Idiopathic Pseudotumours of the Pterygopalatine Fossa: Case Series and a Narrative Review*
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Anatomy of Maxillary and Mandibular Local Anesthesia
Anatomy of Mandibular and Maxillary Local Anesthesia Patricia L. Blanton, Ph.D., D.D.S. Professor Emeritus, Department of Anatomy, Baylor College of Dentistry – TAMUS and Private Practice in Periodontics Dallas, Texas Anatomy of Mandibular and Maxillary Local Anesthesia I. Introduction A. The anatomical basis of local anesthesia 1. Infiltration anesthesia 2. Block or trunk anesthesia II. Review of the Trigeminal Nerve (Cranial n. V) – the major sensory nerve of the head A. Ophthalmic Division 1. Course a. Superior orbital fissure – root of orbit – supraorbital foramen 2. Branches – sensory B. Maxillary Division 1. Course a. Foramen rotundum – pterygopalatine fossa – inferior orbital fissure – floor of orbit – infraorbital 2. Branches - sensory a. Zygomatic nerve b. Pterygopalatine nerves [nasal (nasopalatine), orbital, palatal (greater and lesser palatine), pharyngeal] c. Posterior superior alveolar nerves d. Infraorbital nerve (middle superior alveolar nerve, anterior superior nerve) C. Mandibular Division 1. Course a. Foramen ovale – infratemporal fossa – mandibular foramen, Canal -> mental foramen 2. Branches a. Sensory (1) Long buccal nerve (2) Lingual nerve (3) Inferior alveolar nerve -> mental nerve (4) Auriculotemporal nerve b. Motor (1) Pterygoid nerves (2) Temporal nerves (3) Masseteric nerves (4) Nerve to tensor tympani (5) Nerve to tensor veli palatine (6) Nerve to mylohyoid (7) Nerve to anterior belly of digastric c. Both motor and sensory (1) Mylohyoid nerve III. Usual Routes of innervation A. Maxilla 1. Teeth a. Molars – Posterior superior alveolar nerve b. Premolars – Middle superior alveolar nerve c. Incisors and cuspids – Anterior superior alveolar nerve 2. Gingiva a. Facial/buccal – Superior alveolar nerves b. Palatal – Anterior – Nasopalatine nerve; Posterior – Greater palatine nerves B. -
Morfofunctional Structure of the Skull
N.L. Svintsytska V.H. Hryn Morfofunctional structure of the skull Study guide Poltava 2016 Ministry of Public Health of Ukraine Public Institution «Central Methodological Office for Higher Medical Education of MPH of Ukraine» Higher State Educational Establishment of Ukraine «Ukranian Medical Stomatological Academy» N.L. Svintsytska, V.H. Hryn Morfofunctional structure of the skull Study guide Poltava 2016 2 LBC 28.706 UDC 611.714/716 S 24 «Recommended by the Ministry of Health of Ukraine as textbook for English- speaking students of higher educational institutions of the MPH of Ukraine» (minutes of the meeting of the Commission for the organization of training and methodical literature for the persons enrolled in higher medical (pharmaceutical) educational establishments of postgraduate education MPH of Ukraine, from 02.06.2016 №2). Letter of the MPH of Ukraine of 11.07.2016 № 08.01-30/17321 Composed by: N.L. Svintsytska, Associate Professor at the Department of Human Anatomy of Higher State Educational Establishment of Ukraine «Ukrainian Medical Stomatological Academy», PhD in Medicine, Associate Professor V.H. Hryn, Associate Professor at the Department of Human Anatomy of Higher State Educational Establishment of Ukraine «Ukrainian Medical Stomatological Academy», PhD in Medicine, Associate Professor This textbook is intended for undergraduate, postgraduate students and continuing education of health care professionals in a variety of clinical disciplines (medicine, pediatrics, dentistry) as it includes the basic concepts of human anatomy of the skull in adults and newborns. Rewiewed by: O.M. Slobodian, Head of the Department of Anatomy, Topographic Anatomy and Operative Surgery of Higher State Educational Establishment of Ukraine «Bukovinian State Medical University», Doctor of Medical Sciences, Professor M.V. -
CT of Perineural Tumor Extension: Pterygopalatine Fossa
