Pterygopalatine Fossa and Nasal Cavity

Question 1

Roof of nasal cavity

Answer 1

Frontal bone, ethmoid bone, sphenoid bone

Question 2

Floor of nasal cavity

Answer 2

Palatine process of maxilla, horizontal plate of palatine bone

Question 3

Medial wall of nasal cavity

Answer 3

Nasal septum (perpendicular plate of ethmoid, vomer, septal cartilage, nasal crests of maxillary and palatine bones)

Question 4

Lateral wall of nasal cavity

Answer 4

Superior, middle and inferior nasal conchae

Question 5

Spheno-ethmoidal recess

Answer 5

Most superior, opening of sphenoid sinus

Question 6

Superior nasal meatus

Answer 6

Opening of posterior ethmoidal sinuses

Question 7

Middle nasal meatus

Answer 7

Opening of frontal sinus
Anterior and middle ethmoid sinus drain here
Maxillary sinus also opens into middle nasal meatus in posterior part of semilunar hiatus at the maxillary ostium (below ethmoid bulla)

Question 8

Inferior nasal meatus

Answer 8

Opening of nasolacrimal duct

Question 9

Arteries supplying the lateral and medial walls of the nasal cavity

Answer 9

Supplied via branches of the maxillary artery:
Sphenopalatine artery
Anterior/posterior ethmoidal arteries
Greater palatine artery
Also from branches of facial artery:
Superior labial artery
Lateral nasal branches

Question 10

Venous drainage from lateral and medial walls of nasal cavity

Answer 10

Venous drainage to sphenopalatine, facial and ophthalmic veins

Question 11

Kiesselbach area

Answer 11

Where all 5 arteries come together in a capillary bed

Most likely spot to bleed profusely

Question 12

Maxillary sinus

Answer 12

Largest sinus
Drains via the maxillary ostium into middle meatus
Arterial supply- superior alveolar branches of maxillary artery and greater palatine artery
Innervation- superior alveolar nerve branches

Question 13

Ethmoid sinus

Answer 13

Contains ethmoid air cells
Anterior and middle ethmoidal cells drain into middle meatus
Posterior ethmoidal cells drain into superior meatus
Arterial supply- ethmoidal artery (from ophthalmic)
Innervation- nasociliary nerves (CN V1)

Question 14

Sphenoid sinus

Answer 14

Unevenly divided by bony part of nasal septum
Drains via spheno-ethmoidal recess
Arterial supply- posterior ethmoidal artery
Innervation- posterior ethmoidal nerve

Question 15

Frontal sinus

Answer 15

Between outer and inner tables of frontal bone, posterior to superciliary arches
Drains via frontonasal duct into semilunar hiatus of middle meatus
Arterial supply- supraorbital and anterior ethmoidal arteries
Innervation- Supraorbital nerves (CN V1)

Question 16

Anterior, posterior and medial boarders of pterygopalatine fossa

Answer 16

Fossa is a small pyramid shaped space found inferior to apex of the orbit
Anterior- maxillary tuberosity
Posterior- pterygoid process of sphenoid
Medial- perpendicular plate of palatine bone

Question 17

Lateral border, roof and floor of pterygopalatine fossa

Answer 17

Lateral- opens into infratemporal fossa via pterygomaxillary fissure
Roof- greater wing of sphenoid
Floor- pyramidal process of palatine bone

Question 18

Superior and inferior openings of pterygopalatine fossa

Answer 18

Superior- opens into inferior orbital fissure

Inferior- closed except for palatine foramen

Question 19

Maxillary nerve

Answer 19

Somatic sensory only
Passes through foramen rotundum
Supplies dura mater of anterior part of middle cranial fossa, conjunctiva/skin of inferior eyelid, mucosa of posteroinferior nasal cavity, maxillary sinus, palate and anterior part of superior oral vestibule, maxillary teeth, skin of lateral external nose, anterior cheek and upper lip

Question 20

Mandibular nerve

Answer 20

Somatic sensory and somatic branchial motor
Passes through foramen ovale
Motor innervation to muscles of mastication, mylohyoid, anterior belly of digastric, tensor tympani and tensor veli palatini

