Anterior Palatal Region Research Articles

Upper Jaw Development After Lingual Laser Frenectomy and Myofuntional Therapy.

Over the years, the role of the lingual frenulum in the development of skeletal structures has been evaluated. However, the effect of short lingual frenulum treatment on bone structures is unclear. We need to investigate the effect of surgery and myofunctional therapy on maxillary development. This could be the rationale to establish an orthodontic interception protocol. The case-control study was carried out in the Operative Unit of Pedodontics of the University Dental Clinic, at the Department of Medical, Oral and Biotechnological Sciences of the University of "G. D'Annunzio" Chieti-Pescara. The study population consisted in thirty children. The data were collected through anamnesis carried out by qualified health personnel before dental examination. Photos, frenulum length and cast measurements were taken. Student's t-test statistical analysis was used. Significance was ascertained based on the obtained P value of less than 0.01. The results confirmed the benefit of laser surgical treatment. The change in parameters related to the anterior palate region showed the power of frenectomy and myofunctional therapy in restoring the tongue's ability to stimulate bone development. The protocol adopted in the following study could be used in interceptive orthodontics. However, further studies are needed to evaluate the effects on the upper jaw over the long term that have higher sample numbers.

A cone-beam computed tomography study of canalis sinuosus and its accessory canals in a South African population.

Canalis sinuosus (CS) is a clinically relevant structure in the anterior maxilla. The present study aimed to determine the prevalence and distribution of CS and its accessory canals (ACs) in the South African population and describe its anatomical variations. In total, 500 cone-beam computed tomography (CBCT) scans of the anterior maxilla were assessed for prevalence, sidedness, diameter, and distribution of CS. The frequency, number, diameter, configuration, and point of termination of ACs were also recorded. Statistical analysis was performed using analysis of variance, Kruskal-Wallis, chi-squared, and Fisher Exact tests with P < 0.05. CS was present in most cases (99.6%), and commonly occurred bilaterally (98.8%). The mean diameter of CS was 1.08mm (range: 0.50mm-2.39mm). Sex, population group, and age had no significant effect on the prevalence or sidedness of CS. Additionally, 535 ACs were observed in 58.8% of the sample, with 42.9% of ACs found bilaterally and 57.1% unilaterally. The mean diameter of the ACs was 0.86mm on the left and 0.87mm on the right (range; 0.50mm-1.52mm). The majority of ACs maintained a straight vertical configuration (72.3%). ACs most commonly terminated in the anterior palatal region of the maxilla (57.2%). No significant differences were found in any groups mentioned (P > 0.05). A high prevalence of CS as well as ACs were observed in thesample population. Due to their clinical significance, surgical planning with the aid of high quality CBCT scans of the anterior maxilla is advisable.

Indication and Success Rates of Skeletal Anchorage System in Orthodontics

Skeletal anchorage systems, a pivotal innovation in orthodontics, involve the use of Temporary Anchorage Devices (TADs) or mini-implants, providing stable anchor points in the bone to facilitate precise tooth movements. This comprehensive review article aims to investigate the indications and success rates of skeletal anchorage systems in orthodontics. The research, initiated on November 2nd, 2023, involved an extensive examination of existing literature, utilizing databases like PubMed, Web of Science, and Cochrane. Various components, including mini-screws, mini plates, palatal, buccal shelf implants, and infrazygomatic implants, have enriched orthodontic diversity. Mini screws have displayed remarkable success rates, with most complications related to manageable soft tissue inflammation. Gingival health and smoking habits have been identified as influential factors in mini screw implant success. Mini plates offer sturdy anchorage with resistance to root damage and fracture, surpassing mini screws in overall success rate. Age, implantation site viability, and soft tissue characteristics influence their success. Palatal and buccal shelf implants provide exceptional stability, enhancing the results of fixed bracket appliances. The anterior palatal region is a preferred site for implantation. Infrazygomatic implants, while offering commendable stability, display failure rates within the range of 21-28%, with compromised oral hygiene, immediate loading, inflammation, tooth mobility, and a high mandibular plane angle as potential failure factor. These anchorage methods have expanded treatment possibilities, offering effective solutions for challenging orthodontic cases and ultimately improving patient outcomes.

