ANESTHESIA OF THE GREATER PALATINE NERVE IN THE AREA OF THE PALATINE FORAMEN: CLASSICAL AND MODERN METHODS, ANATOMICAL RATIONALE (LITERATURE REVIEW)
Abstract and keywords
Abstract:
This article presents a literature review of methods for anesthetizing the greater palatine nerve in the area of the greater palatine foramen in dental practice. Particular attention is paid to the anatomical basis of the technique, taking into account the variability of the structure of the greater palatine canal, its morphometric characteristics, and gender differences revealed using cone-beam computed tomography. The aim of the study was to conduct a detailed analysis of classical and modern methods of performing anesthesia in the area of the greater palatine nerve based on diagnostic digital planning of local conduction anesthesia in the maxilla. Materials and methods. A systematic search and analysis of scientific papers was conducted in the scientometric databases Scopus, PubMed, and eLIBRARY. They were devoted to the anatomical, topographic, and morphometric characteristics of the greater palatine canal, as well as modern approaches in dentistry aimed at optimizing manual techniques for anesthetizing the greater palatine nerve using digital and additive technologies. Results and discussion. A comparative analysis of classical and modern methods of conduction anesthesia was conducted, identifying their advantages and disadvantages. The clinical efficacy of various approaches is demonstrated, and potential complications are described. It is shown that preoperative CBCT planning allows for personalized anesthesia tactics, predicting technical difficulties, and minimizing the risk of complications. Conclusion. A priority area for further research is the development of algorithms for selecting an anesthesia method that take into account the anatomical features of the patient, the nature of the surgical intervention, and individual clinical preferences. These can be optimized through the use of additive technologies, which make it possible to manufacture an individual navigation template for performing a greater palatine nerve block.

Keywords:
palatal anesthesia, greater palatine nerve, greater palatine foramen, greater palatine canal, conduction anesthesia of the upper jaw
References

1. Gayvoronskiy I.V., Gayvoronskaya M.G., Cimbalistov A.V., Semenova A.A. Al'veolyarno-nebnyy kompleks. Variantnaya anatomiya, morfometricheskie harakteristiki i prikladnoe znachenie v stomatologii: monografiya. Belgorod: Belgorodskiy gosudarstvennyy nacional'nyy issledovatel'skiy universitet; 2018. 157 s.  Gaivoronsky I.V., Gaivoronskaya M.G., Tsymbalistov A.V., Semenova A.A. Alveolar-palatine complex. Variant anatomy, morphometric characteristics and applied significance in dentistry: monograph. Belgorod: Belgorod State National Research University; 2018. 157 p. (In Russ.).

2. Efremova A.V., Kalmin O.V., Evtushenko A.I., Reutov A.S., Moiseeva R.V. Anatomiya i topografiya bol'shogo nebnogo otverstiya i bol'shogo nebnogo kanala i ih znachenie dlya klinicheskoy praktiki. Izvestiya vysshih uchebnyh zavedeniy. Povolzhskiy region. Medicinskie nauki. 2023;(2):90–103. Efremova A.V., Kalmin O.V., Evtushenko A.I., Reutov A.S., Moiseeva R.V. Anatomy and topography of the greater palatine foramen and the greater palatine canal and their significance in clinical practice. Izvestiya vysshikh uchebnykh zavedeniy. Povolzhskiy region. Meditsinskie nauki = University proceedings. Volga region. Medical sciences. 2023;(2):90–103. (In Russ.). https://doi.org/10.21685/2072-3032-2023-2-10

3. Litvinenko L.M., Nikityuk D.B. Anatomiya cheloveka. Atlas dlya stomatologov, stomatologov-ortopedov. Moskva: LitTerra; 2017. 654 s.  Litvinenko L.M., Nikityuk D.B. Human anatomy. Atlas for dentists, orthopedic dentists. Moscow: LitTerra; 2017. 654 p. (In Russ.).

4. Vavulo P.I., Vasil'eva Yu.F., Krakasevich V.I. Analiz topografo-anatomicheskogo stroeniya nebnogo otrostka verhney chelyusti po dannym konusno-luchevoy komp'yuternoy tomografii. V: Studencheskaya medicinskaya nauka XXI veka: materialy XXIV Mezhdunarodnoy nauchno-prakticheskoy konferencii studentov i molodyh uchenyh; Vitebsk; 24–25 oktyabrya 2024 goda. Vitebsk: Vitebskiy gosudarstvennyy medicinskiy universitet; 2024. Vavulo P.I., Vasilyeva Yu.F., Krakasevich V.I. Analysis of the topographic and anatomical structure of the palatine process of the maxilla based on cone beam computed tomography data. In: Student medical science of the 21st century: materials of the XXIV International scientific and practical conference of students and young scientists; Vitebsk; October 24–25, 2024. Vitebsk: Vitebsk State Medical University; 2024. (In Russ.). https://elibrary.ru/item.asp?id=82300215

