Anatomical characteristics of greater palatine foramen: a novel point of view

Assessment of palatal mucosal thickness and location of the greater palatine foramen using cone-beam computed tomography: a retrospective study

OBJECTIVES

This study aimed to measure the palatal mucosal thickness and examine the location of the greater palatine foramen using cone-beam computerized tomography (CBCT).

METHODS

In this study, cone-beam computed tomography (CBCT) images of the maxillary posterior region of 120 subjects were evaluated. The palatal mucosal thickness (PMT), palatal width and depth, and location of the greater palatine foramen (GPF) were determined on CBCT. The differences in the palatal mucosal thickness according to gender and palatal width/palatal depth were analyzed. The location of the GPF related to the maxillary molars was noted.

RESULTS

The mean palatal mucosal thicknesses from the canine to the second molar teeth were 3.66, 3.90, 4.06, 3.76, and 3.92 mm, respectively. The mean PMT at the second premolar was statistically thicker than at other regions (p < 0,001). There was no relationship between PMT and gender. However, the palatal depth and width of the males were greater than females. (p = 0.004 and p = 0.014, respectively) PMT in the low palatal vault group had statistically higher compared to the high palatal vault group. (p = 0.023) Greater palatine foramen was mostly observed between second and third molar teeth. (48%).

CONCLUSIONS

According to our results, first and second premolar regions can be preferable in soft tissue grafting procedures for safe and successful treatment outcomes. The measurement of the thickness of the palatal mucosa and the evaluation of the greater palatine foramen location before the surgical procedures are essential steps to harvest from the ideal donor site and to achieve optimal surgical outcomes.

Morphology of the greater palatine foramen: a clinical point of view

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.

A systematic review of photogrammetry as a reliable methodology in gender identification of human skull

One of the most important parameters in the identification process in forensic Medicine and Dentistry is the determination of sex through the skull, based on morphological and metric dimorphism. Photogrammetry is an affordable option that allows the reconstruction of position, orientation, shape, and size, allowing the performance of quantitative and qualitative analyzes to identify the sex of the individual. However, there are few systematic reviews in the literature validating whether photogrammetry is a reliable methodology for sexual identification using human skulls. Therefore, the objective of the current systematic review was to validate whether photogrammetry of dry skulls is reliable as a method for calculating sex in human identification. This revision follows the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) and was recorded in the Prospective International Systematic Reviews Registry (PROSPERO) (CRD420223 Systematic Registry) (CRD420223). The inclusion criteria for selecting the studies were based on the PICO question: "Is test photogrammetry reliable as a method for estimating sex in human identification?". A literature search for studies was performed in the databases MEDLINE Scopus, Web of Science, LILACS, and the Cochrane Library. The Kappa agreement presented an approval level of (k = 0.93). This systematic review analyzed 11 ex-vivo studies published between 2001 and 2021. The risk of bias was considered low in 8 of the studies, and high in 3 studies. Based on this systematic review, it can be concluded that the photogrammetry method is viable and reliable in identifying sexual dimorphism.

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

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.

The influence of facial types on the morphology and location of the greater palatine foramen: a CBCT study

OBJECTIVE

This study aimed to assess the morphology and location of the great palatine foramen (GPF) of different facial types using cone beam computed tomography (CBCT) scans.

METHODS

Sixty CBCT scans were divided into: brachyfacial (n = 20), dolichofacial (n = 20) and mesofacial (n = 20) using Ricketts' VERT index for the determination of cephalometric facial type and imported into ImageJ software. GPF shape was characterized as: round, elongated in the anteroposterior direction (EAP), or elongated in the latero-medial direction (ELM). The distances between the GPF and the palatine suture (PS), the center of the GPF and the center incisive foramen (IF), the GPF and the palatine alveolar ridge (PAR), right side GPF (GPFr) and left side (GPFl) GPFs; and the angles formed from the intersection of the GPF, IF and PS were assessed. The position of the GPF was evaluated in relation to the molars.

RESULTS

GPFr and GPFl mean distances from PAR presented higher values for dolichofacial patients (p < 0.05). GPFr and GPFl location distally to the third molar (3 M) was higher for brachyfacial type, while their location distally to the second molar was higher for mesofacial and between the mesial and distal surfaces of the 3 M for dolichofacial (p < 0.05).

CONCLUSIONS

The GPF was more distant from the PAR in the dolichofacial-type group. The location of the GPF in relation to the molars varied according to the facial type. However, the morphology of the GPF was similar in the three facial types, and the elongated in the anteroposterior direction morphology was more frequent.

Septoplasties are unlikely to cause postoperative numbness of the anterior palate

BACKGROUND

Septoplasties and septorhinoplasties are very commonly performed surgical procedures in modern aesthetic and functional medicine. Throughout the surgery, close manipulation to the incisive nerves' course is being executed. This retrospective analysis followed up on potential sensitivity disorders of the anterior palate due to nerve damage.

METHODS

This retrospective review of 2000 patients' charts, who had undergone the procedure of a septoplasty or septorhinoplasty between June 2013 and January 2019 was conducted at the Department of General Otorhinolaryngology, Medical University of Graz. Medical records of all included patients were reviewed with special attention to postoperative numbness of the anterior palate.

