Anatomical evaluation of nasopalatine canal on cone beam computed tomography images
Abstract
Background: Nasopalatine canal (NPC) (incisive canal) morphology is important for oral surgery techniques carried out on the maxilla, in the treatment of naso- palatine cyst, palatal pathologies that require a surgical intervention.
Materials and methods: The morphology of NPC was classified in sagittal, coronal and axial planes on the cone beam computed tomography (CBCT). The length of NPC was found by measuring the distance between the mid-points of nasopalatine foramen and incisive foramen. The numbers, shapes and diameters of incisive and nasopalatine foramina were examined. Nasopalatine angle present between the NPC and the palate and anterior to the NPC was measured.
Results: In the sagittal plane, the shape of NPC was classified in six groups: 26.7% hourglass, 14.7% cone, 13.3% funnel, 16.0% banana, 28.7% cylindrical and 0.7% reverse-cone-shaped. In the coronal plane, shape of NPC was classified in three groups: 63.3% Y-shaped, 36.0% single canal, 0.7% double canal and external border of NPC was classified in four groups: 26.7% U, 28.7% Y, 44.0% V and 0.7% reverse-V-shaped. In the axial plane, the shape of nasopalatine foramen, incisive foramen and NPC at the mid-level was evaluated. The shape of the canal was detected as four types at three evaluated levels: round, oval, heart- and triangle-shaped. It was seen in every three axial planes that the round group is more than the others.
Conclusions: The morphological properties and variations of NPC should be con- sidered with a correct radiological evaluation so as to prevent the complications and improper practices in local anaesthesia, maxillary surgery and implant surgery practices. Especially dentists, otolaryngologist and plastic surgeons need to know the anatomy and variations of NPC.
Keywords: cone beam computed tomographynasopalatine canalnasopalatine foramenincisive foramen
References
- Acar B, Kamburoğlu K. Morphological and volumetric evaluation of the nasopalatinal canal in a Turkish population using cone-beam computed tomography. Surg Radiol Anat. 2015; 37(3): 259–265.
- Arai Y, Hashimoto K, Iwai K, et al. Fundamental efficiency of limited cone-beam X-ray CT (3DX multi image micro CT) for practical use. Shika Hoshasen. 2000; 40(2): 145–154.
- Arai Y, Honda K, Iwai K, et al. Practical model “3DX” of limited cone-beam X-ray CT for dental use. International Congress Series. 2001; 1230: 713–718.
- Artzi Z, Nemcovsky CE, Bitlitum I, et al. Displacement of the incisive foramen in conjunction with implant placement in the anterior maxilla without jeopardizing vitality of nasopalatine nerve and vessels: a novel surgical approach. Clin Oral Implants Res. 2000; 11(5): 505–510.
- Asaumi R, Kawai T, Sato I, et al. Three-dimensional observations of the incisive canal and the surrounding bone using cone-beam computed tomography. Oral Radiology. 2010; 26(1): 20–28.
- Bahşi İ, Orhan M, Kervancioglu P. A sample of morphological eponym confusion: foramina of Stenson/Stensen. Surg Radiol Anat. 2017; 39(8): 935–936.
- Bernardes RA, de Moraes IG, Húngaro Duarte MA, et al. Use of cone-beam volumetric tomography in the diagnosis of root fractures. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009; 108(2): 270–277.
- Bornstein MM, Balsiger R, Sendi P, et al. Morphology of the nasopalatine canal and dental implant surgery: a radiographic analysis of 100 consecutive patients using limited cone-beam computed tomography. Clin Oral Implants Res. 2011; 22(3): 295–301.
- Casado PL, Donner M, Pascarelli B, et al. Immediate dental implant failure associated with nasopalatine duct cyst. Implant Dent. 2008; 17(2): 169–175.
- Cavallaro J, Tsuji S, Chiu TS, et al. Management of the nasopalatine canal and foramen associated with dental implant therapy. Compend Contin Educ Dent. 2016; 38(6): 367–372; quiz 374.
- Chatriyanuyoke P, Lu CI, Suzuki Y, et al. Nasopalatine canal position relative to the maxillary central incisors: a cone beam computed tomography assessment. J Oral Implantol. 2012; 38(6): 713–717.
- Cicciù M, Grossi GB, Borgonovo A, et al. Rare bilateral nasopalatine duct cysts: a case report. Open Dent J. 2010; 4: 8–12.
- Etoz M, Sisman Y. Evaluation of the nasopalatine canal and variations with cone-beam computed tomography. Surg Radiol Anat. 2014; 36(8): 805–812.
- Faitaroni LA, Bueno MR, Carvalhosa AA, et al. Differential diagnosis of apical periodontitis and nasopalatine duct cyst. J Endod. 2011; 37(3): 403–410.
- FCAT. Terminologica Anatomica. Federative Committee on Anatomical Terminology. Stuggart: Thieme. 1998.
