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The anatomy of the sympathetic pathway through the pterygopalatine fossa in humans

Domenii publicaţii > Ştiinţe medicale + Tipuri publicaţii > Articol în revistã ştiinţificã

Autori: Rusu MC, Pop F

Editorial: Annals of Anatomy, doi:10.1016/j.aanat.2009.10.003, 2009.


Usually the sympathetic distribution in the pterygopalatine fossa (PPF) is considered through the pterygopalatine ganglion (PPG) sympathetic root and branches. We hypothesized that there may be a dual sympathetic path within the PPF, through the vidian nerve and the PPG and through the periarterial plexuses. We dissected 10 human adult cadavers, fixed and unfixed; we applied antibodies for tyrosine hydroxylase (TH) on 5 human adult samples of PPF contents dissected out from cadavers at autopsy. We identified: TH(+) nerves and fibers distributed through the neuronal clusters of the PPG but also bundles extrinsic to these clusters, distributed along the maxillary artery. Also, TH(+) reactions were identified at the level of the neuronal capsules of the PPG. All the arteries within the PPF presented TH(+) fibers, periadventitial and intramural – the periarterial plexuses were also identified during dissections, a major one being that along the descending palatine artery, distinctive to the greater palatine nerve. So, in what concerns the sympathetic inflow to the PPF, this one seems to use both the path of the external carotid artery (via the maxillary artery plexus) and the path of the internal carotid artery, via the vidian nerve that supplies the PPG and reinforces the maxillary artery plexus. The sympathetic outflow of the PPF will use the neural scaffold of the PPG branches and also the arterial scaffold. The complex, trigeminal-autonomic, anatomic content of the PPF may be involved in several distinctive facial algias and thus the pain may be relieved by routine approaches of the PPF, based upon an updated anatomical knowledge and a correct diagnostic.

Cuvinte cheie: orofacial pain, facial neuralgia, headache, maxillary artery, superior cervical ganglion, human pterygopalatine ganglion