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Background: The goal of this study is to evaluate the morphologic characteristics of the posterior palatine region among the Chinese population, more specifically, the greater palatine grooves, crests, bridges, and torus palatinus structures and make comparisons between different ethnic groups and minorities., Methods: A total of 323 cone-beam computed tomography (CBCT) scans were collected for analysis on the presence of grooves, crests, bridges, or torus palatinus (TP). Data were collected through recognizing the grooves, crests, bridges, and TPs and calculating the number of those anatomy structures. The statistics index, including average, standard deviation, were adopted to describe the subjects and Wilcoxon test, Mann-Whitney test, and Chi-squared test were all carried out by SPSS., Results: Three different morphologic manifestations of the greater palatine groove (GPG) found in the upper 1st and 2nd molar regions are as follows: no groove, 1 groove, and 2 grooves. The number of crests ranged from 0 to 3. And the incidence of torus palatines was 29%. Moreover, a positive correlation was found between the presence of crests/GPGs and age in the 2nd molar region., Conclusion: The results in this study reveal that GPGs in the upper 1st and 2nd molar regions have 3 different morphologic manifestations among Chinese people and the number of crests can vary from 0 to 3 crests. Although the proportion of GPG or crest and the incidence of TP are different from the proportions of other studies, this may be due to the fact that different ethnic groups and sample sizes were used in the course of this study. Information about the anatomy structures of the posterior region in hard palate directly contributed to a decrease in potential complications during palatal implant surgery and periodontal surgery.

Objective: The aim of this study was to measure palatal bone thickness and select relatively safe regions for mini-implant insertion, and to determine the effect of age and sex on palatal bone thickness and whether there is any difference between right and left sides., Materials and Methods: Cone beam computed tomographic (CBCT) evaluation was used on 107 healthy orthodontic patients, including 51 adolescents (12.90 ± 1.71 years) and 56 adults (26.09 ± 4.35 years), who were selected from the Zhongshan Hospital, Fudan University (Shanghai, China). Seventy-two sites of bone thickness were measured in the palate. Intragroup, intergroup, and sex differences were analyzed by repeated measures analysis of variance., Results: Palatal bone thickness exhibited significant differences in 3 anteroposterior areas of the 2 groups. From anterior to posterior region, palatal bone thickness gradually decreased. Meanwhile, on the sagittal plane, palatal bone thickness decreased gradually from reference line 0 to 9 mm among adults, and from reference line 0 to 12 mm among adolescents posterior to the level of the posterior rim of the incisive foramen. However, on the coronal plane, no significant differences were found in the palatal bone thickness among reference lines 2, 4, 6, and 8 mm lateral to the midpalatal suture. Nor were there differences between right and left sides, between adults and adolescents or between males and females., Conclusions: In terms of bone thickness, the anterior region is relatively safe for orthodontic mini-implant insertion. However, since subjects vary greatly, CBCT scans are needed before undertaking mini-implant insertion.

Objectives: To help surgeons locating anatomic landmarks when performing endoscopic endonasal transcribriform approach to anterior skull base., Methods: High-resolution axial computed tomography (CT) images at thickness of 0.6 mm, and reconstructed 0.41-mm thick gapless sagittal and coronal CT images were taken from 123 subjects. Using mimics software, first located elementary points and line: nasal spine, midpoint of posterior hard palate and the line between them; then located measured points right/left posterior and anterior points; measured distances between measured points and from measured points to nasal spine and angles between lines connecting measured points to nasal spine and the basic line., Results: The distances from nasal spine to right/left posterior and anterior points of anterior skull base are 68.67 ± 6.04 and 61.71 ± 5.09 mm, corresponding angles are 45.89 ± 4.20° and 72.07 ± 4.06°, respectively. The width and length of defect of anterior skull base are 24.45 ± 2.62 and 31.03 ± 4.96 mm; its area ranges from 373.75 ± 94.08 to 800.91 ± 195.07 mm., Conclusions: The study provides information about anterior skull base anatomic landmarks, which can help surgeons to locate them and avoid relative complications during endoscopic endonasal transcribriform approach to anterior skull base. The measurements can be used as surgical indicators to investigate the landmarks.

The primary focus of this study was to assess age-related changes in the vertical distance of the estimated level of velopharyngeal closure in relation to a prominent landmark of the cervical spine: the anterior tubercle of cervical vertebra 1 (C1). Midsagittal anatomic magnetic resonance images were examined across 51 participants with normal head and neck anatomy between 4 and 17 years of age. Results indicate that age is a strong predictor (P = 0.002) of the vertical distance between the level of velopharyngeal closure relative to C1. Specifically, as age increases, the vertical distance between the palatal plane and C1 becomes greater resulting in the level of velopharyngeal closure being located higher above C1 (range 4.88-10.55 mm). Results of this study provide insights into the clinical usefulness of using C1 as a surgical landmark for placement of pharyngoplasties in children with repaired cleft palate and persistent hypernasal speech. Clinical implications and future directions are discussed.

