Communicating root of auriculotemporal nerve with inferior alveolar nerve-looping around accessory meningeal artery

Shakuntala Nallagatla, Manivannan Karuppan, Gangadhara Muninarayanaswamy, Krishna Raja Rao Holavanahalli


Background: The auriculotemporal nerve has been described as having two roots in standard textbooks of anatomy. It lies on the tensor veli palatini muscle while passing backwards behind the lateral pterygoid muscle. It runs behind the temporomandibular joint after passing between the sphenomandibular ligament and the neck of mandible. It ascends over the posterior root of zygoma posterior to superficial temporal vessels. It gives superficial temporal branches and also branches to facial nerve and otic ganglion. The branches to the facial nerve join at the posterior border of masseter. On the face the cutaneous branches supply the tragus, part of the adjoining auricle of the ear and posterior part of temple.

Methods: Variations in the origin of the auriculotemporal nerve have been described by many authors in the past and this prompted the study of the auriculotemporal nerve, its origin and course, in 36 specimens (18 cadaveric heads) in bodies that were allotted for dissection purpose to first year medical students in the department of anatomy in P.E.S Medical College, Kuppam.

Results: It was seen that the auriculotemporal nerve had two roots of origin and they formed a loop to enclose the middle meningeal artery in all the 35 specimens except in one side of the cadaveric heads. In only one half of a cadaveric head it was found to arise by three roots which formed two nerve loops. The first and second nerve roots joined with each other to form a nerve loop. The third root joined with the inferior alveolar nerve and formed the second nerve loop. The accessory meningeal artery passed through the second nerve loop. The normal presentation of two roots enclosing the middle meningeal artery was not present. Instead the accessory meningeal artery was enclosed between the third root and the inferior alveolar nerve. The middle meningeal artery entered the skull through the foramen spinosum as usual but was not enclosed by the nerve roots. The trunk of the auriculo temporal nerve was seen between the middle meningeal artery and inferior alveolar nerve and the study reports the presence of variant nerve loops encircling the accessory meningeal artery.  

Conclusion: The variations in the roots of auriculotemporal nerve have been reported in the past and since it is important in the clinical implications of the region especially for the facio-maxillary surgeons and dental surgeons. The incidence of variation has to be documented as this helps in updating the clinical database for surgical procedures and treatment in the region of infratemporal fossa.



Auriculo temporal nerve, Nerve loops and acessory meningeal artery

Full Text:



Susan Standring. Infratemporal and pterygopalatine fossae and temporomandibular joint. In: Susan Standring, eds. The Anatomical Basis of Clinical Practice. 40th ed. US: Elsevier; 2008: 542-543.

Gulekon, N, Anil A, Poyraz A, Peker T, Turgut HB, Karakose M. Variations in the anatomy of the auriculotemporal nerve. Clin Anat. 2005;18:15-22.

Baumel JJ, Vanderheiden JP, McElenney JE. The auriculotemporal nerve of man. Am J Anat. 1971;130:431-40.

Namking M, Boonruangsri P, Oraputtaporn WW, Guldner FH. Communication between the facial and auriculotemporal nerves. J Anat. 1994;185(Pt 2):421-6.

Komarnitki I, Andrzejczak-Sobocinska A, Tomczyk J, Deszczynska K, Ciszek B. Clinical anatomy of the auriculotemporal nerve in the area of the infratemporal fossa. Folia Morhol (Warsz). 2012;71(3):187-93.

BeeserAndersen N, Bovimand G, Sjaastad O. The frontotemporal peripheralnerves. Topographic variations of the supraorbital, supratrochlear and auriculotemporal nerves and their possible clinical significance. Surg Radiol Anat. 2001;23(2):97-104.

Balaji Thotakura, Sharmila Saran, Rajendran, Vaithianathan Gnanasundaram, Aruna Subramaniam. Variations in the posterior division branches of the mandibular nerve in human cadavers. Singapore Med J. 2013;54(3):149-51.

Pai MM, Swamy RS, Prabhu LV. A variation in the morphology of the inferior alveolar nerve with potential clinical significance. Biomed Int. 2010;1:93-5.

Bronner-Fraser M. Environmental influences on neural crest cell migration. J Neurobiol. 1993;24(2):233-47.

Tannahill D, Cook GMW, Keynes RJ. Axon guidance and somites. Cell Tissue Res. 1997;290(2):275-83.

Sanes DH, Reh TA, Harris WA. Development of the nervous system. In: Sanes DH, Reh TA, Harris WA, eds. A Book. 5th ed. New York: Academic Press; 2000: 189-197.

Ranscht B, Bronner-Fraser M. T-cadherin expression alternates with migrating neural crest cells in the trunk of the avian embryo. Development. 1991;111(1):15-22.

Drebby-Brafman A. Burstyn-Cohen T, Klar A, Kalcheim C. F-spondin, expressed in somite regions avoided by neural crest cells, mediates inhibition of distinct somite domains to neural crest migration. Neuron. 1999;22(3):475-88.

Siessere S, Hallak Regalo SC, Semprini M, Honorato De Oliveira R, Vitti M, MizusakiIyomasa M, et al. Anatomical variations of the mandibular nerve and its branches correlated to clinical situations. Minerva Stomatol. 2009;58(5):209-15.

Janis Jeffrey E, Hatef Daniel A, Ducic Ivica, Ahmad. Jamil, Wong Corinne, Hoxworth Ronald E, et al. Anatomy of the auriculotemporal nerve: variations in its relationship to the superficial temporal artery and implications for the treatment of migraine headaches. Plastic Reconstruc Surg. 2010 May;125(5):1422-8.

Brian L. Schmidt, M. Anthony Pogrel, Marcos Necoechea, Gerard Kearns. The distribution of the auriculotemporal nerve around the temporomandibular joint. Oral Surg Oral Med Oral Pathol Oral Radiol Endodontol. 1998;86(2):165-8.

Simmi Soni, Gayathri Rath, Rajesh Suri, Venkata Ramana Vollala. Unusual organization of auriculo temporal nerve and its clinical implications. J Oral Maxillofac Surg. 2009;67(2):448-50.