Index terms:

Anatomy
Pterygopalatlne fossa

Computed tomographic anatomy

of the pterygopalatine fossa

Hugh D. Curtin, M.D.

Richard Williams, M.D.

Famillarilywith the appearance ofthls obscure fossa and its

related connections Is necessary for early detection of
tumor exteAsion.

Introduction

THIS SUBMITrED MANUSCRIPT WAS The pterygopalatine fossa (PPF) is an important landmark in the assess-
RECEr’JED MARCH 12, 1984 AND AC- ment of tumors of the nose, sinuses, and palate. Involvement of the fossa is
CEPTED FOR PUBLICATION ON
important because of the difficulty of surgical access. Perhaps more impor-
JUNE 1, 1984.
tant, however, is the role of the pterygopalatine fossa as a conduit transmit-
ting tumorfrom one area to another. Tumor can erode direcily into the fossa
by destroying its bony walls. Tumor can also pass through the fissures con-
necting the fossa with the orbit, the nasal ccMiy and the infratemporal fossa
(V. A very insidious form of tumor spread is perineural extension, by which a
tumor passes along a nerve and “resurfaces” more centrally (2, 3).
. Computed tomography can detect tumor extension into the
pterygopalatine fossa by the obliteration of the fat that is normally present
within it or by the enlargement ofthe neural foramina (1, 2, 4 5, 6,7, 8).
The anatomy of the pterygopalatine fossa is somewhat confusing be-
cause of its location in the skull base, partially hidden from view. This paper
seeks to illustrate the anatomy of the fossa, emphasizing the fissures and
foramina by which tumor can pass through the fossa, thus affecting the
I management of the lesion and prognosis ofthe patient. Photographs were
made ofa dried skull using a fiberoptic light source. These photographs were
combined with anatomic drawings and CT slices of normal patients to illus-
trate the anatomy of the pterygopalatine fossa and its connections. All CT
From the Department of
images are from the CuT 880O or the CT/I 98001 Using soft tissue or
Radiology. Eye and Ear Hospital. targeted high spatial resolution bone algorithms (Re\Aew package).1
Pittsburgh, Pennsylvania.
Address reprint requests to 1General Electric Co., Milwaukee, \Msconsin.

H. D. Curtin, M.D., Department of

Radiology. Eye and Ear Hospital.
230 Lothrop Street, Pittsburgh, PA
15213.
L._-: - -,,.,_______
Volume 5, Number 3 May,
#{149} 1985 ‘ RadioGraphics 429
CTanatomy of The pterygopalatine fossa Curtin and Williams

Anatomy

The pterygopalatine fossa is a fat filled space be- fissureforms the entrance to the pterygopalatine fossa
Iween the posterior wall of the maxillary sinus and the from the infratemporal fossa, which is the space deep
pterygoid process ofthe sphenoid bone (9). The upper to the zygomatic arch. The pterygomaxillary fissure
portion ofthefossa is bounded posteriorly by the junc- forms a smooth curve with the inferior orbital fissure
tion of the body, greater wing, and pterygoid process which forms a communication between the infratem-
of the sphenoid. Much of the medial wall of the poral fossa and the orbit. When viewed from below
pterygopalatine fossa is made up of the perpendicu- the zygoma, the curve resembles a boomerang. The
lar plate of the palatine bone. most posterior portion of the inferior orbital fissure
The fossa communicates directly with the submu- meets the most superior portion ofthe pterygopalatine
cosa of the posterior nasal cavity medially via the fossa, so there is no bony separation beiween the fossa
spenopalatine foramen. The wide pterygomaxillary and the orbit.

Figure 1
View of the pterygopalatine fossa from
a point lateral and Just inferior to the
zygomatic arch The infraorbital nerve
passes from the posterior opening of the
infraorbital canal, along the posterior
wall of the maxillary sinus (lower margin
of the inferior orbital fissure) to enter the
Posterior opening
pterygopalatine fossa (see Figure 6). -.

of infraorbital
canal

. __t. wall
of maxilla

Opening of
maxillary sinus

Figure 2
View of the lateral wall of the nasal cav#{149}
Sphenoid
ity The arrow is passing through the
sphenopalatine foramen from the ptery- I nf. t ur bi nate
gopalatine fossa.

