The pterygopalatine fossa is a small pyramidal space located between the posterior maxilla and pterygoid processes. It contains the maxillary nerve, pterygopalatine ganglion, vidian nerve and branches of the maxillary artery. The fossa has anterior, posterior, medial, lateral and superior walls. Imaging shows its low density due to contained fat. Conditions involving the fossa include referred otalgia, foramen ovale lesions, and hay fever. Nerve blocks of the maxillary, mandibular and inferior alveolar nerves provide anesthesia to the region. The transantral approach is commonly used to access the fossa during procedures like vidian neurectomy.
Spaces of middle ear and their surgical importanceDr Soumya Singh
one of the imp topics in ENT that should be understood very thoroughly if u want to pursue as an otologist.I tried to simplify the topic with simple diagrams and models for better understanding .
Spaces of middle ear and their surgical importanceDr Soumya Singh
one of the imp topics in ENT that should be understood very thoroughly if u want to pursue as an otologist.I tried to simplify the topic with simple diagrams and models for better understanding .
Lateral skull base anatomy and applied science by Dr, bomkar bamBomkar Bam
the lateral skull base is complex anatomy that is usually students finds difficult to understand. here concise literature is made to understand the skull base more easily.
Lateral skull base anatomy and applied science by Dr, bomkar bamBomkar Bam
the lateral skull base is complex anatomy that is usually students finds difficult to understand. here concise literature is made to understand the skull base more easily.
Pharynx is upper part of the aerodigestive tract. It has three parts nasopharynx, oropharynx and laryngopharynx. Pharynx plays an important part in respiration and swallowing. Swallowing is a very complex process. To swallow properly it is important to shut down the openings of nasopharynx, oral cavity and larynx and open the upper sphinctor of esophagus.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
2. PTERYGOPALATINE FOSSA
• A small space between the posterior surface of the
Maxilla and the Pterygoid process of the Sphenoid
bone.
3. BOUNDARIES
• It can be considered as a pyramidal space:
• ANTERIOR: posterior surface of maxilla below floor
of orbit
• POSTERIOR: lateral pterygoid plate and a part of
medial plate also
• MEDIAL: perpendicular plate of palate
• LATERAL: pterygomaxillary fissure
• SUPERIOR: under surface of greater wing of sphenoid
• INFERIOR: ABSENT (the post wall meets the ant wall and
between them is greater palatine canal)
4.
5.
6. ANTERIOR
WALL
POST WALL
OF MAXILLA
INFERIOR ORBITAL
FISSURE
ORBIT TRANSMITS INFRAORB
VESSELS,NERVES, ASC BR
OF PtP GANG
POSTERIOR
WALL
LATERAL AND
MEDIAL
PTERYGOID
PLATES
PTERYGOID CANAL MIDDLE
CRANIAL
FOSSA NEAR
F.LACERUM
TRANS VIDIAN NERVE
AND VESSELS
MEDIAL
WALL
PERP PLATE
OF PALATE
SPHENOPALATINE
FORAMEN
NASAL CAVITY SP ARTERY BR AND PtP
GANG BRANCHES TO NP
MUCOSA
LATERAL
WALL
GAP
BETWEEN THE
PTERYGOID
PLATES AND
MAXILLA
PTERYGOMAXILLA
RY FISSURE
INFRATEMPOR
AL FOSSA
TRANS MAX ARTERY
SUPERIOR
WALL
GREATER
WING OF
SPHENOID
F. ROTUNDUM MID CRANIAL
FOSSA
TRANSMITS MAXILLARY
NERVE
INFERIORLY ABSENT GREATER PALATINE
AND LESSER
PALATINE CANALS
ORAL CAVITY
ROOF
GREATER PALATINE AND
LESSER PALATINE NERVES
AND VESSELS
13. MAXILLARY NERVE
•ORIGIN- From a semilunar ganglion in Meckel’s cave
as 2nd part of trigeminal nerve.
•Sensory nerve.
14.
