Palate Sphenopalatine Foramen Pterygopalatine Fossa

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					Palate; Sphenopalatine Foramen; Pterygopalatine Fossa




ASSIGNMENTS

         Moore's Clinically Oriented Anatomy: 950-951; 934-940

         Grant's Dissector:

                   284-288 ; Start at "Sphenopalatine Foramen and Pterygopalatine Fossa"; Stop at "Mouth
                   and Tongue".




HELPFUL HINTS

    1.   How to find the sphenopalatine foramen - The arteries in the nasal mucosa are dried and darkened. They
         will be difficult to see. The sphenopalatine artery may or may not serve as a useful landmark to finding the
         sphenopalatine foramen (Netter plate 3). Use a probe to feel for the sphenopalatine foramen if the
         sphenopalatine artery is not obvious in your specimen.

    2.   How to find the palatine nerves - You must break the perpendicular plate of the palatine bone to see the
         nerves and vessels in the palatine canal. Follow the instructions given in Grant's Dissector (pg. 284) but use a
         probe in place of a needle.

    3.   Take it easy on the soft palate - The muscles of the soft palate (especially those inferior to it) are thin and
         difficult to dissect. Proceed slowly as you remove the mucosa.

    4.   How to find the tensor veli palatini muscle - The tensor veli palatini muscle is hidden behind the medial
         pterygoid plate - to see it, break the plate out with a probe.

    5.   How to find the pterygopalatine ganglion - The pterygopalatine ganglion is not an onion-shaped bulge. It is
         just a flat spot on the palatine nerves at, or slightly inferior to, the level of the sphenopalatine foramen (Netter
         plate 37). To see the ganglion, split the greater and lesser palatine nerves (use a probe) from inferior to
         superior until they refuse to split any farther. The point at which the probe stops is the inferior end of the
         ganglion.

    6.   No wires, please - Don't run a wire up the auditory tube (Grant's Dissector pg. 288) - you will only ruin the
         middle ear causing you to see nothing in a later dissection.




WHEN YOU FINISH THIS SECTION, YOU SHOULD BE ABLE TO PERFORM THE FOLLOWING
TASKS AND ANSWER THESE QUESTIONS

    1.   What vessels supply blood to the palate?

    2.   Review the sensory innervation of the nasal and pharyngeal mucosae. Name the divisions of cranial nerve V
         that are involved and the branches of those divisions.

    3.   You are performing a tonsillectomy (removal of the palatine tonsils). What arteries must you cauterize during
         this procedure? What nerve is found in your surgical field immediately lateral to the tonsil bed?

    4.   List the muscles of the palate, their origins and insertions, actions and innervations.
   5.   To anesthetize the greater palatine nerve, around which foramen would you inject the anesthetic agent?




OSTEOLOGY

        Review the anatomy of the base of the skull, placing particular emphasis on the hard palate and
        pterygoid plates.

PALATE
      Hard palate

             o    Palatine process of the maxilla
                        Incisive foramen
             o    Horizontal plate of the palatine bone
                        Greater palatine foramen
                        Lesser palatine foramen

        Soft palate

             o    Muscles
                          Levator veli palatini m.
                          Tensor veli palatini m.
                          Musculus uvulae
                          Palatoglossus m.
                          Palatopharyngeus m.
             o    Blood vessels
                       Greater palatine a. and v.
                       Lesser palatine a. and v.
                       Ascending palatine branch of facial a. (review this topic)
                       Palatine branch of ascending pharyngeal a. (review this topic)
             o    Nerves
                       Motor
                                 Vagus (X)
                                 Trigeminal (V3)
                       Sensory
                                 Trigeminal (V2)

        Palatine tonsil

             o    Location
             o    Surface features
                        Mucosa
                        Tonsillar crypts
             o    Vascular supply to the palatine tonsil
                        Ascending palatine br. of facial a.
                        Tonsillar br. of facial a.
                        Palatine br. of ascending pharyngeal a.
                        Tonsillar br. of dorsal lingual a.
                        Descending palatine br. of maxillary a.
             o    Important lateral relationships of the palatine tonsil
                        Arteries listed above
                        Glossopharyngeal n.

