The Anatomical Position and Size of Greater Palatine Foramen and Canal in an Iranian Sample Using Cone Beam Computed Tomography

IntroductionDetection of exact location of greater palatine foramen and its anatomical variations are vital prior to posterior maxillary surgeries and gingival grafts. The aim of this study is to determine the anatomical position and size of the greater palatine canal (GPC) and foramen (GPF) using cone beam computed tomography (CBCT) scans.Materials and methodsIn this descriptive-analytic study, CBCT images of 148 patients were assessed. To determine the anatomical foramen position, the posterior maxilla area was divided into five regions on the axial view (A: from the mesial surface of the second molar to the center of the second molar, B: from the center of the second molar to its distal, C: from the mesial surface of the third molar to the center of the third molar, D: from the center of the third molar to the distal of the third molar, E: distal to the third molar.). The length of the canal was investigated on both coronal and sagittal views. Independent and paired T-test were used to analyze the data.ResultsAmong 80 females -68 males, the anatomical position of the GPF was mainly located in region E on the left (55%) and the right (50%), and then, respectively, in region D and region C. The mean diameter of GPF was 4/48 mm on the left and 4/63 mm on the right side (P-value = 0/01). The average length of the canal on the coronal view was 29.46 mm on the left side and 29.75 mm on the right (P-Value = 0/005). The average length of the canal on the sagittal view was 29.62 mm on the left and 30.02 mm on the right (P-value = 0/001).ConclusionThe anatomical position of the GPF was primarily located distal to the third maxillary molar. CBCT is a valuable diagnostic tool for evaluation of vital anatomic landmarks in the maxillofacial region prior to surgeries and interventions.

A study of greater palatine foramen and its importance in the application of maxillary nerve block in South Indian Population

Introduction: The greater palatine foramen (GPF) is located in the posterior part of the hard palate between the articulations of hard palate with the maxilla. GPF continues posteriorly and upwards as greater palatine canal (GPC) which opens in to the inferior wall of pterygopalatine fossa. Exiting the foramen rotendum, maxillary nerve enters the pterygopalatine fossa where it can be blocked. The intraoral route of GPF approach can be preferred for maxillary nerve block because of its low incidence of complications and high success rate. For achieving a painless intra operative period in procedures involving the maxillary region and for tooth extraction achieving a perfect maxillary nerve block is of at most importance. Our present study is aimed at correctly locating the position of GPF, its shape and patency in south Indian population which will be helpful for the intra oral approach of maxillary nerve block through the GPF Materials and Methods: The study was conducted in 30 dry adult skull bones of both sex. The molar relation, shape and the patency of the GPF were observed, the readings were obtained, statistically analyzed and compared with other studies. Results: In our observation on both side of skull, it was noted that GPF was located opposite to the 3rd molar in 90% of cases. Oval shaped GPF is most commonly found in our study which accounts to 53.35% and the overall patency rate for GPF was 95% in our study. Conclusion: Analysis and comparison of data has proven that the position, shape and patency of GPF may vary according to different races. This study has also confirmed that the maxillary nerve block via GPF is relatively safe and easier due to the consistency of the position, shape and the patency of the GPF in south Indian population. KEY WORDS: Greater palatine foramen, maxillary nerve block, regional blocks, Greater palatine canal, pterygopalatine fossa, Maxillary nerve.

Eutectic mixture of Local Anaesthetic (EMLA) an alternative for painful palatal nerve blocks: Randomised controlled trial

The purpose of this study is to compare the efficacy of EMLA to Palatal nerve blocks in providing anaesthesia to the palatal soft tissues during extraction. Seventy patients who reported for extraction of maxillary premolar and maxillary molar tooth were included in this study. These patients were divided into two groups randomly. One group consisted of patients receiving EMLA (Eutectic mixture of Lidocaine and Prilocaine) over the palatal soft tissues adjacent to the tooth with a cotton swab, and the other group consisted of patients receiving 0.4 – 0.6 ml of 2% lignocaine with 1;2,00,000 dilution adrenaline slightly anterior to the greater palatine foramen with a syringe. The mean score VAS while applying EMLA cream in group A was 0.00. In contrast, while giving palatal nerve block in group B, it was 4.09 that was statistically significant using the independent sample t-test. Likewise, the mean VAS score while extraction in the EMLA group was 0.11, whereas in palatal nerve block group was 0.00 that was not statistically significant using independent sample t-test. EMLA may be advantageous in providing palatal soft tissue anaesthesia during prophylactic extraction, thereby avoiding painful palatal nerve blocks.