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Sarna K, Estreed MA, Sonigra KJ, Amuti T, Opondo F, Kamau M, Ngeow WC. Anatomical Patterns of the Nasopalatine Canal and Incisive Foramen in an African Setting: A Cross-Sectional Study. Craniomaxillofac Trauma Reconstr 2023; 16:222-233. [PMID: 37975024 PMCID: PMC10638970 DOI: 10.1177/19433875221100943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
Study Design: Descriptive cross-sectional. Objective: To determine the morphology and morphometry of the nasopalatine canal (NPC) and incisive foramen (IF) in an African population. Methods: Measurements of the NPC and the IF were carried out on 150 Cone-Beam computed tomography (CBCT) scans. The maxillary bone thickness anterior to the NPC was measured at 3 levels. Independent t-test and Chi-square test were performed to determine the presence of sexual dimorphism. Results: The presence of one Stenson's foramen was most prevalent. The mean length of NPC was 13.21 ± 3.25 mm with significantly longer canals in males. The most prevalent shape of NPC was cylindrical in sagittal view and a single canal in coronal view. The mean angulation of NPC was 118.42° to the horizontal plane. The average dimensions of the IF were 3.53 mm and 3.07 mm in the anteroposterior and mediolateral diameter, respectively, while the most common shape was round. The anterior maxillary bone was thicker in males and generally reduced in thickness from the anterior nasal spine superiorly towards the alveolar crest inferiorly. Conclusion: This study highlights the anatomical characteristics of the NPC and IF, with significant sexual dimorphism observed regarding the number of Stenson's foramina, length of NPC, shapes of the NPC and IF, as well as alveolar bone thickness anterior to NPC.
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Affiliation(s)
- Krishan Sarna
- Department of Human Anatomy, University of Nairobi, Kenya
| | | | | | - Thomas Amuti
- Department of Human Anatomy, University of Nairobi, Kenya
| | - Florence Opondo
- Department of Oral and Maxillofacial Surgery, Division of Dental and Maxillofacial Radiology, University of Nairobi, Kenya
| | - Martin Kamau
- Department of Human Anatomy, University of Nairobi, Kenya
- Department of Oral and Maxillofacial Surgery, Oral Pathology and Oral Medicine, Division of Oral and Maxillofacial Surgery, University of Nairobi, Kenya
| | - Wei C. Ngeow
- Department of Oral & Maxillofacial Clinical Sciences, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia
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Radošević D, Erić M, Marić D, Vučinić N, Knezi N, Pupovac N, Ilić A. Morphology of the greater palatine foramen: a clinical point of view. Surg Radiol Anat 2023:10.1007/s00276-023-03188-7. [PMID: 37392229 DOI: 10.1007/s00276-023-03188-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 06/18/2023] [Indexed: 07/03/2023]
Abstract
PURPOSE Anatomical characteristics of the greater palatine foramen (GPF) are essential during the greater palatine nerve block application to anesthetize maxillary teeth, gums, midface, and nasal cavities. The position of GPF is usually described in relation to adjacent anatomical structures. This investigation aims to examine the morphometric relationships of GPF and closely determine its position. METHODS The study included 87 skulls (174 foramina). They were photographed in a horizontal position with bases facing up. The digital data were processed in the ImageJ 1.53n software. RESULTS The average distance of the GPF from the median palatine suture was 15.94 mm. In relation to the posterior border of the bony palate, the distance was 2.05 mm. Statistical significance was found in comparing the angle between the GPF, incisive fossa, and the median palatine suture between the sides of the skulls (p = 0.02). Comparing tested parameters between males and females showed significant differences in GPF-MPS (p = 0.003) and GPF-pb (p = 0.012), with lower values in females. The most significant percentage of skulls (77.01%) had the GPF located at the level of the third molar. The most significant number of bony palates had one lesser opening (60.91%) on the left side. CONCLUSION GPF is located at the level of the maxillary third molar in most of the examined palates. Knowledge of the anatomical position of the greater palatine foramen and its variations is the basis for successfully implementing anesthesia and various surgical interventions.
