Orbital Passage of Pterygopalatine Ganglion Efferents to Paranasal Sinuses and Nasal Mucosa in Man

Abstract

Parasympathetic nerves of pterygopalatine ganglion origin are considered to enter the orbit and distribute to the nasal mucosa with the anterior ethmoidal nerve. As their distribution has never been demonstrated the present study was undertaken to seek evidence of their passage and to identify their relationship with the ethmoidal nerves. The soft tissues of the pterygopalatine fossa and orbit from sixteen sides of twelve cadavers were removed in one piece and either dissected or cut coronally into slabs and prepared histologically using montages of thin resin-embedded sections at intervals suitable for nerve path tracing. Several of the rami orbitales passing mediodorsally from the ganglion enter the orbit apically, branch and enter the posterior ethmoidal foramen terminating in the lining of the paranasal sinuses and others advance to enter the anterior ethmoidal canal to reach the nasal mucosa. No junctions were made with ethmoidal nerves within the orbit or the canal. Failure of surgical lesions of the anterior ethmoidal nerve as a treatment for vasomotor rhinitis may be attributed to the sparing of the separate parasympathetic nerves. Appropriate chemical lesions, on the other hand, could ensure destruction of isolated parasympathetic nerves while limiting damage to the larger anterior ethmoidal nerve.

Sphenopalatine Ganglion (SPG): Stimulation Mechanism, Safety, and Efficacy

“…In addition, numerous postganglionic parasympathetic branches have been shown to course superior medially from the SPG into the orbital cavity, providing parasympathetic innervations to the meningeal and cerebral blood vessels (see Fig. A and B) …”

Original study. Effectiveness of endoscopic posterior nasal neurectomy for the treatment of intractable rhinitis

“…The ramus originating from the pterygopalatine ganglion (PPG) is found to specifically innervate the nasal mucosa and it has been called the posterior nasal nerve. Selective resection of this posterior nasal nerve abolishes parasympathetic supply to the nasal cavity and provides the same benefits of vidian neurectomy, without having any of its complications 18,19 . Ikeda et al 20 observed that posterior nasal neurectomy causes suppression of the secretagogue motor and inhibition of the neurogenic inflammation induced by the parasympathetic and sensory denervation.…”

Raeder's syndrome after embolization of a giant intracavernous carotid artery aneurysm: pathophysiological considerations

“…The orbit receives parasympathetic eff e rents from the E d i n g e r-Westphal and from the superior salivary nuclei. The inferior salivary nucleus sends fibers to the parotid gland 27,28 .…”

“…The inferior division gives rise to the inferior oblique nerve, which c a rries the general visceral motor fibers (parasympathetic) to the ciliary ganglion. Short ciliary nerves, from the ganglion, innervate the ciliary body, sphincter pupillae and uveal tract glands 27,28 .…”