title: Surgical anatomy of the styloid muscles and the extracranial glossopharyngeal nerve.
abstract: OBJECTIVE
  The purpose of the study was to determine the relationships between the extracranial glossopharyngeal (IX) nerve and the muscles of the styloid diaphragm. In humans, the IX nerve is a hidden retrostyloid nerve which plays a critical role notably in swallowing and has to be preserved during infratemporal fossa and parapharyngeal spaces surgical procedures.
  
  
  METHODS
  In ten adult heads from cadavers (20 sides) fixed in formalin, dissection of the extracranial IX nerve was performed under operating microscope with special attention given to the relationships between this nerve and the styloid muscles of the styloid diaphragm. The three styloid muscles delimit three triangular intermuscular intervals which were each thoroughly explored. Different osseous landmarks were investigated for easy nerve location.
  
  
  RESULTS
  The styloid process (SP) is the main superior osseous landmark for the three muscles of the styloid diaphragm. The stylohyoid muscle (SHM) is anteromedially located to the posterior belly of the digastric muscle. The styloglossus muscle (SGM) is medial and anterior to the SHM. The stylopharyngeal muscle (SPM) is the most vertical and medial of the three styloid muscles. It courses from the medial surface of the SP in a deep plane hidden between the SHM and the SGM. The extracranial IX nerve turns around the SPM superiorly with a vertical segment posterior to the SPM and inferiorly with a horizontal segment lateral to the SPM. The meeting point of the two segments of the IX nerve is about 10 mm anteriorly located from the transverse process of the atlas. The external carotid artery and some of its branches lie in contact with the lateral side of the IX nerve.
  
  
  CONCLUSIONS
  Such relationships between the extracranial IX nerve, the styloid muscles and the transverse process of the atlas should be appreciated by clinician who treats patients with stylohyoid complex syndromes and by the surgeon for the parapharyngeal spaces approach.
authors.affiliation: Laboratoire d'Anatomie, Faculté de Médecine J. Lisfranc, University of Saint-Étienne, Saint-Étienne, France, jean.michel.prades@univ-st-etienne.fr.
authors.forename: J M
authors.initials: JM
authors.lastname: Prades
authors.forename: M
authors.initials: M
authors.lastname: Gavid
authors.forename: A
authors.initials: A
authors.lastname: Asanau
authors.forename: A P
authors.initials: AP
authors.lastname: Timoshenko
authors.forename: C
authors.initials: C
authors.lastname: Richard
authors.forename: C H
authors.initials: CH
authors.lastname: Martin
mesh_terms: D002102:Cadaver; D004210:Dissection; D005260:Female; D005930:Glossopharyngeal Nerve / Q000033:anatomy & histology*; D006801:Humans; D008297:Male; D009334:Neck Muscles / Q000033:anatomy & histology*