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The pterygopalatine fossa: morphometric CT study with clinical implications

  • Aleksandra Vuksanovic-Bozaric
  • Batric VukcevicEmail author
  • Marija Abramovic
  • Nemanja Vukcevic
  • Natasa Popovic
  • Miroslav Radunovic
Original Article
  • 64 Downloads

Abstract

Purpose

The pterygopalatine fossa is a deep viscerocranial space containing the maxillary artery and nerve, the pterygopalatine ganglion, and the nerve of the pterygoid canal (vidian nerve). The endoscopic approach to this area relies on adequate preoperative imaging, such as computed tomography (CT). The aim was to determine the morphometric characteristics of the pterygopalatine fossa and its communications, including several previously unpublished measurements.

Methods

100 CT scans (56 male and 44 female patients) were analyzed. The axial, coronal, and sagittal slices, together with the three-dimensional reconstructions, were used in the study.

Results

The central diameter and the length of the foramen rotundum, the vertical diameter and the length of the pterygoid (vidian) canal, and the diameter of the sphenopalatine foramen were significantly larger in men. The central diameters of the foramen rotundum and the vidian canal were significantly smaller than their anterior and posterior transverse diameters. The vidian canal length of 12.1 mm indicates the presence of the type 3 VC with a sensitivity of 83% and a specificity of 85%.

Conclusion

Several new descriptions of the pterygopalatine fossa are presented here (such as the angle between the sphenopalatine foramen and the vidian canal, a new aspect in the understanding of the FR, and the distance between the posterior wall of the maxillary sinus to the vidian canal and the foramen rotundum), which might prove useful in the comprehension of the anatomy of the pterygopalatine fossa.

