The pneumatization patterns of the roof of the parapharyngeal space in CBCT

Germs. 2012 Dec 1;2(4):142-7. doi: 10.11599/germs.2012.1026.


Introduction: The rhinopharynx and the parapharyngeal space (PPS) are complex anatomical territories located beneath the skull base. Thorough knowledge of the complex anatomy of the PPS is essential in treatment of pathologies such as parapharyngeal abscesses. The roof of the PPS is overlooked in anatomy. It was hypothesized that the pneumatization pattern of the PPS roof is individually variable, as determined by the variable pneumatization patterns of the sphenoid and temporal bones. The study was aimed at assessing the anatomy of the PPS roof in CBCT.

Methods: The present study was performed retrospectively on a group of 35 subjects (37.1% males) evaluated by CBCT for various dental procedures.

Results: The mean age of the group was 37.9 (SD: 14.2, range: 18 to 61). The major bony landmarks of the PPS roof were: the petrous apex with the carotid canal, the jugular foramen, the foramen lacerum, the sphenopetrosal fissure or suture, and the root of the pterygoid process. Variable patterns of pneumatization were determined by the petrous apex air cells and the pterygoalar recess of the sphenoidal sinus. As related to the individually pattern of pneumatization, the following types of the PPS roof were defined: (i) type 1 - not pneumatized PPS roof; (ii) type 2 - sphenoidal but not petrosal pneumatization of the PPS roof; (iii) type 3 - petrosal but not sphenoidal pneumatization of the PPS roof; (iv) type 4 - sphenoidal and petrosal pneumatizations of the PPS roof.

Discussion: Although on the left side the degree of pneumatization was higher than on the right side, no statistical differences were recorded (p > 0.05). The pattern of pneumatizations in the PPS roof should be assessed when PPS involvement in otitis or sinusitis is considered.

Keywords: Skull base; air sinus; middle cranial fossa; temporal bone.