Palate and PPF Flashcards
what is the pterygopalatine fossa (PPF)
A. The PPF is a bony space located deeply within the skull; it is located postero-inferiorly to the apex of the orbit, posterior to the maxillary sinus, and deep (medial to) the infratemporal region.
the PPF contains what?
multiple nerves, arteries and veins.
parasympathetic ganglion called the pterygopalatine ganglion
what is transantral access to the PPF
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why is it utilized
Transantral access to PPF. The PPF can be accessed via the maxillary sinus. The upper lip is elevated and the maxillary sinus is entered anteriorly. This approach can be utilized to remove tumors from the PPF or to ligate a sphenopalatine artery in cases of chronic epistaxis (nose bleeding).
what are the general contents of the PPF (3)
- Maxillary artery – third (pterygopalatine) portion
- Maxillary branch of trigeminal nerve (V2)
- Pterygopalatine ganglion
what are the boundaries of the pterygopalatine fossa
lateral superior anterior medial inferior posterior
A. Lateral – pteygomaxillary fissure
B. Superior – greater wing of sphenoid bone- no foramen
-separates PPF from middle cranial fossa
C. Anterior – maxilla
it separates the PPF from the maxillary sinus and orbital floor.
D. Medial – palatine bone
E. Inferior – open via pterygopalatine canal
F. Posterior – pterygoid process of sphenoid bone
what are the openings of the PPF (7)
pterygomaxillary fissure inferior orbital fissure sphenopalatine foramen pterygopalatine foramen rotundum pterygoid canal pharyngeal canal
pterygomaxillary fissure
where in relation to PPF
communicates with what
transmits what
- Lateral
- Communicates with infratemporal fossa
- Transmits – maxillary a.; posterior superior alveolar a.v.n
inferior orbital fissure
anterior to PPF
communicates with orbit
transmits infraorbital a, v, n
zygomatic a,v, n
sphenopalatine foramen
- Medial
- Communicates with nasal cavity
- Transmits
– sphenopalatine a.
nasopalatine n.;
post sup lateral nasal n.
pterygopalatine canal
- Inferior
- Communicates with palate and oral cavity
- Transmits – descending palatine a.
; greater and lesser palatine nn.
foramen rotundum
- Posterior
- Lateral-most of the three posterior openings
- Communicates with middle cranial fossa
- Transmits – V2
pterygoid canal
- Posterior
- Middle of the three posterior openings
- Communicates with middle cranial fossa near foramen lacerum (opens in the foramen lacerum)
- Transmits – nerve and artery of pterygoid canal
pharyngeal canal
- Posterior
- Medial-most of the three posterior openings
- Communicates with nasopharynx
- Transmits – pharyngeal a.v.n.
the posterior wall of the PPF is formed by the sphenoid bone. what are the three foramen which are in this area
foramen rotundum (most lateral)
pterygoid canal (middle)
pharyngeal canal (most medial)
where does the third portion of the maxillary artery enter the PPF
through the pterygomaxillary fissure
what are the 6 branches off the pterygopalatine portion of maxillary artery
posterior superior alveolar infraorbital descending palatine artery of pterygoid canal pharyngeal artery sphenopalatine artery
posterior superior alveolar
enters what foramen
supplies what
- Enters un-named foramen on maxillary bone.
2. Supplies maxillary teeth and gingiva and maxillary sinus
infraorbital artery
exits PPF via what
courses where
exits where
supplies what?
what are its 5 branches
- Exits the PPF anteriorly via the inferior orbital fissure.
- Courses through the floor of orbit in the infraorbital canal
- Exits to face via infraorbital foramen
- Supplies floor of orbit, maxillary sinus, maxillary teeth, and the skin of the face via the following branches:
a. Zygomatic artery
b. Middle superior alveolar a.
c. Anterior superior alveolar a.
d. Nasal branches
e. Superior labial branches
descending palatine artery
exits PPF where?
supplies what?
what are its two main branches?
- Exits the PPF inferiorly via the pterygopalatine canal.
- Supplies the palate, nasal cavity, and palatine tonsil via the following branches:
a. Greater palatine a.
b. Lesser palatine a.
artery of the pterygoid canal
exits PPF where
supplies what?
- Exits the PPF posteriorly via the pterygoid canal.
2. Supplies nasopharynx, auditory tube, tympanic cavity.
pharyngeal artery
exits PPF where
and travels through what?
supplies what?
