Endoscopic endonasal approach to the nerves of the pterygopalatine fossa: a detailed cadaveric anatomical study

Abstract

PurposeThe endoscopic endonasal approach offers a safe, reliable, and minimally invasive method to access the pterygopalatine fossa. In this study, we provide a detailed anatomical exploration of the pterygopalatine fossa, with a particular focus on the nerves and their spatial relationships to key endoscopic landmarks.MethodsA total of 12 pterygopalatine fossae from six formalin-fixed cadaveric heads (five female, one male) were dissected using both endoscopic approach and anatomical microscopic dissection to measure the lengths, diameters, and anatomical relationships of the nerves and arteries.ResultsThe maxillary nerve measured 15.93 +/- 6.19 mm in length and 3.96 +/- 0.69 mm in diameter, while infraorbital nerve measured 24.4 +/- 4.38 mm in length and 3.00 +/- 0.71 mm in diameter. The greater palatine nerve measured 13.15 +/- 4.25 mm in length and 2.70 +/- 0.39 mm in diameter. The Vidian nerve measured 16.78 +/- 1.18 mm in length and 2.15 +/- 0.51 mm in diameter. The pterygopalatine ganglion had a width of 4.59 +/- 1.16 mm and a height of 5.18 +/- 1.63 mm. The infraorbital nerves were primarily located lateral to the infraorbital artery, while the greater palatine nerves were typically found medial to the descending palatine arteries.ConclusionOur findings indicate that the maxillary, infraorbital, and greater palatine nerves, together with the pterygopalatine ganglion, are key landmarks for defining the surgical boundaries of the pterygopalatine fossa. These insights are expected to enhance the safety and precision of surgical interventions in this complex anatomical region, ultimately improving patient outcomes.