| Injectate distribution patterns in posterior infrazygomatic and transoral approaches to the pterygopalatine fossa |
Anže Jerman1,2 
, Luka Pušnik2
, Erika Cvetko2
, Nejc Umek2
, Žiga Snoj3,4
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1Department of Maxillofacial and Oral Surgery, University Medical Center Ljubljana, Ljubljana, Slovenia
2Institute of Anatomy, University of Ljubljana Faculty of Medicine, Ljubljana, Slovenia
3Institute of Radiology, University Medical Center Ljubljana, Ljubljana, Slovenia
4Department of Radiology, University of Ljubljana Faculty of Medicine, Ljubljana, Slovenia |
Corresponding author:
Anže Jerman, Tel: +386-01 543 73 02, Fax: +386-01 543 73 01,
Email: anze.jerman@mf.uni-lj.si
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Received: 21 December 2024 • Revised: 14 April 2025 • Accepted: 1 May 2025 |
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| Abstract |
Background
Injectate distribution patterns in the pterygopalatine fossa may differ based on the drug administration approach used. This study primarily aimed to assess and compare injectate distribution following the posterior infrazygomatic and transoral approaches. The secondary aim was to evaluate the safety of both approaches.
Methods
Injectate distribution patterns were evaluated in 13 cadaveric head specimens. The vessels were perfused with a gelatin-based solution containing an iodinated contrast agent. The ultrasound-guided posterior infrazygomatic approach and transoral approach were performed on contralateral sides, and needle placement was confirmed using computed tomography (CT). A methylene blue and iodinated contrast agent solution was administered following successful needle placement. Injectate distribution and injuries were assessed via CT and anatomical dissection.
Results
With the posterior infrazygomatic approach, methylene blue consistently stained the maxillary artery and nerve, sphenopalatine ganglion, and lateral pterygoid muscle, whereas with the transoral approach, it most frequently surrounded the maxillary artery and structures within the greater palatine canal. The iodinated contrast agent was distributed predominantly along the needle trajectories for both approaches. Injuries to the maxillary artery and facial nerve were documented following the posterior infrazygomatic approach, whereas injury to the lateral pterygoid plate was observed following the transoral approach.
Conclusions
With the posterior infrazygomatic approach, contrast agent encompassed the entire pterygopalatine fossa, whereas the transoral approach yielded a more localized distribution, primarily within the inferior portion and greater palatine canal. These differences in distribution patterns should guide the selection of the most appropriate approach based on the specific clinical indication. |
| Key Words:
Ganglion; Ganglion cysts; Local anesthetics; Maxillary artery; Maxillary nerve; Pterygopalatine fossa; Sphenopalatine ganglion block. |
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