pterygopalatine fossa Flashcards

1
Q

pterygopalatine fissure

A

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

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2
Q

pterygopalatine fossa boundaries (don’t memorize)

A

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

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3
Q

pterygopalatine fossa contents

A

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

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4
Q

entrances/exits from pterygopalatine fossa (7)

A
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
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5
Q

sphenopalatine foramen

A

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

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6
Q

maxillary artery

A

supplies most of innermost structures of nasal cavity and mouth
mandibular part
pterygoid part
pterygopalatine part - enters through pterygomaxillary fissure

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7
Q

pterygomaxillary fissure

A

pterygomaxillary part of maxiallary artery enters here

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8
Q

maxillary artery branches and where they go

A

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

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9
Q

posterior superior alveolar artery

A

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

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10
Q

infraorbital artery

A

branch of pterygopalatine part of maxillary

through infraorbital sepum to supply anterior teeth and gums before terminating on the face

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11
Q

descending palatine artery

A

branch of pterygopalatine part of maxillary
has two branches
greater palatine artery
lesser palatine artery

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12
Q

greater palatine artery

A

branch of pterygopalatine part of maxillary then of descending palatine artery
passes through the greater palatine canal to supply the hard palate

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13
Q

lesser palatine artery

A

branch of pterygopalatine part of maxillary then of the descending palatine artery
passes through the lesser palatine cavity to supply the soft palate

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14
Q

sphenopalatine artery

A

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

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15
Q

maxillary nerve (V2)

A

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

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16
Q

foramen rotundum

A

maxillary nerve (V2) enters pterygopalatine fossa through this

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17
Q

zygomatic nerve

A

branch of the maxillary nerve (V2) that branches off in the pterygopalatine fossa

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18
Q

infraorbital nerve

A

continuation of maxillary nerve through pterygopalatine fossa

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19
Q

greater and lesser palatine branches

A

from maxillary nerve and through pterygopalatine ganglion to hard and soft palates

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20
Q

posterior superior nasal branches and nasopalatine nerve

A

from maxillary nerve and through pterygopalatine ganglion to nasal cavity

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21
Q

pharyngeal branches

A

from maxillary nerve to pterygopalatine ganglion to upper pharynx
supply general sensory fibers to their respective regions

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22
Q

pterygopalatine ganglion

A

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

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23
Q

nerve of the pterygoid canal

A

brings to the pterygopalatine ganglion:
preganglionic parasympathetic fibers from greater petrosal nerve
postganglionic sympathetic fibers from the deep petrosal nerve

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24
Q

greater petrosal nerve

A

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

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25
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
26
major branches of maxillary nerve
``` zygomatic nerve infraorbital nerve ganglionic branches greater and lesser palatine branches posterior and superior nasal branches nasopalatine pharyngeal branches ```
27
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
28
supporting skeleton of external nose
osseus part | cartilagenous part
29
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
30
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
31
septal cartilage
part of cartilaginous part of external nose midline extends bilaterally as the lateral nasal cartilages
32
alar cartilages
part of cartilages of external nose u-shaped maintains patency of nares
33
components of nasal cavites
each has vestibule and a nasal fossa
34
nasal vestibule
component of nasal cavities | lined by skin and has virbrissae
35
vibrissae
coarse hairs that trap and remove particles of dust | in vestibule of nasal cavities
36
nasal fossae
part of nasal cavity | each has a large respiratory area and an olfactory area
37
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
38
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
39
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
40
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
41
nasal septum
separates nasal cavities from each other
42
vomer
forms posterior part of the nasal cavities
43
perpendicular plate of the ethmoid bone
forms superior boarder of nasal cavities
44
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) ```
45
conchae
``` tubercles 3 curved shelf-like extensions project into nasal cavity superior and middle part of ethmoid bone inferior concha is an independent bone ```
46
superior and middle conchae
ethmoid bone
47
inferior conchae
independent bone
48
meatuses
air passageways underneath each of the concha
49
sphenoethmoidal recess
superior and posterior to the superior concha
50
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
51
posterior nasal apertures
where nasal cavities open into nasopharynx | at the choanae
52
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 ```
53
ostia
open into lateral walls of the nasal cavity allowing drainage of mucous and equilibration of air
54
frontal sinuses
located in the vertical portion of the frontal bone | contain frontalnasal duct
55
frontal nasal duct
in upright position, drains inferiorly by gravity into the middle meatus part of frontal sinuses
56
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
57
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
58
lamina papyracea
of the ethmoid bone separates ethmoid sinus from orbit infections can spread readily to cause orbital cellulites
59
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
60
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
61
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
62
inferior nasal meatus
one of the nasal meatuses where paranasal sinus secretions and tears drain into the nasal fossae contains nasolacrimal duct
63
nasolacrimal duct
in inferior nasal meatus | drains into the anterior portion of this meatus
64
sphenoethmoidal recess
one of the nasal meatuses where paranasal sinus secretions and tears drain into the nasal fossae spheniod sinus drains here
65
superior nasal meatus
one of the nasal meatuses where paranasal sinus secretions and tears drain into the nasal fossae posterior ethmoid cells drain here
66
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
67
frontal recess
part of middle nasal meatus | frontonasal duct and anterior ethmoid cells drain here
68
ethmoid bulla
part of middle nasal meatus | bulging middle ethmoidal air cells and their ostia
69
uncinate process
part of middle nasal meatus | a sharp ridge of bone below the ethmoid bulla
70
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
71
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 ethmoidal ```
72
opthalmic 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 sinuses ```
73
facial artery
branch of external carotid | superior labial branch of the facial artery supplies the very antero-inferior portion of the nasal cavity
74
maxillary artery
sphenopalatine branch and greater palatine artery
75
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
76
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
77
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
78
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
79
opthalmic vein
ethmoidal veins drain here | drains into cavernous sinus
80
maxillary vein
remainder of venous drainage is via sphenopalatine vein to pterygoid plexus in infratemporal fossa (mandibular vein - retromandibular vein)
81
facial vein
drains into internal jugular vein
82
lymphatic drainage of nasal cavity
submandibular | deep cervical
83
submandibular lymph nodes
drain anterior region of the nose plus frontal, anterior ethmoidal and maxillary sinuses
84
deep cervical lymph nodes
receive lymph directly or via retropharyngeal nodes
85
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
86
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 - parasymptathetic ```
87
olfactory nerve
CNI perception of smell nerve fibers from the olfactory mucosa pass through the cribriform plate to synapse in the olfactory bulb
88
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