Pterygoid plexus: the deep venous network of the face
Quick facts
- Definition
- Network of veins located between the pterygoid muscles, in the infratemporal fossa.
- Drainage
- Receives veins from the deep face and drains into the maxillary vein and then the retromandibular vein.
- Connections
- Connects to the facial vein and, through emissary veins, to the cavernous sinus.
- Relevance
- Explains deep hematomas and the possible route of spread for facial infections.
The pterygoid plexus is a network of veins located in the infratemporal fossa, between the medial and lateral pterygoid muscles. It collects blood from several deep structures of the face, such as the chewing muscles, the gums and parts of the orbit, and it is one of the venous drainage pathways that the orofacial harmonization (HOF) professional needs to know.
How does the plexus drain?
The plexus receives veins from the chewing muscles, the upper teeth and the infratemporal region. It drains mainly into the maxillary vein, which joins the superficial temporal vein to form the retromandibular vein. It also connects to the facial vein through a communication (the deep facial vein).
| Connection | Where it leads |
|---|---|
| Maxillary vein | Retromandibular vein |
| Deep facial vein | Facial vein |
| Emissary veins | Cavernous sinus, inside the skull |
| Ophthalmic veins | Communication with the orbit |
The veins of the face generally have no valves, which means blood can flow in more than one direction, depending on pressure. This detail is the basis of the concept of the danger triangle of the face.
Why does it matter in HOF?
- Deep hematomas: the plexus sits in a richly vascular region, close to the maxillary artery. Procedures on the lateral and posterior areas of the face can cause deep bleeding, which forms a delayed hematoma.
- Infection: an infection in the facial region can, in rare cases, travel along these veins to the cavernous sinus. For this reason, a facial infection with fever, severe pain, periorbital swelling or visual changes is an emergency.
- Anesthesia and dentistry: blocks in the maxillary tuberosity region can injure the plexus and form a hematoma, which is well known in dentistry.
- Asepsis: preventing infection, with skin antisepsis and clean technique, matters even more because of this anatomy.
What should the professional do in practice?
Venous anatomy rarely drives aesthetic planning, but it does drive precautions.
Also called: pterygoid venous plexus, plexus pterygoideus.
Frequently asked questions
Why is the pterygoid plexus mentioned when talking about infection?
Because it communicates with the facial vein and, through emissary veins, with the cavernous sinus. This creates a path by which an infection of the face can, in rare cases, reach intracranial structures.