731 CT of Perineural Tumor Extension: Pterygopalatine Fossa Hugh D. Curtin1.2 Tumors of the oral cavity and paranasal sinuses can spread along nerves to areas Richard Williams 1 apparently removed from the primary tumor. In tumors of the palate, sinuses, and face, Jonas Johnson3 this "perineural" spread usually involves the maxillary division of the trigeminal nerve. The pterygopalatine fossa is a pathway of the maxillary nerve and becomes a key landmark in the detection of neural metastasis by computed tomogaphy (CT). Oblitera tion of the fat in the fossa suggests pathology. Case material illustrating neural extension is presented and the CT findings are described. Perineural extension is possibly the most insidious form of tumor spread of head and neck malignancy. After invading a nerve, tumor follows the sheath to reach the deeper connections of the nerve, escaping the area of a planned resection. Thus, detection of this form of extension is important in treatment planning and estimation of prognosis. The pterygopalatine fossa (PPF) is a key crossroad in extension along cranial nerve V. The second branch of the trigeminal nerve passes from the gasserian ganglion through the foramen rotundum into the PPF. Here the nerve branches send communications to the palate, sinus, nasal cavity, and face. Tumor can follow any of these routes proximally into the PPF and eventually to the gasserian ganglion in the middle cranial fossa. The PPF contains enough fat to be an ideal subject for computed tomographic (CT) evaluation. Obliteration of this fat is an important indicator of pathology, including perineural tumor spread. Other signs of perineural extension include enlargement of foramina, increased enhancement in the region of Meckel cave (gasserian ganglion), and atrophy of the muscles innervated by the trigeminal nerve. -
MBB: Head & Neck Anatomy
MBB: Head & Neck Anatomy Skull Osteology • This is a comprehensive guide of all the skull features you must know by the practical exam. • Many of these structures will be presented multiple times during upcoming labs. • This PowerPoint Handout is the resource you will use during lab when you have access to skulls. Mind, Brain & Behavior 2021 Osteology of the Skull Slide Title Slide Number Slide Title Slide Number Ethmoid Slide 3 Paranasal Sinuses Slide 19 Vomer, Nasal Bone, and Inferior Turbinate (Concha) Slide4 Paranasal Sinus Imaging Slide 20 Lacrimal and Palatine Bones Slide 5 Paranasal Sinus Imaging (Sagittal Section) Slide 21 Zygomatic Bone Slide 6 Skull Sutures Slide 22 Frontal Bone Slide 7 Foramen RevieW Slide 23 Mandible Slide 8 Skull Subdivisions Slide 24 Maxilla Slide 9 Sphenoid Bone Slide 10 Skull Subdivisions: Viscerocranium Slide 25 Temporal Bone Slide 11 Skull Subdivisions: Neurocranium Slide 26 Temporal Bone (Continued) Slide 12 Cranial Base: Cranial Fossae Slide 27 Temporal Bone (Middle Ear Cavity and Facial Canal) Slide 13 Skull Development: Intramembranous vs Endochondral Slide 28 Occipital Bone Slide 14 Ossification Structures/Spaces Formed by More Than One Bone Slide 15 Intramembranous Ossification: Fontanelles Slide 29 Structures/Apertures Formed by More Than One Bone Slide 16 Intramembranous Ossification: Craniosynostosis Slide 30 Nasal Septum Slide 17 Endochondral Ossification Slide 31 Infratemporal Fossa & Pterygopalatine Fossa Slide 18 Achondroplasia and Skull Growth Slide 32 Ethmoid • Cribriform plate/foramina -
Lecture 7 Anatomy the PTERYGOPALATINE FOSSA
د.احمد فاضل القيسي Lecture 7 Anatomy THE PTERYGOPALATINE FOSSA The pterygopalatine fossa lies beneath the posterior surface of the maxilla and the pterygoid process of the sphenoid bone. The pterygopalatine fossa contains the maxillary nerve, the maxillary artery (third part) and the pterygopalatine parasympathetic ganglion. Boundaries Anteriorly: posterior surface of maxilla. Posteriorly: anterior margin of pterygoid process below and greater wing of sphenoid above. Medially: perpendicular plate of palatine bone. Superiorly: greater wing of sphenoid. Laterally: communicates with infratemporal fossa through pterygomaxillary fissure Communications and openings: 1. The pterygomaxillary fissure: transmits the maxillary artery from the infratemporal fossa, the posterior superior alveolar branches of the maxillary division of the trigeminal nerve and the sphenopalatine veins. 2. The inferior orbital fissure: transmits the infraorbital and zygomatic branches of the maxillary nerve, the orbital branches of the pterygopalatine ganglion and the infraorbital vessels. 3. The foramen rotundum from the middle cranial fossa, occupying the greater wing of the sphenoid bone and transmit the maxillary division of the trigeminal nerve 4. The pterygoid canal from the region of the foramen lacerum at the base of the skull. The pterygoid canal transmits the greater petrosal and deep petrosal nerves (which combine to form the nerve of the pterygoid canal) and an accompanying artery derived from the maxillary artery. 5. The sphenopalatine foramen lying high up on the medial wall of the fossa.This foramen communicates with the lateral wall of the nasal cavity. It transmits the nasopalatine and posterior superior nasal nerves (from the pterygopalatine ganglion) and the sphenopalatine vessels. 6. The opening of a palatine canal found at the base of the fossa. -