15. IN MID
CRANIAL
FOSSA
MENINGEAL BRANCH DURA
IN
PTERYGO
PALATIN
E FOSSA
ZYGOMATIC BRANCH ENTERS ORBIT THROUGH INFRA ORBITAL FISSURE,
THROUGH ZYGOMATICO ORBITAL FORAMEN AND
SUPPLIES LACRIMAL GLAND AND ZYG-FACIAL AND
ZYG-TEMP
GANGLIONIC BRANCH PTERYGOPALATINE NERVES TO GANGLION
POSTERIOR SUPERIOR
ALVEOLAR NERVE
ENERS POST SURFACE OF MAXILLA AND SUPPLY
MOLARS
IN ORBIT ANT SUP ALV NERVE
(FROM INFRAORBITAL NERVE-
A CONTINUATION OF
MAXILLARY)
MAIN TRUNK AFTER ENTERING ORBIT, GIVES THIS
BRANCH FOR PREMOLARS, CANINE AND INCISORS
MIDDLE SUPERIOR ALV NERVE SEEN AT TIMES
IN FACE TERMINAL BRANCHES PALPABRAL, NASAL, LABIAL, LOWER EYELID, ANT
NASAL APERTURE, ANT CHEEK
16.
17. PTERYGOPALATINE GANGLION
• The pterygopalatine ganglion (ganglion
pterygopalatinum, meckel's ganglion, nasal
ganglion, sphenopalatine ganglion) is a
parasympathetic ganglion found in the
pterygopalatine fossa.
• It is one of four parasympathetic ganglia of the
head and neck. (The others are submandibular
gang., otic gang., and ciliary gang.).
18.
19. PTERYGO PALATINE GANGLION
(HAY FEVER GANGLION)
PARASYMPATHETIC
(SECRETOMOTOR)
SUPERIOR SALIVATORY AND LACRIMAL NUCLEAS (PONS) – FACIAL
NERVE – IN MID EAR TRVELS THROUGH GREATER SUPERFICIAL
PETROSAL NERVE – THROUGH A HIATUS ENTERS MID CRANIAL FOSSA
– ENTERS F. LACERUM – JOINS WITH DEEP PETROSAL NERVE
(SYMPATHETIC) – VIDIAN NERVE – PTERYGOID CANAL –
PTERYGOPALATINE FOSSA, RELAYED BY PPt GANG – POST GANG
FIBRES SUPPLY LACRIMAL, NASAL, PALATINE GLANDS
SYMPATHETIC
(VASOCONSTRICTOr)
FROM T1 AND T2 SEGMENTS OF SPINAL CORD – SUPERIOR CERVICAL
SYMPATHETIC GANGLION – PLEXUS AROUND INTERNAL CAROTID –DEEP
PETROSAL NERVE AT THE LEVEL OF F.LACERUM – PASSES THROUGH THE
GANG WITHOUT RELAYING – SUPPLIES THE SAME GLANDS
SENSORY FROM GANGLIONIC BRANCHES OF MAXILLARY NERVE
20.
21. BRANCHES
ASCENDING DESCENDING POSTERIOR MEDIAL
ORBITAL BRANCHES
(secreato motor to
lacrimal and
ethmoidal air cells)
GREATER PALATINE
NERVE (supplies
hard palate and
gives off Postero
inferior lateral nasal
branches)
PHARYNGEAL
BRANCH (supplies
pharyngeal mucosa
around the eust.
tube orifice)
POSTERIO-
SUPERIOR MEDIAL
NASAL (antero-inf
septum and floor of
nose)
LESSER PALATINE
NERVE (supply soft
palate and tonsils)
NASOPALATINE
NERVES (roof of the
mouth)
POSTERO-SUPERIOR
LATERAL NASAL
(upper lateral
quadrant of nasal
septum)
22. NERVE OF PTERYGOID CANAL
(VIDIAN NERVE)
• The nerve of the pterygoid canal (Vidian nerve) is
formed by the junction of the great petrosal nerve and
the deep petrosal nerve within the pterygoid canal
containing the cartilaginous substance which fills the
foramen lacerum.
