Anatomy of pterygopalatine fossa, infra temporal space
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1) The infratemporal fossa and pterygopalatine fossa are two important anatomical spaces located in the skull. 2) The infratemporal fossa contains muscles like the temporalis and pterygoid muscles, nerves like the mandibular and maxillary nerves, and vessels like the maxillary artery. 3) The pterygopalatine fossa is a small triangular space that connects to other areas through openings and contains the maxillary nerve, pterygopalatine ganglion, and branches of the maxillary artery.
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Anatomy of pterygopalatine fossa, infra temporal space
- 1. ANATOMY OF PTERYGOPALATINE FOSSA AND INFRATEMPORAL SPACE PRESENTER : DR SHWETA SHARMA MODERATOR : DR A. K. SHARMA DR. ANIRUDDHA SARKAR
- 2. • Review of osteology • Infratemporal space • Pterygopalatine fossa • Radiology
- 7. Infratemporal space – Boundaries – Contents
- 9. boundaries Superiorly: the inferior (infratemporal) surface of the greater wing of the sphenoid Inferiorly: where the medial pterygoid muscle attaches to the mandible near its angle Laterally: ramus of the mandible Medially: lateral pterygoid plate Anteriorly: posterior aspect of the maxilla Posteriorly: tympanic plate ,mastoid and styloid processes of the temporal bone, anterior aspect of parotid gland
- 12. Contents
- 13. 1. Inferior part of the temporalis muscle 2. Lateral and medial pterygoid muscles 3. Maxillary artery 4. Pterygoid venous plexus 5. Mandibular, inferior alveolar, lingual, buccal, chorda tympani nerves 6. Otic ganglion
- 14. muscles
- 15. MAXILLARY ARTERY
- 18. Pterygoid venous plexus Lies around and within the lateral pterygoid muscles. •Tributaries: Correspond to the branches of the maxillary artery •Communications
- 19. Mandibular nerve Arises from the trigeminal ganglion in the middle cranial fossa. Immediately receives the motor root of the trigeminal nerve Leaves the cranium through the foramen ovale into the infratemporal fossa.
- 20. Mandibular nerve
- 21. Branches within the infratemporal fossa is divided into three groups: 1) Branches arising from the trunk Spinous nerve Medial pterygoid nerve 2) Anterior branches Buccal nerve Masseteric nerve Deep temporal nerves Lateral pterygoid nerve 3) Posterior branches Auriculotemporal nerve Lingual nerve Inferior alveolar nerve
- 23. The spinous nerve passes through the spinous foramen and enters the cranium. It is a sensory nerve innervating the dura mater. The medial pterygoid nerve innervates the medial pterygoid muscle, tensor veli palatini muscle and the tensor tympani muscle. Buccal nerve, masseteric nerve, deep temporal nerves, lateral pterygoid nerve innervate the muscles with the same name except the buccal nerve. Buccal nerve is sensory and innervates the inner surface of the cheek.
- 24. Auriculotemporal nerve Supplies sensory fibers to the auricle and temporal region. Also sends articular (sensory) fibers to the TMJ. Conveys postsynaptic parasympathetic secretomotor fibers from the otic ganglion to the parotid gland.
- 25. The inferior alveolar nerve enters the mandibular foramen and passes through the mandibular canal, forming the inferior dental plexus, which sends branches to all mandibular teeth on its side. The terminal branch of the inferior alveolar nerve is the mental nerve which passes through the mental foramen.
- 26. Chorda tympani nerve A branch of CN VII carrying taste fibers from the anterior two thirds of the tongue. Joins the lingual nerve in the infratemporal fossa. Also carries secretomotor fibers for the submandibular & sublingual salivary glands.
- 28. Lingual nerve sensory to the anterior two thirds of the tongue, the floor of the mouth, and the lingual gingivae.
