Surgical Anatomy of Pterygopalatine Fossa in Endoscopic Endonasal and Trans-maxillary Approaches

Objective To study the surgical anatomy of pterygopalatine fossa in endoscopic endonasal and endoscopic trans-maxillary approaches.Methods Five adult formalin-fixed cadaver specimens(10 sides) were examined.The pterygopalatine fossa was exposed and explored step by step by using endoscopic endonasal and endoscopic trans-maxillary approaches.The observation of infratemporal fossa was facilitated by dissection under surgical microscope.The anatomic structures and their relationship with adjacent regions were carefully observed and recorded.Results In endoscopic endonasal or trans-maxillary approaches,the pterygopalatine fossa could be exposed after removing the posterior maxillary wall and the perpendicular plate of palatine bone.The main neurovascular structures in pterygopalatine fossa included the maxillary nerve,vidian nerve,pterygopalatine ganglion,maxillary artery and its terminal branches,the descending palatine artery and sphenopalatine artery.After opening the pterygopalatine fossa,following the associated anatomic landmarks,the adjacent regions,such as the cavernous sinus,orbital apex and the infratemporal fossa could be reached and exposed.Conclusion The anatomic structures of pterygopalatine fossa can be effectively exposed and manipulated through endoscopic endonasal and trans-maxillary approaches.