|Year : 2020 | Volume
| Issue : 1 | Page : 27-30
Morphological variation of the nasopalatine canal: A cone-beam computed tomography study
Archana Sudheer, Khushboo Rani, Anjali Kumari, Amit K Singh, Kumar Anand, Kriti Singh
Department of Oral Medicine and Radiology, Buddha Institute of Dental Science, Patna, Bihar, India
|Date of Submission||17-Dec-2019|
|Date of Decision||08-Jan-2020|
|Date of Acceptance||11-Mar-2020|
|Date of Web Publication||17-Apr-2020|
Dr. Khushboo Rani
Ashok Nagar, Road No 11, Shila Bhavan, Kankarbagh Patna - 800 020, Bihar
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Aim: 1) To assess the morphological variation of the nasopalatine canal (NPC) concerning age and gender. 2). To assess the correlation between the gender and morphology of the canal. 3). To assess the correlation between age and length of the canal. Material and Method: This is a retrospective, randomized observational study. The study comprised of 50 CBCT scans of maxilla showing NPC completely. The scans were obtained in the department during the period ranging from December 2018 to June 2019. The patients were in the age range of 15–75 years. Scan of 22 females and 28 males were included in the study. Patient below 15 years of age and NPC pathology or impacted teeth in same region were excluded in the study. The scans were obtained using ICAT17-19 machine and analyzed Vision software. Cone-Beam 3D Imaging machine operating at 120 kvp, 37.07 mAs with 0.25 mm voxel size, and a field of view of 16 × 6 cm maxilla. Results: Nasopalatine canal has 4 different morphological shapes. The most common shape was the cylindrical shape amongst both males and females. The least common shape was found to be hourglass shape with increasing age the length of NPC was found to decrease. The length of the canal was found to be longer in males when compared to females. Conclusion: This study highlights the importance of NPC morphology before or during surgical procedures involving the maxilla.
Keywords: Cylindrical shape, hourglass shape, nasopalatine canal, morphological shapes
|How to cite this article:|
Sudheer A, Rani K, Kumari A, Singh AK, Anand K, Singh K. Morphological variation of the nasopalatine canal: A cone-beam computed tomography study. J Indian Acad Oral Med Radiol 2020;32:27-30
|How to cite this URL:|
Sudheer A, Rani K, Kumari A, Singh AK, Anand K, Singh K. Morphological variation of the nasopalatine canal: A cone-beam computed tomography study. J Indian Acad Oral Med Radiol [serial online] 2020 [cited 2020 May 30];32:27-30. Available from: http://www.jiaomr.in/text.asp?2020/32/1/27/282617
| Introduction|| |
The nasopalatine canal (NPC) is also known as the anterior palatine canal. It is a long slender passage that is present in the midline of the anterior maxillary region and it connects the palate to the floor of the nasal cavity. Canal continues in the oral cavity as a single incisive foramen posterior to the central incisor teeth and in the nasal cavity as the foramina of Stenson, which are two in number. It contains the nasopalatine (incisive) nerve and nasopalatine artery, as well as fibrous connective tissue. Proper assessment of the incisive canal and foramen before any surgical procedure such as implant placement in the anterior maxillary region is highly significant. Before placement of dental implant NPC should be properly evaluated.,
To avoid injury to the artery and nerve in the canal, Cone-beam computed tomography (CBCT) should be done as it has high resolution and eliminates superimposition. CBCT facilitates the precise three-dimensional evaluation of bone quantity and NPC canal position in the anterior maxillary region.
Our study aimed to assess the morphological variation of NPC concerning age and gender by using CBCT.
| Material and Methods|| |
This is a retrospective, randomized observational study. The study comprised of 50 CBCT scans of maxilla showing NPC completely. The scans were obtained in the department during the period ranging from December 2018 to June 2019. The patients were in the age range of 15–75 years. Scan of 22 females and 28 males were included in the study. Patient below the 15 years of age and NPC pathology or impacted teeth in same region were excluded in the study. The scans were obtained using ICAT17-19 machine and analyzed Vision software. Cone-Beam 3D Imaging machine operating at 120 kvp, 37.07 mAs with 0.25 mm voxel size, and a field of view of 16 × 6 cm maxilla.
Evaluation of images
The shape of the canal was observed in the sagittal section and is classified as:
- Cylindrical shape: A cylindrical shape formed by parallel labial and palatal walls of the NPC [Figure 1]a.
- Funnel shape: A funnel shape formed by an increasing anteroposterior dimension of the NPC from the nasal fossa to the hard palate [Figure 1]b.
- Hourglass shape: An hourglass shape in which the narrowest anteroposterior dimension of the NPC was at the level compared to the dimensions at the nasal fossa and hard palate levels [Figure 1]c.