PTERYGOPALATINE FOSSA AND GANGLION
                                          Study Note: Pterygopalatine Fossa

The osteology of the pterygopalatine fossa is very complicated. You could easily spend two hours trying to learn
everything about the bones in this area. Do not place great emphasis on this study. We want you to know the general
location of the pterygopalatine fossa and the openings (listed below) that carry important nerves to the nasal and oral
regions. An understanding of the function of the pterygopalatine ganglion is more important than finding it.



           Pterygopalatine ganglion

               o    Location - pterygopalatine fossa

               o    It communicates with the:
                          Nasal cavity - by way of sphenopalatine foramen (nasopalatine n.)
                          Oral cavity - by way of greater palatine canal (greater and lesser palatine nn.)
                          Cranial cavity - by pterygoid canal and foramen lacerum (preganglionic fibers arrive in n.
                            of pterygoid canal)




               o    Function of the pterygopalatine ganglion
                         A parasympathetic (terminal) ganglion
                         Preganglionic fibers - greater petrosal n. (VII)
                         Postganglionic fibers - maxillary division V (V2)



               o    The pterygopalatine ganglion provides motor supply to the:
                         Lacrimal gland [zygomaticotemporal n. (V2) to lacrimal n. (V1)]
                         Nasal mucosa
                         Palatine glands
                         Mucosa of nasal pharynx posterior to the auditory tube



ANATOMY TABLES FOR TODAY'S TOPIC


Osteology

Bone/Cartilage        Structure                  Description                                     Notes

sphenoid                              an irregularly shaped bone           it has many parts, including a body, greater
                                      forming the central portion of the   wing, lesser wing and pterygoid plates
                                      skull

                   scaphoid fossa     an oval depression at the superior   it is the site of origin of the tensor veli
                                      end of the lateral pterygoid plate   palatini m.

                   pterygoid          hook-like projection from the        it acts as a pulley for the tendon of the tensor
                   hamulus            inferior end of the medial           veli palatini m.
                                      pterygoid plate

                   pterygoid canal    canal that occurs at the junction    it transmits the nerve of the pterygoid canal
                                      of the greater wing, the pterygoid   from the pterygoid region to the
                                      process and the body of the          pterygopalatine fossa
                                      sphenoid bone
maxilla                              bone forming the midface                it forms the inferior orbital margin and
                                                                             contains the teeth and maxillary sinus

                  incisive foramen   opening in the midline, posterior       it transmits the terminal branches of the
                                     to the maxillary incisor teeth          nasopalatine nn. & sphenopalatine aa.; it
                                                                             marks the point of union during development
                                                                             of the primary and secondary palate

palatine                             the bone that forms the posterior       paired; failure of the perpendicular plates to
                                     part of the hard palate                 fuse during development leads to a midline
                                                                             defect (cleft palate)

                  sphenopalatine     a notch at the posterosuperior          along with the sphenoid bone it forms the
                  notch              margin of the perpendicular plate       sphenopalatine foramen
                                     of the palatine bone

                  orbital process    a small, superior projection from       it forms a small part of the floor of the orbit
                                     the perpendicular plate of the          located posteroinferiorly near the apex
                                     palatine bone

                  horizontal plate   the portion of the palatine bone        paired; the two horizontal plates meet at the
                                     that forms the posterior 1/3 of the     midline
                                     hard palate

                  greater palatine   an opening in the hard palate           it transmits the greater palatine neurovascular
                  foramen            located medial to the 3rd               bundle; it is an important site for oral
                                     maxillary molar tooth                   anesthesia

                  lesser palatine    an opening in the hard palate           there may be more than one; it transmits the
                  foramen            located posterior to the greater        lesser palatine n. and vessels
                                     palatine foramen


