Analysis of blood supply in the hard palate and maxillary tuberosity—clinical implications for flap design and soft tissue graft harvesting (a human cadaver study)
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The aim of the present study is to provide a detailed macroscopic mapping of the palatal and tuberal blood supply applying anatomical methods and studying specific anastomoses to bridge the gap between basic structural and empirical clinical knowledge.
Materials and methods
Ten cadavers (three dentate, seven edentulous) have been prepared for this study in the Department of Anatomy, Semmelweis University, Budapest, Hungary, and in the Department of Anatomy of the Medical University of Graz. All cadavers were fixed with Thiel’s solution. For the macroscopic analysis of the blood vessels supplying the palatal mucosa, corrosion casting in four cadavers and latex milk injection in other six cadavers were performed.
We recorded major- and secondary branches of the greater palatine artery (GPA) and its relation to the palatine spine, different anastomoses with the nasopalatine artery (NPA), and lesser palatal artery (LPA) as well as with contralateral branches of the GPA. Penetrating intraosseous branches at the premolar-canine area were also detected. In edentulous patients, the GPA developed a curvy pathway in the premolar area. The blood supply around the maxillary tuberosity was also presented.
The combination of different staining methods has shed light to findings with relevance to palatal blood supply, offering a powerful tool for the design and execution of surgical interventions involving the hard palate.
The present study provides clinicians with a good basis to understand the anatomical background of palatal and tuberal blood supply. This might enable clinicians to design optimized incision- and flap designs. As a result, the risk of intraoperative bleeding and postoperative wound healing complications related to impaired blood supply can be minimized.
KeywordsBlood supply Hard palate Incision Surgical flap
The authors would like to express their gratitude to Dr. Gábor Baksa from the Department of Anatomy, Histology and Embryology, Semmelweis University for his precious support. The authors also would like to thank all other co-workers of the Department of Anatomy, Histology and Embryology, and Dr. Ferenc Bartha and Dr. Dániel Palkovics from the Department of Periodontology, Semmelweis University and the Department of Macroscopical and Clinical Anatomy of Graz University for their work and support.
The work was supported by the Department of Periodontology, Semmelweis University, Budapest, Hungary; Department of Anatomy, Histology and Embryology, Semmelweis University, Budapest, Hungary; Department of Macroscopical and Clinical Anatomy, Medical University of Graz, Graz, Austria.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
This article does not contain any studies with human participants or animals performed by any of the authors.
For this type of study, formal consent is not required. Informed consent was obtained from all individual participants included in the study.
- 2.Klosek SK, Rungruang T (2009) Anatomical study of the greater palatine artery and related structures of the palatal vault: considerations for palate as the subepithelial connective tissue graft donor site. Surg Radiol Anat 31(4):245–250. https://doi.org/10.1007/s00276-008-0432-4 CrossRefGoogle Scholar
- 6.Hürzeler MB, Weng D. (1999) A single-incision technique to harvest subepithelial connective tissue grafts from the palate. Int J Periodontics Restorative Dent 19(3):279–87.8)Google Scholar
- 9.Sullivan HC, Atkins JH (1968) Free autogenous gingival grafts. 1. Principles of successful grafting. Periodontics 6(1):5–13Google Scholar
- 12.Tavelli L, Ravidà A, Saleh MHA, Maska B, Del Amo FS, Rasperini G, Wang HL. (2018) Pain perception following epithelialized gingival graft harvesting: a randomized clinical trial. Clin Oral Investig doi: https://doi.org/10.1007/s00784-018-2455-5
- 13.Abrams H, Gossett SE, Morgan WJ (1988) A modified flap design in exposing the palatally impacted canine. ASDC J Dent Child 55(4):285–287Google Scholar
- 16.Niu L, Wang J, Yu H, Qiu L (2018) New classification of maxillary sinus contours and its relation to sinus floor elevation surgery. Clin Implant Dent Relat Res. https://doi.org/10.1111/cid.12606
- 17.Simion M, Fontana F, Rasperini G, Maiorana C (2004) Long-term evaluation of osseointegrated implants placed in sites augmented with sinus floor elevation associated with vertical ridge augmentation: a retrospective study of 38 consecutive implants with 1- to 7-year follow-up. Int J Periodontics Restorative Dent. 24(3):208–221, 2004Google Scholar
- 18.Istvan A. Urban, Sascha A. Jovanovic, Jaime L. Lozada (2017) Vertical ridge augmentation using guided bone regeneration (GBR) in three clinical scenarios prior to implant placement: a retrospective study of 35 patients 12 to 72 months after loading. Biomed Res Int 2017:4042902. doi: https://doi.org/10.1155/2017/4042902., 2017, 1, 11
- 20.Reiser GM, Bruno JF, Mahan PE, Larkin LH (1996) The subepithelial connective tissue graft palatal donor site: anatomic considerations for surgeons. Int J Periodontics Restorative Dent. 16(2):130–137Google Scholar
- 25.Csempesz F, Vág J, Kerémi B, Györfi A, Fazekas A (2000) Blood flow measurements in human oral tissues with laser Doppler flowmetry. Fogorv Sz 93(4):115–120Google Scholar
- 26.Molnár E, Molnár B, Lohinai Z, Tóth Z, Benyó Z, Hricisák L, Windisch P, Vág J (2017) Evaluation of laser speckle contrast imaging for the assessment of oral mucosal blood flow following periodontal plastic surgery: an exploratory study. Biomed Res Int 2017:4042902. doi: https://doi.org/10.1155/2017/4042902, 1, 11.
- 27.Alvernia JE, Pradilla G, Mertens P, Lanzino G, Tamargo RJ (2010) Latex injection of cadaver heads: technical note. Neurosurgery 67(2 Suppl Operative):362–7. doi: https://doi.org/10.1227/NEU.0b013e3181f8c247
- 33.Robinson RE (1966) The distal wedge operation. Periodontics 4(5):256–264Google Scholar