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Purpose: Anatomical characteristics of the greater palatine foramen (GPF) are essential during the greater palatine nerve block application to anesthetize maxillary teeth, gums, midface, and nasal cavities. The position of GPF is usually described in relation to adjacent anatomical structures. This investigation aims to examine the morphometric relationships of GPF and closely determine its position. Methods: The study included 87 skulls (174 foramina). They were photographed in a horizontal position with bases facing up. The digital data were processed in the ImageJ 1.53n software. Results: The average distance of the GPF from the median palatine suture was 15.94 mm. In relation to the posterior border of the bony palate, the distance was 2.05 mm. Statistical significance was found in comparing the angle between the GPF, incisive fossa, and the median palatine suture between the sides of the skulls (p = 0.02). Comparing tested parameters between males and females showed significant differences in GPF–MPS (p = 0.003) and GPF–pb (p = 0.012), with lower values in females. The most significant percentage of skulls (77.01%) had the GPF located at the level of the third molar. The most significant number of bony palates had one lesser opening (60.91%) on the left side. Conclusion: GPF is located at the level of the maxillary third molar in most of the examined palates. Knowledge of the anatomical position of the greater palatine foramen and its variations is the basis for successfully implementing anesthesia and various surgical interventions. [ABSTRACT FROM AUTHOR]

Purpose: Accurate knowledge of greater palatine foramen (GPF) and greater palatine canal (GPC) anatomy is necessary to avoid injury to the greater palatine artery (GPA) when performing a variety of anesthesiologic, dental or surgical procedures. The aim of this paper was to perform a systematic review and meta-analysis of literature on the anatomy and localization of bony structures associated with the GPA, namely the GPF and GPC. Methods: A systematic literature search was performed using PubMed, Embase, ScienceDirect, and Web of Science databases. Seventy-five studies were included in the meta-analysis (n = 22,202 subjects). Results: The meta-analysis showed that the GPF is positioned 17.21 mm (95% CI = 16.34–18.09 mm) from the posterior nasal spine, 2.56 mm (95% CI = 1.90–3.22 mm) from the posterior border of the hard palate, 46.24 mm (95% CI = 44.30–48.18 mm) from the anterior nasal spine, 15.22 mm (95% CI = 15.00–15.43 mm) from the midline maxillary suture, 37.32 mm (95% CI = 36.19–38.45 mm) from the incisive foramen, and opposite the third maxillary molar (M3) in 64.9% (58.7–70.7%) of the total population. Conclusion: An up-to-date, comprehensive analysis of GPF and GPC clinical anatomy is presented. The results from this evidence-based anatomical study provides a unified set of data to aid clinicians in their practice. [ABSTRACT FROM AUTHOR]

Purpose: Although lumbar discectomy is the most common procedure in spine surgery, reports about anatomical relations between discs and prevertebral vessels are limited. Aim of this research was to investigate morphometric of the lumbar region and the relations between intervertebral discs (IVDs) and abdominal aorta. Methods: 557 abdominal computed tomography scans were assessed. For each spinal column level from Th12/L1 down to L4/L5, we investigated: intervertebral disc's and vertebra's height, width, length, and distance from aorta or common iliac artery (CIA). Those arteries were also measured in two dimensions and classified based on location. Results: 54.58% of patients were male. There was a significant difference in arterial-disc distances (ADDs) between genders at the levels: L1/L2 (1.32 ± 1.97 vs. 0.96 ± 1.78 mm; p = 0.0194), L2/L3 (1.97 ± 2.16 vs. 1.15 ± 2.01 mm; p < 0.0001), L3/L4 (2.54 ± 2.78 vs. 1.71 ± 2.61 mm; p = 0.0012), also for both CIAs (left CIA 3.64 ± 3.63 vs. 2.6 ± 3.06 mm; p = 0.0004 and right CIA: 7.96 ± 5.06 vs. 5.8 ± 4.57 mm; p < 0.001)—those ADDs were higher in men at all levels. The length and width of IVD increased alongside with disc level with the maximum at L4/L5. Conclusion: Bifurcations of the aorta in most cases occurred at the L4 level. Collected data suggest that at the highest lumbar levels, there is a greater possibility to cause injury of the aorta due to its close anatomical relationship with discs. Females have limited, in comparison to males, ADD at L1/L2, L2/L3, and L3/L4 levels what should be taken into consideration during preoperative planning of surgical intervention. [ABSTRACT FROM AUTHOR]

Introduction: 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. Results: 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. Conclusion: 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. [ABSTRACT FROM AUTHOR]

