Anatomical evaluation of the medial lingual foramen using cone-beam computed tomography: a retrospective study / Avaliação anatômica do forame lingual medial usando tomografia computadorizada de feixe cônico: um estudo retrospectivo

ABSTRACT Objective: To evaluate the frequency of medial lingual foramina present in the cortex of the mandible using cone beam computed tomography (CBCT). Methods: A total of 953 CBTC exams of the mandible were evaluated to determine the presence of canals in the mandibular midline, canal location in relation to the mental spine, canal diameter, distance to the base and alveolar crest of the mandible, trajectory of the canal, and coincidence measurements of the panoramic image containing the location of the canal in relation to the mental spine. Results: Foramina were located in three positions: above the mental spine (FSS) 89.2%, below the mental spine (FIS) 67.9%, and other positions (FOP) 21.3%. Non-edentulous individuals had a significantly higher number of FSS than did edentulous individuals (P<0.001). Male individuals presented a significantly greater distance from the FSS (P=0.001), FIS (P=0.045) and FOP (p=0.002) to the base of the mandible than female individuals. Younger individuals presented a significantly higher distance from the FSS (P=0.001) and FIS (P=0.001) to the alveolar crest of the mandible. Male individuals had a significantly greater FIS (P=0.002) and FOP (P=0.001) diameter than female individuals. Male individuals had a significantly higher number of bifurcations in FOP than female individuals (P=0.017). Conclusion: CBCT supplies the provider with a detailed assessment of the foramina and canals, which improves the quality of surgical planning and mitigates the chances of surgical intercurrences.

RESUMO Objetivo: Avaliar a frequência dos forames linguais mediais presentes na cortical da mandíbula por meio da tomografia computadorizada de feixe cônico (TCFC). Métodos: Um total de 953 exames de TCFC da mandíbula foram avaliados para determinar a presença de canais na linha média mandibular, localização do canal em relação ao tubérculo geniano, diâmetro do canal, distância à base e crista alveolar da mandíbula, trajetória da canal e medidas de coincidência da imagem panorâmica contendo a localização do canal em relação ao tubérculo geniano. Resultados: Os forames localizaram-se em três posições: acima do tubérculo (FSS) 89,2%, abaixo do tubérculo (FIS) 67,9% e outras posições (FOP) 21,3%. Indivíduos não edêntulos apresentaram um número significativamente maior de FSS do que indivíduos edêntulos (P <0,001). Indivíduos do sexo masculino apresentaram distâncias significativamente maior do FSS (P = 0,001), FIS (P = 0,045) e FOP (p = 0,002) até a base da mandíbula do que indivíduos do sexo feminino. Os indivíduos mais jovens apresentaram uma distância significativamente maior do FSS (P = 0,001) e FIS (P = 0,001) até a crista alveolar da mandíbula. Indivíduos do sexo masculino tiveram um diâmetro de FIS (P = 0,002) e FOP (P = 0,001) significativamente maior do que indivíduos do sexo feminino. Indivíduos do sexo masculino tiveram um número significativamente maior de bifurcações no FOP do que indivíduos do sexo feminino (P = 0,017). Conclusão: a TCFC fornece ao profissional uma avaliação detalhada dos forames e canais, o que melhora a qualidade do planejamento cirúrgico e diminui as chances de intercorrências.

Prevalence and morphometric analysis of double mental foramen and double mandibular foramen from digital panoramic radiographs / Prevalencia y análisis morfométrico de foramen mental y foramen mandibular dobles a través de radiografías panorámicas digitales

The morphological variations of the mental foramen (MF) and mandibular foramen (MBF) have been studied for several years, and the prevalence and morphometric characteristics of double and triple foramina have been reported. The objective of this study was to establish the prevalence of variations in the MF and MBF, and to carry out a morphometric analysis of a Chilean population using digital panoramic radiographs. The study included 927 radiographs; the observed prevalence of double MF was 2.58 %, while the prevalence of double MBF was 1.51 %. No cases of triple foramina were found. In men, double MF was found more frequently in the left hemiarch (64.28 % of cases), while in women it was more frequent in the right hemiarch (80 %). Double MBF was found more frequently in the right hemiarch in women (80 % of cases), while the distribution between left and right in men was even. The mean area, width and height of the double MF were 5.46 mm2, 2.77 mm and 2.57 mm respectively. The means of the same morphometric measurements in double MBF were 6.37 mm2, 2.27 mm and 3.19 mm respectively. In both foramina, statistically significant differences were only found between the height of the foramen and the age of the subjects, with the observation that the greater the subject's age, the smaller the height. Dental surgeons must take these anatomical variants into consideration in clinical and surgical actions; timely diagnosis by radiograph is important to avoid possible complications.

