1. Pterygopalatine Fossa

2. Objectives
Describe the boundaries and communications of the pterygopalatine fossa
Describe the course, anatomical relations, and branches of the maxillary nerve
Name the various types of fibers that the pterygopalatine ganglion receives and their sources
Name the branches of the pterygopalatine ganglion and describe their course and the structures they supply
Name the branches of the 3rd part of the maxillary artery and describe their course and the structures they supply

3. Pterygopalatine Fossa
small pyramidal space located medial to infratemporal fossa
boundaries:
anterior: posterior surface of body of maxilla
posterior: pterygoid process
superior: greater wing of sphenoid
medial: perpendicular plate of palatine
communications:
with infratemporal fossa via pterygomaxillary fissure
with orbit via inferior orbital fissure
with middle cranial fossa via foramen rotundum

4. Pterygopalatine Fossa
communications (cont.):
with nasal cavity via sphenopalatine foramen
pterygoid canal: runs in sagittal direction (anterior to posterior) through upper part of medial pterygoid plate  posterior opening is located in anterior border of foramen lacerum  anterior opening is located in posterior wall of pterygopalatine fossa, medial and inferior to foramen rotundum
greater and lesser palatine canals: begin at inferior end of pterygopalatine fossa and terminate on inferior aspect of hard palate
contents: maxillary nerve, pterygopalatine (3rd) part of maxillary artery, and pterygopalatine ganglion

9. (Pterygoid)

10. Maxillary Nerve contains only general sensory fibers
leaves middle cranial fossa and enters pterygopalatine fossa via foramen rotundum passes anteriorly through upper part of pterygopalatine fossa & enters the orbit via inferior orbital fissure where it becomes the infraorbital nerve.
infraorbital nerve lies first in infraorbital groove and then in infraorbital canal &emerges onto face through infraorbital foramen.

11. Maxillary Nerve Intracranial branch:
meningeal branch: supplies dura mater of middle cranial fossa
branches in pterygopalatine fossa:
ganglionic branches: connect maxillary nerve with pterygopalatine ganglion (parasympathetic ganglion located in pterygopalatine fossa, inferior to maxillary nerve) The ganglionic branches contain mostly sensory fibers (also contain a few postganglionic parasympathetic fibers for lacrimal gland)
zygomatic nerve: enters orbit via inferior orbital fissure & runs anteriorly, along lateral wall of orbit, and divides into zygomaticofacial and zygomaticotemporal nerves

12. Maxillary Nerve branches in pterygopalatine fossa (cont.):
zygomatic nerve (cont.):
zygomaticofacial nerve: supplies skin over prominence of cheek
zygomaticotemporal nerve: supplies skin over anterior temporal region
posterior superior alveolar nerve:
supply maxillary molar teeth and mucosa of maxillary sinus

13. Maxillary Nerve branches from infraorbital part:
middle superior alveolar nerve supplies maxillary premolar teeth and mucosa of maxillary sinus
anterior superior alveolar nerve supplies maxillary incisors and canine and mucosa of maxillary sinus
branches in face:
infraorbital nerve emerges onto face via infraorbital foramen & divides into branches that supply skin and conjunctiva of lower eyelid, skin of side of nose, and skin and mucosa of upper lip

16. Pterygopalatine Ganglion
parasympathetic ganglion located in pterygopalatine fossa, inferior to maxillary nerve
receives three types of fibers (sensory, preganglionic parasympathetic and postganglionic sympathetic), but only preganglionic parasympathetic fibers synapse in ganglion
source of general sensory fibers: maxillary nerve
source of preganglionic parasympathetic fibers: greater petrosal nerve
source of postganglionic sympathetic fibers: deep petrosal nerve
branches that originate from pterygopalatine ganglion contain sensory, postganglionic parasympathetic and postganglionic sympathetic fibers

17. Pterygopalatine Ganglion
Greater petrosal nerve:
branch of facial nerve
contains preganglionic parasympathetic fibers for lacrimal gland and glands of nasal cavity, palate and nasopharynx
joins deep petrosal nerve (branch of internal carotid plexus) to form nerve of pterygoid canal
deep petrosal nerve contains postganglionic sympathetic fibers (from neurons located in superior cervical ganglion of sympathetic trunk)

