Pterygopalatine Fossae Full Set Flashcards
What ganglion is in the pterygopalatine fossa?
The pterygopalatine fossa houses the parasympathetic ptergopalatine ganglion and serves as the crossroads for structures going to or from the following areas via the named ‘openings’:
The pteryogopalatine fossa communicates with the following area of the skull through which openings? What nerves and/or blood vessels travel through? infratemporal fossa? middle cranial fossa? base of the skull? Orbit? nasal cavity? oral cavity (palate)? Nasopharynx ?
infratemporal fossa - pterygomaxillary fissure (maxillary a.)
middle cranial fossa - foramen rotundum (Maxillary n)
base of the skull - pterygoid canal (n. of pterygoid canal – greater and deep petrosal nn; a. of pterygoid canal)
orbit - inferior orbital fissure (infraorbital n., zygomatic n., orbital branches of V2; infraorbital a., inferior opthalmic v)
nasal cavity - sphenopalatine foramen [NP-4,6] (nasal branches of nasopalatine n., V2; sphenopalatine a.)
oral cavity (palate) - greater palatine canal
nasopharynx - lesser palatine canal and pharyngeal canal
The pteryogopalatine fossa communicates to which area of the skull through the following openings?
inpterygomaxillary fissure (maxillary a.)
foramen rotundum (Maxillary n)
pterygoid canal (n. of pterygoid canal – greater and deep petrosal nn; a. of pterygoid canal)
inferior orbital fissure (infraorbital n., zygomatic n., orbital branches of V2; infraorbital a., inferior opthalmic v)
sphenopalatine foramen [NP-4,6] (nasal branches of nasopalatine n., V2; sphenopalatine a.)
greater palatine canal
lesser palatine canal and pharyngeal canal
infratemporal fossa - pterygomaxillary fissure (maxillary a.)
middle cranial fossa - foramen rotundum (Maxillary n)
base of the skull - pterygoid canal (n. of pterygoid canal – greater and deep petrosal nn; a. of pterygoid canal)
orbit - inferior orbital fissure (infraorbital n., zygomatic n., orbital branches of V2; infraorbital a., inferior opthalmic v)
nasal cavity - sphenopalatine foramen [NP-4,6] (nasal branches of nasopalatine n., V2; sphenopalatine a.)
oral cavity (palate) - greater palatine canal
nasopharynx - lesser palatine canal and pharyngeal canal
What blood vessels and nerves travel through the following openings?
infratemporal fossa - pterygomaxillary fissure? middle cranial fossa - foramen rotundum? base of the skull - pterygoid canal? orbit - inferior orbital fissure? nasal cavity - sphenopalatine foramen?
infratemporal fossa - pterygomaxillary fissure (maxillary a.)
middle cranial fossa - foramen rotundum (Maxillary n V2)
base of the skull - pterygoid canal (n. of pterygoid canal – greater and deep petrosal nn; a. of pterygoid canal)
orbit - inferior orbital fissure (infraorbital n., zygomatic n., orbital branches of V2; infraorbital a., inferior opthalmic v)
nasal cavity - sphenopalatine foramen [NP-4,6] (nasal branches of nasopalatine n., V2; sphenopalatine a.)
oral cavity (palate) - greater palatine canal
nasopharynx - lesser palatine canal and pharyngeal canal
What is the location of the Sphenopalatine Foramen?
on the medial wall of the pterygopalaitne fossa formed by a small notch in the upper part of the perpendicular plate of the palatine bone where it joins the sphenoid bone.
What does the maxillary artery supply?
It supplies the innermost structures of the nasal cavity and mouth.
What are the three main parts of the maxillary artery?
mandibular part
pterygoid part
pterygopalatine part
What does the artery pass through and what does it supply?
Posterior superior alveolar artery
enters openings in the maxillary tuberosity to supply posterior teeth, maxillary sinus & gums
What does the artery pass through and what does it supply?
Infraorbital artery
passes through the infraorbital septum to supply anterior teeth and gums before terminating on the face
The descending (sometimes greater) palatine artery gives what two branches?
Greater palatine artery
Lesser palatine artery
What does the artery pass through and what does it supply?
Greater palatine artery
Lesser palatine artery
Greater palatine artery – passes through the greater palatine canal to supply the hard palate
Lesser palatine artery - passes through the lesser palatine canal to supply the soft palate
What does the artery pass through and what does it supply?