Muscles

     Muscle               Origin           Insertion        Action         Innervation       Artery             Notes

constrictor,       medial pterygoid       pharyngeal      constricts       vagus (X),     ascending      the most internal
superior           plate, pterygoid       tubercle and    the              via the        pharyngeal     of the three
pharyngeal         hamulus,               midline         pharyngeal       pharyngeal     a.             pharyngeal
                   pterygomandibular      pharyngeal      cavity           plexus                        constructor mm.
                   raphe, mylohyoid       raphe
                   line of mandible

levator veli       apex of the petrous    muscles and     elevates         vagus nerve    ascending      a derivative of the
palatini           part of the temporal   fascia of the   the soft         (X) via the    pharyngeal     fourth pharyngeal
                   bone and the           soft palate;    palate           pharyngeal     a.             arch
                   medial surface of      palatine                         plexus
                   the auditory tube      aponeurosis
                   cartilage

musculus uvulae    posterior nasal        mucosa of       shortens         vagus nerve    lesser         the soft palate and
                   spine                  the uvula       the uvula        (X) via        palatine a.    uvula resist the
                                                                           pharyngeal                    upward pressure
                                                                           plexus                        of the tongue
                                                                                                         during swallowing

palatoglossus      palatine               side of the     elevates         vagus nerve    tonsilar       although
                   aponeurosis            tongue,         and              (X) via the    branch of      palatoglossus
                                          entering it     retracts the     pharyngeal     the facial     sounds like a
                                          from above      tongue           plexus         a.,            tongue muscle
                                                                                          ascending      (and would
                                                                                          pharyngeal     therefore be
                                                                                           a.             innervated by
                                                                                                          XII), it is a palatal
                                                                                                          muscle innervated
                                                                                                          by X

palatopharyngeus      posterior margin of    posterior       elevates      vagus nerve     ascending      palatopharyngeus
                      the bony palate and    wall of the     the larynx    (X) via         pharyngeal     is part of the inner
                      the palatine           pharynx and                   pharyngeal      a.             longitudinal
                      aponeurosis            the posterior                 plexus                         muscle layer of
                                             margin of                                                    the pharynx
                                             the thyroid
                                             cartilage

tensor veli           scaphoid fossa,        palatine        opens the     mandibular      ascending      remember: V3
palatini              lateral wall of the    aponeurosis     auditory      division of     pharyngeal     innervates both
                      auditory tube                          tube;         the             a.             tensor muscles
                      cartilage                              tenses the    trigeminal                     (tympani and veli
                                                             soft palate   nerve (V)                      palatini); ALL
                                                                                                          other palatal
                                                                                                          muscles are
                                                                                                          innervated by
                                                                                                          vagus


Nerves

         Nerve                Source               Branches                Motor                Sensory            Notes

of the pterygoid         formed by the       ends in the              secretomotor         none            contains:
canal                    union of the        pterygopalatine          (parasympathetic)                    preganglionic axons
                         greater petrosal    ganglion                 to: lacrimal gland                   of the greater
                         n. (preganglionic   (parasympathetic)        and mucous                           petrosal n. bound
                         parasympathetic)                             glands of nasal                      for pterygopalatine
                         and the deep                                 cavity and                           ganglion where they
                         petrosal                                     maxillary sinus;                     will synapse;
                         n.(postganglionic                            sympathetic                          postganglionic
                         sympathetic)                                 innervation to                       sympathetic axons
                                                                      vascular smooth                      of the deep petrosal
                                                                      muscle in the                        n. which will pass
                                                                      same region                          through the
                                                                                                           pterygopalatine
                                                                                                           ganglion without
                                                                                                           synapsing

greater petrosal n.      facial (VII)        no named branches        secretomotor         none            greater petrosal n.
                                                                      (preganglionic                       joins the deep
                                                                      parasympathetic)                     petrosal n. to form
                                                                      to: lacrimal                         the n. of the
                                                                      gland, mucous                        pterygoid canal; the
                                                                      glands of the                        greater petrosal n.
                                                                      lower nasal                          contains:
                                                                      cavity, maxillary                    preganglionic
                                                                      sinus and palate                     parasympathetic
                                                                                                           axons bound for the
                                                                                                           pterygopalatine
                                                                                                           ganglion where they
                                                                                                           will synapse; it
                                                                                                           passes through the
                                                                                                           hiatus of canal of
                                                                                                           greater petrosal n. in
                                                                                                           the petrous part of
                                                                                                           the temporal bone
pterygopalatine   preganglionic        postganglionic          secretomotor to:      none             a parasympathetic
ganglion          parasympathetic      parasympathetic         mucous glands of                       ganglion; the
                  axons arrive via     axons distribute via    the palate, nasal                      pterygopalatine
                  the n. of the        the greater & lesser    cavity, lacrimal                       ganglion hangs off
                  pterygoid canal      palatine nn.,           gland                                  of the maxillary
                  from greater         nasopalatine n.,                                               division of the
                  petrosal n. of the   sphenopalatine n.                                              trigeminal n. (V2)
                  facial n (VII);      and zygomatic n.                                               within the
                  postganglionic                                                                      pterygopalatine
                  sympathetic                                                                         fossa; preganglionic
                  axons arrive via                                                                    axons of the greater
                  the n. of the                                                                       petrosal n. synapse
                  pterygoid canal                                                                     here; postganglionic
                  from the deep                                                                       sympathetic axons
                  petrosal n.                                                                         of the deep petrosal
                                                                                                      n. pass through the
                                                                                                      otic ganglion
                                                                                                      without synapsing
                                                                                                      (they synapse in the
                                                                                                      superior cervical
                                                                                                      sympathetic
                                                                                                      ganglion)

