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Tumours of the oral cavity and pharynx
Published in Anju Sahdev, Sarah J. Vinnicombe, Husband & Reznek's Imaging in Oncology, 2020
Kunwar S S Bhatia, Ann D King, Robert Hermans
Most hard palate tumours are salivary gland neoplasms, and over half of these are benign, notably pleomorphic adenomas. SCCs account for just over half of malignant palatal tumours, followed by minor salivary malignancies (30). Palatal SCCs frequently extend onto the upper alveolus and soft palate. Bony invasion of the hard palate and alveolus can also occur, with subsequent extension into the nasal cavity and maxillary sinus, respectively. Tumours reaching the posterior hard palate can spread via the greater and lesser palatine canals to the pterygopalatine fossa and skull base. The course of these nerves from the palate to the skull base should be examined meticulously, especially as perineural spread can be discontinuous (Figure 1.8).
Anatomy and Embryology of the Mouth and Dentition
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
The hard palate derives its blood supply principally from the greater palatine artery, a branch of the third part of the maxillary artery. The greater palatine artery descends (with its accompanying nerve) in the palatine canal. In the canal, it gives off two or three lesser palatine arteries that are transmitted through lesser palatine canals to supply the soft palate and tonsil (anastomosing with the ascending palatine branch of the facial artery). The greater palatine artery emerges on to the oral surface of the palate at the greater palatine foramen and runs in a curved groove near the alveolar border of the hard palate to the incisive canal. It ascends this canal and anastomoses with septal branches of the nasopalatine artery.
Perineural spread of basosquamous carcinoma to the orbit, cavernous sinus, and infratemporal fossa
Published in Orbit, 2018
Alec L. Amram, William J. Hertzing, Stacy V. Smith, Patricia Chévez-Barrios, Andrew G. Lee
The pterygopalatine or sphenopalatine fossa is a passageway between many major compartments of the skull and is thus a critical location for tumor spread. This fossa is a located in the basilar region of the skull and is bounded medially by the palatine bone, posteriorly by the pterygoid process of the sphenoidal bone, and anteriorly by the posterior wall of the maxillary sinus. It has six communications to major compartments of the skull, communicating medially to the nasal cavity via the sphenopalatine foramen, laterally to the infratemporal fossa via the pterygomaxillary fissure, anteriorly to the orbit through the inferior orbital fissure, posteriorly and superiorly to Meckel’s cave and the cavernous sinus via the foramen rotundum, posteriorly and inferiorly to the middle cranial fossa via the vidian canal, and inferiorly to the palate through the greater and lesser palatine canals. As this fossa has direct access to the nasal cavity, intracranial space, orbit, and cavernous sinus, it is a common site for direct invasion and perineural spread of disease and can present with involvement of any combination of the aforementioned compartments.15 In our patient, the carcinoma most likely spread from the nasal cavity to the sphenopalatine fossa, and then extended to the infratemporal fossa, cavernous sinus, and orbit.