5. Gayvoronskaya M.G., Semenova A.A., Farafonova Yu.A. Morfometricheskie osobennosti stroeniya al'veolyarno- nebnogo kompleksa pri polnoy potere zubov u vzroslogo cheloveka. Morfologiya. 2018;153(3):67-67a. Gaivoronskaya M.G., Semyonova A.A., Farafonova Yu.A. Morphometric characteristics of the structure of the alveolar-palatine complex in an adults with complete teeth loss. Morphology. 2018;153(3):67-67a. (In Russ.). https://elibrary.ru/item.asp?id=35593263

6. Prives M.G., Lysenkov N.K., Bushkovich M.G. Anatomiya cheloveka. 13-e izd., ispr., dop. Moskva: GEOTAR-Media; 2024. 896 s.  Prives M.G., Lysenkov N.K., Bushkovich M.G. Human anatomy. 13th ed., revision, add. Moscow: GEOTAR-Media; 2024. 896 p. (In Russ.).

7. Samedov T.I., Matyushechkin S.V. Prikladnoe znachenie klinicheskoy anatomii chelyustno-licevoy oblasti dlya stomatologov i chelyustno-licevyh hirurgov. Sankt-Peterburg: SpecLit; 2022. 183 s.  Samedov T.I., Matyushechkin S.V. Applied significance of clinical anatomy of the maxillofacial region for dentists and maxillofacial surgeons. St. Petersburg: SpetsLit; 2022. 183 p. (In Russ.).

8. Malamed S.F. Handbook of Local Anesthesia. 7th ed. Elsevier; 2020.

9. Marzook H.A., Elgendy A.A., Darweesh F.A. New accessory palatine canals and foramina in cone-beam computed tomography. Folia Morphologica (Warsz). 2021;80(4):954-962. https://doi.org/10.5603/FM.A2020.0114

10. Cagimni P., Govsa F., Ozer M. A., Kazak Z. Computerized analysis of the greater palatine foramen to gain the palatine neurovascular bundle during palatal surgery. Surgical and Radiologic Anatomy. 2017;(2):177-184. https://doi.org/10.1007/s00276-016-1691-0

11. Asha M., Kumar G.A., Anupama V.S., Jigna V.R., Diksha M. Cone Beam Computed Tomographic Analysis of Anatomical Variations of Greater Palatine Canal and Foramen in Relation to Gender in South Indian Population. Oral Health and Dental Management. 2015;14(6):384–390.

12. Kalmin O.V., Efremova A.V., Zyul'kina L.A. Morfologiya bol'shogo nebnogo otverstiya i bol'shogo nebnogo kanala v zavisimosti ot pola. Morfologicheskie vedomosti. 2021;29(3):62-69. Kalmin O.V., Efremova A.V., Zyul'kina L.A. The morphology of the greater palatine foramen and greater palatine canal depending on sex. Morphological Newsletter. 2021;29(3):62-69. (In Russ.). https://elibrary.ru/item.asp?id=47417910

13. Shevela T.L., Vavulo P.I. Analiz topografo-anatomicheskogo stroeniya nebnogo otrostka verhney chelyusti po dannym konkusno-luchevoy komp'yuternoy tomografii. V: Aktual'nye problemy sovremennoy stomatologii: sbornik nauchnyh statey. Minsk: Belorusskiy gosudarstvennyy medicinskiy universitet; 2025. S. 254-257. Shevela T., Vavulo P. Analysis of the topographic and anatomical structure of the palatine process of maxilla based on cone bean computed tomography. In: Actual problems of modern dentistry: collection of scientific articles. Minsk: Belarusian State Medical University; 2025. Pp. 254-257. (In Russ.). https://rep.bsmu.by/bitstream/handle/BSMU/53080/254_257.pdf?sequence=1&isAllowed=y

14. Duman Tepe R., Guray B., Senel S.N., Cakir Karabas H. Morphometric assessment of greater palatine canal and foramen variations in cleft lip and palate patients using CBCT. Journal of Stomatology Oral and Maxillofacial Surgery. 2025;126(5S):102487. https://doi.org/10.1016/j.jormas.2025.102487

15. Aoun G., Nasseh I., Sokhn S. Radio-anatomical Study of the Greater Palatine Canal and the Pterygopalatine Fossa in a Lebanese Population: A Consideration for Maxillary Nerve Block. Journal of Clinical Imaging Science. 2016;6(1):35. https://doi.org/10.4103/2156-7514.190862

