Size and shape of the pterygopalatine fossa of the skull of a child aged 3–5 years based on the analysis of computed tomography scans

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Abstract

BACKGROUND: Endoscopic microsurgical techniques are used for sparing operations to remove foreign bodies of the pterygopalatine fossa, as well as neoplasms invading into it or growing out of it. These surgeries are performed not only in adults, but also in children as young as one month. For these surgeries, understanding the detailed structure and morphometric characteristics of the pterygopalatine fossa is crucial. However, detailed descriptions specific to children are lacking in the literature.

AIM: This study aimed to examine the size and shape of the pterygopalatine fossa and the relative location of nerve foramina in children aged 3 to 5 years (the period of primary dentition) using computed tomography data.

MATERIALS AND METHODS: To study the size and shape of pterygopalatine fossa, we analyzed anonymous archival frontal and axial computed tomograms of 12 children (24 pterygopalatine fossae) aged 3 to 5 years, obtained for examination of the underlying disease (brain pathology). All computed tomography scans were obtained using a helical computed tomograph (Somatom Sensation 64; Siemens, Germany) with an effective current of 63, 120 kV, a slice thickness of 0.5 mm, a reconstruction step of 0.7 mm, a collimation of 12×0.6 mm, Kernel U 70, a window width of 450 HU and a window center of 50 HU in University Clinic of Russian University of Medicine. The measurements were performed in the Cdviewer software after the preliminary measurements had determined sufficiently constant points on the contours of the pterygopalatine fossa of scans. On axial sections passing through the pterygoid canal, where the measurements had the greatest values, the following were studied: the largest width of the pterygoid canal (the distance between the anterior opening of the pterygoid canal and the orbital process of the palatine bone), the width of the medial wall and separately the width of the sphenopalatine foramen and the sphenoidal process of palate bone, the angle of deviation the medial wall from the sagittal plane, the width of the anterior wall (the distance between the most posteriorly protruding point of the anterior wall of the pterygopalatine fossa to the orbital process of the palatine bone), the greatest depth of the pterygopalatine fossa (posterior wall width) and the width of the pterygomaxillary fissure. The distance from the level of the orifice of the greater palatine canal to the anterior opening of the pterygoid canal and to the round foramen were measured on the frontal sections. According to axial tomograms, the spatial ratios between the orifice of the greater palatine canal and the round foramen and the anterior opening of the pterygoid canal, between these openings and the sphenopalatine foramen, between the round foramen and the anterior opening of the pterygoid canal were assessed.

RESULTS: The study found that the shape of the pterygopalatine fossa differs from the pyramid-like structure, featuring four distinct parts: the main one adjacent to the sphenopalatine foramen, and funnel-shaped constrictions at the vestibule of the pterygoid canal, greater palatine canal, and pterygomaxillary fissure. The data indicated minor individual differences in the size of the pterygopalatine fossa and the uniformity of its shape in children aged 3 to 5 years. The spatial relationships of the orifice of the greater palatine canal, the anterior opening of the pterygoid canal, the round foramen, and the sphenopalatine foramen openings determining the position of the nerves in the pterygopalatine fossa were clarified.

CONCLUSIONS: Pterygopalatine fossa in children aged 3 to 5 years (period of formed primary dentition) is characterized by a complex cavity structure, suggesting a different position of the pterygopalatine ganglion in it than is commonly believed. This circumstance, as well as for the first time the sizes of the pterygopalatine fossa determined by us, should be considered when developing surgical access to the pterygopalatine fossa and the pterygopalatine ganglion.

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About the authors

Aleksandr S. Prokofiev

Russian University of Medicine

Email: prokofev_aleksandr83@mail.ru
ORCID iD: 0009-0008-9620-7810
SPIN-code: 2756-9756
Russian Federation, 23 bldg. 1 Boris Zhigulenkov street, 105275 Moscow

Ekaterina A. Makeeva

Russian University of Medicine

Email: makeevi@inbox.ru
ORCID iD: 0009-0005-1689-8518
SPIN-code: 9106-6445

MD, Cand. Sci. (Medicine), Assistant Professor

Russian Federation, 23 bldg. 1 Boris Zhigulenkov street, 105275 Moscow

Eugenia О. Mitrokhina

Russian University of Medicine

Email: Jony.Mitrokhina@yandex.ru
ORCID iD: 0009-0003-9697-3383
Russian Federation, 23 bldg. 1 Boris Zhigulenkov street, 105275 Moscow

Aleksandr V. Chukbar

Russian University of Medicine

Author for correspondence.
Email: achukbar@yandex.ru
ORCID iD: 0009-0002-3243-878X
SPIN-code: 8463-2948

MD, Dr. Sci. (Medicine), Professor

Russian Federation, 23 bldg. 1 Boris Zhigulenkov street, 105275 Moscow

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2. Fig. 1. Pterygopalatine fossa of a child 3 years 4 months old. Fragments of computed tomography scans in the axial plane: a — at the level of 3 mm above the mouth of the large palatine canal; b — in the plane of the pterygoid canal; c — 1 mm higher; d — at the level of the round hole. 1 — maxillary sinus; 2 — front wall of pterygopalatine ganglion; 3 — orbital process of the palatine bone; 4 — medial wall of pterygopalatine ganglion; 5 — anterior edge of the pterygoid process; 6 — pterygomaxillary fissure; 7 — sphenopalatine foramen; 8 — sphenoid process of the palatine bone; 9 — vestibule of the pterygoid canal; 10 — pterygoid canal; 11 — central part of pterygopalatine ganglion; 12 — vestibule of the pterygomaxillary fissure; 13 — fragment of the pterygoid sinus; 14 — palatovaginal canal; 15 — orbit; 16 — posterior ethmoidal cells; 17 — wall of the sphenoid sinus; 18 — body of the sphenoid bone; 19 — round foramen; 20 — inferior orbital fissure.

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3. Fig. 2. Pterygopalatine fossa of a child 4 years 2 months old. Fragments of CT scans in the frontal plane: a — at the level of the orifice of the greater palatine canal; b — 3 mm posteriorly from the plane of the orifice of the greater palatine canal; c — 2 mm posteriorly from the previous section; d — at the level of the anterior foramen of the pterygoid canal. 1 — central part of pterygopalatine fossa 2 — bottom of the sphenoid sinus; 3 — sphenopalatine foramen; 4 — medial wall of pterygopalatine fossa; 5 — nasal cavity; 6 — orifice of the greater palatine canal; 7 — maxillary sinus; 8 — vestibule of the greater palatine canal; 9 — vestibule of the pterygomaxillary fissure; 10 — lower orbital fissure; 11 — vestibule of the pterygoid canal; 12 — sphenoid sinus; 13 — pterygoid process; 14 — base of the pterygoid process; 15 — greater wing of the sphenoid bone; 16 — round foramen; 17 — medial plate of the pterygoid process; 18 — lateral plate of the pterygoid process; 19 — pterygoid canal; 20 — body of the sphenoid bone; 21 — throat; 22 — middle cranial fossa.

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4. Fig. 3. Three-dimensional reconstruction of the pterygopalatine fossa of a child 3 years 8 months old: 1 — sphenopalatine foramen; 2 — round foramen; 3 — bottom of the sphenoid sinus; 4 — sphenoid process of the palatine bone; 5 — vestibule of the pterygoid canal; 6 — anterior opening of the pterygoid canal; 7 — pterygoid canal; 8 — central part of the pterygopalatine fossa; 9 — vestibule of the greater palatine canal; 10 — pterygomaxillary fissure; 11 — vestibule of the pterygomaxillary fissure.

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