Midpalatal suture bone repair after miniscrew-assisted rapid palatal expansion in adults

BackgroundMidpalatal suture (MPS) repair in growing patients after RPE has been previously reported. However, differences between young and adult patients for timing and pattern of MPS repair after rapid maxillary expansion are expected. The aim of this study was to evaluate the midpalatal suture repair pattern after miniscrew-assisted rapid palatal expansion (MARPE) in adult patients.Materials and methodsThe study included 21 patients (six males, 15 females) successfully treated with MARPE with a mean initial age of 29.1 years of age (SD = 8.0; range = 20.1–45.1). MPS repair was evaluated using maxillary axial and coronal sections derived from CBCT exams taken 16 months after the expansion (SD = 5.9). Objective and subjective assessments of MPS repair were performed. Objective assessments were performed measuring MPS bone density at anterior, median and posterior region of hard palate. Pre-expansion and post-retention bone density changes were evaluated using paired t tests (p < 0.05). Midpalatal suture bone repair was scored 0 to 3 considering, respectively, the complete absence of bone repair in the MPS, the repair of less than 50% of the MPS, the repair of more than 50% of the MPS and the complete repair of the MPS. Intra- and interexaminer reliability evaluation were assessed using Kappa coefficient.ResultsThe objective evaluation showed a significant higher bone density at the pre-expansion stage in all palatal regions. The reliability of the subjective method was adequate with intra- and interexaminer agreements varying from 0.807 to 0.904. Scores 1, 2 and 3 were found in 19.05%, 38.09% and 42.86% of the sample, respectively. The most common region demonstrating absence of bone repair was the middle third. The anterior third of the midpalatal suture was repaired in all patients.ConclusionsA decreased bone density was observed after the retention period when compared to pre-expansion stage. Most adult patients demonstrated incomplete repair of the midpalatal suture 16 months after MARPE. However, adequate bone repair covering more than half of the hard palate extension was observed in 80.95% of the patients.

Influence of nasal septum deviation on fluctuating asymmetries of the nasomaxillary complex: A cross‐sectional study

An important parameter in diagnostic analysis and treatment planning of different biological areas is facial symmetry, and several etiological factors have been attributed to skeletal facial asymmetry. Although causality cannot be determined, previous studies have reported a relationship between the anatomical deviation of the nasal septum and facial development. Diagnosis is critical for patients in growth stages due to the association between nasal septum deviation (NSD) and abnormal growth of the nasomaxillary complex. To understand this relationship, this study aimed to investigate the influence of nasal septum deviation on fluctuating asymmetries (FA) of the nasomaxillary complex at different stages of skeletal maturation. Another goal was to determine whether an association exists between the degrees of septal deviation severity and asymmetry of the nasomaxillary complex. This was a retrospective, cross-sectional observational study comprising 60 selected cone-beam computed tomography (CBCT) scans that were divided into four groups (n= 15) according to the degree of septal deviation and skeletal maturation: mild deviation (MD; <10°), moderate to severe deviation (MSD; ≥10°), early group (EG), and late group (LG). The angle and area of deviation were measured for the greatest NSD, and a geometric morphometric approach was used to evaluate the nasal septum (NS) shape. The morphology of the nasomaxillary complex and the presence of fluctuating asymmetries were evaluated using 23 two-dimensional landmarks on the nasomaxillary complex (nasal, lateral, and palatal regions) with Procrustes ANOVA and Mann-Whitney test. Additionally, Spearman's correlation and multivariate regression were used to correlate the NSD with asymmetries in these regions. No significant differences were observed in the Procrustes FA scores of the nasomaxillary complex between the MD-EG × MSD-EG and MD-LG × MSD-LG (p> 0.05). However, the results of the multivariate regression revealed more specific aspects of asymmetry (asymmetry component), there was a positive correlation between the NSD angle and the palatal regions (p= 0.035 and p= 0.047, middle and posterior, respectively), and the nasal septum shape and anterior palatal regions (p= 0.039). The nasal and lateral regions did not correlate with the NSD angle in the multivariate regression analysis (p> 0.05). The results of this study indicate that there were no significant differences in the fluctuating asymmetry of the nasomaxillary complex between the mild and moderate to severe nasal septum deviation groups, in both early and late skeletal maturation stages. However, a positive correlation was observed in the degree of nasal septum deviation angle and asymmetry components of the middle and posterior palatal regions, likewise between the nasal septum shape and asymmetry components of the anterior palatal region. The diagnosis of nasal septum deviation by both physicians and dentists is important, as a relationship was observed with fluctuating asymmetry component of the palatal region. This information can guide the decision of the treatment planning for these individuals, and should be considered, especially in cases of severe septum deviation, due to the great anatomical proximity of these structures.

