Head & Neck #14 20 minutes Pterygopalatine Fossa Done by : ainaa syahirah,nur atiqah

This lecture is about pterygopalatine fossa. you re already aware of the wall boundary of pterygopalatine fossa which are the walls of maxillary sinus anteriorly, the perpendicular plate of palatine bone medially,the pterygoid process and the root of greater wing of sphenoid posteriorly, and the pterygomaxillary fisure laterally and the body of sphenoid bone and anterior orbital fissure superiorly and then pterygopalatine process continue as canal. but i cant show u the boundaries here,of course this is temporal fossa,this is infratemporal fossa,and then here up there medially is pterygopalatine fossa. so,this pterygopalatine fossa located medial to infratem poral fossa.

The pterygopalatine fossa (ppf ) communicate with other regions of the skull via fissure and foramina. First, 1. Sphenopalatine foramen-enable pterygopalatine fossa(ppf) to communicate with nasal cavity. 2. anterior orbital fissure-enable ppf to communicate with the orbits floor 3. Pharyngeal canal-enable ppf to communicate with nasopharynx which is the upper portion of pharynx 4. Foramen rotundum- enable ppf to communicate with medial cranial fossa 5. Pterygoid canal-ends in the medial cranial fossa in foramen lacerum 6. Pterygopalatine canal-ends in the greater and lesser palatine foramina. 7. Pterygomaxillary fissure (not mentioned by doctor)

We have 3 major contents of pterygopalatine fossa which are maxillary nerve,pterygoplatine ganglion an d maxillary artery.regarding maxillary nerve as you already know it arrives form secondary division of trigeminal ganglion then passing foramen rotundum to enter pterygoplatine fossa. so this space here is pterygopalatine fossa. Before passing foramen rotundum the maxillary artery gives off the meningeal branch. now remember that the maxillary division of trigeminal nerve is purely sensory,means NO motor fibres!

After passing foramen rotundum and entering pterygopalatine fossa,maxillary nerve gives off many branches for example this is zygomatic nerve which will enter the orbit via inferior orbital fissure branching into the zygomaticotemporal and zygomaticofacial nerve. Zygomaticotemporal nerve carry post ganglionic parasympathetic fibre which are g iving to lacrimal gland via lacrimal nerve. Now,if u can see here there are 2 short branches called pterygopalatine branches or ganglionic branches and as u can see they are suspending a ganglion. this ganglion is named according to fossa s name it is loca ted in. so, pterygopalatine ganglion-parasympathetic ganglion. another branch of maxillary nerve here is posterior superior alveolar nerve. this is [10.08.one word is not clear] branch,because it supplies the upper motor teeth as well as the fissure of maxillary sinus.then,the maxillary nerve continue as infraorbital nerve lying in the infraorbital sulcus before entering the infraorbital canal till it reaches the face via infraorital foramen. Once the maxillary nerve located in the infraorbital canal it giv es off 2 branches which are middle-superior alveolar nerve and anterior-superior alveolar nerve. just to memorise the names of these nerves, all of these are

superior.superior..posterior,superior,middle,and anterior.it is superior alveolar because supplying upper teeth.but one is most posterior,one is most anterior and one is in middle.so,remember that the posterior superior comes directly from maxillary nerve while the middle and anterior superior alveolar nerve come from the infraorbital nerve in its canal.

Now,here is pterygopalatine ganglion als o called as sphenopalatine ganglion that is located in pterygopalatine fossa suspended to maxilla ry nerve by ganglionic branches at pterygopalatine nerve which is branch of m axillary nerve. pterygopalatine ganglion receives preganglionic parasympathetic fibre of facial nerve via greater petrosal nerve. so,greater petrosal nerve is a branch of facial nerve carrying preganglionic parasympathetic fibre that are going to synapse with post ganglionic parasympathetic in the pterygopalatine ganglion.now the greater petrosal nerve joins with another nerve called deep petrosal nerve to form the nerve of pterygoid canal.again,the trunks between the pterygopalatine fossa to foramen lacerum....intermital cranial fossa

Remember the trigeminal nerve(V) divides into three divisions.The most superior is the ophthalmic then maxillary then mandibular. The maxillary rises the one that goes to the pterygopalatine fossa passing through the foramen rotundum. If you remember the foramen rotundum is that foreman in greater wing of sphenoid bone, the medial cranial fossa.

