Contents of the pterygopalatine fossa. Abscesses, phlegmons of the pterygopalatine and infratemporal fossae

Pterygopalatine fossa [fossa pterygopalatina(PNA, JNA, BNA)] - paired anatomical depression of the facial skeleton located between the tubercle upper jaw and pterygoid process sphenoid bone.

Anatomy

K. I. has an irregular shape, limited in front by the tubercle of the upper jaw, behind - by the pterygoid process and partially by the greater wing of the sphenoid bone, from the inside - by the outer surface of the perpendicular plate palatine bone. Outside K. I. communicates with the infratemporal fossa through the pterygomaxillary fissure (fissura pterygomaxillaris). Above K. I. communicates anteriorly with the orbit through the inferior orbital fissure (fissura orbitalis inf.), internally with the nasal cavity through the sphenopalatine foramen (foramen sphenopalatinum), posteriorly with the cranial cavity through the round foramen (foramen rotundum). Down K. I. passes into the narrow large palatine canal (canalis palatinus major), which opens with the large and small palatine openings into the oral cavity (Fig. 1-2). Average sizes of K. i. in the anteroposterior direction - 6.2 mm, in the transverse direction - 9.1 mm, in height - 18.6 mm.

IN childhood K. I. It is a small slit-like formation, which increases from three years of age.

Filled with fiber K. I. the second branch passes trigeminal nerve- maxillary nerve (n. maxillaris) with the zygomatic (n. zygomaticus), pterygopalatine (nn. pterygopalatina nerves and posterior superior alveolar nerves (nn. alveolares sup. post.) extending from it, which pass through the alveolar openings of the tubercle of the upper jaw. In addition Therefore, the pterygopalatine ganglion (ganglion pterygopalatinum) lies in the K. I.

Through K. I. branches of the maxillary artery pass through: infraorbital artery (a. infraorbitalis); descending palatine artery (a. palatina descendens); sphenopalatine artery (a. sphenopalatina). In K. I. and the adjacent infratemporal fossa partially contains the pterygoid venous plexus (plexus venosus pterygoideus).

K. I. is projected on the surface of the face from the side in the form of an equilateral triangle, the upper side of which runs along the line connecting the tragus of the ear with the outer edge of the orbit along the zygomatic arch, and the anterior and posterior sides at an angle of 60° from the anterior and posterior points of the upper side downward (Fig. 3).

X-ray anatomy

X-ray image of K. I. obtained from a photograph of the skull in a lateral projection. In this case, a summation of both signals occurs. on top of each other (Fig. 4), which makes it difficult to assess the condition of the test cell, which is located closer to the cassette during radiography. To obtain a separate image of it, the head of the subject from a lateral position is slightly turned with his face towards the cassette within 10°. Isolated image of the examined K. I. also obtained from tomograms.

In a complex image of the skull, it stands out as a wedge-shaped area of ​​clearing (Fig. 5) with a vertical length of about 2 cm. This area begins as an acute-angled clearing from the level of the alveolar process of the upper jaw and, expanding upward, passes into the region of the apex of the orbit. Here its transverse size is about 9 mm, and the diverging boundaries of the K. i. form an angle of 9 - 15°. Above K. I. delimited by the base of the skull in the form of arcuate lines formed by the large wings of the sphenoid bone.

Damage

If the upper jaw or base of the skull is damaged, during tuberal anesthesia and removal of large molars (eighth) teeth of the upper jaw, ruptures and injuries to the vessels and nerves located in the coronary artery are possible. The resulting hematomas do not resolve for a long time; Cases of vascular aneurysm have also been described. Gunshot wounds bones of the facial skeleton, accompanied by a violation of the ratio of the bones that form the cells, also lead to damage to blood vessels and nerve endings. After shrapnel wounds in K. I. sometimes they stay foreign bodies(metal fragments, fragments of bones, teeth, etc.), which can cause long-term inflammatory processes. Treatment of injuries to K. i. comes down to the treatment of damage to the upper jaw and other bones that form its walls. Foreign bodies and fragments are most often removed through the opened maxillary (maxillary) sinus with resection of its posterior wall or through an external wound.

Diseases

Acute purulent processes K. I. may occur as a result of the spread of the inflammatory process from the side temporal region, infratemporal fossa and orbit or develop after damage. Particularly dangerous are phlegmons of K. i., which can quickly spread into the orbit, maxillary sinus or into the cranial cavity. Surgical treatment: incisions are made from the vestibule of the oral cavity with half-closed jaws in the back upper section along the upper transitional fold of the mucous membrane, then carefully penetrate deeper in a blunt way (closed scissors, Kocher probe, etc.). A rubber drainage or rubber strip (turunda) is inserted into the incision, which is fixed with a ligature to the edge of the wound. The wound is often irrigated with antiseptics or antibiotics.