Purpose: Horseshoe kidney is a rare congenital anomaly with potential clinical implications. The aim of this study was to determine the number of renal arteries and veins and the level at which the arteries branched off their parental vessels in individuals with horseshoe kidney (HSK) and in persons with separated kidneys (SK).Materials and methods: The analysis included computed tomography angiography studies of 331 patients (83 HSK and 248 SK). The number of renal vessels and diameters of renal arteries were determined, along with the level at which they branched in relation to other ramifications (four groups of origin were proposed) and their entrance of the vessels to the kidney.Results: Number of renal arteries in HSK group was 4.57 ± 1.39 per patient and 2.4 ± 0.43 in SK group (p < 0.0001). The distribution of branching level of renal arteries in HSK group was: I group ~ 57%, II group ~ 27%, III group ~ 15% and IV group < 1%, whereas in SK group the distribution was respectively: I group ~ 99%, II group < 1%, III and IV group − 0% (p = 0.0001). In HSK group, diameter of renal arteries branching above the IMA was 4.61 ± 1.58 mm, as compared with 3.96 ± 1.34 mm for the arteries branching below (p = 0.0004). Number of veins was 566 in SK group (87.70% of kidneys were supplied by single vein) and 323 in HSK group (9.64% kidneys were supplied by two veins) (p < 0.0001).Conclusion: In HSK group, renal arteries significantly more often branch off their parental vessels below the origin of IMA and such vessels are usually smaller. [ABSTRACT FROM AUTHOR]

Purpose The greater and lesser palatine nerves and vessels supply the hard and soft palates, and the roots of these vessels and nerves run through a bony structure. However, the arrangement of blood vessels in the maxilla requires attention during clinical treatments, but detailed morphological information about changes in the greater and lesser palatine arteries and nerves during aging is unavailable. We therefore need detailed investigations of the morphology of the donor cadaver palatine using cone-beam computed tomography (CBCT) and macroscopic observations. Methods We investigated 72 donor cadavers using macroscopic segmentation and CBCT. The results' analysis examined differences in skull measurement parameters and differences between dentate and edentulous cases. Results The greater palatine artery and nerve showed different macroscopic arrangements in dentate and edentulous cadavers. We also classified three types of bony structures of the nerve and vessel roots in the molar regions of the palatine using CBCT images: the shallow groove, deep groove, and flat groove. The deep groove is the deepest of the three and is remarkable in edentulous elderly cadavers. Conclusion This study of macroscopic and CBCT data provides information useful for planning dental implant surgeries and autogenous bone harvesting. [ABSTRACT FROM AUTHOR]

Purpose: Anatomy of greater palatine foramen is important for maxillary nerve blocks, haemostatic procedures, and the treatment of neuralgia; although metrical data are available about its collocation, still several aspects need to be explored, such as the influence of the cranium size. Methods: The position of greater palatine foramen was assessed on 100 skulls through six measurements (distances from intermaxillary suture, posterior palatal border, posterior nasal spine, and incisive foramen; palatal length; relative position on palatal length) and two angles (angles at incisive foramen and greater palatine foramen). Maximum cranial length, maximum cranial breadth, cranial height and bizygomatic breadth, horizontal cephalic index, and Giardina Y-index were evaluated. Possible differences according to sex and side were assessed through two-way ANOVA ( p < 0.05). Measurements showing sexual dimorphism were further assessed through one-way ANCOVA including cranial parameters as covariates ( p < 0.05). Results: Distances of the greater palatine foramen from intermaxillary suture, incisive foramen, posterior palatal border, posterior nasal spine, palatal length, and position of the greater palatine foramen on the palatal length were statistically different according to sex ( p < 0.05), independently from general cranial dimensions but for the distance from the posterior palatal border. The angle at the incisive foramen and distances from intermaxillary suture and from posterior nasal spine showed statistically significant differences according to side ( p < 0.05). Conclusions: Results highlight that most of sexually dimorphic measurements useful for pinpointing the greater palatal foramen do not depend upon the cranium size. A more complete metrical assessment of the localization of the greater palatine foramen was provided. [ABSTRACT FROM AUTHOR]

Purpose: To analyze anatomical variations of the greater palatine canal (GPC) using cone beam computed tomography (CBCT) images. Methods: This study included 110 CBCTs. Axial slices were used to determine the shape of GPC and the number of lesser palatine foramina (LPF). Sagittal slices were used to assess the shape of the GPC and the number of lesser palatine canals (LPCs). Results: The most prevalent axial and sagittal GPC shapes were oval (46.36%) and hourglass (23.64%). Most GPCs presented one LPF (47.27%) and one LPC (90.91%). Conclusions: GPC anatomy is highly variable. CBCT is a useful tool for evaluating the anatomical variations of GPC. [ABSTRACT FROM AUTHOR]

