pterygopalatine fossa Flashcards
bony boundaries of pterygopalatine fossa
- anterior: maxilla
- posterior: pterygoid process
- medial: perpendicular plate of palatine bone
- lateral: pterygomaxillary fissure
- superior: sphenoid bone
- inferior: pyramidal process of palatine bone and the joining of pterygoid process to maxilla
foramina and fissures used to communicate for pterygopalatine fossa
- foramen rotundum and pterygoid canal to the middle cranial fossa
- palatine canal –> oral cavity (hard palate)
- sphenopalatine foramen–> nasal cavity
- pterygomaxillary fissure–> infratemporal fossa
- inferior orbital fissure–> orbit
- pharyngeal canal–> nasopharynx
pterygoid canal
(also called vidian canal)
- bony canal opening onto posterior surface of pterygoid process
- opens into middle cranial fossa through foramen lacerum and anterior to carotid canal
- transfers vidian nerve (nerve to pterygoid canal to pterygopalatine fossa)
what are the contents of pterygopalatine fossa?
- maxillary nerve
- sphenopalatine parasympathetic ganglion
- pterygopalatine (3rd) part of maxillary artery
- tributaries of pterygoid venous plexus
- neurovascular sheath and a fatty matrix
pterygopalatine fossa is a major site of distribution for:
- maxillary nerve (V2)
- terminal part of maxillary artery
- autonomic fibers (parasympathetic fibers from facial nerve and sympathetic fibers from T1 spinal cord level) that join the branches of V2 in pterygopalatine fossa
maxillary nerve
- completely sensory
- starts from trigeminal ganglion in cranial cavity
- exits middle cranial fossa thru foramen rotundum to pterygopalatine fossa
- continues as infra-orbital nerve thru inferior orbital fissure
- gives sensory fibers to skin of face and side of nose
- carries parasympathetic secretomotor fibers from facial nerve to lacrimal, nasal, and palatine glands
2 ganglionic branches of maxillary nerve (V2)
1. sensory fibers from: upper teeth maxillary sinus nose palate orbit pharynx 2. postganglionic parasympathetic fibers to these glands: lacrimal nasal palatine
what CN does maxillary nerve receive parasymp. stim from?
facial
what CN does mandibular nerve receive parasymp. stim from?
IX and VII to stimulate parotid, submandibular, and sublingual
posterior superior alveolar nerves (PSA)
- exits the pterygopalatine fossa via the pterygomaxillary fissure
- enter the maxilla thru PSA foramina
- supplies maxillary sinus, upper molars, adjacent gingiva and cheek
zygomatic nerve
2 branches:
a. zygomaticotemporal branch–passes into temporal fossa to supply skin of temple
b. zygomaticofacial nerve–skin over prominence of cheek
what is the path to supply the lacrimal gland with secretomotor fibers?
zygomatic nerve joined by postganglionic parasympathetic fibers from SPG which leaves through zygomaticotemporal then to lacrimal of the ophthalmic (V1) to provide lacrimal gland with secretomotor fibers that originally arise from Facial nerve
infraorbital nerve path
- third branch of maxillary
- enters orbit through inferior orbital fissure
- passes in floor of orbit in infraorbital groove then canal before it appears in face through infraorbital foramen
branches of infraorbital nerve
- middle superior alveolar (MSA): upper premolar and adjacent gingiva and cheek
- Anterior superior alveolar (ASA): upper incisors and canine and adjacent gingiva and cheek
- terminal: nasal, palpebral, labial
greater palatine nerve and lesser palatine
- descend through the palatine canal
- supply palate, tonsil, and lateral wall of nasal cavity thru posterior inferior nasal branches
posterior superior nasal branches
- enters nasal cavity via sphenopalatine foramen
- supplies posterior aspect of nasal cavity
- nasopalatine branch reaches palate through incisive foramen
orbital branches
supply periosteum of orbit and ethmoidal and spehnoidal sinuses
pharyngeal nerve
traverses the pharyngeal canal (palatovaginal canal) to innervate part of nasopharynx
terminal branches of infraorbital
palpebral
nasal
labial
zygomaticotemporal communicates with _____
V1
three direct branches of V2
posterior superior alveolar
zygomatic
infraorbital
maxillary division block
blocks upper teeth from nose, eyelid, and maxilla
what is the largest of the 4 parasympathetic ganglia in the head?
pterygopalatine (sphenopalatine or SPG) ganglion
roots of pterygopalatine ganglion
- sensory: 2 ganglionic branches from V2
- sympathetic: from T1
- parasympathetic: functional root–greater superficial petrosal branch of facial nerve: supplies lacrimal, nasal, and palatine glands
secretomotor fibers to lacrimal gland and vidian nerve
- Origin: superior salivatory nucleus of facial nerve in Pons
- carried by greater superficial petrosal (GSPN) branch of facial
- GSPN joined by sympathetic fibers around internal carotid artery (deep petrosal nerve) to form vidian nerve (nerve of pterygoid canal)
- vidian nerve reaches SPG via pterygoid canal
- postganglionic parasympathetic fibers join the zygomatic, zygomaticotemporal (V2) and finally lacrimal nerve (V1) to reach lacrimal gland
ciliary ganglion
input: occulomotor (CN III)
origin: occuluomotor (CN III)
function: innervation of sphincter pupillae muscle for pupillary constriction and ciliary muscle for accomodation of the lens for near vision
pterygopalatine ganglion
input: greater petrosal nerve
origin: facial nerve
function: innervation of lacrimal gland and mucous glands of nasal cavity, maxillary sinus, and palate
otic ganglion
input: lesser petrosal nerve
origin: glossopharyngeal nerve (IX)
function: innervation of parotid gland
submandibular ganglion
input: chorda tympani thru lingual nerve
origin: facial nerve
function: innervation of submandibular and sublingula glands
all glands supplied by _____ except parotid which is supplied by ______
all supplied by facial except parotid which is supplied by IX
which nerve is responsible for excessive lacrimation and rhinorrhea?
sphenopalatine ganglion; facial (greater petrosal)
what is the non-invasive approach to block sphenopalatine ganglion?
sphenopalatine foramen
cluster headache
- attacks severe–boring
- unilateral in and around eye–hot poker
- 15-180 min attack duration
- attack once every 2nd day up to 8X a day
- occur in series lasting weeks to months
- autonomic features (lacrimation, rhinorrhoea, miosis, ptosis)
- males 5-7:1 females
- *sphenopalatine ganglion (SPG) plays a role in headache pain and cranial autonomic symptoms
sphenopalatine ganglion block
minimally invasive procedure used to treat headache and facial pain
