Vol 80, No 4 (2021)
Original article
Published online: 2020-09-11
New accessory palatine canals and foramina in cone-beam computed tomography
1
, 2, 3
, 2, 3
Abstract
Background: Palatal surgeries are associated with many complications. Accessory foramina may be a cause of concern. The present study was conducted to assess the presence and to evaluate the anatomical characteristics of accessory palatine foramina (APF) and related bony canals in cone beam computed tomography (CBCT) scans.
Materials and methods: The incidence, location, and types of foramina on the palate were evaluated in 170 CBCT scans. Readings from coronal, sagittal, and axial planes were recorded using a computer programme and evaluated.
Results: Other than nasopalatine, greater and lesser palatine foramina, 278 foramina were seen in the palate in different locations. New APF were found posteriorly in 14.71% of the studied scans with wide anatomical variations. Unusual foraminal canals were seen crossing the antral floor laterally. The anterior APF were seen in 73.53% of scans while bilateral APF were found in 43.53% of cases.
Conclusions: Accessory palatine foramina and related canals are frequently seen in CBCT with many anatomical variations. New unusual connecting canals are found passing through the antral floor from palatine foramina to the lateral antral wall. These anatomical structures should be considered in preoperative planning for local analgesia and surgical interventions in the palate.
Keywords: cone-beam computed tomographyanatomical landmarksnew palatine foraminanasopalatine foramenpalatecanalis sinuosus
References
- Allareddy V, Vincent SD, Hellstein JW, et al. Incidental findings on cone beam computed tomography images. Int J Dent. 2012; 2012: 871532.
- Arruda JA, Silva P, Silva L, et al. Dental implant in the canalis sinuosus: a case report and review of the literature. Case Rep Dent. 2017; 2017: 4810123.
- Ashwath B, Subramoniam S, Vijayalakshmi R, et al. Anesthetic efficacy of 4% articaine and 2% lignocaine in achieving palatal anesthesia following a single buccal infiltration during periodontal therapy: A randomized double-blind split-mouth study. J Anaesthesiol Clin Pharmacol. 2018; 34(1): 107–110.
- Badshah M, Soames R, Khan MJ, et al. Morphology of the human hard palate: a study on dry skulls. Italian J Anat Embryol. 2018; 123(1): 55–63.
- Bataineh AB, Al-Sabri GA. Extraction of maxillary teeth using articaine without a palatal injection: a comparison between the anterior and posterior regions of the maxilla. J Oral Maxillofac Surg. 2017; 75(1): 87–91.
- Bouloux GF, Bays RA. Neurosensory recovery after ligation of the descending palatine neurovascular bundle during Le Fort I osteotomy. J Oral Maxillofac Surg. 2000; 58(8): 841–5; discussion 846.
- Bouloux GF, Perciaccante VJ. Massive hemorrhage during oral and maxillofacial surgery: ligation of the external carotid artery or embolization? J Oral Maxillofac Surg. 2009; 67(7): 1547–1551.
- Buff LR, Bürklin T, Eickholz P, et al. Does harvesting connective tissue grafts from the palate cause persistent sensory dysfunction? A pilot study. Quintessence Int. 2009; 40(6): 479–489.
- Cagimni P, Govsa F, Ozer MA, et al. Computerized analysis of the greater palatine foramen to gain the palatine neurovascular bundle during palatal surgery. Surg Radiol Anat. 2017; 39(2): 177–184.
- Chrcanovic BR, Custódio ALN. Anatomical variation in the position of the greater palatine foramen. J Oral Sci. 2010; 52(1): 109–113.
- de 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.
- Dridi SM, Chousterman M, Danan M, et al. Haemorrhagic risk when harvesting palatal connective tissue grafts: a reality? PERIO. 2008; 5: 231–240.
- Filippi A, Pohl Y, Tekin U. Sensory disorders after separation of the nasopalatine nerve during removal of palatal displaced canines: prospective investigation. Br J Oral Maxillofac Surg. 1999; 37(2): 134–136.
- Goodman-Topper ED, Chosack A. Radiographic appearance of nutrient canals in the region of the erupting permanent maxillary cuspid. Oral Surg Oral Med Oral Pathol. 1989; 67(5): 606–610.
- Gurler G, Delilbasi C, Ogut EE, et al. Evaluation of the morphology of the canalis sinuosus using cone-beam computed tomography in patients with maxillary impacted canines. Imaging Sci Dent. 2017; 47(2): 69–74.
- Hafeez NS, Ganapathy S, Sondekoppam R, et al. Anatomical variations of the greater palatine nerve in the greater palatine canal. J Can Dent Assoc. 2015; 81: f14.
- Hu KS, Kwak HH, Song WC, et al. Branching patterns of the infraorbital nerve and topography within the infraorbital space. J Craniofac Surg. 2006; 17(6): 1111–1115.
