Ascending palatine artery’s contribution to soft palate blood supply

You can find this paper here¹

Summary of the paper:

1. Problem Addressed:

The paper addresses a gap in understanding the detailed vascular anatomy of the
soft palate, which is particularly important for surgeries related to snoring and
obstructive sleep apnea (OSA). While the soft palate is known to be well
vascularized, detailed knowledge of its blood supply is crucial to minimize
inadvertent injury during surgical procedures. Previous studies were limited as
they mainly focused on vascular anatomy from a cleft palate surgery perspective.

2. Proposed Solution:

The researchers used a novel technique to better visualize and study the fine vascular anatomy of the soft palate:

• They injected red liquid silicone through the common carotid artery
• The specimens were then decolorized using potassium hydroxide solution
• This made the soft palate semi-transparent while keeping the vascular structures visible
• This technique allowed for better visualization of fine blood vessels while maintaining the visible background of the intact soft palate

3. Experiments Conducted:
   The study was performed on:

• 22 Korean cadaveric heads (12 men, 10 women, mean age 80.9 years)
• Preparation process:
  • Blood drained within 3 hours after death
  • Fixation with formalin, ethanol, glycerine, and water
  • Red liquid silicone injection through common carotid arteries
  • Soft palate resection and decolorization in 3% potassium hydroxide for 3 weeks
• Measurements taken:
  • Diameters of anterior and posterior branches of ascending palatine artery
  • Vertical distances from palatal arch to posterior branch termination
  • Statistical comparison of vessel diameters

4. Main Content Summary:
   Key findings:

• The soft palate is primarily supplied by anterior and posterior branches of the ascending palatine artery
• These branches aren’t always present simultaneously:
  • Both branches present: 40% of cases
  • Only anterior branch: 25% of cases
  • Only posterior branch: 35% of cases
• The anterior branch (0.73 ± 0.09 mm) was significantly larger than the posterior branch (0.48 ± 0.08 mm)
• Mean vertical distance from palatal arch to posterior branch termination was about 9.3 ± 2.4 mm

Clinical implications:

• Surgeons need to be aware of these anatomical variations
• Risk of vascular injury may be higher in cases where only one branch type is present
• The findings are particularly relevant for procedures like uvulopalatopharyngoplasty
• Understanding this anatomy could help minimize surgical complications

Limitations noted include the older age of specimens, potential racial differences in anatomy, and the need for further research on clinical implications of vascular damage during surgery.

Descending palatine artery is not included in this paper

While this paper focuses primarily on the ascending palatine artery’s contribution to soft palate blood supply, it does appear to be an oversight that they don’t discuss the descending palatine artery’s role.

1. Indeed, the literature generally describes that the soft palate receives blood supply from both:

   • Ascending palatine artery (from facial artery)
   • Descending palatine artery (from maxillary artery)

2. Potential reasons why this paper might have focused only on the ascending palatine artery:

   • Their dissection/injection technique might have been better at visualizing the ascending vessels
   • The study’s resection margins might have limited their ability to trace the descending palatine contribution (they actually mention this as a limitation: "the resection margin of the specimens was limited")
   • Their primary focus might have been on the posterior aspect of the soft palate where the ascending palatine artery is more dominant

3. This does represent a limitation in their study that should have been addressed:

   • The conclusion would be more complete if it acknowledged the descending palatine artery’s contribution
   • Understanding the complete vascular supply, including both ascending and descending contributions, would be important for surgical planning
   • The interactions or potential compensatory relationships between these two arterial systems would be valuable to understand

1. Cho JH, Kim JW, Park HW, Suh JD, Kim JK, Yoon JH. Arterial supply of the human soft palate. Surg Radiol Anat. 2017 Jul;39(7):731-734. doi: 10.1007/s00276-016-1798-3. Epub 2017 Jan 30. PMID: 28138793. ↩