Oral Cavity: Palate

The palate is the structure that forms the roof of the mouth and floor of the nasal cavity. This structure is divided into soft and hard palates. The palate is formed between weeks 7 and 10 of gestation, and deformities of this structure (cleft palate) are usually relevant because of its role in feeding, especially in infants.

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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 fuse and descend.
    • Primary palate moves posteriorly.
    • Palatine shelves fuse with each other and with the nasal septum.
    • 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 extend off the posterior side of the secondary palates.
  • Fusion occurs from anterior to posterior.
Formation of the palate

Formation of the palate

Image by Lecturio.

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 and nerve supply via the palatine and nasopalatine nerves. 

Location and relations between the hard and soft palate

Location and relations between the hard and soft palate

Image: “Line art drawing of palate” by Pearson Scott Foresman. License: Public Domain

Structure

Hard palate (anterior):

  • Formed anteriorly by the 2 palatine processes of the maxilla
  • 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
Inferior view of the hard palate

Inferior view of the hard palate, showcasing the 2 palatine processes of the maxilla and the horizontal plate of the palatine bones

Image by Lecturio.

Soft palate (posterior):

  • Soft and movable
  • Contains the tensor veli palatini muscle posteriorly
Table: Muscles of the soft palate
MuscleOriginInsertionNerve supplyFunction
Musculus uvulaePosterior nasal spineMusculus uvulae of the opposite sidePharyngeal branch of vagus nervePulls uvula forward
Tensor veli palatiniCartilaginous part of the auditory tubePalatine aponeurosisMuscular branch of the mandibular nerveTenses the soft palate
Levator veli palatiniCartilaginous portion of the eustachian tubePalatine aponeurosisPharyngeal branch of vagus nerveElevates soft palate
PalatopharyngeusPalatine aponeurosis and hard palateUpper border of the thyroid cartilageElevates larynx and the pharynx
PalatoglossusPalatine aponeurosisLateral aspect of the tongueElevates posterior part of the tongue
Muscles that comprise the soft palate

Muscles that comprise the soft palate:
This image is of the coronal plane viewed in an anteroposterior orientation.

Image by Lecturio.

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
Blood supply and innervation of the palate

Blood supply and innervation of the palate

Image by Lecturio.

Related videos

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

Clinical Relevance

  • Cleft palate: results from lack of fusion of the palatal shelves. 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 can result in feeding problems that may be severe. The treatment is usually surgical.
  • Streptococcal infection: Streptococcal pharyngitis often presents with palatal petechiae, where pinpoint red areas can be seen on the soft palate. Patients with streptococcal pharyngitis will also likely have fever, sore throat, and cervical lymphadenopathy. Treatment is with antibiotics.

References

  1. Tolarová, M.M., Cervenka, J. (1998). Classification and birth prevalence of orofacial clefts. Am J Med Genet 75:126–137. https://pubmed.ncbi.nlm.nih.gov/9450872/ 
  2. Mai, C.T., Cassell, C.H., Meyer, R.E., et al. (2014). Birth defects data from population-based birth defects surveillance programs in the United States, 2007 to 2011: highlighting orofacial clefts. Birth Defects Res A Clin Mol Teratol 100:895–904. https://pubmed.ncbi.nlm.nih.gov/25399767/ 
  3. Shkoukani, M.A., Chen, M., Vong, A. (2013). Cleft lip—a comprehensive review. Front Pediatr 1:53. https://pubmed.ncbi.nlm.nih.gov/24400297/ 

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