For some diseases (neuralgia, neuritis, etc.) to influence the vessels and nerves of K. i. blockades are carried out or medications are injected into it.

Tumors

Tumors can develop directly from the periosteum of the base of the pterygoid process and other tissues or grow into it from neighboring areas in case of cancer of the upper jaw, tumors of the nasal cavity, and less commonly the orbit. So-called Langenbeck's maxillary tumors grow rapidly and spread through the openings and crevices of the K. i. into the eye socket, nasal cavity, into the cranial cavity or, destroying the walls of the upper jaw, penetrate into the maxillary sinus. Infiltrative spread of a malignant tumor of the upper jaw leads to destruction first of the anterior and then back wall K. I.

Assessment of the condition of K. I. takes on special significance when malignant tumors upper jaw. If its condition is normal on radiographs and tomograms, radical surgical removal of the tumor is possible, but violation of the integrity of the walls of the fossa under study indicates the impossibility radical surgery. In these cases, radiation and chemotherapy are performed.

The prognosis depends on the type of tumor and the treatment performed.

Bibliography. Aliyakparov M. T. On the technique of radiography of the infratemporal region, Vestn, rentgenol, i radiol., No. 3, p. 74, 1973; Vernadsky Yu. I. Pi Zaslavsky N. I. Essays on purulent maxillofacial surgery, Tashkent, 1978; Tsybulkin A. G. and Grinberg L. M. X-ray anatomy of the pterygopalatine fossa and its possible significance in the clinic of nervous diseases, in the book: Actual. problem stomatoneurol., ed. V. Yu. Kurlyandsky and others, p. 121, M., 1974.

A. I. Rybakov; S. A. Sviridov (rent.).

Pterygopalatine fossa, fossa pterygopalatina, located in the anteromedial region. It is limited posteriorly by the pterygoid process, anteriorly by the tubercle of the upper jaw, and internally by the perpendicular plate of the palatine bone. From the middle cranial fossa through the round opening of the skull, foramen rotundum, the maxillary nerve enters it, n. maxillaris (II branch of the trigeminal nerve). Its direct continuation is the n. infraorbitalis, which enters the infraorbital canal (in the lower wall of the orbit formed by the maxillary bone) and, before its exit into the infraorbital region, gives off the upper alveolar and gingival branches that innervate upper teeth and gums.

Process of the same name fat body Sheki rises into the pterygopalatine fossa from the buccal region.

The deepest part of the region is the pharynx with its surrounding peripharyngeal space, spatium peripharyngeum.

It consists of retropharyngeal space, spatium retropharyngeum, and two lateral ones, spatium lateropharyngeum.

Retropharyngeal space located between the pharynx (with its fascia) and the prevertebral fascia and stretches from the base of the skull to level VI cervical vertebra, where it passes into the spatium retroviscerale of the neck.

The pterygopalatine fossa, pterygopalatine fossa (lat. fossa pterygopalatina) is a slit-like space in the lateral parts of the skull. Located in the infratemporal region, it communicates with the middle cranial fossa, orbit, nasal cavity, oral cavity and the outer base of the skull. It has 4 walls: the medial wall of the pterygopalatine fossa (perpendicular plate of the palatine bone), the anterior wall of the pterygopalatine fossa (tuberculum of the maxillary bone), the posterior wall of the pterygopalatine fossa (pterygoid process), the upper (inferolateral surface of the body and the base of the greater crest of the sphenoid bone ) Openings: sphenopalatine foramen (foramen sphenopalatinum), round, pterygoid canal, greater palatine canal, inferior orbital fissure.

14. Temporal and infratemporal fossa.

Infratemporal fossa (fossa infratemporalis) is a depression on the lateral surface of the skull, limited in front by the tubercle of the upper jaw, above by the greater wing of the sphenoid bone, medially by the pterygoid process, laterally by the zygomatic arch and ramus lower jaw; contains fiber, pterygoid muscles, maxillary artery, pterygoid venous plexus and mandibular nerve. The temporal fossa (fossa temporalis, PNA, BNA, JNA; syn. temple) is a paired depression on the skull formed by the scales of the temporal bone, part of the parietal bone, the greater wing of the sphenoid and the zygomatic process of the frontal bone.

