Pterygopalatine Fossa PDF

Infratemporal & Pterygopalatine fossa Parietal Frontal Temporal Sphenoid Z Maxilla Lat. Pterygoid Plate Pterygomaxillary Fissure Infratemporal Fossa the boundaries of the infratemporal fossa. Temporal Fossa Frontal Parietal Sphenoid Temporal Z Maxilla Lat. Pterygoid Plate Pterygomaxillary Fissure In...

Infratemporal & Pterygopalatine fossa Parietal Frontal Temporal Sphenoid Z Maxilla Lat. Pterygoid Plate Pterygomaxillary Fissure Infratemporal Fossa the boundaries of the infratemporal fossa. Temporal Fossa Frontal Parietal Sphenoid Temporal Z Maxilla Lat. Pterygoid Plate Pterygomaxillary Fissure Infratemporal Fossa INFRATEMPORAL FOSSA  Located below the temporal fossa and medial to the ramus of mandibula.  Lateral wall: Ramus of the mandibula Medial surface of the zygomatic arch  Medial wall: Lateral pterygoid plate Tuber maxilla Pterygomaxillary fissure  Anterior wall: Infratemporal surface of maxilla Pterygomaxillary fissure medially Infrerior orbital fissure superiorly Lateral pterygoid plate Posterior ascpect of buccinator muscle Superior constrictor muscle  Posterior wall: Anterior surface of condylar process of mandibula Styloid process  Roof: Inferior surfaceof the greater wing of sphenoid bone Foramen ovale & Foramen spinosum Infratemporal crest seperates infratemporal and temporal fossa Medial pterygoid attachment to mandibula  Inferior Boundary: The content of the infratemporal fossa Medial pterygoid muscle Lateral pterygoid muscle Mandibular nerve Maxillary vein Part of Maxillary artery Otic ganglion Pterygoid plexus Medial pterygoid muscle Lateral pterygoid muscle Pterygoid muscles: Medial and lateral Originate from the medial and lateral pterygoid plates – thus their names. Maxillary artery Maxillary artery Branches of the Maxillary Artery  1- Retromandibular Deep auricular a. Anterior tympanic a. Middle meningeal a. Accessory meningeal a. Inferior alveolar a.  2- Pterygoid Deep temporal a. Masseteric a. Pterygoid a. Buccal a.  3- Pterygopalatine Posterior superior alveolar a. Infraorbital a. Descending palatine a. Sphenopalatine a. Artery of pterygoid canal a. Pharyngeal a. Ant. Deep Temporal Post. Deep Temporal Infra-orbital Ant. Deep Temporal Post. Deep Temporal Sphenopalatine V3 Septal brr. Maxillary Ext. Cartotid Middle Meningeal Descending palatine Greater palatine Lesser palatine Ext. Cartotid Post. Sup. Alveolar Inf. Alveolar Mandibular nerve It is the third division of trigerminal nerve and being the mixed nerve.It leaves the skull by foramen ovale. There are the branches from trunk,anterior division,and posterior division Ophthalmic n.(V1) Maxillary n.(V2) Mandibular n.(V3) Trigeminal nerve(V) leaving the skull Mandibular trunk meningeal branch, medial pterygoid nerve,  nerve to tensor tympani and tensor veli palatini Mandibular(V3) nerve branches Anterior division All branches of this division are motor nerve except buccal nerve. The branches of this division are: 1.Deep temporal n.(motor) 2.Lateral pterygoid n.(motor) 3.Masseteric n.(motor) 4.Buccal n.(sensory) Posterior division All branches are sensory nerve except mylohyoid nerve The branches from this division are : 1.Lingual nerve(sensory) – Chorda tympani (P/S and taste sense) 2.Inferior alveolar nerve(sensory) – Mylohyoid nerve(motor) 3.Auriculotemporal nerve(sensory) Auriculotemporal n. M MA Chorda tympani n. Lingual n. Inferior alveolar n. Mylohyoid n. Posterior division of mandibular nerve Mandibular division of CN V (V3) Lateral pterygoid m. Medial pterygoid m. Lingual n. Buccal n. V3 – Lateral pterygoid removed Deep temporal nn. Buccal n. Lingual n. Inferior alveolar n. Auriculotemporal n. Foramen ovale Pterygomaxillary fissure Other nerves in the ITF Posterior superior alveolar nerve – from V2 