pterygopalatine fossa Flashcards
pterygopalatine fissure
narrow space that lies between the tuberosity of the maxilla anteriory and pterygoid process of the sphenoid posteriory
entrance from the infratemporal fossa to the more medial located pterygopalatine fossa
pterygopalatine fossa boundaries (don’t memorize)
anterior - maxillary tuberosity
posterior - pterygoid process
medial - perpendicular palate fo the palatine bone
lateral - infratemporal fossa via the pterygomaxiallary fissure
superior - greater wing of the sphenoid and infraorbital fissure
inferior - retropharyngeal space
pterygopalatine fossa contents
parasympathetic ptergopalatine ganglin
crossroasds for:
infratemporal fossa - terygomaxiallary fissure
middle cranial fossa - foramen rotundum
base fo skull - pterygoid canal
orbit - inferior orbital fissure
nasal cavity - sphenopalatine foramen
oral cavity (palate) - greater palatine canal
nasopharynx - lesser palatine canal and pharyngeal canal
entrances/exits from pterygopalatine fossa (7)
on lateral wall: 1: pterygomaxillary fissure on posterior wall: (lateral to medial) 2: foramen rotundum 3: pterygoid canal on medial wall: (from post to ant) 4: pharyngeal canal 5: sphenopalatine foramen 6: greater palatine canal on anterior wall: inferior orbital fissure
sphenopalatine foramen
on medial wall of pterygopalatine fossa
formed by a small notch in the upper part of the perpendicular plate of the palatine bone where it joins the sphenoid
maxillary artery
supplies most of innermost structures of nasal cavity and mouth
mandibular part
pterygoid part
pterygopalatine part - enters through pterygomaxillary fissure
pterygomaxillary fissure
pterygomaxillary part of maxiallary artery enters here
maxillary artery branches and where they go
maxillary artery through pterygomaxiallary fissure
posterior superior alveolar artery branches off - leaves through pterygomaxillary fissure
infraorbital artery through inferior orbital fissure
greater palatine artery through greater palatine canal
spenopalatine artery through sphenopalatine foramen
pharyngeal artery through pharyngeal artery
artery of the pterygoid canal through pterygoid canal
posterior superior alveolar artery
branch of pterygopalatine part of maxillary
through pterygomaxillary fissure after branches off maxillary artery
enters openings in maxillary tuberosity to supply posterior teeth, maxillary sinus and gums
infraorbital artery
branch of pterygopalatine part of maxillary
through infraorbital sepum to supply anterior teeth and gums before terminating on the face
descending palatine artery
branch of pterygopalatine part of maxillary
has two branches
greater palatine artery
lesser palatine artery
greater palatine artery
branch of pterygopalatine part of maxillary then of descending palatine artery
passes through the greater palatine canal to supply the hard palate
lesser palatine artery
branch of pterygopalatine part of maxillary then of the descending palatine artery
passes through the lesser palatine cavity to supply the soft palate
sphenopalatine artery
branch of pterygopalatine part of maxillary
passes through sphenopalatine foramen
supplies posterior portions of the nasal cavity
gives off lateral posterior nasal arteries and posterior septal branches
maxillary nerve (V2)
entirely sensory
enters pterygopalatine fossa posteriorly through foramen rotundum
branches into
1: zygomatic nerve
2: infraorbital nerve
3: 2 ganglionic branches that are distributed as:
- greater and lesser palatine branches
- posterior superior nasal branches
- pharyngeal branches
foramen rotundum
maxillary nerve (V2) enters pterygopalatine fossa through this
zygomatic nerve
branch of the maxillary nerve (V2) that branches off in the pterygopalatine fossa
infraorbital nerve
continuation of maxillary nerve through pterygopalatine fossa
greater and lesser palatine branches
from maxillary nerve and through pterygopalatine ganglion to hard and soft palates
posterior superior nasal branches and nasopalatine nerve
from maxillary nerve and through pterygopalatine ganglion to nasal cavity
pharyngeal branches
from maxillary nerve to pterygopalatine ganglion to upper pharynx
supply general sensory fibers to their respective regions
pterygopalatine ganglion
largest of 4 parasympathetic ganglia in the head
lies within pterygopalatine fossa
attached to maxillary nerve
from nerve of the pterygoid canal, receives:
preganglionic parasympathetic fibers from greater petrosal nerve
postganglionic sympathetic fibers from the deep petrosal nerve
nerve of the pterygoid canal
brings to the pterygopalatine ganglion:
preganglionic parasympathetic fibers from greater petrosal nerve
postganglionic sympathetic fibers from the deep petrosal nerve
greater petrosal nerve
source of preganglionic parasympathetic fibers to the pterygoid ganglion via nerve of the pterygoid canal
synapse in ganglion
attach themselves to branches of maxillary nerve that distribute them to the minor salivary glands of the hard and soft palate, small glands of the nasal cavity and the upper pharynx
secretomotor function to these glands
deep petrosal nerve
source of postgangionic sympathetic fibers to pterygoid ganglion via nerve of the petrosal canal
pass through ganglion without change
travel with branches of maxillary nerve to their destinations
