Surgical anatomy of the pterygopalatine fossa

The pterygopalatine fossa is the distribution centre for the main vessels and nerves of the middle third of the face. Its surgical anatomy is discussed, with particular emphasis on the relationship between the medical plate of the pterygoid process of the sphenoid bone and the vertical plate of the palatine bone; the position of the several foramina is reviewed also. It is stressed that the vascular contents of the pterygopalatine fossa lie in a coronal plane, anterior to the neural contents. Finally, a short review is given of the different surgical approaches to the pterygopalatine fossa. It is concluded that the transantral approach to the fossa, as originally described by Carnochan (1858), still seems to be the best way to gain access to this space.