- Exits the PPF posteriorly via the pharyngeal canal.
- Pharyngeal canal courses through the medial wall of the sphenoid sinus to open into the nasopharynx.
- Supplies nasopharynx, sphenoid sinus, and auditory tube.
sphenopalatine artery
exits ppf where?
supplies what?
- Exits the PPF medially via the sphenopalatine foramen
2. Supplies nasal cavity
where does V2 exits the middle cranial fossa and where is it headed
- V2 exits the middle cranial fossa via the foramen rotundum to enter the PPF.
what components is V2 carrying and to where
GSA to the middle dermatome of the face, nasal cavity, paranasal sinuses, maxillary teeth
what does V2 distribute
parasympathetic innervation from the pterygopalatine ganglion
what are the 11 branches off V2
meningeal branch to dura of middle cranial fossa
zygomatic
posterior superior alveolar n.
infraorbital
pterygopalatine nn’s (suspend from V2)
greater palatine
lesser palatine
posterior superior lateral nasal
pharyngeal
N. of pterygoid canal
Nasopalatine
zygomatic nerve of V2
exits PPF where?
courses through to what
what are its branches and what are these branches supplying ?
how is it related to autonomic innervation?
- Exits PPF anteriorly via the inferior orbital fissure.
- Courses through floor and lateral wall of the orbit and then divides into the following two nerves which supply GSA innervation to the face:
a. Zygomaticofacial n.
b. Zygomaticotemporal n. - Gives rise to communicating branch to lacrimal nerve of V1
- NOTE: Route for autonomic fibers to the lacrimal gland.
posterior superior alveolar nerve
courses where from PPF?
supplies what?
- Enters un-named foramen on maxillary bone.
2. Supplies maxillary teeth and gingiva and maxillary sinus
infraorbital nerve
exits PPF where?
courses where?
supplies what?
what are its 4 branches?
- Exits PPF anteriorly via the inferior orbital fissure.
- Courses through floor of orbit in infraorbital canal and exits to face via infraorbital foramen.
- Supplies floor of orbit, maxillary sinus, maxillary teeth, skin of face via:
a. Middle and anterior superior alveolar n.
b. Inferior palpebral nn.
c. External nasal branches
d. Superior labial branches
pterygopalatine nerve s
2 of these are suspended from the pterygopalatine ganglion to V2
carry parasympathetic nerves to pterygopalatine ganglion (sensory roots)
greater palatine nerve
exits PPF where?
supplies what?
what is a branch off this?
- Exits PPF inferiorly via the pterygopalatine canal to oral cavity.
- Supplies hard palate
- Also supplies the nasal cavity via the:
a. Posterior inferior lateral nasal n.
lesser palatine nerve
exits ppf where?
supplies what?
- Exits PPF inferiorly via the pterygopalatine canal to oral cavity.
- Supplies soft palate and tonsillar bed.
posterior superior lateral nasal nerve
exits PPF where
supplies what?
- Exits PPF medially via sphenopalatine foramen to enter nasal cavity.
- Supply lateral wall of nasal cavity
pharyngeal nerve
exits PPF where?
supplies what
- Exits PPF posteriorly via the pharyngeal canal to nasopharynx.
- Supplies nasopharynx
nerve of pterygoid canal
enters PPF where?
carries what?
- Enters PPF posteriorly via the pterygoid canal.
2. Carries autonomics to PPG (see below)
nasopalatine nerve
exits PPF where
supplies what?
what foramen does it then pass through?
- Exits PPF via the sphenopalatine foramen to nasal cavities.
- Supplies nasal cavity
- Then passes through incisive foramen to supply anterior hard palate
nasopalatine nerve block?
anesthetic injected near incisive foramen
greater palatine nerve block
anesthetic injected near greater palatine foramen
where is the PPG?
what does it contain?
what does it receive ?
what to/where does it distribute
- The PPG is suspended from V2 by pterygopalatine nn.
It contains cell bodies of postganglionic parasympathetic neurons.
The PPG receives preganglionic fibers from facial n (greater petrosal n) and postganglionic fibers from the deep petrosal nerve.
