hello everybody and welcome back today we're going to be looking at the anatomy of the terago Palatine fosser we'll review the different structures that make up its boundaries we'll also look at the framer that connect the terop Palatine fossa to multiple different spaces within the skull and allow for the passageway of nerves and vessels through these frina we'll also name those nerves and vessels and I think the best place probably to start is to figure out where exactly the Tero paltin faucet is if we look at a lateral view of our 3D model we can see a shallow fosset being formed between the neurocranium and the viscerocranium this is a terago Palatine fosser anteriorly you can see the maxilla poster the sphenoid bone and medially the perpendicular plate or perpendicular part of the Palatine bone we can see this fosser also lies medial to the infratemporal fosser it lies deep in the face if we look at our CT scan and go to a similar level here find the infratemporal fosset that we've looked at previously here's the zygomatic Arch and we go medial to to that infratemporal fosser this small fosser here is the terago Palatine fosser anteriorly our maxilla bone posteriorly the sphenoid and immediately the Palatine bone now as you can see these bones come into close contact with one another and it's sometimes difficult to separate out these bones in your mind as a result I've created this 3D diagram a simplified diagram showing you the components of the terop Palatine foser we can see anteriorly this green structure is the maxill bone posteriorly we've got this sphenoid and medially we've got the Palatine bone the horizontal process as well as the perpendicular or vertical process the sphenoid bone we can see a lateral and medial teroid plates as well as the optic Canal that runs through the Lesser wings of the sphenoid here and three separate F that we're going to look at later you can see that the terago Palatine fossa has this inverse pyramid shape it goes from wide to narrow as we head inferiorly anteriorly here this represents maxillary sinuses we know that superiorly the maxilla makes up the inferior or the floor of the orbit and this passageway here is the inferior orbital fissure which we're going to look at later you can see on our 3D model the maxzilla making up the floor of the orbit here what I haven't included in this 3D diagram is the greater wings of this sphenoid and I'm going to show you later on how they contribute to the roof of the terop Palatine foser so let's go back to the CT scan and see how that terago Palatine fosser goes from large to small as we head from Superior to inferior let's scroll superiorly in the terago Palatine fosser here and I'm going to show you how we figure out the borders but let's just look how large the Tero paltin fosser is here and as we scroll down infer that Tero Palatine faucet gets smaller and smaller and smaller it Narrows down until we reach the horizontal plate of the Palatine bone here so that tergo paltin faucet gets narrower and narrower we've seen from that diagram that there are three bones that make up three walls of the Tero palatin foser the anterior medial and posterior wall we said that the anterior wall was made up by the posterior wall of the maxilla here we can see that on our sagittal plane here's the anterior border of the terago Palatine fosser see how that fosser is narrowing down as we head down inferiorly we can see the maxilla also wraps round and makes up the inferior border of the orbit here or the floor of the orbit medially we can see on the axial slice here is the vertical or perpendicular part of the Palatine bone that's making up the medial wall of the terago Palatine foser we can see that on our coronal slice here this medior wall is the Palatine bone here we can see the Palatine bone here separate from the maxilla and the alola process that we've looked at previously posteriorly we can see the teroid process of the sphenoid bone those teroid processes are heading inferiorly from the body of the oid down into the face and we know as those terog processes head down further and further they give off these two plates here a lateral and medial teroid plate anterior to the teroid processes here is the terago Palatine fossor you see laterally there is no boundary wall here laterally is actually an opening known as the terago maxillary fissure if we look at our 3D model where we place this yellow Chopstick through this hole here the hole we're placing ing it through is the terago maxillary Fisher it makes up the lateral boundary of the terago Palatine fosser so we know laterally from the terop Palatine fosser outwards we're going into the infratemporal fosser to go from the terop Palatine fossa to the infratemporal fossa we have to pass through the terago maxillary fure here we can see the terago maxillary fure represented on our 3D model as well here it's this opening here that's a terago axillary fissure so you the anterior medial and posterior walls and we know that the lateral wall is opening out into the infratemporal fosser the floor of the terago Palatine fosa is made up by the pyramidal process of the Palatine bone it's part of