Midsubtemporal Ridge as a Predictor of the Lateral Loop Formed by the Maxillary Nerve and Mandibular Nerve: A Cadaveric Morphological Study

The lateral loop formed by the maxillary nerve (V2) and the mandibular nerve (V3) consists of a part of the far lateral triangle of the cavernous sinus. Because this triangle becomes a surgical corridor of the preauricular infratemporal fossa approach and a landmark of the extradural approach for the ganglion-type trigeminal schwannomas, identification of the lateral loop has important implications at the early stage of middle cranial base surgery. We realized that a bony ridge usually existed just lateral to the lateral loop.To nominate midsubtemporal ridge (MSR) as the name for this anatomically unnamed bony ridge and to clarify its features.Using 35 cadaver heads, we measured the shape of the MSR on both sides and the distance between the MSR and the adjacent structures.The MSR was recognized in 60 of 70 specimens (85.7%). The bony protrusion was 2.9 ± 1.1 mm in height, 6.0 ± 2.1 mm in width, and 9.1 ± 3.2 mm in length. A single peak with anteroposterior length was common in 47 of 60 specimens (78.3%). The MSR was located at the midpoint of the V2 and V3 in 28 specimens (46.7%) and existed 10.7 ± 3.6 mm lateral from the line that bound the foramen rotundum and the foramen ovale.We demonstrate morphological characteristics of the MSR. These data on the MSR will assist the surgeon in identifying the lateral loop as a surgical landmark during middle cranial base surgery.