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Concept: Nasopalatine nerve


This report describes a case of gossypiboma in the septum. A 31-year-old woman presented with nasal obstruction and crusting that started 2 years previously after she underwent rhinoseptoplasty in another private clinic. Physical examination disclosed remaining posterior septal deviation to the left side with septal mucosal erosion on the left side. Under general anesthesia, the septal flap was elevated on the left side of the nasal cavity. A gossypiboma was found around the perpendicular ethmoid plate and between the septal flaps. The perpendicular ethmoid plate was resected and the gossypiboma was removed under endoscopy. Because of severe adhesion between the gossypiboma and the septal mucosa, removal of the gossypiboma resulted in a defect on the left mucoperichondrial flap. Right inferior turbinate mucosa was harvested and grafted on the mucosal defect of the left side. Five months after the operation, the nasal cavity showed a straight septum with a well-healed mucosa without any nasal symptoms. This case is a reminder of the fundamental importance of absolute care at every step of rhinologic surgery.

Concepts: Anesthesia, Nasopalatine nerve, Nose, Mucus


Facial prognathism and projection are important characteristics in human evolution but their three-dimensional (3D) architectonic relationships to basicranial morphology are not clear. We used geometric morphometrics and measured 51 3D-landmarks in a comparative sample of modern humans (N = 78) and fossil Pleistocene hominins (N = 10) to investigate the spatial features of covariation between basicranial and facial elements. The study reveals complex morphological integration patterns in craniofacial evolution of Middle and Late Pleistocene hominins. A downwards-orientated cranial base correlates with alveolar maxillary prognathism, relatively larger faces, and relatively larger distances between the anterior cranial base and the frontal bone (projection). This upper facial projection correlates with increased overall relative size of the maxillary alveolar process. Vertical facial height is associated with tall nasal cavities and is accommodated by an elevated anterior cranial base, possibly because of relations between the cribriform and the nasal cavity in relation to body size and energetics. Variation in upper- and mid-facial projection can further be produced by basicranial topology in which the midline base and nasal cavity are shifted anteriorly relative to retracted lateral parts of the base and the face. The zygomatics and the middle cranial fossae act together as bilateral vertical systems that are either projected or retracted relative to the midline facial elements, causing either midfacial flatness or midfacial projection correspondingly. We propose that facial flatness and facial projection reflect classical principles of craniofacial growth counterparts, while facial orientation relative to the basicranium as well as facial proportions reflect the complex interplay of head-body integration in the light of encephalization and body size decrease in Middle to Late Pleistocene hominin evolution. Developmental and evolutionary patterns of integration may only partially overlap morphologically, and traditional concepts taken from research on two-dimensional (2D) lateral X-rays and sections have led to oversimplified and overly mechanistic models of basicranial evolution.

Concepts: Nasopalatine nerve, Evolution, Hominini, Maxillary nerve, Bones of the head and neck, Nasal cavity, Human evolution, Human


The trigeminal, the fifth cranial nerve of vertebrates, represents the rostralmost component of the nerves assigned to pharyngeal arches. It consists of the ophthalmic and maxillomandibular nerves, and in jawed vertebrates, the latter is further divided into two major branches dorsoventrally. Of these, the dorsal one is called the maxillary nerve because it predominantly innervates the upper jaw, as seen in the human anatomy. However, developmentally, the upper jaw is derived not only from the dorsal part of the mandibular arch, but also from the premandibular primordium: the medial nasal prominence rostral to the mandibular arch domain. The latter component forms the premaxillary region of the upper jaw in mammals. Thus, there is an apparent discrepancy between the morphological trigeminal innervation pattern and the developmental derivation of the gnathostome upper jaw. To reconcile this, we compared the embryonic developmental patterns of the trigeminal nerve in a variety of gnathostome species. With the exception of the diapsid species studied, we found that the maxillary nerve issues a branch (nasopalatine nerve in human) that innervates the medial nasal prominence derivatives. Because the trigeminal nerve in cyclostomes also possesses a similar branch, we conclude that the vertebrate maxillomandibular nerve primarily has had a premandibular branch as its dorsal element. The presence of this branch would thus represent the plesiomorphic condition for the gnathostomes, implying its secondary loss within some lineages. The branch for the maxillary process, more appropriately called the palatoquadrate component of the maxillary nerve (V2 ), represents the apomorphic gnathostome trait that has evolved in association with the acquisition of an upper jaw. J. Morphol. 2013. © 2013 Wiley Periodicals, Inc.

Concepts: Nasopalatine nerve, Neuroanatomy, Vertebrate, Gnathostomata, Mandibular nerve, Trigeminal nerve, Maxillary nerve, Cranial nerves


Sinonasal schwannomas constitute 4% of head and neck nerve sheath tumours; however, schwannomas involving the nasal septum are quite rare. We present a 57-year-old male patient with nasal septal schwannoma who was managed successfully by endoscopic excision. 32 cases of septal schwannoma have been reported so far in the literature. This report discusses certain peculiar features exhibited by schwannomas of the nasal septum. Septal schwannoma does not show any age, sex or side predilection. However, they tend to involve posterior part of the septum and presumed to arise from the nasopalatine branch of the trigeminal nerve. Imaging findings of the sinonasal schwannoma are non-specific, but the histopathological characteristics are diagnostic, with seldom need for immunohistochemistry. Endoscopic excision is the safe and effective treatment option for the septal schwannoma of any size and location. Recurrence has not been reported in the literature following endoscopic excision.

