The sphenomandibular ligament runs from the spine of the sphenoid bone to the lingula of the mandible (mandibular foramen). It is a remnant of Meckel cartilage (first branchial arch cartilage) and encloses the inferior alveolar nerve as it enters the mandibular foramen.
Acts as the medial suspensory ligament of the mandible, limiting inferior displacement. Creates the pterygomandibular space with the medial pterygoid muscle where the inferior alveolar nerve and vessels travel.
The sphenomandibular ligament is the medial boundary of the pterygomandibular space and partially encloses the inferior alveolar nerve. In sagittal split osteotomy, the lingual cortex is cut above the lingula to avoid the sphenomandibular ligament attachment and protect the inferior alveolar nerve.
Rare calcification of the sphenomandibular ligament (Benigno syndrome) producing a radio-opaque band on panoramic radiograph, occasionally causing mandibular pain and restriction.
The sphenomandibular attachment at the lingula guides the level of the medial cortex cut in BSSO — above the lingula to preserve the neurovascular bundle.
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