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Greater Palatine Nerve

nervus palatinus major

The greater palatine nerve descends from the pterygopalatine ganglion through the greater palatine canal to emerge at the greater palatine foramen behind the third upper molar. It supplies sensory innervation to the mucosa of the hard palate from the upper incisors to the soft palate junction, and carries parasympathetic fibres to the palatal mucous glands. The lesser palatine nerves emerge through the lesser palatine foramina to supply the soft palate.

Region: Head & Skull

Clinical Relevance

Clinical Notes

The greater palatine nerve is the target for palatal anaesthesia in dental procedures involving the upper posterior teeth and for palatal flap surgery. The greater palatine foramen, located 1 cm medial to the gum margin at the level of the upper third molar, is the landmark for injection. In cleft palate repair, the greater palatine neurovascular bundle is identified and protected during the Veau-Wardill-Kilner pushback repair. The nerve is also the pathway for pain in palatal trauma and infections.

Pathology

Common Injuries & Conditions

Palatal Nerve Injury in Orthognathic Surgery

Le Fort I osteotomy and palatal expansion surgery risks injury to the greater palatine neurovascular bundle at the greater palatine foramen, producing palatal numbness and occasional ischaemic palatal necrosis if the blood supply is compromised bilaterally.