Sphenopalatine artery
What branches does it give?
- passes through the sphenopalatine foramen to supply the posterior portions of the nasal cavity
Lateral posterior nasal arteries
Posterior septal branches
- Artery of the pterygoid canal and the pharyngeal artery are tiny branches that pass posteriorly
- Artery of the pterygoid canal and the pharyngeal artery are tiny branches that pass posteriorly
THE MAXILLARY NERVE (V2) is entirely sensory.
THE MAXILLARY NERVE (V2) is entirely sensory.
How does the maxillary nerve enter the pterygopalatine fossa?
through the foramen rotundum.
What two branches of the maxillary nerve V2 exit through the inferior orbital fissure?
zygomatic nerve
infraorbital nerve.
What branches of the maxillary nerve V2 pass through pterygopalatine ganglion? (Note these are also called the before they reach the ganglion they are called the “Ganglionic Branches”)
- greater and lesser palatine branches (same named canals)
- posterior superior/lateral nasal branches and the nasopalatine (sphenopalatine foramen)
- pharyngeal branches (pharyngeal canal)
What do the following sensory nerves innervate?
• greater and lesser palatine branches
• posterior superior nasal branches
• pharyngeal branches
• greater and lesser palatine branches to the hard and soft palates
• posterior superior nasal branches to the nasal cavity (medial & lateral) & nasopalatine
• pharyngeal branches to the upper pharynx
These branches supply general sensory fibers to their respective regions.
What para and sympa nerves does the travel with the nerve of the pterygoid canal?
parasympathetic greater petrosal nerve (PREganglionic)
sympathetic deep petrosal nerve (POSTganglionic)
What happens to the parasympathetic nerve fibers after the pterygopalatine ganglion?
postganglionic fibers hitchhike with V2 Maxillary nerve to
minor salivary glands of the hard and soft palate
glands of the nasal cavity
glands of the upper pharynx.
These have secretomotor function.
What are the major branches of the maxillary nerve?
zygomatic nerve infraorbital nerve. ganglionic branches greater and lesser palatine branches posterior superior nasal branches (medial & lateral) & nasopalatine pharyngeal branches
What is the course of para fibers that travel to the lacrimal gland?
main trunk of V2 to zygomatic and zygomaticotemporal branches to communicating branch to V1 opthalmic nerve to lacrimal branch of the ophthalmic nerve (V1).
NOSE
The nose is comprised of the:
external nose
nasal cavities (paired)
Pyramidal in shape, the external nose has a supporting skeleton comprised of:
osseous part
two nasal bones of the bridge articulate with the frontal bone at the root of the nose and the frontal processes f the maxillae.
Cartilaginous part
the midline septal cartilage extends bilaterally as the lateral nasal cartilages,
two U-shaped alar cartilages at the apex of the nose maintain patency of the nares: the opening on to the face
NOSE
The nose is comprised of the:
external nose
nasal cavities (paired)
Pyramidal in shape, the external nose has a supporting skeleton comprised of:
osseous part
two nasal bones of the bridge articulate with the frontal bone at the root of the nose and the frontal processes f the maxillae.
Cartilaginous part
the midline septal cartilage extends bilaterally as the lateral nasal cartilages,
two U-shaped alar cartilages at the apex of the nose maintain patency of the nares: the opening on to the face
What is the vestibule and the nasal fossa?
nasal cavities.
The vestibule has skin and vibrissae (coarse hairs that trap dust).
nasal fossae is medial aspect of the nose and has a respiratory area and a olfactory area.
The mucous membrane of the respiratory area is pseudostratified columnar ciliated epithelium that is highly vascular and contains abundant mucous and serous glands. This humidifies and warms incoming air and creates a sticky surface that traps and filters particulate matter.
Where do the cilia sweep nasal debris?
posteriorly into the nasopharynx.
What is the Olfactory Mucous membrane? (Long general answer)
The olfactory mucous membrane is limited to the roof and the upper portion of both the medial and lateral nasal walls of the fossae. It is less well vascularized and covered with noncilliated epithelium. Modified olfactory nerve cells form nerve fibers that traverse the cribriform plate of the ethmoid bone to synapse in the olfactory bulb.
