PTERYGOPALATINE FOSSA: LIMITS, CONTENT, COMMUNICATIONS - ANATOMY AND PHYSIOLOGY - 2025

The pterygopalatine fossa is an inverted cone-shaped area that is located in the skull and serves as a channel of communication to other areas. There are two pterygopalatine fossae on each side of the nasal opening of the skull, just above the maxilla. These fossae communicate several of the cavities found in the skeleton of the face.

To understand its anatomy it is important to know the bones that make up the face, as well as all the anatomical landmarks that serve as a guide to establish its limits. The nostrils, the fossa that forms the temporal bone, the space of the orbits and the cranial fossa, are the spaces that are communicated with the pterygopalatine fossae.

This image shows the pterygopalatine fissure. Deep to this area, and lateral to the pterygoid canal is the pterygopalatine fossa. It is the concave area that leads to the channel. By Mikael Häggström. When using this image in external works, it may be cited as: Häggström, Mikael (2014). "Medical gallery of Mikael Häggström 2014". WikiJournal of Medicine 1 (2). DOI: 10.15347 / wjm / 2014.008. ISSN 2002-4436. Public Domain.orBy Mikael Häggström, used with permission., Public Domain, By itself, this area does not have a specific function. However, its importance lies in the fact that important vascular and neurological elements run within this space. Therefore, injuries involving the structures that limit it can damage any of these elements, causing serious damage to the patient's health.

A variety of tumors, benign and malignant, can be located deep in this area and their diagnosis and treatment are a clinical challenge for the treating physician.

The communication pathways of the pterygopalatine fossa with the spaces of the facial skeleton, cause malignant diseases to spread rapidly. For this reason, the diagnosis of neoplastic pathology in this area must be made quickly so that the patient can receive timely treatment and improve their prognosis.

Anatomy

Pterygopalatine fossa (2)

The skeleton of the face consists of 14 bones, 6 of which are even bones. They fulfill a function of structure and protection of internal structures. These bones have the peculiarity of forming internal spaces, some filled with air, which communicate with each other.

By Uploaded by Arcadian -, Public Domain, https://commons.wikimedia.org/w/index.php?curid=789633 The pterygopalatine fossa is one of those communicating spaces. Its shape is of a pyramid or inverted cone and is located posterior to the maxilla, on both sides of the facial skeleton, between the pterygoid process, a protrusion of the sphenoid bone, and the vertex of the orbital cavity.

Through eight orifices, this canal communicates with the nasal and oral cavity, also with the orbit, the infratemporal fossa, the pharynx and the middle cranial fossa.

Limits

Located immediately behind the maxillary sinus, posteriorly the pterygopalatine fossa borders the sphenoid bone, specifically the pterygoid foramen and duct and the pterygoid process, while its anterior limit is the posterior aspect of the maxillary bone, exactly the inferior orbital fissure.

Left maxillary sinus open from the outside. By Henry Vandyke Carter - Henry Gray (1918) Anatomy of the Human Body (See «Book» section below) Bartleby.com: Gray's Anatomy, Plate 159, Public Domain, https://commons.wikimedia.org/w/index. php? curid = 792042

Towards the middle part is the perpendicular lamina of the small palatal bone and laterally it borders the pterygomaxillary fissure.

Its lower limit is represented by the palatal process, which is a protrusion of the maxillary bone, and the pterygoid process of the sphenoid bone.

For its part, the upper limit is represented by a small fissure of the orbital bone.

Communications of the pterygopalatine fossa with the spaces of the facial skeleton

The pterygopalatine space alone has no specific function, but its relationships and ducts make it an important region through which many of the hollow spaces of the facial bones communicate.

Through all these accesses important vascular and neurological structures open their way, essential for the proper functioning of the muscles of the face and brain organs.

Its vertex, which is towards the bottom, is the entrance to the greater palatine canal. This means that inferiorly the pterygopalatine fossa communicates with the oral cavity.

Laterally, through the pterygomaxillary notch, it is communicated with the infratemporal fossa. In its medial or internal part, it is in communication with the nasal cavity through the sphenopalatine foramen.

Through the notch and the infraorbital foramen, in its anterior part, it is connected with the orbit; while later it communicates with the middle cranial fossa through the round foramen.

Contents of the pterygopalatine fossa

The communication channels of the pterygopalatine fossa provide a means for several important structures to find a way to reach other regions deep within the skeleton of the face.

The vascular elements are located in a plane anterior to the neurological ones. Some of the vascular elements, such as the maxillary artery, have a highly varied trajectory and are therefore not included as content of the fossa. Not so its branches that are always located within this cavity.

The sphenopalatine ganglion and its branches. By Henry Vandyke Carter - Henry Gray (1918) Anatomy of the Human Body (See «Book» section below) Bartleby.com: Gray's Anatomy, Plate 780, Public Domain, https://commons.wikimedia.org/w/index. php? curid = 541625

The neurological structures within the fossa have a position posterior to the vascular ones and are located in the upper internal part, these are:

- Pterygopalatine ganglion.

- Maxillary division of the trigeminal nerve that, in addition, gives its own branches in its course. These are: the zygomatic nerve, posterior superior alveolar nerve and infraorbital nerve.

- Pterygoid or Vidian nerve.

- Sphenopalatine neurological ganglion.

- Greater palatine neurological ganglion.

The blood vessels that are within the fossa are located in front of the neurological elements, and are the following:

By Double-M from Athens, GA, USA - Maxillary Artery, CC BY 2.0,

• Direct branches of the maxillary artery, such as the pharyngeal artery, the sphenopalatine artery and the posterior nasal artery. The maxillary artery has a course with multiple normal anatomical variations. Although its distal third can be found within the cavity, it is not a constant.
• Tributary veins of the maxillary vein

Clinical considerations

Computed tomography (CT) is the most important and reliable imaging test for evaluating lesions located in the pterygopalatine fossa.

On many occasions, tumor lesions in this region are difficult to diagnose, therefore the doctor must make a diagnostic approach based on the questioning and physical examination.

Timely diagnosis of a malignant lesion deep in the pterygopalatine fossa will improve the patient's prognosis, since once the pathology is known, appropriate and timely treatment can be started.

4% of tumors of neurological origin are located in the nasal cavity and extend to the pterygopalatine fossa by contiguity.

The surgeon who performs the resection of this type of lesion must be familiar with the anatomy of the region, since the damage to nearby structures can be permanent and represent a significant decrease in the quality of life of the patient.

References

1. Cappello, Z. J; Potts, KL (2019). Anatomy, Pterygopalatine Fossa. StatPearls. Treasure Island (FL). Taken from: ncbi.nlm.nih.gov
2. Rosique-López, L; Rosique-Arias, M; Sánchez-Celemin, FJ (2010). Schwannoma of the pterygopalatine fossa: Endoscopic approach. Neurosurgery. Taken from: scielo.isciii.es
3. Tashi, S; Purohit, B. S; Becker, M; Mundada, P. (2016). The pterygopalatine fossa: imaging anatomy, communications, and pathology revisited. Insights into imaging. Taken from: nlm.nih.gov
4. Alves, N. (2013). Anatomical Study of the Pterygopalatine Region in Macerated Skulls of Brazilians with the Objective of Contributing to the Development of the Disjunction Technique of the Sphenomaxillary Suture. International Journal of Morphology.. Taken from: scielo.conicyt.cl
5. Anderson, B. W; Al Kharazi, KA (2019). Anatomy, Head and Neck, Skull. StatPearls. Treasure Island (FL). Taken from: ncbi.nlm.nih.gov