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Affiliation(s)
- Dragana Radošević
- Department of Anatomy, Faculty of Medicine, University of Novi Sad, 3 Hajduk Veljkova Street, 21000, Novi Sad, Serbia.
| | - Mirela Erić
- Department of Anatomy, Faculty of Medicine, University of Novi Sad, 3 Hajduk Veljkova Street, 21000, Novi Sad, Serbia
| | - Dušica Marić
- Department of Anatomy, Faculty of Medicine, University of Novi Sad, 3 Hajduk Veljkova Street, 21000, Novi Sad, Serbia
| | - Nikola Vučinić
- Department of Anatomy, Faculty of Medicine, University of Novi Sad, 3 Hajduk Veljkova Street, 21000, Novi Sad, Serbia
| | - Nikola Knezi
- Department of Anatomy, Faculty of Medicine, University of Novi Sad, 3 Hajduk Veljkova Street, 21000, Novi Sad, Serbia
| | - Nikolina Pupovac
- Department of Anatomy, Faculty of Medicine, University of Novi Sad, 3 Hajduk Veljkova Street, 21000, Novi Sad, Serbia
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Tavelli L, Barootchi S, Stefanini M, Zucchelli G, Giannobile WV, Wang HL. Wound healing dynamics, morbidity, and complications of palatal soft-tissue harvesting. Periodontol 2000 2023; 92:90-119. [PMID: 36583690 DOI: 10.1111/prd.12466] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/17/2022] [Accepted: 05/26/2022] [Indexed: 12/31/2022]
Abstract
Palatal-tissue harvesting is a routinely performed procedure in periodontal and peri-implant plastic surgery. Over the years, several surgical approaches have been attempted with the aim of obtaining autogenous soft-tissue grafts while minimizing patient morbidity, which is considered the most common drawback of palatal harvesting. At the same time, treatment errors during the procedure may increase not only postoperative discomfort or pain but also the risk of developing other complications, such as injury to the greater palatine artery, prolonged bleeding, wound/flap sloughing, necrosis, infection, and inadequate graft size or quality. This chapter described treatment errors and complications of palatal harvesting techniques, together with approaches for reducing patient morbidity and accelerating donor site wound healing. The role of biologic agents, photobiomodulation therapy, local and systemic factors, and genes implicated in palatal wound healing are also discussed.
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Affiliation(s)
- Lorenzo Tavelli
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
- Division of Periodontology, Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Shayan Barootchi
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Martina Stefanini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Giovanni Zucchelli
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | | | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
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Anatomy of the greater palatine foramen and canal and their clinical significance in relation to the greater palatine artery: a systematic review and meta-analysis. Surg Radiol Anat 2023; 45:101-119. [PMID: 36640185 PMCID: PMC9899171 DOI: 10.1007/s00276-022-03061-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/05/2022] [Indexed: 01/15/2023]
Abstract
PURPOSE Accurate knowledge of greater palatine foramen (GPF) and greater palatine canal (GPC) anatomy is necessary to avoid injury to the greater palatine artery (GPA) when performing a variety of anesthesiologic, dental or surgical procedures. The aim of this paper was to perform a systematic review and meta-analysis of literature on the anatomy and localization of bony structures associated with the GPA, namely the GPF and GPC. METHODS A systematic literature search was performed using PubMed, Embase, ScienceDirect, and Web of Science databases. Seventy-five studies were included in the meta-analysis (n = 22,202 subjects). RESULTS The meta-analysis showed that the GPF is positioned 17.21 mm (95% CI = 16.34-18.09 mm) from the posterior nasal spine, 2.56 mm (95% CI = 1.90-3.22 mm) from the posterior border of the hard palate, 46.24 mm (95% CI = 44.30-48.18 mm) from the anterior nasal spine, 15.22 mm (95% CI = 15.00-15.43 mm) from the midline maxillary suture, 37.32 mm (95% CI = 36.19-38.45 mm) from the incisive foramen, and opposite the third maxillary molar (M3) in 64.9% (58.7-70.7%) of the total population. CONCLUSION An up-to-date, comprehensive analysis of GPF and GPC clinical anatomy is presented. The results from this evidence-based anatomical study provides a unified set of data to aid clinicians in their practice.