- Spindle shape: A spindle shape in which the widest anteroposterior dimension of the NPC was at the mid-level compared to the dimensions at the nasal fossa and hard palate levels [Figure 1]d.
|Figure 1: Cone-beam computed tomography images show the four shapes of the nasopalatine canal on sagittal planes. (a) cylindrical shape, (b) funnel shape (c) hourglass shape (d) spindle shape|
Click here to view
Nasopalatine canal length was measured between the floor of the nasal fossa and the level of the hard palate along the long axis of the canal in the sagittal section of the CBCT scan. And the length was measured by using a digital length measuring tool.
| Results|| |
Out of 50 subjects, the most common shape of NPC was cylindrical in both genders. However, the spindle-shaped canal was least common among females.
And there was no reported case of the hourglass canal in the female.
Out of 50 subjects, the most common shape of NPC was found to be a cylindrical shape which was seen in 27 scans and the least common shape of NPC was hourglass shape seen only in 3 scans.
Out of 50 subjects below the age of 25 years, the cylindrical shape of NPC was the most commonly found and least common shape found to be an hourglass shape. Between the age group of 26–35 years the cylindrical shape of NPC was most commonly found and the least common was found to be an hourglass shape. Between the age group of 36–45 years the cylindrical shape of NPC was most commonly found and no case was found to be spindle shape.
According to the age, length of NPC was observed. With the advancement of age, length of the canal was decreasing in both the genders.
The length of the NPC was measured between the level of the nasal fossa and the level of the hard palate along the long axis of the canal. It ranges from 8.75–18.58 mm in male with a mean of 11.38 mm and from 8.73–12.84 mm in females with a mean of 10.78 mm. This shows that the length of the NPC is relatively greater in male than in female.
| Discussion|| |
Anatomical relationship between the NPC and the root of the maxillary central incisors is vital and necessitates for radiological analysis before insertion of a dental implant or any other surgical procedure to be planned in that region.
Lack of knowledge or poor assessment of NPC can pose a surgical risk leading to sensory dysfunction and also has the risk of poor osseointegration of implant.
The present study indicates that the most common shape of NPC was cylindrical shape amongst both males and females. The least common shape was found to be hourglass shape. The findings are similar to the results of the study done by Thakur et al. in 2013, [Table 1].
Present study indicated that the NPC showed a great deal of variability with regard to its length as well as to its morphological appearance. In our study, four anatomical shapes of NPC were seen in the sagittal CBCT slice., The findings are similar to the results of the study done by Mraiwa et al. in 2013. In our study, the cylindrical shape was found in 54% of the scans, the funnel-shaped canal was found in 32%, spindle shape 8%, and an hourglass in 6% [Table 2]. our results are also consistent with the ones of Yasser et al., Liang et al., Asaumi et al.,, Other shapes like (1) coneshape,(2)bananalike,(3) treebranch like shapes of the canal have also been reported by Etoz and Sisman.
The average length of the NPC in our study was found to be 11.12 mm ranging from 8.73 to 18.58 mm; result close to the ones of Richa Mishra et al., Thakur et al., Tozum et al., and Fukuda et al., whose mean canal length measurement in a sagittal plane was 10.08, 10.86 and 11.75 mm ranging from 6.15 mm to 16.04 mm.,,
In our study length of NPC below the 25 year of age the most common NPC shape was found to be cylindrical shape and least common shape was hourglass shape. Between the age range 26-35 years of age the most common NPC shape was cylindrical shape and least common shape was hourglass shape. And between 36-45 year of age range the most common NPC shape was cylindrical shape and least common shape was funnel shape and hourglass shape [Table 3].
In our study length of NPC was found to decrease with increasing age which was similar to the study done by Fernandez-Alonso et al. and Liang et al., [Table 4].
In our scans the GPN canals in females were found to be significantly shorter in the male, a thing which was supported by the findings of Richa Mishra et al., Thakur et al., Liang et al.,, [Table 5].
The variations in NPC concerning sex, shape, age, and length is of paramount importance in pre-surgical planning. With the advent of CBCT, the technological knowledge can be a soon in treatment planning. Larger samples can aid in giving more conclusive statistical data.
| Conclusion|| |
The result from our present study highlights the anatomic variability of the NPC concerning age, gender, shape, length, etc. The result from this study suggests that gender is an important factor that can affect the characteristics of the NPC and the amount of bone in anterior region. The length of canal varies with age. Sound knowledge of the anatomy of NPC concerning age and gender using CBCT is a new diagnostic tool and a boon for surgical planning in the maxillary anterior region.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]