Palatal analysis and osteology of the hard palate of the Kenyan African skulls

One hundred twenty-five dry skulls from Kenya that consisted of about 90% Bantu individuals were examined to obtain data on the gross anatomy of the hard palate. The palatine index showed that 43.2% of the total sample of skulls has narrow (leptostaphyline), 23.7% intermediate (mesostaphyline), and 33.1% wide (brachystaphyline) palates. The palatine height index showed that 40% skulls had low (chamestaphyline), 57% intermediate (orthostaphyline), and 3.0% deep (hypsistaphyline) palates. Mean palatal length, breadth, and height for the total sample was 4.92 cm, 4.02 cm, and 1.22 cm, respectively. The incisive foramen and canal was cone shaped in 80% where the diameter of the foramen was less than 0.4 cm, while it was cylindrical in 20% where the diameter was greater than 0.4 cm. Forty-nine per cent of the skulls had two-five lesser palatine foramina present. The greater palatine foramen was found to lie at the level of the third molar in 76%, intermediate between second and third molars in 13.6%, and opposite the second molar in 10.4%. The greater palatine foramen opened antero-medially in 74% and perpendicularly in 26% of the palates. Extensive longitudinal palatal grooves were found bilaterally in all the palates, 70% showed divisions of the grooves, 63.2% had crests along the border of the grooves, and 19.2% had bridges in the posterior part of the groove near the opening of the greater palatine foramen. The incidence of palatine torus was 4.8%. The incisive suture was present in 6.4% of the adult palates.     

Anatomy of greater palatine foramen and canal and pterygopalatine fossa in Thais: considerations for maxillary nerve block

This study aims to investigate the anatomy of the greater palatine foramen (GPF), greater palatine canal (GPC) and pterygopalatine fossa (PPF) with special reference to the blockage of the maxillary nerve. A correlation between the length of GPC and PPF and the heights of the orbit and the maxilla was also studied using simple linear regression analysis. The morphology of the GPF, GPC and PPF as well as heights of the orbit and the maxilla were assessed in 105 Thai skulls. The thickness of the mucosa over the GPF was also measured from the dissection of 55 cadavers. The results showed that most GPF appeared as an oval foramen located at the palatal aspect of the upper third molar. The GPF was 16.2±1.3 mm lateral to the median sagittal plane of the hard palate, 2.1±1.3 mm anterior to the posterior border of the hard palate and 5.1±1.3 mm from the greatest concavity of the distolateral margin of the hard palate. The mean length of GPC and PPF was 29.7±4.2 mm. The mean angles of the GPC in relation to the hard palate and the vertical plane were 57.9±5.8° and 6.7±5.2°, respectively. In attempting to insert a needle to reach the foramen rotundum through the GPF, 31.7% passed into the orbit while 8.7% passed into the brain. The mean thickness of the mucosa over GPF was 6.7±2.3 mm. Two models for estimating the depth of needle injection in maxillary nerve block have been developed as follows: Length of GPC and PPF=19.038+0.314 (orbital height) and length of GPC and PPF=21.204+0.187 (maxillary height). The calculated length combined with the mucosal thickness was the estimated depth of needle injection. In conclusion, our results concerning the GPF, GPC and PPF will provide the useful reference for clinicians to anesthetize the maxillary nerve with a greater degree of success.     

Anatomical study of the greater palatine artery and related structures of the palatal vault: considerations for palate as the subepithelial connective tissue graft donor site

Palate is considered as a tissue graft donor site for dental surgical procedures. Therefore, the aim of this study was to investigate the anatomy of palatal structures, such as greater palatine artery, greater palatine foramen, and incisive fossa, in order to consider their topography at planning the graft dimensions and reduce the potential risk of injury of greater palatine artery. Direct inspection of 41 Thai cadavers was performed. The results showed the statistically significant differences as for the length of female and male palates (p = 0.017); however, vertical measurements were equally distributed in examined population. Main location of greater palatine foramen was palatal to the second molar (35.7%), as well as, interproximal to the second and third molars (35.7%) in women, and palatal to the second molar in men (65%). GPA was branching most frequently at the level of first premolar (38%) and at first and second molars together (43%) in women. In men, the branching on the alveolar process side was commonly observed at the level of first and second premolars together (56%), and at the level of second and third molars together (32%). In the area between maxillary first premolar and second molar, it appeared possible to harvest a connective tissue graft measuring at least 5 mm in height. The results of this research will provide the useful data for other comparative studies and for assisting periodontologists in planning the dimensions and harvesting the subepithelial connective tissue grafts from palate.     