- 29. Otic ganglion (parasympathetic) Located in the infratemporal fossa, just inferior to the foramen ovale. Presynaptic parasympathetic fibers, derived mainly from the glossopharyngeal nerve (via the lesser petrosal nerve), synapse in the otic ganglion. Postsynaptic parasympathetic fibers, secretory to the parotid gland, pass from the otic ganglion to this gland through the auriculotemporal nerve. Sympatheic root is derived frm the plexus on middle mennigeal artery ( it contains post ganglioninc fibres arising in the superior cervical ganglion; without relaying in otic reach parotid via auriculotemporal nerve)
- 31. glossopharyngeal nerve (via the lesser petrosal nerve)
- 36. Pterygopalatine fossa – Boundaries – Contents
- 37. Pterygopalatine Fossa A small space behind and below the orbital cavity. An inverted 'tear-drop' shaped space between bones on the lateral side of the skull immediately posterior to the maxilla. Pterygomaxillary fissure Infra orbital fissure Posterior surface of maxilla
- 38. Behind : root of pterygoid process & adjoining anterior surface of greater wing of speno Medially : palatine bone’s prependicular plate with its orbital & sphenoidal process Anteriorly : suoero medial part of maxilla’s posterior surface Laterally : connects with infratemporal fossa via pterygomaxillary fissure
- 40. The part of the sphenoid bone that contributes to the formation of the pterygopalatine fossa is the anterosuperior surface of the pterygoid process. Opening onto this surface are two large foramina: • maxillary nerve [V2] through foramen rotundum middle cranial fossa • greater petrosal nerve from the facial nerve [VII] + sympathetic fibers internal carotid plexus join to form the nerve of the pterygoid canal that passes into the pterygopalatine fossa through the anterior opening of the pterygoid canal.
- 41. The pterygoid canal is a bony canal opening onto the posterior surface of the pterygoid process. The pterygoid canal opens into the middle cranial fossa just anteroinferior to the internal carotid artery as the vessel enters the cranial cavity through the carotid canal.
- 42. Although small in size, the pterygopalatine fossa communicates via fissures and foramina in its walls with: 1) the middle cranial fossa 2) infratemporal fossa 3) floor of the orbit 4) lateral wall of the nasal cavity 5) oropharynx 6) roof of the oral cavity
- 43. Gateways 7 foramina and fissures provide apertures through which structures enter and leave the pterygopalatine fossa: foramen rotundum & pterygoid canal middle cranial fossa palatovaginal canal nasopharynx palatine canal leads oral cavity (hard palate) sphenopalatine foramen nasal cavity pterygomaxillary fissure infratemporal fossa inferior orbital fissure orbit
- 45. The contents of the pterygopalatine fossa 1) Third part (pterygopalatine part) of the maxillary artery 2) Maxillary nerve 3) Nerve of the pterygoid canal (Vidian’s nerve) 4) Pterygopalatine ganglion All the upper teeth receive their innervation and blood supply from the maxillary nerve [V2] and the terminal part of the maxillary artery, respectively, that pass through the pterygopalatine fossa.
- 46. Maxillary Nerve (V2) Purely sensory Originates from the trigeminal ganglion in the cranial cavity Exits the middle cranial fossa Enters the pterygopalatine fossa (foramen rotundum) Exits as the infra-orbital nerve (inferior orbital fissure) Gives sensory fibers to the skin of the face and the side of the nose.
- 48. Within the fossa, the maxillary nerve is attached to the pterygopalatine ganglion by two ganglionic branches. Sensory fibers from the nose, the palate, and the pharynx. Postganglionic parasympathetic fibers to the lacrimal gland. Branches
- 49. More anteriorly posterior superior alveolar nerves are given off. Pass through the pterygopalatine maxillary fissure into the infratemporal fossa.
- 50. Here they divide into numerous small branches •Enter the maxilla through the posterior alveolar foramina Supply the upper molar teeth, the mucous membrane on the buccal surface of the associated alveolar process and the lining of the maxillary sinus. Anesthesia of the upper molar teeth and associated buccal mucosa can be achieved by a posterior superior alveolar block.
- 51. As the maxillary nerve is about to enter the inferior orbital fissure it gives rise to the zygomatic nerve. divides into: Zygomaticotemporal branch passing into temporal fossa to supply skin of the temple Zygomaticofacial nerve supplies skin over the prominence of cheek.
