The PPF contains numerous critical neurovascular structures, notably the SPG, the maxillary branch of the trigeminal nerve (V2), and the internal maxillary artery. With the advent of extended endoscopic endonasal surgery, the surgical anatomy of the PPF warrants increased investigation. Intraoperative dissection is essential to prevent postoperative xeropthalmia and facial hypoesthesia.
This present study aims to describe a novel dissection technique for identifying the SPG and defining consistently identifiable landmarks.
Eight cadaveric PPFs were dissected in a step-wise fashion. An endoscopic medial maxillectomy was performed, the SPF was identified, and the posterior maxillary wall was resected. The V2 was placed anterolaterally in its infraorbital canal and traced medially to identify the SPG’s pterygopalatine nerve. The researchers measured the lateral distance and superior/inferior distance from the SPG to the fixed SPF. The surgical technique described allowed for reliable identification of the SPG.
The study concluded that SPG identification and preservation are necessary to prevent complications in endoscopic endonasal PPF surgery. The SPG can be reliably located near the SPF by following the pterygopalatine nerve branch of V2.
Reference: https://journals.sagepub.com/doi/full/10.1177/1945892419896543
