Review of Anatomy and Pathology of the Pterygopalatine Fossa

Congress:

ECR 2020

Poster Number:

C-10353

Type:

Educational Exhibit

Keywords:

Head and Neck, Ear / Nose / Throat, Head and neck, CT, MR, Education, Education and training, Not applicable

Authors:

M. Bolger¹, C. Byrne², J. Hennebry³, A. Stroiescu³, R. Hayden⁴, I. Irvine⁵, L. Greene⁶, M. A. Farrell³; ¹Waterford, Munster/IE, ²Waterford /IE, ³Waterford/IE, ⁴Dublin 9/IE, ⁵Dublin 6/IE, ⁶Brittas/IE

DOI:

10.26044/ecr2020/C-10353

DOI-Link:

https://dx.doi.org/10.26044/ecr2020/C-10353

Learning objectives

Detailed review of anatomy and imaging features of the pterygopalatine fossa (PPF) Review of pathologies that involved the PPF Provide a “review-area” checklist for systematic assessment pathologies affecting the PPF.

Background

The pterygopalatine fossa (PPF) is a long, slender, fat-filled space in head & neck anatomy. This spaces acts as a neurovascular junction and has extensive communications throughout other head & neck (H&N) spaces. Due to PPFs multiple connections throughout the H&N this space can facilitate dissemination of disease via direct extension or perineural spread (PNS)

Findings and procedure details

Imaging the PPF CT: The fat filled is hypodense on CT- Loss of this normal fat signal is an important indicator of infiltration by pathological process CT provides excellent bony detail to assess for bone erosion and ensure symmetric calibre of multiple foramen MRI: T1-weighted imaging (T1WI) is most beneficial for initial assessement- demonstrates normal symmetric high fat signal in PPF. Can see flow voids due to maxillary artery and mild post-gadolinium enhancement secondary to emissary veins Multiplanar post-gadolinium imaging best modality to assess for...

Conclusion

The PPF is a small but crucially important space in H&N radiology, infiltration can be subtle on imaging and it can act as a highway to disseminate pathology throughout the H&N. Detailed anatomical knowledge is crucial to accurately assess the spread of disease processes along one of this spaces many connections. The “review area” checklist above allows systematic approach to this complex anatomical space and will aid in detection of subtle but clinically important spread of disease throughout the H&N spaces.

Personal information and conflict of interest

M. Bolger; Waterford, MUNSTER/IE - nothing to disclose C. Byrne; Waterford/IE - nothing to disclose J. Hennebry; Waterford/IE - nothing to disclose A. Stroiescu; Waterford/IE - nothing to disclose M. A. Farrell; Waterford/IE - nothing to disclose R. Hayden; Dublin 9/IE - nothing to disclose I. Irvine; Dublin 6/IE - nothing to disclose L. Greene; Brittas/IE - nothing to disclose

References

G.-J. Allemeersch et al. All roads lead to the pterygopalatine fossaC-2562; ECR 2017 Tashi S. etal.The pterygopalatine fossa: imaging anatomy, communications and pathology revisted. InsightsImaging2016;7(4):589-599.