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NASAL CAVITY AND PTERYGOPALATINE FOSSA

Santosh K. Sangari
LAB INTRODUCTION: NASAL CAVITY AND PTERYGOPALATINE FOSSA

DATE : December 4, 2017.

SUGGESTED READING:
Essential Clinical Anatomy, Fifth Edition
by Keith L. Moore, Anne M.R. Agur and Arthur F. Dalley,
Pages: 558-566; 643-647.

Santosh K. Sangari, M.D.

Associate Professor of Anatomy in Radiology
Division of Anatomy
Department of Radiology
Weill Cornell Medicine
Email: sks2005@med.cornell.edu
OBJECTIVES:
At the end of this laboratory introduction, the students should be able to identify and describe the:
- Bones and cartilages forming the nasal cavity and their clinical importance
- Paranasal sinuses and clinical anatomy
- Openings in the lateral wall of nasal cavity
- Blood supply of the nasal cavity with its clinical application
- Nerve supply of nasal cavity
- Boundaries and contents of the pterygopalatine fossa
- Pterygopalatine ganglion and its connections
 BONY LANDMARKS AND THE INNERVATION OF THE FACE/ NOSE

V1
Nasal bone

V2
Cartilages of
nose
V3
Ala of nose

Anterior nares /
Nostril

Tip and dorsum of the nose is supplied by Ophthalmic nerve (V1), whereas the ala of the nose is supplied by
Maxillary nerve (V2).
 BONY LANDMARKS - NASAL SEPTUM
(mucous membrane removed)

Perpendicular plate of ethmoid

Septal Groove for sphenopalatine

cartilage artery and nasopalatine nerve

Vomer

Horizontal plate
of palatine bone

Palatine process of maxilla

 LATERAL WALL OF THE NOSE

Superior concha

Middle concha
Sphenoethmoidal recess

Inferior concha Superior meatus

Vestibule of nose Middle meatus

Inferior meatus

The vestibule of nose is lined with hairy skin. Hairs filter the dust particles in the inhaled air.
Respiratory mucosa:
The mucosa lining the nasal cavity is respiratory and is firmly attached to periosteum and perichondrium of the bones and cartilages of the nose.
It humidifies and warms the air and removes dust particles from air.
Olfactory mucosa:
Upper posterior part of the septum, roof and superior choncha of the nasal cavity is lined with olfactory mucosa and carries the sensation of smell.
Olfactory nerves arise from the olfactory epithelium and pierce the cribriform plate of ethmoid bone to synapse with the neurons of the olfactory
bulb.
Lateral wall of the nasal cavity:
Has three shelf like projections- superior, middle and inferior conchae/turbinates, which divide the nasal cavity into meatuses.
Nasal cavity opens into the nasopharynx by posterior nares/choana.
 PARANASAL SINUSES
Sphenoidal air sinus

Frontal air sinus

Anterior
Middle and
Posterior
Ethmoidal
air sinuses

Maxillary air sinus

Paranasal sinuses are air-filled spaces in the bones, lined with respiratory epithelium and communicate with the nasal cavity.
They are named according to bones which contain them : 1) Frontal air sinus, 2) Maxillary air sinus,
3) Sphenoidal air sinus and 4) Ethmoidal air sinuses-anterior, middle and posterior.
They warm, humidify the inspired air and add nasal resonance to your voice.
Clinical note:
Sinusitis: Infection of paranasal sinuses, frequently affects maxillary and frontal air sinuses. Ostium of maxillary air sinus is
much higher than the floor of the sinus, therefore drainage is difficult by gravity and may have to be surgically drained.
 LATERAL WALL OF THE NOSE
(nasal septum removed)

Frontal air sinus

Wire in frontonasal duct Sphenoethmoidal recess

Sphenoidal air sinus

Opening of Bulla ethmoidalis /

maxillary air sinus Ethmoidal bulla

Semilunar hiatus /
Hiatus semilunaris

Opening of
nasolacrimal duct

Inferior meatus: Nasolacrimal duct carries tears from lacrimal sac and opens into inferior meatus.
Middle meatus:
Bulla ethmoidalis: Middle ethmoidal air cells form an elevation called Bulla ethmoidalis and open directly on to the bulla.
Hiatus semilunaris: A depression below the bulla. Maxillary air sinus opens into it.
Frontal air sinus opens into infundibulum by a frontonasal duct. Anterior ethmoidal air cells also open into the
infundibulum. Anterior continuation of hiatus semilunaris is called infundibulum.
Superior meatus : It has the opening of the posterior ethmoidal air cells.
Sphenoethmoidal recess: Sphenoidal air sinus drains into it
 PHARYNX

NASOPHARYNX

OROPHARYNX

LARYNGOPHARYNX

C6

Location:
It extends from base of skull to the lower border of cricoid cartilage/lower border of C6 vertebra
Pharynx is divided into three parts:
1. Nasopharynx: It lies behind nasal cavity and above soft palate against Atlas vertebra (C1)
2. Oropharynx: Lies behind oral cavity against C2 and C3 vertebrae
3. Laryngopharynx: Lies behind larynx (from tip of epiglottis to the lower border of cricoid cartilage) against C4, C5 and
C6 vertebrae
 CAVITY OF PHARYNX
Tensor veli palatini
Adenoids/ ( V3 )
Opening of Auditory tube/Eustachian tube Pharyngeal tonsil Levator veli palatini
(Pharyngeal plexus
Pharyngeal from CN X)
recess
Tubal elevation /
Torus tubarius