Objective: The aim of the study was to compare the effect of conventional maxillomandibular advancement (MMA) and modified MMA with anterior segmental setback osteotomy (MMA-ASSO) on the airway changes in patients with obstructive sleep apnea syndrome (OSAS) using three-dimensional computational fluid dynamics (3D-CFD) analysis., Methods: Two adult male patients with Class I malocclusion, lip protrusion, acute nasolabial angle, and OSAS were treated with conventional MMA (Case 1) and modified MMA-ASSO (Case 2). Individualized 3D airway models were fabricated using computed tomography data obtained 1 month before (T0) and at least 6 months after surgery (T1). A total of 7 cross-sectional areas of the airway were established, starting just above the hard palate (plane 1) with interval of 1 mm caudally. Airflow velocity and negative pressure were investigated using CFD analysis, and polysomnography studies were performed at T0 and T1., Results: There were improvement of apnea-hypoapnea index and the lowest O2 level (T0 versus T1; 43.2 versus 15.2, 79% versus 90% in Case 1; 61.0 versus 6, 89% versus 92% in Case 2). At plane 2 (retropalatal area) in Cases 1 and 2, there were increase in the smallest cross-sectional areas (57.9% versus 28.4%), decrease in the airflow velocity and increase in the negative pressure at the peak of expiration (49.5% versus 31.7%; 88.4% versus 54.3%), end after expiration (53.2% versus 32.2%; 83.2% versus 47.9%), and peak of inspiration (53.1% versus 29.2%; 75.3% versus 48.2%)., Conclusion: Modified MMA-ASSO method might be an effective treatment option for OSAS patients with improvement of airway problems and esthetic facial profile.

The purpose of this study was to evaluate in dry skulls the length and angle between the greater palatine foramen and the foramen rotundum in both the frontal and sagittal planes. In 50 human skulls from the department of morphology, the distance and angulation required to reach the foramen rotundum through the greater palatine canal were measured in the frontal and sagittal planes. A stylet was introduced up to the foramen rotundum in each greater palatine canal and fixed. The skulls were then photographed from a front and lateral view (both right and left). Finally, the stylets were photographed on graph paper. These images were analyzed with Photoshop software. In the frontal plane, mean angulations of 5.32 degrees on the right side and 6.15 degrees on the left side were obtained. In the sagittal plane, mean angulations of 61.66 degrees on the right side and 61.81 degrees on the left side were obtained. Finally, the mean length required to reach the foramen rotundum was 31.95  mm on the right side and 32.49  mm on the left side. Some of these results differ from those stated in the foreign literature (10 degrees front, 70 degrees sagittal). These differences should be considered for both clinical practice and teaching in Chile.

Aim: The aim of this study was to determine whether the sphenovomerine suture (SVS) can be used as a landmark to localize the sphenoidal sinus ostium., Methods: Endoscopic imaging was done on 152 skulls to identify ostium of the sphenoidal sinus, the SVS, and the articulation of sphenoidal process of palatine bone between the body of the sphenoid and the sphenopalatine foramen. The variables were as follows: (1) the distance between the medial border of the ostium and SVS (DSO-SVS); (2) the angle between them (ASO-SVS); (3) the distance between the inferior border of the ostium and the horizontal line (DSO-HL); (4) the distance between intersection point of the SVS-sphenoidal process of the palatine bone and the medial border of sphenopalatine foramen (DSPF-SVS); and (5) the number of sphenopalatine foramen., Results: Of the 152 skulls, 289 sides were included in the study. The mean value for DSO-SVS was 3.15 (1.35) mm, DSO-HL was 5.99 (2.38) mm, DSPF-SVS was 7.07 (1.96) mm, and ASO-SVS was 5.99 (9.73) mm. As DSPF-SVS decreases, DSO-SVS and DSO-HL decrease with statistical significance (Ps = 0.02 and 0.001, respectively). The distribution of the numbers of sphenopalatine foramen was as follows: one 90%, two 9.7%, and four 0.3%., Conclusions: The horizontal distance between the SVS and the sphenopalatine foramen plays a significant role in identifying the location of sphenoid sinus ostium. As with the other landmarks, the SVS provides an additional benefit in locating the sphenoid sinus ostium for endoscopic sinus surgeons. The incidence of 4 sphenopalatine foramen is 0.3%.

