Pterygopalatine Fossa and Plate Flashcards
What are other names for the tonsillar ring?
pharyngeal lymphatic ring, Waldeyer’s ring
Where is the pharyngeal lymphatic ring located?
superior pharynx
What four tonsil type make up the pharyngeal lymphatic ring?
Pharyngeal tonsils (adenoid) : palatine tonsils : tubal tonsils : lingual tonsils
Where are the pharyngeal tonsils located?
on the roof and posterior wall of the nasopharynx
When do the pharyngeal tonsils achieve maximum size?
age 5, then begin to atrophy
What arteries supply the pharyngeal tonsils?
Ascending pharyngeal a., ascending palatine a., pharyngeal brs. of maxillary a., artery of pterygoid canal, and tonsillar brs. of facial a.
what procedure may be performed in regards to the tonsils?
Adenoidectomy (pharyngeal) usually concurrently with a (palatine) tonsillectomy
Which tonsils are commonly referred to as “the” tonsils?
the palatine tonsils
What arteries supply the palatine tonsils?
tonsillar a., dorsal lingual brs., and branches from ascending pharyngeal a. (all associated with external carotid brs.)
What happens to the palatine tonsils later in life?
they atrophy with age. Typically there will be very little lymphoid tissue by the time you are at an advanced age
Where are the tubal tonsils found? What are they shaped like?
directly posterior to the pharyngotympanic tubes. Most variable in shape and appearance
Where do the lymphatics of the tonsillar region drain to?
the jugulodigastric node (tonsillar node - because gets inflamed when tonsils are inflamed) (also part of the superior deep cervical lymph nodes)
What are the components of the hard palate?
Palatine process, and horizontal plate
What covers the hard palate? What is included inside of it?
thick mucosa with some small salivary glands within
What nerves innervate the hard palate? What are they branches of?
it is afferently served by the greater palatine, and nasopalatine nn. (both of V2)
Where do the nerves that innervate the hard palate enter the hard palate?
the greater palatine foramen (greater palatine) and incisive foramen (nasopalatine)
What is the primary arterial supply of the hard palate?
the greater palatine a. (branch of the descending palatine a. > of 3rd part of maxillary)
What path does the greater palatine a. take to get to the hard palate?
it descends through the palatine canal, gives rise to the lesser palatine brs., and enters vis the greater palatine foramen.
Where is the greater palatine foramen?
next to the 2nd maxillary molars
What is the soft palate? Where is it?
a thick músculo-mucosal fold. it extends posteriorly from the hard palate to distinguish the nasopharynx and oropharynx.
What nerve innervates the soft palate? Where does it enter the area?
the lesser palatine n. : the lesser palatine foramen
What arteries supply the soft palate? How do they enter the area?
the lesser palatine aa. : the lesser palatine foramen
What is attached to the posterior border of the hard palate?
the palatine aponeurosis
What is the palatine aponeurosis?
a “widened tendon” of the tensor veli palatini m. that originates on the posterior border of the hard palate
What muscles have attachments to the palatine aponeurosis?
Levator veli palatini m, tensor veli palatini m., palatoglossus m., palatopharyngeus m., and musculus uvulae
What nerves innervate the muscles of the palatine aponeurosis?
Vagus n. (via pharyngeal plexus): Levator veli palatini, palatoglossus, palatopharyngeus, musculus uvulae — Mandibular n. (V3 nerve to tensor veli palatini): tensor veli palatini
Levator veli palatini origen and insertion:
Origen: Temporal bone, sphenoid bone, and pharyngotympanic tube — Insertion: Soft palate, and palatine aponeurosis
Tensor veli palatini origen and insertion:
Origen: Sphenoid bone and pharyngotympanic tube — Insertion: palatine bones, and palatine aponeurosis
Levator veli palatini action:
elevation of soft palate, contraction of posterior wall of pharynx
Tensor veli palatini action:
Tenses soft palate and slightly opens the pharyngotympanic tube
Palatoglossus origen and insertion:
Origen: palatine aponeurosis — Insertion: dorsum of tongue
Palatoglossus action:
elevates tongue (and closes oropharyngeal isthmus during deglutition)
Palatopharyngeus origen and insertion:
Origen: palatine aponeurosis — Insertion: Pharynx
Palatopharyngeus action:
Elevates the pharynx
Musculus uvulae origen and insertion:
Origen: palatine bone and palatine aponeurosis — Insertion: uvula
Musculus uvulae action:
elevation of uvula
What is the dilator tubae m.?
Specific fibers of tensor veli palatine that wrap medially around the pterygoid hamulus and attach to the pharyngotympanic tube
What does the tensor veli palatini separate the palatopharyngeus into?
two separate fasciculi
Where are the palatine tonsils found?
lateral wall of the oropharynx. Within tonsillar fossae - located between the palatoglossal, and palatopharyngeal arches
What forms the tonsillar fossae?
the pharyngobasilar fascia and the superior pharyngeal constrictor m.
What important neurovasculature should be considered during surgeries in this area?
