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The Palatovaginal Canal: Can It Be Identified on Routine CT and MR Imaging?

¹ Department of Radiology, CB #7510, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7510.
² Present address: Department of Radiology, University Hospital "Sestre milosrdnice," Zagreb, Croatia.

View larger version (147K): [in a new window]   Fig. 1A. —32-year-old man with sinusitis. Unenhanced coronal CT image shows triangular shape of pterygopalatine fossa (arrows).

View larger version (144K): [in a new window]   Fig. 1B. —32-year-old man with sinusitis. Unenhanced coronal CT image obtained just posterior to A reveals change in shape of pterygopalatine fossa (arrows) to ovoid and oblique. Round foramen of sphenoid (arrowheads) can also be seen.

View larger version (134K): [in a new window]   Fig. 1C. —32-year-old man with sinusitis. Unenhanced coronal CT image obtained just posterior to B shows that oblique pterygopalatine fossa has separated into larger laterosuperior vidian canal (white arrows) and smaller medioinferior palatovaginal canal (black arrows).

View larger version (135K): [in a new window]   Fig. 2A. —31-year-old woman with sinusitis. Unenhanced coronal CT image shows ovoid and oblique shape of pterygopalatine fossa (arrows) in posterior aspect, with more prominent laterosuperior portion and smaller medioinferior one. Positioning is slightly oblique, with left-sided structures being almost one slice anterior to contralateral side.

View larger version (127K): [in a new window]   Fig. 2B. —31-year-old woman with sinusitis. Unenhanced coronal CT image obtained at adjacent posterior level to A shows separation of palatovaginal canal (black arrow) and vidian canal (white arrow) on right. On left, subtle demarcation between vidian canal and palatovaginal canal (arrowhead) is visible.

View larger version (151K): [in a new window]   Fig. 3. —14-year-old boy with recurrent epistaxis. Unenhanced coronal CT image shows prominent palatovaginal canal (solid black arrow) on right, of approximately same size as ipsilateral vidian canal (white arrow), which measures 1.6 mm in diameter. These findings influenced treatment planning, and embolization was considered. Patient was lost to follow-up before angiogram was obtained. Leftsided palatovaginal canal is seen as semicanal (open black arrow). This case represents typical oblique alignment of three posterior pterygopalatine fossa foramina, with round foramen of sphenoid bone (arrowhead) as most superior and lateral one.

View larger version (134K): [in a new window]   Fig. 4. —37-year-old man with orbital foreign bodies. Unenhanced coronal CT image shows bilateral endosinusal vidian canals (white arrows) with associated dehiscence of roof. Round foramina of sphenoid are also protruding into sphenoidal sinus (arrowheads). Both palatovaginal canals (black arrows) are shown as complete canals.

View larger version (156K): [in a new window]   Fig. 5A. —30-year-old woman evaluated for pituitary microadenoma. Unenhanced coronal T1-weighted MR image obtained at posterior aspect of pterygopalatine fossa shows two linear flow-void structures (arrows) that arose bilaterally from internal maxillary artery and are directed posteromedially.

View larger version (146K): [in a new window]   Fig. 5B. —30-year-old woman evaluated for pituitary microadenoma. Unenhanced coronal T1-weighted MR image obtained posterior to A shows that flow-void structures revealed in A are now found in endosinusal vidian canals (white arrows) and palatovaginal canals (black arrows), corresponding to vidian and pterygovaginal arteries, respectively.

View larger version (142K): [in a new window]   Fig. 6. —28-year-old woman with pituitary microadenoma. Unenhanced coronal T1-weighted MR image shows two low-signal-intensity structures that are bilaterally extending posteriorly from pterygopalatine fossa. These structures presumably correspond to pterygovaginal artery and, possibly, pharyngeal nerve (solid arrows) and vidian artery and nerve (open arrows), although they are not depicted as flow voids. Maxillary nerves are bilaterally visualized in round foramina of sphenoid (arrowheads). Note oblique linear alignment maxillary nerve, vidian artery and nerve, pterygovaginal artery. Compare this image with Figures 1A,1B,1C and 3.

View larger version (130K): [in a new window]   Fig. 7A. —Dry skull specimen from cadaver of adult male. Magnified photograph of skull base as seen from below shows posterior (pharyngeal) orifice of palatovaginal canals on both sides (arrows).

View larger version (128K): [in a new window]   Fig. 7B. —Dry skull specimen from cadaver of adult male. Magnified photograph of skull base as seen from behind again shows posterior orifice of palatovaginal canals bilaterally (arrows).

View larger version (122K): [in a new window]   Fig. 7C. —Dry skull specimen from cadaver of adult male. Direct coronal CT image of specimen with opaque markers (0.018-inch guidewire) placed through both palatovaginal canals (black arrows). Vidian canals (white arrows) and round foramina of sphenoid (arrowheads) are well depicted.

View larger version (115K): [in a new window]   Fig. 7D. —Dry skull specimen from cadaver of adult male. Direct coronal CT image of specimen obtained at level slightly more posterior to C reveals wires in palatovaginal canals (black arrows) descending toward pharynx. Vidian canals (white arrows) are also well depicted.

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