18. Pterygopalatine Ganglion
nerve of pterygoid canal passes anteriorly, through pterygoid canal, and terminates in pterygopalatine ganglion
preganglionic parasympathetic fibers synapse in pterygopalatine ganglion
sensory and postganglionic sympathetic fibers do not synapse in ganglion  pass without interruption into branches of ganglion
branches:
greater palatine nerve: emerges on inferior surface of hard palate via greater palatine foramen  runs anteriorly on inferior surface of hard palate  supplies mucosa of posterior part of hard palate

19. Pterygopalatine Ganglion
branches (cont.):
lesser palatine nerve: emerges on inferior surface of hard palate via lesser palatine foramen  supplies mucosa of soft palate and tonsil
nasopalatine (long sphenopalatine) nerve: enters nasal cavity via sphenopalatine foramen  passes anteriorly and inferiorly along nasal septum and supplies its mucosa  passes through incisive canal and emerges on inferior surface of hard palate via incisive fossa  supplies mucosa of anterior part of hard palate (behind incisor teeth)

20. Pterygopalatine Ganglion
branches (cont.):
posterolateral nasal branches: originate from pterygopalatine ganglion and greater palatine nerve  supply mucosa of posterior part of lateral wall of nasal cavity
pharyngeal nerve: supplies mucosa of sphenoidal sinus and nasopharynx
course of postganglionic parasympathetic fibers for lacrimal gland: pterygopalatine ganglion  maxillary nerve  zygomatic nerve  zygomaticotemporal nerve  communicating branch with lacrimal nerve  lacrimal nerve  lacrimal gland

25. Innervation of the Lacrimal Gland

26. Pterygopalatine (3rd) Part of Maxillary Artery
maxillary artery leaves infratemporal fossa and enters pterygopalatine fossa via pterygomaxillary fissure
its branches follow branches of maxillary nerve and pterygopalatine ganglion
branches:
posterior superior alveolar artery: accompanies posterior superior alveolar nerve  descends on posterior surface of maxilla  divides into branches which pass through alveolar foramina of maxilla  supplies maxillary molar and premolar teeth and mucosa of maxillary sinus

27. Pterygopalatine (3rd) Part of Maxillary Artery
branches (cont.):
infraorbital artery: accompanies infraorbital nerve  enters orbit through inferior orbital fissure  runs anteriorly in infraorbital groove and infraorbital canal  emerges onto face via infraorbital foramen  gives following branches:
anterior superior alveolar artery  supplies maxillary incisor and canine teeth and mucosa of maxillary sinus (sometimes there is also a middle superior alveolar artery)
terminal branches (on face) supply lower eyelid, side of nose and upper lip

28. Pterygopalatine (3rd) Part of Maxillary Artery
branches (cont.):
descending palatine artery: divides into lesser and greater palatine arteries  lesser palatine artery emerges through lesser palatine foramen to supply soft palate and tonsil  greater palatine artery reaches inferior surface of hard palate via greater palatine foramen  passes forward to supply mucosa of hard palate  gives off a branch that passes through incisive canal and anastomoses with a branch of sphenopalatine artery
pharyngeal artery: runs with pharyngeal branch of pterygopalatine ganglion  supplies mucosa of nasopharynx and sphenoidal sinus
artery of pterygoid canal: travels posteriorly in pterygoid canal  supplies walls and contents of pterygoid canal and mucosa of nasopharynx, auditory tube and tympanic cavity

29. Pterygopalatine (3rd) Part of Maxillary Artery
branches (cont.):
sphenopalatine artery: terminal branch of maxillary artery  enters nasal cavity via sphenopalatine foramen  gives off posterolateral nasal branches and posterior septal branches
posterolateral nasal branches: supply mucosa of posterior part of lateral wall of nasal cavity
posterior septal branches: supply mucosa of posterior part of nasal septum  one of these branches anastomoses with a branch of greater palatine artery