Greater Palatine Foramen Research Articles

Palatal temporary skeletal anchorage devices (TSADs): What to know and how to do?

Since palatal temporary skeletal anchorage devices (TSADs) have become important tools for orthodontic treatment, this narrative review was aimed to provide an updated and integrated guidelines for the clinical application of palatal TSADs. A narrative review article including researches on palatal TSADs in orthodontics related to anatomy, success rate and clinical application. The anatomical characteristics, success rate and its consideration factors and clinical application of palatal TSADs based on the direction of tooth movement were evaluated. To improve the stability of TSADs, hard tissue factors such as bone depth, cortical bone thickness, bone density and soft tissue thickness were evaluated. Anatomically risky structures, including the nasopalatine foramen, canal and the greater palatine foramen, nerve, vessel need to be identified before placement. The success rate of palatal TSADs was greater than that of the buccal inter-radicular space. Palatal TSADs have been used for various purposes because they can control tooth movement in all directions and, three-dimensionally; their applications include the retraction of anterior teeth, protraction of posterior teeth, distalization, intrusion, expansion and constriction. They can be applied directly or indirectly to the lingual arch or transpalatal arch. Design modifications using splinted 2 miniscrews have been suggested. Palatal TSADs allow clinicians to perform minimally invasive and easy placement with good stability by understanding the anatomical characteristics of the palatal region, and they show good control over 3-dimensional tooth movements in various clinical cases.

Assessing the greater palatine foramen (GPF) location in the south indian population - a CBCT based study.

Assessing the greater palatine foramen (GPF) location in the south indian population - a CBCT based study.

Morphological and Morphometric Analysis of Greater Palatine Foramen in Dry Human Skulls of South Indian Population

Morphological and Morphometric Analysis of Greater Palatine Foramen in Dry Human Skulls of South Indian Population

Targeted Endodontic Microsurgery: Implications of the Greater Palatine Artery

IntroductionTargeted Endodontic Microsurgery (TEMS) combines trephine burs and 3D-printed guides to make flapless maxillary palatal root-end surgery possible. This study assessed the location of the greater palatine artery (GPA), the relationship of the GPA to maxillary molar root ends, and the feasibility of flapless palatal-approach TEMS. MethodsThree endodontists analyzed 250 cone-beam computed tomographic images of maxillary molars for (1) transition morphology between the hard palate and the alveolar process adjacent to first and second molars as an indication of the most likely location of the GPA, (2) the superior-inferior relationship between the GPA and root ends, and (3) the feasibility of palatal-approach TEMS. ResultsPalatal transition morphology included 20% Spine, 72% Bridge, and 8% Smooth. GPA position as related to palatal root ends was classified as 34% superior, 40% adjacent, and 21% inferior. Five percent of classifications were undefined. TEMS was deemed feasible for 47% of maxillary first molars and 52% of second molars, and was significantly more feasible with GPAs superior to palatal root ends. Reasons for infeasibility included GPA proximity and unfavorable resection angle or level. Maxillary first molar palatal roots were 11.13 ± 2.68 mm from the greater palatine foramen (GPF) and 2.37 ± 1.46 mm from the GPA. Second molar palatal roots were 4.94 ± 2.55 mm from the GPF and 2.53 ± 1.77 mm from the GPA. ConclusionsPalatal transition morphology and GPA position adjacent to maxillary molars, as manifested in cone-beam computed tomographic coronal views, suggested maxillary palatal root TEMS could be accomplished with a 2-mm safety margin in 47% of first molars and 52% of second molars. Historical paradigms that do not consider flapless palatal surgical approaches may need to be revised.

Can the morphological attributes of greater palatine foramen have implications in maxillary nerve block? An analytical study using anatomical planes

IntroductionMost popular approach for maxillary nerve block is via greater palatine canal (GPC) which is often difficult to access due to anatomical variations of its entry point the greater palatine foramen (GPF) thus resulting in failure of nerve block. It was hypothesized that exploring morphology of GPF with a modified approach may be useful towards its localization in an accurate manner. Materials & methodsThe study was conducted on 35 dry adult human skulls with help of anatomical planes and quadrants on surface of hard palate on both sides of mid-sagittal plane (MSP). ResultsIt was observed that GPF was located predominantly in Md2 and M2 quadrants with an incidence of 88.83% and 88.84% on the left and right side of MSP respectively (when third maxillary molar is present) and in 100% cases on both sides of MSP (when third molar is absent). MSP was identified as preferred plane for GPC approach because of its proximity to upper incisors. Two rectangular areas were identified around point of intersection (Px) between P2 and P3 anatomical planes (5 mm anterior to Px, 2 mm posterior to Px and 2 mm on either side of Px) and posterior to point of intersection (Py) between P2 and P4 anatomical planes (5 mm posterior to Py and 2 mm on either side of Py) with high incidence of GPF when third molar is present or absent respectively. ConclusionThe observations from this study may reduce risk of error in localizing GPF during maxillary nerve block.

