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Rhinolaryngoscopy for the Allergist
Published in Pudupakkam K Vedanthan, Harold S Nelson, Shripad N Agashe, PA Mahesh, Rohit Katial, Textbook of Allergy for the Clinician, 2021
Jerald W Koepke, William K Dolen
The septum divides the nasal cavity into right and left chambers. The nasal vestibule is the most anterior and inferior portion of the nasal cavity (Fig. 11.3). It is bounded medially and laterally by the alar cartilages and extends to the inferior border of the lateral nasal cartilage. Above the vestibule and in front of the middle meatus is the nasal atrium, and above this is the agger nasi, a prominence which generally contains anterior ethmoid air cells. The nasal floor is formed anteriorly by the maxillary bone and posteriorly by the palatine bone. It is slightly concave and passes horizontally from the vestibule to the choana. The nasal vault narrows superiorly to form the roof of the nose.
Head and Neck
Published in Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno, Understanding Human Anatomy and Pathology, 2018
Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno
The hard palate is a conglomerate of many structures making up the roof of the oral cavity and these structures also seamlessly contribute to nearby regions. These include the incisive foramen located just posterior to the incisors teeth, alveolar processes superior and adjacent to the teeth and palatine process of the maxilla, the horizontal plate, perpendicular plate, greater palatine foramen, and lesser palatine foramen of the palatine bone, located posterior to the maxilla and the hamulus of the medial plate of the pterygoid process, the lateral plate of the pterygoid process, the scaphoid fossa, and the pterygoid canal of the sphenoid bone located superior and slightly posterior to the maxilla and palatine bones (Plate 3.9). As you can see, the hard palate is made up of many bony parts. The hard palate is also the structure typically subject to facial clefting birth defects (see Branchial arches at the beginning of Chapter 3).
Oral Cavity Tumours Including Lip Reconstruction
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
The maxilla comprises the maxillary alveolus and the hard palate. The osseous alveolar process supports the maxillary dentition, being covered by a mucoperiosteum with a stratified squamous epithelium. The maxillary alveolus merges laterally with the buccal mucosa and lips at the gingival sulcus and medially with the hard palate. The alveolar process extends to the upper end of the pterygopalatine arches posteriorly. The hard palate lies within the horseshoe shape of the maxillary alveolus, merging imperceptively with the alveolar mucosa. The hard palate has minor salivary glands located in the submucosa, 33% of palatal tumours being derived from salivary epithelium.182 Posteriorly, the hard palate merges with the soft palate at the posterior edge of the palatine bone. The WHO classifies these anatomical sites as ICD-10 C05.0 (hard palate) and C03.0 (maxillary alveolus).1 Sensory innervation to the maxillary mucosa is by branches of the maxillary division of the trigeminal nerve. The nasopalatine nerve supplies the anterior hard palate, passing through the incisive foramen, the posterior palate being supplied by the paired greater palatine nerves that pass through the greater palatine foraminae. Lymphatic drainage is to the ipsilateral cervical nodes via the submandibular nodes or potentially the retropharyngeal nodes in posteriorly located tumours.
Patient-specific pre-operative simulation of the surgically assisted rapid maxillary expansion using finite element method and Latin hypercube sampling: workflow and first clinical results
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2023
L. Bonitz, A. Volf, S. Hassfeld, A. Pugachev, B. Ludwig, S. Chhatwani, A. Bicsák
The surgically assisted rapid maxillary expansion (SARME) was first described by E. C. Angell in 1860 (Angell 1860). Today, SARME and surgically assisted rapid palatal expansion (SARPE) are common, combined orthodontic and surgical procedures used to correct maxillary transverse deficiency in skeletally mature patients (de Gijt et al. 2017). The procedure consists of two steps. First, the maxilla is weakened by a bilateral osteotomy in the Le-Fort-I plane and pterygomaxillary suture and an opening in the mid-palatal suture is made (midline split). The extent of osteotomy depends on the patient’s age, bone quality, and anatomical conditions including the dental root position and neural structures (Koudstaal et al. 2005; Han et al. 2009; Rana et al. 2013). The state-of-the-art technique involves weakening the maxilla equally on both sides based on the experience of the surgeon. In this way, the extent of osteotomy can vary widely (Al-Ouf et al. 2010; Nada et al. 2012; Seeberger et al. 2015). In the second step, the maxilla is expanded using a distraction device, which is mounted on the palatine bone or the bicuspids of both the maxillary segments (Sander et al. 2006; Adolphs et al. 2014; Ulusoy and Dogan 2018).
A skeletal Class III facial asymmetry case with a canted occlusal plane treated by LeFort I with unilateral horseshoe osteotomy
Published in Orthodontic Waves, 2021
Tomoyo Tanaka, Mitsuhiro Hoshijima, Norie Yoshioka, Hiroshi Kamioka
After 13 months of presurgical orthodontic treatment, the maxillary LeFort I osteotomy with unilateral horseshoe osteotomy and mandibular IVRO was performed. After accomplishing a LeFort I osteotomy and down fracture, unilateral horseshoe osteotomy was performed. The right side of split line separated molar region of alveolar bone from the palatine bone and the left side of split line passed through nearest midline of the palatal bone (Figure 6(b), dotted line). The maxilla was advanced 2.0 mm at the ANS with transverse rotation and slight yaw rotation via LeFort I osteotomy, and the right side of the maxilla was trimmed for the upward movement and impacted 5.0 mm with unilateral horseshoe osteotomy (Figure 6(a), shaded area, C). The mandible was set back with IVRO for obtaining Angle Class I occlusion. Occlusal rehabilitation was performed for three months using intermaxillary elastics and an occlusal splint. Postsurgical orthodontic treatment was performed to obtain better teeth interdigitation. The total active treatment period was two years and seven months. After removing the appliance, the mandibular anterior teeth were stabilized with a six-unit lingual bonded retainer, and the upper and lower arches were stabilized with Begg-type retainers. The patient was followed for two years.
Endoscopic sphenopalatine artery electrocoagulation for refractory epistaxis: a clinical study
Published in Acta Oto-Laryngologica, 2020
Liang Yu, Xiaofei Li, Shujuan Sun, Li Shi, Yuzhu Wan
All patients underwent operation in the general anesthesia, gauze strips or other packing materials were removed from the nasal cavity and 2% lidocaine cotton sheets containing 0.1% adrenaline were used to shrink the nasal mucosa. Common bleeding sites in the nasal cavity were examined and excluded. Through the middle meatus of the affected side, a curved incision was made in the lateral wall of the nasal cavity 1 cm in front of the posterior end of the middle turbinate. The upper end of the incision started at the horizontal part of the middle turbinate plate, and the lower end did not extend beyond the attachment point of then inferior turbinate. The mucosa was cut through into the bone surface, expose the top of the vertical plate of the palatine bone and the sphenoid palatine notch, or find the ethmoid crest and locate the sphenoid palatine aperture (Figure 1), the ethmoidal ridges were bitten to reveal the sphenopalatine notch, locate the sphenopalatine hole, reveal the sphenopalatine artery. The bipolar electrocoagulation cauterized and disconnected the SPA. The mucosal flap is recovered and the hemostatic gelatin sponge covers the mucosal flap.