Length and anatomic routes of the greater palatine canal as observed by cone beam computed tomography

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.

Radio-Morphometric Evaluation of Greater Palatine Canal and Pterygopalatine Fossa Component: Maxillary Anesthetic Implications

This is a retrospective analytical cross-sectional study involving 131 cone-beam computed tomography (CBCT) scans of adult (18-99 years) that assessed greater palatine canal (GPC) attributes (length, curvature angle, diameter of curvature) and the type of the trajectory of GPC-pterygopalatine fossa (PPF) component. The GPC is an important landmark that connects the oral cavity and PPF. It contains greater and lesser palatine nerves, along-with descending palatine artery and vein by extending from the inferior part of the PPF to the hard palate. The GPC acts as a pathway for infiltration of local anesthesia. The inferior orbital fissure (IOF) is in close proximity to these vital anatomic structures and hence accurate identification of its location during regional block anesthesia is crucial. This is one of the very few studies investigating these important structures on CBCT scans highlighting the importance of preoperative scans for the anatomic determination. The images were analyzed for the lengths and anatomic paths of the right and left GPC-PPF in sagittal plane. The diameters of the upper (higher bony aspect of PPF) and lower openings (GPC opening) displayed statistically significant differences in the comparison between males and females (P < 0.05). Overestimation or underestimation of the GPC length can cause a lack of anesthesia and undesirable diffusion of the anesthetic solution into the orbit thorough the IOF causing diplopia, or into the cranial cavity. A thorough understanding of GPC length and pathway types is obligatory for proper anesthetic administration and performing any maxillofacial procedures.

Morphometric Analysis of Greater Palatine Canal via Cone-Beam Computed Tomography

Background/Aim: The morphology of the greater palatine canal (GPC) should be determined preoperatively to prevent possible complications in surgical procedures required maxillary nerve block anesthesia and reduction of descending palatine artery bleeding. The purpose of this investigation was to evaluate the GPC morphology.

Material and Methods: In this retrospective cross-sectional study, cone-beam computed tomography images obtained for various causes of 200 patients (females, 55%; males, 45%) age ranged between 18 and 86 (mean age±standard deviation=47±13.6) were examined. The mean length, mean angles of the GPC and anatomic routes of the GPC were evaluated.

Results: The mean length of the GPC was found to be 31.07 mm and 32.01 mm in sagittal and coronal sections, respectively. The mean angle of the GPC was measured as 156.16° and 169.23° in sagittal and coronal sections. The mean angle of the GPC with horizontal plane was measured as 113.76° in the sagittal sections and 92.94° in the coronal sections. The mean GPC length was longer in males than in females.

Conclusions: The results of this study showed that the most common pathway of the GPC was “first inferior, and then anterior-inferior direction” in sagittal plane and “first medial-inferior, then inferior direction” in coronal plane.

The Length of the Greater Palatine Canal in a Lebanese Population: a Radio-anatomical Study

OBJECTIVE

The aim of this study was to evaluate the length of the greater palatine canal in a Lebanese population using cone-beam computed tomography (CBCT) technology.

MATERIAL AND METHODS

In this study, we measured the length of 148 greater palatine canals in 74 CBCT images of Lebanese adult patients (38 females and 36 males). The data obtained was analyzed statistically to determine 1) if age is related to the length of the canal, 2) if the length of the left side tends to be systematically larger or smaller than the length of the right side, and 3) if the mean length of the canals in females is different than the one in males.

RESULTS

In a sagittal plane, the average length of the greater palatine canal was 30.62 (30.64 mm on the right and 30.60 mm on the left).

CONCLUSION

Within the limits of this study, we concluded that in our sample in a Lebanese population, the length of the greater palatine canal does not significantly vary according to age, gender, and side.

Radio-anatomical Study of the Greater Palatine Canal and the Pterygopalatine Fossa in a Lebanese Population: A Consideration for Maxillary Nerve Block

Aim:

The aim of this study was to describe the morphology of the component, greater palatine canal-pterygopalatine fossa (GPC-PPF), in a Lebanese population using cone-beam computed tomography (CBCT) technology.

Materials and Methods:

CBCT images of 79 Lebanese adult patients (38 females and 41 males) were included in this study, and a total of 158 cases were evaluated bilaterally. The length and path of the GPCs-PPFs were determined, and the data obtained analyzed statistically.

Results:

In the sagittal plane, of all the GPCs-PPFs assessed, the average length was 35.02 mm on the right and 35.01 mm on the left. The most common anatomic path consisted in the presence of a curvature resulting in an internal narrowing whose average diameter was 2.4 mm on the right and 2.45 mm on the left. The mean diameter of the upper opening was 5.85 mm on the right and 5.82 mm on the left. As for the lower opening corresponding to the greater palatine foramen, the right and left average diameters were 6.39 mm and 6.42 mm, respectively.

Conclusion:

Within the limits of this study, we concluded that throughout the Lebanese population, the GPC-PPF path is variable with a predominance of curved one (77.21% [122/158] in both the right and left sides); however, the GPC-PPF length does not significantly vary according to gender and side.

Analysis of the greater palatine foramen in a Lebanese population using cone-beam computed tomography technology

Objective:

The aim of this study was to describe the diameter and the position of the greater palatine foramen (GPF) in relation to adjacent anatomical landmarks in the maxilla in a Lebanese population using cone-beam computed tomography (CBCT) technology.

Materials and Methods:

CBCT images of 58 Lebanese adult patients were included in this study and a total of 116 GPF were evaluated bilaterally. The diameter of the GPF and its position relative to the maxillary molars, and distances to the midline maxillary suture and to the anterior nasal spine were analyzed.

Results:

Of all foramina assessed, 41.38% were located opposite to the third molar, 29.31% were distal to it, 27.59% were between the second and the third, and only 1.72% were opposite to the second. The average diameter was 5.633 mm on the right and 5.723 mm on the left, and the average distances to midline maxillary suture and anterior nasal spine were 16.228 mm and 48.294 mm on the right and 14.907 mm and 48.122 mm on the left, respectively.

Conclusion:

Within the limits of this study, we conclude that in Lebanese patients, the GPF location is variable, very rarely opposite to the second molar, and more closely related to the third, but may present mesial or distal to it in one-fourth of patients.

Maxillary nerve block via the greater palatine canal: An old technique revisited

BACKGROUND

Maxillary nerve block through the greater palatine canal is rarely adopted by dental practitioners due to lack of experience in the technique at hand which may lead into several complications. Nevertheless, it is an excellent method to achieve profound anesthesia in the maxilla. This review focuses on the anatomy as well as the indications, contraindications, and complications associated with this technique.

MATERIALS AND METHODS

A literature search was performed using the scientific databases (PubMed and Google Scholar) for articles published up to December 2014 in English, using the key words "maxillary nerve block via the greater palatine canal." A total of 34 references met the inclusion criteria for this review and were selected.

CONCLUSION

Block of the maxillary nerve through the greater palatine canal is a useful technique providing profound anesthesia in the hemi-maxilla, if practiced properly.

Computed tomography morphometric analysis of the greater palatine canal: a study of 1,500 head CT scans and a systematic review of literature

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.