RESULTS

Among the 2000 included patients, a septoplasty was performed in 48% (n = 955), a septorhinoplasty in 35% (n = 703) and a septoplasty in combination with a functional endoscopic sinus surgery in 17% (n = 342). In total, 86% (n = 1721) showed no complications at all during the follow-up period. In 0.25% (n = 5) a sensitivity disorder of the anterior palate occurred. Of the five cases with a postoperative numbness of the anterior palate four occurred after a septoplasty and the fifth occurred following a septorhinoplasty.

CONCLUSION

At this current time, this is the largest study investigating postoperative numbness of the anterior palate retracing septoplasty or septorhinoplasty. As a result, the currently used techniques for the operations do not pose a risk for the incisive nerve despite close surgical manipulation to the nerves' course. Nevertheless, patients should be informed and educated about the possibility of an occurring sensitivity disorder regarding the anterior palate during informed consent.

Relationship between lateral angle and shape of internal acoustic canal: cautionary note for diagnosis of sex

Lateral angle (LA) of the internal acoustic canal (IAC) at its opening at the surface of the petrous portion of the temporal bone is known in literature as a dimorphic measurement useful for sex assessment. However, its reliability is still debated. Moreover, no information is available about the possible relationship between LA and shape and size of the IAC. This study aims at assessing breadth, length and lateral angle of IAC on 100 CT scans belonging to subjects aged between 20 and 70 years, equally divided between males and females. Possible differences in the three measurements according to side and sex were assessed through two-way ANCOVA test, using three cranial measurements (distance between anterior and posterior nasal spine, upper facial height, bizygomatic breadth) as covariates (p < 0.05). Possible correlations among IAC measurements and with age were assessed through Pearson's test (p < 0.05). Results showed a significantly greater IAC breadth on the left side than on the right side; moreover, LA was significantly wider in females than in males and was positively correlated with IAC breadth in both males and females. In addition, LA was negatively correlated with age only in the female group. The study first showed that LA is strictly related to IAC morphology; moreover, it is significantly affected by masculinization of skeletal traits in females. Therefore, caution is suggested in using this measurement for sex assessment.

Clinical and anatomical study of foramen locations in jaw bones and adjacent structures

This study aims to find and locate foramens exactly in maxilla and mandible in case of complications during surgeries.Computer topographic angiography (CTA) images of 120 cases were reviewed. The measurements were performed on coronal, sagittal and axial planes after the 3 dimension volume reconstruction. The distances among foramens, bony landmarks, teeth, and facial artery were all measured with the angles as adjustments.The incisive foramen (IF) was measured 20.55 ± 2.81 mm to margo inferior of incisor, and 45.27 ± 5.27 degree from the axial midline. The greater palatine foramen located 43.17 ± 2.55 mm from the IF, while 21.08 ± 3.75 degree from the midline in axial plane. The lesser palatine foramina located 44.56 ± 5.74 mm from the IF and 20.05 ± 3.59 degree to the midline. The Mandibular foramen (MBF) was 91.15 ± 1.86 mm horizontally to the margo inferior of incisor. The angle that the MBF-margo inferior of incisor line made with the axial midline was 31.25 ± 2.89 degree. The shortest horizontal distance from the mental foramen (MF) to the facial artery in sagittal plane was 21.90 ± 1.86 mm, while it became 13.00 ± 2.05 mm in coronary section. The horizontal distance from the MF to the margo inferior of incisor in sagittal plane was 22.04 ± 3.22 mm. It turned out to be 25.78 ± 5.23 mm between MF and mid-sagittal line in coronary section. The vertical distance was 25.20 ± 3.06 mm from the upper margin of the second premolar to the MF.The foramens were clearly seen through CTA. Moreover, linear and angular measurements were presented, which makes it safer and wiser for surgeons to consider the biometric data before operations.

Anatomy of Infraorbital Foramen: Influence of Sex, Side, and Cranium Size

Several researchers have analyzed the collocation of infraorbital foramen, but no study has so far considered the possible influence of cranial size.Three measurements (distances from anterior nasal spine, inferior orbital rim, angle at the intersection between the line from anterior nasal spine and the transversal plane parallel to the Frankfurt plane) were taken on 100 skulls belonging to a contemporary skeletal collection. In addition, maximum cranial length, maximum cranial breadth, cranial height, and bizygomatic breadth were measured, together with 2 indices (horizontal cephalic index and Giardina Y-index). Differences according to sex and side were assessed through 2-way analysis of variance test (P <0.05). Measurements showing statistically significant differences according to sex were further assessed through 1-way analysis of covariance test including cranial measurements and indices as covariates (P <0.05).Statistically significant differences according to sex and side were found respectively for the distance from anterior nasal spine and the angle at infraorbital foramen (P <0.05). One-way analysis of covariance test verified that the sexual dimorphism of infraorbital foramen- anterior nasal spine distance was independent from the general measurements of cranium.The present study first proved that sexually dimorphic parameters useful for the localization of infraorbital foramen do not depend upon the cranium size.

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

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.