Anatomical Variants of Post-ganglionic Fibers within the Pterygopalatine Fossa: Implications for Endonasal Skull Base Surgery

Lifeng Li; Nyall R. London Jr.; Daniel M. Prevedello; Ricardo L. Carrau

doi:10.1055/s-0040-1722714

Journal of Neurological Surgery Part B: Skull Base, Table of Contents

J Neurol Surg B Skull Base 2022; 83(S 02): e83-e88
DOI: 10.1055/s-0040-1722714

Original Article

Anatomical Variants of Post-ganglionic Fibers within the Pterygopalatine Fossa: Implications for Endonasal Skull Base Surgery

Lifeng Li

¹Department of Otolaryngology-Head & Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China

²Department of Otolaryngology-Head & Neck Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University, Columbus, Ohio, United States

,

Nyall R. London Jr.

²Department of Otolaryngology-Head & Neck Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University, Columbus, Ohio, United States

³Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, United States

,

Daniel M. Prevedello

²Department of Otolaryngology-Head & Neck Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University, Columbus, Ohio, United States

⁴Department of Neurological Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University, Columbus, Ohio, United States

,

Ricardo L. Carrau

²Department of Otolaryngology-Head & Neck Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University, Columbus, Ohio, United States

⁴Department of Neurological Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University, Columbus, Ohio, United States

› Author Affiliations

Abstract

Objectives The vidian nerve provides parasympathetic innervation to the nasal cavity and the lacrimal gland. Previous anatomic studies have primarily focused on preservation or severance of the vidian nerve proximal to the pterygopalatine ganglion (PPG). This study aimed to assess its neural fibers within the pterygopalatine fossa after synapsing at the PPG, and to explore potential clinical implications for endoscopic endonasal skull base surgery.

Methods An endonasal transpterygoid approach was performed on eight cadaveric specimens (16 sides). The PPG and maxillary nerve within the pterygopalatine fossa were divided. The vidian nerve was traced retrograde into the foramen lacerum, and postganglionic fibers distal to the PPG were dissected following the zygomatic nerve into the orbit. Potential communicating branches between the ophthalmic nerve (V1) and the PPG were also explored.

Results All sides showed a plexus of neural communications between the PPG and the maxillary nerve. The zygomatic nerve exits the maxillary nerve close to the foramen rotundum, piercing the orbitalis muscle to enter the orbit in all sides. The zygomatic nerve was identified running beneath the inferior rectus muscle toward a lateral direction. In 7/16 sides (43.75%), a connecting branch between V₁ and the pterygopalatine ganglion was observed.

Conclusion Neural communications between the PPG and the maxillary nerve were present in all specimens. A neural branch from V₁ to the PPG potentially contributes additional postganglionic parasympathetic function to the lacrimal gland.

Keywords

vidian nerve - pterygopalatine ganglion - postganglionic fiber - foramen lacerum - orbit

Full Text

References

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