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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 32  |  Issue : 1  |  Page : 27-30

Morphological variation of the nasopalatine canal: A cone-beam computed tomography study


Department of Oral Medicine and Radiology, Buddha Institute of Dental Science, Patna, Bihar, India

Date of Submission17-Dec-2019
Date of Decision08-Jan-2020
Date of Acceptance11-Mar-2020
Date of Web Publication17-Apr-2020

Correspondence Address:
Dr. Khushboo Rani
Ashok Nagar, Road No 11, Shila Bhavan, Kankarbagh Patna - 800 020, Bihar
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaomr.jiaomr_205_19

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   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 Jun 4];32:27-30. Available from: http://www.jiaomr.in/text.asp?2020/32/1/27/282617




   Introduction Top


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.[1] 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.[2] Before placement of dental implant NPC should be properly evaluated.[2],[3]

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.[4]

Our study aimed to assess the morphological variation of NPC concerning age and gender by using CBCT.[5]


   Material and Methods Top


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:

  1. Cylindrical shape: A cylindrical shape formed by parallel labial and palatal walls of the NPC [Figure 1]a.
  2. 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.
  3. 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.
  4. 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.[6]
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

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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 Top


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 Top


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.[1]

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.[2]

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.[3] The findings are similar to the results of the study done by Thakur et al. in 2013[6],[7] [Table 1].
Table 1: Distribution of NPC shape according to gender

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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.[8],[9] The findings are similar to the results of the study done by Mraiwa et al. in 2013.[10] 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].[11] our results are also consistent with the ones of Yasser et al., Liang et al., Asaumi et al.[3],[7],[8] Other shapes like (1) coneshape,(2)bananalike,(3) treebranch like shapes of the canal have also been reported by Etoz and Sisman.[12]
Table 2: Distribution of NPC according to its shape

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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.[1],[5],[6]

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].
Table 3: Distribution of shape according to age

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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.[4],[8] [Table 4].
Table 4: Length of Nasopalatine fossa according to age

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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.[1],[6],[8] [Table 5].
Table 5: Mean length of nasopalatine foramen according to gender


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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.[11]


   Conclusion Top


The result from our present study highlights the anatomic variability of the NPC concerning age, gender, shape, length, etc.[1] 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.[3] 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.[12]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Mishra R, Thimmarasa VB, Jaju PP, Mishra R, et al. influence of gender and age on Nasopalatine canal: A Cone-beam computed tomography study. J Dental Implants 2017;7:15-9.  Back to cited text no. 1
    
2.
Nasseh I, Aoun G, Sokhn S. Assessment of the nasopalatine canal: An anatomical study. Acta Inform Med 2017;25:34-8.  Back to cited text no. 2
    
3.
Yaser S, Mahkameh M, Sepideh R, Mahtab K, MaryamE. Assessment of nasopalatine canal anatomic variations using cone beam computed tomography in a group of Iranian population. Iran J Radiol 2017;14:e37028.  Back to cited text no. 3
    
4.
Fernández-Alonso A, Suárez-Quintanilla JA, Muinelo-Lorenzo J, Varela-Mallou J, Smyth Chamosa E, Suárez-Cunqueiro MM, et al. Critical anatomic region of nasopalatine canal based on tridimensional analysis: Cone beam computed tomography. Sci Rep 2015;5:12568.  Back to cited text no. 4
    
5.
Fukuda M, Matsunaga S, Odaka K, Oomine Y, Kasahara M, Yamamoto M, et al. Three-dimensional analysis of incisive canals in human dentulous and edentulous maxillary bones. Int J Implant Dent 2015;1:12.  Back to cited text no. 5
    
6.
Thakur AR, Burde K, Guttal K, Naikmasur VG. Anatomy and morphology of the nasopalatine canal using cone-beam computed tomography. Imaging Sci Dent 2013;43:273-81.  Back to cited text no. 6
    
7.
Asaumi R, Taisuke K, Iwao S, Shunji Y, Takashi Y. Three-dimensional observations of the incisive canal and the surrounding bone using cone-beam computed tomography. J Oral Radiol 2010;26:20-8.  Back to cited text no. 7
    
8.
Liang X, Jacobs R, Martens W, Hu Y, Adriaensens P, Quirynen M, et al. Macro-And micro anatomical, histological and computed tomography scan characterization of the nasopalatine canal. J Clin Periodontol 2009;36:598-603.  Back to cited text no. 8
    
9.
Rodrigues MT, Munhoz EA, Cardoso CL, Junior OF, Damante JH. Unilateral patent nasopalatine duct: A case report and review of the literature. Am J Otolaryngol 2009;30:137-40.  Back to cited text no. 9
    
10.
Mraiwa N, Jacobs R, Van Cleynenbreugel J, Sanderink G, Schutyser F, Suetens P, et al. The nasopalatine canal revisited using 2D and 3D CT imaging. Dentomaxillofac Radiol 2004;33:396-402.  Back to cited text no. 10
    
11.
Jacob S, Zelano B, Gungor A, AbbottD, Naclerio R, McClintock MK, et al. Location and gross morphology of the nasopalatine duct in human adults. Arch Otolaryngol Head Neck Surg 2000;126:741-8.  Back to cited text no. 11
    
12.
Hakbilen S, Magat G. Evaluation of anatomical and morphological characteristics of the Nasopalatine canal in a Turkish population by cone beam computed tomography. Folia Morphol (Warsz) 2018;77:527-35.  Back to cited text no. 12
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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