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Pterygomandibular Space

spatium pterygomandibulare

The pterygomandibular space is a potential space bounded medially by the medial pterygoid muscle, laterally by the medial surface of the mandibular ramus, superiorly by the lateral pterygoid, anteriorly by the pterygomandibular raphe, and posteriorly by the parotid gland. It contains the inferior alveolar nerve and artery running inferiorly to enter the mandibular foramen, and the lingual nerve crossing anteriorly.

Region: Head & Skull

Clinical Relevance

Clinical Notes

The pterygomandibular space is the target for inferior alveolar nerve block (IAN block), the most common dental injection technique. The needle is inserted just lateral to the pterygomandibular raphe in the pterygomandibular space at the level of the mandibular foramen, depositing local anaesthetic around the inferior alveolar nerve before it enters the foramen. Pterygomandibular space infection from dental abscess or pericoronitis produces trismus from medial pterygoid spasm, and can spread to the parapharyngeal space with airway compromise.

Pathology

Common Injuries & Conditions

Pterygomandibular Space Infection from Pericoronitis

Lower wisdom tooth pericoronitis allows organisms to track into the pterygomandibular space, producing severe trismus from medial pterygoid spasm, ipsilateral pharyngeal swelling, and dysphagia; CT identifies the collection and spread to the parapharyngeal space, managed by tooth extraction and space drainage before airway compromise develops.