Background: Selective inferior orbital fissure (IOF) content transection for the purpose of surgical access to the posterior orbital floor is a technique that facilitates visualization of the posterior bony ledges of traumatic orbital floor defects. It also has potential advantages in achieving stable placement of reconstructive materials. Although not new, the surgical technique has not yet been described, and the morbidity of the technique has not been quantified. This article describes the procedure and assesses the morbidity specific to the division of related neural structures., Methods: The technique and surgical anatomy are described and illustrated with intraoperative photographs. Postoperative assessment of neural structures relevant to the division of IOF contents is performed. These values are compared with the nonoperated side to evaluate the morbidity of the technique., Results: The technique, which is consistently used by the senior author in the repair of orbital floor defects with very small posterior ledges or which extend to and involve the IOF, facilitates better visualization of the posterior ledge and posterolateral ledge in such cases. Surgical outcomes including facial sensation and lacrimal function on the operated side remain within the reference range and are not significantly different when compared with the contralateral nonoperated side., Conclusions: Selective IOF transection aids in the direct visualization of the posterior bony ledges in the repair of posterior orbital floor defects. It therefore may facilitate the placement of reconstructive materials on bony ledges circumferentially, providing stable reconstruction, potentially reducing implant-related complications without causing increased morbidity.

The pterygopalatine fossa (PPF) is a small anatomic region of particular interest in cranial base surgery. Infectious diseases and malignancy may spread through the PPF to contiguous areas as a result of the low resistance offered by the numerous foramina and fissures that surrounds the fossa. We present an anatomic report on the PPF. Twelve sides of six fixed cadaveric heads were dissected through a LeFort I maxillary osteotomy with transantral exposure of the neurovascular content of the PPF. Arterial vascular patterns of the maxillary artery were observed. The pterygopalatine fossa is a deeply located small anatomic region with a rich neurovascular content. The third portion of the maxillary artery in the PPF may demonstrate a variable vascular morphology. A correct understanding and knowledge of the anatomic structures lodged into the PPF, as well as their relationships and functions, remain crucial to minimizing postsurgical morbidity and intraoperative complications.

Study Design: This study compared the reliability of 3 techniques used to measure alignment between the occiput and cervical spine., Objectives: Intraobserver and interobserver intraclass correlation coefficient were computed to determine the most reliable method to measure occipitocervical angle., Summary of Background Data: No studies have been performed comparing occipitocervical angle measurement techniques., Methods: The angles between the inferior endplate of second cervical vertebrae and the occiput line using the Chamberlain line, McRae line, and McGregor line were measured from lateral cervical radiographs of 30 healthy volunteers. Five spine surgeons made measurements., Results: Mean intraobserver variances of the angles using Chamberlain line, McRae line, and McGregor line were 2.0 degrees (ranging from 0 degrees-15 degrees), 4.7 degrees (from 0 degrees-28 degrees), and 1.5 degrees (from 0 degrees-9 degrees), respectively; intraobserver intraclass correlation coefficients of the angles were 0.956, 0.835, and 0.975. Mean interobserver variances of the angles using Chamberlain line, McRae line, and McGregor line were 2.3 degrees (from 0.4 degrees-6.4 degrees), 5.0 degrees (from 1.8 degrees-11.9 degrees), and 1.4 degrees (from 0 degrees-4.5 degrees), respectively; interobserver intraclass correlation coefficients were 0.939, 0.802, and 0.972. The highest reliability indexes were obtained for McGregor line., Conclusions: The McGregor line is the most reproducible and reliable method for measurement of the occipitocervical angle.

Distraction osteogenesis (DO) has recently been applied to the palate. Successful posterior lengthening and medial advancement of the palates was continuously reported. Based on these studies, it is obvious that DO will play a major role in the management of problems related to palatal defects in the near future. Although the results are appealing, they may not be applicable for humans due to anatomic differences. All experimental studies used normal palatal sutures of young dogs for size expansion. Therefore, it is necessary to know normal palatal sutures in infants before one can clinically apply this new technique. With consent, palates of fetuses and neonates who died of various causes were examined. Eight fresh cadavers were available for the dissection, with two being skeletonized using the boiling process. There were three fetal deaths in utero (33-41 weeks of gestational age) and five postnatal deaths (aged between 5 hours and 6 months). All specimens were grossly normal in shape and size except for one with a unilateral complete cleft of lip and palate. A midline palatal suture was found in every noncleft specimen, while premaxillary and transverse palatomaxillary sutures were present in every specimen. Laterally, there was no true suture except for the most posterior portion, which was contiguous with the greater palatine foramen. The palatal sutures of third-trimester fetuses and neonates are not different from adult ones. There is no lateral suture that will allow distraction in the medial direction. It is only the posterior hard palate (palatine bones) that can potentially be moved medially and posteriorly by sutural expansion with DO.