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Temporal fossa

The temporal fossa is a shallow, elongated depression on the lateral aspect of the skull, situated in the temporal region between the superior temporal line superiorly and the zygomatic arch inferiorly.^[1] It represents one of the prominent landmarks of the cranium, providing attachment for the temporalis muscle and housing key neurovascular structures essential for mastication and sensory innervation.^[2] The floor of the temporal fossa is formed by the temporal surfaces of four bones: the frontal bone anteriorly, the parietal bone superiorly, the greater wing of the sphenoid bone posteromedially, and the squamous part of the temporal bone posterolaterally, with these meeting at the pterion—a thin sutural junction vulnerable to trauma.^[1] Anteriorly, it is bounded by the zygomatic process of the frontal bone and the frontal process of the zygomatic bone, while the temporal fascia spans its lateral aspect, splitting into superficial and deep layers to enclose the temporalis muscle.^[2] Inferiorly, the fossa communicates with the infratemporal fossa through a gap deep to the zygomatic arch, allowing passage of structures like the mandibular nerve branches.^[3] Primarily, the temporal fossa contains the temporalis muscle, a fan-shaped masticatory muscle that originates from its walls and floor, inserting onto the coronoid process of the mandible to facilitate jaw elevation and retraction.^[1] Accompanying the muscle are the deep temporal arteries and veins, branches of the maxillary artery and vein, which supply and drain the region, as well as the deep temporal nerves from the mandibular division of the trigeminal nerve (CN V3) that innervate the temporalis.^[2] Additional contents include the superficial temporal artery and vein crossing its anterior superior aspect, the zygomaticotemporal nerve piercing the temporalis to reach the skin, and the auriculotemporal nerve traversing posteriorly.^[1] Clinically, the temporal fossa's proximity to the pterion makes it relevant in head trauma, where fractures here can lacerate the underlying middle meningeal artery, leading to extradural hematomas—a neurosurgical emergency.^[2] Infections from the temporal region may spread inferiorly to the infratemporal fossa, potentially involving the masticator space and risking cavernous sinus thrombosis due to venous connections.^[1] Surgical approaches to the area, such as for temporalis muscle harvest in reconstructive procedures, require careful navigation to avoid damaging these vital structures.^[3]

Anatomy

Boundaries

The temporal fossa is a shallow, irregularly shaped depression located on the lateral surface of the skull, serving as a key anatomical landmark for muscular and fascial attachments in the head region.^[4] Its superior boundary is defined by the superior temporal line, which is a ridge formed by the parietal and frontal bones, extending from the posterior angle of the parietal bone toward the zygomatic process of the frontal bone.^[4]^[5]^[1] The inferior boundary is formed by the zygomatic arch, a bony bridge composed of the zygomatic process of the temporal bone anteriorly and the temporal process of the zygomatic bone posteriorly.^[4]^[5] Anteriorly, the fossa is limited by the zygomatic process of the frontal bone superiorly and the frontal process of the zygomatic bone inferiorly, creating a curved margin that transitions toward the orbital region.^[4]^[1] The posterior boundary is formed by the superior temporal line extending posteriorly toward the mastoid angle of the parietal bone.^[1]^[6] Medially, the boundary is provided by the greater wing of the sphenoid bone, along with contributions from the temporal lines, enclosing the fossa from the inner cranial aspects.^[5]^[7] Laterally, the fossa is delimited by the zygomatic process of the temporal bone, which forms part of the zygomatic arch and provides a superficial limit covered by the temporal fascia.^[4]^[8] Inferiorly, the temporal fossa is continuous with the infratemporal fossa through the interval beneath the zygomatic arch.^[4]

