Abstract
We have performed a detailed morphometric analysis of the length and anatomic routes of the greater palatine canal (GPC) and a systematic review of the literature on the anatomy of the GPC with the aim of informing dentists, maxillofacial surgeons, otorhinolaryngologists and other specialists performing procedures in the area of the GPC. In total, we analysed 1,500 archived adult head computed tomography scans to determine the length of the GPC and of the routes on both sides, as well as the dimensions and opening directions of the greater palatine foramen. The systematic review of the literature was performed according to PRISMA guidelines. The study group comprised 783 females (52.2 %) and 717 males with a mean (± standard deviation) age of 42.1 ± 16.9 years; there was significant difference in age between sexes (p = 0.33). The average length of the GPC was 31.1 ± 2.9 (range 15–44) mm. The GPC travelled three different paths in the sagittal plane and four different paths in the coronal plane. Most often it descended from the pterygopalatine fossa inferiorly before changing to an anterior-inferior direction (68.4 %; sagittal plane) and inferior-laterally before changing to an inferior-medial direction (40.7 %; (coronal plane). In total, the GPF had four different opening directions: inferior-anterior-medial (82.1 %), inferior-anterior-lateral (4.0 %), anterior (7.6 %), and vertical (5.3 %). Twenty-five studies were included in the systematic review. In conclusion, the information presented here provides clinicians with the anatomical knowledge necessary to minimize the risk of complications when performing procedures involving infiltration of the GPC.
Highlights
We analysed 1,500 archived adult head computed tomography scans to determine the length of the greater palatine canal (GPC) and of the routes on both sides, as well as the dimensions and opening directions of the greater palatine foramen
The greater palatine canal (GPC) communicates with the oral cavity through the greater palatine foramen (GPF), which is most commonly located opposite the third molar (Tomaszewska et al 2014a)
The GPC continues in a posterior-superior direction, terminating at the pterygopalatine fossa (PPF) which is an inverse pyramid-shaped space communicating with the middle cranial fossa via the foramen rotundum, the nasal cavity via the sphenopalatine foramen, the orbit via the inferior orbital fissure and the oral cavity via the GPF (Erdogan et al 2003)
Summary
The greater palatine canal (GPC) communicates with the oral cavity through the greater palatine foramen (GPF), which is most commonly located opposite the third molar (Tomaszewska et al 2014a). The GPC houses the descending palatine artery and the greater and lesser palatine nerves as well as their posterior inferior lateral nasal branches, while the PPF contains the maxillary artery and its branches, the accompanying vein, the maxillary nerve and its branches and the pterygopalatine ganglion (Hwang et al 2011) The anatomy of these structures is of great importance to dentists, maxillofacial surgeons, otorhinolaryngologists and other specialists performing medical procedures in the area of the GPC. Due to the close relationship of the anatomical structures inside the GPC and the PPF, as well as the direct communication of the PPF with the inferior orbital fissure, infiltration of the PPF through the GPC may result in complications These include intravascular or intracranial injection, infraorbital nerve injury, transient ophthalmoplegia, diplopia, ptosis, neural tissue damage, intracranial infection and/or even blindness from vasoconstriction of the ophthalmic artery (Das et al 2006; Douglas and Wormald 2006)
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