Tonsillar br. (of facial a.), external palatine v., glossopharyngeal n (CN IX), internal carotid a.
Where is the tonsillar br. located with regard to this area.
closely associated with the palatoglossal arch
Where is the external palatine v. located with regard to this area?
closely associated with superior portion of tonsillar fossa
Where is the glossopharyngeal n. located with regard to this area?
closely associated with the lateral portion of the tonsillar fossa
Where is the internal carotid artery located with regard to this area?
variable/lateral to palatine tonsil
What structures are medial and lateral of the pterygopalatine fossa?
Nasopharynx (medial) infratemporal fossa (lateral)
What are the boundaries of the pterygopalatine fossa?
Superior: body of sphenoid – Anterior: posterior wall of maxilla – Medial: palatine bone – Posterior: anterior surface of greater wing of sphenoid – Lateral: pterygomaxillary fissure
What two openings are included within the pterygopalatine fossa? What bone are the a part of?
foramen rotundum, and pterygoid canal : sphenoid bone
What are the contents of the pterygopalatine fossa?
Maxillary n. (V2) and branches, Pterygopalatine ganglion, 3rd part of Maxillary a. and branches
What are the communications of the pterygopalatine fossa?
Orbit: via inferior orbital fissure – Oral cavity: via greater and lesser palatine canals – Nasal cavity: via sphenopalatine foramen – Infratemporal fossa: via pterygomaxillary fissure
What communication lead from the infratemporal fossa to the Sphenopalatine foramen?
Infratemporal fossa → Pterygomaxillary fissure → Pterygopalatine fossa → Sphenopalatine foramen
What type of innervations are carried out by the maxillary nerve (V2)?
WHOLLY AFFERENT
How does the maxillary n. enter the pterygopalatine fossa?
via the foramen rotundum
What are the main trunk branches of the maxillary n. (V2)?
Zygomatic n., posterior superior alveolar, Infra-orbital n.
How does the zygomatic n. exit the pteryopalatine fossa?
via the inferior orbital fissure.
What are the terminal branches of the zygomatic n.?
zygomaticofacial n., and zygomaticotemporal n.
What are the innervations of the PSA nerve?
maxillary sinus, and joins superior alveolar (dental) plexus to innervate maxillary molars
What is the terminal branch of V2?
the infra-orbital n.
What route does the infra-orbital n. take to get to its innervation point?
pterygopalatine fossa > inferior orbital fissure > inferior orbital canal > infra-orbital foramen
What are the main branches of the infra-orbital n.?
middle superior alveolar n., anterior superior alveolar n.
What are the innervations of the MSA and ASA nn.?
MSA: Maxillary sinus, P1/P2 and sometimes M1 – ASA: Portion of maxillary sinus and nasal cavity floor, incisors and canines
After exiting the skull via the infra-orbital fissure, what branches come off the infra-orbital n.?
nasal, palpebral, and superior labial brs.
What branches of V2 are associated with the pterygopalatine ganglion?
Nasopalatine n., Posterior superior nasal nn., Palatine nn., and nerve to pterygoid canal
What path does the nasopalatine n. take to get to its innervation site?
Pterygopalatine fossa → Sphenopalatine foramen → Nasal cavity → Nasal septum (vomer) → Incisive fossa → Hard palate
What n. does the nasopalatine n. communicate with?
the greater palatine
What are the innervations of the nasopalatine n.?
Afferent: inferior nasal septum, and anterior hard palate
How do the posterior superior nasal nn. enter the nasal cavity?
via the sphenopalatine foramen
What are the innervations of the posterior superior lateral nasal n.?
afferent: posterior ethmoidal sinus, superior and middle nasal conchae
What are the innervations of the posterior superior medial nasal n.?
afferent: posterior portion of roof of nasal septum
What route do the palatine nn. take to get to their innervation point?
both greater and lesser palatine nn. descend from the pterygopalatine ganglion through the greater or lesser palatine canal to the hard and soft palate through greater and less palatine foramen
What are the innervations of the nerve to the pterygoid canal?
Parasympathetic: carries preganglionic parasympathetic fibers from the facial n. destined for the lacrimal – Afferent: to the pharyngotympanic tube
How big is the pterygopalatine ganglion?
it is the largest of the peripheral parasympathetic ganglia
Where is the pterygopalatine ganglion located?
within the pterygopalatine fossa, medial and inferior to the maxillary n. and lateral to the sphenopalatine foramen
What is the deep petrosal n. carrying when it meets with the greater petrosal n.?
postganglionic sympathetic fibers from perivascular plexus of ICA
What two muscle connection points does the Levator veli palatini pass in between?
The palatopharyngeus and musclus uvulae
What structures is located directly above the levator and tensor veli palatini
the torus tubarius
What structures is located directly above the levator and tensor veli palatini
the torus tubarius
What is the main arterial source that supplies the palatine tonsils?
all arteries are branches of the facial a.
What wall of the nasal cavity contains the palatine foramina?
the lateral wall
What does the artery of the pterygoid canal supply?
tympanic cavity, tympanic tube, and superior pharynx