Assessment of rugaoscopic pattern to compare with gender identifi cation in Andhra Pradesh population: An institutional study

Background: Palatal rugae are anatomically asymmetrical and irregular ridges in the anterior palatal region. The palatal ruages were demonstrated to be useful in the field of forensic dentistry. This study was taken to assess the ruage patter to compare with gender identification in those who had attended dental institutions in Andhra Pradesh. Materials and Methods: A total of 40 subjects were included in the present study, those who attended a dental institution as a prospective cross sectional study. The rugae patterns were marked and classified according to Kapali et al., 1997, based on morphological pattern. Results: Female participants were more numerous in study samples when compared with males. The palatal ruage in female participants showed a higher incidence of wavy, circular, and divergent patterns, while male participants showed straight, curved, wavy, and convergent rugae patterns. Comparison of gender with respect to the mean number of rugae patterns on the right and left sides using a student t-test revealed that there was no stastically significant (p≥0.05). Conclusion: The rugae pattern can be one of the important aspects in the field of forensic odontology. The palate represents a suitable landmark for unique and identifying features, with the additional benefit of survival in most post-mortem events that can disrupt or change other body parts. Key word: Gender identification, Identification, Palatal rugae, Palatoscopy

Sex Assessment by Morphological Analysis of Palatal Rugae Patterns in a South Indian Adult Population

BackgroundPalatal rugae are asymmetric and irregular ridges on the anterior palatal region, which have proven to be useful in the field of forensic dentistry. This study aims to use morphological analysis of palatal rugae patterns to assess sex in a South Indian adult population.Materials and MethodsThis cross-sectional study was undertaken to evaluate a total of 300 maxillary dental casts (150 males and 150 females). The rugae patterns were marked by one observer and classified as per Thomas and Kotze criteria by another observer. The rugae patterns were classified based on the total number of rugae, shape, predominant direction of rugae, and unification of rugae.ResultsThe palatal rugae in female participants showed a higher incidence of circular rugae and backward directed rugae, while male participants showed more forward-directed rugae. The logistic regression analysis showed a significant association of with circular (OR=1.48; 95% CI= 1.02–2.13), forward (OR=0.87; 95% CI= 0.78–0.97) and backward (OR=1.23; 95% CI= 1.08–1.41) palatal rugae with sex.ConclusionCertain palatal rugae patterns can be used for the assessment of sex with limited accuracy.

Diode Laser as Minimal Invasive Treatment Modality for Oral Pyogenic Granuloma in a Pediatric Patient: A Case Report

The pyogenic granuloma is a soft-tissue growth relatively common in oral cavity, which is considered as reactive rather than neoplastic in nature. The pyogenic granuloma may occur at any age, but its peak incidence occurs in the second decade of life. Lasers emerged as an alternative surgical tool for such soft tissue lesions. Till now, there was no case reported in the literature about using diode laser for pyogenic granuloma in the pediatric patient. This article presents a case report of an 11 year-old boy with pyogenic granuloma in the anterior hard palatal region in relation to marginal gingiva of central incisors. A GaAlAs diode laser with wavelength 808±10 nm was used to perform laser surgery with parameters settings such as: Pulse-power: 5 W; Pulse-Length: 26μs; Frequency 20 kHz, Average output: 5 W. The fiber tip of 400 μm in contact mode was used for conducting the laser beam in excising the lesion. The whole laser surgical procedure was performed successfully and was found advantageous in intra-operative and post-operative aspects with faster and good healing in follow up visits. The behavior and anxiety of the patient were assessed before, during, and after the laser surgery procedure using the Venhams’s anxiety scale. Hence, Laser was found as the conservative surgical tool for pyogenic granuloma for minimally invasive dentistry and helped in instilling a positive dental attitude and behavior in pediatric patient.

