Anatomy of head and neck

PTERYGOPALATINE FOSSA : Anatomy , Arterial supply , Venous Drainage , Nerve Supply , Radiology

PTERYGOPALATINE FOSSA

 

1)Overview and Topographic Anatomy

GENERAL INFORMATION

 

     Pyramid-shaped fossa  on  the  lateral  aspect of the  skull between the  maxilla’s infratemporal surface  and  the  pterygoid process of the  sphenoid Contains major  nerves  and  blood  vessels  that  supply  the  nasal  cavity, upper jaw, hard palate, and  soft palate: the  maxillary division  of the  trigeminal nerve,  pterygopalatine (sphenopalatine, Meckel’s) ganglion,  and  3rd  portion of the  maxillary artery Allows the  infratemporal fossa,  middle cranial  fossa,  foramen lacerum, nasopharynx, nasal  cavity, orbital  cavity, and  oral cavity to communicate 7 foramina/fissures allow  passage of nerves  and  vessels

pterygopalatine fossa anatomy 

2)Borders and Opening :

 

Border

Structures

Anterior wall

Infratemporal surface of the maxilla

Posterior wall

Pterygoid process of the sphenoid

Medial wall

Perpendicular plate of the palatine

Lateral wall

None (open to the pterygomaxillary fissure)

Superior wall

Inferior surface of the sphenoid and the orbital plate of the palatine bone

Inferior wall

Pyramidal process of the palatine

 

Opening

Location

Transmitted Structures

Pterygomaxillary fissure

Lateral part of the pterygopalatine fossa

Between the infratemporal fossa and the pterygopalatine fossa

Posterior superior alveolar n. from the pterygopalatine fossa into the infratemporal fossa

3rd part of the maxillary a. from the infratemporal fossa into the pterygopalatine fossa

A variable network of veins, such as the sphenopalatine, into the pterygoid

plexus of vv.

Sphenopalatine foramen

Medial wall of the pterygopalatine fossa

Between the nasal cavity and the pterygopalatine fossa

Often located posterior to the

middle nasal concha

Nasopalatine n.

Posterior superior nasal nn.

Sphenopalatine vessels

Inferior orbital fissure

Superior part of the pterygopalatine fossa

Between the pterygopalatine fossa and the orbit

Continues posteriorly with the superior part of the pterygomaxillary fissure

Infraorbital n. from the maxillary division of the trigeminal n. Zygomatic n. from the maxillary

division of the trigeminal

Infraorbital vessels

Inferior ophthalmic v. that connects with

the pterygoid plexus of veins

Palatine canal

Inferior part of the pterygopalatine fossa

Between the pterygopalatine fossa and the hard and the soft palate

Eventually terminates into the greater

and lesser palatine foramina

Greater palatine n. and vessels (through the greater palatine foramen) onto the hard palate

Lesser palatine n. and vessels (through the lesser palatine foramen) onto the soft palate

Foramen rotundum

Posterolateral part of the pterygopalatine fossa

Between the pterygopalatine fossa and the middle cranial fossa

Maxillary division of the trigeminal n.

Pterygoid canal

Posterior part of the pterygopalatine fossa

Between the pterygopalatine fossa and the foramen lacerum

Inferior and medial to the foramen

rotundum

Nerve of the pterygoid canal (vidian n.) An accompanying artery

Pharyngeal canal

Posteromedial part of the pterygopalatine fossa

Between the pterygopalatine fossa and the nasopharynx

Medial to the pterygoid canal

Pharyngeal n. Pharyngeal vessels

 

borders of pterygopalatine fossa

borders of pterygopalatine fossa

 

3)Arterial Supply :

 

ARTERIAL SUPPLY

Artery

Source

Course

Maxillary (3rd part)

External carotid a.

Passes from the infratemporal fossa into the pterygopalatine fossa via the pterygomaxillary fissure

Prior to passing through the pterygomaxillary fissure, it gives off the posterior superior alveolar a. (the only artery from the 3rd part of the maxillary a. that does not normally branch off within the pterygopalatine

fossa)

Infraorbital

The continuation of the 3rd part

of the maxillary a.

Accompanied by the infraorbital n. and v.