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OZ II, Aydogdu A, Yilmaz TF. Radiological evaluation of maxillary artery and descending palatine artery in the pterygopalatine fossa by 3D rotational angiography. Surg Radiol Anat 2022; 44:535-542. [DOI: 10.1007/s00276-022-02916-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/21/2022] [Indexed: 11/29/2022]
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Kareem FA, Rauf AM, Rasheed TA, Hussain FA. Correlation of Three Dimensions of Palate with Maxillary Arch Form and Perimeter as Predictive Measures for Orthodontic and Orthognathic Surgery. CHILDREN-BASEL 2021; 8:children8060514. [PMID: 34204436 PMCID: PMC8234026 DOI: 10.3390/children8060514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/13/2021] [Accepted: 06/14/2021] [Indexed: 11/17/2022]
Abstract
Hard palate is regarded as an important part of the human skull, which contributes to the separation of the oral and nasal cavities. The aims of the study were to investigate the morphology of the hard palate in order to create a general guideline of three-dimensional values of the palate in a Kurdish sample in the city of Sulaimani as well as determining the possible correlations between different palatal parameters in class I malocclusion with the maxillary arch form and perimeter. A retrospective study design was adopted by collecting 100 study models of orthodontic patients aged 16–24 years old attending different private dental clinics in the city of Sulaimani seeking orthodontic management. In this study, three-dimensional palatal measurements including depth, length, and width were measured in an attempt to discover their correlation with each maxillary arch form and perimeter. Additionally, measurements of inter-molar width, inter-canine width, and arch perimeter were carried out. About two-thirds of those seeking orthodontic treatment were females. Nearly 80% of the study sample had narrow palate followed by 15 and 5% of intermediate palate and broad palate, respectively. In regard to arch form, almost 90% of subjects were with tapered maxillary arch form and 10% of them with oval arch form. Males had increased dimensions compared to females, with significant differences, except in palatal depth in the molar area, and palatine height index, in which females showed increased dimensions than males but the differences were statistically non-significant. A strong positive correlation was observed between arch form and canine depth. In regard to arch perimeter, a strong negative correlation was found with molar depth and a medium positive correlation with each of canine depth, palatal width, and palatal length.
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Affiliation(s)
- Fadil A. Kareem
- Pedodontics, Orthodontics and Preventive Dentistry Department, College of Dentistry, University of Sulaimani, Madam Mitterrand St., Sulaimani 46001, Iraq; (F.A.K.); (A.M.R.)
| | - Aras Maruf Rauf
- Pedodontics, Orthodontics and Preventive Dentistry Department, College of Dentistry, University of Sulaimani, Madam Mitterrand St., Sulaimani 46001, Iraq; (F.A.K.); (A.M.R.)
| | - Tara Ali Rasheed
- Pedodontics, Orthodontics and Preventive Dentistry Department, College of Dentistry, University of Sulaimani, Madam Mitterrand St., Sulaimani 46001, Iraq; (F.A.K.); (A.M.R.)
- Correspondence:
| | - Falah Abdullah Hussain
- Oral Surgery Department, College of Dentistry, University of Sulaimani, Madam Mitterrand St., Sulaimani 46001, Iraq;
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Narayan RK, Ghosh SK. Can the morphological attributes of greater palatine foramen have implications in maxillary nerve block? An analytical study using anatomical planes. TRANSLATIONAL RESEARCH IN ANATOMY 2021. [DOI: 10.1016/j.tria.2020.100093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Fonseka MC, Hettiarachchi PS, Jayasinghe RM, Jayasinghe RD, Nanayakkara CD. A cone beam computed tomographic analysis of the greater palatine foramen in a cohort of Sri Lankans. J Oral Biol Craniofac Res 2019; 9:306-310. [DOI: 10.1016/j.jobcr.2019.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 06/21/2019] [Accepted: 06/24/2019] [Indexed: 11/28/2022] Open
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Cone-Beam Computed Tomography Study on Morphologic Characteristics of the Posterior Region in Hard Palate. J Craniofac Surg 2019; 30:921-925. [PMID: 30640859 DOI: 10.1097/scs.0000000000005157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The goal of this study is to evaluate the morphologic characteristics of the posterior palatine region among the Chinese population, more specifically, the greater palatine grooves, crests, bridges, and torus palatinus structures and make comparisons between different ethnic groups and minorities. METHODS A total of 323 cone-beam computed tomography (CBCT) scans were collected for analysis on the presence of grooves, crests, bridges, or torus palatinus (TP). Data were collected through recognizing the grooves, crests, bridges, and TPs and calculating the number of those anatomy structures. The statistics index, including average, standard deviation, were adopted to describe the subjects and Wilcoxon test, Mann-Whitney test, and Chi-squared test were all carried out by SPSS. RESULTS Three different morphologic manifestations of the greater palatine groove (GPG) found in the upper 1st and 2nd molar regions are as follows: no groove, 1 groove, and 2 grooves. The number of crests ranged from 0 to 3. And the incidence of torus palatines was 29%. Moreover, a positive correlation was found between the presence of crests/GPGs and age in the 2nd molar region. CONCLUSION The results in this study reveal that GPGs in the upper 1st and 2nd molar regions have 3 different morphologic manifestations among Chinese people and the number of crests can vary from 0 to 3 crests. Although the proportion of GPG or crest and the incidence of TP are different from the proportions of other studies, this may be due to the fact that different ethnic groups and sample sizes were used in the course of this study. Information about the anatomy structures of the posterior region in hard palate directly contributed to a decrease in potential complications during palatal implant surgery and periodontal surgery.