Postnatal changes in osseous and mucosal morphology of the hard palate

We investigated the postnatal changes in the dimensions, configuration, and surface pattern of the hard palate in 68 skulls, ranging in age from birth to 90 years of age. The number of palatine rugae of the palatine mucosa was assessed in 168 living subjects aged 11-98 years. Before the first dentition appeared, the osseous palate was concave, smooth, and lacked alveolar processes. In maxillar specimens from the end of the first year to the end of the fourth year of life, balloon-like osseous formations, containing the elements of permanent teeth, appeared bilaterally behind the deciduous incisors. With age, the concavity of the palate diminished and became flat with the loss of the teeth. The presence of teeth was associated with the height of the alveolar ridge, which decreased from 7.3 +/- 4.4 mm in specimens with intact teeth to 4.7 +/- 4.1 mm in specimens without teeth (P = 0.020). Palatine rugae were a common finding in living subjects, but were more often absent in older age (2.2% in 11-50 age group vs. 12.8% in 51-98 age group, P = 0.0183). Our results suggest that the morphology of the hard palate rapidly changes during deciduous and permanent teeth eruption and is related to the presence of alveolar ridges and teeth in adults. Palate osseous morphology may be morphologically and functionally independent from its mucosal morphology. Changes in the morphology of the osseous palate are clinically relevant for dental prosthetics and tooth implantation.     

Palatal asymmetry during development: an anatomical study

The purpose of this study was to evaluate hard palate asymmetry during development. The palates of 248 dry skulls were photographed and evaluated digitally. The skulls were divided into seven groups: fetus, newborn, infant, child, adolescent, adult, and aged. Linear measures were obtained from great palatine foramen (GPF) to incisive fossa (INC) and to posterior nasal spine (PNS). Angular measures were obtained from the former landmarks plus the point on sutures intersection between maxillary and palatine bones. Asymmetry was evaluated intra and intergroups. All skulls showed some degree of right-left asymmetry in the hard palate. Regardless of hard palate asymmetry, none of the right-left side differences was statistically significant. For the intergroups assessment, none of the asymmetry index means were statistically different. The posterior part of palate (PNS x GPF) measures was more asymmetric than the anterior part (INC x GPF), showing, respectively, 4.6% and 2.8% of mean asymmetry index. Angular measures showed a more symmetric behavior than the linear ones. Hard palate asymmetry occurs even in the absence of masticatory function, showing that this feature begins early in fetal life and persists through development.     

口腭咽入路的解剖基础及手术中应用

目的　探讨口腭咽入路相应的解剖学结构和临床应用效果。 方法　在15具动脉灌注乳胶的成人尸头上模拟口腭咽入路,在显微镜下观察腭大孔、切牙孔的位置,骨嵴的比例,腭大动脉的走行,硬腭部软组织的结构特点并测量颅底重要解剖结构间的距离;对2006年3月至2010年6月经口腭咽入路行显微手术治疗的18例颅底中线区肿瘤患者的资料进行回顾性分析。 结果　切牙孔距牙槽嵴前端的距离为(5.18±2.44)mm,骨嵴的比例为93.3%,54支腭大动脉走行于硬腭半宽的中内2/3侧,术式的暴露范围主要受限于双侧的视神经、颈内动脉、舌下神经管内口等结构;本组18例中12例全切除,6例次全切除,并发症包括1例脑脊液鼻漏,1例构音不良,无死亡、偏瘫等严重并发症。 结论　口腭咽入路切除颅底中线区肿瘤具有暴露充分、手术创伤小、并发症少的优点。该入路是切除颅底中线区肿瘤的较佳入路。     

Bony bridge on the hard palate anterior to greater palatine foramen

An anatomical pecularity was observed in the form of a bony bridge connecting the palatal spines in front of the greater palatine foramen in 17.1% of edenticulus human skulls, while in the cadavers, these spines were seen connected by a tough fibrous band.     

Topography of the greater palatine artery and the palatal vault for various types of periodontal plastic surgery

The purpose of the present study is to provide useful data that could be applied to various types of periodontal plastic surgery by detailing the topography of the greater palatine artery (GPA), looking in particular at its depth from the palatal masticatory mucosa (PMM) and conducting a morphometric analysis of the palatal vault. Forty‐three hemisectioned hard palates from embalmed Korean adult cadavers were used in this study. The morphometry of the palatal vault was analyzed, and then the specimens were decalcified and sectioned. Six parameters were measured using an image‐analysis system after performing a standard calibration. In one specimen, the PMM was separated from the hard palate and subjected to a partial Sihler's staining technique, allowing the branching pattern of the GPA to be observed in a new method. The distances between the GPA and the gingival margin, and between the GPA and the cementoenamel junction were greatest at the maxillary second premolar. The shortest vertical distance between the GPA and the PMM decreased gradually as it proceeded anteriorly. The GPA was located deeper in the high‐vault group than in the low‐vault group. The premolar region should be recommended as the optimal donor site for tissue grafting, and in particular the second premolar region. The maximum size and thickness of tissue that can be harvested from the region were 9.3 mm and 4.0 mm, respectively. Clin. Anat. 578–584, 2014. © 2013 Wiley Periodicals, Inc.     

