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Chika- SF2 > Pterygopalatine Fossa-Gilland > Flashcards

Pterygopalatine Fossa-Gilland Flashcards

1
Q

Pterygopalatine fossa (location)

A
  • back of the orbit
  • lateral to the nasal cavity
  • deep to the front of the infratemporal fossa
  • straight up from the junction of your hard and soft palate
  • foramen rotundum (FR) and pterygoid canal (below and medial to FR) are connected to the pterygopalatine fossa
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2
Q

Why is the pterygopalatine fossa important?

A
  • it’s a place to distribute nerves and BVs to all the surrounding structures (orbit, nasal cavity, palate, upper part of pharynx); neurovascular pathways to these regions converge and diverge at this space
  • the boundaries and communications with adjacent spaces lead to the concept of the pterygopalatine fossa as a room connected to six surrounding rooms by seven openings for neural and vascular structures
  • Main contents of the pterygopalatine fossa:
  • the parasympathetic pterygopalatine ganglion
  • the maxillary nerve and many of its branches
  • third part of the maxillary artery
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3
Q

What is the anterior, posterior, medial, and lateral boundary of the pterygopalatine fossa?

A

anterior boundary: superomedial part of the infratemporal surface of maxilla

posterior boundary: root of the pterygoid process and adjoining anterior surface of the greater wing of the sphenoid

medial boundary: perpendicular plate of the palatine bone, with its orbital and sphenoidal processes

lateral boundary:
pterygomaxillary fissure (in btw back wall of maxilla and pterygoid process)
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4
Q

How does the pterygopalatine fossa communicate with the following?

  • nasal cavity
  • orbit
  • infratemporal fossa
  • oral cavity
  • middle cranial fossa
  • pharyngeal wall
  • maxillary sinus
A

the fossa communicates with the:

  • nasal cavity: medially via the sphenopalatine foramen
  • orbit: antero-superiorly via the medial end of the inferior orbital fissure
  • infratemporal fossa: laterally via the pterygomaxillary fissure
  • oral cavity: inferiorly via the greater palatine canal
  • middle cranial fossa: postero-superiorly via the foramen rotundum and pterygoid canal
  • pharyngeal wall: posteriorly via the palatovaginal canal
  • maxillary sinus: anteriorly via alveolar foramina
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5
Q

What connects the pterygopalatine fossa to oral cavity?

A

greater palatine canal

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6
Q

What connects the pterygopalatine fossa to nasal cavity?

A

sphenopalatine foramen

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7
Q

What connects the pterygopalatine fossa to orbit?

A

inferior orbital fissure

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8
Q

What connects the pterygopalatine fossa to middle cranial fossa?

A

foramen rotundum and pterygoid canal

pterygoid canal sits right next to the cavernous sinus and temporal bone (easy for the lesser petrosal nerve to leave the temporal bone and go through this canal; easy for sympathetic fibers from the internal carotid plexus to jump off and go through this canal )

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9
Q

What connects the pterygopalatine fossa to maxillary sinus?

A

alveolar foramina in the back wall of the maxilla

-where the posterior alveolar nerves go through

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10
Q

What connects the pterygopalatine fossa to pharyngeal wall?

A

palatovaginal canal

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11
Q

What two fissures join the pterygopalatine fossa to adjoining spaces?

A
  • inferior orbital fissure

- pterygomaxillary fissure

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12
Q

As seen from lateral view, the pterygoid process of the sphenoid continues up the skull as what?

A

greater wing of the sphenoid

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13
Q

What two foramina open in the pterygopalatine fossa? What does each foramina transmit?

A
  • foramen rotundum: located posteriorly and transmits the maxillary nerve from the middle cranial fossa
  • sphenopalatine foramen: located medially and transmits nerves and vessels through the posterior, medial wall of the nasal cavity
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14
Q

What are the 3 canals that open in the pterygopalatine fossa? What do they each transmit?