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Bahşi İ, Orhan M, Kervancıoğlu P, Yalçın ED. Morphometric evaluation and clinical implications of the greater palatine foramen, greater palatine canal and pterygopalatine fossa on CBCT images and review of literature. Surg Radiol Anat 2019; 41:551-567. [DOI: 10.1007/s00276-019-02179-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 01/03/2019] [Indexed: 10/27/2022]
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What Is the Safety Zone for Palatal Soft Tissue Graft Harvesting Based on the Locations of the Greater Palatine Artery and Foramen? A Systematic Review. J Oral Maxillofac Surg 2018; 77:271.e1-271.e9. [PMID: 30395825 DOI: 10.1016/j.joms.2018.10.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 10/01/2018] [Accepted: 10/01/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE Palatal soft tissue graft harvesting is a common procedure in periodontal and implant dentistry. However, most of the complications after this procedure are associated with the underestimation of anatomic structures, such as the greater palatine artery (GPA). Therefore, the aim of this study was to provide guidelines for a safety zone for palatal harvesting. MATERIALS AND METHODS A systematic search was conducted to identify cadaveric and computed tomography (CT) or cone beam CT studies assessing the location of the greater palatine foramen (GPF) and the path of the GPA in relation to the maxillary teeth. The effect of age, gender, and cadaveric and CT or cone beam CT studies on the location of the GPF and on the course of the GPA also was assessed. RESULTS This systematic review included 26 studies, investigating 5,768 hemipalates. The most common location of the GPF was in the midpalatal aspect of the third molar (57.08%). As it traverses the palate anteriorly, the distance from the GPA to the maxillary teeth gradually decreases, except in the second premolar region, where it has the tendency to increase (13.8 ± 2.1 mm). The least distance from the GPA to the teeth was found in the canine area (9.9 ± 2.9 mm), whereas the greatest distance was in the second molar region (13.9 ± 1 mm). A safety zone for palatal harvesting was proposed based on the anatomic findings. CONCLUSIONS This study provides guidelines for identifying the position of the GPF and defines a safety zone for harvesting a free gingival graft or connective tissue graft, minimizing the risk of GPA injury.
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Janssen R, Moisik SR, Dediu D. Modelling human hard palate shape with Bézier curves. PLoS One 2018; 13:e0191557. [PMID: 29447175 PMCID: PMC5813942 DOI: 10.1371/journal.pone.0191557] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 01/08/2018] [Indexed: 11/18/2022] Open
Abstract
People vary at most levels, from the molecular to the cognitive, and the shape of the hard palate (the bony roof of the mouth) is no exception. The patterns of variation in the hard palate are important for the forensic sciences and (palaeo)anthropology, and might also play a role in speech production, both in pathological cases and normal variation. Here we describe a method based on Bézier curves, whose main aim is to generate possible shapes of the hard palate in humans for use in computer simulations of speech production and language evolution. Moreover, our method can also capture existing patterns of variation using few and easy-to-interpret parameters, and fits actual data obtained from MRI traces very well with as little as two or three free parameters. When compared to the widely-used Principal Component Analysis (PCA), our method fits actual data slightly worse for the same number of degrees of freedom. However, it is much better at generating new shapes without requiring a calibration sample, its parameters have clearer interpretations, and their ranges are grounded in geometrical considerations.