Custom-Made Cleft Palate Models to Teach V-Y Pushback Palatoplasty.

We developed custom-made cleft palate (CP) models to teach V-Y pushback palatoplasty, with a focus on design and mucoperiosteal elevation.A model (23 cm wide, 30 cm long, and 13 cm high) was made using silicone (model 1; M1). On the palate of a skull model, 2 layers of colored rubber clay were applied to represent the superficial oral mucoperiosteum and deep nasal mucosa (model 2; M2). From the greater palatine foramen, threads of dental floss were inserted inside the clay, representing the greater palatine artery. In a workshop, a mouth gag was applied on M1, and participants designed 2-flap palatoplasty and 4-flap palatoplasty. On the palate of M2, incisions were made with a #15 blade. On M2, a mucoperiosteal flap (rubber clay over the hard palate) was elevated using a periosteal elevator, avoiding injury to the dental floss mimicking the greater palatine artery. Six participants were recruited for the workshop and were asked to rate their satisfaction with the outcome on a Likert scale.For CP design, participants answered that they had learned useful knowledge from this workshop, reflecting a significant improvement (4.0 ± 1.1 for incomplete CP, 4.2 ± 1.2 for complete CP). They became confident in this skill after the workshop (4.2 ± 0.8 for incomplete CP, 3.8 ± 0.8 for complete CP). For cleft mucoperiosteal flap elevation, they likewise learned useful knowledge (4.7 ± 0.5 for incomplete CP, 4.5 ± 0.5 for complete CP) and became confident in this skill (3.8 ± 0.8 for incomplete CP, 4.0 ± 0.6 for complete CP.)These models can be useful for V-Y pushback palatoplasty training for medical personnel.

Sphenopalatine Ganglion Block in Endoscopic Sinus Surgery: A Comparative Study

Objectives: The aim of this study was to find the effect of sphenopalatine ganglion block given via greater palatine foramen in managing intraoperative bleeding, postoperative pain and its effect on functional outcome and postoperative adverse effects in Functional Endoscopic Sinus Surgery (FESS). Methods: In this prospective study, a total of 60 consenting patients posted for FESS for chronic sinusitis were selected and randomised into two groups. Group A received sphenopalatine ganglion block via greater palatine foramen and group B did not. Intraoperative surgical field visibility was measured by Average Category Scale by Fromm and Boezaart. Postoperatively those with pain score more than 4 in VAS were given diclofenac injection. Functional outcome was measured by SNOT 22. Results: There was no significant difference in age and sex distribution of patients in both groups. Preoperative SNOT scores were comparable in both groups. There was improvement noted in surgical field in block group compared to non- block group. Significantly lesser requirement of postoperative analgesics was noted in this study with p value <.01. Postoperatively functional outcome with SNOT22 scores significantly improved in both groups compared to preoperative SNOT 22 scores. Better improvement was seen in block (A) group. Mean postoperative SNOT22 score in group B (14.3) was significantly higher than that in group A (5.2). Number of adverse effects reported in both groups was comparable. Conclusion: Intraoperative bleeding which reduces surgical field visibility and postoperative pain which results in excessive use of analgesics are common problems faced by endoscopic sinus surgeons. In this study, addition of sphenopalatine ganglion block to general anesthesia was tried in FESS to overcome these problems and to improve the outcome. This study showed a significantly reduced need for postoperative analgesics with use of SPG block. Patients who received SPG block showed better improvement in functional outcome and comparable occurrence of adverse effects with the no block recipients. Even though there was improvement in surgical field in SPG block group, we couldn’t establish a statistically significant outcome.

