The purpose of this article is to explain the anatomy of the pterygopalatine ganglion (PPG), its location in the pterygopalatine fossa (PPF) in the skull, and the relationship it has to the Vidian nerve terminal branches and the fifth cranial nerve. An overview of the neuro-anatomical/clinical correlations, a spectrum of pathologies affecting the seventh cranial nerve and some therapies both medical and surgical are noted. The focus is the pterygopalatine region with discussion of the proximal courses of the seventh and fifth cranial nerves and their pathological processes. The ganglion is used as an example of neuro-anatomical model for explaining cluster headaches (CH). Radiological correlation is included to clarify the location of the PPF and its clinical importance.

Clinical functional anatomy of the pterygopalatine ganglion, cephalgia and related dysautonomias: A review.

The pterygopalatine fossa (PPF) is accessed via the greater palatine canal (GPC) in an attempt to reduce bleeding during paranasal sinus surgery. This study aims to investigate the anatomy of the greater palatine foramen (GPF), GPC, and the PPF, with reference to PPF infiltration using three-dimensional reconstruction of computer tomographic (CT) scan measurements. The CT scans of 50 patients were retrospectively evaluated. The morphology of the GPF, GPC, and the PPF was assessed in a three-dimensional model. The thickness of the mucosa over the GPF was evaluated in the parasagittal plane. The mean length of the GPC was 13.8 ± 2.0 mm, and the mean height of the PPF was 21.0 ± 3.4 mm. The mean angles of the GPC in relation to the hard palate and the PPF were 67.4° ± 6.9° and 159.8° ± 7.1°, respectively. The GPF was 16.2 ± 1.3 mm lateral to the sagittal plane of the posterior nasal spine (PNS) and 6.1 ± 1.7 mm anterior to the coronal plane of the PNS. The mean volume of the PPF was 1039.9 ± 280.0 mm3. The mean thickness of the mucosa overlying the GPF was 10.7 ± 1.8 mm. We recommend that the PNS may be used as the bony landmark to locate the position of the GPF during PPF infiltration. The needle delivering the anesthetic should be bent 25 mm from the tip at a 45° angle, and a 1-ml injection of anesthetic should be administered in adults. Clin. Anat. 24:576–582, 2011. © 2011 Wiley-Liss, Inc.

An anatomic study using three-dimensional reconstruction for pterygopalatine fossa infiltration via the greater palatine canal.

The pterygopalatine fossa (PPF) infiltration is performed to reduce blood flow during endoscopic sinus surgery and septorhinoplasty, as well as to control posterior epistaxis and provide regional anesthesia in dental procedures. PPF infiltration performed with consideration of the morphometrics of greater palatine foramen (GPF), greater palatine canal (GPC) and PPF would increase the success of the procedure and reduce the risk of complications. The aim of this study is to investigate the GPF, GPC, lesser palatine foramen (LPF), lesser palatine canal (LPC) and PPF morphology via the images obtained by CBCT, to provide information for interventional procedures. GPF, GPC, LPF, LPC and PPF were morphometrically evaluated retrospectively in CBCT images of 75 female and 75 male cases by Planmeca Romexis program. The 19 parameters were measured on these images. These parameters were evaluated statistically. The comparison of these parameters by genders revealed significant differences in distances between GPC–PC, PC–IOF, LPC–GPF, GPF–MS in the coronal and transverse planes, the distance between GPF and the occlusal plane of the teeth, GPF–PNS, GPF–IF and TD-GPF, and in the area of GPF. The number of LPF was found ranging from 1 to 5. Our results may help to insert to needle properly for application of maxillary nerve block with a high success rate and minimal complication. We recommend that the needle should be inserted 14–15 mm lateral to the midsagittal plane, 19–20 mm over the occlusal plane of the teeth and on the same line with the third molar teeth. For PPF infiltration through the GPF, the needle should be pushed forward 28 mm upward at 66° angle on the transverse plane and 14°–15° angle on the vertical plane.