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Affiliation(s)
- Rick Janssen
- Language and Genetics Department, Max Planck Institute for Psycholinguistics, Nijmegen, The Netherlands
| | - Scott R. Moisik
- Language and Genetics Department, Max Planck Institute for Psycholinguistics, Nijmegen, The Netherlands
- Linguistics and Multilingual Studies, Nanyang Technological University, Singapore, Singapore
| | - Dan Dediu
- Language and Genetics Department, Max Planck Institute for Psycholinguistics, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
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Beetge MM, Todorovic VS, Oettlé A, Hoffman J, van Zyl AW. A micro-CT study of the greater palatine foramen in human skulls. J Oral Sci 2018; 60:51-56. [DOI: 10.2334/josnusd.16-0783] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Mia-Michaela Beetge
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Pretoria
| | - Vladimir S. Todorovic
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Pretoria
- School of Dental Medicine, University of Belgrade
| | - Anna Oettlé
- Department of Anatomy, Faculty of Health Sciences, University of Pretoria
| | | | - Andre W. van Zyl
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Pretoria
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Gibelli D, Borlando A, Dolci C, Pucciarelli V, Cattaneo C, Sforza C. Anatomical characteristics of greater palatine foramen: a novel point of view. Surg Radiol Anat 2017; 39:1359-1368. [DOI: 10.1007/s00276-017-1899-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 07/17/2017] [Indexed: 10/19/2022]
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Rapado-González O, Suárez-Quintanilla JA, Suárez-Cunqueiro MM. Anatomical variations of the greater palatine canal in cone-beam computed tomography. Surg Radiol Anat 2016; 39:717-723. [DOI: 10.1007/s00276-016-1791-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 11/28/2016] [Indexed: 11/24/2022]
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Monsour P, Huang T. Morphology of the greater palatine grooves of the hard palate: a cone beam computed tomography study. Aust Dent J 2016; 61:329-32. [DOI: 10.1111/adj.12375] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2015] [Indexed: 11/29/2022]
Affiliation(s)
- P Monsour
- Dentomaxillofacial Radiology; UQ Oral Health Centre; School of Dentistry; The University of Queensland; Herston Queensland Australia
| | - T Huang
- Private Practice; Perth Western Australia Australia
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Computed tomography morphometric analysis of the greater palatine canal: a study of 1,500 head CT scans and a systematic review of literature. Anat Sci Int 2014; 90:287-97. [PMID: 25467526 PMCID: PMC4548015 DOI: 10.1007/s12565-014-0263-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 11/11/2014] [Indexed: 11/02/2022]
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.
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Yu SK, Lee MH, Park BS, Jeon YH, Chung YY, Kim HJ. Topographical relationship of the greater palatine artery and the palatal spine. Significance for periodontal surgery. J Clin Periodontol 2014; 41:908-13. [DOI: 10.1111/jcpe.12288] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Sun-Kyoung Yu
- Department of Anatomy and Orofacial Development; School of Dentistry; Chosun University; Gwangju Korea
| | - Myoung-Hwa Lee
- Department of Anatomy and Orofacial Development; School of Dentistry; Chosun University; Gwangju Korea
| | - Byung Sun Park
- Department of Anatomy and Orofacial Development; School of Dentistry; Chosun University; Gwangju Korea
| | - Yong Hyun Jeon
- Department of anatomy; School of Medicine; Chosun University; Gwangju Korea
| | - Yoon Young Chung
- Department of anatomy; School of Medicine; Chosun University; Gwangju Korea
| | - Heung-Joong Kim
- Department of Anatomy and Orofacial Development; School of Dentistry; Chosun University; Gwangju Korea
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Tomaszewska IM, Tomaszewski KA, Kmiotek EK, Pena IZ, Urbanik A, Nowakowski M, Walocha JA. 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. J Anat 2014; 225:419-35. [PMID: 25131842 DOI: 10.1111/joa.12221] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2014] [Indexed: 11/27/2022] Open
Abstract
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.
