Head & Neck #14

20 minutes

Pterygopalatine Fossa

Done by : ainaa syahirah,nur atiqah

This lecture is about

pterygopalatine fossa.
you’re already aware of
the wall boundary of
pterygopalatine fossa
which are the walls of
maxillary sinus
anteriorly, the
perpendicular plate of
palatine bone
medially,the pterygoid
process and the root of greater wing of sphenoid posteriorly, and the
pterygomaxillary fisure laterally and the body of sphenoid bone and anterior
orbital fissure superiorly and then pterygopalatine process continue as canal.
but i cant show u the boundaries here,of course this is temporal fossa,this is
infratemporal fossa,and then here up there medially is pterygopalatine fossa.
so,this pterygopalatine fossa located medial to infratemporal fossa.
The pterygopalatine fossa (ppf ) communicate with other regions of the skull
via fissure and foramina. First,
1. Sphenopalatine foramen-enable pterygopalatine fossa(ppf) to
communicate with nasal cavity.
2. anterior orbital fissure-enable ppf to communicate with the orbits floor
3. Pharyngeal canal-enable ppf to communicate with nasopharynx which is
the upper portion of pharynx
4. Foramen rotundum- enable ppf to communicate with medial cranial
fossa
5. Pterygoid canal-ends in the medial cranial fossa in foramen lacerum
6. Pterygopalatine canal-ends in the greater and lesser palatine foramina.
7. Pterygomaxillary fissure (not mentioned by doctor)

We have 3 major contents of pterygopalatine fossa which are maxillary

nerve,pterygoplatine ganglion and maxillary artery.regarding maxillary nerve
as you already know it arrives form secondary division of trigeminal ganglion
then passing foramen rotundum to enter pterygoplatine fossa. so this space
here is pterygopalatine fossa. Before passing foramen rotundum the maxillary
artery gives off the meningeal branch. now remember that the maxillary
division of trigeminal nerve is purely sensory,means NO motor fibres!
After passing foramen rotundum and entering pterygopalatine fossa,maxillary
nerve gives off many branches for example this is zygomatic nerve which will
enter the orbit via inferior orbital fissure branching into the
zygomaticotemporal and zygomaticofacial nerve. Zygomaticotemporal nerve
carry post ganglionic parasympathetic fibre which are giving to lacrimal gland
via lacrimal nerve.
Now,if u can see here there are 2 short branches called pterygopalatine
branches or ganglionic branches and as u can see they are suspending a
ganglion. this ganglion is named according to fossa’s name it is located in. so,
pterygopalatine ganglion-parasympathetic ganglion. another branch of
maxillary nerve here is posterior superior alveolar nerve. this is [10.08.one
word is not clear] branch,because it supplies the upper motor teeth as well as
the fissure of maxillary sinus.then,the maxillary nerve continue as infraorbital
nerve lying in the infraorbital sulcus before entering the infraorbital canal till it
reaches the face via infraorital foramen.
Once the maxillary nerve located in the infraorbital canal it gives off 2 branches
which are middle-superior alveolar nerve and anterior-superior alveolar nerve.
just to memorise the names of these nerves, all of these are
superior.superior..posterior,superior,middle,and anterior.it is superior alveolar
because supplying upper teeth.but one is most posterior,one is most anterior
and one is in middle.so,remember that the posterior superior comes directly
from maxillary nerve while the middle and anterior superior alveolar nerve
come from the infraorbital nerve in its canal.

Now,here is pterygopalatine ganglion also called as sphenopalatine ganglion

that is located in pterygopalatine fossa suspended to maxillary nerve by
ganglionic branches at pterygopalatine nerve which is branch of maxillary
nerve. pterygopalatine ganglion receives preganglionic parasympathetic fibre
of facial nerve via greater petrosal nerve. so,greater petrosal nerve is a branch
of facial nerve carrying preganglionic parasympathetic fibre that are going to
synapse with post ganglionic parasympathetic in the pterygopalatine
ganglion.now the greater petrosal nerve joins with another nerve called deep
petrosal nerve to form the nerve of pterygoid canal.again,the trunks between
the pterygopalatine fossa to foramen lacerum....intermital cranial fossa

Remember the trigeminal nerve(V) divides into three divisions.The most

superior is the ophthalmic then maxillary then mandibular. The maxillary rises
the one that goes to the pterygopalatine fossa passing through the foramen
rotundum. If you remember the foramen rotundum is that foreman in greater
wing of sphenoid bone, the medial cranial fossa.
 So again the greater petrosal nerve join the deep petrosal nerve to form
the nerve of the pterygoid canal. Remember that the deep petrosal nerve
consists of post ganglionic sympathetic fibres. These fibres are commuting
from the plexus around the internal carotid artery. Do you remember that the
internal carotid artery which is the branch of the common carotid artery
entering the cranium or the cranial cavity. Now, there are three groups of
cervical ganglia. So inferior, middle and superior cervical ganglia. She will talk
more about this in another lecture. You have that post ganglionic with post
ganglionic sympathetic plexus around the internal carotid artery. And then the
post ganglionic sympathetic fibres are travelling to their destination from that
plexus. So some of those fibres are carried in this deep petrosal nerve here.
And both of these join forming the nerve of the pterygoid canal.

