Anatomy of the structures medial to the temporomandibular joint,☆☆

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Abstract

Objective. To define the relationship of the branches of the trigeminal nerve and the infratemporal vessels to the zygomatic arch and medial capsular ligament of the temporomandibular joint (TMJ). Material and Method. In a study of 20 cadaveric dissections of the infratemporal fossa, measurements were obtained in anterior-posterior and transverse directions to identify the relationship of the trigeminal nerve, carotid artery, internal jugular vein, and middle meningeal artery to the zygomatic arch. The distance from the lateral to the medial aspect of the glenoid fossa was measured to further delineate the proximity of these structures to the medial portion of the capsule of the TMJ. Results. The mean transverse distance from the zygomatic arch to the middle meningeal artery was 31 mm (range, 21 mm to 43 mm). The mean anterior-posterior distance from the height of the glenoid fossa to the middle meningeal artery was 2.4 mm (–2 mm to 8 mm). The transverse distance from the carotid artery to the zygomatic arch was a mean of 37.5 mm (29 mm to 48 mm) with the mean anterior-posterior distance of –6.5 mm (–21 mm to 6 mm). The mean distance from the internal jugular vein to the zygomatic arch was 38.3 mm (31 mm to 49 mm). The mean anterior-posterior distance was –8.7 mm (–20 mm to 7 mm). The transverse distance from the trigeminal nerve to the arch was a mean distance of 35 mm (24 mm to 46 mm). The mean anterior-posterior distance was 9.2 mm (1 mm to 25 mm). The mean medial to lateral width of the glenoid fossa was 18.7 mm (16 mm to 23 mm). Conclusion. The arteries, nerves, and veins are close to the medial aspect of the TMJ. A knowledge of these relationships can guide the surgeon on the medial aspect of the TMJ and can help to prevent complications associated with these structures. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;88:674-8)

Section snippets

MATERIAL AND METHODS

These data were gathered from 20 formalin-fixed cadaveric specimens.

RESULTS

The mean distance from the outer aspect of the zygomatic arch to the middle meningeal artery was 31 mm (SD ± 4.9 mm; range, 21 mm to 43 mm). The AP distance from the artery to the height of glenoid fossa was 2.4 mm (SD ± 2.9 mm; range, –2 mm to 8 mm). The mean distance from zygomatic arch to the carotid artery was 37.5 mm (SD ± 5.0 mm; range, 29 mm to 48 mm). The AP distance was –6.5 mm (SD ± 15; range, –21 mm to 6 mm). The distance to the internal jugular vein was 38.3 mm (SD ± 4.9 mm; range,

DISCUSSION

Although complications associated with the medial aspect of the TMJ are rare, they are potentially devastating. We selected the zygomatic arch as a reference point because it is always visible during TMJ operations. We report mean values with a range of measurements. Clinically, attention should be paid to the values in closest potential relationship to a surgical site (ie, smallest zygomatic arch distance of 21 mm to middle meningeal artery, 29 mm to carotid artery, 31 mm to internal jugular

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☆☆

Reprint requests: M. Anthony Pogrel, DDS, MD, FACS, FRCS, Department of Oral and Maxillofacial Surgery, University of California, San Francisco, 521 Parnassus Ave, C522, San Francisco, CA 94143-0440

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