• It passes forward through the pterygoid canal with its
corresponding artery (artery of the pterygoid canal)
and is joined by a small ascending sphenoidal branch
from the otic ganglion. It then enters the
pterygopalatine fossa and joins the posterior angle of
the pterygopalatine ganglion.
23.
24. • Parasympathetic preganglionic fibers from the facial
nerve (contained within the greater petrosal nerve)
which synapse in pterygopalatine ganglion.
• Sympathetic postganglionic fibers from the deep
petrosal nerve which do not synapse in
pterygopalatine ganglion.
• The postganglionic parasympathetic fibers of the
deep petrosal nerve, upon synapsing in the
pterygopalatine ganglion, will distribute to the nose,
palate, and lacrimal gland through various nerves
leaving the pterygopalatine fossa.
25. VIDIAN CANAL
• It is through this canal the vidian nerve passes. This is a
short bony tunnel seen close to the floor of sphenoid
sinus. This canal transmits the vidian nerve and vidian
vessels from the foramen lacerum to the pterygopalatine
fossa.
• According to CT scan findings the vidian canal is
classified into:
Type I: The vidian canal lies completely within the floor
of sphenoid sinus
Type II: In this type the vidian canal partially protrudes
into the floor of sphenoid sinus
Type III: Here the vidian canal is competely embedded in
the body of sphenoid bone
26.
27. ARTERY OF THE PTERYGOID CANAL
• The artery of the pterygoid canal (Vidian artery) is an
artery that can arise from the internal carotid (ICA) or
external carotid (ECA), or serve as an anastomosis
between these arteries.
• It more commonly arises from the ECA.
• The artery passes backward along the pterygoid canal
with the corresponding nerve. It is distributed to the upper
part of the pharynx and to the auditory tube, sending into
the tympanic cavity a small branch which anastomoses
with the other tympanic arteries.
28.
29. MAXILLARY ARTERY
• The main arterial supply to the infratemporal fossa
• Largest terminal branch of the external carotid artery
• The maxillary artery arises just posterior to the neck of
the mandible in the substance of the parotid gland and
courses somewhat obliquely through the fossa to end in
the pterygomaxillary fissure.
• Through its course It usually lies lateral (superficially
to the lateral pterygoid muscle, but it can sometimes lie
on the deep side of the muscle.
30. • Divided into three parts by lateral pterygoid muscle
• BRANCHES:-
1ST PART 2ND PART 3RD PART
IN FRONT OF STYLOMAND
LIGAMENT ALONG THE
LOWER BORDER OF LAT
PTERYGOID
DEEP TO LATERAL PTERY
MUSCLE UPTO
PTERYGOMAXILLARY
FISSURE
ENTERS
PTERYGOMAXILLAY
FISSURE INTO
PTERYGOPALATINE FOSSA
1ST PART 2ND PART 3RD PART
Deep auricular
Anterior tympanic
Middle meningeal
Accessory meningeal
Inferior alveolar
Deep temporal
Masseteric
Pterygoid
Buccal
Post . Superior
alveolar
Infra orbital
Greater palatine
Sphenopalatine
Pharyngeal
Art.of pterygoid
canal
31.
32.
33. THIRD PART OF MAXILLARY ARTERY
• Enters pterygopalatine fossa through
Pterygomaxillary fissure.
GREATER PALATINE AND LESSER
PALATINE ARTERIES
THROUGH THE GP AND LP CANALS AND SUPPLIES HARD
AND SOFT PALATE
POSTERIOR SUPERIOR
ALVEOLAR ARTERY
MOLARS, PREMOLARS AND MAXILLARY SINUS
SPHENOPALATINE ARTERY ENTERS NOSE THROUGH POSTERIOR PART OF SUPERIOR
MEATUS, THROUGH SPHENOPALATINE FORAMEN
DIVIDES INTO: POST LATERAL NASAL AND POST SEPTAL
ARTERY OF PTERYGOID CANAL SUPPLIES THE ROOF OF THE PHARYNX
PHARYNGEAL ARTERY SUPPLIES ROOF OF NASOPHARYNX
INFRA ORBITAL ARTERY CONTINUATION OF THE MAX ARTERY, ENTERS ORBIT
AND APPEARS IN FACE THROUGH INFRA ORBITAL
FORAMEN
ANTERIOR SUPERIOR
ALVEOLAR (INFRA-ORBITAL BR)
BEFORE EXITING THROUGH THE INFRA-ORBITAL
FORAMEN
37. Contrast-enhanced axial CT scan shows pterygopalatine
fossa (arrows) between posterior wall of maxillary sinus and
anterior surface of pterygoid process of sphenoid bone.