A Study of the Anatomical Variations in the number and Location of Palatine Foramina among Egyptian Population A Dry Bone and Radiological Study

The hard palate is an essential region of the skull; its gross anatomy and morphological variations have been of interest in many studies. The bones and dental structures of the palate are often preserved even in case of serious damage at or following death. The hard palate presents many important features including the greater and lesser palatine foramina. Locating the greater palatine foramen (GPF) is of paramount importance for dentists, oral and maxillofacial surgeons.The present work was designed to locate the greater palatine foramen in relation to specific anatomical landmarks, assess the number of lesser palatine foramina (LPF) and estimate the direction of greater palatine canal in dry skulls and CT scans.The present work was carried out on 30 dry skulls and 200 CT scans of brain and paranasal sinuses. It was designed to demonstrate the location of GPF in relation to specific surrounding anatomical landmarks being of paramount importance for both dentists, oral and maxillofacial surgeons. Variation in the location of GPF is remarkably common. Regarding linear measurements, no statistically significant difference existed between sides, but a statistically highly significant difference existed between males and females. Regarding the position of GPF in relation to maxillary molar teeth, the most frequent location was opposite the third maxillary molar (50% of dry skulls and 41% of CT scans). The direction of the greater palatine canal (GPC) was elucidated only in dry skulls, and in individual specimen the same direction was encountered on both sides.

Facial Blanching after Local Anesthesia Injection: Clinico-anatomical Correlation-Review of Literature.

Facial blanching as a complication of local anesthesia is reported in dentistry. Inadvertent arterial penetration and subsequent vasospasm has been accepted as the mechanism of this phenomenon. Most cases occur after inferior alveolar nerve block injection. In this article, five cases are reported after Gow-Gates injection, maxillary nerve block via greater palatine foramen, inferior alveolar nerve block, and maxillary buccal infiltration. It is the largest case series in this topic. Also, clinico-anatomical correlation between facial–mucosal blanching and the site of intra-arterial injection is explained. To the best of our knowledge, partial blanching of the face subsequent to buccal infiltration is reported for the first time in this article. Cutaneous surgeon should be aware of this complication and should not carry out unnecessary treatment.

Изменчивость большого небного канала и большого небного отверстия и их значение для проведения блокады крылонебного ганглия

Изменчивость большого небного канала и большого небного отверстия и их значение для проведения блокады крылонебного ганглия

Sex estimation from the cranial base in a Thai population

ABSTRACT One part of the skeleton that often preserves well when other areas do not is the cranial base. This study examined 13 dimensions of the palate and the posterior portion of the cranial base in 200 Thai skulls. We also created three triangles from these dimensions. ROC analysis was possible to find sectioning points for both sexes. The distance from right to left mastoidale proved to exhibit the greatest estimated accuracy with 46% of males and 48% of females sexed at 90% accuracy or better, 51% of males and 54% of females sexed at 85% accuracy or better, and 58% of males and 64% of females sexed at 80% accuracy or better. The combination of one triangle (large base area) and the distance from posterior nasal spine to the right greater palatine foramen produced 90% estimated accuracy for 46% of males and 60% of females, 85% estimated accuracy for 67% of males and 68% of females, and 80% estimated accuracy for 77% of males and 79% of females. These results underperform some other metric approaches to sex estimation among Thai skeletons, but suggest that the cranial base can be useful in situations of poor preservation or taphonomic degradation.

Endoscopic posterior nasal neurectomy

Surgical techniques for resistant chronic rhinitis (rhinorrhoea) vary, ranging from vidian neurectomy to post-nasal neurectomy. The techniques vary mainly on the basis of instrumentation, and the avoidance of post-operative epistaxis, transient hypoesthesia of the soft palate and dryness of the eye. Endoscopic visualisation, and cauterisation or resection of posterior nasal nerve branches, can prevent such complications. The technique and surgical steps of endoscopic posterior nasal neurectomy are presented. The critical steps include: bilateral sphenopalatine nerve blocks, transnasally or transorally via the greater palatine foramen; vertical incisions made behind the posterior fontanelle; and elevation of the mucoperiosteal flap. The sphenopalatine foramen and artery is identified. The posterior nasal nerve is located 4-5 mm inferior to the sphenopalatine artery, and is resected or cauterised. The flaps are repositioned back into place. No post-operative nasal packing is required. The same procedure is performed on the opposite side for effective results. This technique provides consistent, robust results, with long-term relief of allergic and vasomotor rhinitis related nasal symptoms, without risk of complication.

Greater palatine foramen: assessment with palatal index, shape, number and gender.

Accurate knowledge of location and relation with different para- meters of the greater palatine foramen (GPF) is a crucial necessity in performing a variety of anaesthesiological, dental and surgical procedures. The main aim of this study was to identify the GPF's locations, numbers and shapes via associating with gender and palatal indices and compare with literature results. This study was held on the cranium collections of the many anatomy departments in Turkey. Various metric assessments were observed on sexed, dry, total of 97 craniums. Thirty-eight male cranium observed and mean values of palatal indices was 86.28 ± 10.75 and for 48 female craniums mean value for palatal indices was 81.06 ± 10.56. Location of GPF observed bilaterally and mostly found near the third upper molar in either of both males and females. It was 62.7% (right), 60.9% (left) for male craniums and 49.0% (right) and 47.1% (left) for female craniums observed near the lateral border of upper third molar. GPF found oval shape for male craniums 62.8% (right) and 61.0% (left) and for female craniums 66.0% (right) and 66.0% (left). These results were compared with already existing anatomical data in other races and populations. These results would have great clinical influence in localising the palatine foramina toward better palatal area surgical approaches to and anaesthetise this area.

