Anatomy of the greater palatine foramen and canal and their clinical significance in relation to the greater palatine artery : a systematic review and meta-analysis

Purpose: Accurate knowledge of greater palatine foramen (GPF) and greater palatine canal (GPC) anatomy is necessary to avoid injury to the greater palatine artery (GPA) when performing a variety of anesthesiologic, dental or surgical procedures. The aim of this paper was to perform a systematic review and meta-analysis of literature on the anatomy and localization of bony structures associated with the GPA, namely the GPF and GPC. Methods: A systematic literature search was performed using PubMed, Embase, ScienceDirect, and Web of Science databases. Seventy-five studies were included in the meta-analysis (n = 22,202 subjects). Results: The meta-analysis showed that the GPF is positioned 17.21 mm (95% CI = 16.34–18.09 mm) from the posterior nasal spine, 2.56 mm (95% CI = 1.90–3.22 mm) from the posterior border of the hard palate, 46.24 mm (95% CI = 44.30–48.18 mm) from the anterior nasal spine, 15.22 mm (95% CI = 15.00–15.43 mm) from the midline maxillary suture, 37.32 mm (95% CI = 36.19–38.45 mm) from the incisive foramen, and opposite the third maxillary molar (M3) in 64.9% (58.7–70.7%) of the total population.Conclusion: An up-to-date, comprehensive analysis of GPF and GPC clinical anatomy is presented. The results from this evidence-based anatomical study provides a unified set of data to aid clinicians in their practice.