Morphometric evaluation and clinical implications of the greater palatine foramen, greater palatine canal and pterygopalatine fossa on CBCT images and review of literature
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The pterygopalatine fossa (PPF) infiltration is performed to reduce blood flow during endoscopic sinus surgery and septorhinoplasty, as well as to control posterior epistaxis and provide regional anesthesia in dental procedures. PPF infiltration performed with consideration of the morphometrics of greater palatine foramen (GPF), greater palatine canal (GPC) and PPF would increase the success of the procedure and reduce the risk of complications. The aim of this study is to investigate the GPF, GPC, lesser palatine foramen (LPF), lesser palatine canal (LPC) and PPF morphology via the images obtained by CBCT, to provide information for interventional procedures.
Materials and methods
GPF, GPC, LPF, LPC and PPF were morphometrically evaluated retrospectively in CBCT images of 75 female and 75 male cases by Planmeca Romexis program. The 19 parameters were measured on these images.
These parameters were evaluated statistically. The comparison of these parameters by genders revealed significant differences in distances between GPC–PC, PC–IOF, LPC–GPF, GPF–MS in the coronal and transverse planes, the distance between GPF and the occlusal plane of the teeth, GPF–PNS, GPF–IF and TD-GPF, and in the area of GPF. The number of LPF was found ranging from 1 to 5.
Our results may help to insert to needle properly for application of maxillary nerve block with a high success rate and minimal complication. We recommend that the needle should be inserted 14–15 mm lateral to the midsagittal plane, 19–20 mm over the occlusal plane of the teeth and on the same line with the third molar teeth. For PPF infiltration through the GPF, the needle should be pushed forward 28 mm upward at 66° angle on the transverse plane and 14°–15° angle on the vertical plane.
KeywordsGreater palatine canal Greater palatine foramen Lesser palatine canal Lesser palatine foramen Pterygopalatine fossa Cone-beam computed tomography Maxillary nerve block
Greater palatine canal
Greater palatine foramen
Inferior orbital fissure
Lesser palatine canal
Lesser palatine foramen
Posterior nasal spine
The authors are greatful to Associate Professor Dr. Seval KUL, Department of Biostatistics, School of Medicine, Gaziantep University, for the support.
BI: protocol/project development, data collection or management, data analysis and manuscript writing/editing. OM: data collection or management, data analysis and manuscript writing/editing. KP: data analysis and manuscript writing/editing. YED: manuscript writing/editing.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
This study was approved by the ethics committee of Gaziantep University (approval date and number: 07 March 2016; 2016/72). We declare that this human study has been approved by the ethics committee of Gaziantep University and has, therefore, been performed in accordance with the ethical standards laid down in the Declaration of Helsinki and its later amendments.
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