A
  • pterygoid canal: located posteriorly and transmits the nerve to the pterygoid canal AKA Vidian nerve (combination of greater petrosal and deep petrosal nerves) from the middle cranial fossa
  • palatovaginal canal: also located posteriorly and transmits nerves and vessels to the upper pharynx
  • greater palatine canal: located inferiorly and transmits nerves and vessels to the hard and soft palate
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15
Q

What does the pterygoid canal transmit to the pterygopalatine fossa?

A

nerve to the pterygoid canal (Vidian nerve) from the middle cranial fossa

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16
Q

What does the foramen rotundum transmit to the pterygopalatine fossa?

A

maxillary nerve from the middle cranial fossa

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17
Q

What does the greater palatine canal transmit to the pterygopalatine fossa?

A

nerves and vessels to the hard and soft palate

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18
Q

What does the sphenopalatine foramen transmit to the pterygopalatine fossa?

A

nerves and vessels of the nasal cavity

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19
Q

What is the 3rd part of the maxillary artery?

A

the maxillary artery passes from the infratemporal fossa into the pterygopalatine fossa through the pterygomaxillary fissure and terminates as the “third part of the maxillary artery”

-termination of the maxillary artery goes upwards and forwards (lab exam)

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20
Q

What are the 6 major branches of the 3rd part of the maxillary artery?

A
  • infraorbital artery
  • sphenopalatine artery
  • posterior superior alveolar artery
  • greater (descending) palatine artery
  • artery of the pterygoid canal
  • pharyngeal artery
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21
Q

What is the sphenopalatine artery?

A

gives lateral and septal branches in the nasal cavity

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22
Q

What is the posterior superior alveolar artery?

A

-goes to the maxilla and supplies the posterior of the maxillary teeth

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23
Q

What supplies and innervates the mucosa of the hard and soft palate?

A
  • greater (descending)palatine artery

- greater and lesser palatine nerves

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24
Q

What is important about the infraorbital artery?

A

supplies the roof of the maxillary sinus and floor of the orbit

25
Q

What are the 2 branches of the maxillary artery we see before it disappears from the infratemporal fossa?

A
  • deep temporal artery

- buccal artery

26
Q

What arteries supplies the hard and soft palate?

A
  • greater palatine artery on the hard palate

- lesser palatine artery on the soft palate

27
Q

What are the 4 parasympathetic ganglion?

A
  • ciliary ganglion
  • pterygopalatine ganglion
  • submandibular ganglion
  • otic ganglion
28
Q

Maxillary Nerve branches in the Pterygopalatine fossa:

What branches come directly off of the maxillary nerve?

A

To Dura:
-meningeal nerve (middle)

To Pterygopalatine ganglion:
-ganglionic nerve (only V2 branch to go to PG)

To Orbit:

  • infraorbital nerve
  • zygomatic nerve
  • they do not dive into the pterygopalatine fossa

To Maxilla:
-posterior, middle, and anterior superior alveolar nerves

29
Q

What branches of the maxillary nerve associated with the pterygopalatine ganglion (branches off of the ganglion)?

A
  • orbital nerve
  • nasopalatine nerve
  • posterior superior nasal nerve
  • greater (anterior) palatine nerve
  • lesser (posterior) palatine nerve
  • pharyngeal nerve
30
Q

The pterygopalatine ganglion sits directly beneath what nerve?

A

maxillary nerve (remember it goes through the foramen rotundum)

and in front of the pterygoid canal

31
Q

What is the ONLY synaptic input of the pterygopalatine ganglion that runs straight to it?

A

facial nerve via the greater petrosal nerve (which becomes part of the nerve to the pterygoid canal)

  • pterygoid canal comes from the geniculate ganglion to the pterygopalatine ganglion
  • it is the only functional input to the pterygopalatine ganglion

NOT the ganglionic nerve branch from the maxillary nerve (V2)

32
Q

What are the deep petrosal nerves?

A

sympathetic fibers we pick up from the internal carotid plexus

33
Q

What are the trigeminal sensory (afferent) fibers that branch off of the pterygopalatine ganglion?