Now again these fibres that are parasympathetic carried the greater
petrosal nerve that are preganglionic . so they need to synapses on post
ganglionic parasympathetic neurons which are present in the pterygopalatine
ganglion. However the sympathetic fibres carried in the deep petrosal nerve
are already post ganglionic. They have already synapses on post ganglionic
sympathetic neurons, that plexus around the internal carotid artery. So they
pass here in the pterygopalatine ganglion without synapsing.

There are many nerves that are arising or coming off from this pterygopalatine
ganglion. Remember that all of these nerves or branches contain three types of
fibres which are sensory, post ganglionic sympathetic, and post ganglionic
parasympathetic. So the first branch, we said that this is the pterygopalatine
canal leading into the greater and lesser palatine foramina. So the first branch
here that you can see is greater palatine nerve which descends in this canal,
the pterygopalatine canal exiting through the greater palatine foramen to
supply the mucosa of the roof of the mouth here, of the hard palate in addition
to the gums.

The second branch is the lesser palatine nerve, which exits through the
lesser palatine foramina to supply the soft palate and the tonsil. Then you have
the posterior inferior lateral nasal nerve which supplies the lower half or the
lower part of the nasal mucosa and the lateral wall of the nasal cavity. Then
you have the superior posterior lateral nasal nerve to supply the mucosa for
the upper part of the nasal cavity on the lateral wall.

Then you have this nerve here, this is called the nasopalatine nerve. Now the
nasopalatine nerve and posterior superior lateral nasal nerve, both pass
through the sphenopalatine foramen. We say here you have the superior and
inferior posterior lateral nasal nerves, they supply parts of the upper and lower
parts of the lateral wall. This nasopalatine nerve supplies the nasal septum. So,
the medial wall of the nasal cavity. So what happens is the nasopalatine nerve
pass through the sphenopalatine foramen crosses roof of the nasal cavity
reaching nasal septum. After you reaching the nasal septum, this nerve runs
anteriorly and inferiorly the nasal septum to reach the incisive canal. While
doing that, it supplies the nasal septum.

Another branch of the pterygopalatine ganglion is the pharyngeal branch

here or the pharyngeal nerve which crosses through the pharyngeal canal to
supply the mucosa in the nasopharynx. And that is the last branch of this
ganglion. So again, remember pterygopalatine ganglion is parasympathetic
ganglion containing post ganglionic parasympathetic fibres or preganglionic
parasympathetic fibres pair with greater petrosal nerve which is branch of the
facial nerve. Then after synapsing in its neurons, those post ganglionic
parasympathetic fibres supply the lacrimal nerve of the lacrimal gland and the
mucosal glands in the nasal cavity, oral cavity and pharynx the same with the
nasopharynx.
The last content of the pterygopalatine fossa is the maxillary artery. You
remember the maxillary artery is one of the terminal branches of the external
carotid artery. And if you remember maxillary artery is subdivided into three
portions according to its location. So you have mandibular portion, the
pterygoid protion and the last portion is the pterygopalatine portion which is
the third portion of the maxillary artery.
 Now the pterygopalatine portion starts at the pterygomaxillary fissure,
so can you see this space here? This is the pterygomaxillary fissure which
between the pterygoid process of the sphenoid bone and that of maxilla.

Now there are many branches of the maxillary artery. So you have here
is the descending palatine artery which descends in the pterygopalatine artery
dividing into the greater and lesser palatine arteries. And then you have this
here, this is the posterior superior alveolar artery which runs with the posterior
superior alveolar nerve. Then this is the infraorbital artery, you can see that it
lies in the infraorbital sulcus perceiving the infraorbital canal. And then you can
see the sphenopalatine artery, which runs through or passes through the
sphenopalatine foramen and it runs with the nasopalatine nerve on the nasal
septum, supplying that medial wall of the nasal cavity. Then you can see the
pharyngeal artery which runs with the pharyngeal nerve and the artery of the
pterygoid canal running in the pterygoid canal together with the nerve of the
pterygoid canal.