430 RadioGraphics May,

#{149} 1985 Volume
#{149} 5, Number 3
Curtin and Williams CTanatomy ofthe pterygopalaiine fossa

Figure 3
View of the floor of the orbit looking from in front of, and
slightlyabovethe orbit The inferior orbital fissure can be
seen passing posteriorly. The foramen rotundum, which
opens into the upper section of the pterygopalatine fossa,
marks the position of the fossa. The pterygopalatine fossa
extends inferiorlyfromthe pointofentrance oftheforamen
rotundum. The foramen rotundum cannot be visualized in
this manner on all skull specimens because of differences
in the configurations ofthe orbital floors and inferior orbital
fissures (see Figure 7).

infraorbital canal

Sup. orbital
Pterygoid canal ..

Figure 4
Anterior view of a disarticulated sphenoid bone The
arrow is in the approximate position ofthe sphenopalatine
foramen. The shaded area represents the projection of the
pterygopalatinefossa onthe pterygoid process. The maxil-
lary division of the trigeminal nerve passes through the
foramen rotundum.

pterygoid plates

Figure 5
The course ofthe maxillary division of the trigeminal
nerve The maxillary division passes through the foramen
rotundum and continues on, paralleling the inferior orbital
fissure untilthe nerves turn into the infraorbital canal. The
palatine nerves pass inferiorlythroughthe pterygopalatine
canal and palatine foramina.

Volume 5, Number 3 May, 1985

#{149} #{149}RadioGraphic. 431
CTanatomy of Thepterygopalatine fossa Curtin and Williams

The pterygopalatine fossa is a branching point of slightly inferior and medial to the foramen rotundum
the maxillary division of the trigeminal nerve. The van- carries Vidian’s nerve and a small branch from the
ousforamina bywhich the branches enter and exit the internal maxillary artery. The maxillary nerve passes
pterygopalatine fossa are important pathways of po- along the inferior orbitalfissure to reach the infraorbital
tential tumor spread. This is especiallytrue of penineural groove and canal in the floor of the orbit. The greater
metastasis. palatine nerve passes infeniorly through the
The foramen rotundum links the pterygopalatine pterygopalatine canal to the greaten palatine fora-
fossa with the Gassenian ganglion and carries the men. The lesser palatine nerves pass through the lesser
maxillary nerve (“2) \fdian’s canal (pterygoid canal) palatine foramina.

Figure 6
View from beneath the zygoma This view looks through the pterygomaxillary fissure into the
pterygopalatine fossa. The fissure is in effect the entrance to the pterygopalatine fossa. The
pterygomaxillary fissure curves anteriorly meeting the inferior orbital fissure. Together the pter-
ygomaxillary fissure and the inferior orbital fissure form a boomerang-shaped cleftthrough which
the infratemporal fossa communicates with the pterygopalatine fossa interiorly and the orbit su-
periorly. Afiberoptic light source, aimed through the foramen rotundum, shines upon the anterior
wall ofthe pterygopalatine fossa. The sphenopalatine foramen can be seen as a black “hole” just
beneath the lighted area. This connects the pferygopalatine fossa with the posterior nasal cavity.
The inferior orbital fissure extends anteriorly just above the bright light (see Figure 1).

432 RadioGraphics May,

#{149} I 985 Volume
#{149} 5, Number 3
Curtin and Williams CTanatomy of The pterygopalatine fossa

Figure 7
Frontal vlewof the orbitwith a fiberoptic light source placed in the foramen rotundum The
foramen rotundum marks the upper limit of the pterygopalatine fossa. Note its relationship to
the posterior segment ofthe inferior orbital fissure (see Figure 3).

Figure 8
Lateral view looking into the pterygopalatine fossa The light source is in the nasal cavity.
The bright light seen in the pterygopalatine fossa is shining from the nasal cavity through the
sphenopalatine foramen.