Keywords

Computed tomography Morphometry Pterygopalatine fossa Pterygoid canal 

Notes

Author contributions

AV-B: data analysis, manuscript writing, and editing; BV: data collection and manuscript writing; MA: data collection and analysis; NV: manuscript writing; NP: manuscript writing; MR: data analysis and manuscript editing.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Acar G, Cicekcibasi AE, Cukurova I, Ozen KE, Seker M, Guler I (2017) The anatomic analysis of the vidian canal and the surrounding structures concerning vidian neurectomy using computed tomography scans. Braz J Otorhinolaryngol S1808-8694(17):30215-X.  https://doi.org/10.1016/j.bjorl.2017.11.008 CrossRefGoogle Scholar
  2. 2.
    Alfieri A, Jho HD, Schettino R, Tschabitscher M (2003) Endoscopic endonasal approach to the pterygopalatine fossa: anatomic study. Neurosurgery 52:374–380CrossRefGoogle Scholar
  3. 3.
    Aoun G, Nasseh I, Sokhn S (2016) Radio-anatomical study of the greater palatine canal and the pterygopalatine fossa in a Lebanese population: a consideration for maxillary nerve block. J Clin Imaging Sci 6:35CrossRefGoogle Scholar
  4. 4.
    Berlis A, Putz R, Schumacher M (1992) Direct and CT measurements of canals and foramina of the skull base. Br J Radiol 65(776):653–661.  https://doi.org/10.1259/0007-1285-65-776-653 CrossRefPubMedGoogle Scholar
  5. 5.
    Bryant L, Goodmurphy CW, Han JK (2014) Endoscopic and three-dimensional radiographic imaging of the pterygopalatine and infratemporal fossae: improving surgical landmarks. Ann Otol Rhinol Laryngol 123(2):111–116.  https://doi.org/10.1177/0003489414523707 CrossRefPubMedGoogle Scholar
  6. 6.
    Chen CC, Chen ZX, Yang XD, Zheng JW, Li ZP, Huang F, Kong FZ, Zhang C (2010) Comparative research of the thin transverse sectional anatomy and the multislice spiral CT on the pterygopalatine fossa. Turk Neurosurg 20(2):151–158.  https://doi.org/10.5137/1019-5149.JTN.2732-09.0 CrossRefPubMedGoogle Scholar
  7. 7.
    Craiu C, Rusu MC, Hostiuc S, Sandulescu M, Derjac-Arama AI (2017) Anatomic variation in the pterygopalatine angle of the maxillary sinus and the maxillary bulla. Anat Sci Int 92:98–106.  https://doi.org/10.1007/s12565-015-0320-z8.CrossRefPubMedGoogle Scholar
  8. 8.
    Daniels DL, Mark LP, Ulmer JL, Mafee MF, McDaniel J, Shah NC, Erickson S, Sether LA, Jaradeh SS (1998) Osseous anatomy of the pterygopalatine fossa. AJNR Am J Neuroradiol 19(8):1423–1432Google Scholar
  9. 9.
    Daniels DL, Rauschning W, Lovas J, Williams AL, Haughton VM (1983) Pterygopalatine fossa: computed tomographic studies. Radiology 149:511–516.  https://doi.org/10.1148/radiology.149.2.6622697 CrossRefPubMedGoogle Scholar
  10. 10.
    Derinkuyu BE, Boyunaga O, Oztunali C, Alimli AG, Ucar M (2017) Pterygopalatine fossa: not a mystery! Can Assoc Radiol J 68(2):122–130.  https://doi.org/10.1016/j.carj.2016.08.001 CrossRefPubMedGoogle Scholar
  11. 11.
    Elhadi AM, Zaidi HA, Yagmurlu K, Ahmed S, Rhoton AL Jr, Nakaji P, Preul MC, Little AS (2016) Infraorbital nerve: a surgically relevant landmark for the pterygopalatine fossa, cavernous sinus, and anterolateral skull base in endoscopic transmaxillary approaches. J Neurosurg 125(6):1460–1468.  https://doi.org/10.3171/2015.9.JNS151099 CrossRefPubMedGoogle Scholar
  12. 12.
    Erdogan N, Unur E, Baykara M (2003) CT anatomy of the pterygopalatine fossa and its communications: a pictorial review. Comput Med Imaging Graph 27(6):481–487CrossRefGoogle Scholar
  13. 13.
    Fahmy CE, Carrau R, Kirsch C, Meeks D, de Lara D, Solares A, Otto BA, Prevedello DM (2014) Volumetric analysis of endoscopic and traditional surgical approaches to the infratemporal fossa. Laryngoscope 124:1091–1096.  https://doi.org/10.1002/lary.24428 CrossRefGoogle Scholar
  14. 14.
    Falcon RT, Rivera-Serrano CM, Miranda JF, Prevedello DM, Snyderman CH, Kassam AB, Carrau RL (2011) Endoscopic endonasal dissection of the infratemporal fossa: anatomic relationships and importance of Eustachian tube in endoscopic skull base surgery. Laryngoscope 121:31–41.  https://doi.org/10.1002/lary.21341 CrossRefPubMedGoogle Scholar
  15. 15.
    Fortes FSG, Sennes LU, Carrau RL, Brito R, Ribas GC, Yasuda A, Rodrigues AJ Jr, Snyderman CH, Kassam AB (2008) Endoscopic anatomy of the pterygopalatine fossa and the transpterygoid approach: development of surgical instruction model. Laryngoscope. 118:44–49.  https://doi.org/10.1097/MLG.0b013e318155a492 CrossRefPubMedGoogle Scholar
  16. 16.
    Grewal SS, Kurbanov A, Anaizi A, Keller JT, Theodosopulous PV, Zimmer LA (2014) Endoscopic endonasal approach to the maxillary strut: anatomical review and case series. Laryngoscope 124:1739–1743.  https://doi.org/10.1002/lary.24528 CrossRefPubMedGoogle Scholar
  17. 17.
    Gu Y, Yu Y, Zhang X, Hu F, Wang X, Xu W, Xie T (2015) Endoscopic endonasal transmaxillary transpterygoid approach to Meckel cave: anatomical study and preliminary clinical results. J Neurol Surg A Cent Eur Neurosurg 76(3):205–210.  https://doi.org/10.1055/s-0034-1389092 CrossRefPubMedGoogle Scholar
  18. 18.
    Guo J, Huang D, Chen S, Zhu S, Rong Q (2015) Treatment of a subtype of trigeminal neuralgia with descending palatine neurotomy in the pterygopalatine fossa via the greater palatine foramen—pterygopalatine canal approach. J Craniomaxillofac Surg 43:97–101.  https://doi.org/10.1016/j.jcms.2014.10.016 CrossRefPubMedGoogle Scholar
