Pterygopalatine Fossa 

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • The pterygopalatine fossa:
    • Is a small, cone- or inverted pyramid-shaped depression located deep within the upper face
    • It sits beneath the apex of the orbit, posterior to the maxilla, and medial to the infratemporal fossa
    • It acts as a major neurovascular crossroad connecting multiple regions of the skull
  • Borders / Boundaries – The borders of the pterygopalatine fossa are formed by the palatine, maxilla and sphenoid bones:
    • Anterior: 
      • Maxillary tuberosity and posterior surface of the maxilla
    • Posterior: 
      • Pterygoid process of the sphenoid bone (lateral pterygoid plate)
    • Medial: 
      • Perpendicular plate of the palatine bone
    • Lateral: 
      • Pterygomaxillary fissure opening into the infratemporal fossa
    • Superior: 
      • Inferior surface of the greater wing of the sphenoid bone
      • Inferior orbital fissure of the eye
    • Inferior:
      • Pyramidal process of the palatine bone
  • Major Contents:
    • Maxillary nerve (V2): 
      • The second division of the trigeminal nerve (cranial nerve V):
        • Passing through via the foramen rotundum (middle cranial fossa)
    • Pterygopalatine ganglion (Sphenopalatine ganglion): 
      • A parasympathetic ganglion:
        • Associated with cranial nerve VII
    • Maxillary artery: 
      • The third (terminal) part of the maxillary artery and its accompanying branches
    • Nerve of the pterygoid canal (Vidian nerve): 
      • Carrying sympathetic (via the deep petrosal nerve) and parasympathetic fibers (via the greater petrosal nerve) into the fossa
  • Communications and Openings:
    • The fossa communicates with surrounding anatomic regions via several key foramina and fissures:
      • Middle cranial fossa: 
        • Via the foramen rotundum
      • Orbit: 
        • Via the inferior orbital fissure
      • Nasal cavity: 
        • Via the sphenopalatine foramen
      • Oral cavity / Palate: 
        • Via the greater and lesser palatine canals
      • Infratemporal fossa: 
        • Via the pterygomaxillary fissure
      • Pharynx / Nasopharynx: 
        • Via the pharyngeal / palatovaginal canal
  • Clinical Significance:
    • Because of its numerous pathways and high density of nerves and blood vessels:
      • The pterygopalatine fossa can act as a conduit for the spread of infections and malignant tumors from the face or nasal cavity into the cranial vault
    • Surgeons also target this area for nerve blocks or approaches to control severe bleeding (epistaxis)
Left infratemoporal fossa demonstrating the opening of the pterygopalatine fossa (circled in red). Note: the zygomatic arch has been removed in this image.
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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