- Fernández-Alonso A, Suárez-Quintanilla JA, Muinelo-Lorenzo J, et al. Three-dimensional study of nasopalatine canal morphology: a descriptive retrospective analysis using cone-beam computed tomography. Surg Radiol Anat. 2014; 36(9): 895–905.
- Gönül Y, Bucak A, Atalay Y, et al. MDCT evaluation of nasopalatine canal morphometry and variations: An analysis of 100 patients. Diagn Interv Imaging. 2016; 97(11): 1165–1172.
- Güncü GN, Yıldırım YD, Yılmaz HG, et al. Is there a gender difference in anatomic features of incisive canal and maxillary environmental bone? Clin Oral Implants Res. 2013; 24(9): 1023–1026.
- Hakbilen S, Magat G. Evaluation of anatomical and morphological characteristics of the nasopalatine canal in a Turkish population by cone beam computed tomography. Folia Morphol. 2018; 77(3): 527–535.
- Harris D, Buser D, Dula K, et al. European Association for Osseointegration. E.A.O. guidelines fo the use of diagnostic imaging in implant dentistry. A consensus workshop organized by the European Association for Osseointegration in Trinity College Dublin. Clin Oral Implants Res. 2002; 13(5): 566–570.
- Jornet PL, Boix P, Sanchez Perez A, et al. Morphological characterization of the anterior palatine region using cone beam computed tomography. Clin Implant Dent Relat Res. 2015; 17 Suppl 2: e459–e464.
- Liang X, Jacobs R, Martens W, et al. Macro- and micro-anatomical, histological and computed tomography scan characterization of the nasopalatine canal. J Clin Periodontol. 2009; 36(7): 598–603.
- Mardinger O, Namani-Sadan N, Chaushu G, et al. Morphologic changes of the nasopalatine canal related to dental implantation: a radiologic study in different degrees of absorbed maxillae. J Periodontol. 2008; 79(9): 1659–1662.
- McCrea SJJ. Aberrations causing neurovascular damage in the anterior maxilla during dental implant placement. Case Rep Dent. 2017; 2017: 5969643.
- McCrea SJ. Nasopalatine duct cyst, a delayed complication to successful dental implant placement: diagnosis and surgical management. J Oral Implantol. 2012 [Epub ahead of print]; 40(2)–195.
- Mraiwa N, Jacobs R, Van Cleynenbreugel J, et al. The nasopalatine canal revisited using 2D and 3D CT imaging. Dentomaxillofac Radiol. 2004; 33(6): 396–402.
- Nelson BL, Linfesty RL. Nasopalatine duct cyst. Head Neck Pathol. 2010; 4(2): 121–122.
- Neves FS, Oliveira LK, Ramos Mariz AC, et al. Rare anatomical variation related to the nasopalatine canal. Surg Radiol Anat. 2013; 35(9): 853–855.
- Oliveira-Santos C, Rubira-Bullen IRF, Monteiro SAC, et al. Neurovascular anatomical variations in the anterior palate observed on CBCT images. Clin Oral Implants Res. 2013; 24(9): 1044–1048.
- Peñarrocha D, Candel E, Guirado JL, et al. Implants placed in the nasopalatine canal to rehabilitate severely atrophic maxillae: a retrospective study with long follow-up. J Oral Implantol. 2014; 40(6): 699–706.
- Peñarrocha M, Carrillo C, Uribe R, et al. The nasopalatine canal as an anatomic buttress for implant placement in the severely atrophic maxilla: a pilot study. Int J Oral Maxillofac Implants. 2009; 24(5): 936–942.
- Sekerci AE, Buyuk SK, Cantekin K. Cone-beam computed tomographic analysis of the morphological characterization of the nasopalatine canal in a pediatric population. Surg Radiol Anat. 2014; 36(9): 925–932.
- Song WC, Jo DI, Lee JY, et al. Microanatomy of the incisive canal using three-dimensional reconstruction of microCT images: an ex vivo study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009; 108(4): 583–590.
- Standring S. Gray's anatomy: the anatomical basis of clinical practice. 41. Edition ed: Elsevier Health Sciences. 2016.
- Takeshita K, Funaki K, Jimbo R, et al. Nasopalatine duct cyst developed in association with dental implant treatment: A case report and histopathological observation. J Oral Maxillofac Pathol. 2013; 17(2): 319.
- Teughels W, Merheb J, Quirynen M. Critical horizontal dimensions of interproximal and buccal bone around implants for optimal aesthetic outcomes: a systematic review. Clin Oral Implants Res. 2009; 20 Suppl 4: 134–145.
- Thakur AR, Burde K, Guttal K, et al. Anatomy and morphology of the nasopalatine canal using cone-beam computed tomography. Imaging Sci Dent. 2013; 43(4): 273–281.
- Youssefzadeh S, Gahleitner A, Dorffner R, et al. Dental vertical root fractures: value of CT in detection. Radiology. 1999; 210(2): 545–549.