Razi Journal of Medical Sciences

  Background : Our aim in this study was to recognize the endoscopic anatomy of the Pterygopalatine fossa (PPF) and the anatomic variations of the related neurovascular structures, to define the endoscopic endonasal approach to this region.

  Methods: In a case series study 17 fresh adult cadavers were studied by endoscopic endonasal approach. To reach the pterygopalatine fossa endonasally, we performed the antrostomy and uncinectomy in all cadavers. The medial and posterior walls of the maxillary sinus were defined and studied. The internal maxillary artery and pterygopalatine ganglion and the other nerves were exposed. The posterior wall of maxillary sinus was opened to expose the pterygopalatine fossa and its neurovascular contents, which were studied and documented . Mean, median, range, standard deviation, frequency and frequency percentage were determined using statistical software SPSS V.19 and using descriptive analyses. For comparison of qualitative averages, independent t test was used after the normal distribution of data was tested to determine whether it is followed by 1-sample KS and -Chi square statistical test was used for the comparison of qualitative ratios. In all tests, significance level was considered as two tails and p value less than 0.05.

  Results: The PPF was easily approached by endoscopic transnasal transmaxillary approach. The PPF region was best exposed by the middle meatus tranasal approach. In the PPF infraorbital nerve, vidian nerve, greater palatine nerve, the infraorbital artery, internal maxillary artery, sphenopalatine artery, descending palatine artery, posterior superior alveolar artery and buccal artery were exposed.

  Conclusion: During the endoscopic transnasal transmaxillary approach to the PPF, it is possible to face wide range of variations in every phase of the approach but they are similarities at the base. Understanding the anatomy of this region and the neurovascular relations from the endoscopic view by cadaver dissections, will help us to perform more controlled and safe surgery.