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Affiliation(s)
- Iwona M Tomaszewska
- Department of Medical Education, Jagiellonian University Medical College, Krakow, Poland
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Sharma NA, Garud RS. Greater palatine foramen – key to successful hemimaxillary anaesthesia: a morphometric study and report of a rare aberration. Singapore Med J 2013; 54:152-9. [DOI: 10.11622/smedj.2013052] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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21
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Piagkou M, Xanthos T, Anagnostopoulou S, Demesticha T, Kotsiomitis E, Piagkos G, Protogerou V, Lappas D, Skandalakis P, Johnson EO. Anatomical variation and morphology in the position of the palatine foramina in adult human skulls from Greece. J Craniomaxillofac Surg 2011; 40:e206-10. [PMID: 22055651 DOI: 10.1016/j.jcms.2011.10.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Revised: 09/28/2011] [Accepted: 10/07/2011] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To investigate the anatomical variability of the palatine structures in Greek population. MATERIAL AND METHODS 71 Greek adult dry human skulls were examined to detect the position of the greater palatine (GPF) and lesser palatine foramina (LPF) related to adjacent anatomical landmarks. RESULTS The perpendicular distance of the GPF to the midline sagittal suture was 1.53 cm and 0.3 cm from the inner border of the alveolar ridge. The mean distance from the posterior palatal border was consistent 0.46 cm on the right and 0.47 cm on the left side of the skulls. In the greater majority of the skulls (76.2%), the GPF were between proximal-distal surfaces of the 3rd maxillary molar. A single LPF was observed in 53.45% of the skulls, two LPF were observed in 31% of the skulls bilaterally and five LPF were rare (2.1%). The commonest position of LPF was at the junction of the palatine bone and the inner lamella of the pterygoid plate (71.9%). CONCLUSION Our results can help clinicians localize the palatine foramina in patients with and without maxillary molars and to predict the depth of a needle to anaesthetise the maxillary nerve with greater success when performing surgical procedures in the hard and soft palate.
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Affiliation(s)
- Maria Piagkou
- Department of Anatomy, Medical School, Faculty of Health Sciences, UOA, Athens, Greece.
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22
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Chrcanovic BR, Custódio ALN. Anatomical variation in the position of the greater palatine foramen. J Oral Sci 2010; 52:109-113. [PMID: 20339241 DOI: 10.2334/josnusd.52.109] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
The present study measured the position of the greater palatine foramen relative to adjacent anatomical landmarks in Brazilian skulls. The perpendicular distance of the greater palatine foramen to the midline maxillary suture in Brazilian skulls was about 14 mm and the distance of greater palatine foramen to the incisive foramen was approximately 36 mm. The distance of greater palatine foramen to the posterior border of the hard palate was approximately 3 mm, and the mean angle between the midline maxillary suture and the line from the incisive foramen and the greater palatine foramen was 22.71 degrees . In almost 70% of the cases, the greater palatine foramen opened in an anterior direction. The mean palatine length was approximately 52 mm. In the greater majority of the skulls (93.81%), the greater palatine foramina were opposite or distal to the maxillary third molar. These data will be helpful in comparing these skulls to those from various other regions as well as comparing skulls of different races. It can also provide professionals with anatomical references, in order to block the maxillary division of the trigeminal nerve through the greater palatine foramen. Our results would help clinicians locate the greater palatine foramen in patients with and without upper molars.
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Affiliation(s)
- Bruno R Chrcanovic
- Department of Morphology, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Brazil.
