
innervate the gingival an mucous membranes of the cheek.
• Those bers entering the foramen distribute to the maxillary sinus, teeth,
supporting structures, and gingival as far anteriorly as the rst molar, where a
dental plexus is formed with the middle and anterior superior alveolar nerves,
innervating the remaining maxillary sinus teeth, supporting structures, and
gingival.

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Pterygopalatine fossa

H ID
S
• Deep region of the face internally and anteriorly passes through the
pterygopalatine fossa, which is bounded

AA
‣ Anteriorly - by the tuberosity of the maxilla

R ‣ Posteriorly - pterygoid process of the sphenoid bone

‣ Medially - perpendicular plate of the palate bone

‣ Superiorly - body and greater wing of the sphenoid bone.

• Inferiorly it becomes narrow and passes to the major canal of the palate (canalis
palatines major).
• From buccal region to the pterygopalatine fossa passes bucca fat body process.
• From middle cranial fossa through the round foramen in the pterygopalatine
fossa passes maxillary nerve, where from it arises zygomatic nerve,
pterygopalatine nerve, and infraorbital nerve.
• In the pterygopalatine fossa inferiorly and medially to the maxillary nerve is
located pterygopalatine ganglion (ganglion pterygopalatinum), to which connects
greater and deep petrosal nerves.
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• From maxillary nerve to the pterygopalatine ganglion passes pterygopalatine
nerves (nn. pterygopalatin).
• From the ganglion arises palatine nerves (nn. palatine), which with descending
palatine arteries passes through the hard and soft palate, and rami nasals
posteriors, which enters nasal cavity by sphenopalatine foramen.

H
H ID
A S
R A

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