- Iwanaga J, Kido J, Lipski M, et al. Anatomical study of the palatine aponeurosis: application to posterior palatal seal of the complete maxillary denture. Surg Radiol Anat. 2018; 40(2): 179–183.
- Jung J, Yim JH, Kwon YD, et al. A radiographic study of the position and prevalence of the maxillary arterial endosseous anastomosis using cone beam computed tomography. Int J Oral Maxillofac Implants. 2011; 26(6): 1273–1278.
- Kolli NK, Nirmala SV, Nuvvula S. The effectiveness of articaine and lidocaine single buccal infiltration versus conventional buccal and palatal injection using lidocaine during primary maxillary molar extraction: a randomized control trial. Anesth Essays Res. 2017; 11(1): 160–164.
- 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.
- Machado Vd, Chrcanovic BR, Felippe MB, et al. Assessment of accessory canals of the canalis sinuosus: a study of 1000 cone beam computed tomography examinations. Int J Oral Maxillofac Surg. 2016; 45(12): 1586–1591.
- Majid OW, Ahmed AM. The anesthetic efficacy of articaine and lidocaine in equivalent doses as buccal and non-palatal infiltration for maxillary molar extraction: a randomized, double-blinded, placebo-controlled clinical trial. J Oral Maxillofac Surg. 2018; 76(4): 737–743.
- Manhães Júnior LR, Villaça-Carvalho MF, Moraes ME, et al. Location and classification of Canalis sinuosus for cone beam computed tomography: avoiding misdiagnosis. Braz Oral Res. 2016; 30(1): e49.
- Mittal M, Sharma S, Kumar A, et al. Comparison of anesthetic efficacy of articaine and lidocaine during primary maxillary molar extractions in children. Pediatr Dent. 2015; 37(7): 520–524.
- Neves FS, Crusoé-Souza M, Franco LC, et al. Canalis sinuosus: a rare anatomical variation. Surg Radiol Anat. 2012; 34(6): 563–566.
- Orhan K, Gorurgoz C, Akyol M, et al. An anatomical variant: evaluation of accessory canals of the canalis sinuosus using cone beam computed tomography. Folia Morphol. 2018; 77(3): 551–557.
- Ortug A, Uzel M. Greater palatine foramen: assessment with palatal index, shape, number and gender. Folia Morphol. 2019; 78(2): 371–377.
- Ozeç I, Taşdemir U, Gümüş C, et al. Is it possible to anesthetize palatal tissues with buccal 4% articaine injection? J Oral Maxillofac Surg. 2010; 68(5): 1032–1037.
- Patel JR, Wuehrmann AH. A radiographic study of nutrient canals. Oral Surg Oral Med Oral Pathol. 1976; 42(5): 693–701.
- Piagkou M, Xanthos T, Anagnostopoulou S, et al. Anatomical variation and morphology in the position of the palatine foramina in adult human skulls from Greece. J Craniomaxillofac Surg. 2012; 40(7): e206–e210.
- Shelley AM, Rushton VE, Horner K. Canalis sinuosus mimicking a periapical inflammatory lesion. Br Dent J. 1999; 186(8): 378–379.
- Tavelli L, Barootchi S, Ravidà A, et al. 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. 2019; 77(2): 271.e1–271.e9.
- Tomaszewska IM, Tomaszewski KA, Kmiotek EK, et al. 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(4): 419–435.
- Tomaszewska IM, Frączek P, Gomulska M, et al. Sex determination based on the analysis of a contemporary Polish population's palatine bones: a computed tomography study of 1,200 patients. Folia Morphol. 2014; 73(4): 462–468.
- Tomaszewska IM, Kmiotek EK, Pena IZ, et al. 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. 2015; 90(4): 287–297.
- Tomaszewska IM, Zwinczewska H, Gładysz T, et al. Anatomy and clinical significance of the maxillary nerve: a literature review. Folia Morphol. 2015; 74(2): 150–156.
- Torres MG, de Faro Valverde L, Vidal MT, et al. Branch of the canalis sinuosus: a rare anatomical variation: a case report. Surg Radiol Anat. 2015; 37(7): 879–881.
- von Arx T, Lozanoff S. Anterior superior alveolar nerve (ASAN). Swiss Dent J. 2015; 125(11): 1202–1209.
- von Arx T, Lozanoff S, Sendi P, et al. Assessment of bone channels other than the nasopalatine canal in the anterior maxilla using limited cone beam computed tomography. Surg Radiol Anat. 2013; 35(9): 783–790.
- Wanzeler AM, Marinho CG, Alves Junior SM, et al. Anatomical study of the canalis sinuosus in 100 cone beam computed tomography examinations. Oral Maxillofac Surg. 2015; 19(1): 49–53.
