Patent nasopalatine duct: a diagnostic pitfall

Unique air inclusions within the nasopalatine duct indicating its presence radiographically: a case presentation

The anterior maxilla is characterized by the nasopalatine canal that originates bilaterally from the anterior nasal floor, subsequently fuses, and terminates at the incisive foramen in the anterior palate. Embryologically, this structure forms within the primary palate, and contains the neurovascular bundle, but also continuous epithelialized bands. The latter, termed nasopalatine ducts, usually degenerate and/or obliterate before birth. However, in some individuals, the ducts may remain partially or completely patent. The present case report describes for the first time in the literature a rare finding of air inclusions within the anatomical area of the nasopalatine canal indicating the presence of a nasopalatine duct as visualized with cone beam computed tomography. The patient was asymptomatic and the radiographic findings were seen incidentally. An endoscopic inspection of the anterior nasal cavities confirmed the presence of the nasal openings of the partially patent nasopalatine ducts.

Patent nasopalatine ducts: an update of the literature and a series of new cases

PURPOSE

The objective of this review is to present an update and summary of clinical findings of cases with a patent nasopalatine duct (NPD) reported in the literature from 1881 to 2016.

METHODS

Previous articles and reviews about patent NPDs were studied and copies of all original publications were obtained for data verification. Furthermore, a literature search was conducted. In addition, the study sample was complemented with four cases recently seen in our institution.

RESULTS

Ten out of 67 published cases were to be excluded for this analysis due to misinterpretation or misreporting in previous articles. Overall, 57 cases with NPD patency could be analyzed. Males outnumbered females in a ratio of 2:1. The mean age (when this information was available) was 34.1 ± 17.6 years (range 6-69 years). NPDs were located bilaterally (60%), unilaterally (20%) or centrally (20%). Complete or partial patency was reported in 73.9 and 26.1%, respectively. 74.1% of patients presented a variety of clinical signs and symptoms. The ability of the patient to produce a squeaky or whistling sound was the most frequent clinical finding (23.8%).

CONCLUSIONS

Caution must be exercised when reading review articles about NPD patency since wrong data have been copied in several subsequent publications. Since epidemiological data are missing with regard to patent NPDs, age and gender predilections are not warranted. Bilateral occurrence and full patency were prevailing features in the evaluated case reports of patent NPDs.

Surgical treatment option of the patent nasopalatine duct: a case report

The nasopalatine duct (NPD) is a bilateral, epithelium-lined oronasal communication formed in the early fetal period. It connects the oral cavity with the nasal cavity within the primary palatal process. Mostly, the NPD obliterates during prenatal development and only epithelial remnants can be found after birth. A persistent NPD is therefore considered a developmental abnormality that often exists undetected without any clinical signs of discomfort. The presence of a persisting NPD, however, can be associated with pain sensation in the anterior maxilla. Differential diagnosis of the patent NPD is of importance, in order to prevent unnecessary therapy, such as endodontic treatment or tooth extractions. The present case report describes the diagnostic procedures, surgical treatment and follow-up of the patent NPD in a 53-year-old female patient suffering from maxillary pain caused by a patent NPD.

Morphological characterization of the nasopalatine region in human fetuses and its association to pathologies

The nasopalatine region is composed of structures such as the vomeronasal organ and nasopalatine duct. The nasopalatine duct may provide the communication of the mouth to the nasal cavity in human fetuses and can be obliterated in an adult human. Knowledge on the development of the nasopalatine region and nasopalatine duct in humans is necessary for understanding the morphology and etiopathogenesis of lesions that occur in this region.

Microanatomy of the incisive canal using three-dimensional reconstruction of microCT images: an ex vivo study

OBJECTIVES

The purpose of this study was to investigate the general structure of the incisive canal (IC) using 3-dimensional reconstruction and to classify into various types according to several criteria.

STUDY DESIGN

The materials used in the study were 56 anterior maxillae harvested from human cadavers. The specimens were scanned with microscopic computerized tomography (microCT), and the resulting microCT images were reconstructed in 3 dimensions.

RESULTS

Many ICs had 1 foramen inferiorly and 2 foramina superiorly, and the separating level was just beneath the nasal floor. The middle part of the IC was not always a single hollow canal. Single-channel, 2-channel, 3-channel, and even 4-channel ICs were observed. The ICs were classified into 4 types according to the lateral shape of the canal: vertical-straight, vertical-curved, slanted-straight, and slanted-curved.

CONCLUSIONS

This study disclosed the detailed morphologic features of the IC, which will be helpful in the placement of local anesthesia or implants.