Pterygomandibular raphe
The pterygomandibular raphe (pterygomandibular ligament) is a ligamentous band of the buccopharyngeal fascia. It is attached superiorly to the pterygoid hamulus of the medial pterygoid plate, and inferiorly to the posterior end of the mylohyoid line of the mandible. It connects the buccinator muscle in front to the superior pharyngeal constrictor muscle behind. It resists mandibular realignment. Structure. The pterygomandibular raphe is a ligament that forms from the buccopharyngeal fascia. It is a paired structure, with one on each side of the mouth. Superiorly, it is attached to the pterygoid hamulus of the medial pterygoid plate of the  sphenoid bone. Inferiorly, it is attached to the posterior end of the mylohyoid line of the mandible. Variation. In foetuses, the pterygomandibular raphe is always very prominent. However, in adults, it may become less distinctive. It is very large and distinctive in around 36% adults. It is fairly small, and only an upper triangular portion visible, in around 36% of adults. It is not visible in around 28%, making the superior pharyngeal constrictor muscle and the buccinator muscle continuous. This may vary by ethnic group. Function. The pterygomandibular raphe is the common meeting point of the superior pharyngeal constrictor muscle  and the buccinator muscle. It holds them together, forming part of the mouth. Clinical significance. When the mandible is splinted for gradual realignment (such as to treat sleep apnea), the pterygomandibular ligament slightly resists the realignment. History. The pterygomandibular ligament was first noted in 1784.