Morphometric evaluation and clinical implications of the greater palatine foramen, greater palatine canal and pterygopalatine fossa on CBCT images and review of literature

To analyze greater palatine canal (GPC) dimensions using cone-beam computed tomography (CBCT) images, and to evaluate the position of the greater palatine foramen (GPF) with respect to various landmarks selected in relation to dental status. This study included 150 CBCTs. Axial slices were used to determine the position and dimensions of the GPF. Sagittal slices were used to assess GPC length. Reference lines were established to evaluate the GPC diameter in sagittal and coronal slices. From the 77 GPF analyzed, 76 were located on level 2. Average posterior GPF distance was 6.59 ± 3.27 mm on right side and 7.35 ± 3.40 mm on left side. Several measurements to determine the position and dimensions of the GPF presented significant values (p ≤ 0.05). GPC length was 12.31 ± 1.96 mm on right side and 12.52 ± 2.15 mm on left side, statistically significant differences were detected between genders only on right canal (p ≤ 0.004). Sagittal and coronal reference lines presented significantly higher values for men except for the S3 (p < 0.062) and C1 (p < 0.067) in the left GPC. CBCT is a useful tool for evaluating GPC morphometrically in the three anatomical slices. The sagittal nasal plane and posterior nasal plane are two intraoral anatomical landmarks for the location of the GPF. Their scant variability allows accurate identification of GPFs in both dentate as well as edentulous patients.

https://link.springer.com/content/pdf/10.1007%2Fs00276-015-1511-y.pdf

Morphometric study of the greater palatine canal: cone-beam computed tomography

The greater palatine foramen (GPF) is an important anatomical landmark and has substantial clinical relevance in dental surgery. Knowledge of its precise location and dimensions is required for proper planning of surgical procedures involving the posterior maxilla. We used microfocus computed tomography to determine the location and dimensions of the GPF, and any sex and race variations in those measurements, in 77 human skulls scanned at the South African Nuclear Energy Corporation. Specialized software was used for three-dimensional rendering, segmentation, and visualization of the reconstructed volume data. GPF location ranged from adjacent to the first molar to distal of the third molar. The most common GPF location was near the third molar (66.7% of skulls), and the GPF was as close as 6.31 mm (mean distance 12.75 ± 3 mm). The mean GPF dimensions were 5.22 mm on the anterior-posterior axis and 2.81 mm on the lateral-medial axis. We noted no significant differences in relation to race, sex, or age in the sample. The GPF was adjacent or posterior to the third maxillary molar in most skulls.

A micro-CT study of the greater palatine foramen in human skulls

Aim To explore a method to obtain sub-millimeter data of the thin transverse section of the pterygopalatine fossa (PPF), and to study the thin transverse sectional anatomy of the adult pterygopalatine fossa and its communicating structure for providing anatomic gist for the imaging diagnosis and minimal invasive operation when PPF diseased. Material and methods Two heads of adult cadaver without macroscopic trauma (four sides of PPF) were selected to observe. Images of 0.6 mm-thick multi-planar construction (MPR) were obtained with multislice spiral CT (MSCT) based on the superior orbitomeatal line. Then, the specimens were sliced into 0.1 mm serial section on the transverse plane with the computerized milling machine, the figures were taken with digital camera and the sectional data were stored in the computer. Lastly, the thin transversal section of PPF was investigated and compared with multislice spiral CT images acquired by MPR technique to explore and discuss the anatomy of the thin transverse section of the internal structure of PPF. Results PPF was divided into four portions: infrapterygopalatine portion, pterygopalatine ganglionic one, suprapterygopalatine one and roof of PPF according to the structural characteristics of the transverse section of PPF. The infrapterygopalatine portion communicated laterally with the infratemporal fossa through the pterygomaxillary fissure and communicated downwards with the oral cavity via palatine greater and lesser canals. The pterygopalatine ganglion was shown clearly in the pterygopalatine ganglionic portion, and its dimensions were 3.91x1.92 mm at the best layer. In the suprapterygopalatine portion, the sphenopalatine foramen and artery were obviously shown on the medial wall, while the palatovaginal canal and artery, the pterygoid canal and artery, and the foramen rotundum and maxillary nerve were shown from the inferiomedial to laterosuperior on the posterior wall. The vomerovaginal canal and artery were located at the slightly superior portion of the medial side of the palatovaginal canal. Conclusion Figures of thin transverse section and multislice spiral CT have highly consistency for the display of PPF. Both of them can correctly identify the micro-structure, the complex relationship of the connectivity and the spatial localization in the narrow space of PPF. It can provide reference gist for the imaging diagnosis and minimal invasive operation.

/pdf/comparative-research-of-the-thin-transverse-sectional-5c8wsckq5k.pdf

Comparative research of the thin transverse sectional anatomy and the multislice spiral CT on Pterygopalatine Fossa.

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Comparative research of the thin transverse sectional anatomy and the multislice spiral CT on Pterygopalatine Fossa.