Morphometric evaluation, locational relationship, and surgical significance of the maxillofacial region landmarks / Evaluación morfométrica, relación de ubicación e importancia quirúrgica de los puntos de referencia de la región maxilofacial

SUMMARY: The aim of this study was to examine the localization of the landmarks in the maxillofacial region and their relations with each other and to evaluate them morphologically and clinically. Our study included 41 dry adult human skulls of unknown age and sex of Anatolian population. Statistical analysis of the data obtained in our study was performed with SPSS v.20.0 software (IBM Corp., Armonk, NY, USA). Statistical significance was accepted as P ? 0.05. Whereas the mean right supraorbital depth (SOD) value was significantly greater than the mean left SOD value (p 0.05). Correlation values in our study varied between -0.156 and 0.612. The highest correlation value was obtained in the positive direction between the orbital height (OH) and supraorbital foramen-infraorbital foramen (SOF-IOF) measurements (r = 0.612, p < 0.001). We believe that measurements of the orbit, SOF, and IOF and our data on their localizations, along with the relationships that we observed in our study will allow surgeons to avoid damaging the neurovascular bundles during surgical interventions and local anesthesia procedures in the frontal, periorbital, and maxillofacial regions.

RESUMEN: El objetivo de este estudio fue examinar la localización de los hitos en la región maxilofacial y sus relaciones entre sí y evaluarlos morfológica y clínicamente. Nuestro estudio incluyó 41 cráneos humanos adultos secos de edad y sexo desconocidos de la población de Anatolia. El análisis estadístico de los datos obtenidos en nuestro estudio se realizó con el software SPSS v.20.0 (IBM Corp., Armonk, NY, EE. UU.). La significación estadística se aceptó como P ? 0,05. Mientras que el valor medio de la profundidad supraorbitaria derecha (SOD) fue significativamente mayor que el valor medio de la SOD izquierda (p 0,05). Los valores de correlación en nuestro estudio variaron entre -0,156 y 0,612. El mayor valor de correlación se obtuvo en la dirección positiva entre las medidas de altura orbitaria (OH) y foramen supraorbitario-foramen infraorbitario (SOF-IOF) (r = 0,612, p <0,001). Creemos que las mediciones de la órbita, SOF e IOF y nuestros datos sobre sus localizaciones, junto con las relaciones que observamos en nuestro estudio, permitirán a los cirujanos evitar dañar los haces neurovasculares durante las intervenciones quirúrgicas y los procedimientos de anestesia local en la zona frontal, periorbitaria. y regiones maxilofaciales.

A Metric Scrutiny Of The Orbital Margins

Background: The anatomical boundaries of the orbit are defined and the contribution of various bones in makingup the orbital margins is determined .Associated with this, orbital dimensions like length, breadth and theorbital index are determined along with the associated dimorphic and bilateral variations. The findings of theseterritorial specimens are analyzed and compared with similar findings from other vernacular territories. Thebilateral craniofacial structures are studied and they are dimensionally classified and characterized.Comprehensive documentation thus promulgated functions to prove vital in the conquest of dexterity in the fieldof surgery and forensic anthropometry alike. The evaluated parameters also serve as an empirical guide indiscerning tenuous sites that are susceptible to impaction and in defining the safe limits of orbital explorationResults: The study has returned an average value of 81.47 as the orbital index of the scrutinized dry skullspecimens thus placing them under the category of microseme. The average values of orbital length and breadthwere found to be 31.26mm and 38.37mm respectively. The superior margin formed exclusively by the frontalbone measured 32.7mm on average with the supraorbital notch/foramen being displaced 5.92mm from themedial limit of the superior margin. For 25.88mm, which was the average length of medial margin, maxilla stoodthe dominant contributor (13.81mm) with the frontal bone chipping in to contribute to the rest. The inferiormargin paints a contrary picture of maxilla being the secondary contributor (16.13mm) whilst here it is thezygoma which makes a greater contribution (17.29mm).Conclusion: This study hereby establishes Microseme to be the predominant orbital index of the scrutinized skullspecimens in addition to quantifying the contributions of various bones towards making up the margins.Comparative analysis with confluent such studies from other provinces of the Indian subcontinent has confirmedthe latitude variation associated with orbital index. The results thus established will be unerringly essential inthe field of surgery and forensic anthropometry

A comparison of the relationship between the golden ratio and anatomical characteristics of the supraorbital foramen in bare skulls belonging to the Byzantine era and modern era / Comparación de la relación entre la proporción áurea y las características anatómicas del foramen supraorbitario en cráneos de la época bizantina y la edad moderna

