Analysis of blood supply in the hard palate and maxillary tuberosity-clinical implications for flap design and soft tissue graft harvesting (a human cadaver study).

Abstract

The aim of the present study is to provide a detailed macroscopic mapping of the palatal and tuberal blood supply applying anatomical methods and studying specific anastomoses to bridge the gap between basic structural and empirical clinical knowledge. Ten cadavers (three dentate, seven edentulous) have been prepared for this study in the Department of Anatomy, Semmelweis University, Budapest, Hungary, and in the Department of Anatomy of the Medical University of Graz. All cadavers were fixed with Thiel's solution. For the macroscopic analysis of the blood vessels supplying the palatal mucosa, corrosion casting in four cadavers and latex milk injection in other six cadavers were performed. We recorded major- and secondary branches of the greater palatine artery (GPA) and its relation to the palatine spine, different anastomoses with the nasopalatine artery (NPA), and lesser palatal artery (LPA) as well as with contralateral branches of the GPA. Penetrating intraosseous branches at the premolar-canine area were also detected. In edentulous patients, the GPA developed a curvy pathway in the premolar area. The blood supply around the maxillary tuberosity was also presented. The combination of different staining methods has shed light to findings with relevance to palatal blood supply, offering a powerful tool for the design and execution of surgical interventions involving the hard palate. The present study provides clinicians with a good basis to understand the anatomical background of palatal and tuberal blood supply. This might enable clinicians to design optimized incision- and flap designs. As a result, the risk of intraoperative bleeding and postoperative wound healing complications related to impaired blood supply can be minimized.