Individual Differences in the Structure of the Pterygopalatine Fossa of the Adult Skull

The use of endoscopic microsurgical techniques in a number of surgical interventions on deep anatomical structures of the face requires detailed knowledge on the shape and individual variability of the size of the pterygopalatine fossa, containing vascular and nerve structures that provide blood supply and innervation of the upper face, including the pterygopalatine ganglion. The aim was to study individual differences in the shape and size of the pterygopalatine fossa of the adult human skull. Material and methods. The study included 62 archival series of anonymous CT scans (37 men and 25 women), performed with slice thickness of 0.5 mm. On axial and frontal scans, the X and Y coordinates were determined relative to the upper left corner of the scan of the opening of the greater palatine canal, which later serves as the zero point. On subsequent sections, a point with the coordinates of the opening of the greater palatine canal and the distance from this point to another point of interest along the X and Y axes were determined. The difference between the slice numbers multiplied by the thickness of the slice is the distance between two points along the Z axis. Based on the obtained coordinates, a 3- D image of the pterygopalatine fossa was constructed in the isometry system. On axial, frontal and sagittal scans, the width of the medial, anterior and posterior walls of the pterygopalatine fossa, its depth, height and other dimensions characterizing the relative location of the openings passing nerves were measured. The right and left sides of the scans, which had no pathology in this area, were examined. Results. It was stated that in the cavity of the pterygopalatine fossa, one should distinguish between the most bulk main (central) region, adjacent on the lateral side to the sphenopalatine foramen, and narrower regions which are directed downwards (vestibule of the greater palatine canal); backward (vestibule of the pterygoid canal); and laterally (vestibule of the pterygomaxillary fissure). New information has also been obtained characterizing the variability of the size of the pterygopalatine fossa. Conclusion. This study has been shown that the pterygopalatine fossa has a more complex shape than a narrow slit or pyramid, and the presence of the vestibule of the pterygoid canal in its cavity suggests a different position of the pterygoid ganglion in the pterygopalatine fossa and its external structure.

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