Computed tomographic features of adenoid cystic carcinoma in the palate

BackgroundTo evaluate the computed tomographic features and create a prediction model for clinical diagnosis of adenoid cystic carcinoma (ACC) in the palate with intact mucosa.MethodsFrom March 2016 to May 2018, 102 patients with palatal tumors and intact mucosa, including 28 patients with a pathological diagnosis of ACC after surgery, were enrolled in this study. The patients’ clinical symptoms, computed tomographic features and pathological diagnoses were recorded and analyzed. Independent predictors of ACC were determined by using univariate analysis and multivariate logistic regression, and the discrimination and calibration of the prediction model was evaluated, and internal validation was performed.ResultsUnivariate analysis of patients showed that ACC patients were more likely than non-ACC patients to be older (P = 0.019); to have palatine bone destruction (P<0.001) and greater palatine foramen (GPF) enlargement (P<0.001); to have involvement of the pterygopalatine fossa (P<0.001), foramen rotundum (P<0.001), nasal cavity (P<0.001) and maxillary bone (P<0.001); and to have numbness (P = 0.007) and pain (P<0.001). Multivariate logistic analysis showed that age and GPF enlargement were independent predictors of ACC in palatal tumors. The diagnostic prediction model showed good discrimination and calibration, as evaluated by the area under the receiver operating characteristic curve (0.98) and the Hosmer-Lemeshow goodness-of-fit test (P = 0.927).ConclusionsThe palate ACC prediction model based on age and GPF enlargement shows excellent discrimination with no evidence of poor calibration. Older patients with palatal tumors and intact mucosa should be considered for ACC when they have GPF enlargement.

Morphometric evaluation and clinical implications of the greater palatine foramen, greater palatine canal and pterygopalatine fossa on CBCT images and review of literature.

The pterygopalatine fossa (PPF) infiltration is performed to reduce blood flow during endoscopic sinus surgery and septorhinoplasty, as well as to control posterior epistaxis and provide regional anesthesia in dental procedures. PPF infiltration performed with consideration of the morphometrics of greater palatine foramen (GPF), greater palatine canal (GPC) and PPF would increase the success of the procedure and reduce the risk of complications. The aim of this study is to investigate the GPF, GPC, lesser palatine foramen (LPF), lesser palatine canal (LPC) and PPF morphology via the images obtained by CBCT, to provide information for interventional procedures. GPF, GPC, LPF, LPC and PPF were morphometrically evaluated retrospectively in CBCT images of 75 female and 75 male cases by Planmeca Romexis program. The 19 parameters were measured on these images. These parameters were evaluated statistically. The comparison of these parameters by genders revealed significant differences in distances between GPC-PC, PC-IOF, LPC-GPF, GPF-MS in the coronal and transverse planes, the distance between GPF and the occlusal plane of the teeth, GPF-PNS, GPF-IF and TD-GPF, and in the area of GPF. The number of LPF was found ranging from 1 to 5. Our results may help to insert to needle properly for application of maxillary nerve block with a high success rate and minimal complication. We recommend that the needle should be inserted 14-15mm lateral to the midsagittal plane, 19-20mm over the occlusal plane of the teeth and on the same line with the third molar teeth. For PPF infiltration through the GPF, the needle should be pushed forward 28mm upward at 66° angle on the transverse plane and 14°-15° angle on the vertical plane.

Anatomical and Radiological Study of the Greater Palatine Foramen in Adult Human Skulls

Thirty adult human skulls with full eruption of the third molar teeth were examined to determine the anatomy of the greater palatine foramen and canal. Forty computerized tomography scans of the patients were collected to study the location of the greater palatine foramen, direction and length of the greater palatine canal. Dry skulls were differentiated into 14 males and 16 females. Bony results demonstrated that the most common location for the greater palatine foramen was opposite the upper third molar tooth. The most common direction for the greater palatine canal into the oral cavity was anteroinferiorly. In radiological results (CT scan): the mean length of the greater palatine canal was 21.7 mm in males; and 18.1 mm females. The most common location of the greater palatine foramen (GPF) was (1) Opposite the third molar in 45% of the males; and 45% of the females. (2) The next common location was between the second and third molar teeth in 25% of the males; and 30% of the females. (3) Then opposed to the second molar in 20% of the males; and in 25% of the females, (4) Distal to the to the third molar in 10% of the males; and non in females. The direction of the greater palatine canal was anteroinferiorly in 55% of the males; and in 65% of the females. It is concluded that the dentist has to take these anatomical notes with consideration to obtain a successful injection for greater palatine nerve block.

