CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery
DOI: 10.1055/s-0040-1718430
Original Article | Artigo Original

Pterygopalatine Fossa: Microsurgical Anatomy and its Relevance for Skull Base Surgery

Fossa Pterigopalatina: Anatomia microcirúrgica e sua relevância para a cirurgia da base do crânio
1  The Center for Advanced Neurology and Neurosurgery (CEANNE), Brazil
2  Diane and M Gazi Yasargil Microsurgical Laboratory, University of Arkansas for Medical Sciences, Little Rock, AK, United States of America
,
2  Diane and M Gazi Yasargil Microsurgical Laboratory, University of Arkansas for Medical Sciences, Little Rock, AK, United States of America
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3  Division of Neurosurgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
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3  Division of Neurosurgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
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3  Division of Neurosurgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
› Author Affiliations

Abstract

Introduction The purpose of this study was to define the anatomical relationships of the pterygopalatine fossa (PPF) and its operative implications in skull base surgical approaches.

Methods Ten cadaveric heads were dissected at the Dianne and M Gazi Yasargil Educational Center MicrosurgicaLaboratory, in Little Rock, AK, USA. The PPF was exposed through an extended dissection with mandible and pterygoid plate removal.

Results The PPF has the shape of an inverted cone. Its boundaries are the pterygomaxillary fissure; the maxilla, anteriorly; the medial plate of the pterygoid process, and greater wing of the sphenoid process, posteriorly; the palatine bone, medially; and the body of the sphenoid process, superiorly. Its contents are the maxillary division of the trigeminal nerve and its branches; the pterygopalatine ganglion; the pterygopalatine portion of the maxillary artery (MA) and its branches; and the venous network. Differential diagnosis of PPF masses includes perineural tumoral extension along the maxillary nerve, schwannomas, neurofibromas, angiofibromas, hemangiomas, and ectopic salivary gland tissue. Transmaxillary and transpalatal approaches require extensive resection of bony structures and are narrow in the deeper part of the approach, impairing the surgical vision and maneuverability. Endoscopic surgery solves this problem, bringing the light source to the center of the surgical field, allowing proper visualization of the surgical field, extreme close-ups, and different view angles.

Conclusion We provide detailed information on the fossa's boundaries, intercommunications with adjacent structures, anatomy of the maxillary artery, and its variations. It is discussed in the context of clinical affections and surgical approaches of this specific region, including pterygomaxillary disjunction and skull base tumors.

Resumo

Introdução O presente estudo objetiva definir as relações anatômicas da fossa pterigopalatina (FPP) e suas implicações na cirurgia de base de crânio.

Métodos Dez cadáveres foram dissecados no centro educacional Dianne and M Gazi Yasargil, em Little Rock, AK, EUA. A FPP foi exposta via uma dissecção estendida com remoção da mandíbula e placa pterigoidea.

Resultados A FPP tem o formato de um cone invertido. Seus limites são a fissure pterigomaxilar; a maxila, anteriormente; a placa medial do processo pterigoide e a asa maior do processo esfenoide, posteriormente; o osso palatino, medialmente; e o corpo do processo esfenoide, superiormente. Os conteúdos são a divisão maxilar do nervo trigêmeo e seus ramos; o gânglio pterigopalatino; a porção pterigopalatina da artéria e seus ramos; e o plexo venoso. O diagnóstico diferencial de massas da FPP inclui extensão perineural de tumores sobre o nervo maxilar, schwannomas, neurofibromas, angiofibromas, hemangiomas e tecido salivar ectópico. Abordagens transmaxilares e transpalatais requerem ressecção extensa de estruturas ósseas e são estreitas em sua porção mais profunda, dificultando a visão cirúrgica. Cirurgia endoscópica é uma solução para tal, iluminando e possibilitando visualização adequada do centro do campo cirúrgico, aproximação extrema e diferentes ângulos.

Conclusão Descreve-se detalhadamente os limites, intercomunicações e estruturas adjacentes à FPP, anatomia da artéria maxilar e suas variações, com contextualização clínica e cirúrgica.



Publication History

Received: 27 July 2020

Accepted: 05 August 2020

Publication Date:
16 October 2020 (online)

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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