major branches of maxillary nerve
zygomatic nerve infraorbital nerve ganglionic branches greater and lesser palatine branches posterior and superior nasal branches nasopalatine pharyngeal branches
lacrimal gland innervation
postganglionic parasympathetic fibers pass into the main trunk of maxillary via ganglionic branches
ultimately supplies secretomotor fibers to lacrimal gland
travel from main trunk along zygomatic and zygomaticotemporal branches then cross to lacrimal branch of opthalmic nerve (V1)
terminate as secretomotor fibers to the lacrimal gland
supporting skeleton of external nose
osseus part
cartilagenous part
osseus part of external nose
two nasal bones of the bridge articulate with the frontal bone at the root of the nose and the frontal process of the maxillae
cartilaginous part of the external nose
midline septal cartilage extends bilaterally as the lateral nasal cartilages
two u-shaped alar cartilages at the apex of the nose maintain patency of the nares
septal cartilage
part of cartilaginous part of external nose
midline
extends bilaterally as the lateral nasal cartilages
alar cartilages
part of cartilages of external nose
u-shaped
maintains patency of nares
components of nasal cavites
each has vestibule and a nasal fossa
nasal vestibule
component of nasal cavities
lined by skin and has virbrissae
vibrissae
coarse hairs that trap and remove particles of dust
in vestibule of nasal cavities
nasal fossae
part of nasal cavity
each has a large respiratory area and an olfactory area
respiratory area of nasal cavity
part of nasal fossae
has mucous membrane of pseudostratified columnar ciliated epithelium
highly vascular
contains abundant mucous and serous glands
purpose: humidify and warm incoming air
creates sticky surface that traps and filters particulate matter
cilia that sweep secretions and debris posteriorly into the nasopharynx
olfactory mucous membrane
in roof of upper portion of both the medial and lateral nasal walls of the fossae
less well vascularlized
nonciliated epithelium
modified olfactory nerve cells form nerve fibers that traverse the cribriform plate of the ethmoid bone to synapse in olfactory bulb
movement of air during respiration
during quiet respiration: air circulates around mucosal lining primarily along inferior and middle conchae of lateral nasal walls
sniffing: creates eddies - send air toward roof and olfactory mucosa
borders of nasal cavities
inferior: separated from oral cavity by hard palate = palatine portions of maxillae and horizontal plates of the palatine bones
superior: separated from anterior cranial fossa by frontal, cribriform plate of the ethmoid and sphenoid bones
lateral: series of bones (see other card)
medially: separated by nasal septum
posterior: vomer
superior: perpendicular plate of ethmoid bone
anterior: septal cartilage
nasal septum
separates nasal cavities from each other
vomer
forms posterior part of the nasal cavities
perpendicular plate of the ethmoid bone
forms superior boarder of nasal cavities
lateral bones of nasal cavity (don’t memorize)
maxilla lacrimal bone ethmoid bone inferior nasal concha palatine bone (vertical plate) sphenoid bone (medial pterygoid plate)
conchae
tubercles 3 curved shelf-like extensions project into nasal cavity superior and middle part of ethmoid bone inferior concha is an independent bone
superior and middle conchae
ethmoid bone
inferior conchae
independent bone
meatuses
air passageways underneath each of the concha
sphenoethmoidal recess
superior and posterior to the superior concha
conchae and meatusese purpose
increase surface area and prevent laminar flow
provide greater contact between the inspired air and mucosal surfaces in order to filter, warm, and humidify the air
posterior nasal apertures
where nasal cavities open into nasopharynx
at the choanae
paranasal sinuses
four bilaterally paired sinuses air-filled evaginations of the respiratory part of the nasal cavity named for bones which they invade: frontal ethmoid maxillary sphenoid all sinuses lined by respiratory epithelium
ostia
open into lateral walls of the nasal cavity allowing drainage of mucous and equilibration of air
frontal sinuses
located in the vertical portion of the frontal bone
contain frontalnasal duct
frontal nasal duct
in upright position, drains inferiorly by gravity into the middle meatus
part of frontal sinuses
ethmoid sinuses
honeycomb of small separate air cells within the thin-walled ethmoid labyrinth
lies between the medial wall of the orbit and the upper lateral wall of the nasal cavity
sub-grouped based on location of air cells or ostia
separated from the orbit by the thin-walled lamina papyracea of the ethmoid bone
sub-groups of ethmoid sinuses
- anterior ethmoid cells open into middle meatus
- middle ethmoid cells open into middle meatus on or above the ethmoidal bulla
- posterior ethmoid cells drain into the superior meatus
lamina papyracea
of the ethmoid bone
separates ethmoid sinus from orbit
infections can spread readily to cause orbital cellulites
maxillary sinuses
- in body of maxilla, largest paranasal air sinus
- drainage occurs through the ostium located on teh most superior part of the medial wall into the middle meatus - drainage non-gravity dependent and so poor
