Radiological Classification of Palatal Vascular Anatomy for Periodontal Surgery: Insights from 3D-RA

Objective: This study aimed to comprehensively evaluate the anatomical variations and detailed vascular anatomy of the palatal mucosa, emphasizing the greater palatine artery (GPA) and lesser palatine artery (LPA), through the use of three-dimensional rotational angiography (3D-RA). This detailed vascular analysis aims to inform clinical decisions and reduce the risk of vascular injury during palatal graft harvesting procedures. Methods: A retrospective analysis of radiological data was conducted on 80 consecutive patients who underwent cerebral or carotid digital subtraction angiography (DSA) incorporating 3D-RA imaging. Detailed measurements were obtained for the GPA, descending palatine artery (DPA), and LPA, including arterial diameters, branching patterns, and their spatial relationships with palatal mucosal thickness and vault morphology. Based on GPA and LPA branching patterns, the vascular supply to the hard palate was classified. Results: The GPA was classified into three branching patterns, with Type I (absence of medial branch) being most prevalent (65%), typically accompanied by the presence of LPA contributions to the medial hard palate. The mean diameter of the GPA was 0.99 ± 0.16 mm, while DPA was significantly larger in males (p = 0.036). The GPA’s lateral branch narrowed anteriorly, with the smallest mucosal-to-vessel distance measured at the first premolar region (2.55 ± 1.11 mm), indicating a heightened risk for surgical injury. No significant relationship was found between palatal vault morphology and mucosal thickness. Conclusion: Significant anatomical variability exists within the palatal vasculature. The understanding of the branching patterns of GPA and LPA can greatly assist in planning for surgeries and make mucogingival graft procedures safer by reducing the risk of vascular complications.