602: Pterygopalatine Fossa

- Maxillary nerve blocks
- Panoramic radiograph interpretation
- Bleeding complications
- Facial trauma
- Odontogenic maxillary sinusitis
- Maxillary surgery

Why study the nasal cavity and PFF?

Pyramidal space medial to the infratemporal fossae between the sphenoid, maxilla, and palatine bone
- Posterior to the maxillary sinus
- Posteroinferior to the orbit

What is the pterygopalatine fossae?

- Maxillary artery (3d part or pterygopalatine part)
- Maxillary nerve (V2, 2nd division of the trigeminal)
- Pterygopalatine ganglion-associated autonomic nerves

The pterygopalatine fossa is the major distribution site for:

Major somatic sensory nerve for:

- Face

- Nasal cavity and nasopharynx

- Maxillary sinuses

- Meninges (dura)

- Oral cavity: maxillary teeth, hard and soft palate, gingiva

What does CN V2 do?

Greater petrosal n (from CN VII)

What parasympathetic autonomics are associated with the pterygopalatine ganglion?

Deep petrosal n (from internal carotid plexus)

What sympathetic autonomics are associated with the pterygopalatine ganglion?

pterygomaxillary fissure

what structure leads to the pterygopalatine fossa?

pterygopalatine fossa

traveling medially from the pterygomaxillary fissure will place you in the:

inferior

The pterygopalatine fossa is ________to the apex of the orbit.

lateral

The pterygopalatine fossa is ________ to the sphenopalatine foramen

foramen rotundum
pterygoid (vidian) canal
pharyngeal canal

what 3 foramen are located on the posterior wall of the pterygopalatine fossa?

sphenopalatine foramen

if you move a probe medially in the pterygopalatine fossa to get to the nasal cavity, you must go through the:

Pterygoid process of the sphenoid

the posterior boundary of the pterygopalatine fossa is the:

Posterior border of the maxilla

the anterior boundary of the pterygopalatine fossa is the:

Perpendicular plate of the palatine

the medial boundary of the pterygopalatine fossa is the:

Part of the greater wing of the sphenoid

the superior boundary of the pterygopalatine fossa is the:

pterygomaxillary fissure, open to the infratemporal fossa

the lateral boundary of the pterygopalatine fossa is the:

Pyramidal process of the palatine

the inferior boundary of the pterygopalatine fossa is the:

pterygopalatine canal

the floor of the pterygopalatine fossa is the:

maxilla

the anterior wall of the pterygopalatine fossa is formed by the:

maxilla
sphenoid
palatine

what 3 bones make up the pterygopalatine fossa

sphenoid bone

the posterior wall and roof of the pterygopalatine fossa is formed by what bone?

- 3rd part of maxillary a.
- Maxillary nerve (V2)
- Pterygopalatine ganglion

What three main contents are in the pterygopalatine fossa?

pterygomaxillary fissure
inferior orbital fissure

name the 2 fissures associated with the pterygopalatine fossa:

foramen rotundum
sphenopalatine foramen

name the 2 foramen associated with the pterygopalatine fossa:

vidian canal/ pterygoid canal
pterygopalatine canal
pharyngeal canal

name the 3 canals associated with the pterygopalatine fossa:

inferior orbital fissure

what hole is located anterior and superior on the maxilla bone in the pterygopalatine fossa?

orbit

a probe from the pterygopalatine fossa through the infraorbital fissure, you would arrive in the:

inferior orbital fissure

if you wanted to go from the orbit to the pterygopalatine fossa, you'd take the

sphenopalatine foramen

what hole is located superiorly on the palatine bone?

nasal cavity

a probe from the pterygopalatine fossa through the sphenopalatine foramen, you would arrive in the:

sphenopalatine foramen

if you wanted to go from the nasal cavity to the pterygopalatine fossa, you'd take the

middle cranial fossa

a probe from the pterygopalatine fossa through the foramen rotundum, you would arrive in the:

foramen rotundum

what hole is located superiorly on the sphenoid bone?

foramen rotundum

if you wanted to go from the middle cranial fossa to the pterygopalatine fossa, you'd take the

nasopharynx

a probe from the pterygopalatine fossa through the pharyngeal canal, you would arrive in the:

pharyngeal canal

if you wanted to go from the nasopharynx to the pterygopalatine fossa, you'd take the

foramen lacerum in the middle cranial fossa

a probe from the pterygopalatine fossa through the vidian canal/ pterygoid canal, you would arrive in the:

vidian canal/ pterygoid canal

if you wanted to go from the foramen lacerum to the pterygopalatine fossa, you'd take the

oral cavity

a probe from the pterygopalatine fossa through the pterygopalatine canal, you would arrive in the:

pterygopalatine canal

if you wanted to go from the oral cavity to the pterygopalatine fossa, you'd take the

Palatine canal

If you wanted to go to the palate from the pterygopalatine fossa, you'd take the

Pterygomaxillary fissure

If you wanted to go to the infratemporal fossa from the pterygopalatine fossa, you'd take the

Zygomatic n.
Infraorbital n.
Infraorbital vv.