Nasopalatine Duct Cyst: A Case Report and Review of Literature

Nasopalatine duct cyst is the most common developmental non-odontogenic cysts seen in the midline region of anterior maxilla. An epithelial remnant of the nasopalatine ducts remain in the incisive canal is the most common etiology. Nasopalatine duct cysts are generally asymptomatic and infrequently produce a swelling and associated pain in the anterior palate if secondarily infected. On radiograph it presents with a welldefined round, oval or heart shaped radiolucency. Histopathologically it shows non-keratinized epithelium typically with neurovascular bundles in the connective tissue capsule. Surgical enucleation is the treatment of choice. In the present case report clinical features, diagnosis and management of nasopalatine duct cyst in a 23-year-old male in the anterior maxillary palatal region is discussed.

Estimation of height and width of bone in anterior hard palate as a donor site for autogenous bone graft using IOPA by long cone paralleling technique.

The purpose of this study was to determine the amount of bone available for harvesting from the anterior palate region using IOPA (Intra Oral Peri Apical) radiographs. A total of 80 patients visiting the outpatient Department of Periodontics were selected. Two groups of male and female consisting 40 patients each were made. They were further subdivided into two groups based on age, 18-30 and 31-60 years of age, each with twenty patients. The patients were subjected to radiographic examination consisting of IOPA radiographs. All IOPA radiographs were taken using long cone paralleling technique. Availability of bone for harvesting, above the apices of teeth was calculated. The bone available in the incisor region was approximately 6.5 to 6.9 mm in height and 7.4 to 8 mm in width, in canine region 6.35 to 6.65 mm in height and 7.6 to 8.1 mm width, and in the premolar region 3.65 to 3.75 mm in height and width. When the bone height and width were compared gender and age wise for CI (central incisors), LI (lateral incisors), canine and premolars, using Student's t- test the results were not statistically significant. For the purpose of harvesting autogenous bone, from the region of incisor and canine approximately 6.35 to 6.9 mm height and 7.4 to 8.1 mm width of bone may be harvested maintaining a safe distance from the apices of the teeth and the nasal floor. The premolar region does appear to yield sufficient bone at safe distances from the maxillary sinus and the apices of the premolars.

Effectiveness of the Greater Palatine Nerve Block for Anaesthetising Anterior Palate: A Prospective Study

Introduction: Local Anaesthesia (LA) is the mainstay of any routine dental extraction. Accomplishing optimum anaesthesia with least pain and anxiety to patients is a challenge. Hence, modification of technique and application of routine dental LA to enhance patient comfort is the need of the hour. In this pursuit, a prospective cohort study was carried out to evaluate the effectiveness of greater palatine nerve block as an alternative to nasopalatine nerve block in anaesthetising the anterior palatal mucosa and to achieve optimum palatal anaesthesia. Aim: The primary outcome variable is to assess the extent of the anaesthetic effect of greater palatine nerve block in maxillary anterior palatal region. Materials and Methods: A total of 100 patients scheduled for the extraction of ipsilateral anterior and posterior maxillary teeth were included in this prospective study between June 2017 to June 2019. Palatal anaesthesia for all the extractions done was achieved only with greater palatine nerve block. After an interval of five minutes, the extent of palatal anaesthesia from the posterior palatal tissue to the anterior region was evaluated for both subjective and objective symptoms. Pain on the palatal mucosa was assessed using Numerical rating scale of 0-10. Post-evaluation, depending on the proposed tooth of extraction, buccal anaesthesia was achieved with Posterior superior alveolar nerve block for posterior teeth and infraorbital nerve block for anterior teeth. Results: Of the 100 patients administered with greater palatine nerve block, it was observed that in 36 patients (36%) had effectiveness in anaesthesia till central incisor, 28 (28%) patients had effectiveness in anaesthesia till lateral incisor, 20 (20%) patients had effective in anaesthesia till the canine and 16 (16%) patients anaesthetic effects were limited to posterior teeth. Overall, 84% had varied degree of positive anterior anaesthesia with greater palatine nerve block alone. Conclusion: Greater palatine nerve block was effective in providing anaesthesia to the posterior region till the premolars, with the extended complete anaesthesia in the anterior region with similar action as the nasopalatine nerve block administered to anaesthetise the anterior palate for extraction of the anterior teeth.