Application of the foramina of the trigeminal nerve as landmarks for analysis of craniofacial morphology.

ObjectiveThe objective of this study was to develop new parameters based on the foramina of the trigeminal nerve and to compare them with the conventional cephalometric parameters in different facial skeletal types.MethodsCone-beam computed tomography (CBCT) scans and cephalograms from 147 adult patients (57 males and 90 females; mean age, 26.1 years) were categorized as Class I (1° < ANB < 3°), Class II (ANB > 5°), and Class III (ANB < −1°). Seven foramina in the craniofacial area—foramen rotundum (Rot), foramen ovale (Ov), infraorbital foramen, greater palatine foramen, incisive foramen (IF), mandibular foramen (MDF), and mental foramen (MTF)—were identified in the CBCT images. Various linear, angular, and ratio parameters were compared between the groups by using the foramina, and the relationship between the new parameters and the conventional cephalometric parameters was assessed.ResultsThe distances between the foramina in the cranial base did not differ among the three groups. However, the Rot-IF length was shorter in female Class III patients, while the Ov-MTF length, MDF-MTF length, and Ov-MDF length were shorter in Class II patients than in Class III patients of both sexes. The MDF-MTF/FH plane angle was larger in Class II patients than in Class III patients of both sexes. Most parameters showed moderate to high correlations, but the Ov-MDF-MTF angle showed a relatively low correlation with the gonial angle.ConclusionsThe foramina of the trigeminal nerve can be used to supplement assessments based on the conventional skeletal landmarks on CBCT images.

Study of Variation in the Position of Greater Palatine Foramen in North Karnataka Population

Study of Variation in the Position of Greater Palatine Foramen in North Karnataka Population

Morphology of the human hard palate: a study on dry skulls

To determine morphological variations of the hard palate in dry human skulls, 85 skulls of unknown age and sex from nine medical schools in Khyber Pakhtunkhwa, Pakistan were examined. The transverse diameter, number, shape and position of the greater (GPF) and lesser (LPF) palatine foramina; canine to canine inter-socket distance; distance between greater palatine foramen medial margins; on each side, the distances between greater palatine foramen and base of the pterygoid hamulus, median maxillary suture and posterior border of the hard palate; palatal length, breadth and height; maximum width and height of the incisive foramen; and the angle between the median maxillary suture and a line between the orale and greater palatine foramen were determined. Palatine index and palatal height index were also calculated. An oval greater palatine foramen was present in all skulls, while a mainly oval lesser palatine foramen was present in 95.8% on the right and 97.2% on the left. Single and multiple lesser palatine foramina were observed on the right/left sides: single 44.1%/50.7%; double 41.2%/34.8%; triple 10.2%/11.6%. The greater palatine foramen was located above the third molar in 74.7% (right)/87.8% (left), between the second and third molars in 25.3%/9.5%, and above the second molar in 2.7% (left). A single oval-shaped incisive foramen was observed in 87.1%. The median maxillary suture angle was 13.74±1.58° on the right and 13.14±1.68° on the left. In conclusion, no significant differences were observed in any distances on the right and left side related to greater palatine foramen; however a significant difference (p <0.05) was observed between the right and left sides for median maxillary suture angle.

A micro-CT study of the greater palatine foramen in human skulls.

The greater palatine foramen (GPF) is an important anatomical landmark and has substantial clinical relevance in dental surgery. Knowledge of its precise location and dimensions is required for proper planning of surgical procedures involving the posterior maxilla. We used microfocus computed tomography to determine the location and dimensions of the GPF, and any sex and race variations in those measurements, in 77 human skulls scanned at the South African Nuclear Energy Corporation. Specialized software was used for three-dimensional rendering, segmentation, and visualization of the reconstructed volume data. GPF location ranged from adjacent to the first molar to distal of the third molar. The most common GPF location was near the third molar (66.7% of skulls), and the GPF was as close as 6.31 mm (mean distance 12.75 ± 3 mm). The mean GPF dimensions were 5.22 mm on the anterior-posterior axis and 2.81 mm on the lateral-medial axis. We noted no significant differences in relation to race, sex, or age in the sample. The GPF was adjacent or posterior to the third maxillary molar in most skulls.