Floor

The floor of the temporal fossa is composed of portions from four cranial bones: the posterior aspect of the frontal bone anteriorly, the anteroinferior portion of the parietal bone superiorly, the squamous part of the temporal bone laterally and posteriorly, and the lateral aspect of the greater wing of the sphenoid bone medially and inferiorly.^[1]^[2]^[9] This bony base forms an irregular, shallow, vertically oriented depression that extends from the superior temporal line to the infratemporal crest on the greater sphenoid wing.^[1]^[2] The superior limit of the floor is delineated by the temporal lines, which originate on the frontal bone near the coronal suture and continue across the parietal bone.^[1]^[10] The bones of the floor converge at the pterion, a critical H-shaped sutural junction anteriorly in the fossa, where the frontal, parietal, sphenoid, and temporal bones meet.^[1]^[11] Key articulations include the sphenofrontal suture anteriorly, uniting the frontal bone and greater wing of the sphenoid; the sphenoparietal suture medially, joining the sphenoid and parietal bones; the coronal suture superiorly, connecting the frontal and parietal bones; and the squamosal (parietotemporal) suture posteriorly, linking the parietal and temporal bones.^[12]^[13] The floor is enclosed inferiorly by the zygomatic arch.^[2]

The temporal fossa primarily houses the temporalis muscle, a fan-shaped muscle that occupies the majority of the space within the fossa and originates from its bony floor and lateral boundaries, including portions of the temporal lines, the temporal surface of the greater wing of the sphenoid bone, and the squamous part of the temporal bone.^[1]^[14] This muscle is enveloped by layers of fascia and connective tissue, with the superficial layer consisting of the temporalis fascia—a tough, fibrous sheet that attaches superiorly to the superior temporal line and splits inferiorly to form the roof over the muscle.^[1]^[15] The neurovascular supply to the contents of the temporal fossa includes the deep temporal nerves, which are branches of the anterior division of the mandibular nerve (CN V3), providing motor innervation to the temporalis muscle as they course between the muscle and the pericranium.^[1]^[16] Accompanying these nerves are the deep temporal arteries and veins; the arteries arise from the second part of the maxillary artery, while the veins drain into the pterygoid plexus, supplying and draining the temporalis muscle and adjacent tissues.^[1]^[14] Other structures include the superficial temporal artery and vein, which cross the anterior superior aspect superficial to the fascia; the zygomaticotemporal nerve, which pierces the temporalis muscle to innervate the skin; and the auriculotemporal nerve, which runs posteriorly between the layers of temporal fascia.^[1] Additional minor elements within the temporal fossa include loose connective tissue and adipose tissue interspersed among the muscle fibers, as well as occasional extensions of the superficial temporal vessels that may penetrate deeper layers to contribute to the regional vascular network.^[1] The deep aspect of the temporalis muscle directly interfaces with the bony floor of the fossa through a thin layer of pericranium and subperiosteal connective tissue, facilitating attachment and movement.^[1]^[15]

Function

Muscular attachments

The temporal fossa primarily serves as the site of origin for the temporalis muscle, a fan-shaped masticatory muscle that occupies much of the fossa's volume. The temporalis originates broadly from the floor of the temporal fossa, encompassing the temporal surfaces of the frontal, parietal, temporal, and greater wing of the sphenoid bones, as well as from the deep surface of the overlying temporal fascia. Its fibers converge inferiorly to form a thick tendon that inserts onto the apex, medial surface, and anterior border of the coronoid process of the mandible, with some anterior fibers extending to the anterior border of the mandibular ramus down to the level of the last molar tooth.^[17]^[18]^[19] The temporal fascia, which roofs the fossa and contributes to muscular origins, consists of superficial and deep layers that split approximately 2 cm superior to the zygomatic arch; the deep layer attaches superiorly to the superior temporal line along with the superficial layer, providing structural reinforcement to the temporalis attachments.^[1]^[20]

