Palate: Anatomy

Embryology

The embryology of the palate is complex, with a critical stepwise process to midline fusion. Interruption of this process can result in cleft disorders. 

• Process:
  • Medial nasal prominences Medial nasal prominences Development of the Nervous System and Face fuse and descend.
  • Primary palate moves posteriorly.
  • Palatine shelves fuse with each other and with the nasal septum Nasal septum The partition separating the two nasal cavities in the midplane. It is formed by the septal nasal cartilage, parts of skull bones, and membranous parts. Nose Anatomy (External & Internal).
  • Secondary palate is formed.
  • Primary palate fuses with the secondary palate.
  • Point of fusion is marked by the incisive foramen.
  • Hard palate is formed.
  • Soft palate and uvula Uvula A fleshy extension at the back of the soft palate that hangs above the opening of the throat. Peritonsillar Abscess extend off the posterior side of the secondary palates.
• Fusion occurs from anterior to posterior.

Gross Anatomy

The palate is divided into the hard palate and soft palate. The hard palate is located anterior to the soft palate, and each receives blood supply from branches of the external carotid artery External carotid artery Branch of the common carotid artery which supplies the exterior of the head, the face, and the greater part of the neck. Carotid Arterial System: Anatomy and nerve supply via the palatine and nasopalatine nerves. 

Structure

Hard palate (anterior):

• Formed anteriorly by the 2 palatine processes of the maxilla Maxilla One of a pair of irregularly shaped bones that form the upper jaw. A maxillary bone provides tooth sockets for the superior teeth, forms part of the orbit, and contains the maxillary sinus. Skull: Anatomy
• Formed posteriorly by the horizontal plates of the palatine bones
• Foramina:
  • Incisive fossa
  • A pair of greater palatine foramina
  • A pair of lesser palatine foramina

Soft palate (posterior):

• Soft and movable
• Contains the tensor veli palatini muscle posteriorly

Neurovasculature

Blood supply:

• Greater palatine artery: supplies the area anterior to the greater palatine fossa
• Lesser palatine artery: supplies the area posterior to the greater palatine fossa
• Ascending palatine artery
• Palatine branches of the ascending pharyngeal artery.

Innervation:

• Hard palate: greater palatine and nasopalatine nerves
• Soft palate: lesser palatine nerve

Microscopic Anatomy

The microscopic anatomy of the palate consists primarily of squamous epithelial tissue, although the hard palate also contains osseous components. 

The palate contains:

• Mucus-secreting glands: moisten the oral cavity
• Masticatory mucosa: stratified squamous epithelium Stratified squamous epithelium Surface Epithelium: Histology

Clinical Relevance

• Cleft palate Cleft palate Congenital fissure of the soft and/or hard palate, due to faulty fusion. Cleft Lip and Cleft Palate: results from lack of fusion of the palatal shelves. Cleft palate Cleft palate Congenital fissure of the soft and/or hard palate, due to faulty fusion. Cleft Lip and Cleft Palate can be isolated to either the soft or the hard palate, or it can affect both palates at the same time. Cleft palate Cleft palate Congenital fissure of the soft and/or hard palate, due to faulty fusion. Cleft Lip and Cleft Palate can result in feeding problems that may be severe. The treatment is usually surgical.
• Streptococcal infection: Streptococcal pharyngitis Streptococcal Pharyngitis Rheumatic Fever often presents with palatal petechiae Petechiae Primary Skin Lesions, where pinpoint red areas can be seen on the soft palate. Patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship with streptococcal pharyngitis Streptococcal Pharyngitis Rheumatic Fever will also likely have fever Fever Fever is defined as a measured body temperature of at least 38°C (100.4°F). Fever is caused by circulating endogenous and/or exogenous pyrogens that increase levels of prostaglandin E2 in the hypothalamus. Fever is commonly associated with chills, rigors, sweating, and flushing of the skin. Fever, sore throat Sore throat Pharyngitis is an inflammation of the back of the throat (pharynx). Pharyngitis is usually caused by an upper respiratory tract infection, which is viral in most cases. It typically results in a sore throat and fever. Other symptoms may include a runny nose, cough, headache, and hoarseness. Pharyngitis, and cervical lymphadenopathy Lymphadenopathy Lymphadenopathy is lymph node enlargement (> 1 cm) and is benign and self-limited in most patients. Etiologies include malignancy, infection, and autoimmune disorders, as well as iatrogenic causes such as the use of certain medications. Generalized lymphadenopathy often indicates underlying systemic disease. Lymphadenopathy. Treatment is with antibiotics.