Blood supply of the human levator and tensor veli palatini muscles

In spite of its clinical importance in cleft palate, there are few detailed accounts of the blood supply of the soft palate and palatal muscles. A series of dissections was carried out to investigate the supply of the levator and tensor veli palatini muscles. Ten adult cadavers and 12 fetuses were used, all of which had been previously injected with a variety of media to outline the vascular tree. Conventional dissection was performed on the cadavers, and microsurgical instruments and a dissection microscope were utilized for fetal dissections. In 70% of dissections the m. levator veli palatini had a dual arterial supply, from the ascending palatine and ascending pharyngeal arteries. In the remainining cases the muscle was supplied by a single artery, either the ascending palatine or ascending pharyngeal. In 79% of dissections the tensor muscle had a dual supply from the accessory meningeal artery along with either the ascending palatine, ascending pharyngeal, or, in one case, the lesser palatine arteries. The results suggest that in careful surgical closure of the cleft soft palate the normal dual arterial supply would protect the tensor and levator muscles from vascular damage. In the minority of patients where only a single vessel supplies the levator, a radical intrapalatal dissection may jeopardize its vascularity.     

Microvascular architecture of the palatine mucosa in the common squirrel monkey (Saimiri sciureus).

Detailed observations were made of the structure and microvasculature of the palatine mucous membrane of the common squirrel monkey (Saimiri sciureus) by means of the plastic injection method under a scanning electron microscope. The findings obtained were compared with those of the Japanese monkey and other mammals. The osseous palate was flat horizontally and a pair of incisive foramina were apparently open at the anterior end of the hard palate. At the posterior end of the osseous palate, the pterygopalatine incisurae were found bilaterally. The incisive papilla was not obvious in form and size, and a pair of openings of the incisive canal were always situated on both sides of the papilla. The transverse palatine plicae or ridges numbered 7 or 8 symmetrically. They arched posterolaterally with an anterior protrusion near each median end. Posterior plicae were underdeveloped. Numerous openings of the palatine glands were found in the soft palatine mucosa. The arteries supplying the palate were the major palatine artery passing through the major palatine foramen and the soft palatine artery passing through the pterygopalatine incisura. The major palatine artery extended forwards giving off numerous medial and lateral branches, and its end on the respective side entered a small foramen located lateral to the incisive foramen. Medial and lateral branches formed the submucous arterial network. Arterioles diverging from this network were directed to the epithelial surface and formed an arterial network in the lamina propria. Further, capillaries diverging from the latter network built up the subepithelial capillary network immediately beneath the epithelium. Capillary loops sprouting from the capillary network were found in the form of a simple hair-pin without locational differences in their heights. The microvascular architecture thus displayed some similarity with that of the Japanese monkey. However, the vascular networks in the lamina propria and submucous layer were not distinct in size and scale as compared to those of the Japanese monkey. These differences may be related to the stature, living environment and food habits of this species.     

Clinical anatomy of the posterior maxilla pertaining to Le Fort I osteotomy in Thais

This article studies the anatomy of the posterior maxilla pertaining to bone-cut design of Le Fort I osteotomy to avoid the injury to the descending palatine artery in Thais. Fifty-five skulls (38 males, 17 females) were assessed for the anatomical landmarks by a combination of direct inspection, computerized imaging, and computed tomography scan analysis. The results showed that 27.28% of the pterygomaxillary junction (PMJ) became synostosis. The mean heights of the PMJ, posterior maxilla, and maxillary tuberosity were 15.14 +/- 2.46 mm, 22.51 +/- 3.50 mm, and 7.45 +/- 2.76 mm, respectively. The mean length of the medial sinus wall measuring from the piriform rim to the descending palatine canal at the Le Fort I level was 34.40 +/- 2.96 mm. The mean widths of the posterior incision of Le Fort I osteotomy at the maxillary tuberosity and PMJ were 20.38 +/- 2.82 mm and 11.60 +/- 1.57 mm. The mean length of the posterior maxilla was 27.18 +/- 2.49 mm. Distances from the greater palatine foramen to the maxillary tuberosity incision and PMJ incision were 1.76 +/- 1.12 mm and 3.59 +/- 1.40 mm. The mean angle between the descending palatine canal and the hard palate was 57.33 +/- 4.54 degrees . There were no significant differences in any measurements between sides and genders, except the pterygoid process width and posterior maxilla length of males were longer than those of females (P < 0.05). This study could provide better understanding of the posterior maxillary anatomy that is important for the bone-cut design of Le Fort I osteotomy to avoid excessive intraoperative and postoperative hemorrhage including ischemia of the mobilized maxilla.     

