Endoscopic Anatomy of the Pterygopalatine Fossa

2007 ◽  
Vol 21 (5) ◽  
pp. 644-647 ◽  
Author(s):  
Seth J. Isaacs ◽  
Parul Goyal
Keyword(s):  
Pterygopalatine Fossa ◽  
Maxillary Artery ◽  
Internal Maxillary Artery ◽  
Sphenopalatine Foramen ◽  
Neoplastic Processes ◽  
Patient Morbidity ◽  
Infraorbital Canal ◽  
Vidian Canal ◽  
Foramen Rotundum ◽  
Neurovascular Structures

Background The pterygopalatine fossa can be involved with a variety of infectious and neoplastic processes. This region can be entered endoscopically, but endoscopic landmarks to localize the neurovascular structures in the pterygopalatine fossa have not yet been reported. Objectives The purpose of this study is to describe the location of the neurovascular structures in the pterygopalatine fossa in relation to consistent intranasal landmarks. Methods Endoscopic dissections of cadaveric heads were performed. The locations of neurovascular structures in the region were defined. Results The sphenopalatine foramen (SPF) served as the primary intranasal landmark to the pterygopalatine fossa (PPF). Mean distances from the SPF were measured with the following results: SPF to sphenopalatine ganglion (SPG), 4 mm medially and 6 mm laterally; SPF to foramen rotundum (FR), 7 mm; and SPF to vidian canal (VC), 2 mm. The internal maxillary artery followed an irregular and inconsistent course, making it difficult to define a reliable landmark for its location in the fossa. Conclusion Entering the PPF inferior to the horizontal plane of the SPF along a vertical line drawn inferiorly from the infraorbital canal will avoid injury to the major neural structures in the fossa. Because of the inconsistent course and location of the internal maxillary artery, this structure may be at risk no matter where the fossa is entered. These landmarks will allow the surgeon to enter the PPF with more accuracy and less patient morbidity.

MICROSURGICAL AND ENDOSCOPIC ANATOMY OF THE VIDIAN CANAL

2009 ◽  
Vol 64 (suppl_5) ◽  
pp. ons385-ons412 ◽  
Author(s):  
Shigeyuki Osawa ◽  
Albert L. Rhoton ◽  
Askin Seker ◽  
Satoru Shimizu ◽  
Kiyotaka Fujii ◽  
...  
Keyword(s):  
Cavernous Sinus ◽  
Sphenoid Sinus ◽  
Posterior Part ◽  
Pterygopalatine Fossa ◽  
Sphenoid Bone ◽  
Petrous Apex ◽  
Maxillary Artery ◽  
Medial Part ◽  
Vidian Nerve ◽  
Vidian Canal

Abstract OBJECTIVE The vidian canal, the conduit through the sphenoid bone for the vidian nerve and artery, has become an important landmark in surgical approaches to the cranial base. The objective of this study was to examine the anatomic features of the vidian canal, nerve, and artery, as well as the clinical implications of our findings. METHODS Ten adult cadaveric specimens and 10 dried skulls provided 40 vidian canals for examination with ×3 to ×20 magnification and the endoscope. RESULTS The paired vidian canals are located in the skull base along the line of fusion of the pterygoid process and body of the sphenoid bone. The canal opens anteriorly into the medial part of the pterygopalatine fossa and posteriorly at the upper part of the anterolateral edge of the foramen lacerum. The vidian nerve, when followed posteriorly, reaches the lateral surface of the anterior genu of the petrous carotid and the anteromedial part of the cavernous sinus where the nerve is continuous with the greater petrosal nerve. The bone surrounding the upper part of 12 of 20 vidian canals protruded into the floor of the sphenoid sinus and one canal had a bony dehiscence that exposed its contents under the sinus mucosa. Nine petrous carotid arteries (45%) gave rise to a vidian artery, all of which anastomosed with the vidian branch of the maxillary artery in the vidian canal or pterygopalatine fossa. The vidian canal can be exposed by opening the floor of the sphenoid sinus, the posterior wall of the maxillary, the posterior part of the lateral wall of the nasal cavity, and the medial part of the floor of the middle fossa. CONCLUSION The vidian canal and nerve are important landmarks in accessing the anterior genu of the petrous carotid, anteromedial part of the cavernous sinus, and petrous apex.

Locating and Preserving the Sphenopalatine Ganglion in Endoscopic Endonasal Pterygopalatine Fossa Surgery: An Anatomical Study

2019 ◽  
Vol 34 (3) ◽  
pp. 348-351
Author(s):  
Daniel B. Spielman ◽  
Matthew Kim ◽  
Jonathan Overdevest ◽  
David A. Gudis
Keyword(s):  
Trigeminal Nerve ◽  
Anatomical Study ◽  
Surgical Anatomy ◽  
Pterygopalatine Fossa ◽  
Maxillary Artery ◽  
Sphenopalatine Ganglion ◽  
Nerve Branch ◽  
Endoscopic Endonasal ◽  
Sphenopalatine Foramen ◽  
Dissection Technique

