Palet- Pterygopaletine Fossa Flashcards
Explain th Pterygopaletine fossa
(sphenopaletine)
- Inverted pyramidal shape
- Fat filled
- On lateral side of skulll
- Between infratemporal fossa & Nasopharynx
Known as major Neurovascular Crossroadsbetween the orbit – nasal cavity – the infratemporal fossa and the cranial fossa
PP fossa!
What is the anterior wall of the PP fossa?
Posterior surface of the maxilla
What is the medial wall of the PP fossa?
Lateral surface of the paletine bone
What makes the roof/posterior wall of the PP fossa?
- Sphenoid (anterosuperior surface of pterygoid process)
The PP fossa communitcates with what 6 things?
- Middle cranial fossa
- Infratemporal fossa
- Floor of the orbit
- Lateral wall of the nasal cavity
- Oropharynx
- Roof of the oral cavity
The PP fossa is a major site for what?
Maxillary Nerve (CN5V2) sensory!
The PP fosa is a terminal site for what?
Maxillary artery!
What important ganglion is in the PP fossa?
Pterygopaletine ganglion
What merges in the PP gnaglion?
Merger
* Pre-ganglionc sympathetic fibers from Facial CN7
* Post ganglionic PARAsympathetic fibers
**These join sympathetic fibers from T1 joing branches of V2; sensory **
Oral Facial Pain
The PP fossa is formed by the ?
anterosuperior surface of pterygoid process
on the sphenoid bone
What are the 3 foramen in the spehnoid bone?
- Foramen Rotundum (max V2)
- Anterior opening of Pterygoid canal
- Foramen Lacerum
How many gateways are in the PP fossa? What do they do?
7 formanina & Fissure
1. Foramen rotundum
2. Pterygoind canal
3. Paltovaginal canal
4. Paletine Canal
5. Ptergomaxillary fissure
6. Inferior orbital fissure
7. PP foramen
What exits via formaen rotundum?
Maxillary CN5V2 (sensory)
Explain where the maxillary nerve goes once it exits the foramen rotundum
- Passes anteriorly through inferior orbital fissure to become the infra-orbital nerve
Trauma to the infraorbital area results in?
Losing sensory, also a source of pain!
What does the infra-orbital nerve (branch from V2) supply?
Supplys orbital wall; sphenoidal & ethmoidal sinus
If you have excess mucous in the sphenoidal and ethmoidal sinus, what can this causes?
Pressure on the infra-orbital nerve which sends sensory signals back and give us that pain pressure sensation. Sinus pressure!
What exits via the paletine canal?
greater & lesser paletine nerves
* Branches off V2
What does the greater paletine nerve innervate?
Branch off V2
- Roof oral cavity
- Muscosa
- Glands of hard pallte
- Lingual Gingiva of incisors
- give rise to post. nasal nerves of nose
What does the lesser palentine innervate?
branch off V2
soft pallate
Where is the greater paletine formaen?
Posterior, bilaterally
What does through the sphenopaletine foramen?
- 7 Nasal nerves to nasal cavity
most go to supply the lateral, some medial wall
branch of V2
WHere does the Nasopaletine n go and exit into the oral cavity?
1/7 nasal nerve brances of V2
- Down nasal septum into oral cavity via incisive foramen adj to incisors.
What goes through the Palatovaginal Canal?
Chains from below.
Explain zygomatic nerve
Branch off V2
Branch off V2
* Supplies mucosa & glands of nasopharynx
* Divides into zygomatico- temporal & facial
Explain the zygomaticotemporal branch of zygomatic n
Goes up and supplies skin over temple
Explain the zygomaticofacial branch of zygomatic n
Supply adjacent skin of zygomatic bone
What stems from the Pterygopaletine fisure?
(infratemporal fossa)
Posterior Superior Alveolar Nerve
branch off V2
What does the Posterior Superior Alveolar nerve do & supply?
branch off V2
- Joings with superior dental plexus inferior to max sinus
- Supplies innervation to:
1. molar teeth
2. buccal gingiva
3. max sinus
What goes through the inferior orbital fissure?
Inferior orbital nerve
Continuation of V2
Explain the infra-orbital n. Location and branches
- lies in infra-orbital groove, exit via infraorbital canal
- Branches are middle & anterior superior alveolar nerves
What do the middle & anterior superior branches off the infra-orbital canal do?
join superior alveolar plexus supplies maxillary teeth
Infra-orbital nerve
What does the middle superior alveolar nerve supply?
Maxiillary sinus
What does the anterior superior alveolar nerve supply?
Small nasal branch into nasal floor & walls
What branchesdoes the end of the infra-orbital nerve divide into? (3). Supply what?