vagus n.          medulla: dorsal      auricular br.,          SVE: intrinsic        GSA: skin        also known as: CN
                  motor nucleus        pharyngeal br.,         muscles of the        of the           X, 10th cranial
                  (GVE                 superior laryngeal,     larynx, pharynx       external         nerve; the vagus n.
                  preganglionic        superior and inferior   (except               auditory         passes through the
                  parasympathetic);    cervical cardiac        stylopharyngeus),     meatus;          jugular foramen to
                  inferior ganglion    brs., recurrent         and palate            GVA:             exit the posterior
                  (GVA); nucleus       laryngeal n.,           (except tensor        viscera of       cranial fossa; vagus
                  ambiguus (SVE);      thoracic cardiac        veli palatini);       head, neck,      means "wanderer"
                  superior ganglion    brs., brs. to the       GVE: smooth           thorax &         in reference to its
                  (GSA); inferior      pulmonary plexus,       muscle of the         abdomen          extensive
                  ganglion(SVA)        brs. to the             respiratory tree &    proximal to      distribution to the
                                       esophageal plexus,      gut (proximal to      the left colic   body cavities
                                       anterior and            the left colic        flexure;
                                       posterior vagal         flexure), heart;      SVA: taste
                                       trunks                  secretomotor:         from the
                                                               mucous glands of      epiglottis
                                                               the larynx,
                                                               respiratory tree,
                                                               pharynx and gut;
                                                               secretomotor to
                                                               digestive glands

trigeminal n.     motor root arises    ophthalmic,             SVE: anterior         skin of the      also known as: CN
                  from the             maxillary and           belly of the          face;            V, 5th cranial nerve;
                  trigeminal motor     mandibular              digastric m.,         mucous           some brs. carry pre-
                  nucleus in the       divisions               mylohyoid m.,         membranes        or postganglionic
                  pons (SVE);                                  tensor veli           of the nasal     parasympathetic
                  sensory part                                 palatini m., tensor   and oral         fibers; the
                  arises from the                              tympani m.;           cavities;        trigeminal n.
                  trigeminal                                   muscles of            general          divides into three
                  ganglion (GSA)                               mastication:          sensation        divisions at the
                  and projects into                            temporalis m.,        (GSA) to the     trigeminal ganglion;
                  the pons to the                              masseter m.,          anterior 2/3     SVE supplies
                  primary sensory                              lateral pterygoid     of the           muscles of 1st
                  nucleus of V or                              m., medial            tongue           pharyngeal arch
                  more inferiorly to                           pterygoid m.                           origin
                  the nucleus of the
                  spinal root of V
                       (medulla and
                       upper spinal
                       cord)