Volume 5, Number 3 May,

#{149} 1985 RadioGraphics
#{149} 433
 CTanatomy of The pterygopalatine fossa Curtin and Williams

On CT, the pterygopalatine fossa is best seen in

transverse sections as a fat filled gap between the
posterior wall of the maxillary sinus and the anterior
cortex of the pterygoid plates. Occasionally, the fat in
the pterygopalatinefossa can be seen in coronal sec-
tions. The infraorbital canal, foramen rotundum and
Vidian’s canal are seen in cross section in coronal
scans, and in longitudinal section in transverse scans.
The palatine canals are seen in cross section in trans-
verse scans.

13,17 -

12,16 -

Figure 9
This diagram shows the location ofthe CT
sections in Figures 10-1 7, seen from the 11
lateral view. Locations are only approxi-
mated to show the relationship of the
sections. 10,15 -

Figure 10
Transverse CT section with window and centering setfor soft
tissue detail This is the most inferior transverse section, showing
the pterygopalatine canal. It is in the region of the suture lying
between the maxilla and the palatine bone which, at this level,
represents an inferior continuation ofthe anterior surface of the
pterygoid process. Therefore the fat ofthe pterygopalatine fossa
cannot be seen. Long arrow = pterygopalatine canal; Short ar-
rows = pterygoid plates; Small arrowheads = posterolateral wall
ofthe maxillary sinus; Large arrowhead = lateral pterygoid
muscle.

434 RadioGraphics May,

#{149} 1985 Volume
#{149} 5, Number 3
Curtin and Williams CTanatomy of The ptetygopalatine fossa

Figure 11
Transverse CT section with window and centering setfor soft
tissue detail This is a slightly higher transverse section. The
maxilla and pterygoids are now separated. and a fat-filled fossa
(short arrow) can be identified. C = mandibular condyle; Long
arrow the anterior extent ofthe infraorbital canal.

Figure 12
Transverse CT section with window and centering setfor soft
tissue detail Transverse section showing the soft tissue window
of the pterygopalatine fossa. The small densities within it represent
arterial and neural elements (long arrow). The sphenopalatine
foramen (spf) can be seen opening into the nasal cavity. The
pterygopalatine fossa opens widely into the infratemporal fossa
(hF) through the pterygomaxillary fissure. Short arrow = infra-
orbitalcanal.

Figure 13
Transverse CT section with window and centering setfor soft
tissue detail More superiorly. the pterygopalatine fossa meets
the inferior orbital fissure (long arrow).

Volume 5, Number 3 May,

#{149} 1985 RadioGraphics
#{149} 435
CTanatomy of The pterygopalatlne fossa Curtin and Williams

Figure 14
Transverse CT section with window and centering setfor bone
detail This is ah inferior section through the palate showing the
greater palatine foramen (large arrowhead) and the lesser
palatine foramina (small arrowhead). The section is atthe level of
the suture between the maxilla and the palatine bone (arrow).

Figure 15
Transverse CT sections with window and centering setfor bone
detail This slightly higher section Isthrough the plane of the
lower maxillary sinus (m). The section demonstrates the pterygo- I A

palatine canal (short arrow) atthe greater palatine foramen.

The lesser palatine foramina (small arrowhead) lies in the same I
plane as the suture (long Orrow) between the maxillary and
palatine bones. Large arrowhead = inferior turbinate.

436 RadioGraphics May,

#{149} 1985 Volume
#{149} 5, Number 3
Curtin and Williams CTanatomy of The pter,’gopalatine fossa

Figure 16
Transverse CT sections with window and centering setfor bone
detail This section lies slightly higher than Figure 15, through the
pterygopalatine fossa. The infraorbital canal (small arrowheads)
can be identifIed in longitudinal section. Vidian’s canal (short
arrow) can be seen passing from the pterygopalatine fossa
through the sphenoid to the region of the foramen lacerum. The
foramen ovale (long arrow) and foramen spinosum can be iden-
tified just lateral to Vidian’s canal. The sphenopalatine foramen
(spf) can be identified as a defect in the medial wall of the
pterygopalatine fossa, and the communication between the
pterygopalatine fossa and infratemporal fossa is visualized.