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Liang X, Jacobs R, Martens W, Hu Y, Adriaensens P, Quirynen M, Lambrichts I. Macro- and micro-anatomical, histological and computed tomography scan characterization of the nasopalatine canal. J Clin Periodontol 2009; 36:598-603. [PMID: 19538333 DOI: 10.1111/j.1600-051x.2009.01429.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
AIM To determine the human anatomic variability of the nasopalatine canal and determine its characteristics using an anatomical, histological and computed tomography (CT) scan evaluation. MATERIALS AND METHODS Measurements for the canal characteristics were carried out on 163 dry human skulls and 120 upper jaw spiral CT scans, taken from patients for pre-operative planning purposes of implant placement in the incisor region. Furthermore, four human cadaver specimens were imaged using a high-resolution magnetic resonance imaging (HR-MRI) unit. Afterwards, these specimens were serially sectioned for histological examination to evaluate the nasopalatine canal region and its content. RESULTS The nasopalatine canal anatomy showed a large variability in morphology and dimensions, with the canal branching in up to four canals at the level of the nose. The canal diameter was on average 3.3 mm (+/-0.9 mm SD), and typically enlarged by age and male gender (p<0.05). HR-MRI and histological sections enabled to identify the neurovascular structures within the canals. CONCLUSIONS The large anatomic variations, the increased canal dimensions with age and the neurovascular canal content are all factors favouring a thorough three-dimensional planning before surgery, such as implant placement, of the anterior maxillary region.
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Affiliation(s)
- Xin Liang
- Oral Imaging Centre, Faculty of Medicine, School of Dentistry, Katholieke Universiteit Leuven, Leuven, Belgium.
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Klosek SK, Rungruang T. 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. Surg Radiol Anat 2008; 31:245-50. [DOI: 10.1007/s00276-008-0432-4] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2008] [Accepted: 10/09/2008] [Indexed: 11/28/2022]
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Methathrathip D, Apinhasmit W, Chompoopong S, Lertsirithong A, Ariyawatkul T, Sangvichien S. Anatomy of greater palatine foramen and canal and pterygopalatine fossa in Thais: considerations for maxillary nerve block. Surg Radiol Anat 2005; 27:511-6. [PMID: 16228112 DOI: 10.1007/s00276-005-0016-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2004] [Accepted: 06/15/2005] [Indexed: 10/25/2022]
Abstract
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 degrees and 6.7+/-5.2 degrees , 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.
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Affiliation(s)
- D Methathrathip
- Department of Anatomy, Faculty of Dentistry, Chulalongkorn University, Bangkok 10330, Thailand.
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Ennes J, Consolaro A. Sutura palatina mediana: avaliação do grau de ossificação em crânios humanos. ACTA ACUST UNITED AC 2004. [DOI: 10.1590/s1415-54192004000500008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVOS: Avaliar o grau de ossificação da sutura palatina mediana em crânios humanos de diferentes grupos etários. AMOSTRA: Crânios humanos (28) divididos em quatro grupos de acordo com a fase do desenvolvimento cronológico: crianças, adultos jovens, adultos e idosos. MATERIAL: Radiografias Oclusais Totais da Maxila dos crânios dos diferentes grupos (28). Imagens digitalizadas das Radiografias Oclusais Totais da Maxila (28). MÉTODOS: A presença de pontes de ossificação na sutura palatina mediana foi identificada macroscópica e estereomicroscopicamente, registrada e quantificada. Os crânios foram radiografados pela Técnica Oclusal total da Maxila, com modificação na posição do filme, no eixo horizontal. As imagens radiográficas obtidas foram digitalizadas e submetidas à variação de tons claros e escuros e ao ajuste de contraste e brilho para a investigação do grau de ossificação da sutura palatina mediana. CONCLUSÃO: Concluiu-se que a ossificação da sutura palatina mediana inicia-se principalmente na fase adulta e no segmento posterior. A técnica Radiográfica Oclusal Total da Maxila não proporciona imagem adequada à identificação do grau de ossificação na sutura palatina mediana.
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Lee SP, Paik KS, Kim MK. Variations of the prominences of the bony palate and their relationship to complete dentures in Korean skulls. Clin Anat 2001; 14:324-9. [PMID: 11754220 DOI: 10.1002/ca.1059] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The osteological and morphological variations of the prominences in the bony palate of 160 Korean skulls were studied. The frequency of the occurrence of the posterior palatine crest, located on the posterior border of the greater palatine foramen, was 13.8%. Palatal ridges were observed commonly in the skulls; however, the smooth type, which has no palatal ridges in the palate, was shown in 14.7% of cases, and palatal spines were observed in 33.8%. The prevalence of palatal tubercles was 11.6%, and all were found in the molar region. The palatine torus was found in 18.8% of cases and the most common type was along the median palatine suture from the incisive foramen to the posterior border of the palatine bone (63.3%). No significant differences between sexes or sides were found in the posterior palatine crest, palatal ridges, and palatal tubercle. However, the sex distribution of the palatine torus was significantly different (P < 0.05). These results would be helpful clinically in fabricating maxillary complete dentures for edentulous patients.