A
  • pharyngeal nerves
  • lesser palatine nerves
  • greater palatine nerves
  • posterior superior nasal nerves
  • posterior inferior nasal nerves
  • nasopalatine nerve

all of them are really sensory branches of V2 (maxillary nerve)

34
Q

What are the post-ganglionic parasympathetic fibers going from the pterygopalatine ganglion going to?

A

PS fibers going to the lacrimal nerve leave the ganglion and go back into the maxillary nerve primarily from the zygomatic branch of V2

35
Q

NEED TO KNOW- pterygopalatine ganglion

A
  • largest of the peripheral parasympathetic ganglia
  • flattened, reddish-grey in color as it is surrounded by CT
  • supplies the lacrimal gland, ocular choroidal vessels (PS input causing vasoDILATION), and glands of the nasal mucosa
  • neurons of the pterygopalatine fossa use acetylcholine as their main transmitter with many also using vasoactive intestinal peptide (VIP) and nitric oxide
  • majority of branches of the pterygopalatine ganglion are connected with the ganglion morphologically, not functionally because they are primarily sensory branches of V2 AKA they pass through the ganglion WITHOUT synapsing and enter the maxillary nerve through it ganglionic branches; some of the
  • predominant sensory branches do convey some parasympathetic fibers to the palatine, pharyngeal, and nasal mucous glands
  • general sensory fibers destined for distribution via orbital, nasopalatine, superior alveolar, palatine, and pharyngeal branches of the maxillary division of the trigeminal nerve run through the ganglion WITHOUT synapsing!!!!
36
Q

Cerebral arteries have both sympathetic and postsynaptic input.

A

brain likes a constant supply regardless of whatever else is changing

PS input causes vasoDILATION.
Sympathetic input causes vasoCONSTRICTION

37
Q

What comprises of the input to the pterygopalatine ganglion?

A

Preganglionic parasympathetic fibers run initially in the greater petrosal branch of the facial nerve, and then in the nerve of the pterygoid canal (Vidian nerve), after the greater the greater petrosal unites with the deep petrosal nerve.

The nerve of the pterygoid canal enters the ganglion posteriorly.

38
Q

What comprises of the output to the pterygopalatine ganglion?

A

Postganglionic parasympathetic fibers projecting to the lacrimal gland leave the ganglion and join the maxillary nerve via a ganglionic branch, then travel via the zygomatic and zygomaticotemporal branches of the maxillary nerve to the gland.

Other postganglionic fibers are distributed to palatine, pharyngeal, and nasal mucous glands via palatine and nasal branches of the maxillary nerve.

39
Q

What bypasses the pterygopalatine ganglion?

A

Postganglionic SYMPATHETIC fibers pass through the ganglia without synapsing and supply blood vessel and other orbitalis (smooth) muscle. They arise in the superior cervical ganglion and travel via the internal carotid plexus.

40
Q

The pterygopalatine ganglion is also known as what?

A

sphenopalatine ganglion

41
Q

Lateral approach to the pterygopalatine fossa by removing the lateral wall of the orbit and opening the pterygoid canal

A

Start laterally and keep grinding deeper until you see the internal carotid artery with the internal carotid plexus, greater petrosal coming out of the temporal bone crossing right pass the internal carotid artery that’s headed to the cavernous sinus. You also see the back opening of the pterygoid canal (running through the pterygoid process) where the greater petrosal and deep petrosal merge together to run through the pterygoid canal to get to the pterygopalatine ganglion. Ganglionic fibers run with V2 (maxillary nerve)

42
Q

Medial approach to the pterygopalatine fossa by opening the greater palatine canal

A

At the back of the middle concha is the sphenopalatine foramen where the pterygopalatine ganglion will.

Inferior to the sphenopalatine foramen is the greater palatine canal leading to the greater palatine foramen.

You can open up the sphenoid sinus and see the nerve to the pterygoid canal.

43
Q

Cranial parasympathetics primarily innervate what?

