Pterygopalatine Fossa Masses in Children: Oh, the Places They'll Go!

The pterygopalatine fossa is a complex anatomic structure that forms a crossroad between the intracranial compartment and extracranial soft tissues. Each of the 7 corridors to and from the pterygopalatine fossa transmits individual nerves, vessels, and lymphatic systems. Lesions that arise or spread through the pterygopalatine fossa have severe clinical consequences because this pathway provides direct access to the cavernous sinus, orbit, skull base, cranial vault, nasal cavity, and masticator space. This article reviews the complex anatomy of the pterygopalatine fossa, illustrates the wide variety of mass lesions that may involve the pterygopalatine fossa in the pediatric population (either primarily or by direct extension), and discusses the imaging characteristics of potential malignant spread of such lesions between compartments. Prognosis and treatment options are also discussed. Cross-sectional and 3-dimensional illustrations of the pterygopalatine fossa demonstrate the normal pterygopalatine fossa anatomy compared with the distorted anatomy caused by masses. Pterygopalatine fossa masses are classified and reviewed as follows: primary tumors (vascular, neurogenic, and mesenchymal) and secondary tumors (known for pterygopalatine fossa invasion). Understanding these pathways, the normal anatomy, and different lesions is critical in the identification, diagnosis, treatment planning, and follow-up of such processes.

Learning Objectives: (1) Understand the anatomy of the pterygopalatine fossa and identify potential routes of tumor spread, and (2) describe imaging characteristics, clinical significance, and epidemiology of common pediatric tumors that may involve the pterygopalatine fossa.