Fossa is seen as low density because of contained fat.
38. CLINICAL SIGNIFICANCE
• REFERRED OTALGIA:
Mandibular nerve also innervates a portion of ear (by
Auriculo-Temporal branch) and hence pain in
infected lower tooth (by Inferior alveolar branch)
may be referred to ear
• FORAMEN OVALE LESION:
Paraesthesia of mandible, teeth and side of the face
and paralysis of Masticatory muscles, hearing
abberations and jaw jerk loss
39. • HAY FEVER GANGLION:
In allergic states, congestion of the nasal
glands, lacrimal glands and palatine glands
result in running nose and lacrimation due to
stimulation of Pterygopalatine ganglion. Hence
it is called “Hay fever ganglion”
41. INFERIOR ALVEOLAR NERVE BLOCK
• By inserting the needle, lateral to pterygomandibular
raphae, about 6-10mm above the occlusal table of
mandibular teeth, then sliding posteriorly along the
medial aspect of the ramus.
• Approach area of injection from contralateral premolar
region ,with other hand thumb retracting the buccal
mucosa pressing on the coronoid process.
• Vicinity of mandibular foramen can be reached.
• Tongue and skin of chin are also anaesthetised due to
Lingual and mental nerve blockade.
42.
43.
44. MAXILLARY NERVE BLOCK
• By inserting the needle, through the mandibular notch
(gingivo buccal sulcus opp to 2nd molar) and guiding
it 45degrees superiorly and medially, along the
pterygoid plate, until the pterygopalatine fossa is
reached at a depth of 6-7 cm .
• This can be confirmed by absence of bony resistence
and adjusting the angle accordingly.
• Foramen rotundum can be reached.
• Useful in trigeminal neuralgia involving maxillary
division.
45.
46. MANDIBULAR NERVE BLOCK
• By inserting the needle – 4cm deep through
Mandibular notch and sliding the needle posteriorly
along the lateral surface of the pterygoid plates.
• Foramen ovale can be reached.
• Useful in trigeminal neuralgia involving Mandibular
division.
47.
48.
49. JUVENILE NASOPHARYNGEAL
ANGIOFIBROMA
• Spread of a tumor along the axis of Pterygomaxillary
fissure with the expansion of the walls.
• Tumor in the sphenopalatine foramen can spread to
pterygopalatine fossa and through the PtM fissure into
the infratemporal fossa.
• Most important sign in the imaging is the ‘bowing’ of
posterior wall of Antrum.
• They quickly spread to parapharyngeal and carotid
space.
53. VIDIAN NEURECTOMY
Indications:-
• Severe intractable vasomotor rhinitis
• Crocodile tears
• Senile nasal drip
• Severe recurrent nasal polyposis
General anaesthesia-hypotensive-60 mm/Hg
Antrum opened (wider) as for Caldwell Luc
procedure- preserve infra orbital nerve
54.
55. • Elliptical
Posterior antral
window is made
with chisel cuts
after removing
mucosa
• A Zeiss
microscope with
300 mm lens used
to remove only
bone
62. • Shenopalatine
ganglion is found
8mm medial and
inferior to foramen
rotundum.
• A hook is slipped
over divergence of
Shenopalatine bundle
and sickle knife
passed beneath it to
cut VIDIAN NERVE
emerging from
pterygoid canal.
