Pterygopalatine.txt

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emm64
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118388
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Pterygopalatine.txt
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2011-11-21 18:51:48
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PterygoPalatine HN
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PterygoPalatine HN
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  1. pterygopalatine fossa
    • medial to the infratemporal fossa
    • lateral to the nasal cavity.
    • contains:
    • -V2 (Maxillary) Division of the trigeminal and its branches
    • -pterygopalatine ganlion
    • -3rd (pterygopalatine) part of the maxillary artery and its branches.
    • pathway of innervation to
    • (1): the maxillary teeth,
    • (2) mucosal glands of the nasal cavity, superior nasopharynx,
    • (3) lacrimal gland, and
    • (4) part of the face
  2. pterygopalatine fossa Boundaries
    • It is useful to think of the infratemporal fossa as a room – which has a “closet” in its medial wall.
    • This “closet” is the pterygopalatine fossa which has a lateral wall, anterior wall, posterior wall, medial wall, roof, and floor.
    • 1. roof – greater wing of sphenoid
    • 2. anterior wall – posterior surface of maxilla
    • 3. posterior wall – pterygoid process of sphenoid (which has lateral & medial plates)
    • 4. medial wall – palatine bone (with sphenopalatine foramen)*
    • 5. lateral wall – pterygomaxillary fissure (between the lat. pterygoid plate & posterior maxilla)
  3. SphenoPalatine Foramen
    • Pterygopalatine Fossa -> Nasal cavity
  4. Palatine Canal
    • pterygopalatine fossa -> oral cavity
  5. Communications of the Pterygopalatine Fossa
    • (1) pterygomaxillary fissure – with infratemporal fossa
    • (2) inferior orbital fissure- with orbit
    • (3) foramen rotundum - with middle cranial fossa
    • (4) pterygoid canal - with middle cranial fossa
    • (5) palatine canal- with oral cavity
    • (6) sphenopalatine foramen. - with nasal cavity
  6. Arteries of the Pterygopalatine Fossa
    • branches of the 3rd (pterygopalatine) part of the maxillary artery.
    • The maxillary artery is one of the two terminal branches of the external carotid artery (the other terminal branch is the superficial temporal a.).
    • It passes deep to the neck of the mandible and travels through the infratemporal fossa.
    • The maxillary artery passes through the pterygomaxillary fissure to enter the pterygopalatine fossa.
    • Here, the branches of the 3rd part are given off.
    • Then maxillary artery terminates by passing through the sphenopalatine foramen into the nasal cavity to become the sphenopalatine artery.
  7. Maxillary Artery Branches Summary:
    • 1st (Retromandibular) Part:
    • 1. deep auricular a.
    • 2. anterior tympanic a.
    • 3. middle meningeal a.
    • 4. accessory meningeal a.
    • 5. inferior alveolar a.
    • 2nd (Pterygoid) Part:
    • 1. deep temporal as.
    • 2. pterygoid as.
    • 3. masseteric a.
    • 4. buccal a.
    • 3rd (Pterygopalatine) Part:
    • 1. posterior superior alveolar a.
    • 2. infraorbital a.
    • 3. descending palatine a.
    • 4. artery of pterygoid canal
    • 5. pharyngeal a.
    • 6. sphenopalatine a.
  8. Maxillary Artery 1st Part:
    • (Retromandibular)
    • 1. deep auricular a.
    • 2. anterior tympanic a.
    • 3. middle meningeal a.
    • 4. accessory meningeal a.
    • 5. inferior alveolar a.
  9. Maxillary Artery 2nd Part:
    • (Pterygoid)
    • 1. deep temporal as.
    • 2. pterygoid as.
    • 3. masseteric a.
    • 4. buccal a.
  10. Maxillary Artery 3rd Part:
    • (Pterygopalatine)
    • 1. posterior superior alveolar a.
    • 2. infraorbital a.
    • 3. descending palatine a.
    • 4. artery of pterygoid canal
    • 5. pharyngeal a.
    • 6. sphenopalatine a.
    • The branches of the 3rd part originate in the pterygopalatine fossa.
  11. posterior superior alveolar a.
    • Maxillary Artery 3rd Part (Pterygopalatine)
    • travels with the post. superior aveolar n. (V2 branch)
    • supplies the maxillary molar and premolar teeth, buccal gingiva,and lining of the maxillary sinus.