腭瓣的应用解剖

解剖了44侧硬腭的软组织,观察了软组织的层次持点和腭大动脉的定位。硬腭软组织外侧厚于正中,后部厚于前部。腭大动脉恒定地分布于硬腭半宽的内中2/3,外径约1.2mm。讨论了腭瓣手术的取材范围和腭大动脉的保护问题。     

Surgical anatomy of the sphenopalatine foramen and its arterial content

The sphenopalatine artery is the end artery of the maxillary artery located within the pterygopalatine fossa and passes through the sphenopalatine foramen (SPF) on lateral nasal wall. Nasal bleeding from this artery is potentially life threatening and may urgently require endonasal endoscopic occlusion. The aims of the present study have been first to investigate the location of the SPF, secondly the pattern of the main branches of the sphenopalatine artery at the foramen. 12 adult dry skulls and 6 adult cadaver heads injected within Indian Ink have been analyzed under an operating microscope Leica. All measurements were assessed using a digital calliper. The inferior border of the SPF has been situated 18.27 mm (15.09–20.87 mm) above the horizontal plate of the palatine bone and 13.04 mm (9.01–14.85 mm) above the horizontal lamina of the nasal inferior turbinate. Endoscopically, the posterior wall of the maxillary sinus is located at the level or anteriorly within 10 mm to the anterior border of the SPF. In all cases, the anterior border of the SPF is characterized by an easy recognizable sharp bony crest at the narrow middle part of the hourglass shape foramen. The SPF is 6.13 mm high (5.24–6.84 mm), with deep grooves extended superiorly and inferiorly from the foramen in eight skulls (8/12). The posterior lateral nasal artery which courses inferiorly and vertically (diameter 1.80 ± 0.20 mm) and the nasal septal artery which courses superiorly and vertically (diameter 1.30 ± 0.30 mm) have been the two major branches just leaving the SPF. One or two smaller collateral branches (diameter less than 1 mm) to the superior and/or the middle turbinate can get out coming from the stem of the main branches or directly from the SPF. So, the success rate of sphenopalatine artery ligation during endoscopic surgical procedure needs selective dissection of the two main branches of the sphenopalatine artery close to the SPF.     

Angiographic study of the arterial supply to the palatine mucoperiosteum.

Studies on the arterial supply of dog palatal mucoperiosteum have contributed to the success of surgical procedures on the hard palate of humans. We decided to undertake a more detailed anatomical study of the arterial supply of the canine palate. 15 male dogs of the species Canis familiaris were used. Contrast solution (barium sulfate) was injected into the palatal arterial system, followed by the removal of the dog's palate together with its mucoperiosteum. To obtain good radiographic imaging of the arterial network of the palatal mucoperiosteum, decalcification of the palatal bone was carried out. X-ray images were taken by a mammography X-ray machine set for 23 kV and 10 mA. The X-ray images showed that the mucoperiosteal arterial network is composed of a left and a right major artery which enters the mucoperiosteum through the left and right foramen, respectively. Anastomoses were observed between these two major arteries along their path from the posterior to the anterior regions of the mucoperiosteum. These anastomoses always occurred at the palatal transversal crests. The statistical study of the collected data showed that, for the posterior third of the palate, there is a proportionality between the number of the arterial derivations from the two major arteries and the mucoperiosteal area. The X-ray images also showed that the middle third of the palate is the least supplied with arterial derivations.     

An anatomic study using three-dimensional reconstruction for pterygopalatine fossa infiltration via the greater palatine canal