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Affiliation(s)
- S P Lee
- Department of Oral Anatomy, College of Dentistry, Seoul National University, Seoul, South Korea
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28
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Irish JD. Characteristic high- and low-frequency dental traits in sub-Saharan African populations. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 1997; 102:455-67. [PMID: 9140538 DOI: 10.1002/(sici)1096-8644(199704)102:4<455::aid-ajpa3>3.0.co;2-r] [Citation(s) in RCA: 74] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
In an earlier investigation (Irish [1993] Biological Affinities of Late Pleistocene Through Modern African Aboriginal Populations: The Dental Evidence [Ann Arbor: University Microfilms]), biological affinities of 32 sub-Saharan and North African dental samples were estimated using comparative analyses of 36 dental morphological traits. Marked dental homogeneity was revealed among samples within each of the two geographic regions, but significant interregional differences were noted. Assuming dental phenetic expression approximates or is an estimate of genetic variation, the present study of 976 sub-Saharan-affiliated Africans indicates they are not closely related to other world groups; they are characterized by numerous morphologically complex crown and root traits. Turner ([1984] Acta Anthropogenetica 8:23-78; [1985] in R Kirk and E Szathmary (eds.): Out of Asia: Peopling the Americas and the Pacific [Canberra: The Journal of Pacific History], pp. 31-78; [1990] Am. J. Phys. Anthropol. 82:295-318; [1992] Persp. Hum. Biol. 2/Archaeol. Oceania 27:120-127; [1992] in T Akaszawa, K Aoki, and T Kimura (eds.): The Evolution and Dispersal of Modern Humans in Asia [Tokyo: Hokusen-Sha Publishing Co-], pp. 415-438) reports that Northeast Asian/New World sinodonts also have complex teeth relative to Europeans, Southeast Asian sundadonts, Australian/Tasmanians, and Melanesians. However, sinodonty is characterized by UI1 winging, UI1 shoveling, UI1 double shoveling, one-rooted UP1, UM1 enamel extension, M3 agenesis, and three-rooted LM1. Sub-Saharan peoples exhibit very low frequencies of these features. It is proposed that the collection of dental traits which best differentiate sub-Saharan Africans from other worldwide samples includes high frequencies of the Bushman Canine, two-rooted UP1, UM1 Carabelli's trait, three-rooted UM2, LM2 Y-groove pattern, LM1 cusp 7, LP1 Tome's root, two-rooted LM2, UM3 presence, and very low incidences of UI1 double shoveling and UM1 enamel extension. This suite of diagnostic traits is termed the sub-Saharan African dental complex.
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Affiliation(s)
- J D Irish
- Department of Anthropology, University of New Mexico, Albuquerque 87131-1086, USA.
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Halffman CM, Scott GR, Pedersen PO. Palatine torus in the Greenlandic Norse. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 1992; 88:145-61. [PMID: 1605314 DOI: 10.1002/ajpa.1330880204] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Physical anthropologists have long been intrigued by the distinctive oral tori expressed by the medieval Norse populations of Iceland and Greenland. To assess the temporal and spatial variation of one form of oral tori, palatine torus, observations were made on all available Greenlandic Norse skeletons, as well as on samples of medieval Icelanders and Norwegians. In terms of temporal variation, 12th to 14th century (medieval) Greenlanders from the Eastern and Western settlements exhibited higher frequencies and more pronounced expressions of palatine torus compared with early 11th century Greenlanders. The early Greenlandic sample closely approximated the medieval Icelandic and Norwegian samples for total torus frequency, although the Norwegians exhibited the trait to a less pronounced degree. As degree of expression is the most distinctive aspect of torus variation among the Norse, some combination of environmental factors, including increased masticatory stress and chronic undernutrition, probably accounts for most of the difference between settlement period and medieval Greenlanders. Although palatine torus may be hereditary in part, environmental factors play a significant role in the expression of this trait.
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Affiliation(s)
- C M Halffman
- Department of Anthropology, University of Alaska, Fairbanks 99775
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