PICTORIAL ESSAY   

Il Giornale Italiano di Radiologia Medica 2019 Luglio-Agosto;6(4):356-71

DOI: 10.23736/S2283-8376.19.00196-7

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English, Italian

Exploration of pterygopalatine fossa: an important crossroads for spread of pathologies

Emanuela RUBERTO ¹✉, Simona GAUDINO ¹, Giammaria MARZIALI ¹, Massimo BENENATI ¹, Antonello VIDIRI ², Cesare COLOSIMO ¹

¹ Department of Radiological Sciences, School of Medicine, A. Gemelli University Hospital Foundation, Sacred Heart Catholic University, Rome, Italy; ² Department of Radiology and Diagnostic Imaging, IRCCS Regina Elena National Cancer Institute, Rome, Italy

The pterygopalatine fossa (PPF) is a central transit station for many head and neck pathologies, through which a direct access to the intracranial compartment is possible. It is a small space crossed by numerous vascular and nervous structures, connecting nasal cavities (sphenopalatine foramen), oral cavity (palatine canals), orbit (lower orbital fissure), masticator space (pterygomaxillary fissure), middle cranial fossa (round foramen) and foramen lacerum (vidian canal). Pathologies affecting PPF are commonly neoplastic (juvenile angiofibroma, nasopharyngeal tumors, tumors of palate, paranasal sinuses or skin, mesenchymal tumours of masticator spaces, meningiomas of the middle cranial fossa), more rarely infectious (sinusitis) and inflammatory (pseudotumour). For a correct interpretation of imaging findings it is necessary a deep anatomical knowledge of the PPF and of its contents (adipose tissue, pterygopalatine ganglion, V2 maxillary nerve and its divisions, vidian nerve, branches of the maxillary artery and venous vessels). CT and MRI are complementary methods for the study of bone anatomy and pathology of PPF: MRI allows to detect invasion of PPF better than CT and it is the technique of choice to identify signs of perineural diffusion, findings that play a key role for the staging of the disease and the consequent therapeutic management of patients. In this article we illustrate the anatomy (CT and MRI) and the pathology (direct invasion/ perineural diffusion) of PPF, with a hint to some pitfalls that can mimic malignant pathologies.

KEY WORDS: Pterygopalatine fossa; Pathologies: diffusion; Magnetic resonance imaging