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Clinical Neuroanatomy
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
This very large ganglion is suspended from the maxillary division, deep in the pterygopalatine fossa. It receives its main contribution from the nerve of the pterygoid canal. This carries preganglionic, parasympathetic fibres derived from the pontine lacrimatory nucleus via the nervus intermedius (VIIth nerve) and sympathetic elements derived from fibres on the middle meningeal artery. Both groups of fibres are then relayed via their subsequent complex course to the lacrimal gland in the lacrimal branch of the nasociliary nerve. The main outflow of the ganglion is via the orbital, palatine, nasal and pharyngeal nerves to the mucous membranes of the orbit, nasal passages, pharynx, palate and upper gums.
Growth of the Cranial Base HHiH
Published in D. Dixon Andrew, A.N. Hoyte David, Ronning Olli, Fundamentals of Craniofacial Growth, 2017
The complexity of sphenoid growth was studied in animals (rats, rabbits, guinea pigs, pigs) by Hoyte (1971). The lateral accretion which widens the body “converts the roots of the attached processes into ’body’, and simultaneous remodeling (activity) must fashion new roots somewhat more laterally — thus carrying wings and processes laterally with growth.” Put the other way, “wing is remodeled to root, and root to body” (Hoyte, 1989). Note from Figure 11.20 that the pterygoid canal and foramen rotundum are also “carried” laterally with body widening — a “movement” that can only be active within the bone by preceding resorption and following deposition. The foramina ovalia and spinosa, the anterior clinoid processes (growing laterally and backwards), the optic foramina, all “move” in the same manner.
Bilateral sphenopalatine ganglion block with adrenaline additive for post-dural puncture headache in orthopedic patients: A randomized controlled trial
Published in Egyptian Journal of Anaesthesia, 2022
Amany Mohamed Abotaleb, Mohammed Said ElSharkawy, Hussen Gamal Almawardy
The sphenopalatine ganglion is a parasympathetic extracranial ganglion approximately 5 mm in diameter situated in the pterygopalatine fossa, posterior to the middle nasal turbinate and anterior to the pterygoid canal [10]. Within the ganglion, only the preganglionic parasympathetic fibers synaptize. Sympathetic neurons and somatic sensory fibers from the trigeminal nerve’s maxillary division run through the ganglion [11]. SPB blocks all of these fibers [12].
Acute Vision Loss as an Ophthalmic Complication of Dental Procedures
Published in Seminars in Ophthalmology, 2021
Cody Lo, Ashley H.S. Kim, Ahmed Hieawy, Nawaaz A. Nathoo
While this review focuses on vision loss in the context of dental procedures, there were many other ophthalmic conditions reported such as cranial nerve palsies and Horner’s syndrome that were deemed to be primarily due to diffusion of local anesthetic.27 Multiple reviews have found that ophthalmic complaints not related to visual acuity or fields following dental procedures were actually more common than those impacting vision.27,31 Cranial nerve palsies that cause ophthalmoplegia or diplopia could be described as “vision loss” by patients and still require ophthalmic assessment. In particular, local anesthesia of the upper jaw nerve blocks can often result in transient horizontal diplopia upon deviation from primary gaze due to a sixth cranial nerve palsy and paralysis of the lateral rectus muscle.50 This phenomenon is due to anesthetic deposition near the pterygoid canal and diffusion of anesthetic superomedially into the orbit to the lateral rectus muscle.50 In addition to the mechanisms discussed Horner’s syndrome is a constellation of signs and symptoms that corresponds to a lesion in the sympathetic pathway leading to the face and orbit. It is thought to be one of the most common ophthalmic complications of dental procedures.31 The leading explanation for this association is that local anesthetic injected into either the upper or lower jaw can diffuse through fascial tissue planes via the pterygomandibular space into the stellate ganglion, a significant part of the sympathetic pathway at the level of C7.51 Prakasm et al. (2009) note that anesthesia of the upper jaw can lead to diffusion into the ciliary ganglion, which contains fibres more specific to the eye but both the sympathetic and parasympathetic nerve fibres.52 It is important to recognize that in addition to visual acuity and visual fields, vision complaints related to compromise of extraocular adnexal structures can still result in patients presenting with vision changes or visual complaints.