Transmaxillary pterygopalatine fossa

Goals of Dissection:

• Understand the relationship of the pterygoid fossa to the maxillary sinus and nasal cavity

• Explore the pterygopalatine fossa to understand the anatomy

Dissection: 

1. Start with Weber-Ferguson incision to expose the anterior wall of the maxilla.

   • Expose the entire face of the maxilla, the zygoma, and the coronoid process of the mandible. 

   • Try to preserve the infraorbital nerve.

2. Open the anterior face of the maxilla and expose the entire maxillary sinus.

3. Reflect inferiorly the temporalis muscle and remove the coronoid process.

   • Identify the internal maxillary artery.

4. Remove the bone of the posterior maxillary sinus wall to the lateral pterygoid muscle.

5. Remove the lateral pterygoid muscle to identify V3.

6. Trace back V2 to identify the infraorbital fissure (aka inferior orbital fissure - IOF).

   • This will require removal of a portion of the orbital floor and lateral orbital wall.

7. Follow the internal maxillary artery medially until you reach nasal cavity and spenopalatine foramen.

8. Bonus points to identify Vidian nerve.