Explain the difference in air circulation between quiet breathing and smelling. (general answer)
During quiet respiration = inferior and middle conchae
Sniffing = inspired air toward the roof and permits the olfactory mucosa to recognize odors.
What separates the nasal cavities from the…
oral cavity (inferior)
anterior cranial fossa (superior)
orbits (lateral)
oral cavity (inferior) by the hard palate comprised of the palatine portions of the maxillae and horizontal plates of the palatine bones
anterior cranial fossa (superior) by the frontal, cribriform plate of the ethmoid and the sphenoid bones
orbits (lateral) by a series of bones mentioned later
What forms the bony portion of the nasal septum?
Vomer
perpendicular plate of the ethmoid bone (superior)
Multiple bones contribute to the more complex lateral nasal walls. (Be generally aware of this but please do not spend time committing to memory)
They are the: maxilla (pink) lacrimal bone (teal) ethmoid bone (purple) inferior nasal concha (off white) palatine bone (vertical plate) (blue) sphenoid bone (medial pterygoid plate) (orange)
Multiple bones contribute to the more complex lateral nasal walls. (Be generally aware of this but please do not spend time committing to memory)
They are the: maxilla (pink) lacrimal bone (teal) ethmoid bone (purple) inferior nasal concha (off white) palatine bone (vertical plate) (blue) sphenoid bone (medial pterygoid plate) (orange)
Which conchae are part of the ethmoid bone? Which is an independent bone in and of itself?
superior and middle conchae are part of the ethmoid bone.
inferior concha is an independent bone.
What are Meatuses?
air passageways underneath each of the concha.
What is the Sphenoethmoidal recess?
lies superior and posterior to the superior concha.
The conchae and meatuses serve to increase surface area and prevent laminar flow thereby providing greater contact between the inspired air and mucosal surfaces in order to filter, warm and humidify the air.
What are Choanae?
the nasal cavities open into the nasopharynx at the choanae (posterior nasal apertures)
What are the Paranasal Sinuses?
frontal
Ethmoid
maxillary
sphenoid
All sinuses are lined by respiratory epithelium. Their ostia open into the lateral walls of the nasal cavity allowing drainage of mucous and equilibration of air.
Where is the Frontal sinus?
located in the vertical portion of the frontal bone
Which meatus does the frontonasal duct drain into?
– into the middle meatus
Where are the Ethmoid sinuses?
a honeycomb of small, separate air cells within the thin-walled ethmoid labyrinth that lies between the medial wall of the orbit and the upper lateral wall of the nasal cavity.
sub-grouped based on location of air cells or ostia
What meatus does each empty into?
anterior ethmoid cells
middle ethmoid cells
posterior ethmoid cells
anterior ethmoid cells open into the middle meatus
middle ethmoid cells open into the middle meatus on or above the ethmoidal bulla
posterior ethmoid cells drain into the superior meatus
What separates the ethmoid air cells from the orbit?
What are the clinical consequences of this?
separated from the orbit by the thin-walled lamina papyracea of the ethmoid bone: infections can spread readily to cause orbital cellulites
Maxillary sinuses drain into what meatus?
Is it gravity dependent?
What is the clinical significance of teeth with this sinus?
drainage occurs through the ostium located on the most superior part of the medial wall into the middle meatus. It is non-gravity dependent and, therefore, poor.
roots of teeth may erupt into these sinuses
What brain and cardiovascular structures is the sphenoid sinuses related to?
related to the pituitary gland, optic chasm, cavernous sinus and carotid artery
Explain drainage of the sphenoid sinus.
drainage occurs into the sphenoethmoidal recess by ciliary action only. Gravity drainage is poor. The ostium on the anterior wall of the sinus is well above the floor.
Nasal Meatuses: paranasal sinus secretions and tears drain into the nasal fossae
Nasal Meatuses: paranasal sinus secretions and tears drain into the nasal fossae
The nasolacrimal duct (red arrow) drains into what?
the anterior portion of the Inferior nasal meatus
Middle nasal meatus.... What is the fronal recess and frontonasal duct? What is the ethmoid Bulla? What is the uncinate process? What is the semilunar hiatus?
frontal recess –frontonasal duct (yellow arrow) and anterior ethmoid cells (green arrows) drain here
ethmoid bulla – bulging middle ethmoidal air cells and their ostia (green arrows)
uncinate process – a sharp ridge of bone below the ethmoid bulla
semilunar hiatus – opening between the ethmoid bulla above and uncinate process below leading into a groove: maxillary sinus drains here (orange arrow)
posterior ethmoid cells drain into what? (green arrow)
Superior nasal meatus
Sphenoid sinus drains into what? (blue arrow)
Sphenoethmoidal recess
What are the three main arterial vessels that provide blood to the nasal cavity?
