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

Abstract

Accurate knowledge of greater palatine foramen (GPF) anatomy is necessary when performing a variety of anaesthesiological, dental or surgical procedures. The first aim of this study was to localize the GPF in relation to multiple anatomical landmarks. The second aim was to perform a systematic review of literature, and to conduct a meta-analysis on the subject of GPF position to aid clinicians in their practice. One-hundred and fifty dry, adult, human skulls and 1200 archived head computed tomography scans were assessed and measured in terms of GPF relation to other anatomical reference points. A systematic literature search was performed using the PubMed, Embase and Web of Science databases, and a meta-analysis on the subject of GPF relation to the maxillary molars was conducted. On average, in the Polish population, the GPF was positioned 15.9 AE 1.5 mm from the midline maxillary suture (MMS), 3.0 AE 1.2 mm from the alveolar ridge (AR) and 17.0 AE 1.5 mm from the posterior nasal spine (PNS); 74.7% of GPF were positioned opposite the third maxillary molar (M3). Twenty-seven studies were included in the systematic review and 23 in the meta-analysis (n = 6927 GPF). The pooled prevalence of the GPF being positioned opposite the M3 was 63.9% (95% confidence interval = 56.6-70.9%). Concluding, the GPF is most often located opposite the M3 in the majority of the world's populations. The maxillary molars are the best landmarks for locating the GPF. In edentulous patients the most useful points for approximating the position of the GPF are the AR, MMS and PNS. This study introduces an easy and repeatable classification to reference the GPF to the maxillary molars.

MORPHOLOGY OF THE HARD PALATE: A STUDY OF DRY SKULLS AND REVIEW OF THE LITERATURE. Morfología del paladar duro: Un studio en cráneos secos y revision de la literatura

“…Previous studies reported a mean GPF-MMS distance of between 14.3 and 16.7 mm, which is comparable to the present study (13.8 ± 1.5 mm) ( Table 3). The mean distance between the two GPF in the present study was 27.6 mm, less than that reported by Urbano et al (2010) and Tomaszewska et al (2014) (Table 3). The pterygoid hamulus is palpable in the oral cavity and is therefore a suitable anatomical landmark from which to determine the location of the GPF.…”

Contribución al Estudio Descriptivo del Foramen y Canal Palatino Mayor

“…El conocimiento específico y detallado de la conformación, ubicación, dirección, longitud, relaciones, contenido y diferencias etarias, étnicas y sexuales, permite abordar con éxito el FPM y el CPM, para procedimientos quirúrgicos odontológicos extensos o cuando otras técnicas anestésicas no puedan ser utilizadas por procesos infecciosos y/o inflamatorios en el sitio de punción, permitiendo realizar un correcto bloqueo anestésico local y troncular al nervio maxilar, ramo del nervio trigémino (Carrea;Alvarado et al;Malamed & Trieger, 1983;Malamed, 2006;Howard-Swirzinski et al, 2010;Lopes et al, 2011;Nimigean et al, 2013;Sheikhi et al, 2013;Ilayperuma et al, 2014;Tomaszewska et al, 2014;Rapado-González et al, 2015).…”

Local anaesthetic techniques for the equine head, towards guided techniques and new applications

“…Tomaszewska et al . (), used a CT scan to determine anatomical landmarks for localisation of the greater palatine foramen in man. CT scans have been used to compare two different techniques for maxillary nerve blocks in horses and yielded very useful information on anatomical landmarks for these techniques (Staszyk et al .…”