Las variaciones morfológicas del foramen mental (FM) y mandibular (FMB) han sido estudiadas durante varios años, reportándose su prevalencia y las características morfométricas de forámenes dobles y triples. El objetivo de este estudio fue establecer la prevalencia de variaciones de los FM y FMB y realizar un análisis morfométrico a través de radiografías panorámicas digitales de una muestra de población chilena. En el estudio se incluyeron 927 radiografías y se observó una prevalencia de FM doble de 2,58 %, mientras que la prevalencia de FMB doble fue de 1,51 %. No se encontraron casos de forámenes triples. En hombres, el FM doble se encontró mayoritariamente en la hemiarcada izquierda (64,28 % de los casos), mientras que en mujeres fue en la hemiarcada derecha (80% de los casos). Para el caso de los FMB dobles, en mujeres se presentó mayoritariamente en la hemiarcada derecha (80 % de los casos), mientras que en hombres fue equitativo en ambos lados. El promedio del área, ancho y alto de los FM dobles fue de 5,46 mm2, 2,77 mm y 2,57 mm, respectivamente. Asimismo, los promedios de estas medidas morfométricas para el FMB doble fueron 6,37 mm2, 2,27 mm y 3,19 mm, respectivamente. Para ambos forámenes sólo se encontraron diferencias estadísticamente significativas entre el alto y la edad de los sujetos, observando que, a mayor edad menor era el alto del foramen. Los cirujanos dentistas deben tener en consideración estas variantes anatómicas para la realización de distintas acciones clínicas y quirúrgicas, su diagnóstico radiográfico oportuno es importante para prevenir posibles complicaciones.

A Study of Anatomical Variations in Transverse Foramen of Cervical Vertebrae for Morphological and Clinical Importance

Introduction: Cervical vertebrae constitute the skeletal framework of vertebral column in the region. The most important feature to identify the cervical vertebra is the presence of foramen transversarium. Vertebral artery, vertebral vein and sympathetic chain run through this foramen as a single unit. Compartmentalization or absence of the foramen may alter the course of these structures. Material and methods: The study was performed on 240 dry human cervical vertebrae of both sexes, which were collected from Anatomy department of MSYMCH, Meerut and HIMS, Varanasi. The variations in number and shape were observed, recorded and analyzed. The intact cervical vertebrae without any degenerative or traumatic disorders were included in this study. Result: Out of 240 cervical vertebrae, 63 vertebrae were found to have variations in the transverse foramina. Complete double transverse foramina were observed in 48 vertebrae (20%), out of which unilateral double foramina were found in 29 vertebrae (12%) and bilateral double foramina were found in 19 vertebrae (8%). Similarly, incomplete double transverse foramina were observed in 15 vertebrae (6%), of which the foramina were unilateral in 8 vertebrae (4%) and bilateral in 5 vertebrae (2%). Conclusion: In our study, we observed the double foramen transversarium in 26.25% of the cases. These variations may alter the course of vertebral artery. Presence of compartmentalization suggests the chances of compression of neurovascular bundle. Spicules of incomplete septation between the two foramina may pierce the vascular or neural structures resulting into vascular insufficiency or persisting pain. These findings may suggest a cue to the spinal surgeons in planning preoperative procedures for surgeries related to this region

To Determine the Incidence of Accessory Foramen Transversarium

To find the incidence of accessory foramen transversarium in dried cervical vertebrae. 150 dried cervicalvertebrae were collected from Postgraduate department of Anatomy Government Medical College Jammuand examined for the accessory foramen transversarium.Out of 150 cervical vertebrae, only 24 hadaccessory foramen transversarium with preponderance in sixth cervical vertebrae. Amongst the vertebraewith accessory foramen transversarium, 14 were bilateral and 10 were unilateral. In the present study theincidence of accessory foramen transversarium was 16%. This is important for Radiologists to interpretComputed Tomography Images and Magnetic Resonance Imaging of cervical spine.

Anatomical variations of the foramen transversarium in cervical vertebrae / Variaciones anatómicas del foramen transverso en vértebras cervicales

