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Transnasal Route to the Sphenoid Sinus and Sella

Surgical Correlation

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E, The anterior wall of the sella and the lateral wall of the sphenoid sinus have been removed to expose the petrous and cavernous segments of the carotid artery and the pituitary gland. The posterior wall of the maxillary sinus has been removed to expose the maxillary nerve and artery and the pterygopalatine ganglion in the pterygopalatine fossa. F, Enlarged view of the right orbit and pterygopalatine fossa. The maxillary nerve gives rise to the infraorbital and zygomatic nerves and communicating rami to the pterygopalatine ganglion. Branches of the maxillary artery course through the pterygopalatine fossa. The posterior wall of the pterygopalatine fossa is formed by the pterygoid process. G, Enlarged view. The branches of the maxillary artery penetrate the lateral wall of the nasal cavity to course along the sphenoid face. The maxillary nerve sends communicating rami to the sphenopalatine ganglion. The vidian nerve enters the posterior aspect of the sphenopalatine ganglion. The pituitary gland is surrounded by the cavernous sinuses laterally and an anterior intercavernous sinus above. H, The optic nerves have been elevated to show the suprasellar area and the relationships between the orbital apex, optic canals, nasal cavity, pterygopalatine fossa, and the petrous and intracavernous segments of the internal carotid artery. The superior hypophyseal arteries pass to the lower margin of the optic chiasm and the pituitary stalk. (Images courtesy of AL Rhoton, Jr.)

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