Oral Cavity Tumours Including Lip Reconstruction
John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford in 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.
Head and Neck
Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno in Understanding Human Anatomy and Pathology, 2018
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).
Prenatal Development of the Facial Skeleton
D. Dixon Andrew, A.N. Hoyte David, Ronning Olli in Fundamentals of Craniofacial Growth, 2017
In the second study, the possibility of a reciprocal influence of epithelium on mesenchymal differentiation in the secondary palate of embryonic chicks was analyzed (Tyler and McCobb; 1981), specifically to find out whether or not an epithelium is needed for the formation of the palatine bone. Epithelium and mesenchyme were separated enzymatically in palatal processes from chicks incubated for 5-7 days. Several types of graft to chorioallantoic membranes were carried out, including each of the palatal tissues, i.e., mesenchyme or epithelium, as well as the intact palatal processes. Osteoblasts differentiated in the palatal mesenchyme of intact processes and ossification began between Stage 35.5 and Stage 36. The initial age of the expiant determined differentiation of mesenchyme isolated from its epithelium. When isolated before Stage 26, the grafted mesenchyme formed cartilage but no membrane bone. The results indicated that mesenchyme artificially separated from epithelium will form bone in addition to cartilage only if the separation is done at Stage 26 or later.
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.
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.
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.
Related Knowledge Centers
- Anatomy
- Maxilla
- Pterygopalatine Fossa
- Hard Palate
- Nasal Cavity
- Irregular Bone
- Facial Skeleton
- Uvula
- Throat
- Pterygoid Processes of The Sphenoid