Question 21

Mandibular nerve sensory innervation

Answer 21

Mucosa of anterior 2/3rds of tongue, floor of mouth, posterior and anterior inferior oral vestibule, mandibular teeth, lower lip; buccal, parotid and temporal regions of face, and external ear including TM

Question 22

Contents of pterygopalatine fossa

Answer 22

Maxillary nerve
Pterygopalatine ganglion
Third part of maxillary artery

Question 23

Inferior orbital fissure transmits what nerves and vessels

Answer 23

Infraorbital nerve, zygomatic nerve, orbital branches from CN V2
Infraorbital artery/vein
Inferior ophthalmic vein

Question 24

Pterygoid canal transmits what nerves and vessels

Answer 24

Nerve of pterygoid canal (greater and deep petrosal nerve)

Artery/vein of pterygoid canal

Question 25

Greater palatine canal transmits what nerves and vessels

Answer 25

Greater palatine nerve | Descending and greater palatine arteries

Question 26

Lesser palatine canal transmits what nerves and vessels

Answer 26

Lesser palatine nerve | Lesser palatine artery (terminal branch of descending palatine artery)

Question 27

Sphenopalatine foramen transmits what nerves and vessels

Answer 27

Medial and lateral superior and posterior inferior nasal branches (from nasopalatine nerve, CN V2) Sphenopalatine artery/vein

Question 28

Maxillary nerve gives off what branches within the pterygopalatine fossa

Answer 28

Zygomatic nerve- zygomaticofacial and zygomaticotemporal (ZMT has communicating branch conveying parasympathetic fibers to lacrimal nerve) branches Pterygopalatine nerves

Question 29

Parasympathetic fibers to pterygopalatine ganglion

Answer 29

Come from the facial nerve via the greater petrosal nerve | Greater petrosal nerve joins the deep petrosal nerve to from the nerve of the pterygoid canal

Question 30

Sympathetic supply to the pterygopalatine ganglion

Answer 30

Supplied by the deep petrosal nerve (postsynaptic) from the internal carotid plexus and the superior cervical ganglion (presynaptic) Deep petrosal nerve conveys postsynaptic sympathetic fibers which join branches of the maxillary nerve via the pterygopalatine ganglion Presynaptic fibers are from the superior cervical ganglion

Question 31

List all nerves of the pterygopalatine fossa/pterygopalatine ganglion

Answer 31

Infraorbital Zygomatic Orbital branches V2 Maxillary nerve V2 Nerve of pterygopalatine canal (greater and deep petrosal nerves) Greater/lesser palatine Medial and lateral superior and posterior inferior nasal branches from nasopalatine nerve V2

Question 32

Branches of mandibular portion of maxillary artery

Answer 32

Inferior alveolar- enters mandibular foramen, supplies mandible, lower teeth, chin, mylohyoid Anterior tympanic-internal TM Deep auricular- EAC, external TM, TMJ Middle meningeal- enters cranium via foramen spinosum, supplies trigeminal ganglion, facial nerve, geniculate ganglion, tympanic cavity and tensor tympani Accessory meningeal- enters cranium via foramen ovale, supplies otic ganglion and sphenoid bone

Question 33

Branches of pterygoid part of maxillary artery

Answer 33

Masseteric Deep temporal Pterygoid branches Buccal

Question 34

Branches of pterygopalatine part of maxillary artery

Answer 34

Descending palatine (greater/lesser palatine arteries) Posterosuperior alveolar- supplies upper teeth and maxillary sinus Infraorbital- traverses inferior orbital fissure, supplies inferior oblique/rectus, infraorbital region of face Artery of pterygoid canal- mucosa of upper pharynx and eustachian tube Sphenopalatine (lateral posterior nasal artery and posterior septal branches)- supplies all sinuses and septum

Question 35

All arteries for pterygopalatine fossa arise from which main artery

Answer 35

Maxillary artery

Question 36

Superficial temporal artery runs close to

Answer 36

Auriculotemporal nerve

Question 37

Branches of internal carotid

Answer 37

Ophthalmic Anterior cerebral Middle cerebral

Question 38

Path of internal carotid

Answer 38

Enters cranial cavity through petrous temporal bone via carotid canal Courses anteriorly through cavernous sinuses Runs in carotid groove