- roots of teeth may erupt into these
sphenoid sinuses
- located in the body of the sphenoid bone posterior to upper part of the nasal cavities
- related to the pituitary gland, optic chasm, cavernous sinus and carotid artery
- drainage occurs into the sphenoethmoidal recess by ciliary action only - gravity drainage is poor - ostium on the anterior wall of the sinus is well above the floor
nasal meatuses
paranasal sinuses and tears drain into the nasal fossae
1: inferior nasal meatus
2: middle nasal meatus
3: superior nasal meatus
4: sphenoethmoidal recess
inferior nasal meatus
one of the nasal meatuses where paranasal sinus secretions and tears drain into the nasal fossae
contains nasolacrimal duct
nasolacrimal duct
in inferior nasal meatus
drains into the anterior portion of this meatus
sphenoethmoidal recess
one of the nasal meatuses where paranasal sinus secretions and tears drain into the nasal fossae
spheniod sinus drains here
superior nasal meatus
one of the nasal meatuses where paranasal sinus secretions and tears drain into the nasal fossae
posterior ethmoid cells drain here
middle nasal meatus
one of the nasal meatuses where paranasal sinus secretions and tears drain into the nasal fossae
frontal recess - frontonasal duct and anterior ethmoid cells drain here
ethmoid bulla - bulging middle ethmoidal air cells and their ostia
uncinate process - a sharp ridge of bone below the ethmoid bulla
semilunar hiatus - opening between teh ethmoid bulla above and uncinate process below leading into a groove - maxillary sinus drains here
frontal recess
part of middle nasal meatus
frontonasal duct and anterior ethmoid cells drain here
ethmoid bulla
part of middle nasal meatus
bulging middle ethmoidal air cells and their ostia
uncinate process
part of middle nasal meatus
a sharp ridge of bone below the ethmoid bulla
semilunar hiatus
part of middle nasal meatus
opening between the ethmoid bulla above and uncinate process below leading into a groove
maxillary sinus drains here
arteries to nasal cavities
external carotid system
- maxillary
- sphenopalatine artery
- greater palatine artery (terminal portion)
- facial artery
internal carotid system
- opthalmic artery
- ethmoidal branches
- anterior ethmoidal
- posterior ethmoidalopthalmic artery
branch of the internal carotid
ethmoidal branches
- anterior
- posterior
supply blood to roof of superior medial and lateral walls of both nasal cavities and frontal and ethmoidal sinusesfacial artery
branch of external carotid
superior labial branch of the facial artery supplies the very antero-inferior portion of the nasal cavity
maxillary artery
sphenopalatine branch and greater palatine artery
sphenopalatine artery
branch of maxillary artery
enters nasal cavity through sphenopalatine foramen
main blood supply to the nasal mucosa - to conchae and meatuses of lateral wall and posteroinferior portion of the nasal septum
greater palatine artery
branch of maxillary artery
passes down the palatine canal and exits the greater palatine foramen
travels anteriorly on the oral surface of the hard palate
passes through the incisive foramen and canal to enter the nasal cavity and anastomose with a septal branch of the sphenopalatine artery on the anterior portion of the septum
little’s area/kiesselbach’s plexus
regin in anterioinferior part of the nasal septum wehre 4 arteries anastomose to form a vascular plexus
arteries:
1: anterior ethmoidal (from opthalmic)
2: sphenopalatine artery (from maxillary)
3: greater palatine artery (from maxillary)
4: septal branch of superior labial artery (from facial)
common site for nose bleed
venous drainage of nasal cavity
extensive submucosal cavernous plexuses especially dense over inferior and middle concha and posterior nasal septum
to warm and humidify inspired air, every 6 hours there’s a cyclical fluctuation of venous engagement - veins of one nasal cavity become engorged, other side becomes decongested
opthalimic vein
maxillary vein
facial vein
opthalmic vein
ethmoidal veins drain here
drains into cavernous sinus
maxillary vein
remainder of venous drainage is via sphenopalatine vein to pterygoid plexus in infratemporal fossa (mandibular vein - retromandibular vein)
facial vein
drains into internal jugular vein
lymphatic drainage of nasal cavity
submandibular
deep cervical
submandibular lymph nodes
drain anterior region of the nose plus frontal, anterior ethmoidal and maxillary sinuses
deep cervical lymph nodes
receive lymph directly or via retropharyngeal nodes
retropharyngeal lymph nodes
drain into deep cervical nodes
receive lymph from posterior region of the nasal cavity including posterior ethmoidal cells, sphenoid sinuses and nasopharynx
nerves to nasal cavity
olfactory nerves (CN1)
ordinary sensation:
- opthalmic (V1)
- nasociliary nerve
- anterior ethmoidal nerve
- nasal branches
- internal
- external
- maxillary (V2)
autonomic nerves
- sympathetic
- parasymptatheticolfactory nerve
CNI
perception of smell
nerve fibers from the olfactory mucosa pass through the cribriform plate to synapse in the olfactory bulb
maxillary nerve
through foramen rotundum to pterygopalatine fossa
supplies posteroinferior portion of nasal cavity
lateral - to posterior superior lateral nasal branches
medial - posterior superior medial nasal branches, nasopalatine nerve