The aim of the present study is to determine the frequency of the occurrence of supraorbital foramen/notch (SOF/N) in the skulls of the people who lived in the modern era and the late Byzantine era, to determine the symmetry and the asymmetry between the two halves of the skulls by measuring the linear distance to various landmarks, to check the consistency between the location of the SOF/N and the golden ratio by calculating the ratio between linear distances and to evaluate the differences between the skulls from both historical periods. In the study, the frequency of the occurrence of the supraorbital notch in the skulls from the Byzantine era was found to be 26.60 % on the right and 13.30 % on the left while it was 14.30 % on the right and 9.52 % on the left in the skulls belonging to modern humans. In the skulls belonging to the Byzantine era, the average distance between SOF/N and the sagittal axis passing along the lateral orbital wall was found to be 34.81±2.51 mm and 32.99±2.81 mm respectively on the right and the left while it was 33.14±2.19 mm and 33.39±2.06 mm in the skulls belonging to modern era. The average distance between the SOF/N and the sagittal plane passing along the midline of the skull was found to be 24.55±2.79 mm and 21.57±2.44 mm on the right and the left respectively in the skulls belonging to the Byzantine era while it was 0.04±3.30 mm and 20.96±2.37 mm in the skulls belonging to the modern era. The average distance between the SOF/N and sagittal plane passing along the medial orbital wall was found to be 23.78±3.60 mm and 23.81±3.20 mm on the right and the left respectively in the skulls belonging to the Byzantine era while it was found to be 22.23±3.29 mm and 23.97±1.93 mm in the skulls belonging to the modern era. The average value of the distance between the sagittal planes passing along the lateral and medial sides of the orbit and the ratios between the distance from SOF/N to the sagittal plane passing along the lateral side of the orbit was found to be 1.47±0.21 mm and 1.60±0.08 mm respectively in the skulls belonging to the Byzantine era and the modern era. No significant difference was found between this ratio and the golden ratio; the average value of the ratios between the distance from the SOF/N to the sagittal plane passing along the midline of the skull and the distance from the SOF/N to the sagittal plane passing along the lateral side of the orbit was found to be 0.98±0.26 mm and 1.04±0.36 mm respectively in the skulls belonging to the Byzantine era and the modern era. A significant difference was found between this ratio and the golden ratio for both historical periods (modern society and late Byzantine period) (p <0.005). The comparison of the relevant anatomic characteristics of the SOF/N is very important for anthropologists while a broad knowledge on proportional calculations regarding morphometric values and the location are important for reconstructive surgeons and the experts in forensics and pain control.

El objetivo fue determinar la frecuencia del foramen y incisura supraorbitaria (FSO/E) en cráneos de individuos de la era moderna y aquellos de la era bizantina, para determinar la simetría y asimetría entre las dos mitades de cráneos, mediante la medición de la distancia lineal a varios puntos de referencia, para comprobar la coherencia entre la ubicación del FSO/ y la proporción áurea, a través del cálculo de la relación entre las distancias lineales. Además, se evaluaron las diferencias entre los cráneos de periodos históricos. En el estudio, se determinó que la frecuencia registrada de la incisura supraorbitaria en los cráneos de la época bizantina fue del 26,60% en el lado derecho y 13,30 % en el izquierdo; mientras que en cráneos humanos modernos fue de 14,30% en el lado derecho y 9,52 % en el izquierdo. En los cráneos pertenecientes a la época bizantina, la distancia media entre FSO/E y el eje sagital a lo largo de la pared lateral de la órbita fue de 34,81±2,51 mm y 32,99±2,81 mm, a la derecha e izquierda, respectivamente; mientras que en cráneos de la era moderna fue de 33,14±2,19 mm y 33,39±2,06 mm, a la derecha e izquierda, respectivamente. La distancia media entre la FSO/E y el plano sagital que pasa a lo largo de la línea mediana del cráneo, en los cráneos de la época bizantina, fue de 24,55±2,79 mm y 21,57±2,44 mm a la derecha e izquierda, respectivamente; mientras que fue de 0,04±3,30 mm y 20,96±2,37 mm en los cráneos de la era moderna. La distancia media entre la FSO/E y el plano sagital que pasa a lo largo de la pared medial de la órbita, en los cráneos pertenecientes a la época bizantina fue de 23,78±3,60 mm y 23,81±3,20 mm, a la derecha e izquierda, respectivamente; mientras que en los cráneos pertenecientes a la era moderna fue de 22,23±3,29 mm y 23,97±1,93 mm, a la derecha e izquierda, respectivamente. Se determinó que el valor medio de la distancia entre los planos sagitales a lo largo de los márgenes lateral y medial de la órbita y las proporciones entre la distancia desde FSO/E al plano sagital a lo largo del lado lateral de la órbita fueron de 1,47±0,21 mm y 1,60±0,08, respectivamente, en los cráneos pertenecientes a la época bizantina y la era moderna. No encontramos diferencias significativas entre esta relación y la proporción áurea. El valor medio de las relaciones entre la distancia de la FSO/E al plano a lo largo de la línea mediana del cráneo y la distancia de la FSO/E al plano sagital a lo largo de la pared lateral de la órbita fueron de 0,98±0,26 mm y 1,04±0,36 mm, respectivamente, en los cráneos pertenecientes a la era bizantina y la era moderna. No se encontró una diferencia significativa entre esta relación y la proporción áurea en ambos períodos históricos (la sociedad moderna y el periodo bizantino tardío) (p <0,005). La comparación de características anatómicas relevantes para el FSO/E son importantes para los antropólogos, donde un conocimiento integro de cálculos proporcionales con respecto a los valores morfométricos, mientras que para los cirujanos reconstructivos y los expertos en medicina forense es importante su ubicación.