- 53. Pterygopalatine Ganglion (Ganglion pterygopalatinum, Meckel's ganglion, Nasal ganglion, Sphenopalatine ganglion) Largest of the 4 parasympathetic ganglia in the head Formed by the cell bodies of the postganglionic neurons associated with preganglionic parasympathetic fibers of the facial nerve [VII] carried by the greater petrosal nerve and the nerve of the pterygoid canal.
- 56. Branches • Orbital branches, enter the orbit (inferior orbital fissure) Supply of the orbital wall and of the sphenoidal and ethmoidal sinuses. • Greater and lesser palatine nerves, supply the palate, the tonsil, and the nasal cavity. • The greater palatine nerve originates from the geniculate ganglion of the facial nerve [VII] in the temporal bone. • In the palatine canal, gives origin to posterior inferior nasal nerves, which contribute to the innervation of the lateral nasal wall. •Greater petrosal nerve enters the pterygoid canal and becomes the nerve of the pterygoid canal • Pharyngeal branch, which supplies the roof of the nasopharynx
- 57. 1. infraorbital nerve 2. posterior superior alveolar nerve 3. pterygopalatine ganglion (parasympathetic) 4. greater palatine nerve 5. lesser palatine nerve cut 6. nasopalatine nerve 7. nerve of the pharyngeal canal
- 58. CONCLUSSION
- 59. Maxillary Artery A major branch of the external carotid artery in the neck. Passes through the infratemporal fossa Enters the pterygopalatine fossa through the pterygomaxillary fissure.
- 60. Branches of the third part of the maxillary artery 1)Posterior superior alveolar artery 2)Infra-orbital artery 3)Greater palatine artery 4)Pharyngeal artery 5)Sphenopalatine arteries 6)Artery of the pterygoid canal Collectively, these branches supply much of the nasal cavity, the roof of the oral cavity, and all upper teeth. In addition, they contribute to the blood supply of the sinuses, oropharynx, and floor of the orbit.
- 61. The maxillary artery gives off the posterior superior alveolar branch as it enters the pterygopalatine fossa. Runs with the corresponding branches of the maxillary nerve to suppy the upper posterior teeth and adjacent structures.
- 62. Veins The veins pass through the pterygomaxillary fissure to join the pterygoid plexus of veins in the infratemporal fossa.
- 63. Innervation of the lacrimal gland The parasympathetic secretomotor nerve supply is derived from the lacrimal nucleus of the facial nerve. The preganglionic fibers reach the pterygopalatine ganglion via the nervus intermedius and its great petrosal branch.
- 65. Radiology Axial CT bone window of skull base from inferior to superior aspect showing major apertures of skull base
- 66. Axial CT bone window of skull base from inferior to superior aspect showing major apertures of skull base
- 67. Axial CT bone window of skull base from inferior to superior aspect showing major apertures of skull base
- 68. Coronal CT bone window of central skull base
- 69. THANK YOU
Editor's Notes
- deep and inferior to the zygomatic arch, deep to the ramus of the mandible and posterior to the maxilla. Communicates with the temporal fossa through the interval between (deep to) the zygomatic arch and (superficial to) the cranial bones. Temporal fossa is superior to the zygomatic arch, The infratemporal fossa is inferior to the zygomatic arch. Deep tp pterion lies middle mennigeal artey and deeeeper still lateral sulcus
- The four compartents of the right masticator space. A Temporalis muscle, B Masseter muscle, C Lateral pterygoid muscle, D Medial ptaerygoid muscle, E Superficial temporal space, FDeep temporal space, GSubmasseteric space, HPterygomandibular space, IApproximate location of infratemporal space.