the horizontal portion of the Palatine bone here in that floor in that pyramidal process we've got two separate feram that we're going to look at later now the roof of the terago Palatine foser is a little bit more difficult to appreciate even using this simplified 3D model if we look at our scan here we're on our axial slice let's head up superiorly and make our way to the Superior part of the Tero Palatine fosser now a good Landmark to find the superior region of the Tero Palatine fosser is to look for the fan rundum here you can see it on our axial slice you can see it on the sagittal slice here as well as a coronal slice if we head out posteriorly the fan randum is going to supply the maxillary division of the trigeminal nerve and that plays a major role in the nerve Supply that travels through the terago paltin fucer that we're going to look at later if we go to our sagittal scan here you can see that superior to the Fon randum is this bone here which is the sphenoid bone this bone extends out as the greater wings of the sphenoid and anterior to the greater wings of the sphenoid is going to be this opening here which is the inferior orbital fure you can see on the 3D model the inferior orbital fissure has two boundaries an inferior boundary made up by the maxillary bone and a superior boundary that's made up by the greater wing of the sphenoid if we look on our CT scan here here's a maxillary bone making up that inferior boundary here's the greater wing of the sphenoid making up the superior boundary as I scroll out laterally you can see that fisher extending out laterally here's the greater wing of the sphenoid remember it's making up that middle cranial fosser and here is a maxilla bone you can see how the greater wing of the sphenoid is wrapping over the top like this and making up the roof of the terago Palatine fosser so that's the roof of the terago Palatine fosser we've labeled all of the boundaries now now let's have a look at some of the parameter that connect the terop Palatine fosser to various different spaces within the skull we've mentioned one here the inferior orbital fure that connects the terago Palatine fosser to the orbit we've also looked at the fan randum the fan rundum connects the middle cranial fosser to the terop Palatine fosser now below the frame and randum we've looked at a canal previously known as the vidiian canal this is also called the teroid canal the vidian canal or terago canal connects the terago Palatine fosser to the F and lerum as well as the cored canal here and you see why this Anatomy is important when we look at the nerves later on so we've seen the fan randum we've seen the teroid or vidian Canal if we head slightly inferior and more medially we're going to see a third opening traveling through the sphenoid bone this is what's known as the palatov vaginal Canal or the fenal Canal the fenal canal connects the terago Palatine fossa to the farings here so they're three faram running through the teroid process of the sphenoid bone if we have a look at our 3D model we can see those three faram here we've got the fan rundum the vidan canal or teroid Canal as well as the paletto vaginal Canal or the fenal Canal superiorly what I've represented here are the Lesser wings of the sphenoid remember making up part of the anterior cranial fosser and we can see the Lesser wings of the sphenoid have the optic canal running through it that's Superior to our terago Palatine fosser inferiorly or at the bottom of the terago Palatine fosser we've got two separate Fram running through the Palatine bone this is what's known as the greater and lesser Palatine Fram they connect the terago Palatine fosser to the oral cavity let's have a look at that on our scan let's scroll down inferiorly through the terago Palatine fosser as we head more and more inferiorly we're going to see two separate feram forming anterior is the greater Palatine framan and posterior is the Lesser Palatine framan let's have a look at that on our sagittal scan I'm going to scroll all the way across to the greater and lesser palatin framen you can see the greater palatin framen here extending into the oral cavity as well as the smaller lesser palatin frame and lying posteriorly here posterior to that are the medial and lateral plates of the teroid bone you can see how close contact we have between the Palatine bone and the sphenoid bone here now we've got one more opening to mention and that is in the superior medial portion of the terago Palatine fosser let's head up superiorly and we can see the Palatine bone on the medial surface here that Palatine bone part of it is going to come to an abrupt end above the Palatine bone is going to be an opening that connects a terago Palatine faucet to the nasal cavity let's head up more and more superiorly until we see that Palatine bone disa appear this opening on the medial surface on the superior aspect of the terop Palatine fosser is what's known as the speno Palatine framing connecting the terago Palatine foset to the nasal cavity if we head over to our 3D model and I pass this yellow Chopstick through the nasal cavity and then we look at the terop Palatine fosser from