mandibular division    trigeminal         meningeal br.,         SVE: mylohyoid       GSA: skin       also known as: V3;
of the trigeminal n.   ganglion; motor    medial pterygoid       m., anterior belly   of the lower    passes through the
                       root arises from   and lateral            of the digastric     lip and jaw     foramen ovale to
                       the pons           pterygoid nn.,         m.; tensor           extending       exit the middle
                                          masseteric n.,         tympani m.,          superiorly      cranial fossa; the
                                          anterior and           tensor veli          above level     otic ganglion is
                                          posterior deep         palatini m.;         of the ear;     associated with the
                                          temporal nn., buccal   muscles of           mucous          medial side of V3
                                          n., auriculotemporal   mastication          membrane        below the foramen
                                          n., lingual n.,        (temporalis,         of the          ovale; the
                                          inferior alveolar n.   masseter, medial     tongue and      auriculotemporal n.
                                                                 pterygoid and        floor of the    carries
                                                                 lateral pterygoid)   mouth;          postganglionic
                                                                                      lower teeth     parasympathetic
                                                                                      and gingiva     axons to the parotid
                                                                                      of the          gland; the
                                                                                      mandibular      submandibular
                                                                                      alveolar        ganglion is
                                                                                      arch            associated withe the
                                                                                                      lingual n. near the
                                                                                                      submandibular
                                                                                                      gland;
                                                                                                      postganglionic
                                                                                                      parasympathetics
                                                                                                      from the
                                                                                                      submandibular
                                                                                                      ganglion supply the
                                                                                                      submandibular
                                                                                                      gland and the
                                                                                                      sublingual gland

maxillary division     trigeminal         meningeal br.,         none                 GSA: skin       also known as: V2;
of the trigeminal n.   ganglion           posterior superior                          of the upper    maxillary division
                                          alveolar n.,                                lip, cheek,     of the trigeminal n.
                                          pharyngeal,                                 lower           passes through the
                                          posterior superior                          eyelid;         foramen rotundum
                                          medial and lateral                          mucous          to enter the
                                          nasal brs.,                                 membrane        pterygopalatine
                                          nasopalatine n.,                            of the          fossa; the
                                          greater and lesser                          palate; teeth   pterygopalatine
                                          palatine nn.,                               and gingiva     ganglion is
                                          zygomatic n.,                               of the          associated with it in
                                          infraorbital n.                             maxillary       the pterygopalatine
                                                                                      alveolar        fossa;
                                                                                      arch; the       postganglionic
                                                                                      mucous          parasympathetic
                                                                                      membrane        fibers distribute
                                                                                      lining most     with branches of the
                                                                                      of the nasal    maxillary division
                                                                                      cavity; the     to mucous glands of
                                                                                      mucous          the nasal cavity and
                                                                                      membrane        palate; the
                                                                                      lining the      zygomatic n. & its
                                                                                      maxillary       brs. carry
                                                                                      sinus           postganglionic
                                                                                                      parasympathetic
                                                                                                      axons to the orbit to
                                                                                                       reach the lacrimal n.
                                                                                                       and lacrimal gland

lacrimal n.           ophthalmic          no named branches       carries              skin of the     lacrimal n. carries
                      division of the                             secretomotor         lateral         the postganglionic
                      trigeminal n.                               axons to the         portion of      parasympathetic
                      (V1)                                        lacrimal gland       the upper       axons from the
                                                                                       eye lid and     zygomaticotemporal
                                                                                       its             br. of the maxillary
                                                                                       associated      n. that originate in
                                                                                       conjunctiva     the pterygopalatine
                                                                                                       ganglion

glossopharyngeal n.   medulla: spinal     tympanic nerve to       GSE:                 GVA:            also known as: CN
                      trigeminal          the tympanic plexus     stylopharyngeus;     carotid         IX, 9th cranial
                      nucleus from the    and lesser petrosal     GVE:                 body,           nerve; the
                      superior ganglion   n., carotid sinus n.,   secretomotor to      carotid         glossopharyngeal n.
                      (GVA); nucleus      stylopharyngeus         the parotid gland    sinus,          exits the posterior
                      solitarius from     brs., pharyngeal brs.   (preganglionic       pharynx,        cranial fossa by
                      the inferior                                parasympathetic      middle ear;     passing through the
                      ganglion (SVA);                             via the tympanic     GSA: skin       jugular foramen;it
                      nucleus                                     n. to the lesser     of the          may penetrate the
                      ambiguus                                    petrosal n. to the   external ear;   stylopharyngeus m.
                      (GVA); inferior                             otic ganglion;       SVA: taste
                      salivatory                                  postganglionic       from the
                      nucleus (GVE -                              parasympathetic      posterior 1/3
                      preganglionic                               via the              of the
                      parasympathetic)                            auriculotemporal     tongue
                                                                  n.)