External carotid system Maxillary artery Facial artery Internal carotid system Ophthalmic artery
What do anterior and posterior ethmoidal branches of the ophthalmic artery supply?
superior medial and lateral walls of both nasal cavities
frontal and ethmoidal sinuses
What does the superior labial branch of the facial artery supply?
the very antero-inferior portion of the nasal cavity
What branch of the maxillary enters the nasal cavity? What foramen does it pass through?
sphenopalatine branch
sphenopalatine foramen.
What does the sphenopalatine branch of the maxillary supply?
What is one of the sphenopalatine artery’s branches?
conchae and meatuses of lateral wall
posteroinferior portion of the nasal septum
greater palatine artery
What is the course of the greater palatine artery?
What does it anastomose with?
palatine canal ==> greater palatine foramen ==> hard palate ==> incisive foramen and canal ==> nasal cavity
anastomose with a septal branch of the sphenopalatine artery on the anterior portion of the septum.
What four arteries anastomose at Little’s area/Kiesselbach’s plexus?
Anterior ethmoidal from the ophthalmic artery
Spenopalatine artery (from the maxillary artery)
Greater palatine artery (from the maxillary artery)
Septal branch of the superior labial artery (from the facial artery)
What is epistaxis?
Nose bleed
Little’s area (Kiesselbach’s plexus) – common site for epistaxis (nose bleed)
anterior septal wall of nasal cavity has a very rich superficial blood supply due to the anastomosis of branches of the greater palatine, sphenopalatine, anterior ethmoidal and facial (superior labial) arteries
Summary Card:
Where does the Ophthalmic vein drain into?
Where does the Maxillary vein drain into?
Where does the Facial vein drain into?
ethmoidal veins ==> ophthalmic vein ==> cavernous sinus.
Maxillary ==> sphenopalatine vein to the pterygoid plexus in the infratemporal fossa (mandibular vein – retromandibular vein)
facial ==> internal jugular vein
What part of the nasal cavity does the Ophthalmic vein drain?
ethmoidal veins drain via the ophthalmic vein and then into the cavernous sinus.
What part of the nasal cavity does the Maxillary vein drain?
Posterior part of the nasal cavity had drains via the sphenopalatine vein to the pterygoid plexus in the infratemporal fossa (mandibular vein – retromandibular vein)
What part of the nasal cavity does the Facial vein drain? Into what blood vessel does the facial vein drain into?
Anterior part of the nasal cavity
internal jugular vein
What is the venous drainage of the anterior nasal cavity?
Facial to internal jugular vein
What is the venous drainage of the ethmoidal area?
Ethmoidals via ophthalmic vein to cavernous sinus
What the venous drainage of the posterior nasal cavity?
Sphenopalatine veins to pterygoid plexus in infratemporal fossa
submandibular lymph nodes drain what aspects of the nasal cavity and sinuses?
anterior region of the nose plus
the frontal sinus
anterior ethmoidal sinus
maxillary sinuses
deep cervical lymph nodes drain what aspects of the nasal cavity and sinuses?
receive lymph directly or via retropharyngeal nodes from: posterior region of the nasal cavity posterior ethmoidal cells sphenoid sinuses nasopharynx
What are the Nerves
to the nasal cavity?
Olfactory nerves (CN I)
Ordinary sensation ophthalmic (V1) maxillary (V2) Autonomic nerves sympathetic parasympathetic
What branches of the Ophthalmic nerve (V1) provide general sensation to the anterior nose and forhead?
nasociliary nerve anterior ethmoidal nerve nasal branches Internal external
Explain the general sensation areas and course of the maxillary nerve V2
Maxillary nerve – V2
enters via the sphenopalatine foramen and supplies the posteroinferior portion of the nasal cavity
lateral
posterior superior lateral nasal branches
medial
posterior superior medial nasal branches
nasopalatine nerve
(V2) greater palatine nerve
posterior inferior lateral nasal nerves
