Boundaries of the temporal region
The topographic boundaries of the temporal region are clearly defined by bony and muscular landmarks:
- Anteriorly (from the orbit): the boundary is formed by the zygomatic process of the frontal bone and the frontal process of the zygomatic bone.
- Inferiorly (from the lateral facial region): the region is bounded by the zygomatic arch.
- Superiorly: the upper boundary is projected along the contour of the upper edge of the temporalis muscle, which corresponds to the temporal line.
Layer-by-layer structure: superficial layers
The anatomy of the temporal region includes several consecutive layers, starting from the skin and ending with the periosteum.
- Skin. In the temporal region, it is thinner than in the frontoparietooccipital region. Hair coverage is retained in the posterior part. The skin is less firmly adhered to the superficial fascia, especially in the anteroinferior section.
- Subcutaneous fat. This is where the superficial temporal fascia (the continuation of the epicranial aponeurosis) is located. A rudimentary muscle — the superior auricular muscle (m. auricularis superior) — is often found above the auricle.
- Superficial neurovascular bundle. It runs in the adipose tissue between the leaves of the superficial fascia.
- Vessels: trunks and branches of the superficial temporal vessels (a. et v. temporales superficiales). They emerge from the substance of the parotid gland, ascend anterior to the tragus, and divide into frontal and parietal branches at the level of the supraorbital margin.
- Nerves: sensation is provided by the auriculotemporal nerve (n. auriculotemporalis, a branch of the third division of the trigeminal nerve), and motor innervation of the facial muscles is provided by branches of the facial nerve (rr. frontalis et zygomaticus).
Fasciae and fascial spaces
The most important structure of the region is the temporal fascia (fascia temporalis). It has the appearance of a strong aponeurosis with fan-shaped fiber bundles. Attaching to the bony boundaries, it encloses the temporal fossa externally.
At 3–4 cm above the zygomatic arch, the temporal fascia splits into superficial and deep leaves. Both leaves attach to the upper edge of the zygomatic arch. The interaponeurotic fat pad is enclosed between them.
The subaponeurotic space lies beneath the temporal aponeurosis. It contains the temporalis muscle, vessels, nerves, and adipose tissue.
- The subaponeurotic loose adipose tissue lies on the outer side of the temporalis muscle and extends downwards from the zygomatic arch into the masseteric-mandibular space.
- The temporal process of the buccal fat pad is located beneath the aponeurosis in the space between the anterior edge of the temporalis muscle and the lateral wall of the orbit.
Muscles, deep vessels, and nerves
The temporalis muscle (m. temporalis) originates from the periosteum (planum temporale) and from the deep surface of the temporal aponeurosis. Its muscle fibers converge downwards and anteriorly, transitioning into a strong tendon. It attaches to the coronoid process (processus coronoideus) and the anterior edge of the ramus of the mandible. The surgical feature of the muscle is that the tendon is attached very firmly — during surgeries, instead of dissecting it, the coronoid process of the mandible must be sawed through.
The deep vessels and nerves of the region (anterior and posterior deep temporal arteries, veins, and nerves — a., v. et n. temporales profundi anteriores et posteriores) ascend from the infratemporal fossa and run directly along the periosteum.
Features of blood supply and innervation
The branches of the superficial temporal artery form a well-developed network of anastomoses:
- Frontal branch (external carotid artery system) anastomoses with the supraorbital artery (a. supraorbitalis, internal carotid artery system).
- Parietal branch anastomoses with the occipital artery (a. occipitalis, external carotid artery system).
- Branches of the left and right superficial temporal arteries anastomose with each other.
Sensory innervation is provided by the main auriculotemporal nerve (n. auriculotemporalis) and the accessory zygomaticotemporal nerve (n. zygomaticotemporalis — a branch of n. maxillaris), which emerges through the foramen of the same name in the zygomatic bone and innervates the skin of the anterior temporal region.
Motor innervation is provided by branches of the facial nerve passing in the subcutaneous tissue above the anterior third of the zygomatic arch. The frontal branch (r. frontalis) runs to the frontal belly of the occipitofrontalis muscle, and the zygomatic branch (r. zygomaticus) runs to the orbicularis oculi muscle.
