Where is it? • Deep to the infratemporal fossa • Anterior to the pterygoid process • Behind the posterior wall of the maxillary sinus (perpendicular plate of the palatine bone) Pterygopalatine fossa and its connections David R. DeLone, MD ©2017 MFMER | slide-1 ©2017 MFMER | slide-2 What’s in it? What’s in it? ©2017 MFMER | slide-3 ©2017 MFMER | slide-4 Autonomic function What goes in and out of it? • Posterior • Parasympathetic • Foramen rotundum • Parasympathetic preganglionic fibers coming along Vidian nerve (GSPN) • Vidian canal synapse at pterygopalatine ganglion. • Palatovaginal (pharyngeal) canal • Postganglionic fibers pass along the pterygopalatine nerves, to maxillary nerve, zygomatic nerve (inferior orbital fissure), and then along • Vomerovaginal (basipharyngeal) canal zygomaticotemporal nerve. The fibers then communicate with the lacrimal • Medial branch of the ophthalmic nerve. • Sphenopalatine foramen • Supplies the lacrimal gland and mucosa of nasopharynx and nasal cavity. • Lateral • Sympathetic • Pterygomaxillary fissure • Postganglionic fibers arising from superior cervical ganglion pass along the carotid plexus, become deep petrosal nerve, which joins the GSPN to form • Anterosuperior the Vidian nerve. • Inferior orbital fissure • Sympathetic fibers pass through pterygopalatine ganglion without synapse and then distribute analogously to the parasympathetic fibers. • Inferior • Greater and lesser palatine foramina ©2017 MFMER | slide-5 ©2017 MFMER | slide-6 What goes in and out of it? • Posterior • Foramen rotundum (Meckel’s cave) • Maxillary nerve (V2) • Artery of foramen rotundum • Emissary veins • Vidian canal (foramen lacerum) • Vidian nerve and Vidian artery • Greater superficial petrosal nerve • Deep petrosal nerve • Palatovaginal (pharyngeal) canal • Pterygovaginal artery • Pharyngeal nerve to Eustachian tube • Vomerovaginal (basipharyngeal) canal • Branch of the sphenopalatine artery Vidus Vidius Tubbs Neurosurgery 2006 (Guido Guidi) Rumboldt AJR 2006 circa 1547. Meng Int J Clin Exp Med 2015 ©2017 MFMER | slide-7 ©2017 MFMER | slide-8 What goes in and out of it? What goes in and out of it? • Medial • Lateral • Sphenopalatine foramen (nasal cavity) • Pterygomaxillary fissure (masticator space) • Sphenopalatine artery • Maxillary artery • Nasopalatine nerve • Posterior superior alveolar nerve • Posterior superior nasal nerve ©2017 MFMER | slide-9 ©2017 MFMER | slide-10 What goes in and out of it? What goes in and out of it? • Anterosuperior • Inferior • Inferior orbital fissure (orbit) • Greater and lesser palatine foramina (palate) • Infraorbital nerve • Greater and lesser palatine nerves • Greater runs along hard palate to incisor teeth, gingiva, and • Zygomatic nerve mucosa. • Small branches from the pterygopalatine ganglion • Lesser supplies the soft palate, uvula, and tonsil. • Infraorbital artery • Greater and lesser palatine arteries ©2017 MFMER | slide-11 ©2017 MFMER | slide-12 ©2017 MFMER | slide-13 ©2017 MFMER | slide-14 ©2017 MFMER | slide-15 ©2017 MFMER | slide-16 ©2017 MFMER | slide-17 ©2017 MFMER | slide-18 [email protected] ©2017 MFMER | slide-19 ©2017 MFMER | slide-20 .