Three-dimensional analysis of maxillary anatomic landmarks for greater palatine nerve block anesthesia

Greater palatine nerve block anesthesia (GPNBA) is a local anesthetic procedure used for maxillary and nasal treatment. Investigation of the three-dimensional anatomic location of the greater palatine foramen (GPF) is important for successful local anesthesia. The study aim was to provide standards for anatomic structures in the oral cavity that can be easily referred to in GPNBA. Maxillary computed tomography data were obtained from patients between 8 and 16 years of age whose maxillary incisors and first molars had already erupted (the growth group, n = 103); changes in the maxilla were observed over time in this group. Reference values for GPNBA in adults were measured in 107 patients older than 18 years. Maxillary computed tomography images were reconstructed three-dimensionally. Regression analysis demonstrates that all maxillary measurements in the growth group except for the distance from the posterior nasal spine to the GPF in the coronal plane correlated significantly with age. In adults, the mean perpendicular distance from the interdental alveolar bone between the left and right central incisors (1alvB) to the GPF in the coronal plane was 46.16 mm, and the mean distance from 1alvB to the GPF was 51.05 mm. The mean distance from the maxillary central incisor to the GPF was 57.58 mm. The mean angle between the line from the maxillary central incisor to each GPF and the sagittal plane was 16.49 degrees. The mean perpendicular distance from the anterior nasal spine to the GPF in the coronal plane was 43.49 mm, whereas the mean perpendicular distance from the GPF to the bone plane was 12.67 mm, and the mean perpendicular distance from the GPF to the occlusal plane was 22.13 mm. These measurements can be used to find the height of the GPF. In adults, the measured perpendicular distance from the incisive foramen to the GPF in the coronal plane was 32.04 mm, and the perpendicular distance from the median of the line that connects both of the contact points between the maxillary tuberosity and the pterygoid plate to the GPF in the coronal plane was 5.23 mm. Three-dimensional reference values relative to the anatomic structures in the oral cavity may increase the success rate of GPNBA and reduce complications. Although the maxillary growth pattern was analyzed, a limitation of this study is that maxillary anatomic measurements were not analyzed with regard to race or ethnicity.