The pterygopalatine fossa (PPF) is accessed via the greater palatine canal (GPC) in an attempt to reduce bleeding during paranasal sinus surgery. This study aims to investigate the anatomy of the greater palatine foramen (GPF), GPC, and the PPF, with reference to PPF infiltration using three-dimensional reconstruction of computer tomographic (CT) scan measurements. The CT scans of 50 patients were retrospectively evaluated. The morphology of the GPF, GPC, and the PPF was assessed in a three-dimensional model. The thickness of the mucosa over the GPF was evaluated in the parasagittal plane. The mean length of the GPC was 13.8 ± 2.0 mm, and the mean height of the PPF was 21.0 ± 3.4 mm. The mean angles of the GPC in relation to the hard palate and the PPF were 67.4° ± 6.9° and 159.8° ± 7.1°, respectively. The GPF was 16.2 ± 1.3 mm lateral to the sagittal plane of the posterior nasal spine (PNS) and 6.1 ± 1.7 mm anterior to the coronal plane of the PNS. The mean volume of the PPF was 1039.9 ± 280.0 mm(3) . The mean thickness of the mucosa overlying the GPF was 10.7 ± 1.8 mm. We recommend that the PNS may be used as the bony landmark to locate the position of the GPF during PPF infiltration. The needle delivering the anesthetic should be bent 25 mm from the tip at a 45° angle, and a 1-ml injection of anesthetic should be administered in adults.     

Anatomical landmarks for the localization of the greater palatine foramen – a study of 1200 head CTs, 150 dry skulls,systematic review of literature and meta‐analysis

Accurate knowledge of greater palatine foramen (GPF) anatomy is necessary when performing a variety of anaesthesiological, dental or surgical procedures. The first aim of this study was to localize the GPF in relation to multiple anatomical landmarks. The second aim was to perform a systematic review of literature, and to conduct a meta‐analysis on the subject of GPF position to aid clinicians in their practice. One‐hundred and fifty dry, adult, human skulls and 1200 archived head computed tomography scans were assessed and measured in terms of GPF relation to other anatomical reference points. A systematic literature search was performed using the PubMed, Embase and Web of Science databases, and a meta‐analysis on the subject of GPF relation to the maxillary molars was conducted. On average, in the Polish population, the GPF was positioned 15.9 ± 1.5 mm from the midline maxillary suture (MMS), 3.0 ± 1.2 mm from the alveolar ridge (AR) and 17.0 ± 1.5 mm from the posterior nasal spine (PNS); 74.7% of GPF were positioned opposite the third maxillary molar (M3). Twenty‐seven studies were included in the systematic review and 23 in the meta‐analysis (n = 6927 GPF). The pooled prevalence of the GPF being positioned opposite the M3 was 63.9% (95% confidence interval = 56.6–70.9%). Concluding, the GPF is most often located opposite the M3 in the majority of the world's populations. The maxillary molars are the best landmarks for locating the GPF. In edentulous patients the most useful points for approximating the position of the GPF are the AR, MMS and PNS. This study introduces an easy and repeatable classification to reference the GPF to the maxillary molars.     

Innervation of human soft palate muscles

Our objective was to determine the branching and distribution of the motor nerves supplying the human soft palate muscles. Six adult specimens of the soft palate in continuity with the pharynx, larynx, and tongue were processed with Sihler's stain, a technique that can render large specimens transparent while counterstaining their nerves. The cranial nerves were identified and dissection followed their branches as they divided into smaller divisions toward their terminations in individual muscles. The results showed that both the glossopharyngeal (IX) and vagus (X) nerves have three distinct branches, superior, middle, and inferior. Only the middle branches of each nerve contributed to the pharyngeal plexus to which the facial nerve also contributed. The pharyngeal plexus was divided into two parts, a superior innervating the palatal and neighboring muscles and an inferior innervating pharyngeal constrictors. The superior branches of the IX and X nerves contributed innervation to the palatoglossus, whereas their middle branches innervated the palatopharyngeus. The palatoglossus and palatopharyngeus muscles appeared to be composed of at least two neuromuscular compartments. The lesser palatine nerve not only supplied the palatal mucosa and palatine glandular tissue but also innervated the musculus uvulae, palatopharyngeus, and levator veli palatine. The latter muscle also received its innervation from the superior branch of X nerve. The findings would be useful for better understanding the neural control of the soft palate and for developing novel neuromodulation therapies to treat certain upper airway disorders such as obstructive sleep apnea.     

腭部恶性肿瘤的CT诊断

探讨腭部恶性肿瘤的CT表现及其诊断价值。回顾性分析32例经病理证实的腭部恶性肿瘤的CT表现,其中男27例,女5例。所有病例均行横断增强扫描,其中8例同时行平扫,2例加冠状位扫描。腭部恶性肿瘤的CT表现为:(1)腭部肿块(26例)、腭部软组织增厚(6例)和腭骨质破坏(6例),其中病变位于软腭(22例)、硬腭(4例)、软硬腭交界处(3例);(2)邻近结构受累及(27例);(3)颈部淋巴结转移(17例)。CT是一种优良的检查技术,能显示腭部恶性肿瘤的大体病理改变以及侵犯途径,为临床治疗和预后提供重要信息。