Assesment of accessory branches of canalis sinuosus on CBCT images.

Background The aim of this study is to describe the presence, to reveal the frequency and characteristics of accessory canals (ACs) of the canalis sinuosus (CS) by cone beam computed tomography (CBCT). Material and Methods A total of 326 CBCT examinations were scanned retrospectively. The anatomical views were evaluated on sagittal, axial, coronal and cross sectional imaging. The following parameters were recorded: age, sex, presence or absence of ACs, location in relation to the adjacent teeth and distance to the nasal cavity floor (NCF), alveolar ridge crest (ARC) and buccal cortical bone (BCB), and incisive canal. All the collected data were statistically analyzed. Results 113 patients (34,7%); presented ACs in total 214 foramina of the sample. There were no statistically significant changes in the presence of ACs regarding age groups excluding 80-89 years. But there is a statistically significant difference regarding the frequency of ACs and the gender. The prevalence for male patients was higher than female patients. Curved-shape configuration of CS prevalence is found as 69,15%. The prevalence of vertical tracing is 26,16% and Y-shape configuration of CS prevalence is 4,67%. Diameter of the foramens of the CS branches was 1.30 mm. The mean distance of the AC to the NCF, BCB, and ARC were found 13,83 mm, 6,60 mm and 5,32 mm, respectively. Conclusions In the anterior palatal region, ACs are mostly related to CS’s branches. So; knowing the course of CS branches in surgical planning and radiographic evaluations in this region is extremely important for preventing complications and avoiding misdiagnosis. Key words:Anterior superior alveolar nerve, canalis sinuosus, maxilla.

Comparación del grosor óseo palatino bilateral para inserción de miniimplantes

Objetivo: comparar el grosor óseo palatino bilateral e identificar zonas seguras para inserción de miniimplantes. Métodos: se llevó a cabo un estudio transversal que incluyó 100 tomografías de haz cónico (CBCT) pretratamiento de pacientes que asistieron a la Especialidad de Ortodoncia en la Universidad Autónoma de Nayarit (UAN). Las imágenes fueron orientadas utilizando el mismo protocolo. En el corte sagital, las mediciones se realizaron de los 0 a los 24mm, con intervalos de 3mm entre cada una, con la primera medición en el borde posterior del foramen incisivo. Las mediciones del grosor palatino se realizaron en el corte coronal a los 2, 4, 6 y 8mm de la sutura media palatina hacia ambos lados. Resultados: se encontró mayor grosor en la zona anterior en las medidas sagitales de 0 mm y 3 mm, a diferencia del resto del paladar. Se hallaron diferencias estadísticamente significativas al comparar los valores tanto sagitales como transversales. Con la prueba Post Hoc de Tukey no se encontraron diferencias estadísticamente significativas al comparar el lado derecho con el izquierdo en cada una de las medidas transversales. Conclusiones: no se encontraron diferencias significativas entre los dos lados, se determinó como zona segura la región anterior del paladar de 0mm a 6mm y es primordial la CBCT en todos los pacientes con indicación de miniimplantes en paladar.

Three-dimensional quantitative assessment of palatal bone height for insertion of orthodontic implants - a retrospective CBCT study