Salpingo-
pharyngeal fold
Palatoglossal
fold
(Palatoglossus)

Palatopharyngeal
fold
(Palatopharyngeus)

Lingual tonsil Palatine tonsil

NASOPHARYNX:
1. - Opening of auditory tube / eustachian tube- It equalizes the pressure between nasopharynx and middle ear cavity.
- It is open during swallowing and yawning.
- It is horizontal in children. Therefore there are more chances of middle ear infection in children with sore throat.
- It is bounded by the tubal elevation.
2. Collection of lymphatic tissue around the opening of auditory tube is called tubal tonsil.
3. Salpingopharyngeus muscle extends from auditory tube to pharynx. It is covered by mucous membrane and raises a
fold called salpingopharyngeal fold. A depression behind the salpingopharyngeal fold is known as pharyngeal recess.
4. Pharyngeal tonsil / adenoids: It is a collection of lymphoid tissue at the junction between the roof and the posterior
wall of pharynx. It regresses after the age of 5 and atrophies after puberty. If inflamed, it blocks the nasopharynx and
the child becomes a mouth breather. Recurrent infections of it gives rise to a long face called -Adenoid facies.
OROPHARYNX:
1. Palatoglossal arch/Anterior pillar: Palatoglossus muscle covered by a mucous membrane.
2. Palatopharyngeal arch/Posterior pillar: Palatopharyngeal muscle covered by mucous membrane.
3. Tonsillar fossa: It lies between the two arches. The lateral wall is formed by superior constrictor muscle. It lodges the
palatine tonsil. Infection of palatine tonsil is called tonsillitis. It may give rise to peritonsillar abscess and may spread
into the retropharyngeal space.
LARYNGOPHARYNX:
1. Lies behind the inlet of larynx.
2. Piriform fossa -Space between wall of larynx and thyroid cartilage. Foreign bodies can get stuck there (fish bone).

Sensory innervation of Pharynx:

Mainly from Glossopharyngeal nerve except the area above the torus tubarius, which is innervated by maxillary nerve
(Pharyngeal branch of V2).
 LEVATOR AND TENSOR
VELI PALATINI

Remove the mucous membrane

below the tubal elevation to
find Tensor veli palatini and
Levator veli palatini

Tensor veli palatini

Innervated by
Mandibular nerve/ V3
Torus Tubarius/
Tubal elevation

Levator veli palatini

Innervated by
Paryngeal plexus (CN X)
 BLOOD SUPPLY OF NASAL CAVITY

Sphenopalatine artery
Anterior ethmoidal artery

Posterior ethmoidal
artery
Greater palatine artery

Anterior and Posterior ethmoidal arteries: They are branches of ophthalmic artery.
Sphenopalatine artery: A branch of maxillary artery, runs on the septum of the nose and gives branches to the lateral wall
and septum of the nose, passes through the incisive foramen to supply the palate.
Greater palatine artery: A branch of maxillary artery, passes through the greater palatine canal, runs on the under surface
of bony palate and passes through the incisive foramen to enter the septum of the nose.
Superior labial branches of Facial artery give branches to septum of the nose to contribute to Kiesselbach’s area.
 Kiesselbach’s /Little’sarea

Kiesselbach’s area
Anterior ethmoidal
artery Sphenopalatine artery
Sphenopalatine artery
Anterior ethmoidal artery

Posterior ethmoidal
artery

Kiesselbach’s area
Greater palatine artery Greater palatine artery

Kiesselbach’s  area  /  Little’s  area:  Plexus  of  arteries  formed  in  the  lower  part  of  the  septum  of  
the  nose  and  can  give  rise  to  bleeding   from  the  nose  (epistaxis).  
The  arteries  which  anastomose  are:
:  Anterior  ethmoidal
:  Sphenopalatine  
:  Greater  palatine   and  
:  Branches  from  superior  labial   branches  of  facial  artery
 NERVE SUPPLY OF THE NASAL CAVITY

Anterior ethmoidal nerve

Olfactory
nerves

Nasopalatine nerve

Pterygopalatine ganglion

Greater palatine nerve

Lesser palatine nerves

Olfactory nerves: They are responsible for sense of smell. They pierce the cribriform plate of ethmoid to synapse with the
neurons of olfactory bulb.
Clinical note: Hemorrhage in the anterior cranial fossa may result in bleeding from the nose. Fracture of anterior cranial
fossa floor might lead to CSF running through nose (CSF Rhinorrhea).
Anterior ethmoidal nerve: Branch of nasociliary nerve. It is sensory to the septum and the lateral wall of the nose.
Nasopalatine, greater and lesser palatine nerves carry sensory and parasympathetic secretomotor nerve fibers, are
branches of V2 and pterygopalatine ganglion to supply the nasal cavity and the palate.
 PTERYGOPALATINE/ SPHENOPALATINE FOSSA

pharynx

Pterygomaxillary fissure leading to

Pterygopalatine fossa
eolar

It is a space between the maxilla and the pterygoid plates and limited medially by the perpendicular plate
of palatine bone.