Background The pterygopalatine fossa (PPF) contains numerous important neurovascular structures; notably, the sphenopalatine ganglion (SPG), the maxillary branch of the trigeminal nerve (V2), and the internal maxillary artery. With the advent of extended endoscopic endonasal surgery, the surgical anatomy of the PPF warrants increased investigation. Intraoperative dissection and preservation of the SPG is essential to prevent postoperative xeropthalmia and facial hypoesthesia. Objective This study aims to (1) describe a novel dissection technique for identifying the SPG and (2) define the SPG location relative to the sphenopalatine foramen (SPF), which is a consistently identifiable landmark. Methods Eight cadaveric PPFs were dissected in step-wise fashion. An endoscopic medial maxillectomy was performed, the SPF was identified, and the posterior maxillary wall was resected. The maxillary branch of the trigeminal nerve (V2) was identified anterolaterally in its infraorbital canal and traced medially to identify the pterygopalatine nerve to the SPG. The lateral distance and superior/inferior distance from the SPG to the fixed SPF was measured. Results The surgical technique described allowed for reliable identification of the SPG. The SPG was located on average 4.5 ± 1.1 mm lateral and 1 ± 1.4 mm inferior to the SPF. Conclusion Identification and preservation of the SPG is necessary to prevent complications in endoscopic endonasal PPF surgery. The SPG can be reliably located near the SPF by following the pterygopalatine nerve branch of V2.

scholarly journals Outcomes of sphenopalatine and internal maxillary artery ligation inside the pterygopalatine fossa for posterior epistaxis

2018 ◽  
Vol 56 (2) ◽  
pp. 144-148 ◽  
Author(s):  
K. Piastro ◽  
R. Scagnelli ◽  
N. Gildener-Leapman ◽  
C.D. Pinheiro-Neto
Keyword(s):  
Pterygopalatine Fossa ◽  
Maxillary Artery ◽  
Internal Maxillary Artery ◽  
Artery Ligation

scholarly journals 326. Radiologic Findings of COVID-19 Associated Mucormycosis (CAM) from India

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S268-S269
Author(s):  
Aswath Govindaraju ◽  
Deepti H Vijayakumar ◽  
Raghavendra Tirupathi ◽  
Jaffar A Al-Tawfiq ◽  
Ali A Rabaan
Keyword(s):  
Optic Neuritis ◽  
Paranasal Sinuses ◽  
Orbital Cellulitis ◽  
Pterygopalatine Fossa ◽  
Fungal Culture ◽  
Imaging Features ◽  
Middle Meatus ◽  
Sphenopalatine Foramen ◽  
Contrast Enhanced ◽  
Left Middle

Abstract Background The unique feature of the second wave of the COVID -19 pandemic in India has been the alarming surge of acute invasive fungal infection among COVID -19 patients. The increased incidence of rhino-orbito-cerebral mucormycosis is a matter of concern, as this fulminant infection has high morbidity and mortality. Hence, it is imperative to understand it’s imaging features, for early diagnosis, staging and treatment. Methods We systematically reviewed 32 COVID-19 cases with imaging diagnosis of acute invasive fungal rhino-sinusitis or rhino-orbital-cerebral disease between March to May 2021. These patients underwent contrast MRI of the paranasal sinus, orbit and brain. Contrast enhanced CT chest and paranasal sinuses were done as needed. Results The age group ranged between 30 to 71 yrs with male preponderance. The most common predisposing factors were intravenous steroid therapy and supplemental oxygen. All cases were confirmed by fungal culture and most common was Mucor. The rhino-orbito-cerebral mucormycosis was staged as below In our study we found that the most common site in the nasal cavity was the middle turbinate /meatus and the earliest sign was non-enhancing / “black” turbinate. Premaxillary and retroantral fat necrosis was the earliest sign of soft tissue invasion. Spread via the sphenopalatine foramen and pterygopalatine fossa was more common than bony erosions. Orbital cellulitis and optic neuritis were the most common among stage 3 cases. Of patients with CNS involvement, the most common were cavernous sinus thrombosis and trigeminal neuritis. Two patients with pulmonary mucormycosis showed large necrotic cavitary lesions, giving the characteristic “bird’s nest” appearance. Figure 1. Black turbinate Contrast enhanced coronal T1 FS images of paranasal sinuses shows necrotic non-enhancing right superior and middle turbinates (*) Figure 2: Axial contrast enhanced T1 FS image showing necrotic non enhancing premaxillary (arrowhead) and retroantral fat (straight arrow) walled off by thin enhancing rim. Figure 3: Contrast enhanced axial T1 FS images of paranasal sinuses shows necrotic non-enhancing left middle meatus spreading along sphenopalatine foramen in to pterygopalatine fossa (arrow head) Conclusion The mortality rate was 20% in our study. In our short term follow up, 30 % of recovered patients had relapse on imaging due to incomplete clearance and partial antifungal treatment. High clinical suspicion and low imaging threshold are vital for early Mucormycosis detection in COVID-19 patients. Familiarity with early imaging signs is critical to prevent associated morbidity /mortality. Figure 4: Contrast enhanced coronal T1 FS and diffusion weighted images shows necrotic non-enhancing left middle meatus with left orbital cellulitis (*) and optic neuritis (white arrow) Figure 5. Bird’s nest Axial CT chest image in lung window shows necrotic right upper lobe cavity with internal septations and debris on a background of surrounding COVID-19 changes. Disclosures All Authors: No reported disclosures

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