TEMPORAL and INFRATEMPORAL FOSSAE (Grant's Dissector [16Th Ed.] Pp
TEMPORAL AND INFRATEMPORAL FOSSAE (Grant's Dissector [16th Ed.] pp. 256-262) TODAY’S GOALS: 1. Identify the boundaries and bony landmarks of the temporal and infratemporal fossae 2. Identify the muscles of mastication 3. Identify the maxillary artery and its major branches, along with the pterygoid venous plexus and maxillary vein 4. Identify the branches of the mandibular division of the trigeminal nerve [CN V3] 5. Identify the temporomandibular joint, its articular disc, and compartments DISSECTION NOTES: General comments: Perform today’s dissection on the side of the head that the parotid gland had been previously removed (from the last lab session). Access to the temporal and infratemporal fossae will be accomplished by making saw cuts: (a) through the zygomatic bone and arch and reflecting the masseter muscle inferiorly, and (b) through the coronoid process, (c) neck, and (d) upper half of ramus of the mandible (see Dissector pp. 258, 259, Figs. 7.30 and 7.31). In preparation for this work, review the following osteology and landmarks. I. Osteology A. Temporal fossa 1. Bony landmarks and boundaries • Temporal fossa (shallow depression on lateral aspect of skull formed by portions of the parietal, frontal, squamous portion of the temporal, and greater wing of sphenoid bones) • Superior temporal line – upper attachment of temporal fascia • Inferior temporal line – upper attachment of temporalis muscle • Zygomatic arch – bony arch formed by fusion of the zygomatic process of the temporal bone and the temporal process of the zygomatic bone A horizontal plane between the zygomatic arch and lateral surface of the skull forms the boundary between the temporal fossa and infratemporal fossa. -
Craniumcranium
CRANIUMCRANIUM THETHE SKULLSKULL R.R. DrugaDruga InstituteInstitute ofof Anatomy,Anatomy, 2nd2nd andand 1st1st MedicalMedical FacultyFaculty NEUROCRANIUMNEUROCRANIUM SPLANCHNOCRANIUMSPLANCHNOCRANIUM CRANIUM,CRANIUM, THETHE SKULLSKULL II MostMost highlyhighly modifiedmodified regionregion inin thethe axialaxial skeletonskeleton TheThe neurocraniumneurocranium –– developeddeveloped fromfrom aa seriesseries ofof cartilagescartilages ventralventral toto thethe brainbrain (base)(base) FromFrom mesenchymemesenchyme overover thethe domedome ofof thethe headhead (calvaria(calvaria oror calva)calva) CranialCranial cavitycavity SplanchnocraniumSplanchnocranium –– branchialbranchial apparatusapparatus (cartilaginous(cartilaginous elements)elements) havehave beenbeen replacedreplaced byby overlyingoverlying dermaldermal bonesbones BranchialBranchial apparatusapparatus TheThe mandibularmandibular regionregion andand thethe neckneck areare formedformed byby sixsix pairedpaired branchialbranchial archesarches (cart.(cart. barsbars supportingsupporting thethe gillgill apparatus).apparatus). InIn thethe tetrapodstetrapods branchialbranchial archesarches werewere modifiedmodified andand persistpersist inin thethe facialfacial (maxilla,(maxilla, mandibula)mandibula) andand neckneck skeletonskeleton (laryngeal(laryngeal cartilages)cartilages) Derivatives of cartilagines of the branchial arches 1st arch = Meckel cart., mandibula, malleus 2nd arch = Reichert cart., stapes, styloid proc.,stylohyoid lig. 3rd arch = hyoid bone 4th and 6th arch = laryngeal -
Extended Endoscopic Endonasal Approach to the Pterygopalatine Fossa: Anatomical Study and Clinical Considerations