CONTENTS:
- Third part of maxillary artery and its branches
- Pterygopalatine ganglion and its branches
- Maxillary nerve and branches
 Openings in the Pterygopalatine fossa
Pterygomaxillary fissure:
Transmits maxillary artery and maxillary nerve
from/to the infratemporal fossa

Pterygopalatine fossa Foramen rotundum:

For maxillary nerve from middle cranial fossa
Sphenopalatine artery
Maxillary artery Inferior orbital fissure:
Transmits infraorbital nerve and vessels through
orbit to the face

Greater and lesser palatine foramen:

for greater and lesser palatine nerve and vessels to
the palate

Sphenopalatine foramen:
for sphenopalatine artery and nasopalatine nerve to
the nasal cavity

Greater palatine External carotid artery Pterygoid canal:

artery Transmits Vidian nerve /nerve of pterygoid
canal

Palatovaginal canal: for pharyngeal

branches of V2 to the nasopharynx
 PTERYGOPALATINE / SPHENOPALATINE GANGLION
Olfactory
nerves Olfactory bulb
Anterior
Ethmoidal Maxillary nerve
nerve
Vidian nerve /
Nerve of pterygoid canal

Pterygopalatine ganglion

Pharyngeal branch

Greater palatine nerve

Descending palatine
Lesser palatine nerve nerves

It is a parasympathetic ganglion lying in the pterygopalatine fossa

It is suspended from the maxillary (V2) nerve by the ganglionic branches of V2
Branches of maxillary nerve (V2):
- Nasal: for supplying nasal cavity
- Nasopalatine nerve
- Greater and Lesser palatine: for mucosa over the hard palate and soft palate
- Pharyngeal: to supply the nasopharynx above the eustachian tube
 FORMATION OF THE VIDIAN NERVE

Facial nerve (CN VII)

Maxillary Foramen rotundum
Greater petrosal nerve nerve/V2

Deep petrosal nerve

Vidian nerve/ Pterygopalatine

Superior Nerve of pterygoid canal ganglion
cervical
Vidian nerve/Nerve of Pterygoid canal: It brings sympathetic and
ganglion parasympathetic nerve fibers to the pterygopalatine ganglion and is formed by
union of:

1. Greater petrosal nerve: Preganglionic parasympathetic axons from cell bodies

in Superior salivatory nucleus, run in Facial nerve/CN VII
and
2. Deep petrosal nerve: Postganglionic sympathetic axons with cell bodies in the
Superior cervical ganglion.
 PTERYGOPALATINE / SPHENOPALATINE FOSSA

Maxillary nerve
Pterygopalatine ganglion

Greater palatine nerve

Vidian nerve /
Nerve of pterygoid canal

Lesser palatine nerve

 PTERYGOPALATINE / SPHENOPALATINE GANGLION
Nerve of Pterygoid canal

Superior salivatory nucleus

VII nerve
Pterygopalatine
ganglion Greater petrosal nerve
Deep petrosal nerve

CONNECTIONS :
Parasympathetic root: Preganglionic parasympathetic fibers arise from superior salivatory nucleus in pons, run in VII nerve
Greater petrosal nerve Nerve of pterygoid canal Synapses in Pterygopalatine ganglion Postganglionic
parasympathetic secretomotor fibers run in the branches of pterygopalatine ganglion to supply glands of palate, nasal
cavity, pharynx and lacrimal gland.
Sympathetic root: Preganglionic fibers from T1 spinal segment pass through Inferior and middle cervical ganglion
without relay Synapse in Superior cervical ganglion postganglionic fibers travel in Internal carotid plexus form
deep petrosal nerve Deep petrosal nerve joins the greater petrosal nerve to form nerve of pterygoid canal / Vidian
nerve These fibers pass through the ganglion without synapsing and pass in all the branches coming off the
ganglion.
Sensory root: From Maxillary nerve (V2) and its branches. It makes no synapse in the pterygopalatine ganglion and the cell
body of the neuron lies in trigeminal ganglion.
 THIRD PART OF THE MAXILLARY ARTERY

Sphenopalatine artery
Maxillary artery

External carotid artery

Greater palatine
artery
BRANCHES OF THIRD PART OF MAXILLARY ARTERY:
The maxillary artery enters the pterygopalatine fossa by passing through the pterygomaxillary fissure
- Sphenopalatine artery: runs on the nasal septum, supplies the septum and lateral wall of nose
- Greater palatine artery: supplies the palate and anastomoses in the nasal septum
- Infraorbital artery: passes through the infraorbital canal and foramen and supplies face
- Posterior superior alveolar arteries: supply maxilla and upper teeth
- Pharyngeal artery: supplies the wall of the nasopharynx