THE PTERYGOPALATINE FOSSA

Dr.Huda Moutaz Ismail Department of oral & maxillofacial surgery

University of Baghdad /college of dentistry

Pterygopalatine FossaA small space behind and below the orbital

cavity.

Boundaries

Anteriorly: posterior surface of maxilla. Posteriorly: anterior margin of pterygoid process below and greater wing of sphenoid above.Medially: perpendicular plate of palatine bone. Superiorly: greater wing of sphenoid. Laterally: pterygomaxillary fissure

Medially: perpendicular plate of palatine bone.

Communications: The pterygomaxillary fissure: the maxillary artery the posterior superior alveolar branches the sphenopalatine veins.

The inferior orbital fissure: infraorbital and zygomatic branches of V2, the orbital branches of the pterygopalatine G. the infraorbital vessels.

The foramen rotundum

Maxillary nerve >> Enters the pterygopalatine fossa (foramen rotundum)

The pterygoid canal the greater petrosal deep petrosal nerve accompanying artery

The sphenopalatine foramen is a foramen in the skull that connects the nasal cavity with the pterygopalatine fossa. transmits the sphenopalatine artery and vein and the posterior superior lateral nasal nerveand nasopalatine nerves.

The pterygoid canal

The foramen rotundum

The sphenopalatine foramen

• The opening of a palatine canal • the greater and lesser palatine nerves, • companying vessels

• Pharyngeal canal: courses posteriorly and medially into pharynx, for pharyngeal artery and nerve

The contents of the pterygopalatine fossa1) Third part (pterygopalatine part) of the maxillary artery2) Maxillary nerve3) Nerve of the pterygoid canal (Vidian’s nerve)4) Pterygopalatine ganglion

Maxillary Nerve (V2)

Purely sensory Originates from the trigeminal ganglion in the

cranial cavity Exits the middle cranial fossa Enters the pterygopalatine fossa (foramen

rotundum)

Branches from the main maxillary nerve trunk:•Meningeal nerve•Ganglionic branches•Zygomatic nerve zygomaticotemporal nerve zygomaticofacial nerve•Posterior superior alveolar nerve•Infraorbital nerve middle superior alveolar nerve anterior superior alveolar nerve

Branches from the pterygopalatine ganglion:

Orbital nerveNasopalatine nervePosterior superior nasal nervePosterior inferior nasal nerveGreater (anterior) palatine nerveLesser (posterior) palatine nervePharyngeal branch

Maxillary nerve branches

Post super alveolar nerve

Infra orbital nerve

greater & lesser palatine nerve

Nasopalatine nerve

Meningeal branch: not in the fossa

Ganglionic branchesWithin the fossa, the maxillary nerve is attached to the pterygopalatine ganglion by two ganglionic branches.

Post sup alveolar nerve

Infraorbital nerve

Infraorbital nerve:The terminal branchRun in IO groove, canal, foramenGive ant. and middle sup. alveolar nerve

• As the maxillary nerve is about to enter the inferior orbital fissure it gives rise to the zygomatic nerve.

• divides into:Zygomaticotemporal branch passing into temporal fossa to supply skin of the temple Zygomaticofacial nerve supplies skin over the prominence of cheek.

More anteriorly posterior superior alveolar nerves are given off.

IO Nerve block

Pterygopalatine Ganglion(Ganglion pterygopalatinum, Meckel's ganglion, Nasal ganglion, Sphenopalatine ganglion)

Largest of the 4 parasympathetic ganglia in the head Formed by the cell bodies of the postganglionic neurons associated

with preganglionic parasympathetic fibers of the facial nerve [VII] carried by the greater petrosal nerve and the nerve of the pterygoid canal.

The pterygopalatine ganglion

Pterygopalatine Ganglion

The postganglionic fibers, together with sympathetic fibers, join fibers from the ganglionic branches of the maxillary nerve [V2].

Postsynaptic fibers arising from the pterygopalatine ganglion supply the lacrimal gland as well as nasal glands and minor salivary glands within the oral cavity. The postsynaptic fibers innervating the lacrimal gland pass to the lacrimal nerve to reach the lacrimal gland.

The postganglionic parasympathetic and sympathetic fibers leave the zygomaticotemoral branch of the zygomatic nerve and form a special autonomic nerve, which joins the lacrimal nerve.

The lacrimal nerve is a major general sensory branch of the ophthalmic nerve [V1].

The postganglionic parasympathetic and sympathetic fibers pass with the lacrimal nerve to the lacrimal gland.

Innervation of the lacrimal glandThe parasympathetic secretomotor nerve supply is derived from the lacrimal nucleus of the facial nerve. The preganglionic fibers reach the pterygopalatine ganglion via the nervus intermedius and its great petrosal branch.

4 - Lacrimal gland

5 - Lacrimal sac

Branches• Orbital branches, enter the orbit (inferior orbital fissure) Supply of the orbital wall and of the sphenoidal and ethmoidal sinuses and orbitalis muscle

• Greater and lesser palatine nerves, supply the palate, the tonsil, and the nasal cavity.

• Pharyngeal branch, which supplies the roof of the nasopharynx

• posterior superior and inferior nasal that supply nasal cavity

Thank u