Anatomy of the Skull Base and Infratemporal Fossa
John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed in Paediatrics, The Ear, Skull Base, 2018
Two important structures are in this region, providing the blood supply to part of the nasal cavity. The first, found 24 mm posterior to the anterior lacrimal crest on the frontal process of the maxilla, along the frontoethmoid suture on the medial wall of the orbit, is the anterior ethmoidal foramina, transmitting the anterior ethmoidal artery; 12 mm behind this is the posterior ethmoidal foramina and its corresponding artery; 6 mm behind that lies the optic nerve in its canal. The second, found at the top of the perpendicular plate of the palatine bone, posterior to the maxillary hiatus (and so the middle concha), is the sphenopalatine foramen. This transmits the corresponding neurovascular bundle, important in control of the main blood supply to the nasal cavity and also in treating juvenile nasopharyngeal angiofibroma. Of note is the fact that the sphenopalatine artery rarely presents as one arterial trunk, as it divides in two or more (up to 10 branches) just after exiting the sphenopalatine foramen.
Case 66
Simon Lloyd, Manohar Bance, Jayesh Doshi in ENT Medicine and Surgery, 2018
In a young man presenting with a unilateral epistaxis with nasal obstruction and a mass arising from the lateral nasal wall in the region of the sphenopalatine artery the likely diagnosis is juvenile nasopharyngeal angiofibroma (JNA). This is confirmed on the imaging, which shows a heterogeneous mass arising from the posterior lateral nasal wall, enlarging the sphenopalatine foramen and extending into the infratemporal fossa. These are benign lesions accounting for 0.05% of head and neck tumours. They occur exclusively in males predominantly in the second decade with the highest incidence between the ages of 7 and 19 years. They rarely occur over the age of 25. CT scans can help to demonstrate bony involvement of the paranasal sinuses, orbit, pterygomaxillary fossa, greater wing of the sphenoid, basesphenoid and baseocciput. MRI scan allows for more accurate assessment of the size of the lesion and extent of expansion into the pterygomaxillary fossa/infratemporal fossa, orbit as well as skull base and intracranial spread. Biopsy is not advocated as this would cause brisk haemorrhage.
Head and Neck
Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno in Understanding Human Anatomy and Pathology, 2018
The temporal region (Plates 3.8 and 3.28 through 3.30) includes the temporal fossa and the infratemporal fossa, which lie superiorly and inferiorly to the zygomatic arch, respectively. The bony features of this region are shown in Plate 3.8 and described in detail in Section 3.2. Briefly, the parietal bone and frontal bone include the superior and inferior temporal lines for attachment of the temporalis muscle. The zygomatic arch is formed by the zygomatic process of the temporal bone and the temporal process of the zygomatic bone. The temporal fossa is formed by the parietal, frontal, squamous part of the temporal, and greater wing of the sphenoid, and contains the temporalis muscle. The infratemporal fossa contains the medial pterygoid muscle, lateral pterygoid muscle, branches of the mandibular nerve (CN V3) and the maxillary artery, and the venous pterygoid plexus converging into the maxillary veins (Plate 3.29). These two fossae communicate with each other through the interval between the zygomatic arch and the lateral surface of the skull. The pterygomaxillary fissure lies between the lateral plate of the pterygoid process of the sphenoid bone and the infratemporal surface of the maxilla. The pterygopalatine fossa lies at the superior end of the pterygomaxillary fissure, and the sphenopalatine foramen (which opens into the nasal cavity) is medial to the fossa (Plate 3.8c; see Box 3.9 for an easy way to remember these structures). The inferior orbital fissure lies between the maxilla and the greater wing of the sphenoid bone, which contains the foramen ovale and foramen spinosum.
Perineural spread of basosquamous carcinoma to the orbit, cavernous sinus, and infratemporal fossa
Published in Orbit, 2018
Alec L. Amram, William J. Hertzing, Stacy V. Smith, Patricia Chévez-Barrios, Andrew G. Lee
The pterygopalatine or sphenopalatine fossa is a passageway between many major compartments of the skull and is thus a critical location for tumor spread. This fossa is a located in the basilar region of the skull and is bounded medially by the palatine bone, posteriorly by the pterygoid process of the sphenoidal bone, and anteriorly by the posterior wall of the maxillary sinus. It has six communications to major compartments of the skull, communicating medially to the nasal cavity via the sphenopalatine foramen, laterally to the infratemporal fossa via the pterygomaxillary fissure, anteriorly to the orbit through the inferior orbital fissure, posteriorly and superiorly to Meckel’s cave and the cavernous sinus via the foramen rotundum, posteriorly and inferiorly to the middle cranial fossa via the vidian canal, and inferiorly to the palate through the greater and lesser palatine canals. As this fossa has direct access to the nasal cavity, intracranial space, orbit, and cavernous sinus, it is a common site for direct invasion and perineural spread of disease and can present with involvement of any combination of the aforementioned compartments.15 In our patient, the carcinoma most likely spread from the nasal cavity to the sphenopalatine fossa, and then extended to the infratemporal fossa, cavernous sinus, and orbit.
Isolated cranio-orbitofacial neurofibroma mimicking vascular malformation
Published in Orbit, 2018
Harinder S. Chahal, Brandon Kuiper, Puneet S. Braich, A. Tyrone Glover
Magnetic resonance imaging (MRI) with gadolinium revealed a large multi-lobulated mass in the right superior orbit with insinuation into multiple anatomic compartments (Figure 2A). The mass extended posteriorly through the orbital apex, without significant compression of the optic nerve, and into the right cavernous sinus with medial displacement of the internal carotid artery. Inferiorly, the mass extended into the infratemporal fossa via the sphenopalatine foramen, with extensive involvement of the maxillary sinus and retro-maxillary space (Figure 2B). Additional lesions were noted inferior to the right pterygoid muscles, and in the right occipital upper neck region, though it was not clear if these lesions were contiguous. The findings were felt to be consistent with a macrocystic lymphatic malformation.
Bilateral juvenile nasopharyngeal angiofibroma: A rare case report
Published in Acta Oto-Laryngologica Case Reports, 2021
Marlinda Adham, Kartika Hajarani, Lisnawati Rachmadi, Indrati Suroyo
Juvenile nasopharyngeal angiofibroma (JNA) is a rare, highly vascular benign tumour that was first described by Chaveau in 1906. They account for less than 0.5% of all head and neck tumours and the vast majority of cases manifest in males aged 10–24 years [1]. The site of the origin tumour is most likely at the superior margin of the sphenopalatine foramen and spreads into the submucosal plane. Over 98% of the tumours primarily involve the nasopharynx and thus called juvenile nasopharyngeal angiofibroma. Nevertheless, it can occur outside the nasopharynx as reported in some cases. Although benign, JNA can cause morbidity because of their highly vascular nature and local invasion through extensive bone destruction and remodelling [1]. The tumour can extend into the contralateral side of the nasopharynx, giving a false bilateral appearance. A true bilateral mass (two separate mass arising from both sides simultaneously) are extremely rare and to best of our knowledge only four cases was reported and ours is the most extensive case of bilateral JNA [2–5].
Related Knowledge Centers
- Nasopalatine Nerve
- Palatine Bone
- Pterygopalatine Fossa
- Sphenoid Bone
- Sphenopalatine Artery
- Nasal Cavity
- Sulcus
- Posterior Superior Alveolar Nerve
- Orbital Process of Palatine Bone
- Sphenoidal Process of Palatine Bone