BackgroundOrthodontic implants have found widespread use as means of maximum skeletal anchorage in fixed orthodontic treatment, their optimal insertion location in the hard palate, however, is still controversial. The aim of this study was therefore to assess mean bone height across the hard palate and possible age- and sex related differences to identify the most favourable location according to maximum bone height, optimizing primary stability and survival of inserted orthodontic implants.MethodsIn this retrospective cross-sectional study, maxillary pretreatment CBCT scans of 180 healthy orthodontic patients (95♀, 85♂, age 8–40 years) were analysed with regard to vertical palatal bone height in the midpalatal area at 88 validated points distanced 2 mm from each other forming a grid of 0–14 mm posterior to the incisive foramen and 10 mm lateral of the midpalatal suture. Differences in bone height regarding sex and topographical location were assessed by three-way ANOVA.ResultsIn general, the midpalatal suture as well as the anterior-lateral palatal region showed distinctly higher mean palatal bone height with its maximum 4 mm posterior of the incisive foramen, whereas bone height was limited at the posterior region of the midpalatal suture. Women generally had significantly decreased palatal bone height compared to men at all measurement points. Higher age was associated with a decrease of bone height in the anterior and posterior lateral palatal region and the median palatal raphe with significant age differences.ConclusionsThe midpalatal suture as well as the anterior lateral palate seem to be most suitable for the insertion of orthodontic implants. Palatal bone height, however, was found to be sex- and age-specific, thus sex- and age-related differences should be taken into account, particularly regarding implant length. The ideal insertion site in the palate with sufficient bone height for orthodontic implants is 0-8 mm (men) or 0-6 mm (women) posterior to the incisive foramen and 10 mm lateral to the midpalatal suture.Trial registraionThis study has been registered and approved by the Ethics Committee of the University of Witten/Herdecke, Germany (12/2016).

Longitudinal morphometric analysis of dental arch of children with cleft lip and palate: 3D stereophotogrammetry study

This study aimed to perform a longitudinal morphometric analysis of the alterations of the maxillary dental arches in children with cleft lip and palate before and after primary lip and/or palate surgeries using a 3-dimensional stereophotogrammetry system. The sample consisted of dental casts of 60 children with complete unilateral cleft lip (UCL) and complete unilateral cleft lip and palate (UCLP). Dental arches were evaluated before cheiloplasty (T1), after cheiloplasty (T2), and 1 year after palatoplasty (T3). Independent t test and Mann-Whitney U test were used for intergroup comparisons, and paired t test, Wilcoxon's test, and repeated-measures analysis of variance (ANOVA), followed by Tukey's test, were used for intragroup comparisons. At T1, the intercanine and intertuberosity distances in the UCLP group were statistically greater than those in the UCL group. At T2, the maxillary dimensions significantly increased, except for the intertuberosity distance in UCL. Between T1 and T3, the intercanine distance and the anterior length decreased significantly, whereas the intertuberosity distance and the total length of the palate increased significantly. Our results indicated that the primary lip surgery altered the development of dental arches, evidently in children with UCLP. The primary palate surgery interfered in the growth of the anterior palatal region in the UCLP group. Children with UCLP had more restricted development of the maxillary dental arch compared with children with UCL.

A Hypothesis and Pilot Study of Age-Related Sensory Innervation of the Hard Palate: Sensory Disorder After Nasopalatine Nerve Division.

BackgroundThe nasopalatine nerve may be injured during extraction of teeth embedded in the anterior hard palate. The neural recovery process and its impact on sensation in the anterior hard palatal region are controversial. In our clinical practice, we noticed a distinct recovery process in children compared with adolescents or adults after surgery. We hypothesized that the sensory innervations of the anterior palate might shift during later childhood and pre-adolescence, which is due to the development of the nasopalatine nerve along with the maxillary growth and permanent teeth eruption.Material/MethodForty patients (20 females and 20 males, mean age 11.8±2.2) with impacted supernumerary teeth in anterior palatine area were included into our study, and were divided into 3 groups according to their age. A 24-week follow-up was conducted and the sensation in the anterior hard palate region was examined at every check point. All the data were collected and analyzed by Kaplan-Meier analysis.ResultsFourteen children did not complain of any numbness immediately after anesthetization, and other children with sensory disorders had shorter healing periods compared to adolescent/adult patients.ConclusionsThe results indicated that the dominant nerve of the anterior hard palate region was dramatically changed from the greater palatine nerve to the nasopalatine nerve, which is important in deciding when to operate and in selection of anesthesia method.