a lateral view you can see the tip of that Chopstick through the sphenopalatine framan so medially we've got this pheno Palatine framan and laterally we got the terox Fisher here now these ferina and Fishes become extremely important when figuring out the nerves and vessels that are passing into and out of the terop Palatine fossa so let's first have a look at the arteries that travel through the terop Palatine fossa and how they connect to the different spaces in the skull I think the best way to appreciate how the blood vessels travel through the terop Palatine faucet is by using the simplified 3D diagram now the major blood supply to the terop Palatine fosa is the maxillary artery now the maxillary artery is a branch of the external cored artery let's have a look at a time of flight MRA and see that maxillary artery we're here at the level of the nasal cavity we can see the lateral and medial teroid muscles the internal cored artery here got three different branches from the external cored artery this branch is this superficial temporal artery we know that artery that travels up superficially anterior to the ear you can feel that artery if you place your finger here that's one of the terminal branches of the external cored artery another terminal branch is the maxillary artery that we're going to look at today let's scroll down inferiorly here is the maxillary artery extending through the pared gland and running either deep or superficial to the lateral teroid muscle the maxillary artery is going to make its way to the terago Palatine fucer we know that the maxity artery also gives off a branch and this branch is something we've looked at before this branch is the middle menal artery which is going to travel through the frame and spinosum I don't know if you can remember that from our neurocranium torque we can follow that middle menial artery and see how it runs on the internal surface of the cranium here that's the one that we talked about when we looked at the teron and how the middle menial artery is susceptible to being ruptured if we get a fracture at the sight of the teron so let's scroll back down to the middle menial artery I've got a little bit of a tangent there here's our middle menial artery heading out towards the terop Palatine fosser see how it enters the terago Palatine fosser here and it's going to give off multiple branches branches that are going to be difficult to see on this scan we may be able to see one or two branches we can see a very faint Branch going into the floor of the orbit here and we can see some branches coming IM medially here let's go back to our diagram and see the branches that come off the maxillary artery first I mentioned that middle menial artery that's going to run through the fan spinosum and head up onto the internal surface of the cranium now that we're inside the Tero Palatine fosser we get our first branch that runs through the inferior orbital Fisher and runs along the floor of the orbit the floor of the orbit again is made up by the maxilla this is what's known as the infraorbital artery now the infraorbital artery gives off two branches an anterior and a middle Superior alviola artery we also have a separate Branch coming off the maxillary artery here which is the posterior Superior Alvi artery so we've got an anterior middle and posterior Superior alv artery we then have a branch that heads down inferiorly Bates and heads through the greater and lesser Palatine feram respectively this is what's known as the descending Palatine artery and it separates into a greater Palatine artery and a lesser Palatine artery the next Branch coming off this maxillary artery is the sphenopalatine artery that goes through the sphenopalatine framing that supplies blood to the nasal cavity when we get nose bleeds often those nose beds are coming from these vessels here we also have an artery going through the Vian Canal as well as a terago canal so the arteries are basically named by the fena that they pass through now the terop palatin foser is a small space we've already filled it with arteries we've still got to consider the nerves that travel through the terop Palatine fosser now you may have noticed I've included a separate structure within the terop Palatine fossa this is what's known as a terop Palatine gangon and that's going to become important later when we look at parasympathetic supply to the structures of the face now the main nerve that's passing into the terago palatin fosa is the maxillary division of the trial nerve we know that passes through the fan rundum let's have a look at our scan again go up to the level of the fan rundum the fan rundum we've looked at previously transmits the maxillary division of the trial nerve that then becomes the infraorbital nerve that travels through the infraorbital Groove infraorbital canal and out through the infraorbital forment we've looked at that in the previous talk so we know this nerve passing through giving off our infraorbital nerve there are other branches from this maxillary division though the first branch is the one we've looked at traveling through the inferior orbital fissure giving off an anterior a middle