So again the greater petrosal nerve join the deep petrosal nerve to form the nerve of the pterygoid canal. Remember that the deep petrosal nerve consists of post ganglionic sympathetic fibres. These fibres are commuting from the plexus around the internal carotid artery. Do you remember that the internal carotid artery which is the branch of the common carotid artery entering the cranium or the cranial cavity. Now, there are three groups of cervical ganglia. So inferior, middle and superior cervical ganglia. She will talk more about this in another lecture. You have that post ganglionic with post ganglionic sympathetic plexus around the internal carotid artery. And then the post ganglionic sympathetic fibres are travelling to their destination from that plexus. So some of those fibres are carried in this deep petrosal nerve here. And both of these join forming the nerve of the pterygo id canal.

Now again these fibres that are parasympathetic carried the greater petrosal nerve that are preganglionic . so they need to synapses on post ganglionic parasympathetic neurons which are present in the pterygopalatine ganglion. However the sympathetic fibres carried in the deep petrosal nerve are already post ganglionic. They have already synapses on post ganglionic sympathetic neurons, that plexus around the internal carotid artery. So they pass here in the pterygopalatine ganglion without synapsing.

There are many nerves that are arising or coming off from this pterygopalatine ganglion. Remember that all of these nerves or branches contain three types of fibres which are sensory, post ganglionic sympathetic, and post ganglionic parasympathetic. So the first branch, we said that this is the pterygopalatine canal leading into the greater and lesser palatine foramina. So the first branch here that you can see is greater palatine nerve which descends in this canal, the pterygopalatine canal exiting through the greater palatine foramen to supply the mucosa of the roof of the mouth here, of the hard palate in addition to the gums.

The second branch is the lesser palatine nerve, which exits through t he lesser palatine foramina to supply the soft palate and the tonsil. Then you have the posterior inferior lateral nasal nerve which supplies the lower half or the lower part of the nasal mucosa and the lateral wall of the nasal cavity. Then

you have the superior posterior lateral nasal nerve to supply the mucosa for the upper part of the nasal cavity on the lateral wall.

Then you have this nerve here, this is called the nasopalatine nerve. Now the nasopalatine nerve and posterior superior lateral nasal nerve, both pass through the sphenopalatine foramen. We say here you have the superior and inferior posterior lateral nasal nerves, they supply parts of the upper and lower parts of the lateral wall. This nasopalatine nerve supplies the nasal septum. So, the medial wall of the nasal cavity. So what happens is the nasopalatine nerve pass through the sphenopalatine foramen crosses roof of the nasal cavity reaching nasal septum. After you reaching the nasal septum, this ne rve runs anteriorly and inferiorly the nasal septum to reach the incisive canal. While doing that, it supplies the nasal septum.

Another branch of the pterygopalatine ganglion is the pharyngeal branch here or the pharyngeal nerve which crosses through the pharyngeal canal to supply the mucosa in the nasopharynx. And that is the last branch of this ganglion. So again, remember pterygopalatine ganglion is parasympathetic ganglion containing post ganglionic parasympathetic fibres or preganglionic parasympathetic fibres pair with greater petrosal nerve which is branch of the facial nerve. Then after synapsing in its neurons, those post ganglionic parasympathetic fibres supply the lacrimal nerve of the lacrimal gland and the mucosal glands in the nasal cavity, oral cavity and pharynx the same with the nasopharynx. The last content of the pterygopalatine fossa is the maxillary artery. You remember the maxillary artery is one of the terminal branches of the external carotid artery. And if you remember maxillary artery is subdivided into three portions according to its location. So you have mandibular portion, the pterygoid protion and the last portion is the pterygopalatine por tion which is the third portion of the maxillary artery.

Now the pterygopalatine portion starts at the pterygomaxillary fissure, so can you see this space here? This is the pterygomaxillary fissure which between the pterygoid process of the sphenoid bo ne and that of maxilla.

Now there are many branches of the maxillary artery. So you have here is the descending palatine artery which descends in the pterygopalatine artery dividing into the greater and lesser palatine arteries. And then you have this here, this is the posterior superior alveolar artery which runs with the posterior superior alveolar nerve. Then this is the infraorbital artery, you can see that it lies in the infraorbital sulcus perceiving the infraorbital canal. And then you can see the sphenopalatine artery, which runs through or passes through the sphenopalatine foramen and it runs with the nasopalatine nerve on the nasal septum, supplying that medial wall of the nasal cavity. Then you can see the pharyngeal artery which runs with the pharyngeal nerve and the artery of the pterygoid canal running in the pterygoid canal together with the nerve of the pterygoid canal.

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