  12. infraorbital a.
    • Maxillary Artery 3rd Part (Pterygopalatine)
    • Leaves the pterygopalatine artery by passing through the inferior orbital fissure.
    • Travels in the infraorbital groove and canal, then through the infraorbital foramen.
    • Travels with the infraorbital nerve.
    • Supplies the inferior eyelid, lacrimal sac, infraorbital region of the face, side of the nose, and upper lip.
  13. descending palatine a.
    • Maxillary Artery 3rd Part (Pterygopalatine)
    • Descends in the (pterygo)palatine canal (a.k.a “greater palatine canal” or “palatine canal”) along with the greater and lesser palatine nerves.
    • Gives rise to the greater and lesser palatine arteries which emerge onto the hard palate through the greater and lesser palatine foramina, respectively.
    • Supply the mucous membrane and glands of the hard palate (roof of mouth), palatine gingiva, soft palate & palatine tonsils.
  14. sphenopalatine a.
    • Maxillary Artery 3rd Part (Pterygopalatine)
    • Termination of the maxillary artery which changes names once it goes through the sphenopalatine foramen to enter the nasal cavity.
    • This foramen is in the medial wall of the pterygopalatine fossa.
    • Supplies the lateral nasal wall, nasal septum, and adjacent paranasal sinuses.
  15. Pterygopalatine Ganglion
    • (a.k.a. “sphenopalatine” or “Meckel’s” ganglion)
    • Largest of the 4 special parasympathetic ganglia of the head.
    • Located within the pterygopalatine fossa and “hangs” from the V2 (maxillary) Division (a.k.a. “maxillary nerve).
    • Its branches (VE-para/post) innervate the lacrimal gland and mucosal glands of the nasal cavity, nasopharynx (superior ½), and palate.
  16. Pterygopalatine Nerves
    Pterygopalatine Ganglion hangs from V2 via 2 pterygopalatine nerves which can be considered the the SA “sensory root” of the ganglion.
  17. pterygopalatine ganglion branches:
    • (1) orbital brs – travel through the inferior orbital fissure to enter the periosteum of the orbit. They innervate the mucosa of the posterior ethmoidal air cells and sphenoidal sinus.
    • (2) posterior superior nasal ns. – lateral & medial groups supply VE-para/post fibers to mucosal glands of the nasal cavity, VE-symp/post fibers to blood vessels in the area, and SA fibers to the mucosa of lateral nasal wall (superior & middle nasal concha) & nasal septum.
    • (A) nasopalatine n – is one of the medial group branches of post. superior nasal nerves. It supplies VE-para/post fibers to the mucosal glands, VE-symp/post fibers to blood vessels, and SA fibers to the nasal septum and hard palate near the incisor teeth. It runs along the nasal septum to the incisive canal of the hard palate.
    • (3) greater palatine n. - travels in the (pterygo)palatine canal to the oral cavity and supplies VE-para/post fibers to mucosal glands, VE-symp/post to blood vessels, and SA fibers to the gums and mucus membrane of the hard palate. This nerve gives rise to the posterior inferior nasal n. (which innervates the mucosaof the inferior nasal concha).
    • (4) lesser palatine n. - travels in the (pterygo)palatine canal to the oral cavity and supplies VE-para/post fibers to mucosal glands, VE-symp/post to blood vessels, and SA fibers to the region of the soft palate & uvula. It also contains some SS(taste) fibers to the soft palate. The SS cell bodies are in the geniculate ganglion and travel with the greater petrosal nerve (to Vidian’s Nerve and then to the pterygopalatine ganglion and out with the lesser palatine nerves).
    • (5) pharyngeal br. - supplies VE-para/post fibers to mucosal glands, VE-symp/post to blood vessels, and SA fibers to the region of the superior nasopharynx.
    • (6) fibers to the lacrimal gland – supply VE-para/post fibers (secretomotor) to the lacrimal gland. Any accompanying VE-symp/post fibers go to blood vessels, SA innervation of the gland (there are a few twigs) is from the lacrimal nerve (br of V1).
  18. pterygopalatine ganglion orbital brs
    • travel through the inferior orbital fissure to enter the periosteum of the orbit.
    • innervate the mucosa of the posterior ethmoidal air cells and sphenoidal sinus.
