The buccinator has a posterior aponeurotic attachment to the pterygomandibular raphe, a tendinous band between the pterygoid hamulus superiorly and the posterior mandibular alveolus inferiorly. This raphe transmits force between the superior pharyngeal constrictor and the buccinator.
The pterygomandibular raphe and buccinator aponeurosis are critical landmarks in inferior alveolar nerve block technique, where the needle is directed just lateral to the raphe. Trismus from pterygomandibular space infection may involve the buccinator aponeurotic attachment. The raphe is incised in transoral approaches to the parapharyngeal space. Buccal fat pad herniation may occur through weaknesses in the buccinator aponeurosis.
Disruption at the pterygomandibular raphe from mandibular trauma or forceful mouth opening producing cheek pain and trismus, contributing to buccal fat herniation through the weakened buccinator.
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