Surgical Anatomy of Palate

Dr. Amit T. SuryawanshiOral and Maxillofacial Surgeon

Pune, India

Contact details :Email ID - amitsuryawanshi999@gmail.com

Mobile No - 9405622455

Contents - • Introduction- • Development of palate.• Hard Palate• Soft Palate

Hard Palate - - Boundaries - Anatomical structures

Soft palate - - Borders and Surfaces

- Contents - Movements and Functions

• Studying surgical anatomy of palate helps Oral surgeons to have complete knowledge while performing surgeries of the palate.

Which include , 1. Cleft palate surgery 2. Squamous cell carcinoma of palate3. Adenoid cystic carcinoma of palate.4. Surgical removal of Torus palatinus

Introduction -

• Palate forms the roof of the Oral cavity.

• It is the partition between nasal and oral cavities.

• The palate is divided into two parts,

• 1. Hard palate, • 2.Soft palate or velum.

Introduction -

Development of Face

• Palate develops from 3 parts.A. Two Palatal processesB. Frontonasal process.

• From each maxillary process, a plate like shelf grows medially . This is called as a Palatal Process.

Development of palate

• Palate is formed by the fusion of these 3 parts-

1.Each palatal process fuses with posterior margin of primitive palate(premaxilla).

2. Two palatal processes fuse with each other in the midline .Their fusion begins anteriorly and proceeds posteriorly.

Development of palate

3. The medial edges of the palatal processes fuse with the free lower edge of the nasal septum, thus separating two nasal cavities, from each other and from the mouth.

4. At later stage mesoderm in the palate undergoes intramembranous ossification to form hard palate.

Development of palate

5. However, ossification does not extend to the most posterior portion hence it remains as the Soft palate.

6. Part of the palate developed from frontonasal process is Primary palate.

7. Part of palate developed from Palatal processes is Secondary palate.

Development of palate

• Elevation of the palatine shelves occurs when tongue descends , which allows their meeting in the midline and fusion.

•Its anterior 2/3rd is formed by Palatine processes of Maxilla .

•Posterior 1/3rd is formed by Horizontal plates of Palatine bone.

HARD PALATE-

• The hard palate is covered by a mucous membrane which is attached to the periosteum.

• Deep to the membrane, there are mucus-secreting palatine glands.

• The anterior mucous membrane has 3-4 transverse palatine folds called as Rugae.

Rugae

Boundaries of Hard palate

Antero-lateral margins – Continuous with alveolar arches and gingiva .Posterior margins - Gives attachment to Soft Palate.Superior Surface - Forms the floor of nasal cavity.Inferior Surface – Forms the roof of the oral cavity.

Anatomical structures of Hard palate

Median palatine suture

• The incisive foramen - The opening of the incisive canal.

Neurovasculature - -The Nasopalatine nerve -The terminal branch of the Sphenopalatine artery

• Greater palatine foramen -One opening of the palatine canal.

Neurovasculature - -The Greater palatine nerve and vessels.

Anatomical structures of Hard palate

• Lesser palatine foramen -Another opening of the palatine canal.

Neurovasculature - -The Lesser palatine nerve and vessels.

Anatomical structures of Hard palate

Lymphatics – They drain mostly to Upper deep cervical lymph

nodes and partly to Retropharyngeal lymph nodes .

Anatomical structures of Hard palate

Soft Palate

• It is a movable, muscular fold suspended from the posterior border of hard Palate.

• It separates the Nasopharynx from the Oropharynx.

• It is covered with a mucous membrane.• Its free posterior border has a conical

projection in the midline called Uvula.• It has no bony framework.

Soft Palate

• Soft Palate has 2 surfaces-

1. Anterior Surface. 2. Posterior Surface.

• It has 2 borders – 1. Superior Border. 2. Inferior Border.

Contents of Soft Palate

• Palatine aponeurosis • Muscles• Lymphoid tissues• Glands.

Palatine aponeurosis

• It is a fibrous sheet attached to the posterior border of the hard palate.

• It is a extended tendon of Tensor veli palatini and forms the fibrous basis of the palate.

Spine of Sphenoid bone

Soft palate

Uvula

Musculus Uvulae

Palatine aponeurosis Pterygoid

hamulus

Tensor veli palatini

• Near median plane, the aponeurosis splits to enclose the musculus uvulae.

Palatine aponeurosis

Muscles of Soft Palate

1. Tensor veli palatini.2. Levator veli palatini.3. Musculus uvulae.4. Palatoglossus.5. Palatopharyngeus.

Tensor veli palatini

Origin – 1. Spine of the

sphenoid,2. Lateral side of

auditory tube.3. Scaphoid fossa.