These autonomic fibers then distribute via various branches of V2 to the mucus glands of the deep head (nasal and paranasal cavities, palate, pharynx) and to the lacrimal gland.
what makes up nerve of pterygoid canal?
what is it carrying
greater petrosal nerve
deep petrosal nerve
a. Carries parasympathetic (pre) and sympathetic (post) to PPG.
what cranial nerve is greater petrosal off
CN VII
what is the pathway of parasympathetic innervation via greater petrosal nerve….
preganglionic cell bodies
preganglionic fibers
postganglionic cell bodies
postganglionic fibers
- Pathway of parasympathetic fibers concerned with PPG
- Preganglionic cell bodies located in brainstem in salivatory nucleus.
- Preganglionic fibers travel with CN VII → greater petrosal nerve → nerve of pterygoid canal → pterygopalatine ganglion.
- Postganglionic fibers then distribute via branches of the maxillary nerve.
what is the pathway of sympathetic innervationg via the deep petrosal nerve ?
where are the preganglionic cell bodies
preganglionic fibers
postganglionic cell bodies
postganglionic fibers
- Pathway of sympathetic innervation to (through) PPG
- Preganglionic cell bodies located in the IMLCC from T1/T4.
- Preganglionic fibers travel within sympathetic chain to the superior cervical sympathetic ganglion (SCG).
- Postganglionic cell bodies are located in the SCG.
- Postganglionic fibers form internal carotid nerve → deep petrosal nerve → nerve of pterygoid canal → pass through PPG without synapsing.
- Postganglionic fibers then distribute via branches of the maxillary nerve.
what is the parasympathetic innervation to the lacrimal gland?
preganglionic cell bodies
preganglionic fibers
postganglionic cell bodies
postganglionic fibers
function
- Preganglionic cell bodies located in the salivatory nucleus in brainstem.
- Preganglionic fibers travel with the greater petrosal nerve (CN VII).
- Postganglionic cell bodies in pterygopalatine ganglia.
- Postganglionic fibers travel with the zygomatic (V2) and lacrimal (V1) nerves.
- Increase lacrimal gland secretions.
sympathetic innervation to the lacrimal gland
preganglionic cell bodies preganglionic fibers postganglionic cell bodies postganglionic fibers function
B. Sympathetic innervation
- Preganglionic cell bodies located in upper thoracic spinal levels (T1-T4).
- Preganglionic fibers enter sympathetic chain and ascend.
- Postganglionic cells bodies in superior cervical sympathetic ganglia; fibers distributed via internal carotid nerve (deep petrosal nerve).
- Greater and deep petrosal nerves merge to form the nerve of the pterygoid canal.
- Postganglionic fibers distribute with the zygomatic (V2) and lacrimal (V1) nerves.
- Vasomotor; creates more watery lacrimal fluid
what is the autonomic innervation (PARASYMPATHETIC) to mucous secreting glands of the head
- Preganglionic cell bodies – salivatory nucleus in brainstem
- Preganglionic fibers travel with facial n.
- Facial n provides greater petrosal branch which exits temporal bone via the hiatus for the greater petrosal n.
- Now in the middle cranial fossa, the greater petrosal nerve joins the deep petrosal nerve to form the nerve of the pterygoid canal.
- N. of pterygoid canal travels in pterygoid canal to pterygopalatine fossa.
- Postganglionic cell bodies – pterygopalatine ganglion
- Postganglionic fibers travel with branches of V2 to distribute to the nasal cavities and paranasal sinuses.
what is the sympathetic innervation pathway of innervation to mucous-secreting glands of the head
- Preganglionic cell bodies – T1-T4
- Postganglionic cell bodies – superior cervical ganglion
- Postganglionic fibers form the internal carotid nerve → deep petrosal n.
- Deep and greater petrosal nerve form nerve of the pterygoid canal.
- Postganglionic fibers travel with branches of V2 to distribute to the nasal cavities and paranasal sinuses.
what makes up the palate
what does it form a boundary between
what covers the superior surface
what covers the inferior (oral) surface
A. Consists of hard (ossified) and soft (musculofascial) portions.
B. Forms boundary between nasal and oral cavities.
C. Superior (nasal) surface is covered with a respiratory mucosa.
D. Inferior (oral) surface is covered with a typical oral mucosa.
what is the hard palate?
what bones make up the hard palate
a. Palatine processes of maxillary bones
b. Horizontal plate of palatine bones
what are the 3 foramina of the hard palate
a. Incisive foramen – passage of nasopalatine n. and greater palatine a.
b. Greater palatine foramine – passage of greater palatine a.v.n
c. Lesser palatine foramina – passage of lesser palatine a.v.n
what are the parts of the mucosa of the hard palate
a. Palatine glands – mucous-secreting.
b. Transverse palatine folds
c. Palatine raphe
where is anesthetic for the hard palate placed?
d. CLINICAL CORRELATION – anesthetic injection is very painful here because the mucosa is very tightly adhered to the underlying bone, thus anesthetic agent is typically injected into superior gingiva mucosa.
what is the soft palate
what is its function?