Neurosurg Focus 19 (1):E5, 2005 Extended endoscopic endonasal approach to the pterygopalatine fossa: anatomical study and clinical considerations LUIGI M. CAVALLO, M.D., PH.D., ANDREA MESSINA, M.D., PAUL GARDNER, M.D., FELICE ESPOSITO, M.D., AMIN B. KASSAM, M.D., PAOLO CAPPABIANCA, M.D., ENRICO DE DIVITIIS, M.D., AND MANFRED TSCHABITSCHER, M.D. Department of Neurological Sciences, Division of Neurosurgery, Università degli Studi di Napoli Federico II, Naples, Italy; Microsurgical and Endoscopic Anatomy Study Group, University of Vienna, Austria; and Center for Image-Guided and Minimally Invasive Neurosurgery, Department of Neurosurgery, University of Pittsburgh Medical Center-Presbyterian, Pittsburgh, Pennsylvania Object. The pterygopalatine fossa is an area located deep in the skull base. The microsurgical transmaxillary–trans- antral route is usually chosen to remove lesions in this region. The increasing use of the endoscope in sinonasal func- tional surgery has more recently led to the advent of the endoscope for the treatment of tumors located in the pterygo- palatine fossa as well. Methods. An anatomical dissection of three fresh cadaveric heads (six pterygopalatine fossas) and three dried skull base specimens was performed to evaluate the feasibility of the approach and to illustrate the surgical landmarks that are useful for operations in this complex region. The endoscopic endonasal approach allows a wide exposure of the pterygopalatine fossa. Furthermore, with the same access (that is, through the nostril) it is possible to expose regions contiguous with the pterygopalatine fossa, either to visualize more surgical landmarks or to accomplish a better lesion removal. Conclusions. In this anatomical study the endoscopic endonasal approach to the pterygopalatine fossa has been found to be a safe approach for the removal of lesions in this region. -
LOCOREGIONAL ANESTHESIA of the HEAD PAIN MANAGEMENT Luis Campoy, LV Certva, Dipecvaa, MRCVS
LOCOREGIONAL ANESTHESIA OF THE HEAD PAIN MANAGEMENT Luis Campoy, LV CertVA, DipECVAA, MRCVS Local blockade of the nerves serving the oral cavity and face in the dog and cat requires simple equipment and material readily available at any veterinary practice, syringes and thin needles. Needle size can vary from 25-gauge to 30-gauge, 12 mm, 25 mm, or 36 mm in length. Procedures for which locoregional anesthesia may be indicated include: • Dental extractions • Periodontal flap surgery • Endodontic procedures • Restorative procedures • Implant surgery • Oronasal fistulas • Palatal defect (cleft palate) closure • Maxillary and mandibular fracture repairs • Posttraumatic soft-tissue reconstruction • Oncologic surgery with excision of hard (i.e., maxillectomy, mandibulectomy) and soft tissue (i.e., glossectomy, palatectomy). Anatomy The majority of the sensory innervation of the teeth, bone, and soft tissue of the oral cavity and the facial skin is provided by the right and left trigeminal nerves (V). The three branches of the sensory root (ophthalmic [V1], maxillary [V2] and mandibular [V3] branches) supply the skin of the face and the mucous membranes of the eyes, nose, and oral cavity, except for the pharynx and the base of the tongue. The maxillary branch runs through the round foramen, the alar canal, and the rostral alar foramen into the caudal portion of the pterygopalatine fossa, and then courses rostrally on the dorsal surface of the medial pterygoid muscle. In the rostral part of the pterygopalatine fossa it leaves off the zygomatic and the pterygopalatine nerves and continues as the infraorbital nerve into the maxillary foramen and the infraorbital canal. During its course within the canal, the infraorbital nerve gives off branches to supply the maxillary teeth. -
Endoscopic Transnasal Approach to the Pterygopalatine Fossa
ORIGINAL ARTICLE Endoscopic Transnasal Approach to the Pterygopalatine Fossa John M. DelGaudio, MD Objective: To describe an endoscopic transnasal ap- through the same approach with further lateral expo- proach to the pterygopalatine fossa (PPF). sure to the area of the inferior orbital fissure. Design: Case series of 3 patients. Results: All patients had successful endoscopic ap- proaches for tumor removal (case 1) and biopsy (cases Setting: An academic medical center. 