Spine of Sphenoid bone

Soft palate

Uvula

Musculus Uvulae

Palatine aponeurosis Pterygoid

hamulus

Tensor veli palatini

Palatopharyngeus

Tensor veli palatini

Levator veli palatini

Musculus Uvulae

Posterior wall of pharynx

Auditory tube

Scaphoid fossa

Insertion- 1. Palatine

aponeurosis 2. Horizontal

part of palatine bone.

Tensor veli palatini

Spine of Sphenoid bone

Soft palate

Uvula

Musculus Uvulae

Palatine aponeurosis Pterygoid

hamulus

Tensor veli palatini

• Nerve supply – Nerve to medial pterygoid.

Tensor veli palatini.

Action –1. It tenses the soft palate

and assists the levator veli palatini in elevating the palate to prevent entry of food into the nasopharynx during swallowing.

Action –

2. It equalises air pressure between the tympanic cavity and the outside air during swallowing or yawning.

Levator Veli Palatini

• Origin- 1. Undersurface

of petrous part of temporal bone

2. Medial surface of cartilage of auditory tube.

Spine of Sphenoid bone

Soft palate

Uvula

Musculus Uvulae

Palatine aponeurosis Pterygoid

hamulus

Levator veli palatini

Palatopharyngeus

Tensor veli palatini

Levator veli palatini

Musculus Uvulae

Posterior wall of pharynx

Auditory tube

• Insertion- Upper

surface of the palatine aponeurosis.

Levator Veli Palatini

Spine of Sphenoid bone

Soft palate

Uvula

Musculus Uvulae

Palatine aponeurosis Pterygoid

hamulus

Levator veli palatini

• Nerve supply- -Pharyngeal plexus

• Action- -Assists the Tensor veli palatini in

elevating the palate to occlude and prevent entry of food into the nasopharynx during swallowing.

Levator Veli Palatini

Palatoglossus

• Origin- From the undersurface of

palatine aponeursis, where it is continuous with the muscle of opposite side.

• Insertion- It passes in front of tonsil

and it is inserted into the side of the tongue.

• Nerve supply- -Cranial part of accessory nerve via

pharyngeal plexus.

• Action- -Pulls the root of the tongue upward &

backward. Both muscles contracting together cause the palatoglossal arches to approach the midline, thus opening between the oropharynx & oral cavity is narrowed.

Palatoglossus

Palatopharyngeus• Origin –1. Posterior

border of hard palate

2. Palatine

aponeurosis

Palatopharyngeus

Palatine aponeurosis

Posterior border of hard palate

Palatopharyngeus

Palatopharyngeus

• Insertion – It is inserted to the posterior border of

lamina of thyroid cartilage .

Palatopharyngeus

• Nerve supply- - Cranial part of accessory nerve via

pharyngeal plexus.

• Action – Pulls the wall of pharynx upwards.

Palatopharyngeus

Musculus Uvulae

• Origin – 1. Posterior border

of hard palate 2. Palatine

aponeurosis

• Insertion – Mucous

membrane of the Uvula.

Palatine aponeurosis

Posterior border of hard palate

• Nerve supply- -Pharyngeal plexus

• Action – Pulls up the Uvula.

Musculus Uvulae

Muscles of soft palate

• Blood supply – All the muscles of soft palate are supplied by

lesser palatine artery.

Faucial pillars of mouth

Passavant’s Ridge

• Some of the upper fibers of the palatopharyngeus pass circularly deep to the mucous membrane of the pharynx, and constitute Passavant’s muscle internal to the superior constrictor.

• which on contraction raises a ridge (Passavant’s ridge) on the posterior wall of the nasopharynx .

• When the soft palate is elevated, it comes in contact with the ridge and two of them together close the pharyngeal isthmus (between the nasopharynx and oropharynx).

Movements & Functions of Soft palate-

• Palate control two gates – 1. Pharyngeal isthmus 2. Oropharyngeal isthmus

• It closes gates or regulate their size according to requirements. Through these movements ,the soft palate plays an important role in chewing, swallowing, speech, coughing, sneezing, etc.

• It isolates mouth from oropharynx during chewing so that breathing is unaffected.

• In second stage of swallowing, it separates oropharynx from nasopharynx.

• It modifies quality of voice.• During sneezing, it divides blast of air and

directs through nasal & oral cavities.• During coughing, it directs air & sputum into

mouth & not into the nose.

Movements & Functions of Soft palate-

References -

• Grey's anatomy• Atlas of anatomy • Snell –Textbook of Anatomy• Sicher • Internet

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