The pterygomandibular raphe is a fibrous band running from the pterygoid hamulus of the medial pterygoid plate superiorly to the posterior end of the mylohyoid line on the mandible inferiorly. It marks the boundary between the buccinator muscle anteriorly and the superior pharyngeal constrictor posteriorly, with both muscles taking origin from it. It forms the visible fold behind the last molar tooth in the oral cavity.
| Origin | Pterygoid hamulus of the medial pterygoid plate |
|---|---|
| Insertion | Posterior end of the mylohyoid line of the mandible |
Provides the common origin for the buccinator and superior pharyngeal constrictor muscles; marks the pterygomandibular space lateral to it; creates the palpable fold behind the retromolar triangle that guides inferior alveolar nerve block injection.
The pterygomandibular raphe is the primary landmark for inferior alveolar nerve block (IANB): the needle is inserted lateral to the raphe fold, into the pterygomandibular space, targeting the mandibular foramen on the medial ramus. The pterygomandibular space between the medial pterygoid and the ramus contains the inferior alveolar and lingual nerves and vessels. Infection in this space, often from lower third molars, causes severe trismus and needs drainage. Oral tumours of the retromolar trigone spread along the raphe into the pterygomandibular space and pharynx, and raphe involvement usually requires composite resection.
Odontogenic infection spreading into the space lateral to the raphe, causing severe trismus, pain and swelling, treated with antibiotics and surgical drainage.
Squamous carcinoma of the retromolar trigone extending along the raphe to the pterygomandibular space and pharynx, requiring wide composite resection.
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