The artery passes forward in the infraorbital groove,

infraorbital canal, and exits the infraorbital foramen

In the infraorbital canal, it gives rise to various orbital

branches that aid in supplying the lacrimal gland and

extraocular muscles

In the infraorbital canal, it also gives rise to the anterior

and middle (if present) superior alveolar aa. that supply

the maxillary teeth from the central incisors to the

premolars (where they anastomose with the posterior

superior alveolar a.) and the mucous membrane of the

maxillary sinus

On exiting the infraorbital foramen, the artery is located

between the levator labii superioris and levator anguli

oris mm. and follows the branching pattern of the

nerve:

 Inferior palpebral branch (supplies the lower eyelid)

 Nasal branch (supplies the lateral side of the nose)

 Superior labial branch (supplies the upper lip)

Descending palatine

3rd part of the maxillary a.

Descends into the palatine canal

Within the canal, the artery splits into the greater and

lesser palatine aa.

Greater palatine a. exits the greater palatine foramen and

passes anteriorly toward the incisive foramen and

supplies the hard palate gingiva, mucosa, and palatal

glands and anastomoses with the terminal branch of

the sphenopalatine a. that exits the incisive foramen

Lesser palatine a. supplies the soft palate and palatine

tonsil

Artery of the pterygoid canal

Passes posteriorly into the pterygoid canal, accompanying the nerve of the pterygoid canal (vidian n.)

Helps supply the auditory tube and sphenoid sinus

Pharyngeal

Passes posteromedially into the pharyngeal canal

Helps supply the auditory tube and nasopharynx

Sphenopalatine

Passes medially into the sphenopalatine foramen to enter the nasal cavity

It then gives rise to the posterior lateral nasal branches and posterior septal branches, which supply the nasal concha, mucous membranes, and nasal septum

The sphenopalatine a. continues along the nasal septum to enter the hard palate via the incisive canal

 

arterial supply of pterygopalatine fossa

 

 

4)Venous Supply :

VENOUS DRAINAGE

Vein

Course

Posterior superior alveolar

Receives blood from the posterior teeth and soft tissue

Eventually communicate with the pterygoid plexus of veins

Pharyngeal

Receives blood from the nasopharynx

Descending palatine

Receives blood from the hard and soft palate

Infraorbital

Receives blood from the midface via the lower eyelid, lateral side of the nose, and the upper lip

Sphenopalatine

Receives blood from the nasal cavity and the nasal septum

Vein of the pterygoid canal

Receives blood from the foramen lacerum region and the sphenoid sinus

Inferior ophthalmic

Receives blood from the floor  of the orbit

Branches into 2 parts

The first branch travels posteriorly with the infraorbital v. that passes through the

inferior orbital fissure to communicate with the pterygoid plexus and the

cavernous sinus

The main branch travels posteriorly to communicate with the superior

ophthalmic vein in the superior orbital fissure or travels posteriorly in the

fissure to join the cavernous sinus

Pterygoid plexus

An extensive network of veins that parallels the 2nd and 3rd parts of the maxillary a.

The tributaries of the pterygoid plexus eventually converge to form a short maxillary v.

Venous Drainage of pterygopalatine fossa

 

 

5)Nerve Supply :

 

MAXILLARY NERVE

Nerve

Source

Course

Maxillary division of the trigeminal n.

Trigeminal n.

Sensory in function

Travels along the lateral wall of the cavernous sinus

Before exiting the middle cranial fossa, it gives off a

meningeal branch that innervates the dura mater

Passes from the middle cranial fossa into the

pterygopalatine fossa via the foramen rotundum

Within the pterygopalatine fossa, gives rise to 4 branches:

 Posterior superior alveolar n.

 Zygomatic n.

 Ganglionic branches

 Infraorbital n.

Posterior superior alveolar

Maxillary division

of the trigeminal

n. in

pterygopalatine

fossa

Passes through the pterygomaxillary fissure to enter the infratemporal fossa

In the infratemporal fossa, it passes on the posterior surface of the maxilla along the region of the maxillary tuberosity

Gives rise to a gingival branch that innervates the buccal gingiva alongside the maxillary molars

Enters the posterior surface of the maxilla and supplies the maxillary sinus and the maxillary molars with  the possible exception of the mesiobuccal root of the 1st

maxillary molar

Zygomatic

Passes through the inferior orbital fissure to enter the orbit

Passes on the lateral wall of the orbit and branches into the zygomaticotemporal and zygomaticofacial branches

A communicating branch from it joins the lacrimal n. from the ophthalmic division of the trigeminal to carry autonomics to the lacrimal gland

Ganglionic branches

 

Usually 1 or 2 ganglionic branches that connect the maxillary division of the trigeminal to the pterygopalatine ganglion

Contain sensory fibers that pass through the pterygopalatine ganglion (without synapsing) to be distributed with the nerves that arise from the pterygopalatine ganglion

Also contain postganglionic autonomic fibers to the lacrimal gland that pass through the pterygopalatine ganglion (Parasympathetic fibers form a synapse here between the preganglionic fibers from the vidian n. and

the postganglionic fibers)

 

Infraorbital

Considered the continuation of the maxillary division of the trigeminal n.

