Palate and PPF Flashcards
PPF
posteroinferiorly to apex of orbit
posterior to maxillary sinus
deep to infratemporal region
contains nerves. arteries, veins
transantral access to PPF
can be accessed via maxillary sinus
to remove tumors or ligate sphenopalatine artery in cases of chronic nose bleeds (epistaxis)
contents of PPF
maxillary artery third portion
maxillary branch of trigeminal
-V2
pterygopalatine ganglion - parasympathetics
lateral border of PPF
pterygomaxillary fissure
**open - from infratemporal fossa to pterygomaxillary fissure
location of maxillary artery 3rd portion and posterior superior alveolar a/v/n
superior border of PPF
greater wing of sphenoid
no foramina here, just roof
anterior border of PPF
maxilla
inferior orbital fissure
-transmits infraorbital a/v/n and zygomatic a/v/m
medial border of PPF
palatine bone
sphenopalatine foramen
inferior border o PPF
open via pterygopalatine canal
posterior border of PPF
pterygoid process of sphenoid bone
inferior orbital fissure
anterior PPF
-transmits infraorbital a/v/n and zygomatic a/v/n
sphenopalatine foramen
medial PPF
sphenopalatine a/v
nasopalatine n
posterior superior lateral nasal n
pterygomaxillary fissure
lateral PPF
maxillary a
posterior superior alveolar a/v/n
pterygopalatine canal
inferior PPF
descending palatine a
greater and lesser palatine nn
foramen rotundum
posterior PPF
to middle cranial fossa
transmits V2
pterygoid canal
posterior PPF
to to middle cranial fossa
transmits n and a of pterygoid canal
pharyngeal canal
posterior PPF
to nasopharynx
transmits pharyngeal a/v/n
posterior PPF lateral to medial
foramen rotundum
pterygoid canal
pharyngeal canal
maxillary artery
courses through infratemporal fossa
-3rd portion enters PPF through phenomaxillary fissure
branches of pterygopalatine portion of maxillary artery
posterior superior alveolar a. infraorbital a. descending palatine a. artery of pterygoid canal pharyngeal a. sphenopalatine a.
posterior superior alveolar a.
enters un-named foramen in maxillary bone
maxillary teeth and gingiva
infraorbital a
exits PPF - inferior orbital fissure
ANTERIOR
to face via infraorbital foramen
floor of orbit, maxillary sinus, maxillary theeth, skin of face
branches along the way
-middle superior and anterior superior alveolar aa
descending palatine a
exits PPF - pterygopalatine canal
INFERIOR
to palate, nasal cavity, palatine fossa
artery of pterygoid canal
exits PPF - pterygoid canal
POSTERIOR
to nasopharynx, auditory tube, tympanic cavity
pharyngeal a
exits PPF - pharyngeal canal
POSTERIOR
to nasopharynx, sphenoid sinus, auditory tube
sphenopalatine a
exits PPF - sphenopalatine foramen
MEDIAL
to nasal cavity
maxillary nerve
V2 - GSA to middle dermatome of face
enters PPF via foramen rotundum
PS to pterygopalatine ganglion
has meningeal branch
zygomatic nerve
exits PPF anterior - inferior orbital fissure
- GSA to face
- zygomaticofacial and zygomaticotemporal
GSA to face
zygomaticofacial and zygomaticotemporal
branches of zygomatic nerve from V2
posterior superior alveolar nerve
branch of infraorbital nerve
infraorbital nerve
exits PPF anterior - inferior orbital fissure
supplies floor of orbit, maxillary sinus, maxillary teeth, skin of face
pterygopalatine nerves
suspend pterygopalatine ganglion from V2
-carry PS to ganglion**
greater palatine nerve
exits PPF inferior - pterygopalatine canal
to oral cavity - hard palate
branch - posterior inferior lateral nasal artery
lesser palatine nerve
exits PPF inferior - pterygopalatine canal
to soft palate and tonsillar bed
posterior superior lateral nasal nerve
exits PPF medial - sphenopalatine foramen
-to nasal cavity
lateral wall of nasal cavity
pharyngeal nerve
exits PPF posterior - pharyngeal canal
to nasopharynx
nerve to pterygoid canal
exits PPF posterior - pterygoid canal
autonomics to PPG
nasopalatine nerve
exits PPF medial - sphenopalatine foramen
-to nasal cavities
then through incisive foramen to anteiror hard palate
nerve blocks 2x?
nasopalatine n - incisive foramen
greater palatine n - greater palatine foramen
ganglion we need to know?
