Clinical functional anatomy of the pterygopalatine ganglion, cephalgia and related dysautonomias: A review

Abstract

The purpose of this article is to explain the anatomy of the pterygopalatine ganglion (PPG), its location in the pterygopalatine fossa (PPF) in the skull, and the relationship it has to the Vidian nerve terminal branches and the fifth cranial nerve. An overview of the neuro-anatomical/clinical correlations, a spectrum of pathologies affecting the seventh cranial nerve and some therapies both medical and surgical are noted. The focus is the pterygopalatine region with discussion of the proximal courses of the seventh and fifth cranial nerves and their pathological processes. The ganglion is used as an example of neuro-anatomical model for explaining cluster headaches (CH). Radiological correlation is included to clarify the location of the PPF and its clinical importance.

The Sphenopalatine Ganglion: Anatomy, Pathophysiology, and Therapeutic Targeting in Headache

“…The sympathetic innervation is inhibitory to the same elements. The secretomotor production is more watery‐mucoid with parasympathetic stimulation, and more viscous‐mucoid with sympathetic stimulation …”

A Three‐Dimensional Print Model of the Pterygopalatine Fossa Significantly Enhances the Learning Experience

“…Anatomical knowledge of the PPF is important as it is utilized as a junction during endoscopic procedures to reach other cranial spaces (Schmidt et al, 2012). Pathological complications involving the PPF may be manifested as severe epistaxis, debilitating trigeminal neuralgia, and severe headaches known as cluster headaches or trigeminal autonomic cephalgia (Khonsary et al, 2013). Residing in the PPF is the pterygopalatine ganglion (PPG), one of the four-paired parasympathetic ganglions that are located in the head and neck.…”

Clinical Anatomy of Blockade of the Pterygopalatine Ganglion: Literature Review and Pictorial Tour Using Cadaveric Images

“…Sluder [1,12] suggested a procedure that involved applying cocaine just posterior to the posterior tip of the middle turbinate over the ganglion. He also experimented with 2% silver and 0.5% formaldehyde solutions.…”

“…He also experimented with 2% silver and 0.5% formaldehyde solutions. In 1913, he reported a treatment that included phenol-alcohol injections into the region of the sphenopalatine foramen [12,13]. These were the fi rst accounts of any procedure intended to alleviate pain associated with what were fi rst described as "nasal headaches" [1].…”