- Mobile; assists with swallowing.
a. Presses against tongue to hold food in oral cavity
b. Presses against roof of pharynx to prevent food from passing into nasal cavity
what is the soft palate composed of?
what is the posterior ending of the palate called?
- Composed of palatine aponeurosis and overlying mucosa with palatine glands.
- Ends in posterior projection called the uvula.
what are fauces of the palate?
passage from oral cavity to pharynx
what are the superior, inferior and lateral boundaries of the palate fauces
superior – > palate
inferior –> base of tongue
Lateral–> faucial pillars
- palatoglossal arch
- palatopharyngeal arch
- isthmus of the fauces
what is the palatoglossal arch
fold of mucosa overlying palatoglussus muscle (more anterior than palatopharygeal arch)
what is the palatopharyngeal arch?
fold of mucosa overlying palatopharyngeus muscle
what is the isthmus of the fauces
constricted portion of fauces bounded by palatoglossal pillars
what is the tonsillar bed?
what is the tonsillar bed formed by (5 structures)
what does it house
- Depression between palatoglossal and palatopharyngeal folds
- Houses palatine tonsil
- Structures forming tonsillar bed:
a. Superior constrictor
b. Hyoglossus
c. Middle constrictor
d. Glossopharyngeal n
e. Tonsillar vessels
what are the 5 arteries that supply the palatine tonsil
a. Facial a.
b. Palatine branch of ascending pharyngeal a.
c. Ascending palatine a.
d. Dorsal lingual a.
e. Lesser palatine a.
what is the venous drainage of the palatine tonsil?
a. Tonsillar plexus
b. Pharyngeal plexus of veins
what are the muscles of the palate? 5
levator veli palatini tensor veli palatini musculus uvulae palatopharyngeus palatoglossus
palatoglussus attachments
- Origin – soft palate via palatine aponeurosis
2. Insertion – tongue
palatoglossus innervation
function
- Innervation – vagus n
4. Function – pulls tongue and soft palate together during swallowing
palatopharyngeus attachments
soft palate via palatine aponeurosis
inserts on thyroid cartilage
palatopharyngeus innervation and function
- Innervation – vagus n
4. Function – swallowing, pulls thyroid cartilage up to epiglottic cartilage, close larynx and opens laryngopharynx
musculus uvulae
attachments
innervation
function
- Origin – soft palate via palatine aponeurosis
- Insertion – uvula
- Innervation – vagus n.
- Function – shortens and elevates uvula
tensor veli palatini attachments
- Origin – lateral side of cartilaginous auditory tube; membranous auditory tube; medial pterygoid plate; scaphoid fossa; spine of sphenoid bone.
- Insertion – attaches to palatine aponeurosis via a tendon which passes inferior to the pterygoid hamulus.
tensor veli palatini innervation?
trigeminal (V3)
funciton of tensor veli palatini
- Function – tenses palate; functions during mastication and swallowing; opens membranous portion of auditory tube. Acts before the levator palatini
levator veli palatini attachments
innervation and function
- Origin – medial side of cartilaginous auditory tube; petrous portion of temporal bone
- Insertion – passes between base of skull and superior constrictor to attach to the palatine aponeurosis.
- Innervation – vagus n.
- Function – elevate palate; pull against roof of pharynx
what happens to muscles in the palate region if CN X is lesions
- CLINICAL CORRELATION: With paralysis of CN X, the soft palate and the faucial pillars will sag. Also, the uvula will deviate to the unaffected side.
what is the vasculature of the palate (arterial)
- Maxillary artery (3rd portion)
a. Greater palatine
b. Lesser palatine - Facial artery
a. Ascending palatine a.
what s the venous drainage of the palate
pterygoid plexus of veins
to maxillary vein
what three nerves off the trigeminal nerve (V2) provide sensory innervation to the palate
what else do these branches of V2 carry
- Nasopalatine n.
- Greater palatine n- most.
- Lesser palatine n.
B. NOTE: These branches of V2 also distribute autonomic fibers to the blood vessels and glands of the palate.