Objective: Investigation of the computerized dimensional anatomic location of the greater palatine foramen (GPF) and lesser palatine foramens (LPF) is important indicating site to collect palatal donor tissue, reconstructioning the orofacial area of the oncology patient and applying the greater palatine nerve block anesthesia. The aim of this study is to determine a patient-friendly landmark and to specify the precise location of the GPF in order to standardise certain anatomical marks of safe neurovascular bundle. Materials and methods: 120 bony palates were examined to detect the position of the GPF and the LPF related to adjacent anatomical landmarks using a computer software program. The GPF was assessed regarding the position, the diameter and the distances between each foramen and the midline maxillary suture (MMS), the inner border of alveolar ridge (AR), posterior palatal border (PBB), and incisive foramen (IF). Results: The GPF was identified as single in 81 %, double in 16 %, triple in 2 % and absent in 2 % of the specimens. The mean distances between the GPF and the MSS, the GPF and the AR, the GPF and the PPB, the GPF and the IF were 16, 4, 4, and 40 mm, respectively. In majority of the cases, the GPF was seen between the distal surfaces of the third maxillary molar (78 %). Single LPF was observed in 53.45 % of the skulls, two LPF were observed in 31 % of the skulls bilaterally and five LPF were rare in 2.1 % of the specimens. The LPF was most commonly at the junction of the palatine bone and the inner lamella of the pterygoid plate (71.9 %). Conclusions: This study made possible to investigate the variability of the GPF and the feasibility of the greater palatine neurovascular bundle, and to calculate the lengths of some parameters with the help of certain software. To collect the donor tissue of the neurovascular greater palatine network, each distance among the AR-GPF-PPB were equal to 4 mm. To estimate the possible length of the graft, the incision was made along the third and the second molar to the IF as 4 cm. The data we obtained within this study have been presented to help the surgeons avoid unexpected hemorrhage during the palatinal procedures such as posttraumatic dental reconstruction, maxillofacial tumor resections, palatal micro-implants, and dentofacial orthopedic surgery. [ABSTRACT FROM AUTHOR]

Purpose: To analyze greater palatine canal (GPC) dimensions using cone-beam computed tomography (CBCT) images, and to evaluate the position of the greater palatine foramen (GPF) with respect to various landmarks selected in relation to dental status. Methods: This study included 150 CBCTs. Axial slices were used to determine the position and dimensions of the GPF. Sagittal slices were used to assess GPC length. Reference lines were established to evaluate the GPC diameter in sagittal and coronal slices. Results: From the 77 GPF analyzed, 76 were located on level 2. Average posterior GPF distance was 6.59 ± 3.27 mm on right side and 7.35 ± 3.40 mm on left side. Several measurements to determine the position and dimensions of the GPF presented significant values ( p ≤ 0.05). GPC length was 12.31 ± 1.96 mm on right side and 12.52 ± 2.15 mm on left side, statistically significant differences were detected between genders only on right canal ( p ≤ 0.004). Sagittal and coronal reference lines presented significantly higher values for men except for the S3 ( p < 0.062) and C1 ( p < 0.067) in the left GPC. Conclusions: CBCT is a useful tool for evaluating GPC morphometrically in the three anatomical slices. The sagittal nasal plane and posterior nasal plane are two intraoral anatomical landmarks for the location of the GPF. Their scant variability allows accurate identification of GPFs in both dentate as well as edentulous patients. [ABSTRACT FROM AUTHOR]

Background: Various surgical interventions including esthetic surgery, salivary gland excision, and open reduction of fracture have been performed in the area around the mandibular angle and condyle. This study aimed to comprehensively review the anatomy of the neurovascular structures on the angle and condyle with recent anatomic and clinical research. Methods and results: We provide detailed information about the branching and distributing patterns of the neurovascular structures at the mandibular angle and condyle, with reported data of measurements and proportions from previous anatomical and clinical research. Our report should serve to help practitioners gain a better understanding of the area in order or reduce potential complications during local procedures. Reckless manipulation during mandibular angle reduction could mutilate arterial branches, not only from the facial artery, but also from the external carotid artery. The transverse facial artery and superficial temporal artery could be damaged during approach and incision in the condylar area. The marginal mandibular branch of the facial nerve can be easily damaged during submandibular gland excision or facial rejuvenation treatment. The main trunk of the facial nerve and its upper and lower distinct divisions have been damaged during parotidectomy, rhytidectomy, and open reductions of condylar fractures. Conclusion: By revisiting the information in the present study, surgeons will be able to more accurately prevent procedure-related complications, such as iatrogenic vascular accidents on the mandibular angle and condyle, complete and partial facial palsy, gustatory sweating (Frey syndrome), and traumatic neuroma after parotidectomy. [ABSTRACT FROM AUTHOR]

It is recognized that the branches of the external carotid artery (ECA) can show variation, but the presence of a thyrolinguofacial trunk is extremely rare and always originates from the ECA. We report a case of the thyrolinguofacial trunk arising from the carotid bifurcation (CB) on the left side in a 76-year-old man with advanced tongue cancer, as revealed by three-dimensional computed tomography angiography for vascular mapping of the carotid vessels prior to superselective intra-arterial catheterization. The thyrolinguofacial trunk arose 1.6 mm below the CB from the anterior surface of the left CB. The inner diameter of the thyrolinguofacial trunk at origin was 4.4 mm and the angle between the thyrolinguofacial trunk and CB was 128°. After a 1.7-mm course, the trunk divided into the superior thyroid artery and a linguofacial trunk, the inner diameters of which were 1.5 and 3.4 mm, respectively, at origin. The angle between the two arteries was 88°. After a 9.8-mm course from the bifurcation, the linguofacial trunk divided into the lingual artery and facial artery, the inner diameters of which were 1.8 and 1.9 mm, respectively, at origin. The angle between the two arteries was 61°. It is important to recognize such an anatomic variation of the branches of the ECA prior to superselective intra-arterial catheterization or microsurgical reconstruction for head and neck cancer. [ABSTRACT FROM AUTHOR]