Delayed removal of maxillary third molar displaced into the infratemporal fossa. Third molar extraction is a common procedure and it is rarely associated with complications. One complication that may be associated with this procedure is displacement of the tooth into the infratemporal fossa, an anatomical structure that contains the temporalis muscle, medial and lateral pterygoid muscles, the pterygoid plexus, the maxillary artery and its branches, the mandibular nerve and its branches, and the chorda tympani. The present case report illustrates delayed surgical removal of a maxillary third molar that was displaced into the infratemporal fossa, via the intraoral access and under local anesthesia. Despite the rarity of this complication, oral and maxillofacial surgeons should be aware of its management and able to choose the optimal technique, taking into account the patient's signs and symptoms as well as the knowledge and experience of the surgeon. Keywords: Third molar.
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Sign up. Illustrated anatomical parts with images from e-Anatomy and descriptions of anatomical structures. The infratemporal fossa is an irregularly shaped cavity, situated below and medial to the zygomatic arch. Boundaries are defined anteriorly by the infratemporal surface of the maxilla and the ridge which descends from its zygomatic process; posteriorly by the articular tubercle of the temporal and the spinal angularis of the sphenoid; superiorly by the greater wing of the sphenoid below the infratemporal crest, and by the under surface of the temporal squama; inferiorly, by the medial pterygoid muscle attaching to the mandible; medially by the lateral pterygoid plate; laterally by the ramus of mandible.
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The infratemporal fossa is an irregularly shaped cavity, situated below and medial to the zygomatic arch. It is not fully enclosed by bone in all directions, and it contains superficial muscles that are visible during dissection after removing skin and fascia: namely, the lower part of the temporalis muscle, the lateral pterygoid, and the medial pterygoid. The internal maxillary vessels, consisting of the maxillary artery originating from the external carotid artery and its branches. Mandibular nerve , inferior alveolar nerve , lingual nerve , buccal nerve , chorda tympani nerve , and otic ganglion. Its motor fibers innervate all the muscles of mastication plus the mylohyoid, anterior belly of the digastric, and the tensores veli palati and tympani. The foramen ovale and foramen spinosum open on its roof, and the alveolar canals on its anterior wall.
The infratemporal fossa is a complex space of the face that lies posterolateral to the maxillary sinus and many important nerves and vessels traverse it. The fossa is actually open to the neck posteroinferiorly and in doing so has no true anatomical floor. The lateral pterygoid forms the foundation whereupon all other contents of the fossa are related. The branches of the mandibular nerve and the attachments of the medial pterygoid lie deep to the lateral pterygoid while the maxillary artery lies superficial to it. Between the two heads of the lateral pterygoid emerges the buccal branch of the mandibular nerve.