- Temporalis muscle fibres before attaching to coronoid process Some Anatomists Like Freaking Out Poor Medical Students S - superior thyroid artery A - ascending pharyngeal artery L - lingual artery F - facial artery O - occipital artery P - posterior auricular artery M - maxillary artery S - superficial temporal artery Superior constrictor Origin and insertion[edit] The four parts of this muscle arise from: - the lower third of the posterior margin of the medial pterygoid plate and its hamulus(Pterygopharyngeal part) - from the pterygomandibular raphe (Buccopharyngeal part) - from the alveolar process of the mandible above the posterior end of the mylohyoid line(Myolopharyngeal part) - and by a few fibers from the side of the tongue (Glossopharyngeal part) The fibers curve backward to be inserted into the median raphe, being also prolonged by means of an aponeurosis to the pharyngeal spine on the basilar part of the occipital bone. The superior fibers arch beneath the levator veli palatini muscle and the Eustachian tube.
- it arises from the temporal fossa and the deep part of temporal fascia. It passes medial to the zygomatic arch and inserts onto the coronoid process of themandible, with its insertion extending into the retromolar fossa posterior to the most distal mandibular molar Lateral p The upper/superior head originates on the infratemporal surface and infratemporal crest of the greater wing of the sphenoid bone, and the lower/inferior head on the lateral surface of the lateral pterygoid plate. Inferior head inserts onto the neck of condyloid process of the mandible; upper/superior head inserts onto the articular disc and fibrous capsule of the temporomandibular joint. Medial p It consists of two heads. The bulk of the muscle arises as a deep head from just above the medial surface of the lateral pterygoid plate. The smaller, superficial head originates from the maxillary tuberosity and the pyramidal process of the palatine bone. Its fibers pass downward, lateral, and posterior, and are inserted, by a strong tendinous lamina, into the lower and back part of the medial surface of the ramus and angle of themandible, as high as the mandibular foramen. The insertion joins the masseter muscle to form a common tendinous sling which allows the medial pterygoid and masseter to be powerful elevators of the jaw.
- The maxillary artery is the larger of the two terminal branches of the external carotid artery. It arises posterior to the neck of the mandible and is divided into three parts based on its relation to the lateral pterygoid muscle. 1st (mandibular) part: Deep to the condyle of mandible 2nd (pterygoid) part: Neighbourhood of lateral pterygoid muscle 3rd (pterygopalatine) part: Inside the infratemporal fossa (extends into the pterygopalatine fossa) Branches of the 1st part: Deep auricular (to external acoustic meatus) Anterior tympanic artery (to the tympanic membrane) Middle meningeal (to dura mater and calvaria) Accessory meningeal aa. (to the cranial cavity) Inferior alveolar artery (to the mandibular gingiva and teeth) Branches of the 2nd part: Deep temporal aa. (to the temporal muscle) Pterygoid aa. (to the pterygoid muscles) Masseteric artery (to the masseter muscle) Buccal artery (to the buccinator muscle) Branches of the 3rd part: Posterior superior alveolar Infraorbital Greater palatine Pharyngeal Artey of pterygoid canal Sphenopalatine (terminal part)
- Lies around and within the lateral pterygoid muscle. The tributaries of the plexus correspond to the branches of maxillary artery. The plexus is drained by the maxillary vein which begins at the posterior end of the plexus and unites with the superficial temporal vein to form the retromandibular vein. Thus maxillary vein accompanies only the first part of the maxillary artery. The plexus communicates a) with the inferior ophthalmic vein through the inferior orbital fissure: b) with the cavernous sinus through the emissary veins and c) with the facial vein through the deep facial vein.
- Frey syndrome is a constellation of symptoms including unilateral hyperhidrosis and flushing of the malar region and pinna of the ear that occurs when eating or drinking anything that stimulates the parotid gland to produce saliva (Figure 13-1). Also known as auriculotemporal syndrome, Baillarger syndrome, Dupuy syndrome, salivosudoriparous syndrome, and gustatory sweating syndrome,this disorder usually occurs 2 to 13 months after surgery, open trauma, or infection of the parotid gland. It is thought to be caused by improper regeneration of the sympathetic and parasympathetic nerves subserving the parotid gland and affected anatomic areas. The severity of symptoms associated with Frey syndrome can range from mild to debilitating. Although the incidence of Frey syndrome after parotid surgery can be decreased by careful attention to surgical technique, including careful identification and preservation of The auriculotemporal nerve arises from fibers of the mandibular nerve. The auriculotemporal nerve courses upward through the parotid gland, passing between the temporomandibular joint and the external auditory meatus, where it gives off branches that provide sensory innervation to the temporomandibular joint and portions of the pinna of the ear and the external auditory meatus. Ascending over the origin of the zygomatic arch, the auriculotemporal nerve continues upward along with the temporal artery, providing sensory innervation to the temporal region and lateral scalp.
