Pterygopalatine Fossa

Question 1

PPF Importance

Answer 1

Innervation and blood supply for superior dentition pass through fossa!
– Nerves (branches of Maxillary n)
– Arteries (branches of Maxillary a)

Also has autonomics here

Question 2

Borders

Answer 2

Anterior wall – Posterior surface of maxilla
(directly anterior is also the maxillary sinus)

• Medial wall – Palatine bone (perpendicular plate)
• Posterior wall – Sphenoid (root of pterygoid process)
• Lateral border – Pterygomaxillary fissure
• Superior border – Inferior orbital fissure (orbit), spenoid

• Inferior border – Greater palatine canal,
pyramidal process of palatine bone

Question 3

Communication

Answer 3

Laterally – infratemporal fossa via pterygomaxillary fissure

• Medially – nasal cavity via sphenopalatine foramen
• Inferiorly – oral cavity via greater & lesser palatine foramina
• Posteriorly – middle cranial fossa via foramen rotundum & pterygoid canal (pterygoid canal is medial to rotundum)

• Posteriorly – nasal pharynx via pharyngeal (palatovaginal) and
vomervaginal canal.

• Anteriorly – orbit via inferior orbital fissure.

Question 4

Maxillary Nerve (v2)

Answer 4

– Pterygopalatine (ganglionic)
– Posterior Superior alveolar – 3rd, 2nd and distobuccal root of 1st
maxillary molars
– Pharyngeal
– Nasopalatine
– Posterior superior nasal
– Greater and Lesser palatine (Descending palatine)
• Posterior inferior nasal
– Zygomatic – enters orbit via inferior orbital fissure.
• Zygomaticofacial.
• Zygomaticotemporal –communicating link to lacrimal of V1 with
postganglionic parasympathetics for lacrimal gland.

Question 5

Parasympathetic Pathway

Answer 5

CN VII preganglionic parasympathetic cell bodies are in Superior Salivitory nucleus.
– CN VII fibers which are not branchial motor are referred to as nervus intermedius.
• CN VII emerges from brainstem and enters Internal Auditory Meatus
• Greater petrosal n branches from facial n at geniculate ganglion within the petrous temporal
bone. (Greater Petrosal n has little connection to the ganglion, which is sensory.)
• Greater petrosal nerve emerges in the middle cranial fossa, travels down the hiatus of the
greater petrosal nerve, crosses foramen lacerum, enters pterygoid canal.
• In the pterygoid canal, Greater Petrosal Nerve is joined by postganglionic sympathetics (Deep
Petrosal Nerve) from the internal carotid plexus. The two together are called Nerve of the
Pterygoid Canal or Vidian nerve.
• Greater petrosal nerve synapses at the Pterygopalatine ganglion. Deep Petrosal and sensory
fibers from (V2) also traverse the pterygopalatine ganglion without synapsing.
• Postganglionics from the ganglion travel with branches of the maxillary nerve to supply mucosa
of the hard palate and structures superior to the palate. They also supply lacrimal gland
by traveling in turn with maxillary, zygomatic, zygomaticotemporal nerves,
and finally with a communicating branch to lacrimal nerve, which is a branch
of V1.

Question 6

3rd part of Maxillary Artery

Answer 6

Branches travel with nerves bearing the same
name – EXCEPT SPENOPALATINE ARTERY
TRAVELS WITH NASOOPALATINE NERVE

• Sphenopalatine a anastomoses with Greater
palatine a

Question 7

Veins

Answer 7

Pterygoid plexus to cavernous sinus
• Deep facial v connects facial v to pterygoid
plexus.
• Facial v connects to superior and inferior
ophthalmic veins. Sup ophthalmic v drains into
cavernous sinus; inf ophthalmic v into
cavernous sinus, or pterygoid plexus of veins or
sup ophthalimic v.
• Pterygoid plexus connects with pharyngeal
plexus of veins via veins of pharyngeal and
pterygoid canals.
• Scalp veins communicate with dural venous
sinuses via veins in parietal and mastoid
foramina, and posterior condylar canal.
• There are other emissary veins.
• Emissary veins have no valves