facial n.             pons and            greater petrosal n.     stapedius m.,        taste (SVA)     also known as: CN
                      medulla: nucleus    (preganglionic          stylohyoid m.,       from the        VII, 7th cranial
                      solitarius of       parasympathetic to      posterior belly of   anterior 2/3    nerve; exits the
                      medulla via         pterygopalatine         digastric m.,        of the          posterior cranial
                      nervus              ganglion,               muscles of facial    tongue; part    fossa by passing
                      intermedius         postganglionic          expression;          of the skin     into the internal
                      (SVA sensory        parasympathetic         secretomotor to      of the          acoustic meatus,
                      root) from          travels with brs. of    lacrimal,            external        goes through the
                      geniculate          maxillary division      submandibular,       auditory        facial canal; motor
                      ganglion;           of V), chorda           sublingual, and      meatus          to muscles of facial
                      superior            tympani (SVA taste      mucous glands of                     expression exits the
                      salivatory          from anterior 2/3 of    the nasal and oral                   skull at the
                      nucleus (GVE        the tongue;             cavities                             stylomastoid
                      preganglionic       preganglionic                                                foramen
                      parasympathetic)    parasympathetic to
                      of pons via         the submandibular
                      nervus              ganglion,
                      intermedius;        postganglionic
                      facial motor        parasympathetic to
                      nucleus of pons     the submandibular
                      via motor root      and sublingual
                                          glands), n. to
                                          stapedius, posterior
                                          auricular n.,
                                          intraparotid plexus
                                          with temporal,
                                          zygomatic, buccal,
                                          marginal
                                          mandibular &
                                          cervical brs.

infraorbital n.       maxillary           middle alveolar n.,     none                 mucous          infraorbital n.passes
                      division of the     anterior superior                        membrane         through the
                      trigeminal n.(V2)   alveolar n.                              of the           infraorbital groove,
                                                                                   maxillary        canal and foramen
                                                                                   sinus; upper
                                                                                   premolar,
                                                                                   canine and
                                                                                   incisor
                                                                                   teeth;
                                                                                   maxillary
                                                                                   gingiva;
                                                                                   skin of the
                                                                                   lateral nose,
                                                                                   lower
                                                                                   eyelid,
                                                                                   upper lip
                                                                                   and
                                                                                   zygomatic
                                                                                   region

nasopalatine n.       maxillary           no named branches    none                mucous           nasopalatine n.
                      division of the                                              membrane         innervates the
                      trigeminal n.                                                of the nasal     mucosa overlying
                      (V2)                                                         septum;          the primary palate
                                                                                   mucous           (development); it
                                                                                   membrane         passes through two
                                                                                   of the           openings in bone:
                                                                                   anterior         sphenopalatine
                                                                                   portion of       foramen and
                                                                                   the palate       incisive canal

petrosal, deep        internal carotid    no named branches    vascular smooth     none             deep petrosal n.
                      plexus                                   muscle of the                        joins the greater
                                                               mucous                               petrosal n. to form
                                                               membranes of the                     the n. of the
                                                               lower nasal                          pterygoid canal; the
                                                               cavity, maxillary                    deep petrosal n.
                                                               sinus and palate                     contains
                                                                                                    postganglionic
                                                                                                    sympathetic axons
                                                                                                    (synapse occurred
                                                                                                    in the superior
                                                                                                    cervical
                                                                                                    sympathetic
                                                                                                    ganglion)

zygomatic n.          maxillary           zygomaticofacial &   carries             skin of the      zygomatic n. carries
                      division of the     zygomaticotemporal   secretomotor        face lateral     postganglionic
                      trigeminal n.                            fibers              and superior     parasympathetic
                      (V2)                                                         to the orbit     fibers from the
                                                                                                    pterygopalatine
                                                                                                    ganglion to the
                                                                                                    lacrimal gland (via
                                                                                                    the communicating
                                                                                                    br. of the
                                                                                                    zygomaticotemporal
                                                                                                    n. which joins the
                                                                                                    lacrimal n.)

zygomaticofacial n.   zygomatic from      no named branches    none                skin of face     zygomaticofacial n.
                      the maxillary                                                lateral to the   passes through the
                      division of the                                              orbit            zygomaticofacial
                      trigeminal n.                                                                 foramen
                        (V2)

zygomaticotemporal      zygomatic from       communicating br.      carries                skin of face  zygomaticotemporal
n.                      the maxillary                               secretomotor           superolateral n. carries
                        division of the                             fibers                 to the orbit  postganglionic
                        trigeminal n.                                                                    parasympathetic
                        (V2)                                                                             fibers from the
                                                                                                         pterygopalatine
                                                                                                         ganglion to the
                                                                                                         lacrimal gland (via
                                                                                                         the communicating
                                                                                                         br. which joins the
                                                                                                         lacrimal n.)