65. • Surgery is completed with haemostasis
Post op complications
1. Absence of lacrimation
2. Facial analgesia
3. Ophthalmoplegia
4. Infection of antrum
69. TRANS NASAL APPROACH
• Endoscopic
• Minnis and Morrison -1971(Trans septal)
• Patel and Gaikward -1975 (Direct)
70. Endoscopic Transsphenoidal Approach
• After general anesthesia is administered,
the patient is placed in the semi-Fowler
position.
• Cottonoids soaked with diluted
epinephrine (1:100 000) and cocaine, 10%
benzoylmethylecgonine),are positioned
between the middle turbinate and the nasal
septum to enlarge the space between them
and to obtain decongestion of the nasal
mucosa.
71. • The head of the middle turbinate is delicately
dislocated laterally to further widen the virtual
space between the middle turbinate and the nasal
septum.
• After creation of adequate space between the
middle turbinate and the nasal septum, the
endoscope is angled upward along the roof of the
choana until it reaches the sphenoid ostium,
usually located approximately 1.5 cm above the
roof of the choana.
72. • Once the sphenoid cavity is reached,
coagulation of the area around the sphenoid
ostium is performed. This serves to avoid
arterial bleeding originating from septal
branches of the sphenopalatine artery.
• Ostium enlargement proceeds
circumferentially by use of bone punches; care
must be taken in the inferolateral direction,
where the sphenopalatine artery or its major
branches lie.
73. • Once the anterior sphenoidotomy is
completed, A 70° endoscope is used to identify
the vidian canal, usually at the sphenoid sinus
floor, lateral to the natural ostium. Transection
of the nerve is performed using an angle probe
under direct vision.
74. Intraoperative endoscopic views of
the transsphenoidal approach.
The vidian canal can be visualized
at the floor of the sphenoid sinus.
A probe is used to transect the
vidian canal.
Successful transection of the vidian
nerve is performed by direct vision.
75. • The fragment of the nerve is removed
whenever possible and is sent for
pathologic examination. At the end of the
procedure, hemostasis is obtained, and the
middle turbinate is gently restored in a
medial direction.
• Packing of the nasal cavity- bleeding
from the nasal mucosa- usually removed
on the second day. Most patients are
discharged 2 days after surgery.
76. TRANSNASALAPPROACH
• The patient is prepared, and the sphenoid
ostium is identified as in the
transsphenoidal approach. Sphenoidotomy
is performed near the level of the sphenoid
sinus floor.
• Just enough space is offered for the
entrance of a 4-mm endoscope. The
mucoperiosteum is elevated off the anterior
and inferior surfaces of the sphenoid
77. • The vidian canal can usually be identified
between its exit from the sphenoid bone
and its entrance into the
pterygopalatinefossa, usually medial to the
root of the middle turbinate.
• The nerve is subsequently transected by a
sickle knife or by an angle probe. The
remainder of the procedure is performed as
described for the transsphenoidal approach.
78.
79. TRANS PALATALAPPROACH
• Done under GA
• Boyle – Davis mouth gag
• Curving incision 1 cm anterior to the
posterior margin of hard palate
• 5mm bone removed
• 300mm Zeiss microscope –visualise ET
orifice
• Incision over mucosa to expose medial
pterygoid plate, -which is removed with burr
• Pterygoid canal is 2-3 mm deep- cauterised
80. Maxillary nerve block
• Maxillary nerve may be blocked in PPF by
anaesthetic infiltration to greater palatine
canal
• Also a method of anaesthesia to posterior
superior alveolar nerve
• Indications:
1. Dento facial deformities
2. Maxillary sinus surgeries
3. Diagnostic or therapeutic in trigeminal
neuralgia cases
81. • Two intra oral approaches
i. High tuberosity approach and
ii. Greater palatine canal approach
High tuberosity approach- direct needle posteriorly
superior and medially along zygomatic and
infraorbital surfaces of maxilla to enter the PPF
• Depth of insertion is measuring distance from
gingival crest of premolar to infra orbital rim on face
Greater palatine canal approach-7mm anterior to jn.
Of hard and soft palate- a 25 g needle bent at 45
degree parallel to mid sagittal plane-in postero
superior direction-gently rotate the needle as it falls
into the canal