Morphology of the pterygomandibular raphe in human fetuses and adults.

The pterygomandibular raphe as described in current anatomy textbooks is not supported by actual observations in cadavers. A study was made on 60 adult Caucasian and Negro cadavers (52 right and 58 left sides, giving a total of 110 sides) providing comparison with an earlier study on Japanese specimens. In addition, 50 fetuses (25 mm crown-rump length to term) were examined to determine the arrangement of the raphe prenatally. Variations in the morphology of the raphe region were classified into three types: Type A--only the upper portion of the raphe could be identified and had a broad, triangular shape. Type B--the buccinator and superior pharyngeal constrictor muscles were widely separated by a broad, fascial region. Type C--the raphe was absent with complete continuity of the buccinator and superior pharyngeal constrictor muscles. A prominent, narrow, tendinous band with attachments as described in current textbooks was never found in adults. There was a complete absence of the raphe in 36% of the specimens resulting in continuity of the buccinator and superior pharyngeal constrictor muscles (type C). However, the remaining adult specimens (64%) exhibited some form of a broad, fascial region that either completely (type B, 36%) or partially (type A, 28%) separated the two muscles. All of the fetuses exhibited the type B arrangement exclusively, indicating that changes in the shape of the raphe occur postnatally. The frequency of appearance of the raphe types in adults differs significantly according to race.