16. Borodulin V.G., Filimonov S.V. Blokada krylonebnogo gangliya nebnym dostupom v sovremennoy rinologicheskoy praktike. Vestnik otorinolaringologii. 2016;81(4):38‑41. Borodulin V.G., Filimonov S.V. The blockade of sphenopalatineganglionthrough the palatal approachin the present-day rhinological practice. Russian Bulletin of Otorhinolaryngology. 2016;81(4):38‑41. (In Russ.). https://doi.org/10.17116/otorino201681438-41

17. Rapado-González O., Suárez-Quintanilla J.A., Otero-Cepeda X.L., Fernández-Alonso A., Suárez-Cunqueiro M.M. Morphometric study of the greater palatine canal: cone-beam computed tomography. Surgical and Radiologic Anatomy. 2015;37(10):1217-1224. https://doi.org/10.1007/s00276-015-1511-y

18. Rapado-González O., Suárez-Quintanilla J.A., Suárez-Cunqueiro M.M. Anatomical variations of the greater palatine canal in cone-beam computed tomography. Surgical and radiologic anatomy. 2017;39(7):717-723. https://doi.org/10.1007/s00276-016-1791-x

19. Özdede Meliha, Keriş Yıldızer Elifb, Altunkaynak Bülentc, Peker İlkay Morphometric analysis of greater palatine canal via cone-beam computed tomography. Balkan Journal of Dental Medicine. 2018;22(3):150-156. https://doi.org/10.2478/bjdm-2018-0026

20. Bahşi İ., Orhan M., Kervancıoğlu P., Yalçın E.D. Morphometric evaluation and clinical implications of the greater palatine foramen, greater palatine canal and pterygopalatine fossa on CBCT images and review of literature. Surgical and Radiologic Anatomy. 2019;41(5):551-567. https://doi.org/10.1007/s00276-019-02179-x

21. Zheleznyak V.A., Vasil'ev Yu.L., Balin V.V. Mestnaya anesteziya na stomatologicheskom prieme. Sankt-Peterburg: Chelovek; 2025. 52 s. Zheleznyak V.A., Vasiliev Yu.L., Balin V.V. Local anesthesia at a dental appointment. St. Petersburg: Chelovek; 2025. 52 p. (In Russ.).

22. Vaysblat S.N. Provodnikovaya anesteziya v hirurgii zubov i chelyustey. Kiev: Gosmedizdat USSR; 1948. 196 s. Weissblat S.N. Conduction anesthesia in surgery of teeth and jaws. Kyiv: Gosmedizdat USSR; 1948. 196 p. (In Russ.).

23. Bogaevskaya O.Yu. Bezopasnost' i effektivnost' mestnoy anestezii v stomatologii. Moskva: Rossiyskiy universitet druzhby narodov (RUDN); 2021. 69 s. Bogaevskaya O.Yu. Safety and efficacy of local anesthesia in dentistry. Moscow: Peoples' Friendship University of Russia (RUDN); 2021. 69 p. (In Russ.).

24. Ermakov A.V., Dubina E.A., Hramova M.A., Ustinova E.A., Trusov Yu.A. Vybor metoda anestezii: sravnenie metodov anestezii v obschey medicine i klinicheskoy stomatologii. Stomatologiya. 2025;104(1):76‑80. Ermakov A.V., Dubina E.A., Khramova M.A., Ustinova E.A., Trusov Yu.A. On the issue of choosing anesthesia methods: a comparison of general medicine and clinical dentistry. Stomatology. 2025;104(1):76‑80. (In Russ.). https://doi.org/10.17116/stomat202510401176

25. Yunusov D.A. Komp'yuternaya tomografiya v diagnostike retinirovannyh tret'ih molyarov verhney i nizhney chelyustey. Medicinskiy vestnik Nacional'noy akademii nauk Tadzhikistana. 2024;14(2):102-107. Yunusov D.A. Computed tomography in the diagnosis of impacted third molars of the upper and lower jaws. Medical Bulletin of the National Academy of Sciences of Tajikistan. 2024;14(2):102-107. (In Russ.). https://elibrary.ru/item.asp?id=74772195

26. Vázquez R.N., Caballero D.M.P., Pérez C.L.R. Anesthesia: Its advantages and risks for human health Rachel. International Journal of Health Sciences. 2019;3(2):1-10. https://doi.org/10.29332/ijhs.v3n2.284