Concepts: Head and neck anatomy, Nasal septum, Cranial nerves, Cerebellum, Nasopalatine nerve, Maxillary nerve, Anatomical pathology, Nerve sheath tumor


This article describes a computer-aided design and computer-aided manufacturing (CAD-CAM) technique to perform a precise nerve block of the nasopalatine and greater palatine nerves by using an implant surgical guide. The technique uses additional guide anchor pins planned and positioned for specific anatomic landmarks during guided implant surgical guide planning. A relief modification virtually designed on the intaglio surface of the surgical guide allows for palatal soft tissue distension following administration of local anesthetic. This information is then transferred to the guide manufacturer to order the modified guided implant surgical guide. The purpose of this procedure is to provide precise delivery of local anesthetic and to prevent any discrepancy in surgical guide seating following injection.

Concepts: Cranial nerves, Nervous system, Nasopalatine nerve, Greater palatine nerve, Computer-aided design, Pterygopalatine ganglion, Anesthesia, Local anesthetic


Nasal septum perforation (NSP) is a communication between the two nasal cavities. This review contributes to the better knowledge of NSP causes, diagnosis, and treatment.

Concepts: Nasal septum deviation, Nasal septum, Nasal cavity, Philosophy of science, Nasopalatine nerve, Nose


Historical reports describe the sphenopalatine ganglion (SPG) as positioned directly under the nasal mucosa. This is the basis for the topical intranasal administration of local anaesthetic (LA) towards the sphenopalatine foramen (SPF) which is hypothesized to diffuse a distance as short as 1 mm. Nonetheless, the SPG is located in the sphenopalatine fossa, encapsulated in connective tissue, surrounded by fat tissue and separated from the nasal cavity by a bony wall. The sphenopalatine fossa communicates with the nasal cavity through the SPF, which contains neurovascular structures packed with connective tissue and is covered by mucosa in the nasal cavity. Endoscopically the SPF does not appear open. It has hitherto not been demonstrated that LA reaches the SPG using this approach.

Concepts: Foramina of the skull, Maxillary nerve, Tissues, Blood, Muscle, Pterygopalatine fossa, Mucus, Nasopalatine nerve


To evaluate the effects of rapid maxillary expansion (RME) on the vocal quality, maxillary central incisors, midpalatal suture, and nasal cavity in patients with maxillary crossbite.

Concepts: Cavity wall insulation, Human voice, Nasopalatine nerve, Maxillary nerve, Nasal cavity, Maxillary central incisor


Orthognathic surgery including Le Fort I osteotomy involves changes in the nasal septum and maxillary sinus. This study assesses nasal septum changes after Le Fort I osteotomy using cone beam computed tomography images and evaluates mucosal changes in the maxillary sinus after the surgery.This was a retrospective study of 33 patients who underwent orthognathic surgery including Le Fort I osteotomy. To assess the maxillary sinus, changes in the mucosa of the maxillary sinus were analyzed by volume and geometry. We measured the air cavity per se and mucosal thickening of the maxillary sinus using SIMPLANT (Materialise, Belgium) software. And the geometry of the distribution of the mucosa was analyzed using cone beam computed tomography images.The septal angle was decreased after surgery, but not significantly (P > 0.05). The volume reduction of the air cavity per se and the volume increase associated with mucosal thickening were statistically significant (P < 0.05). Mucosal thickening was observed in the posterior-inferior direction.In this study, nasal septum deviation was not statistically significant after Le Fort I osteotomy. Decrease of the air cavity per se, decrease of the total volume of the maxillary sinus, and increase of mucosal thickening were prominent. Furthermore, the mucosal thickening that occurs after surgery appears to be mainly in the posterior lower part of the maxillary sinus.

Concepts: Mucous membrane, Pyramid, Nasopalatine nerve, Oral and maxillofacial surgery, Mucus, Medical imaging, Sinusitis, Maxillary sinus


Maxillary hypoplasia (MH) is a rare cause of respiratory dysfunction in infants and may occur in association with genetic abnormalities or as an isolated condition. It is included in the differential diagnosis of congenital nasal obstruction. This paper seeks to report a case series of infants with MH, discuss methods for its diagnosis, and compare computed tomography (CT) measurements of nasal cavities of infants with MH and without craniomaxillofacial abnormalities. The therapeutic approach in each patient is also described. All infants with MH admitted to a tertiary hospital between 2012 and 2015 were included. Baseline nasal endoscopy was performed at bedside. The width of the infants' nasal cavities was measured by a radiologist with experience in CT scanning of facial bones. Control patients were infants of matched sex and similar age who underwent head CT scanning for various reasons. Overall, 8 infants with MH and 8 controls were assessed. All nasal cavity dimensions of infants with MH were significantly smaller than those of control subjects. The authors conclude that the diagnosis of MH should be considered in infants with nasal obstruction and nasal cavity narrowing at nasal endoscopy.

Concepts: Nasopalatine nerve, Mucus, Medical terms, Maxillary nerve, Respiratory system, Nose, Medical imaging, Nasal cavity