and a posterior Superior alola nerve this is mirroring the arterial Supply that we've looked at now but these are all coming off the infraorbital nerve the second Branch again mirrors what we looked at in our arterial Supply we have a lesser Palatine nerve and a greater Palatine nerve now descending as two separate NES and traveling through their respective frina they're going to supply sensation to the hard palate here we then have a separate branch that branches off the maxillary division of the trial nerve as it travels through the framan rundum and heads towards this ganglion here it heads towards this gangon and then the nerves travel on multiple different paths we've got a branch that heads through the sphenopalatine framan into the nasal cavity that's what's known as a nasopalatine nerve we have a zygomatic nerve heading away toward towards the and we've got a nerve that travels now backwards through the fenal Canal towards the FX these are all divisions of the trigeminal nerve they're V2 they're the maxillary divisions of the trial nerve you can see now how V2 suppli sensation to the structures of the face notice how the fenal nerve is traveling from anterior to posterior that nerve is traveling out of the terop Palatine fosser if we look at our scan this is where the maxillary division of the trial nerve is going to enter the Tero paltin foser and give off all those branches one of those branches that we've just mentioned now is going to head into the fings through the Fingal Canal or through the petto vaginal Canal out in towards the fing here now how are we getting sympathetic and Paris sympathetic supply to the face we know that that's not coming from the maxillary division of the trigeminal nerve sympathetic and parasympathetic Supply needs to come from somewhere else the sympathetic Supply coming from the sympathetic chain and the parasympathetic Supply coming from the facial nerve let's look at how that enters the terop Palatine foser firstly we have a nerve called the greater protal nerve this is a branch of the facial nerve and we're going to look at the pathway and the branches of the facial nerve in detail in a later talk but this is one of the branches and it has parasympathetic Supply traveling towards the terago Palatine fucer it's joined by a separate nerve known as a deep petal nerve these are petal nerves they're traveling through the protal portion of the temporal bone this deep Pro oal nerve is actually a sympathetic Supply coming from the sympathetic chain at the level of T1 those sympathetic nerves head up from the sympathetic chain and sinapse at the superior cervical ganglion before giving a post sinapic nerve that travels around the cored that sympathetic cored plexus if we look at our scan here we can see where the cored artery travels through the petus portion of the temporal bone that cored artery has sympathetic nerves in that sympathetic plexus traveling along with it now the greater petal nerve and the Deep petal nerve travel through this petris portion and they reach the fan lerum here that's where they combine to form the vidian nerve and that vidian nerve is going to travel through the vidian canal into the terop paltin fosser if we have a look at our diagram here we'll see those nerves uniting forming the vidian nerve now you can see that that vidian nerve is going to sinapse in this terago paltin ganglion here now these synapses are formed by the parasympathetic Supply from the greater protal nerve here this parasympathetic Supply then has a post synaptic nerve that's going to travel along the branches of the maxillary division of the trigeminal nerve these post synaptic branches that now hitchhike along the V2 division is what allows us to get parasympathetic supply to the face if you think of the laal gland for instance it needs parasympathetic Supply and this is how it happens the sympathetic Supply that is traveling from the deep protal nerve is not going to syapse at this Gangland it's already a post synaptic nerve but it's also going to follow the various different Pathways to various different structures of the face that need sympathetic Supply so this is a basic overview of the nerves that travel through the terop Palatine fosser as you can see if you know the boundaries of the terop paltin fosser and you know the openings it's quite easy to figure out where the vessels and where the nerves travel as they head into and out of the terop Palatine foser hopefully this talk has given you some conceptual understanding of how this fucer is formed it's a very small space but you can see it connects to the orbit connects to the nasal cavity connects to the oral cavity connects to the infratemporal fossa the middle cranial fossa the FX there's so many connections and when we have pathology we can see how pathology can travel through these various different openings and why knowing this Anatomy is important now if you want to test yourself on this Anatomy any head and neck and neuro Anatomy I've linked a question Bank below that you can test your knowledge figure out what you know well and what you don't know well otherwise I'll see you in the next talk goodbye everybody