Arteries

    Artery           Source                 Branches                        Supply to                      Notes

palatine,          facial a.     no named branches                 superior pharyngeal         ascending palatine a. shares
ascending                                                          constrictor, soft palate,   supply of the tonsil bed
                                                                   palatine tonsil             with 4 other aa. (see also:
                                                                                               tonsillar br. of the facial a.,
                                                                                               palatine br. of the
                                                                                               ascending pharyngeal a.,
                                                                                               tonsillar br. of the dorsal
                                                                                               lingual a., tonsillar br. of
                                                                                               the descending palatine a.)

palatine,          maxillary     greater palatine a., lesser       palate                      descending palatine a.
descending         a.            palatine a.                                                   accompanies the greater
                                                                                               palatine n. within the
                                                                                               palatine canal

palatine,          descending    no named branches                 hard palate, palatine       greater palatine a.
greater            palatine a.                                     glands, palatine            accompanies the greater
                                                                   mucosa                      palatine n., it is endangered
                                                                                               by anesthetic injections for
                                                                                               dental procedures

palatine, lesser   descending    no named branches                 muscles of the soft         lesser palatine a. is
                   palatine a.                                     palate, mucosa and          endangered by anesthetic
                                                                   glands of the soft          injections for dental
                                                                   palate, upper part of the   procedures
                                                                   tonsil bed

facial             external      ascending palatine a., tonsilar   lower part of the           the angular branch of the
                   carotid a.    br., submental a., superior       palatine tonsil,            facial a. anastomoses with
                                 labial a., inferior labial a.,    submandibular gland,        the ophthalmic a.
                                 lateral nasal a., angular a.      facial muscles and
                                                                   fascia

dorsal lingual     lingual a.    no named branches                 posterior tongue,           dorsal lingual a. is only one
                                                                   palatine tonsil, soft       of five arteries that supply
                                                                   palate                      the tonsil bed

ascending          external      pharyngeal brs., inferior         pharynx, meninges           ascending pharyngeal a.
pharyngeal         carotid a.    tympanic a., posterior                                        arises from the medial side
                                 meningeal a.                                                  of the external carotid a.
                                                                                               close to the birfurcation

maxillary          external      deep auricular a., anterior       deep face,                  maxillary a. may course
                 carotid a.       tympanic a., middle                infratemporal fossa,        medial or lateral to the
                                  meningeal a., inferior alveolar    tympanic cavity,            lateral pterygoid m.
                                  a., masseteric a., posterior       muscles of mastication
                                  deep temporal a., anterior
                                  deep temporal a., buccal a.,
                                  posterior superior alveolar a.,
                                  infraorbital a., a. of the
                                  pterygoid canal, descending
                                  palatine a., sphenopalatine a.

infraorbital     maxillary        anterior superior alveolar a.,     maxillary sinus,            infraorbital a. is one of four
                 a.               middle superior alveolar a.        maxillary incisors,         terminal branches of the
                                                                     canine and premolar         maxillary a. (see also:
                                                                     teeth, skin of the cheek    descending palatine a.,
                                                                     below the orbit,            sphenopalatine a., posterior
                                                                     mucosa over the             superior alveolar a.)
                                                                     maxillary alveolar arch
                                                                     and the adjacent cheek

sphenopalatine   maxillary        posterior lateral nasal brs.,      posterolateral nasal        sphenopalatine a.
                 a.               posterior septal brs.              wall, posteroinferior       accompanies the
                                                                     nasal septum, hard          nasopalatine n.
                                                                     palate behind the
                                                                     maxillary incisor teeth