  19. pterygopalatine ganglion posterior superior nasal ns.
    lateral & medial groups supply VE-para/post fibers to mucosal glands of the nasal cavity, VE-symp/post fibers to blood vessels in the area, and SA fibers to the mucosa of lateral nasal wall (superior & middle nasal concha) & nasal septum.
  20. nasopalatine n
    • one of the medial group branches of post. superior nasal nerves.
    • supplies VE-para/post fibers to the mucosal glands, VE-symp/post fibers to blood vessels, and SA fibers to the nasal septum and hard palate near the incisor teeth.
    • runs along the nasal septum to the incisive canal of the hard palate.
  21. pterygopalatine ganglion greater palatine n.
    • travels in the (pterygo)palatine canal to the oral cavity and supplies VE-para/post fibers to mucosal glands, VE-symp/post to blood vessels, and SA fibers to the gums and mucus membrane of the hard palate.
    • This nerve gives rise to the posterior inferior nasal n. (which innervates the mucosaof the inferior nasal concha).
  22. pterygopalatine ganglion lesser palatine n.
    • travels in the (pterygo)palatine canal to the oral cavity and supplies VE-para/post fibers to mucosal glands, VE-symp/post to blood vessels, and SA fibers to the region of the soft palate & uvula.
    • It also contains some SS(taste) fibers to the soft palate.
    • The SS cell bodies are in the geniculate ganglion and travel with the greater petrosal nerve (to Vidian’s Nerve and then to the pterygopalatine ganglion and out with the lesser palatine nerves).
  23. pterygopalatine ganglion pharyngeal br.
    supplies VE-para/post fibers to mucosal glands, VE-symp/post to blood vessels, and SA fibers to the region of the superior nasopharynx.
  24. pterygopalatine ganglion fibers to the lacrimal gland
    • supply VE-para/post fibers (secretomotor) to the lacrimal gland.
    • Any accompanying VE-symp/post fibers go to blood vessels, SA innervation of the gland (there are a few twigs) is from the lacrimal nerve (br of V1).
  25. Vidian’s Nerve
    • The nerve of the pterygoid canal (Vidian’s Nerve) joins the ganglion along its posterior aspect.
    • It brings VE-para/pre and symp/post fibers to the ganglion.
    • (It is also carrying SS taste fibers which will be incorporated into the lesser palatine nerves).
    • This nerve is formed by the joining of the greater petrosal nerve with the deep petrosal nerve.
  26. greater petrosal nerve
    • branch of CN VII and carries VE-para/pre fibers(and SS taste fibers) to Vidian’s nerve.
    • It travels within the petrous part of the temporal bone and is considered to be the “motor root” of the ganglion.
  27. deep petrosal nerve
    • consists of VE-symp/post fibers which jump off the internal carotid plexus to join Vidian’s nerve.
    • considered to be the “sympathetic root” of the ganglion.
    • joins the greater petrosal n. just before it enters the pterygoid canal.
  28. Fiber Types in the Branches of pterygopalatine ganglion:
    • 1. Each branch carries general sensory (SA) fibers which join V2 via the pterygopalatine ns and brings info from the periphery back to the cell bodies in the trigeminal ganglion that then pass the info back to the CNS.
    • 2. Each branch carries VE-symp/post fibers to blood vessels. The symp/post fibers jump off the internal carotid plexus to form the deep petrosal nerve. The deep petrosal n. is the sympathetic root of the ganglion. This nerve joins the greater petrosal n. to form Vidian’s Nerve which brings the symp/post fibers to the ganglion.
    • 3. Each branch carries VE-para/post fibers to their target glands. The para/pre cell bodies are in the superior salivatory nucleus in the brain stem. These fibers follow CN VII and its branch “the greater petrosal nerve.” This nerve is the“motor root” of the ganglion. It joins the deep petrosal n. to form the nerve of the pterygoid canal (Vidian’s Nerve). Vidian’s Nerve brings the para/pre fibers to the ganglion.
  29. pterygopalatine ganglion Symp/Post Fibers
    • symp/post fibers jump off the internal carotid plexus to form the deep petrosal nerve.
    • The deep petrosal n. is the sympathetic root of the ganglion.
    • This nerve joins the greater petrosal n. to form Vidian’s Nerve which brings the symp/post fibers to the ganglion.