What are the nerves and vessels that travel through the infra-orbital fissure?

3rd part of maxillary artery
Posterior superior alveolar nn.

What are the nerves and vessels that travel through the pterygomaxillary fissure?

Opening for posterior superior alveolar n.

Identify the structure at the arrow

Sphenopalatine a.
Nasopalatine n.
Posterior superior lateral nasal n.

What are the nerves and vessels that travel through the sphenopalatine foramen?

Descending palatine artery
Greater palatine n.
Lesser palatine n.

What are the nerves and vessels that travel through the palatine canal?

Pharyngeal n.
Pharyngeal a.

What are the nerves and vessels that travel through the pharyngeal canal?

N. of the pterygoid canal (greater petrosal n. and deep petrosal n.)
A. of the pterygoid canal

What are the nerves and vessels that travel through the pterygoid canal?

Greater petrosal n. (parasympathetic)
Deep petrosal n. (sympathetic)

What nerves make up the nerve of the pterygoid canal (vidian n.)?

Pharyngeal canal (aka palatovaginal canal)

Identify the structure at #1

Pterygoid (vidian) canal

Identify the structure at #2

Foramen lacerum

Identify the structure at #3

CN V

Identify the structure at #1

V2

Identify the structure at #2

Foramen rotundum

Identify the structure at #3

Trigeminal ganglion

Identify the structure at #4

Pterygomaxillary fissure

Identify the structure at #1

Sphenopalatine foramen

Identify the structure at #2

Inferior orbital fissure

Identify the structure at #3

Infraorbital foramen

the infraorbital nerve (ION) passes through the inferior orbital fissure, travels through the infraorbital groove and exits onto the face through the...

True - there are NO somatic motor fibers

T/F: V2 is entirely somatic sensory

Dura
Lacrimal gland
Face
Maxillary teeth/sinus
Nasal cavity
Palate
Pharynx

What are the targets of V2?

Face > Orbit > Pterygopalatine fossa > Middle cranial fossa > Trigeminal ganglion

What spaces does V2 travel from the face to the trigeminal ganglion?

Middle cranial fossa

Identify the region in blue

Pterygopalatine fossa

Identify the region in green

Orbit

Identify the region in orange

Face

Identify the region in purple

Trigeminal ganglion (outside fossa in middle cranial fossa)
Pterygoplaatine ganglion (in fossa)

What are the two ganglia associated with pterygopalatine fossa?

Trigeminal ganglion

Identify the ganglion:

• Houses all of the trigeminal somatic sensory nerve cell bodies.

• These are unipolar neurons carry sensation from the periphery to the brainstem

Pterygopalatine ganglion

Identify the ganglion:

• Preganglionic parasympathetic fibers (from greater petrosal n) synapse here

• Sympathetic and sensory fibers travel through the ganglion without synapsing

• Autonomic fibers leave the ganglion and travel with V2 branches

Trigeminal ganglion (somatic sensory)

Identify the structure in pink

Pterygopalatine ganglion (parasympathetic)

Identify the structure in green

foramen rotundum

the maxillary division of CN V enter the pterygopalatine fossa via the:

infraorbital n.

V2 after fibers pass through the infraorbital fissure is called the:

Foramen rotundum

Identify the structure at #1

Infraorbital fissure

Identify the structure at #2

Infraorbital groove and canal

Identify the structure at #3

Infraobrital foramen

Identify the structure at #4

Pterygomaxillary fissure

Identify the structure at #5

Incisive canal

Identify the structure at #6

Incisive canal

Identify the structure at #7

Sphenopalatine foramen

Identify the structure at #8

Pterygoid (vidian) canal

Identify the structure at #9

Palatine canal

Identify the structure at #10

Lesser palatine foramen

Identify the structure at #11

Greater palatine foramen

Identify the structure at #12

Middle cranial fossa

Identify the structure at #1

Foramen rotundum

Identify the structure at #2 (foramen)

Groove for greater (superficial) petrosal n.

Identify the structure at #3

Greater petrosal n.

Identify the structure at #4

Hiatus of facial canal

Identify the structure at #5

Pterygopalatine fossa, pterygoid canal

The greater petrosal nerve will travel through the groove for greater (superficial) petrosal nerve and the parasympathetic fibers from VII will enter the __________ through the __________

meningeal n. branch

which branch from V2 does NOT pass through the foramen rotundum?

meningeal n. branch

provides sensory innervation to the dura mater:

V2

meningeal nerve branch is a branch of:

middle meningeal a.

meningeal nerve branch travels with what structure?

meningeal n. branch

identify the structure:

sensory innervation of dura mater

if this structure was lacerated, what function would be diminished