Surgical Anatomy of the Greater Palatine Canal: A Cone-Beam CT-Based Framework for Posterior Maxillary Interventions

Procedures involving the posterior hard palate, including greater palatine nerve blocks, palatal graft harvesting, implant placement, and sinus augmentation, require precise knowledge of the greater palatine canal (GPC) and greater palatine foramen (GPF). This study aimed to develop an integrated CBCT-based morphometric framework combining canal orientation, caliber, curvature, and lateral anatomic relationships to support preoperative planning.

A retrospective CBCT analysis was performed on 50 scans (100 GPCs). Using standardized orthogonal multiplanar reconstructions and fixed anatomic landmarks, the authors measured coronal (V1) and sagittal (V2) canal angulation, canal diameter at the conchal crest (V3), structures lateral to the GPF (V4), and the number of angular inflections in the coronal (V5) and sagittal (V6) planes. Bilateral symmetry was assessed by comparing both the magnitude and direction of canal angulation (same-sign versus opposite-sign orientations).

Coronal angulation demonstrated side-specific laterality, with right canals tending toward a mild lateral tilt and left canals toward a mild medial tilt. Sagittal angulation was comparatively uniform, most commonly between 20° and 40° bilaterally. Mean canal diameter was ∼3.0 mm, with most canals measuring 2 to 4 mm. At the GPF, the edentulous alveolar process was the most frequent lateral neighbor, followed by erupted or impacted third molars and, less commonly, the maxillary sinus. Most canals were straight or showed a single inflection, and bilateral angular differences were generally modest.

This integrated, side-specific morphometric profile of the GPC provides a reproducible framework for individualizing trajectories, anticipating anatomic constraints, and informing posterior maxillary interventions.