Endoscopic Anatomy of the Pterygopalatine Fossa

Abstract

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.

Anatomical Variability of the Maxillary Artery

“…14 Other reports have described the branching types of the maxillary artery in the pterygopalatine fossa. 5,10 Morton and Khan found that the arterial branching was contained in the middle third of the vertical height of the posterolateral wall of the antrum, with occasional extension into the upper third. 2 In contrast to their study, we found the most arterial branching (62.0%) in the superior and medial thirds of the posterior wall of the maxilla.…”

An anatomic study using three‐dimensional reconstruction for pterygopalatine fossa infiltration via the greater palatine canal

“…Because the course of the maxillary artery through the PPF is tortuous and variable (Isaacs and Goyal, 2007), this technique prevents the needle tip from advancing into the main trunk of the maxillary artery and decreases the possibility of intraarterial injection and the risk of delivering anesthetic to the oculomotor nerves (III, IV, and VI) (Peñarrocha-Diago and Sanchis-Bielsa, 2000). A few authors have reported that an amount of anesthetic and vasoconstrictor, which exceed the volumetric capacity of the PPF, could spread through communications of the PPF to other cavities, resulting in the sudden onset of headaches or a more serious complication such as inadvertent brain-stem anesthesia (Gallardo et al, 2008;Stajcíc et al, 2010).…”

Endoscopic transnasal approaches to pterygopalatine fossa tumors

“…The pterygopalatine fossa (PPF) is a critical area located behind the posterior wall of the maxillary sinus and bordered by the pterygoid plates posteriorly, the palatine bone medially, and the middle cranial fossa superiorly. It has connections with the infratemporal fossa laterally through the pterygomaxillary fissure, the posterior nasal cavity medially through the sphenopalatine foramen, the orbit superiorly through the inferior orbital fissure, and the palate inferiorly through the palatine foramina . Given this fact, the PPF represents the main pathway for the spread of different inflammatory or neoplastic diseases from the skull base to the head and neck.…”