2 and 3) of the PPF. The second patient had a repeat en- doscopic biopsy 1 week later to obtain more tissue for Patients: One patient presented with an asymptomatic diagnostic purposes. None of the patients had any ma- PPF schwannoma. The second patient presented after a jor vascular complications. At follow-up, 2 of 3 patients sudden onset of complete unilateral vision loss with a com- had persistent sensory deficits. plete ipsilateral sphenoid sinus opacification and radio- graphic signal abnormality in the PPF and inferior or- bital fissure. The third patient had a history of adenoid Conclusions: The endoscopic transnasal approach to the cystic carcinoma of the lacrimal gland, and was found PPF is a safe and effective method for biopsy and re- to have new-onset facial numbness. moval of PPF masses. The endoscopic approach im- proves access and visualization, and has the potential to Intervention: One patient had a complete excision of reduce complications compared with open approaches. a schwannoma by means of an endoscopic transnasal ap- Image guidance is helpful in these cases. proach. The other 2 patients had wide exposure and bi- opsies of the PPF. -
Pharynx, Larynx, Nasal Cavity and Pterygopalatine Fossa
Pharynx, Larynx, Nasal cavity And Pterygopalatine Fossa Mikel H. Snow, Ph.D. Dental Anatomy [email protected] July 29, 2018 Pharynx Food & Air Passage Pharynx The pharynx is a skeletal muscle tube that opens anteriorly with 3 regions. The upper part communicates with nasal cavity, the middle communicates with oral cavity, and the lower communicates with the larynx. Nasal cavity Nasal Oral cavity cavity Larynx Air Nasopharynx: between Oral sphenoid sinus & uvula Food/ cavity Oropharynx: between uvula & epiglottis drink Laryngopharynx: between epiglottis & esophagus Esophagus Trachea The posterior and lateral walls are 3 skeletal muscles (constrictors) that propel food/liquid inferiorly to the esophagus. Constrictors innervated by CNX. Additional muscles elevate the pharynx (stylopharyngeus is external). Stylopharyngeus innervated by CNIX. Stylopharyngeus Superior constrictor Middle constrictor Inferior constrictor Two additional internal muscles we’ll get to later… Key relationship: Glossopharyngeal nerve wraps around stylopharyngeus muscle. CN IX wraps around stylopharyngeus muscle and Stylopharyngeus innervates it. Pharyngeal constrictors Pharynx Interior 1 Nasopharynx: 1. Pharyngeal tonsils 2. Auditory tube ostia 2 3 3. Salpingopharyngeal fold 4 4 Oropharynx: 4. Palatine tonsils 5 5 Laryngopharynx: Slit open 5. Piriform recess constrictors to examine interior Lateral Wall of Pharynx 5. Salpingopharyngeus muscle 6. Levator veli palatini muscle 1. Pharyngeal tonsils 7. Tensor veli palatini muscle 2. Torus tubarius 8. Palatine tonsil 3. -
Anatomy of the Pterygopalatine Fossa: an Innovative Metrical Assessment Based on 3D Segmentation on Head CT-Scan
Surgical and Radiologic Anatomy (2019) 41:523–528 https://doi.org/10.1007/s00276-018-2153-7 ORIGINAL ARTICLE Anatomy of the pterygopalatine fossa: an innovative metrical assessment based on 3D segmentation on head CT-scan Daniele Gibelli1 · Michaela Cellina2 · Stefano Gibelli3 · Annalisa Cappella1 · Marta Maria Panzeri4 · Antonio Giancarlo Oliva2 · Giovanni Termine3 · Claudia Dolci1 · Chiarella Sforza1 Received: 1 September 2018 / Accepted: 7 December 2018 / Published online: 12 December 2018 © Springer-Verlag France SAS, part of Springer Nature 2018 Abstract Purpose The pterygopalatine fossa is an important anatomical structure for several surgical and anaesthesiologic procedures; yet, very few data are available about its size. This study aims at providing a metrical assessment of pterygopalatine fossa through an innovative 3D segmentation procedure on head CT-scans. Methods CT-scans from 100 patients (50 males and 50 females) aged between 18 and 85 years were chosen for the study. Right and left pterygopalatine fossae were segmented through ITK-SNAP open source software. Height and volume were calculated on the acquired 3D models. In addition, anterior–posterior nasal spine distance, upper facial height (nasion–pros- thion) and biorbital breadth (ectoconchion–ectoconchion) were measured as well. Statistically significant differences of height and volume according to sex and side were assessed through two-way ANOVA test: sexually dimorphic measurements were further assessed through one-way ANCOVA test using the three cranial measurements as covariates (p < 0.05). Results On average pterygopalatine fossa height was 24.1 ± 3.5 mm in males, and 22.8 ± 3.4 mm in females, whereas volume was 0.930 ± 0.181 cm3 in males and 0.817 ± 0.157 cm3 in females, with statistically significant differences according to sex (p < 0.05), but not to side (p > 0.05); interaction was negligible for both the measurements.