Pterygopalatine Fossa and Nasal Cavity Flashcards
Roof of nasal cavity
Frontal bone, ethmoid bone, sphenoid bone
Floor of nasal cavity
Palatine process of maxilla, horizontal plate of palatine bone
Medial wall of nasal cavity
Nasal septum (perpendicular plate of ethmoid, vomer, septal cartilage, nasal crests of maxillary and palatine bones)
Lateral wall of nasal cavity
Superior, middle and inferior nasal conchae
Spheno-ethmoidal recess
Most superior, opening of sphenoid sinus
Superior nasal meatus
Opening of posterior ethmoidal sinuses
Middle nasal meatus
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)
Inferior nasal meatus
Opening of nasolacrimal duct
Arteries supplying the lateral and medial walls of the nasal cavity
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
Venous drainage from lateral and medial walls of nasal cavity
Venous drainage to sphenopalatine, facial and ophthalmic veins
Kiesselbach area
Where all 5 arteries come together in a capillary bed
Most likely spot to bleed profusely
Maxillary sinus
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
Ethmoid sinus
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)
Sphenoid sinus
Unevenly divided by bony part of nasal septum
Drains via spheno-ethmoidal recess
Arterial supply- posterior ethmoidal artery
Innervation- posterior ethmoidal nerve
Frontal sinus
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)
Anterior, posterior and medial boarders of pterygopalatine fossa
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
Lateral border, roof and floor of pterygopalatine fossa
Lateral- opens into infratemporal fossa via pterygomaxillary fissure
Roof- greater wing of sphenoid
Floor- pyramidal process of palatine bone
Superior and inferior openings of pterygopalatine fossa
Superior- opens into inferior orbital fissure
Inferior- closed except for palatine foramen
Maxillary nerve
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
Mandibular nerve
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
Mandibular nerve sensory innervation
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
Contents of pterygopalatine fossa
Maxillary nerve
Pterygopalatine ganglion
Third part of maxillary artery
Inferior orbital fissure transmits what nerves and vessels
Infraorbital nerve, zygomatic nerve, orbital branches from CN V2
Infraorbital artery/vein
Inferior ophthalmic vein
Pterygoid canal transmits what nerves and vessels
Nerve of pterygoid canal (greater and deep petrosal nerve)
Artery/vein of pterygoid canal
Greater palatine canal transmits what nerves and vessels
Greater palatine nerve
Descending and greater palatine arteries
Lesser palatine canal transmits what nerves and vessels
Lesser palatine nerve
Lesser palatine artery (terminal branch of descending palatine artery)
Sphenopalatine foramen transmits what nerves and vessels
Medial and lateral superior and posterior inferior nasal branches (from nasopalatine nerve, CN V2)
Sphenopalatine artery/vein
Maxillary nerve gives off what branches within the pterygopalatine fossa
Zygomatic nerve- zygomaticofacial and zygomaticotemporal (ZMT has communicating branch conveying parasympathetic fibers to lacrimal nerve) branches
Pterygopalatine nerves
Parasympathetic fibers to pterygopalatine ganglion
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
Sympathetic supply to the pterygopalatine ganglion
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
List all nerves of the pterygopalatine fossa/pterygopalatine ganglion
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
Branches of mandibular portion of maxillary artery
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
Branches of pterygoid part of maxillary artery
Masseteric
Deep temporal
Pterygoid branches
Buccal
Branches of pterygopalatine part of maxillary artery
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
All arteries for pterygopalatine fossa arise from which main artery
Maxillary artery
Superficial temporal artery runs close to
Auriculotemporal nerve
Branches of internal carotid
Ophthalmic
Anterior cerebral
Middle cerebral
Path of internal carotid
Enters cranial cavity through petrous temporal bone via carotid canal
Courses anteriorly through cavernous sinuses
Runs in carotid groove
