Further evaluation of the superficial and deep tendons of the human temporalis muscle.

The superficial and deep tendons of the human temporalis muscle and their fasciae were examined for specific attachments. It was found that as they pass inferiorly along the ramus of the mandible, a structure consisting of tendon and fascia (herein referred to as the fascial-tendinous complex of FTC) is projected anteromedially and inferiorly. The FTC is a unifying structure in the oral-buccal area, serving as a common point of attachment for three muscles of mastication (temporalis, masseter, and medial pterygoid) as well as the buccinator, superior pharyngeal constrictor (SPC), and the mylohyoid muscles, and their corresponding fasciae. The FTC creates a defined fascial space containing loose connective tissue, the buccal nerve, and corresponding blood vessels between the posterior buccal region and the anterior ramus and posterior body of the mandible. The FTC has two components: (1) a medial part which merges into the posterior buccal region in the area of the pterygomandibular depression and (2) a lateral part which continues inferiorly to the posterior area of the body of the mandible. A distinct slip of the medial pterygoid muscle was found to attach to the FTC which caused the lingual nerve to be sandwiched between this slip and the main bulk of the medial pterygoid as it inserts into the mandible. The pterygomandibular raphe, as previously described, was not found. Because of the FTC, the buccinator and SPC do not have simple hamulus-raphe-mylohyoid line attachments. The exact relationship of the buccinator and SPC is dependent upon the extent of the FTC. The larger the FTC, the greater are the muscle attachments and vice versa. In large FTCs a separate muscle (Hamular-FTC muscle) was found attaching from the hamulus to the FTC. The pterygomandibular fold was found not to coincide with the "raphe." The concavity of the pterygomandibular depression upon depression of the mandible was found to be the result of the FTC.