pterygopalatine
otic
submandibular
ciliary
4x***
pterygopalatine ganglion contains
postganglionic parasympathetic neurons
receives:
nerve of pterygoid canal
-deep petrosal - S
-greater petrosal - PS
deep petrosal nerve
postganglionic S from superior cervical sympathetic ganglion
pass through PPG
greater petrosal nerve
preganglionic PS from CN VII **
synapse at PPG
nerve to pterygoid canal
contains S and PS
from greater petrosal n and deep petrosal n
parasympathetic to lacrimal gland
increase gland secretions
-PPG - to zygomatic branch of V2
lacrimal branch of V1 to gland
**source is greater petrosal nerve of CN VII
sympathetic to lacrimal gland
secretions more watery
vasomotor - more watery lacrimal fluid
-PPG - zygomatic branch of V2
lacrimal branch of V1 to gland
**source is IMLCC > SCG to deep petrosal nerve
dysfunction of PS to lacrimal gland?
dry, red eye
eyes itchy and very dry
use eye drops all the time
parasympathetic to mucous-secreting glands of palate
increases production of mucus
dysfunction: dry, irritated nasal passages, increased risk of infection
PPG - postganglionic fibers with branches of V2 to nasal cavities and paranasal sinuses
sympathetic to mucous secreting glands
makes gland secretions more watery
dysfunction - minimal effect
sympathetic levels
T1-T4 lateral horn
> superior cervical ganglion via sympathetic chain
> postganglion via internal carotid nerves to PPG
PPG > distributes
sympathetics to head
not too significant
lacrimal and mucous glands
Palate
between nasal and oral cavity
hard palate
bony
anterior 2/3
palatine process of maxillary bone
horizontal plate of palatine bone
soft palate
fascial support
posterior 1/3
foramina of hard palate
incisive foramen
greater palatine foramen
lesser palatine foramen
mucosa of hard palate
mucous secreting
palatine glands
transverse palatine folds
palatine raphe
incisive foramen
nasopalatine n
greater palatine a
greater palatine foramen
passage of greater palatine a/v/n
lesser palatine foramen
passage of lesser palatine a/v/n
composition of soft palate
palatine aponeurosis
-ends at uvula
fauces
oral cavity to pharynx
boundaries of fauces
superior palate
inferior base of tongue
lateral - faucial pillars
faucial pillars
palatoglossal arch
palatopharyngeal arch
isthmus of fauces
palatoglossal arch
fold of mucosa overlying palatoglossus muscle
palatopharyngeal arch
fold of mucosa over palatopharyngeus muscle
isthmus of fauces
constricted portion of fauces bounced by palatoglossal pillars
palatine tonsil
lymphoid tissue
-between palatoglossal and palatopharyngel arches
tonsillar bed
depression between palatoglossal and palatopharyngeal arches
-houses palatine tonsil
tonsillar bed blood supply
facial a palatine branch of ascending pharyngeal a ascending palatine a dorsal lingual a lesser palatine a
5 arteries supplying blood
complications after tonsillectomy** - because of rich blood supply
formation of tonsillar bed
superior constrictor m
hyoglossus m
middle constrictor m
glossopharyngeal n
courses right through tonsillar bed
venous drainage of palatine tonsil
tonsillar plexus and pharyngeal plexus of veins
oropharyngeal membrane
at tonsillar bed
innervation of tonsillar bed
posterior - glossopharyngeal GVA
anterior - lesser palatine GSA
palatoglossus m.
soft palate - tongue
vagus innervation
pulls tongue and soft palate together during swallowing
palatopharyngeus m.
soft palate to thyroid
vagus innervation
swallowing - pulls thyroid up to epiglottis
musculus uvulae
soft palate to uvula
vagus innervation
shortens and elevates uvula
tensor veli palatini
tenses palate
-passes under pterygoid hamulus
during mastication and swallowing - opens membranous portion of auditory tube
levator veli palatini
elevates palate
pull against roof of pharynx
base of skull to soft palate
paralysis of CN X
soft palate and faucial pillars sag
-uvula deviates to UNAFFECTED side***
when open mouth and say “AH”
not innervated by vagus
tensor veli palatine
trigeminal V3
muscles that attach to auditory tube
tensor veli palatini and levator veli palatini
tensor - only one to membranous part**
results in opening of auditory tube
to equalize pressure**
vascular to palate
maxillary artery - greater and lesser palatine aa
facial artery
-ascending palatine a
venous drainage of palate
pterygoid plexus of veins to maxillary vein
anterior to incisive foramen innervation
nasopalatine nerve
posterior to incisive foramen innervation
greater palatine nerve majority
also a little lesser palatine nerve
nerve to upper lip
V2 via infraorbital
-in PPF
dry irritated nasal passages
PS to PPG > nasal passages
inschemia to posterior nasal cavity
sphenopalatine a.
from maxillary a. in PPF
red, irritative eye
less PS to lacrimal and mucous glands of deep head
xerostomia
dry mouth
not affected in PPF
either otic ganglionic or chorda tympani
submandibular and sublingual glands