The cervical vertebrae are recognized mainly by the presence of the foramen transversarium, which is crossed by the vertebral artery and vein, accompanied by sympathetic fibers. The main objective of this study was to observe and describe the anatomy and variations in the foramen transversarium. 121 cervical vertebrae were analyzed, including the macroscopic characteristics, shape and diameter and presence of the foramen transversarium, as well as the accessory foramen transversarium. All cervical vertebrae presented the foramen transversarium, with a mean diameter of 5.60 mm and a mean diameter of 4.40 mm on the right and 5.92 mm - 5.56 mm on the left, respectively. With regard to shape classification according to Taitz et al. (1978), 90.08 % presented the same shape on both sides, and 9.91 % had different shapes. The presentation of the different shapes was as follows: shape 1 41.32 %; shape 2 4.13 %; shape 3 18.8 %; shape 4 14.04 %; and shape 5 12.39 %. Regarding the presence of accessory foramen transversarium, 17.35 % of the vertebrae presented it, 66.6 % unilateral, 57.14 % on the right side and 42.85 % on the left side. Osteophytes, were presented in 5.7 %. The anatomical knowledge of these variations is useful for spine surgeons in preoperative planning and for preventing vertebral vessel and sympathetic nerve injuries during cervical surgical approaches.

Las vértebras cervicales son reconocidas principalmente por la presencia del foramen transverso (FT), por el cual transita la arteria y vena vertebral además de fibras simpáticas. Las variaciones en el FT pueden estar asociadas con una alteración en el calibre y el curso de la arteria vertebral. El objetivo del presente estudio fue observar y describir la anatomía así como las variaciones en el FT. Fueron analizadas 121 vértebras cervicales, en las cuales el FT fue observado macroscópicamente de manera bilateral así como el foramen transverso accesorio (FTA) en las que se encontrara presente. La forma y diámetros máximo y mínimo del FT fue medido de manera bilateral con ayuda de un cáliper digital. De 121 vértebras cervicales, la totalidad presentaron FT con diámetros máximo y mínimo derecho de 5,60 y 4,40 mm respectivamente y de 5,92 y 5,56 mm máximo y mínimo del lado izquierdo. Con respecto a la clasificación de forma de Taitz et al. (1978) el 90,08 % presentó la misma forma de manera bilateral y un 9,91% formas distintas. La forma 1 se presentó en un 41,32 %, la 2 en un 4,13 %, forma 3 18,8 %, 4 14,04 % y 5 en 12,39 %. Con respecto a la presencia de FTA, un 17,35 % lo presentó, siendo 66,6 % unilaterales, un 57,14 % derecho y 42,85 % izquierdo. La anatomía y variaciones en el FT y la arteria vertebral y los componentes nerviosos están interrelacionados. Su conocimiento morfológico es clínicamente importante, ya que el curso de la arteria vertebral puede distorsionarse en tales situaciones. Por lo que es importante a la hora de adoptar medidas cautelares para salvaguardar la arteria vertebral en las cirugías de columna cervical.

A Study Of Accessory Foramen Transversarium In Dry Cervical Vertebrae And Its Clinical Implications.

Background & Objective: The foramen transversarium in the transverse process is the characteristic feature for cervical vertebrae and distinguish it from other vertebrae. It transmits the vertebral artery, vertebral vein and sympathetic nerves. These foramina show variations in its size, shape and number. The present study was done to find out the incidence of accessory foramen transversarium and compare it with other study. Methodology: A total 150 dried cervical vertebrae were observed macroscopically for accessory foramen transversarium in the department of anatomy. Results: Out of 150 vertebrae, accessory foramen transversarium was found in 41(27.33%) vertebrae. Among 41 vertebrae unilateral accessory foramen transversarium was found in 27(18%) vertebrae and bilateral was found in 14(9.33%) vertebrae. Conclusion: The knowledge of accessory foramen transversarium is useful for spine surgeons in surgery around cervical vertebrae. It helps radiologists in interpretation of computed tomogram and magnetic resonance image scans. It is also helpful for anatomist, anthropologist and clinicians.

Study of Accessory Foramen Transversarium in Cervical Vertebrae.

Introduction: Foramen transversaria are located on transverse processes of each cervical vertebra and transmit the vertebral artery, vertebral vein, and sympathetic nerves. These foramina are known to exhibit variations in size, shape and numbers and may be absent, incomplete or duplicate, which may lead to various symptoms. Their etiology is related with the variations in the course of vertebral artery due to developmental reasons. Objective: The present study was conducted to find the incidence of accessory foramina transversaria in the cervical spine.The recognition of these variations provide accurate and safety for the posterior surgical approaches of the cervical spine. Methodology: 210 dry cervical vertebrae of both sexes were studied in the Department of Anatomy, GCS Medical College, Ahmedabad. During our study we excluded all broken, damaged cervical vertebrae and observed the variations of foramen transversarium both in right and left transverse process of each cervical vertebra. Result: Variations in foramina were found unilaterally as well as bilaterally. 34 (16.19%) out of total 210 vertebrae studied presented accessory foramen transversarium. Conclusion: Variations in foramina may indicate, the variation in course of vertebral artery.The present study has important clinical implications for head and neck and vascular surgeons and radiologists