Passes through the inferior orbital fissure to enter the orbit

Passes anteriorly through the infraorbital groove, infraorbital canal, and exits onto the face via the infraorbital foramen

Within the infraorbital canal, it gives rise to:

 Anterior superior alveolar (supplies the maxillary sinus; maxillary central incisor, lateral incisor, and canine; gingiva and mucosa alongside the same teeth)

 A small branch of the anterior superior alveolar

(supplies the nasal cavity)

 Middle superior alveolar (present about 70% of the time; supplies the maxillary sinus, maxillary premolars and often the mesiobuccal root of the 1st maxillary molar, and gingiva and mucosa alongside the same teeth)

 

nerve supply of pterygopalatine fossa

BRANCHES OF THE MAXILLARY DIVISION OF THE TRIGEMINAL NERVE

ASSOCIATED WITH THE PTERYGOPALATINE GANGLION

A parasympathetic ganglion named because it is a collection of cell bodies in the peripheral nervous system (postganglionic cell bodies)

The ganglionic branches are of the maxillary division of the trigeminal n. that pass through the pterygopalatine ganglion

The vidian n. connects to the pterygopalatine ganglion

3 sets of nerve fibers travel through the pterygopalatine ganglion:

 General sensory fibers from the trigeminal n. (without synapsing)

 Postganglionic sympathetic fibers (carried to the pterygopalatine ganglion via the vidian n, without

synapsing)

 Preganglionic parasympathetic fibers (carried to the pterygopalatine ganglion via the vidian n. and formed by synapsing in the pterygopalatine ganglion with the postganglionic parasympathetic fibers)

All branches arising from the pterygopalatine ganglion carry these 3 sets of fibers to the areas where they terminate

These nerves of the maxillary division travel through the pterygopalatine ganglion:

 Nasopalatine n.

 Posterior superior nasal n.

 Greater palatine n.

 Lesser palatine n.

 Pharyngeal n.

Branch

Source

Course

Vidian (nerve of the pterygoid canal)

Formed by the greater and

deep petrosal nn.

An autonomic nerve:

 Greater petrosal n. carries the preganglionic

parasympathetic fibers

 Deep petrosal n. carries the postganglionic sympathetic fibers

Communicates with the pterygopalatine ganglion, which allows the autonomics to be distributed along any nerve connected to the ganglion

Nasopalatine

Branches of the pterygopalatine ganglion in the pterygopalatine fossa

Passes through the sphenopalatine foramen to enter the nasal cavity

Passes along the  superior portion of the  nasal cavity to the nasal septum; then travels  anteroinferiorly to the incisive canal

Exits the incisive foramen on the hard palate and supplies the palatal gingiva and mucosa from the region of the central incisors to the canines

Posterior superior nasal

Passes through the sphenopalatine foramen to enter the nasal cavity, where it divides into 2 nerves:

 Lateral posterior superior (supplies the lateral wall of the nasal cavity)

 Medial posterior superior nasal (supplies the posterosuperior portion of the nasal septum)

Greater palatine

Passes through the palatine canal to enter the hard palate via the greater palatine foramen

Supplies the palatal gingiva and mucosa from  the area in the premolar region to the posterior border of the hard palate to the midline

Lesser palatine

Passes through the palatine canal to enter and supply the soft palate via the lesser palatine foramen

Pharyngeal

Passes through the pharyngeal canal to enter and supply the nasopharynx

nerve supply of pterygopalatine fossa

AUTONOMICS TRAVERSING THE PTERYGOPALATINE FOSSA

Type of

Neuron

Name of Cell

Body

Characteristics of the Cell

Body

 

Course of the Neuron

Anatomic Pathway for Parasympathetics Associated with the Maxillary Division of the Trigeminal Nerve

 

  preganglionic neuron

 

Superior salivatory nucleus

 

A collection of nerve cell bodies located in the pons

Travel through the nervus intermedius of the facial n. into the internal acoustic meatus

In the facial canal, the facial n. gives rise to 2 parasympathetic branches:

 Greater petrosal n.

