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B3-GA (pkt 9): Pterygopalatine Fossa

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boundaries of Pterygopalatine fossa
anterior: infratemporal (post) surface of body of maxilla
posterior: pterygoid process
superior: greater wing of sphenoid
media: perpendicular plate of palatine
communications of PTP fossa:
-w/ infratemporal fossa via pterygomaxillary fissure
-w/ orbit via inferior orbital fissure
-w/ middle cranial fossa via foramen rotundum
-w/ nasal cavity via spenopalatine foramen
-w/ nasopharynx via palatovaginal canal
-greater and lesser canals
-pterygoid canal
pterygoid canal
runs in SAGGITAL (A/P) direction through BASE OF MEDIAL PTERYGOID PLATE-->
posterior opening is located in ANTERIOR border of FORAMEN LACERUM
anterior opening is located in POSTERIOR WALL OF PTERYGOPALATINE FOSSA, medial & inferior to FORAMEN ROTUNDUM
Greater & Lesser Palatine Canals
begin @ inferior end of pterygopalatine fossa
terminate on inferior aspect of hard palate
contents of Pterygopalatine Fossa
maxillary n.
pterygopalatine (3rd) pt of maxillary a
pterygopalatine ganglion
Maxillary n. contains what type of fibers?
ONLY GENERAL SENSORY FIBERS
route of Maxillary n. (V2)
leaves middle cranial fossa-->goes through FORAMEN ROTUNDUM to enter pterygopalatine fossa-->passes anteriorly through upper part of PtP fOSSA--> goes through INFERIOR ORBITAL FISSURE to enter orbit

**from this point on, Maxillary n. is known as INFRAORBITAL N.

Infraorbital n. lies first in INFRAORBITAL GROOVE and then in INFRAORBITAL CANAL-->enters face through INFRAORBITAL FORAMEN
Intracranial br. of Maxillary n.
Meningeal br.
-supplies dura mater of middle cranial fossa
3 brs. of Maxillary n. in Pterygopalatine Fossa
Ganglionic brs.
Zygomatic n.
Posterior Superior Alveolar n.
Ganglionic brs. of maxillary n.
connect Maxillary n. w/ Pterygopalatine gangion (which is a PARASYMP. ganglion in the Pterygopalatine Fossa, inferior to Maxillary n.)
-->
ganglionic brs. contain MOSTLY SENSORY FIBERS (and also a FEW post-ganglionic parasym. fibers for Lacrimal Gland)
Zygomatic n. (a br. of Maxillary n. in the PtP Fossa)
goes through inferior orbital fissure to enter orbit-->runs anteriorly along lateral wall of orbit-->divides into:
ZYGOMATICOFACIAL N. & ZYGOMATICOTEMPORAL N.
Zygomaticofacial n. supplies what?
skin over prominence of cheek
Zygomaticotemporal n. supplies what? It is connected to what n.?
supplies skin over anterior temporal region

Zygomaticotemporal n. is connected to Lacrimal n. by a COMMUNICATING BR. (contains POST-GANG. PARASYM. FIBERS FOR LACRIMAL GLAND
Posterior Superior Alveolar n. path & what it supplies
descends on Infratemporal surface of Maxilla
divides into brs. that pass through ALVEOLAR FORAMINA OF MAXILLA TO ENTER MAXILLA

supplies SENSORY innerv. to MAXILLARY MOLAR TEETH & MUCOSA OF MAX. SINUS
2 brs. of Maxillary n. from Infraorbital part
Middle Superior Alveolar n. (supplies max. pre-molar teeth and mucosa of max. sinus)

Anterior Superior Alveolar n. (supplies max. incisors and canine and mucosa of max. sinus
In upper jaw, 3 superior alveolar nn. supply the upper teeth. Name them.
posterior superior alv. n.
middle sup. alv. n
anterior sup. alv. n

ALL 3 GIVE SENSORY INNERV 2 MAX SINUS AS WELL!
Brs. of Max. n in face
infraorbital n. goes through INFRAORBITAL FORAMEN to enter FACE -->
divides into brs. that supply:
skin & conjunctiva of lower eyelid
skin on side of nose
skin and mucosa of upper lip
Pterygopalatine Ganglion is functionally related to what n.?
Facial n.
Pterygopalatine ganglion-type and location
located in Pterygopalatine Fossa, inferior to Max. n.
PARASYMP. GANGLION