15. Nasal cavity, walls.

The nasal cavity, cavum nasi, is located in the middle, in the upper section facial skull. The cavity consists of the nasal cavity itself and paranasal sinuses, lying upward, outward and posterior to it. The nasal cavity is divided by a septum into two halves and passes from behind through the choanae into the upper part of the pharyngeal cavity - the nasopharynx. There are three walls of the nasal cavity: The upper one is formed partly by the frontal bone, the cribriform plate of the ethmoid bone, and the sphenoid bone. Through the holes of the cribriform plates pass olfactory nerves. The lateral one is formed by the nasal bone, the frontal process and the nasal surface of the upper jaw, the lacrimal bone, and the medial plate of the pterygoid process of the sphenoid bone. On this wall there are three nasal conchas, limiting the three nasal passages: upper, middle and lower. The lower passage goes under the lower sink, the middle one is between the lower and middle sinks, the upper one is between the upper and middle sinks. The lower one is formed by the palatine process of the upper jaw and the horizontal plate of the palatine bone. The additional cavities of the nose are the sinuses - frontal, maxillary (Maxillary) and sphenoid, as well as the cells of the labyrinth of the ethmoid bone.

16. Messages from the nasal cavity.

The nasal cavity communicates with the external environment through the nasal openings - the nostrils, and with the nasopharynx - through the choanae (posterior nasal openings).

17. Orbit, walls.

The orbit is a paired cavity in the skull. The base is facing forward and forms the entrance to the orbit. The apex is directed back and medially to the optic canal. In the cavity of the orbit there are located: the eyeball, its muscles, the lacrimal gland, etc. It has 4 walls: upper (paries superior orbitae, formed by the orbital part of the frontal bone), medial (paries medialis orbitae, formed (from front to back) by the lacrimal bone, orbital plate, lamina orbitalis, ethmoid bone and the lateral surface of the body of the sphenoid bone), lower (paries inferior orbitae, formed mainly by the orbital surface of the upper jaw) and lateral (paries laleralis orbitae, formed in the posterior part by the orbital surface of the greater wing of the sphenoid bone, in the anterior part - by the orbital surface of the zygomatic bone)

fossa pterygopa-Iatina canalis palatinus major,

Inner base of the skullbasis cranii interna,

Anterior cranial fossa, fossa cranii anterior,

Middle cranial fossa, fossa cranii media,

fissura orblalis superior,

Posterior cranial fossa, fossa cranii posterior, clivus,

Outside surface base of the skull. Holes and their purpose.

External base of the skull, basis cranii externa, closed in front facial bones. The posterior section of the base of the skull, free for inspection, is formed by the outer surfaces of the occipital, temporal and sphenoid bones. Here you can see numerous holes through which arteries, veins, and nerves pass in a living person. Almost in the center of this area there is a large occipital foramen, and on its sides there are occipital condyles. Behind each condyle there is a condylar fossa with a non-permanent opening - the condylar canal. The base of each condyle is penetrated by the hypoglossal canal. The posterior section of the base of the skull ends at the outer occipital protrusion with the upper nuchal line extending from it to the right and left. Anterior to the foramen magnum lies the basilar part of the occipital bone with a well-defined pharyngeal tubercle. The basilar part passes into the body of the sphenoid bone. On each side of the occipital bone, on each side, the lower surface of the pyramid of the temporal bone is visible, on which the following important formations are located: external foramen sleepy channel, muscular-tubal canal, jugular fossa and jugular notch, which forms with the jugular notch of the occipital bone jugular foramen, styloid process, mastoid process, and between them the stylomastoid foramen. Adjacent to the pyramid of the temporal bone on the lateral side is the tympanic part of the temporal bone, surrounding the external auditory opening. Posteriorly, the tympanic part is separated from the mastoid process by the tympanomastoid fissure. On the posteromedial side of the mastoid process are the mastoid notch and the groove of the occipital artery.

On a horizontally located section of the squamous part of the temporal bone there is a mandibular fossa, which serves for articulation with the condylar process of the lower jaw. In front of this fossa is the articular tubercle. The gap between the petrous and scaly parts of the temporal bone on the whole skull includes rear end greater wing of the sphenoid bone; the foramen spinosum and foramen ovale are clearly visible here. The pyramid of the temporal bone is separated from the occipital bone by the petrooccipital fissure, fissura petrooccipitalis, and from the greater wing of the sphenoid bone by the sphenoid-petrosal fissure, fissura sphenopetrosa. In addition, on the lower surface of the outer base of the skull, a hole with uneven edges is visible - torn hole, foramen lacerum, limited laterally and posteriorly by the apex of the pyramid, which is wedged between the body of the occipital and the greater wing of the sphenoid bones.

