The muscle least related to the pterygomandibular raphe is the lateral pterygoid. The pterygomandibular raphe primarily connects the superior pharyngeal constrictor and the buccinator muscles, while the medial and lateral pterygoid muscles are involved in the movement of the jaw but do not have a direct attachment to the raphe. Here’s a breakdown of the relationships:

Muscle Relationships to the Pterygomandibular Raphe

• Superior Pharyngeal Constrictor:

  • Attaches to the posterior margin of the pterygomandibular raphe.

  • Plays a role in swallowing and constricting the pharynx.

• Medial Pterygoid:

  • While not directly attached, it is located near the pterygomandibular raphe and contributes to jaw movement.

• Lateral Pterygoid:

  • Least related to the pterygomandibular raphe.

  • Primarily involved in moving the jaw forward and side to side, with no direct attachment to the raphe.

• Buccinator:

  • Attaches to the anterior margin of the pterygomandibular raphe.

  • Important for chewing and keeping food between the teeth.

The nerve to masseter passes through the mandibular notch to enter the muscle on its medial surface

The nerve to the masseter muscle is the masseteric nerve, which is a branch of the mandibular nerve (CN V3), the largest division of the trigeminal nerve (cranial nerve V). The masseter muscle is one of the muscles of mastication that lifts the lower jaw, contributing to the action of biting and chewing.

The masseteric nerve originates from the anterior division of the mandibular nerve and typically passes:

1. Deep to the medial pterygoid muscle: The medial pterygoid muscle is located in the infratemporal fossa, which is the space deep to the zygomatic arch and medial to the temporomandibular joint (TMJ). The masseteric nerve runs in a deep position relative to the medial pterygoid muscle as it travels towards the masseter muscle. This muscle is involved in the side-to-side movement of the jaw, known as lateral excursion.

2. Posterior to the temporomandibular joint: The TMJ is the articulation between the mandible and the temporal bone of the skull. It is a synovial joint that allows for the hinge movement of the jaw, such as opening and closing the mouth. The masseteric nerve passes behind the TMJ to reach the masseter muscle. This nerve does not actually cross the joint itself but runs in a position posterior to it.

3. Superior to the zygomatic arch: The zygomatic arch is the bony structure that extends from the zygomatic process of the temporal bone to the zygomatic bone of the skull. It forms the prominence of the cheek. The masseteric nerve runs superior to the zygomatic arch to reach the masseter muscle. The arch serves as a landmark for the nerve's course, and the nerve typically does not pass through the arch itself.

4. Through the mandibular notch: This statement is not entirely correct. The masseteric nerve does not pass through the mandibular notch, which is a depression on the medial surface of the ramus of the mandible, but rather it passes above (superior to) the notch. The mandibular notch is the location where the masseteric nerve and the other branches of the mandibular nerve leave the infratemporal fossa and enter the submandibular space to innervate the muscles of mastication, including the masseter. The nerve then runs along the lateral surface of the lateral pterygoid plate and enters the deep surface of the masseter muscle.

In summary, the masseteric nerve passes deep to the medial pterygoid muscle, posterior to the TMJ, and superior to the zygomatic arch. It does not pass through the mandibular notch; instead, it runs superior to it before reaching the masseter muscle. The anatomical pathway of this nerve allows it to effectively innervate the masseter muscle, which is crucial for the function of the muscle in mastication.

The spleen follows the long axes of ribs 9 to 11 and lies mostly posterior to the stomach, above the colon, and partly anterior to the kidney. It is attached to the stomach by a broad mesenterial band, the gastrosplemic ligament. Therefore, it is the most likely organ of the group to be pierced by a sharp object penetrating just above rib 10 at the posterior axillary line. Note that the pleural cavity, and possibly the lower part of the inferior lobe of the lung, would be pierced before the spleen. The ascending colon (choice 1) is on the wrong side (the right) to be penetrated by a sharp instrument piercing the left side.

Most of the duodenum (choice 2) is positioned too far to the right to be affected by this injury.

Even the third part of the duodenum, which runs from right to left, would still be out of harm's way. In addition, the duodenum lies at about levels L1 to L3, placing it too low to be injured in this case.

The superior pole of the left kidney (choice 3) is bordered by the lower part of the spleen. However, it is crossed by rib 12 and usually does not extend above rib 11. It would probably be too low and medial to be injured in this case because this penetration is at the posterior axillary line.

It attaches superiorly at the medial border of the mandible and inferiorly at the body of the hyoid

The trigeminal ganglion lies on Anterior surface of petrous temporal bone near its apex in Meckel’s cave which is a space of dura mater