Anatomy, Pterygopalatine Fossa

Excerpt

The pterygopalatine fossa, also known as the sphenopalatine or sphenomaxillary fossa, is a pyramid-shaped depression inferior to the posteriormost boundary of the orbit at the orbital apex. The pterygopalatine fossa lies deep to the infratemporal fossa and is bounded laterally by the temporalis muscle, medially by the palatine bone, anteriorly by the distalmost maxilla and maxillary tuberosity, posteriorly by the pterygoid process of the sphenoid, inferiorly by the pyramidal process of the palatine bone, and superiorly by the greater wing of the sphenoid. The pterygopalatine fossa communicates with the orbit, nasal cavity, oral cavity, infratemporal fossa, middle cranial fossa (MCF), and pharynx through 8 foramina or canals.

This region is critical in transmitting parasympathetic fibers and blood vessels to and from the face and is clinically important in disease spread and cranial surgical approaches. A 3-dimensional understanding of the pterygopalatine fossa is crucial for the rhinologist and basicranial surgeon to control epistaxis and remove basicranial lesions. A pterygopalatine space approach is used to treat lesions in the areas posterior to the maxillary sinus, including the pterygopalatine space and lateral sphenoid recess. Pathologic processes in this space are rare, with the most common being juvenile nasopharyngeal angiofibroma, neurogenic tumors, sinonasal malignancy perineural extension, and meningoencephaloceles.