15. Classification of bone joints: Continuous bone joints.

Types of continuous bone connections, their structure.

Pterygopalatine fossa: its walls, openings and their purpose.

Pterygopalatine (pterygopalatine) fossa, fossa pterygopa-Iatina, has four walls: anterior, superior, posterior and medial. The anterior wall of the fossa is the tubercle of the maxilla, the upper wall is the inferolateral surface of the body and the base of the greater wing of the sphenoid bone, the posterior wall is the base of the pterygoid process of the sphenoid bone, the medial wall is the perpendicular plate of the palatine bone. On the lateral side, the pterygopalatine fossa does not have a bone wall and communicates with the infratemporal fossa. The pterygopalatine fossa gradually narrows downwards and passes into the greater palatine canal, canalis palatinus major, which at the top has the same walls as the fossa, and at the bottom it is delimited by the upper jaw (laterally) and the palatine bone (medially). Five openings enter the pterygopalatine fossa. On the medial side, this fossa communicates with the nasal cavity through the sphenopalatine foramen, superiorly and posteriorly with the middle cranial fossa through the round foramen, posteriorly with the region of the foramen lacerum via the pterygoid canal, and inferiorly with the oral cavity through the greater palatine canal.

The pterygopalatine fossa is connected to the orbit through the inferior orbital fissure.

13. Internal base of the skull, openings and their purpose.

Inner base of the skullbasis cranii interna, has a concave, uneven surface, reflecting the complex topography of the lower surface of the brain. It is divided into three cranial fossae: anterior, middle and posterior.

Anterior cranial fossa, fossa cranii anterior, formed by orbital parts frontal bones, on which cerebral elevations and finger-like impressions are well defined. In the center, the fossa is deepened and filled with a cribriform plate of the ethmoid bone, through the openings of which the olfactory nerves (1st pair) pass. In the middle of the cribriform plate the cock's comb rises; in front of it are the foramen cecum and the frontal crest.

Middle cranial fossa, fossa cranii media, much deeper than the anterior one, its walls are formed by the body and large wings of the sphenoid bone, the anterior surface of the pyramids, and the scaly part of the temporal bones. In the middle cranial fossa, a central part and lateral parts can be distinguished.

On the lateral surface of the body of the sphenoid bone there is a well-defined carotid groove, and near the apex of the pyramid an irregularly shaped lacerated foramen is visible. Here, between the lesser wing, the greater wing and the body of the sphenoid bone, the superior orbital fissure is located, fissura orblalis superior, through which the oculomotor nerve passes into the orbit ( III pair), trochlear (IV pair), abducens (VI pair) and ophthalmic (first branch of V pair) nerves. Posterior to the superior orbital fissure there is a round foramen for the passage of the maxillary nerve (second branch of the V pair), then an oval foramen for the mandibular nerve (third branch of the V pair).

At the posterior edge of the greater wing lies the foramen spinosum for the passage of the middle meningeal artery into the skull. On the anterior surface of the pyramid of the temporal bone, on a relatively small area, there are the trigeminal depression, the cleft of the greater petrosal nerve canal, the groove of the greater petrosal nerve, the cleft of the lesser petrosal nerve canal, the groove of the lesser petrosal nerve, the roof tympanic cavity and an arcuate elevation.

Posterior cranial fossa, fossa cranii posterior, the deepest. The occipital bone, the posterior surfaces of the pyramids and inner surface mastoid processes right and left temporal bones. The fossa is complemented by a small part of the body of the sphenoid bone (in front) and the posteroinferior angles parietal bones- from the sides. In the center of the fossa there is a large occipital foramen, in front of it there is a slope, clivus, formed by the fused bodies of the sphenoid and occipital bones in an adult.

The internal auditory foramen (right and left) opens into the posterior cranial fossa on each side, leading to the internal ear canal, in the depths of which the facial canal for facial nerve(VII pair). The vestibulocochlear nerve (VIII pair) emerges from the internal auditory opening.

It is impossible not to note two more paired large formations: the jugular foramen, through which the glossopharyngeal (IX pair), vagus (X pair) and accessory (XI pair) nerves pass, and the hypoglossal canal for the nerve of the same name (XII pair). In addition to the nerves, the internal jugular vein, into which the sigmoid sinus continues, lying in the groove of the same name. The boundary between the arch and internal base of the skull in the region of the posterior cranial fossa is the groove of the transverse sinus, which passes on each side into the groove of the sigmoid sinus.

The pterygopalatine fossa is a space resembling a fissure, it is located in the lateral sectors of the human skull. This part of the body is characterized irregular shape, which is limited by the tubercle in front of the upper jaw, and behind it is framed by the pterygoid process.

