Vâlcu M, Rusu M C, Sendroiu Vivian Mihaela, Didilescu Andreea Cristiana
Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
Rom J Morphol Embryol. 2011;52(3):947-9.
Except the oral clefts and their associated dental development disturbances, no other discrete morphologies are reported in the literature as related to altered fusions of the fetal maxilla and premaxilla. We report here two cases related by the persistence in adult of an aberrant canal at the fusion site of the fetal premaxilla and maxilla. The first case presents an anastomosis of the superior anterior alveolar and greater palatine nerves, encountered during the dissection of a human adult male cadaver; that anastomosis, bilaterally present, projected on the aforementioned fusion site and traversed the hard palate to continue within the maxillary sinus wall. The second case evidenced on CT the unilateral presence of aberrant lateral incisive canals (LIC) at the level of the fetal premaxilla and maxilla fusion site; those canals, external (1.5 mm diameter) and internal (1.07 mm diameter), were corresponding as location to that one traversed by the aberrant anastomosis in the first case. Both LIC opened inferiorly but not superiorly, rather seeming to communicate with the bony canals within the nasal fossa floor at that level. We consider that such aberrant canals and nerves may represent very rare forms of clefting, previously undescribed; the possible anastomoses of the superior anterior alveolar and greater palatine nerves can be altered during a Le Fort I fracture and may be the morphology that can explain aberrant clinical nervous distributions at the level of the upper dentoalveolar arch and hard palate.
除了腭裂及其相关的牙齿发育障碍外,文献中未报道其他与胎儿上颌骨和前上颌骨融合改变相关的离散形态。我们在此报告两例成年患者,其在胎儿前上颌骨和上颌骨融合部位持续存在异常管道。第一例是在解剖一名成年男性尸体时发现的上前牙槽神经和腭大神经的吻合;该吻合双侧存在,投影于上述融合部位,并穿过硬腭在上颌窦壁内延续。第二例在CT上显示胎儿前上颌骨和上颌骨融合部位单侧存在异常的侧切牙管(LIC);这些管道,外部(直径1.5毫米)和内部(直径1.07毫米),在位置上与第一例中异常吻合所穿过的管道相对应。两个LIC均向下开口但不向上开口,似乎与该水平鼻窝底部的骨管相通。我们认为,这种异常管道和神经可能代表非常罕见的腭裂形式,此前未被描述;上前牙槽神经和腭大神经的可能吻合在Le Fort I骨折期间可能会改变,并且可能是可以解释上牙牙槽弓和硬腭水平异常临床神经分布的形态。