A

salivary glands to regulate saliva mostly during the period of consumption of food

44
Q

Submandibular ganglion innervation

A
  • chorda tympani supplies the superior salivatory nucleus fibers to the submandibular ganglion
  • postganglionic fibers will go to both submandibular and sublingual gland
45
Q

Otic ganglion innervation

A

takes preganglionic information from the tympanic via lesser petrosal nerve

-postganglionic fibers go to the parotid gland

46
Q

There are mucosal glands and sinus throughout the respiratory epithelium. There are all primarily innervated by what?

A

parasympathetic input primarily from pterygopalatine ganglion

47
Q

Smooth muscles in the orbit

A

2 PS from ciliary ganglion

1 sympathetic

48
Q

There are several pathways to the innervation of the lacrimal gland.

A

Surgeons have shown that lesion through the zygomatic area, the pt still has the ability to produce tears.

49
Q

The greater and lesser palatine nerves that run down the greater palatine canal innervate what? What is there relation to the mucosal glands in mouth?

A
  • mucosa of the hard and soft palate
  • greater and lesser palatine nerve will carry some parasympathetic fibers from the pterygopalatine ganglion to innervate some of the mucosal glands
50
Q

Describe the vasodilation property of the internal carotid vessels.

A

Vasodilation response in ocular choroid

  • mediated by neuronal nitric oxide (NO) released by pterygopalatine ganglion cells
  • NO release appears to be stimulated by hypothalamic input to Superior Salivatory Nucleus during periods of systemic hypotension in order to maintain constant blood flow to choroid.

Vasodilation response in anterior cerebral circulation
-neuronal nitric oxide released by pterygopalatine ganglion cells contributes to vasodilation of cerebral branches of the internal carotid artery (ICA). These include ophthalmic artery, anterior cerebral artery, middle cerebral artery, and posterior communicating artery.

51
Q

Describe the autonomic innervation of the nasal cavity.

A

Superior cervical sympathetic ganglion gives fibers to the internal carotid plexus from which the deep petrosal nerve comes off

Parasympathetic greater petrosal nerve branches off from the facial nerve as it is going through the temporal bone

Both of these nerves merge together to form the nerve to the pterygoid canal synapse on the pterygopalatine ganglion

Postganglionic fibers include:

  • nasopalatine nerve
  • greater palatine nerve
  • lesser palatine nerve
52
Q

What are the 3 cervical sympathetic ganglia that supply the head, neck, heart, and upper limb?

A
  • superior cervical ganglion (SCG)
  • Middle cervical ganglion (MCG)
  • Inferior cervical ganglion (ICG)
53
Q

What does the superior cervical ganglion supply?

A
  • craniofacial structures via internal and external carotid plexuses
  • upper neck structures via cervical gray rami to C1-C4
  • cardiac targets via superior cardiac nerve

SCG is right next to the internal and external carotid artery

54
Q

What does the middle cervical ganglion supply?

A
  • cardiac targets via middle cardiac nerve

- cervical targets via gray rami to C5-6

55
Q

What does the inferior cervical ganglion supply?

A
  • lower neck, upper limb, and cardiopulmonary targets

- usually fused with the 1st thoracic ganglion to form the stellate ganglion

56
Q

Preganglionic sympathetics are only found where?

A

intermediolateral cell columns of T1-L2

57
Q

Where do fibers from the internal carotid plexus come from?.

A

postganglionic fibers from superior cervical ganglion become the nerve to the internal carotid artery which fans out as the internal carotid plexus once on the ICA

58
Q

What is Horner’s syndrome and what are the classical signs of it?

A

Horner’s syndrome is interruption of sympathetic supply to the head (usually tumor or trauma to the superior cervical ganglion)

Classic Triad of signs:

  • drooping eyelids (partial ptossi or psuedo-ptosis)
  • contracted pupil (meiosis)
  • lack of thermal sweating (anhidrosis)

Other signs:

  • sunken globe
  • narrow palpebral fissure
  • vasodilation

ON THE AFFECTED SIDE

Chika- SF2 (63 decks)

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