Detailed anatomy

The pterygopalatine fossa is partially formed by a significant wing of the bone in the form of a wedge. Delving into the anatomy of this space, you can also notice that from the inside it is surrounded outer surface from the plate of the palatine bone, located perpendicularly.

From the outside it comes into direct contact with the infratemporal structure through a gap called the pterygomaxillary. Where are the boundaries of the pterygopalatine fossa?

At the top, the fossa in front connects with the orbit through the inferior orbital fissure, and inside there is contact with the nasal cavity passing through the wedge-shaped palatine foramen. From behind, the anatomy of this space is arranged in such a way that you can clearly see how it connects with the cranial cavity through the bottom, where it transitions into a thin large palatine canal, which opens through the large and small palatal spaces into the oral cavity. The average dimensions of the pterygopalatine fossa are considered to be six millimeters in the anterior direction, and nine millimeters in the transverse direction, while the height reaches eighteen units.

During childhood, the fossa is a tiny formation in the form of a gap, which begins to increase from the age of three. In the fossa filled with fiber there is the second branch of the triple nerve, which is called the maxillary nerve with the zygomatic and pterygopalatine nerves branching from it, as well as the posterior superior alveolar connection. These weaves go through the openings of the tubercles of the upper jaw. In addition, in the pterygopalatine fossa lies a node consonant with its name.

What does the pterygopalatine fossa communicate with?

Branches of arteries

Through the fossa there are branches of the so-called maxillary arteries, namely:

• infraorbital artery;
• descending palatine;
• sphenoid palatine artery.

In the foveal space and in the adjacent infratemporal recess, pterygoid venous weaves are selectively located.

The fossa seems to be projected onto the surface of the face as an isosceles triangle, top part it runs along a line that connects the point of the ear with the outer edges of the eye sockets in the direction of the zygomatic arch. The front, like the back, is at an angle of sixty degrees.

Anatomy of the pterygopalatine fossa with x-ray

The X-ray image of the foveal space appears as a result of lateral projections. During such operations, a total overlap of both dimples may occur. Such measures may make it somewhat difficult to assess the palatal space being examined, which is located closer to the cassette during the x-ray. To achieve a split image, the patient's head is turned from a lateral position slightly facing the cassette area; this should be done within ten degrees. Isolated images of the analyzed fossa are achieved through the use of tomography. The openings of the pterygopalatine fossa can be seen.

Separate area of ​​enlightenment

In difficult-to-see images of the skull, it is isolated in the form of a clearing area that stretches vertically over a distance of approximately two centimeters. Such a section originates as an angular clearing, starting from the point of the jaw, and then it expands upward. Then this area passes into the upper region of the orbit. In such an area, its transverse size reaches approximately nine millimeters, 9 mm, and the boundaries diverge and create an angle reaching fifteen degrees. On top, the fossa is framed by a part in the form of certain arcs, which are created by large parts of the sphenoid bone.

Possible damage to the pterygopalatine fossa

When either the base of the skull is damaged, during anesthesia and removal of molars, ruptures and injuries to blood vessels and nerves located in the area of ​​the pterygopalatine space may occur. The hematomas that arise in this case may not resolve for quite a long time. Situations when vascular aneurysms occur are also possible. bone structures skeleton, which are accompanied by an incorrect relationship of bones and form the pterygopalatine fossa, can also lead to injury to nerve endings and blood vessels. After suffering shrapnel wounds, foreign bodies may remain in the hole, for example, metal fragments, pieces of teeth, etc. This will most likely provoke prolonged inflammatory processes. Methods for restoring its damage rely on treating defects in the jaw and other bones that form its plates. Removal foreign bodies, as well as fragments, is most often carried out by opening maxillary sinus, or through an external wound.

Diseases

Purulent inflammation of this space usually occurs due to an increase in pain processes from the area in the temple area, or develops after the acquisition of damage. The most dangerous are the so-called phlegmons of the pterygopalatine fossa, which can rapidly spread into the orbit, oral cavity, or into the area of ​​the maxillary sinus of the skull. In such cases, steps should be taken surgical treatment. For these purposes, incisions are made from the side of the vestibule oral cavity in the posterior upper section along the mucous membrane, and then carefully try to get deep using, for example, closed scissors, a Kocher probe, and the like. A rubber turunda or drainage is inserted into the space, which must be secured with a ligature from the edge of the wound. The wound is usually irrigated with antibiotics or an antiseptic. For diseases such as neuralgia and neuritis, the necessary medications can be injected into the pterygopalatine fossa in order to influence the nerves and blood vessels.