Confirmation of Supraorbital Nerve and Its Branch in the Supraorbital Notch with Ultrasound Guidance / 계명의대학술지

A 55-year-old female with severe herpes zoster related forehead pain radiating to anterior and posterior scalp visited our pain clinic. The right side forehead pain with numerical rating score of 7 had persisted in spite of antiviral and anticonvulsant medication. We blocked the right supraorbital nerve under ultrasound guidance, and obtained the proper pain relief. In this case, we would like to present the method to identify the supraorbital notch or foramen and possible visualization of the supraorbital nerve.

Supraorbital notch/foramen in Sri Lankan skulls: morphometry and surgical relevance / Escotadura/foramen supraorbitario en cráneos de Sri Lanka: morfometría y relevancia quirúrgica

Evidence supports the ethnic and sex variation in the form and position of the supraorbital foramen. Therefore, detailed knowledge of the population specific data on biometric features of the supraorbital foramen will facilitate diagnostic, local anesthetic and surgical manipulations in the maxillo-facial region. The goal of this study was to elucidate the morphological features and precise anatomical position of the supraorbital foramen with reference to surrounding surgically encountered anatomical landmarks in an adult Sri Lankan population. A total of one hundred and eight adult dry skulls of known sex were assessed to determine the number, shape, orientation, vertical and transverse diameters of the supraorbital foramen, transverse distance from the supraorbital foramen to the nasal midline and the zygomatico-maxillary suture and the vertical distance from the supraorbital foramen to the supraorbital rim and infraorbital foramen. The position of the supraorbital foramen was determined in relation to the infraorbital foramen. Data were evaluated between sides and sex. The supraorbital notch (64.81%) was found more frequently than the supraorbital foramen (35.19%). Of the skulls investigated, 55.56% displayed bilateral supraorbital notches, whereas 20.37% had bilateral supraorbital foramina and 24.07% had a notch on one side and a foramen on the contralateral side. The incidence of multiple supraorbital foramina was 6.48%. Sex variations were observed in the relative position of supraorbital notch/foramen from nasal midline (male: 26.12±3.89; female: 24.40±2.76), temporal crest of the frontal bone (male: 32.74±3.94; female: 30.87±4.18) and infraorbital foramen (male: 44.86±3.35; female: 43.26±3.63). The modal position for the infraorbital foramen was lateral to the lateral margin of the supraorbital notch/foramen (68.52%) and supraorbital and infraorbital foramina were lying in the same sagittal plane only in 24.07% of the skulls. The results of this study highlight the racial and sex differences and emphasize the need for meticulous preoperative evaluation of the supraorbital foramen to define the optimal locations in patients who are candidates for maxillo-facial surgeries and regional block anesthesia.

