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A Cadaveric Study of the Course and Characteristics of the Greater Palatine Artery

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A Cadaveric Study of the Course and Characteristics of the Greater Palatine Artery A CADAVERIC STUDY OF THE COURSE AND CHARACTERISTICS OF THE GREATER PALATINE ARTERY Sandra Koutras A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master in Dentistry Johannesburg, 2019 DECLARATION I, Sandra Koutras declare that this research report is my own work. It is being submitted for the degree of Master in Dentistry at the University of the Witwatersrand, Johannesburg. It has not been submitted before for any other degree or examination at this or any other University. Sandra Koutras 0404632F 28th day of February 2019 i ABSTRACT Background: The purpose of this study was to detail the topography of the greater palatine artery (GPA), looking specifically at its depth from the overlying masticatory mucosa as well as its diameter so as to be able to ascertain the safest area for graft harvesting from partially and fully edentate individuals. Methods and materials: Thirty-six maxillae from human cadavers, whose age and sex are known, were analysed at the School of Anatomical Sciences, University of the Witwatersrand, Johannesburg, South Africa. Following dissection of 72 GPA, the width and length of the palate as well as the diameter of the greater palatine artery and its relationship to the overlying palatal mucosa was recorded at 3mm intervals. Results: A total of 64 GPA were evaluated. Despite a relatively even distribution of male and female individuals, there was no statistically significant difference between the sexes. The left and right diameters of the GPA as well as the right and left distances from the GPF to the palatal raphe were not found to be significantly different. The depth of the GPA decreased as it coursed anteriorly from the greater palatine foramen ranging from 6.67 mm to 4.35 mm. The depth at both the 3mm and 6mm intervals decreased by approximately 1.2mm with an increase of 10mm in palatal width. Conclusion: No directional asymmetry or sex and age bias could be found. Wider palates tend to have shallower GPAs posteriorly at the 3mm and 6mm landmark. A new landmark is recommended for use in partially dentate and edentulous individuals to measure the GPA depth at the point where the palatal raphe bisects a line adjoining the two GPFs. ii DEDICATION To Bjørn and Magnus (and Lennox) iii ACKNOWLEDGEMENTS I would like to thank Dr. Hemingway for his guidance and mentorship throughout this long journey both hands on in the collection of data and write up and giving way beyond what is required of a supervisor. Also to the School of Anatomical Sciences and all the individuals who donated their bodies to medical education and research, who gave up their last possession for the benefit of future generations. iv TABLE OF CONTENTS DECLARATION ..................................................................................................................... i ABSTRACT ........................................................................................................................... ii DEDICATION ...................................................................................................................... iii ACKNOWLEDGEMENTS ...................................................................................................... iv TABLE OF CONTENTS .......................................................................................................... v LIST OF FIGURES .............................................................................................................. viii LIST OF TABLES .................................................................................................................. ix CHAPTER 1: INTRODUCTION AND LITERATURE REVIEW .................................................. 1 1.1 Introduction .................................................................................................................. 1 1.2 Literature review ........................................................................................................... 2 1.3 Aims and objectives ....................................................................................................... 5 CHAPTER 2: MATERIALS AND METHODS ......................................................................... 6 2.1 Study Design .................................................................................................................. 6 2.2 Study population and sample size .................................................................................. 6 2.3 Sample size .................................................................................................................... 6 2.4 Instrumentation ............................................................................................................ 6 2.5 Methods and procedures ............................................................................................... 8 2.5.1 Dissection Protocol ........................................................................................................... 8 2.5.2 Data collection .................................................................................................................. 9 2.6 Calibration .................................................................................................................... 11 2.7 Data analysis ................................................................................................................ 1 2 CHAPTER 3: RESULTS ..................................................................................................... 13 3.1 Calibration .................................................................................................................... 13 3.2 Sample size, age and population group ......................................................................... 13 3.3 Descriptive statistics ..................................................................................................... 13 3.4 Test for directional asymmetry ..................................................................................... 14 v 3.5 Differences between male and female individuals ........................................................ 15 3.6 Greater palatine artery depth discrepancy postero‐anteriorly ...................................... 16 3.7 Correlations amongst variables .................................................................................... 18 CHAPTER 4: DISCUSSION ............................................................................................... 21 4.1 Sample sizes ................................................................................................................. 2 1 4.2 GPA diameter ............................................................................................................... 21 4.3 GPA depth .................................................................................................................... 2 2 4.4 Directional asymmetry and sexual dimorphism ............................................................ 23 4.5 Palatal dimensions in relation to the depth of the GPA ................................................. 24 4.6 Proposed harvesting site .............................................................................................. 25 4.7 Limitations ................................................................................................................... 27 CHAPTER 5: CONCLUSION ............................................................................................. 28 APPENDIX ......................................................................................................................... 29 REFERENCES ..................................................................................................................... 30 vi ABBREVIATIONS CEJ- Cemento-enamel junction CT- Computed tomography GPA – Greater palatine artery GPF- Greater palatine foramen GPN- Greater palatine nerve LGPF- Line adjoining the greater palatine foramina PM- Palatal mucosa R- Coefficient of reliability SCTG- Subepithelial connective tissue graft TEM – Technical error of measurement TMJ – Temporomandibular joint UNC-15 – University of North Carolina- 15 vii LIST OF FIGURES Figure 2.1. Hillson-Fitzgerald Dental Caliper………………………………………………7 Figure 2.2. UNC-15 probe…………………………………………………………………..7 Figure 2.3. Greater palatine artery (right) after dissection………………………………….10 Figure 2.4. Measurements taken from the hard palate………………………………………11 Figure 3.1. The depth of the GPA) in relation to the distance from the line adjoining the greater palatine foramina (mm) ……………………………………………………………...17 Figure 3.2. The average depth of the GPA (mm) in relation to the distance (mm) along the palatal raphe at 3mm intervals ……………………………………………………………….18 Figure 3.3. Scatterplot illustrating the relationship between the palate width and the depth of the GPA at the 3mm interval…………………………………………………………………19 Figure 3.4. Scatterplot illustrating the relationship between the palate width and the depth of the GPA at the 6mm interval…………………………………………………………………20 viii LIST OF TABLES Table 3.1. Intra-observer error using the technical error of measurement…………………..13 Table 3.2. Descriptive statistics for all the measures, separated by sex and side…………...14 Table 3.3. Descriptive statistics for all the measures averaged for side; independent of sex..15 Table 3.4. Pairwise comparisons between observed depths of the GPA at 3mm intervals….16 Table 3.5. Association between
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