Role in mastication

The temporal fossa serves as the primary origin site for the temporalis muscle, a key component of mastication that elevates and retracts the mandible to facilitate chewing. The muscle's anterior and middle fibers contract to lift the mandible upward, while the posterior fibers pull it backward, enabling efficient closure of the jaw against food resistance. This action occurs as the temporalis fibers, fanning out from the fossa, converge into a tendon that passes beneath the zygomatic arch and inserts onto the coronoid process of the mandible, generating a pulling force on the jaw.^[21]^[22]^[17] In coordination with other masticatory muscles, the temporalis ensures balanced force distribution during chewing. It works alongside the masseter and medial pterygoid muscles to elevate the mandible, providing a posterior vector that complements the masseter's more vertical pull and the medial pterygoid's protrusive action. The lateral pterygoid, meanwhile, opposes these by depressing and protruding the jaw, allowing for side-to-side grinding motions; the temporalis's retraction helps stabilize and return the mandible to a centered position. This synergistic interplay distributes occlusal forces evenly across the temporomandibular joint.^[21]^[23]^[24] Biomechanically, the temporal fossa's structure enhances the temporalis's efficiency by offering a broad, concave surface for muscle attachment, which maximizes leverage and force generation, supporting powerful biting actions essential for processing food. The fossa's depth and extent allow for the muscle's fan-shaped configuration, optimizing the posterior pull and reducing strain on the joint during repetitive chewing cycles.

Clinical significance

Trauma and fractures

The temporal fossa is commonly affected by fractures of the squamous portion of the temporal bone, which arise from high-energy lateral impacts such as those occurring in motor vehicle accidents, falls, or assaults.^[25] These injuries often propagate from the temporal bone and may involve the zygomatic arch, leading to depressed or linear fractures that disrupt the fossa's boundaries.^[26] In a study of head injury patients, road traffic accidents accounted for over 60% of such temporal bone fractures, with the squamous portion involved in approximately 43% of cases.^[27] Consequences of these fractures include temporalis muscle impingement or hematoma formation, resulting in localized pain, swelling, and restricted mouth opening (trismus) due to muscle spasm or displaced bone fragments.^[28] Nerve damage is frequent, particularly to the facial nerve (cranial nerve VII) in 7-12% of cases, potentially causing partial or complete paralysis, while extensions into adjacent regions may affect deep temporal nerve branches of the mandibular division of the trigeminal nerve (cranial nerve V), leading to sensory or motor deficits in the temporalis muscle.^[25] If the fracture extends to the middle cranial fossa, cerebrospinal fluid (CSF) leaks occur in up to 28% of patients, manifesting as otorrhea or rhinorrhea and increasing the risk of meningitis.^[27] Hearing impairment, often conductive due to hemotympanum, affects around 70% of individuals, with sensorineural loss less common.^[25] Diagnosis relies on clinical evaluation of symptoms such as temporal pain, swelling, trismus, and neurological deficits, supplemented by high-resolution computed tomography (CT) imaging with thin slices (≤1.5 mm) to identify fracture patterns, including otic capsule-sparing longitudinal types that predominate in 80% of temporal bone fractures involving the fossa.^[26] CT scans effectively detect associated soft tissue injuries and extensions to the infratemporal fossa in complex cases.^[27] Bedside assessments like tuning fork tests help differentiate hearing loss types, guiding further management.^[25]

Surgical applications

The temporal fossa serves as a critical anatomical landmark in neurosurgical and maxillofacial procedures, particularly through the utilization of the temporalis muscle as a pedicled flap for reconstruction. The temporalis muscle flap is commonly employed in reconstructive surgery to address skull base defects following tumor resection, providing robust vascularized tissue to prevent cerebrospinal fluid leakage and promote healing.^[29] In oral cavity repairs, such as those for palatal or maxillary defects after oncologic ablation, the flap is rotated inferiorly into the defect while preserving the neurovascular pedicle, including the deep temporal arteries and nerves, to maintain flap viability and minimize donor site morbidity.^[30]^[31] This technique leverages the muscle's proximity and bulk, allowing for tension-free closure in challenging craniofacial reconstructions.^[32] In neurosurgery, the temporal fossa provides an essential access route via the pterional craniotomy, a standard approach for managing anterior circulation aneurysms and suprasellar tumors. This procedure involves placing a burr hole in the temporal fossa posterior to the superior temporal line, followed by dissection along the temporal lines to elevate a frontotemporal bone flap, thereby exposing the Sylvian fissure with minimal retraction of surrounding structures.^[33]^[34] The approach facilitates microsurgical clipping of aneurysms or tumor debulking while preserving the temporalis muscle's integrity to reduce postoperative cosmetic and functional deficits.^[35] Surgical interventions in the temporal fossa carry specific risks, including potential injury to the deep temporal vessels, which can lead to intraoperative hemorrhage if not meticulously preserved during muscle dissection.^[36] Additionally, manipulation of the temporalis muscle may result in postoperative trismus due to fibrosis or scarring, affecting mastication and requiring conservative management such as physical therapy.^[37] Historically, the temporalis muscle flap was first described by Lentz in 1895 for use after resection of the condylar neck in temporomandibular joint ankylosis, with early applications including Golovin's adaptation for orbital defects in 1898.^[32]^[38]

