Dr. Ahmed Fathalla Ibrahim
THE PTERYGOPALATINE FOSSA
THE PALATE
THE PTERYGOPALATINE FOSSA • BOUNDARIES: 1. ANTERIOR: Maxillary bone 2. POSTERIOR: Pterygoid process of sphenoid bone 3. MEDIAL: Perpendicular plate of palatine bone
THE PTERYGOPALATINE FOSSA • COMMUNICATIONS: 1. With infratemporal fossa: through pterygomaxillary fissure 2. With cranial cavity: through foramen rotundum 3. With nasal cavity: through sphenopalatine foramen 4. With orbit: through inferior orbital fissure 5. With palate: through greater & lesser palatine canals & foramina 6. With pharynx: through pterygoid canal & palatovaginal canal
THE PTERYGOPALATINE FOSSA • 1. 2. 3. CONTENTS: Pterygopalatine ganglion Maxillary nerve Maxillary artery
MAXILLARY NERVE • ORIGIN: It arises from the trigeminal ganglion in the middle cranial fossa • TYPE OF FIBERS: Pure sensory (general somatic afferent)
MAXILLARY NERVE ZF ZT Zygomatic Meningeal PSA MSA ASA
COURSE OF MAXILLARY NERVE • THE CRANIAL CAVITY: It passes in the lateral wall of cavernous sinus then passes through the foramen rotundum to enter: • THE PTERYGOPALATINE FOSSA: It passes through pterygomaxillary fissure to enter: • THE INFRATEMPORAL FOSSA: It crosses the fossa & passes through the inferior orbital fissure to enter: • THE ORBIT: The nerve is now called the infraorbital nerve. It runs on the floor of the orbit & passes through the infraorbital groove, canal & foramen to enter: • THE FACE
BRANCHES OF MAXILLARY NERVE • 1. IN THE CRANIAL CAVITY: Meningeal branch: supplies middle cranial fossa • 1. IN THE PTERYGOPALATINE FOSSA: Two ganglionic branches connecting the nerve to pterygopalatine ganglion: contain postganglionic parasympathetic fibers to lacrimal gland & sensory fibers from nose, palate & pharynx • 1. IN THE INFRATEMPORAL FOSSA: Posterior superior alveolar nerve: supplies maxillary sinus & upper molar teeth Zygomatic nerve: passes through inferior orbital fissure to enter the orbit & divides into zygomaticotemporal & zygomaticofacial nerves 2.
BRANCHES OF INFRAORBITAL NERVE • IN THE INFRAORBITAL CANAL: 1. Middle superior alveolar nerve: supplies maxillary sinus & upper premolar teeth 2. Anterior superior alveolar nerve: supplies maxillary sinus & upper canine & incisors • 1. 2. 3. IN THE FACE: Palpebral: supplies lower eyelid Nasal: supplies ala of nose Labial: supplies upper lip
MAXILLARY ARTERY
MAXILLARY ARTERY Sphenopalatine ASA PSA Lesser palatine Greater palatine
MAXILLARY ARTERY • ORIGIN: It is the larger of the 2 terminal branches of external carotid artery, behind the neck of mandible (within parotid gland) • COURSE: It is divided into 3 parts: • First part: runs deep to neck of mandible (below auriculotemporal nerve) & emerges from the lower border of lateral pterygoid • Second part: ascends superficial (sometimes deep) to lower head of lateral pterygoid • Third part: passes between the 2 heads of lateral pterygoid then through pterygomaxillary fissure to reach pterygopalatine fossa where it terminates
BRANCHES OF MAXILLARY ARTERY • FROM FIRST PART: 1. Middle meningeal artery: lies deep to lateral pterygoid, behind the trunk of mandibular nerve, between the 2 roots of auriculotemporal nerve. It passes through foramen spinosum to reach cranial cavity 2. Inferior alveolar artery: same course & distribution as inferior alveolar nerve 3. Deep auricular & anterior tympanic arteries: supply external auditory meatus & tympanic membrane
BRANCHES OF MAXILLARY ARTERY • FROM SECOND PART: 1. Muscular branches: to muscles of mastication 2. Buccal artery: same course & distribution as buccal nerve
BRANCHES OF MAXILLARY ARTERY • 1. 2. 3. 4. 5. 6. FROM THIRD PART: Infraorbital artery: same course & distribution as infraorbital nerve Posterior superior alveolar artery: same course & distribution as posterior superior alveolar nerve Greater palatine artery: passes through greater palatine canal & foramen to the palate, supplies hard palate & gums, gives lesser palatine artery supplying soft palate & tonsils Sphenopalatine artery: passes through sphenopalatine foramen to the nose, supplies nasal cavity & nasal septum Artery of pterygoid canal: supplies auditory tube, tympanic cavity & pharynx Pharyngeal artery: supplies nasopharynx, sphenoidal air sinuses
• PTERYGOID PLEXUS OF VEINS SITE: It surrounds & lies in substance of lateral pterygoid muscle • TRIBUTARIES: correspond to branches of maxillary artery • TERMINATION: It forms the maxillary vein that passes deep to neck of mandible & unite with superficial temporal vein to form retromandibular vein (inside parotid gland) • COMMUNICATIONS: 1. With cavernous sinus: by emissary veins through foramen ovale & lacerum 2. With facial vein: by deep facial vein 3. With inferior ophthalmic vein: by communicating veins through inferior orbital fissure
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