27. Bogaevskaya O.Yu., Sohov S.T., Evdoshenko O.A. Mestnye i obschie oslozhneniya v stomatologii pri ispol'zovanii mestnoy anestezii. Sovremennaya nauka: aktual'nye problemy teorii i praktiki. Seriya “Estestvennye i tehnicheskie nauki”. 2022;(3-2):68-73. Bogaevskaya O., Sokhov S., Evdoshenko O. Local and general complications of local anesthesia in dentistry. Modern Science: actual problems of theory and practice. Series “Natural & Technical Sciences”. 2022;(3-2):68-73. (In Russ.). http://www.nauteh-journal.ru/index.php/3/2022/%E2%84%9603/2/afc05f20-9f23-4e12-a9c6-e0edf04e07b9

28. Bogaevskaya O.Yu., Sohov S.T. Riski in'ekcionnogo obezbolivaniya pri stomatologicheskom lechenii. Vestnik rossiyskogo universiteta druzhby narodov. Seriya: Medicina. 2020;24(1):61-68. Bogaevskaya O.Y., Sokhov S.T. The risks of injection anesthesia in dentistry. RUDN Journal of Medicine. 2020;24(1):61-68. (In Russ.)]. https://doi.org/10.22363/2313-0245-2020-24-1-61-68

29. Shahbazyan O.V., Oganesyan V.A., Makeeva O.D. Oslozhneniya pri provedenii provodnikovoy anestezii v stomatologicheskoy praktike i mery ee profilaktiki. Colloquium-Journal. 2019;(16-5):51-53. Shakhbazyan O.V., Oganesyan V.A., Makeeva O.D. Complications of regional anesthesia in dental practice. Colloquium-Journal. 2019;(16-5):51-53. (In Russ.). https://www.elibrary.ru/item.asp?id=39242830

30. Chahov A.A., Ushnickiy I.D., D'yachkovskaya T.K., Kalandarov N.S., Sakanov D.N., Sayputdinov S.G. i dr. Klinicheskaya harakteristika faktorov i sredstv, vliyayuschih na effektivnost' i bezopasnost' mestnoy anestezii v stomatologii. Stomatologiya. 2018;97(4):77‑81. Chakhov A.A., Ushnitsky I.D., Dyachkovskaya T.K., Kalandarov N.S., Sakanov D.N., Sayputdinov S.G. et al. Clinical characteristic of factors and tools influencing the effectiveness and safety of local anesthesia in dentistry. Stomatology. 2018;97(4):77‑81. (In Russ.). https://doi.org/10.17116/stomat20189704177

31. Bul'hin S.D., Rybakov A.G. Variantnaya anatomiya vetvey troynichnogo nerva v aspekte obezbolivaniya v stomatologii. Molodezhnyy innovacionnyy vestnik. 2024;13(S1):235-236. Bulkhin S.D., Rybakov A.G. Variant anatomy of trigeminal nerve branches in the aspect of anesthesia in dentistry. Molodežnyj innovacionnyj vestnik. 2024;13(S1):235-236. (In Russ.). https://elibrary.ru/item.asp?id=68633977

32. Gulgeldiev G. Sovremennye metody obezbolivaniya v hirurgicheskoy stomatologii. Matrica nauchnogo poznaniya. 2025;(11-1):236-238. Gulgel'diev G. Modern methods of pain relief in surgical dentistry. Matrica naučnogo poznaniâ. 2025;(11-1):236-238. (In Russ.). https://elibrary.ru/item.asp?id=83219379

33. Kabak S.L., Mel'nichenko Yu.M., Pil'chuk A.V. Klinicheskaya anatomiya verhney chelyusti. Zhurnal anatomii i gistopatologii. 2024;13(4):82-89. Kabak S.L., Mel'nichenko Yu.M., Pil'chuk A.V. Clinical Anatomy of the Maxilla. Journal of Anatomy and Histopathology. 2024;13(4):82-89. (In Russ.). https://doi.org/10.18499/2225-7357-2024-13-4-82-89

34. Hao Y., Zhang Z., Meng Y. Application Effect of Computer-Assisted Local Anesthesia in Patient Operation. Contrast media & molecular imaging. 2021;2021:8643867. https://doi.org/10.1155/2021/8643867

35. Ermakov A.V., Dubina E.A., Hramova M.A., Ustinova E.A., Trusov Yu.A. Vybor metoda anestezii: sravnenie metodov anestezii v obschey medicine i klinicheskoy stomatologii. Stomatologiya. 2025;104(1):76‑80. Ermakov A.V., Dubina E.A., Khramova M.A., Ustinova E.A., Trusov Yu.A. On the issue of choosing anesthesia methods: a comparison of general medicine and clinical dentistry. Stomatology. 2025;104(1):76‑80. (In Russ.). https://doi.org/10.17116/stomat202510401176


Login or Create
* Forgot password?