- Inferior alveolar block
- The chorda tympani exits the skull through the internal acoustic meatus as part of the facial nerve, then it travels through the middle ear, where it runs from posterior to anterior across the tympanic membrane. It passes between the malleus and the incus, on the medial surface of the neck of the malleus. The nerve continues through the petrotympanic fissure, after which it emerges from the skull into the infratemporal fossa. It soon combines with the larger lingual nerve, a branch of the mandibular nerve. The fibers of the chorda tympani travel with the lingual nerve to the submandibular ganglion. Here, the preganglionic fibers of the chorda tympani synapse with postganglionic fibers which go on to innervate the submandibularand sublingual salivary glands.
- Salivary glands supply
- Greater petrosal nerve arises from the geniculate ganglion of the facial nerve; carries both gustatory and parasympathetic fibres. And enters the middle cranial fossa through the hiatus for the greater petrosal nerve on the anterior surface of pertrous part of temporal bone. It proceeds towards foramen lacerum; where it joins the deep pertrosal nerve which carries sympathetic fibres to form the nerve to pterygoid canal N of pterygoid canal passes through the pterygoid canal to reach the pterygopalatine ganglion. Parasympathetic fibres relay in this ganglion. Postganglionic parasympathetic fibres arising in the ganglion ultimately supply the lacrimal gland and mucosal glands of the nose, palate and pharynx. Gustatory or taste fibres do not relay in the ganglion and are distributed to the palate Deep petrosal nerve, sympatheic in nature is a branch of the sympathetic plexus around the internal carotid artery. It contains postganglionic fibres from the superior cervical sympathetic ganglion. The nerve joins the greater petrosal nerve to form the nerve of the pterygoid canal. The sympathetic fibres in it are distributed through the branches of the pterygopalatine ganglion Lesser petrosal parasympathetic in nature is a branch of the tympanic plexus, deriving its preganglionic parasympathetic fibres from the branch of the glossopharyngeal nerve. It emerges through the hiatus for the lesser petrosal nerve, situated just lateral to the hiatus for the greater petrosal nerve, passes out of the skull through the foramen ovale and ends in the otic ganglion supply the parotid gland through the auriculotemporal nerve
- The pterygopalatine fossa (PPF) is an important anatomic location of the deep portion of the face. It is essential to review this area on both pre- and post treatment studies of head and neck malignancies to assess local extent of disease or recurrence and perineural tumor spread. Identification of disease in the PPF has serious treatment and prognostic implications (1, 2, 4). Often, it signifies the presence of perineural spread in the absence of a gross, local, destructive neoplasm. As in a head and neck malignancy at first presentation, the treatment approach to recurrent tumor involving the PPF may be altered to include a wider resection or nonresectability and expansion of the radiation portal. The 5-year survival rate of patients with sinonasal malignancies and invasion of the PPF is dismal (4, 5). Not infrequently, perineural spread in the PPF also portends tumor recurrence and reduced survival (1). In older texts, the pterygomaxillary fissure is sometimes called the pterygopalatine fissure.
- Because of its strategic location, the pterygopalatine fossa is a major site of distribution for the maxillary nerve [V2] and for the terminal part of the maxillary artery. ALSO parasympathetic fibers from the facial nerve [VII] Sympathetic fibers from the T1 spinal cord level joinining the branches of the maxillary nerve [V2] in the pterygopalatine fossa.
- Otic, sphenopalatine, submandibular, geniculate