  30. pterygopalatine ganglion Para/Post Fibers
    • VE-para/post fibers to their target glands
    • para/pre cell bodies are in the superior salivatory nucleus in the brain stem.
    • These fibers follow CN VII and its branch “the greater petrosal nerve.” This nerve is the“motor root” of the ganglion.
    • It joins the deep petrosal n. to form the nerve of the pterygoid canal (Vidian’s Nerve).
    • Vidian’s Nerve brings the para/pre fibers to the ganglion.
  31. Pathway of VE-para/post fibers to the lacrimal gland
    • pterygo-palatine ganglion → pterygopalatine ns → V2 → zygomatic n. → zygomatico-temporal n. → communicating branch → lacrimal n. → lacrimal gland
  32. V2 Branches (that do not course through the ganglion)
    • One can think of the sensory (SA) fibers coursing through the pterygopalatine ganglion as being V2 branches.
    • There are other V2 branches, however, that do not course through the ganglion.
    • (1) zygomatic n.,
    • (2) posterior superior alveolar n., and
    • (3) infraobital n. & its branches (middle superior alveolar n. and anterior superior alveolar n.).
    • Note: All V2 branches are SA.
  33. Zygomatic nerve
    • arises from V2 in the pterygopalatine fossa.
    • Divides into 2 branches: the zygomaticofacial nerve and zygomatical temporal nerve.
  34. Posterior superior alveolar nerve
    • Arises from V2 in the pterygopalatine fossa.
    • Supplies 3 molar teeth, the adjacent buccal gingiva and mucous membrane of the cheek, and maxillary sinus.
  35. Infraorbital nerve
    • Once V2 enters the inferior orbital fissure, it changes names and becomes the infraorbital nerve.
    • The infraorbital nerve will lie in the infraobital groove and then enter the infraorbital canal to emerge on the face through the infraorbital foramen.
    • It gives rise to the middle & anterior superior alveolar nerves.
  36. Middle superior alveolar nerve
    • arises from the infraorbital nerve before it enters the infraorbital canal.
    • It supplies 2 premolar teeth, adjacent buccal gingival and mucous membrane of the cheek, and maxillary sinus.
  37. Anterior superior alveolar nerve
    • arises from the infraorbital nerve in the infraorbital canal.
    • It supplies the 2 incisor and canine teeth, adjacent labial gingiva and maxillary sinus.
    • The anterior, middle, and posterior superior alveolar nerves interconnect and form the superior dental plexus.
  38. CN VII (Facial Nerve)
    • motor root and a part called “nervus intermedius.”
    • The motor root contains all the branchial motor fibers – which innervate muscles of facial expression and several other muscles.
    • The nervus intermedius part contains all the other fiber types (VE-para/pre, SS for taste, & SA).
    • The VE-para/pre fibers from CN VII go to the pterygopalatine and submandibular ganglia.
    • The SS fibers supply the anterior 2/3rd of the tongue.
    • Some SA fibers innervate the concha area of the outer ear.
  39. Motor root of CN VII
    • consists of branchial motor fibers to the muscles of facial expression, stapedius m. (in the inner ear), and the posterior belly of the diagstric m.
  40. Nervus intermedius part of CN VII
    • consists of VE-para/pre fibers, SS (taste), and SA fibers.
    • 1. VE-para/pre fibers go the the:
    • a. submandibular ganglion – via chorda tympani n.
    • 1. VE-para/post fibers from this ganglion innervate the submandibular & sublingual glands
    • b. pterygopalatine ganglion – via the greater petrosal n (and then Vidian’s nerve)
    • 1. VE-para/post fibers from this ganglion innervate the lacrimal gland, & mucus glands of the nasal cavity, nasopharynx, and palate (hard and soft) regions.
    • 2. Special Sense (SS) fibers for taste to to the:
    • a. anterior 2/3rd of the tongue – via chorda tympani joining the lingual n.
    • b. “taste” cell bodies are in the geniculate ganglion.
    • 3. Geniculate Ganglion - is the sensory ganglion of CN VII (& lies within the petrous bone). It contains SS (taste) cell bodies and some SA cell bodies for fibers from the external ear (concha area).
  41. Geniculate Ganglion
    • sensory ganglion of CN VII (& lies within the petrous bone).
    • It contains SS (taste anterior 2/3rds tongue) cell bodies and some SA cell bodies for fibers from the external ear (concha area).

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