Development and variations

Embryological origins

The temporal fossa develops from the lateral calvarial region of the embryonic skull during weeks 6-8 of gestation, primarily through intramembranous ossification of mesenchymal condensations derived from neural crest cells and paraxial mesoderm.^[39] This process involves the differentiation of mesenchymal cells into osteoblasts, which deposit bone matrix directly within the fibrous membrane, without a preceding cartilaginous stage, forming the foundational structures of the neurocranium's vault.^[40] The lateral positioning of the fossa reflects the coordinated expansion of the developing brain, which induces surrounding mesenchyme to ossify and delineate the fossa's boundaries. Key contributing bones arise from specific ossification centers: the frontal bone originates from bilateral centers at the frontal eminences, driven by neural crest-derived mesenchyme; the parietal bone forms from centers at the parietal eminences, primarily from paraxial mesoderm; the squamous portion of the temporal bone develops from a center near the root of the zygomatic process, also neural crest-derived; and the greater wing of the sphenoid ossifies from the ala temporalis, involving neural crest contributions.^[39]^[40] These centers activate around the 8th gestational week, with initial bone spicules radiating outward to form the irregular, bowl-shaped depression characteristic of the fossa.^[39] By week 10, the superior and inferior temporal lines emerge as ridges on the parietal and temporal bones, marking early sites for muscular attachments and further defining the fossa's superior margin.^[40] The fossa's outline becomes more distinct by the third intrauterine month (approximately week 12), as continued skull expansion and ossification integrate these elements into a cohesive lateral depression accommodating the temporalis muscle.^[39] Sonic hedgehog (SHH) signaling pathways are essential in regulating cranial neural crest cell survival, proliferation, and patterning during craniofacial development.^[41] Disruption of SHH, as observed in conditional knockout models, leads to reduced mesenchymal growth and altered calvarial bone fusion.^[41]

Anatomical variations

The temporal fossa displays variations in depth across individuals, often resulting from differences in the prominence of the superior temporal line and the convexity of the parietal bone. A shallower fossa may occur due to reduced temporal line prominence, while a deeper configuration can arise from increased parietal convexity, contributing to individual morphological diversity in cranial architecture.^[42] Such depth variations are noted in anthropometric analyses based on geometric morphometric studies of cranial form.^[42] Bilateral asymmetry in the temporal fossa is prevalent, with differences in boundary alignment such as variations in zygomatic arch height between sides. This asymmetry aligns with broader skull base patterns, where only about 5% of skulls exhibit complete symmetry.^[43] Accessory structures within the temporal fossa are infrequent but include occasional septa or foramina in the floor, which may transmit aberrant vessels. These variants occur rarely and can alter the fossa's internal compartmentalization. Population-based differences in temporal fossa morphology are evident from global anthropometric studies. The fossa tends to be more pronounced (larger spatial extent) in Asian skulls, particularly Northeast Asian populations, compared to the smaller, more constricted form in Europeans, where reduced temporal fossa space correlates with narrower zygomatic regions and lower masticatory demands.^[42] These variations hold relevance for applications like prosthetic fitting, where population-specific cranial metrics inform design.^[42]

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