 Chorda tympani n.

Greater Petrosal Nerve

 

Greater petrosal n. exits along the hiatus for the greater petrosal n. toward the foramen lacerum, where it joins the deep petrosal n. (sympathetics) to form the nerve of the pterygoid canal (vidian n.)

Vidian n. passes through the

pterygoid canal and enters

the pterygopalatine fossa,

where it joins with the

pterygopalatine ganglion

Postganglionic neuron

Pterygopalatine ganglion

Pterygopalatine ganglion is a collection of nerve cell bodies located in the pterygopalatine fossa

Postganglionic parasympathetic fibers that arise in the pterygopalatine ganglion are distributed to the ophthalmic and maxillary divisions of the trigeminal n. to the:

 Lacrimal gland

 Nasal glands

 Palatine glands

 Pharyngeal glands

Ophthalmic Division

Distribution

 

Postganglionic fibers travel along the zygomatic branch of the maxillary division for a short distance to enter the orbit

A short communicating branch joins the lacrimal n. of the ophthalmic division of the trigeminal

n.

These fibers innervate the

lacrimal gland to cause

the secretion of tears

 

Maxillary Division Distribution

 

Postganglionic fibers travel along the maxillary division of the trigeminal n. to be distributed along its branches that are located

in the nasal cavity, oral cavity, and pharynx (e.g., nasopalatine, greater palatine)

These fibers innervate:

 Nasal glands

 Palatine glands

 Pharyngeal glands

 

nerve supply of pterygopalatine fossa

AUTONOMICS TRAVERSING THE PTERYGOPALATINE FOSSA CONTINUED

Type of

Neuron

Name of Cell

Body

Characteristics of the

Cell Body

 

Course of the Neuron

Anatomic Pathway for Sympathetics Associated with the Maxillary Division of the Trigeminal Nerve

 

Preganglionic neuron

 

Intermediolateral horn nucleus

 

Collection of nerve cell bodies located in the lateral horn nucleus of the spinal cord between spinal segments T1 and T3 (and possibly T4)

 

Arise from the intermediolateral horn nuclei from T1 to T3 (4)

Travel through the ventral root of the spinal cord to the spinal n.

Enter the sympathetic chain via a white ramus communicantes

Once in the sympathetic chain, the preganglionic fibers for the eye  will ascend and synapse with postganglionic fibers in the superior cervical

ganglion

Postganglionic neuron

Superior cervical ganglion

Collection of nerve cell bodies located in the superior cervical ganglion, which is located at the base of the skull

Postganglionic sympathetic fibers follow the internal carotid or external carotid a. to pass near their respective effector organs (e.g., nasal cavity)

Nasal Cavity and Palate

 

Postganglionic sympathetic fibers follow both the internal and external carotid aa.

Postganglionic sympathetic fibers from the internal carotid branch in the region of the foramen lacerum to form the deep petrosal n.

The deep petrosal n. joins the greater petrosal n. (parasympathetics) to form the nerve of the pterygoid canal (vidian n.)

Postganglionic sympathetic fibers travel along the branches of the maxillary division of the trigeminal n. associated with the pterygopalatine ganglion to be distributed along its branches in the nasal cavity and palate

Postganglionic sympathetic fibers from the external carotid branch and follow the maxillary a.

These fibers travel along the branches of the maxillary a. to be distributed along

the nasal cavity and palate

 

Lacrimal Gland

 

Postganglionic sympathetic fibers  follow the internal carotid a.

Postganglionic sympathetic fibers from the internal carotid branch off in the region of the foramen lacerum to form the deep petrosal n.

 

Postganglionic neuron

 

 

 

The deep petrosal n. joins the greater petrosal n. (parasympathetics) to form the nerve of the pterygoid canal (vidian n.)

Postganglionic fibers travel along the zygomatic branch of the maxillary division for a short distance to enter the orbit

A short communicating branch joins the lacrimal n. of the ophthalmic division of the trigeminal n.

These fibers are distributed to the lacrimal gland

 

nerve supply of pterygopalatine fossa 

 

6)Imaging :

pterygopalatine fossa radiology