  19. 19.
    Hwang SH, Joo YH, Seo JH, Kim SW, Cho JH, Kang JM (2011) Three-dimensional computed tomography analysis to help define an endoscopic endonasal approach of the pterygopalatine fossa. Am J Rhinol Allergy 25:346–350.  https://doi.org/10.2500/ajra.2011.25.363 CrossRefPubMedGoogle Scholar
  20. 20.
    Kantola VE, McGarry GW, Rea PM (2013) Endonasal, transmaxillary, transpterygoid approach to the foramen ovale: radio-anatomical study of surgical feasibility. J Laryngol Otol 127:1093–1102.  https://doi.org/10.1017/S0022215113002338 CrossRefPubMedGoogle Scholar
  21. 21.
    Khonsary SA, Ma Q, Villablanca P, Emerson J, Malkasian D (2013) Clinical functional anatomy of the pterygopalatine ganglion, cephalgia and related dysautonomias: a review. Surg Neurol Int 4:S422–S428.  https://doi.org/10.4103/2152-7806.121628 CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Kim HS, Kim DI, Chung IH (1996) High-resolution CT of the pterygopalatine fossa and its communications. Neuroradiology 38(1):S120–S126CrossRefGoogle Scholar
  23. 23.
    Li J, Xu X, Wang J, Jing X, Guo Q, Qiu Y (2009) Endoscopic study for the pterygopalatine fossa anatomy: via the middle nasal meatus—sphenopalatine foramen approach. J Craniofac Surg 20(3):944–947.  https://doi.org/10.1097/SCS.0b013e3181a2d9c8 CrossRefPubMedGoogle Scholar
  24. 24.
    Mohebbi A, Rajaeih S, Safdarian M, Omidian P (2017) The sphenoid sinus, foramen rotundum and vidian canal: a radiological study of anatomical relationships. Braz J Otorhinolaryngol 83(4):381–387.  https://doi.org/10.1016/j.bjorl.2016.04.013 CrossRefPubMedGoogle Scholar
  25. 25.
    Oyama K, Tahara S, Hirohata T, Ishii Y, Prevedello DM, Carrau RL. Froelich S, Teramoto A, Morita A, Matsuno A (2017) Surgical anatomy for the endoscopic endonasal approach to the ventrolateral skull base. Neurol Med Chir (Tokyo) 57:534–541.  https://doi.org/10.2176/nmc.ra.2017-0039 CrossRefGoogle Scholar
  26. 26.
    Pinheiro-Neto CD1, Fernandez-Miranda JC, Rivera-Serrano CM, Paluzzi A, Snyderman CH, Gardner PA, Sennes LU (2011) Endoscopic anatomy of the palatovaginal canal (palatosphenoidal canal): a landmark for dissection of the vidian nerve during endonasal transpterygoid approaches. Laryngoscope 122(1):6–12.  https://doi.org/10.1002/lary.21808 CrossRefPubMedGoogle Scholar
  27. 27.
    Reymond J, Charuta A, Wysocki J (2005) The morphology and morphometry of the foramina of the greater wing of the human sphenoid bone. Folia Morphol 64(3):188–193Google Scholar
  28. 28.
    Rusu MC (2011) Doubled foramen rotundum and maxillary nerve fenestration. Anat Sci Int 33:723–772.  https://doi.org/10.1007/s00276-011-0810-1 CrossRefGoogle Scholar
  29. 29.
    Rusu MC (2010) Microanatomy of the neural scaffold of the pterygopalatine fossa in humans: trigeminovascular projections and trigeminal-autonomic plexuses. Folia Morphol 69(2):84–91Google Scholar
  30. 30.
    Rusu MC, Didilescu AC, Jianu AM, Paduraru D (2013) 3D CBCT anatomy of the pterygopalatine fossa. Surg Radiol Anat 35:143–159.  https://doi.org/10.1007/s00276-012-1009-9 CrossRefPubMedGoogle Scholar
  31. 31.
    Rusu MC, Pop F, Curca GC, Podoleanu L, Voinea LM (2009) The pterygopalatine ganglion in humans: a morphological study. Ann Anat 191:196–202.  https://doi.org/10.1016/j.aanat.2008.09.008 CrossRefPubMedGoogle Scholar
  32. 32.
    Sharma NA, Garud RS (2011) Morphometric evaluation and a report on the aberrations of the foramina in the intermediate region of the human cranial base: a study of an indian population. Eur J Anat 15(3):140–149Google Scholar
  33. 33.
    Tashi S, Purohit BS, Becker M, Mundada P (2016) The pterygopalatine fossa: imaging anatomy, communications, and pathology revisited. Insights Imaging 2016 7(4):589–599.  https://doi.org/10.1007/s13244-016-0498-1 CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Tomaszewska IM, Kmiotek EK, Pena IZ, Sredniawa M, Czyzowska K, Chrzan R, Nowakowski M, Walocha JA (2015) Computed tomography morphometric analysis of the greater palatine canal: a study of 1500 head CT scans and a systematic review of literature. Anat Sci Int 90(4):287–297.  https://doi.org/10.1007/s12565-014-0263-9 CrossRefPubMedGoogle Scholar
  35. 35.
    Uehara M, Tominaga K, Asahina I (2013) Surgical approach to the pterygopalatine fossa—comparison between anterior approach and lateral approach. J Craniofac Surg 24:536–539.  https://doi.org/10.1097/SCS.0b013e3182646b44 CrossRefPubMedGoogle Scholar
  36. 36.
    Wormald PJ, Athanasiadis T, Rees G, Robinson S (2005) An evaluation of effect of pterygopalatine fossa injection with local anesthetic and adrenalin in the control of nasal bleeding during endoscopic sinus surgery. Am J Rhinol 19(3):288–292CrossRefGoogle Scholar
  37. 37.
    Xu F, Sun X, Hu L, Wang J, Wang D, Pasic TR, Kern RC (2011) Endoscopic surgical treatment of neurogenic tumor in pteryopalatine and infratemporal fossae via extended medial maxillectomy. Acta Otolaryngol 131:161–165.  https://doi.org/10.3109/00016489.2010.522594 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  • Aleksandra Vuksanovic-Bozaric
    • 1
  • Batric Vukcevic
    • 1
    Email author
  • Marija Abramovic
    • 1
  • Nemanja Vukcevic
    • 1
  • Natasa Popovic
    • 1
  • Miroslav Radunovic
    • 1
  1. 1.Faculty of MedicineUniversity of MontenegroPodgoricaMontenegro

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