Pterygopalatine Fossa.pdf
- 1. November 22nd, 2020 Halder Jamal Pterygopalatine fossa
- 2. Outline • What is it? • Where is it? • Boundaries? • Communications? • Contents? • Clinical signi f icance? Pterygopalatine fossa
- 3. Pterygopalatinefossa • It is a small pyramidal space below the apex of the orbit on the lateral side of the skull. Placed between the infratemporal fossa laterally and the nasopharynx medially. • It functions as a neurovascular conduit.
- 4. Boundaries • Anterior wall → the posterior surface of the maxilla. • Posterior wall → anterior surface of the pterygoid process of the sphenoid bone. • Medial wall → the lateral surface of perpendicular plate of palatine bone. • Laterally → Pterygomaxillary f issure. • Roof → Apex of orbit. • Floor → pyramidal process of the palatine bone.
- 5. Communications • Foramen rotundum & Pterygoid canal → Middle cranial fossa. • Pterygomaxillary f issure → Infratemporal fossa. • Inferior orbital f issure → Floor of the orbit. • Sphenopalatine foramen → Lateral wall of the nasal cavity. • Palatovaginal canal→ Nasopharynx. • Pterygopalatine canal → Roof of the oral cavity.
- 6. Contents • Maxillary nerve. • Terminal part of Maxillary artery. • Nerve of the pterygoid canal. • Pterygopalatine ganglion. • Veins & lymphatics. • And their branches....
- 7. Maxillarynerve(CNV2) • Two ganglionic branches • Posterior superior alveolar nerve • Zygomatic nerve • Infra-orbital nerve Branches: • It is purely sensory, originates from the trigeminal ganglion in the cranial cavity, exits the middle cranial fossa, and enters the pterygopalatine fossa through the foramen rotundum.
- 8. Nerve of pterygoid canal It is formed in the middle cranial fossa by the union of: Greater petrosal nerve: (a parasympathetic branch of the facial nerve) Deep petrosal nerve: (a sympathetic branch from superior cervical ganglion through plexus around the internal carotid artery) It enters the pterygopalatine fossa via pterygoid canal. It will form the pterygopalatine ganglion inside the fossa.
- 9. Pterygopalatineganglion • It is the largest of the four parasympathetic ganglia in the head and is formed by: • Nerve of pterygoid canal • Two ganglionic branches of the maxillary nerve Branches: • Nasal nerves • Orbital branches • Palatine nerves • Pharyngeal nerve
- 10. Maxillary artery • Descending palatine artery • Pharyngeal branch • Artery of the pterygoid canal • Posterior superior alveolar artery • Sphenopalatine arteries • Infra-orbital artery • The maxillary artery is a major branch of the external carotid artery. • It passes forward through the infratemporal fossa, and then the terminal (3rd) part of it enters the pterygopalatine fossa through the pterygomaxillary f issure. Branches:
- 12. Clinical signi f icance • lesion of parasympathetic f ibers of facial nerve → dry eye, this can cause vision loss in the affected eye if left untreated. • Because of the location of fossa and associated connections, It is often involved in the spread of tumors, infections, and in f lammations caused by neoplastic diseases in the head and neck (such as juvenile nasopharyngeal angio f ibroma, nasopharyngeal carcinoma, bacterial sinusitis). • Maxillary nerve block may be required in cases of extensive dental surgery. The maxillary nerve in the pterygopalatine fossa is most often approached intra-orally via the greater palatine canal. • Ligation of sphenopalatine artery as a treatment of chronic epistaxis. It can be surgically approached via the maxillary sinus.
- 13. Thank you