- Nasal (skin over nose + nasal septum)
- Palpebral (lower skin of eyelids)
- Superior labial (cheek, upper lip, oral mucosa)
What innervates the maxillary teeth?
- Post superior alveolar (branch off V2)
- Anterior & middle superior alveolar (branch off infraorbital)
What provides blood supply to maxillary teeth?
3 Branches off Maxillary Artery
1. Posterior
2. Middle
3. Anterior
Alveolar arteries
What innervates mandibular teeth?
Inferior alveolar nerve (V3 branch, sensory + motor)
What is blood supply of the mandibular teeth?
Inferior alveolar artery off maxillary artery
What is located in the pterygoid canal?
Nerve to the pterygoid Canal
Formed by Joining of:
* greater petrossa (branch from CN7)
* *deep petrosal *(branch from internal carotid plexus)
pre ganglionic para sympathetic & post ganglion sympathtic fibers
Explain the Greater Petrossal nerve
Branch from CN7
* Pre-ganglionic Parasympathetic innervation
* Joins with deep petrosal to form nerve to pterygoid canal
What does the parasympathetic innervation of the greater petrosal nerve go?
- mucous glands of nasal cavity
- salivary glands in upper half of oral cavity
- lacrimal gland in orbit
- taste from soft palate
Explain the Deep Petrossal nerve
Brnach from internal carotid plexus
* Post-ganglionic sympathetic fibers for blood vessles
* Joins with Greater petrosal to form to pterygoid canal
Where does the deep petrosal nerve orignate from?
Superior cervical sympathetic ganglion that gives off the **internal carotid plexus then deep petrosal **
Explain Pterygopaletine Ganglion (PP ganglion)
- Largest of 4 parasympathetic ganglion in head
- Merging of nerve fibers CN7 and V2
- Located directly back though nose
What are the 3 branches off of the PP ganglion continued off V2?
- Orbital Branch
- Nasopaletine Branch
- Pharyngeal branch
What does a pterygopalatine ganglion block do?
Helps manage oral facial pain & headache.
* Block using a sphenocath through nose allows for direct injection into the nose.
How do you Relieves trigeminal autonomic cephalalgias such as
* cluster headache
* migraine
* chronic paroxysmal hemicrania (CPH)
* certain neuralgias
Pterygopaletin ganglion block via injection of anesthetic!
What does the PP ganglion contain (3 types of nerve fibers)
- Parasympathetic
- Sympathetic
- Somatosensory
Help block sinus related pain & superfical nerve pain
What innervates the lacrimal gland?
- Zygomaticotemporal; autonomic nerve
- General sensory branch off opthalmic Nerve V1
Explain maxillary artery and 6 branches
primary arterial distribution from ECA
1. Post Sup Alveolar
2. Greater paletine
3. Infra-orbital
4. Pharyngeal
5. Artery of pterygoid canal
6. Spheno paletine artery
Maxillary artery branch
supplies blood molars / premolars – adjacent gingivae and maxillary sinus
Posterior Superior Alveolar Artery
Maxillary artery branch
Supplies blood to structures around the orbital floor
Infra-orbital artery
Maxillary artery branch
Supplies blood to incisors canines and maxillary sinus
Anterior Superior Alveolar Artery
Maxillary artery branch
Through palatine canal becomes lesser palatine branch:
supplies:
* soft palate – continues to greater palatine foramen to supply hard palate – to anterior septum of nose
Greater Paletine Artery
Maxillary artery branch
**supplies blood **
* posterior aspect of roof of nasal cavity
* Sphenoidal sinus
* pharygotympanic tube
Pharyngeal branch
Maxillary artery branch
Terminal branch of maxillary artery
Supplies:
* Lateral wall of nasal cavity
* Paranasal sinues (septum)
Sphenopaletine branch
Maxillary Artery branch
at **pterygoid canal **
* supplies surrounding tissues
* fills foramen lacerum
* terminates in mucosa of nasopharynx
Artery of pterygoid canal
All veins in the PP fossa pass ____ through PP ____ to from the ____ in the infratemporal fossa
All veins in the PP fossa pass laterall through PP fissure to from the pterygoid plexus in the infratemporal fossa
How does the pterygoid plexus communitcate witht the cavernous sinus?
Emmissary veins that comme off the pterygoid plexus and go up into the cavernous sinus
What 2 veins join befroe foing to pterygoid plexus?
Facial + Deep Facial
Where does the pterygoid plexus mainly drain into via what??
External jugular via the **retromandibular vein **
Where is the pterygoid plexus located
Infratemporal fossa; between temporalis m. & lateral pterygoid m.
Whre does the external jugular vein drain into?
Subclavian vein
Where does the cavernous sinus drain?
The brains dura