Otic ganglion Below foramen ovale Parasympathetic Related with glossopharyngeal nerve Maxillary vein Pterygoid venous plexus It is the venous plexus which locate around the pterygoid muscle. Moreover, it has connection to these veins 1.The maxillary vein 2.Deep facial vein 3.Inferior ophthalmic vein 4.Cavernous sinus(in the cranial cavity) Therefore,the infection could invade from external to internal area Pterygoid venous plexus Inferior ophthalmic v. Emissary vein connect to cavernous sinus in brain Maxillary v. Deep facial v. Pterygoid venous plexus of vein PTERYGOPALATINE FOSSA Located deep to the infratemporal fossa and inferior to the apex of the orbit. Anterior wall: tuber maxilla Posterior wall: anterior surface of pterygoid process Medial wall: perpendicular lamina of the palatine bone Lateral wall: pterygomaxillary fissure Roof: greater wing of sphenoid Floor:pyramidal proc of palatine bone The content of the pterygopalatine fossa Maxillary artery Maxillary nerve Pterygopalatine ganglion Ant. Deep Temporal Post. Deep Temporal Infra-orbital Ant. Deep Temporal Post. Deep Temporal Sphenopalatine V3 Septal brr. Maxillary Ext. Cartotid Middle Meningeal Descending palatine Greater palatine Lesser palatine Ext. Cartotid Post. Sup. Alveolar Inf. Alveolar Maxillary artery Pterygopalatine ganglion Maxillary nerve Maxillary Nerve It is pure sensory nerve and divided into three ramus as follows: 1.Zygomatic n.:They are zygomaticofacial and zygomaticotemporal nerves 2. Infraorbital nerve branches; – Superior anterior, middle and posterior alveolar nerves which supply alveolar and upper teeth – Infraorbital nerve which traverses infraorbital foramen to supply cheek and lower eyelid. 3.Pterygopalatine n. Communications of Pterygopalatine Fossa 1.Laterally  infratemporal fossa through pterygomaxillary fissure 2. Medially nasal cavity through sphenopalatine foramen 3. Anteriorly Orbit through the inferior orbital fissure 4. Posterosuperiorly Middle cranial fossa through foramen rotundum 5. Inferiorly  Oral cavity through pterygopalatine canal Fossa FromTo thePP ITF: To PP Fossa via pterygomaxillary fissure From middle cranial fossa: To PP Fossa via foramen rotundum From the orbit: To PP Fossa via inferior orbital fissure To ITF From the hard palate/oral cavity: To PP Fossa via greater palatine foramen & palatine canal From the nasal cavity: To PP Fossa via sphenopalatine foramen Anterior view of sphenoid bone Pterygoid process of sphenoid ---- PP Fossa Note: These open on the posterior wall of the PPF. Pterygoid canal Foramen rotundum Contents of the PP Fossa Third part of maxillary artery Venous tributaries of pterygoid plexus Maxillary nerve (V2) and branches Pterygopalatine ganglion Maxillary artery (Part 3) Ant. Deep Temporal Post. Deep Temporal Infra-orbital Ant. Deep Temporal Post. Deep Temporal Sphenopalatine V3 Septal brr. Maxillary Ext. Cartotid Middle Meningeal Descending palatine Greater palatine Lesser palatine Ext. Cartotid Post. Sup. Alveolar Inf. Alveolar From the 3rd part of the maxillary artery: Artery of the pterygoid canal Pharyngeal a. Sphenopalatine a. Descending palatine a. Maxillary nerve (V2) Communicating branch with V1 Zygomatic nerve Ganglionic branches PP Ganglion Posterior superior alveolar nerve Infra-orbital nerve Pterygopalatine ganglion “Branches” of the PP ganglion (Branches of V2) Pharyngeal n. – To nasopharynx. Nasopalatine n. – To nasal septum and hard palate. Posterior superior lateral nasal nn. – To posterior superior lateral nasal wall. Greater palatine n. – To hard palate – Posterior inferior lateral nasal nn. to lateral nasal wall. Lesser palatine n. – To soft palate Greater and lesser palatine nerves (and vessels) Nasopalatine nerve Nerve of the pterygoid canal (Vidian nerve)