Figure 17
Transverse CT section with window and centering setfor bone
detail This slightly higher slice shows the foramen rotundum
(short arrow) in longitudinal section passing from the
pterygopalatine fossa to the middle cranial fossa. The inferior
orbital fissure is seen extending anteriorly in direct communica-
tion with the upper pterygopalatine fossa. Long arrow = inferior
orbitalfissure.

.. - -

Volume 5, Number 3 May,

#{149} I 985 ‘ RadioGraphics 437
CTanatomy of The pterygopalatine fossa Curtin and Williams

21 20 19
I I I
I I I
I I I

PPF...

Figure 18
This diagram shows the location of the CT
slices in Figures 19-21, seen from the lat- Maxillary
Pterygoid
eral view. Locations are only approxi- sinus
process
mated to show the relationships of the
sections.

I I I
I I I
I I I

Figure 19
Coronal CT section This coronal section
through the orbital floor shows the infraorbital
canal in cross section (arrow) in a patient with a
“blow-out” fracture. M = maxillary sinus.

438 RadioGraphics May,

#{149} 1985 Volume
#{149} 5, Number 3
Curtin and Williams CTanatomy of The pterygopalatine fossa

Figure 20
Coronal CT section This coronal section is through the
pterygopalatine fossa itself (ppf). The communication with
the infratemporalfossa laterally can be appreciated. The
small black arrows are on either side ofthe communication
between the pterygopalatine fossa and the orbital apex.
The sphenopalatine foramen medially can also be seen.
Arrow = sphenopalatine foramen; Large arrowhead =
inferiorturbinate; Small arrowhead = middle turbinate.

Figure 21
Coronal CT section This coronal section, with window
and centering selected for bone detail, lies posterior to the
pterygopalatine fossa showing the foramen rotundum (R)
and Vidian’s canal (‘I) in the sphenoid bone. The lateral
and medial pterygoid plates (arrowheads) are identified.
This section is immediately posteniorto the pterygopalatine
fossa.

Volume 5, Number 3 May,

#{149} I 985 RadioGraphics
#{149} 439
CTanatomy of The pterygopalatine fossa Curtin and Williams

Summary

The anatomy of the pterygopalatine fossa and its connecting fissures

and foramina are illustrated by photographs, drawings and CT images.
Familiarity with the appearance of the fossa and related connections is
necessary for early detection of tumor extension.

References

1. HesselinkJR,WeberAL. Pathways oforbitalextension of extraorbi- Pterygopalaline fossa: Computed tomographic studies. Radiol-
tal neoplasms. J ComputAssistTomogr 1982; 613: 593-597. ogy 1983; 149:511-516.
2. Ballanlyne AJ, McCarten AS, lbanez ML. The extension of cancer 6. ForbesW, FawcittR, sherwood l,Webb R, Farringtoe T. Computed
ofthe head and neck through peripheral nerves. Am J Surg tomography in the diagnosis ofdiseases ofthe paranasal sinuses.
1983; lO#{243}:651-667. Clin Radiol 1978; 29:501-511.
3. Dodd GD. Dolan PA Baliantyne ,AJ, et al. The dissemination of 7. Leekam R, TerBrugge KG, Chiu MC. Computed tomography of
tumors of the head and neck a the cranial nerves. Radial Clin the pterygopalafine fossa. J Can Assoc Radiol 1981; 32:97-101.
North Am 1970; 8:445-4#{243}1. 8. Parsons C, Hodson N. Computed tomography of paranasal sinus
4. Bryan RN, Sessions RB, Horowilz BL. Radiographic management tumors. Radiology 1979; 132:641-645.
ofjuvenile angiofibromas. AJNR 1981; 2:157-166. 9. GrayH.Anatomyofthe human body. 29th Edilion. Lea &Febiger.
5. Daniels DL. Rauschning W, Lovas J. Williams AL, Haughton VTvI. Philadelphia, 1973.

440 RadioGraphics May, I 985

#{149} Volume
#{149} 5, Number 3