A retrospective study detecting the neurovascular anatomical variations in the anterior palate observed on cone beam computed tomography images

Introduction: Premaxilla or the anterior maxilla is one of the most important sites for different surgical procedures, and any variations in the normal anatomic features can lead to misdiagnosis and altered treatment planning for a clinician. Hence, it is very necessary for the early detection and evaluation of the anatomical variations associated with anterior maxillary region, and the procedure becomes easy with the incorporation of the specific radiologic appliances such as cone beam computed tomography (CBCT). Materials and Methods: One hundred CBCT scans were collected retrospectively for examination of additional foramina and canals in the anterior palatal region, through CBCT images, describing location, and diameter. Results: The mean canal diameter was 1.4 mm, out of the 100 scans evaluated 11 scans were found in which additional foramina were detected and 9 scans wherein canalis sinosus was detected. The mean canal diameter was 1.4. Conclusion: Although there are variations in each patient, with the knowledge of the anatomic landmarks and with the use of advanced imaging techniques, the chances of error in diagnosis and treatment planning can be greatly reduced.

English

Abstract Myiasis is a rare condition caused due to larvae infestation of body tissues. This can be caused by several species of Dipteran fly larvae and may be secondary to serious medical conditions. Common predisposing factors for oral myiasis are incompetent lips, poor oral hygiene, severe halitosis, anterior open bite, mouth breathing, facial trauma, extraction wounds, ulcerative lesions and carcinoma. Here, we describe a case of oral myiasis in the anterior palatal region in a mentally challenged patient caused by the larvae of Musca Nebulo whose clinical features, management and treatment outcome are discussed and case was followed up periodically. Keywords: Oral myiasis; House fly; Necrosis Introduction The term myiasis (Greek: myi= fly, asis= disease) is applied to infestation of living tissues of humans and animals, by dipterous larvae [1]. Zumpt descriptively defined myiasis as “the infestation of live human and vertebrate animals with dipterous larvae, which, at least for a certain period, feed on the host’s dead or living tissue, liquid body substances, or ingested food” [2]. Myiasis is well recognized in the animals, but rare in humans [2,3]. Human myiasis is extremely rare in developed countries, but it is not an uncommon parasitic infestation in the tropics and subtropics [4]. Myiasis can target any body tissue or cavity that is accessible to egg-laying and development of larvae, but most common anatomic sites involved are the nose, eye, lung, ear, anus, vagina, and more rarely, the mouth [3,5].Oral myiasis was first described by Laurence in 1909 [5]. Predisposing factors for development of oral myiasis are anterior open bite, mouth breathing, neglected mandibular fractures, Cancrum Oris, extraction sockets and patient with neurologic deficit, diabetes, and peripheral vascular disease [3].In this article a case of oral myiasis in the anterior palatal region in a patient with neurological deficit is presented.

Median palatal cyst in a 7-year-old child: A case report

The median palatal cyst is a developmental cyst at the midline of the palate, usually presenting as an asymptomatic swelling, located just behind the maxillary central incisors. It is the most common non-odontogenic cyst of the jaws, but is rarely seen in children. The median palatal cyst has recently been identified as a possible posterior version of the nasopalatine duct cyst. The purpose of this paper is to report an unusual case of a median palatal cyst in a 7-year-old boy who presented with a slow-growing swelling in the anterior palatal region and management of the cyst.

Cone beam computed tomographic analysis of neurovascular anatomical variations other than the nasopalatine canal in the anterior maxilla in a pediatric population.

This study aimed to analyze and assess the presence of accessory foramina and canals other than the nasopalatine canal (NPC) in the anterior palate region in a pediatric population, through cone beam computed tomography (CBCT) images, describing their location, direction, and diameter. Reformatted sagittal, coronal and axial slices of 368 individual CBCT images were analyzed. Any bone canal with a minimum diameter of 1.00 mm other than the nasopalatine canal was analyzed regarding size, location, and course, as well as patient gender and age. Eighty-two patients (22.3 %); presented additional foramina in the anterior palate (AFP) and in total 131 additional foramina were registered. A higher frequency of accessory canals was observed in girls (29.5 %) than in boys (15.7 %) (p = 0.012). The average diameter of AFP was 1.2 mm. Their location was variable, with most of the cases occurring in the alveolar process near the incisors or canines. Gender and age did not significantly influence the diameter. The study confirms the presence of bone channels within the anterior maxilla other than the NPC in a pediatric population. Over 22 % of the population studied had additional foramina other than the NPC in the anterior palate, between 1 and 1.7 mm wide, with variable locations.