Briefly: answers to topical questions
Name all layers of the temporal region in strict sequence from superficial to deep.
The layers of the temporal region are arranged in the following strict sequence from superficial to deep:
- Skin — thin, loosely adherent to the superficial fascia.
- Subcutaneous tissue — contains the superficial temporal fascia and neurovascular structures.
- Temporal fascia (fascia temporalis) — splits into superficial and deep layers, between which lies the interaponeurotic adipose tissue.
- Subaponeurotic space — contains loose connective tissue.
- Temporalis muscle (m. temporalis).
- Deep (subtemporal) space — located between the muscle and the periosteum.
- Periosteum of the temporal bone.
Where does lymphatic drainage from the tissues of the temporal region occur?
Lymphatic drainage from the tissues of the temporal region occurs depending on the specific part:
- From the anterior parts — lymph drains into the superficial parotid nodes (nodi parotidei superficiales) and then proceeds to the deep parotid and deep lateral cervical nodes.
- From the posterior parts — lymph is directed to the occipital (nodi occipitales) and mastoid (nodi mastoidei) nodes. Efferent vessels from these nodes pass to the deep lateral cervical and superficial parotid nodes.
With which fascial spaces and regions does the subaponeurotic space of the temporal region communicate?
The subaponeurotic space of the temporal region communicates with the following spaces and regions:
- Masseteric-mandibular cleft — the space continues into it inferiorly from the zygomatic arch.
- Deep lateral facial region (including the pterygomandibular and parapharyngeal spaces) — communication occurs via the masseteric-mandibular cleft.
- Orbit fat — communicates via the temporal process of the buccal fat pad (corpus adiposum buccae).
- Buccal region — also communicates via the temporal process of the buccal fat pad.
These pathways determine the potential spread of purulent processes from the temporal region to the face and neck.
From which major vessels and trunks do the deep temporal arteries and nerves originate?
The deep temporal arteries and nerves originate from the following major vessels and trunks:
- Deep temporal arteries (aa. temporales profundae anterior et posterior) — arise from the second (pterygoid) part of the maxillary artery (a. maxillaris).
- Deep temporal nerves (nn. temporales profundi anterior et posterior) — are branches of the mandibular nerve (n. mandibularis), which is the third branch of the trigeminal nerve.
Which veins provide venous drainage from the temporalis muscle, and where do they empty?
Venous drainage from the temporalis muscle is carried out via two venous pathways:
- Middle temporal vein (v. temporalis media) — forms directly within the thickness of the temporalis muscle, pierces the temporal fascia, and empties into the superficial temporal vein (v. temporalis superficialis).
- Deep temporal veins (vv. temporales profundae) — anastomose with the middle temporal vein within the muscle and drain into the pterygoid venous plexus (plexus venosus pterygoideus).
Class and exam questions
Where is the interaponeurotic adipose tissue located in the temporal region?
It lies between the superficial and deep layers of the temporal fascia, which splits approximately 3–4 cm above the zygomatic arch.
With which artery does the frontal branch of the superficial temporal artery anastomose?
The frontal branch of the superficial temporal artery (from the external carotid artery system) anastomoses with the supraorbital artery (from the internal carotid artery system).
Why is the coronoid process often osteotomized during maxillofacial surgeries?
Because the tendon of the temporalis muscle is attached to the coronoid process so firmly that dissecting the tendon itself is technically impractical.
Where does the subaponeurotic loose connective tissue continue?
The subaponeurotic adipose tissue located on the outer surface of the temporalis muscle continues inferiorly from the zygomatic arch into the masseteric-mandibular cleft.
What else to study on this topic
- Anastomoses of the external and internal carotid arterial systems in the temporal region
- Topography of the facial nerve branches above the zygomatic arch
- Connection of the subaponeurotic space with the masseteric-mandibular cleft
- Course and distribution of deep temporal vessels and nerves
- Spatial arrangement of the temporal process of the buccal fat pad
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