Viscera

       Organ                  Location/Description                                        Notes

pharynx               the space posterior to the nasal        divided into 3 parts: nasopharynx, oropharynx and
                      cavity, oral cavity and larynx          laryngopharynx; the airway and the pathway of ingested
                                                              foods and liquids cross at this location

nasopharynx           the portion of the pharynx              nasopharynx communicates; anteriorly with the nasal cavity
                      located posterior to the posterior      through the choanae and inferiorly with the oropharynx; it
                      nasal apertures and superior to         contains the torus tubarius, pharyngeal recess and pharyngeal
                      the soft palate                         tonsil

oropharynx            the portion of the pharynx              oropharynx communicates: anteriorly with oral cavity
                      located posterior to the                through oropharyngeal isthmus (palatoglossal arch),
                      palatoglossal arches of the oral        superiorly with the nasopharynx through pharyngeal isthmus
                      cavity and inferior to the soft         (posterior margin of soft palate), inferiorly with the
                      palate                                  laryngopharynx at the superior margin of epiglottis; it
                                                              contains the palatine tonsil which is located in the tonsilar
                                                              bed (between the palatoglossal arch and the palatopharyngeal
                                                              arch)

laryngopharynx        the portion of the pharynx              connects: superiorly with oropharynx at the superior border
                      located posterior to the laryngeal      of epiglottis, anteriorly with the larynx through laryngeal
                      inlet and the posterior wall of         inlet, inferiorly with the esophagus at the lower border of the
                      the larynx                              cricoid cartilage; laryngopharynx contains the piriform
                                                              recesses which are lateral to the aryepiglottic folds

torus tubarius        mucosal fold covering the               torus tubarius projects toward the midline from the lateral
                      anteromedial end of the auditory        wall of the nasopharynx
                      tube cartilage

salpingopharyngeal    mucosal fold descending from            salpingopharyngeal fold contains the salpingopharyngeus m.
fold                  the posterior margin of the torus
                      tubarius
pharyngeal recess       space located posterior to the      the pharyngeal tonsil is located in this region
                        torus tubarius in nasopharynx

palatoglossal fold      fold of mucosa covering the         palatoglossal fold marks the anterior boundary of the bed of
                        palatoglossus m.                    the palatine tonsil

palatopharyngeal        fold of mucosa covering the         palatoglossal fold marks the posterior boundary of the bed of
fold                    palatopharyngeus m.                 the palatine tonsil

piriform recess         shallow depression located          the internal branch of the superior laryngeal n. is located
                        lateral to the aryepiglottic fold   immediately deep to the mucosa in this region; also known
                        in the laryngopharynx               as: piriform fossa


Lymphatics

                                                                                                Regions
Structure            Location                  Afferents from              Efferents to                           Notes
                                                                                                drained

tonsil,       superior surface of     lymphatic vessels of the tongue    superior deep       "guards" the     lingual tonsil
lingual       the root of the                                            cervical nodes      entrance of      is part of the
              tongue                                                                         the              tonsillar ring
                                                                                             oropharynx       (of
                                                                                                              Waldeyer)

tonsil,       lateral wall of the     lymphatic vessels of the           superior deep       "guards" the     palatine
palatine      oropharynx              posterior tongue and               cervical nodes,     entrance of      tonsil is part
              between the             palatoglossal/palatopharyngeal     especially the      the              of the
              palatoglossal and       arch region                        jugulodigastric     oropharynx       tonsillar ring
              palatopharyngeal                                           node                                 (of
              arches                                                                                          Waldeyer)

tonsil,       roof and posterior      lymphatic vessels of the wall of   superior deep       "guards" the     pharyngeal
pharyngeal    wall of the             the pharynx                        cervical nodes      entrance to      tonsil is part
              nasopharynx                                                                    the              of the
                                                                                             nasopharynx      tonsillar ring
                                                                                                              (of
                                                                                                              Waldeyer);
                                                                                                              also known
                                                                                                              as: adenoids

tonsil,       pharyngeal recess       lymphatic vessels of the torus     superior deep       "guards" the     tubal tonsil is
tubal                                 tubarius and auditory tube         cervical nodes      entrance to      located at the
                                                                                             the              pharyngeal
                                                                                             nasopharynx      orifice of the
                                                                                                              auditory tube

				
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