receives 3 types of fibers (sensory, pre-ganglionic parasymp, and post-ganglionic sympathetic), but ONLY PRE-GANG. PARASYMP. FIBERS SYNAPSE IN GANGLION
What is the only type of fibers that synapse in the pterygopalatine ganglion?
preganglionic parasympathetic fibers
source of general sensory fibers of pterygopalatine ganglion?
maxillary n.
source of pre-ganglionic parasympathetic fibers of pterygopalatine ganglion?
GREATER PETROSAL N. (br. of Facial n.)
Source of Post-ganglionic SYMPATHETIC fibers of pterygopalatine ganglion?
DEEP PETROSAL N. (from sympathetic plexus that surrounds ICA)
brs. that originate from pterygopalatine ganglion contain what kinds of fibers?
sensory
post-ganglionic parasympathetic
post-ganglionic sympathetic
Greater Petrosal n.
br. of facial n
contains pre-ganglionic parasymp. fibers for lacrimal gland and glands of nasal cavity, palate, and nasopharynx, ans some special sensory/taste fibers for palate

exits petrous pt of temporal bone to enter middle cranial fossa-->runs anteriorly and medially, deep to trigeminal ganglion toward FORAMEN LACERUM-->
JOINS DEEP PETROSAL N. (br. of Internal Carotid Plexus) -->
to FORM NERVE OF PTERYGOID CANAL
Greater Petrosal n. (br of Facial n.) + Deep Petrosal n. (br. of internal carotid plexus) =
Nerve of Pterygoid Canal
deep petrosal n. contains what type of fibers?
post-ganglionic SYMPATHETIC FIBERS from neurons located in superior cervical ganglion of Sympathetic Trunk
N. of Pterygoid canal terminates where?
Pterygopalatine Ganglion
branches of n. of pterygoid canal
greater palatine n.
lesser palatine n.
nasopalatine n.
posterolateral nasal brs.
pharyngeal n.
course of post-ganglionic parasympathetic fibers for lacrimal gland
pterygopalatine ganglion --> max. n. --> zygomatic n. --> zygomaticotemporal n. --> communicating br. w/ lacrimal n. --> lacrimal n. --> lacrimal gland
Pterygopalatine (3rd) Maxillary artery brs.
max. a. leaves infratemporal fossa and enters pterygopalatine fossa via pterygomaxillary fissure

brs: (follow brs. of maxillary n. and pterygopalatine ganglion)

posterior superior alveolar a.
infraorbital a. (brs. to ant. sup. alv. a. and terminal brs.)
descending palatine a. (divides into lesser and greater palatine aa.)
pharyngeal a.
artery of pterygoid canal
sphenopalatine a. (terminal br. of max. a.; gives off posterolateral nasal brs. and posterior septal brs.)
Posterior Superior Alveolar a.
posterior superior alveolar artery: accompanies posterior superior alveolar nerve --> descends on infratemporal surface of maxilla --> divides into branches which pass through alveolar foramina of maxilla --> supplies maxillary molar and premolar teeth and mucosa of maxillary sinus
Infraorbital a.
accompanies infraorbital nerve --> enters orbit through inferior orbital fissure --> runs anteriorly in infraorbital groove and infraorbital canal --> emerges onto face via infraorbital foramen --> gives following branches:

anterior superior alveolar artery
terminal branches
brs. of Infraorbital a.
anterior superior alveolar artery -->supplies maxillary incisor and canine teeth and mucosa of maxillary sinus (sometimes there is also a middle superior alveolar artery)

terminal branches (on face) supply lower eyelid, side of nose, and upper lip
descending palatine a.
descending palatine artery: divides into lesser and greater palatine arteries -->
lesser palatine artery emerges through lesser palatine foramen to supply soft palate and tonsil -->
greater palatine artery reaches inferior surface of hard palate via greater palatine foramen -->
passes forward to supply mucosa of hard palate -->
gives off a branch that runs up into incisive canal to ANASTOMOSE with a septal branch of sphenopalatine artery
Pharyngeal a.
pharyngeal artery: runs within palatovaginal canal w/ pharyngeal branch of pterygopalatine ganglion --> supplies mucosa of nasopharynx and sphenoidal sinus
a. of pterygoid canal
artery of pterygoid canal: travels posteriorly in pterygoid canal -->
supplies walls and contents of pterygoid canal and mucosa of nasopharynx, auditory tube, and tympanic cavity
sphenopalatine artery
sphenopalatine artery: terminal branch of maxillary artery -->
enters nasal cavity via sphenopalatine foramen gives off posterolateral nasal branches and posterior septal branches

posterolateral nasal branches
posterior septal branches
brs. of spenopalatine a.
posterolateral nasal branches:
supply mucosa of posterior part of lateral wall of nasal cavity

posterior septal branches:
supply mucosa of posterior part of nasal septum -->
one of these branches passes anteriorly and inferiorly on nasal septum toward incisive canal, with nasopalatine nerve -->
anastomoses with a branch of greater palatine artery