La evidencia señala que existe dimorfismo étnico y sexual en la forma y posición del foramen supraorbitario. Por lo tanto, el conocimiento detallado de los datos específicos de una población sobre las características biométricas del foramen supraorbitario facilitará el diagnóstico, anestesia local y procedimientos quirúrgicos en la región maxilofacial. El objetivo fue determinar las características morfológicas y posición anatómica exacta del foramen supraorbitario con referencia a los referencias anatómicas circundantes encontradas quirúrgicamente en una población adulta de Sri Lanka. Ciento ocho cráneos adultos secos de sexo conocido se evaluaron para determinar el número, forma, orientación, diámetros vertical y transversal del foramen supraorbitario, distancia transversal desde el foramen supraorbitario a la línea mediana nasal y sutura cigomático-maxilar y distancia vertical desde el foramen supraorbitario hasta el margen supraorbitario y foramen infraorbitario. La posición del foramen supraorbitario se determinó en relación al foramen infraorbitario. Los datos fueron evaluados según lado y sexo. La incisura supraorbitaria (64,81%) se encontró con mayor frecuencia que el foramen supraorbitario (35,19%). El 55,56% de las incisuras supraorbitarias y 20,37% de los forámenes supraorbitarios fueron bilaterales; mientras que el 24,07% de las incisuras fueron unilaterales con un foramen en el lado contralateral. La incidencia de los forámenes supraorbitarios múltiples fue del 6,48%. Se observaron variaciones sexuales en la posición relativa de la incisura/foramen supraorbitario respecto a la línea mediana nasal (hombres= 26,12±3,89; mujeres: 24,40±2,76), cresta temporal del hueso frontal (hombres= 32,74±3,94; mujeres: 30,87±4,18) y foramen infraorbitario (hombres= 44,86±3,35; mujeres= 43,26±3,63). La posición modal para el foramen infraorbitario fue lateral al margen lateral de la incisura/foramen supraorbitario (68,52 %), y los forámenes supraorbitario e infraorbitario se ubicaron en el mismo plano sagital sólo en el 24,07% de los cráneos. Los resultados muestran las diferencias raciales y sexuales y enfatizan la necesidad de una evaluación preoperatoria minuciosa del foramen supraorbitario para definir su posición en pacientes que son candidatos a cirugías maxilofaciales y bloqueo anestésico regional.

Prenatal Morphometric Analysis Of Supraorbital, Infraorbital And Mental Foramina In Human Foetuses And Their Clinical Correlations To Anaesthesia And Surgical Procedure.

Modern surgical procedures, anesthesia, acupuncture and other invasive procedures on the face require a more precise understanding of the anatomy of important landmarks to prevent subsequent neurovascular complications in the frontal region, upper jaw and lower jaw. Studies on bilateral locational relationship of SOF, IOF and mental foramen in foetal skull are still lacking, so aim of our study was 1) to examine the various morphometric variations (the location and shape) of SOF, IOF and mental foramina of the facial skeleton in human foetuses at different age of gestation 2) to establish whether or not, the location of these foramina get changed as the foetus matures and 3) to establish the pattern of growth of aforesaid foramina. For these 40 formalin-fixed foetuses between 17 and 32 weeks of gestation were studied for SOF, IOF and mental foramina. Foetuses were divided into two groups according to age. It was interesting to note that supra-orbital and mental foramina were placed in the same sagittal plane on both sides of the midline. Infra-orbital foramen was located lateral to sagittal plane for supra-orbital and mental foramina. The shape of SOF was recorded as a notch or rarely a foramen, whereas the shape of IOF and mental foramen were determined as a circular and an oval opening respectively.

Anatomical Location and Distribution of Supraorbital Notch and Foramen Evaluations Using Facial 3D Computed Tomography

PURPOSE: To evaluate anatomical locations and distributions of supraorbital notch and foramen using facial 3D computed tomography in the Korean adult population. METHODS: The study sample was composed of 87 adult patients with no history of trauma or ocular disease. The horizontal position of the supraorbital foramen or notch was recorded in relation to a vertical line defined by a reproducible hypothetical point, such as the nasion and mid-maxilla and the midpoint of the horizontal supraorbital plane. The distance and angle for each supraorbital foramen and notch were calculated from the defined vertical line. Furthermore, vertical distance from supraorbital plane, which was established using the highest points of both supraorbital rims, was obtained from the supraorbital foramen. RESULTS: The mean age of the 87 patients was 45.44 +/- 8.34 years (range, 30-59 years). There were 66 eyes in the supraorbital notch and 108 eyes in the supraorbital foramen. There were no distributional differences between the 2 sides. The mean horizontal distance of both types was 23.95 +/- 3.93 mm (range, 16.41-38.94 mm). The horizontal distance of male patients was longer than the female patients (25.18 +/- 4.16 mm vs. 22.63 +/- 3.19 mm, p < 0.001, based on independent t-test) and the horizontal distance of supraorbital notch was shorter than the supraorbital foramen (22.59 +/- 3.18 mm vs. 26.18 +/- 4.04 mm, respectively, p < 0.001, based on independent t-test). The mean vertical distance and mean angles of the supraorbital foramen were 3.02 +/- 1.119 mm and 6.81 +/- 2.31 degrees (degrees), respectively. CONCLUSIONS: The present study described the anatomical location of each supraorbital opening type in Korean adults. According to horizontal distance, a surgeon can avoid iatrogenic injury of the supraorbital neurovascular complex, especially during brow surgery. In addition, the anatomy can aid in targeting supraorbital neurovascular complex in cases of nerve block.

Anatomic Characteristics of Supraorbital Foramina in Korean Using Three-Dimensional Model

BACKGROUND: The aims of this study were to analyze the anatomic variations of supraorbital foramina/notches in Koreans and to compare the results with those of previous studies examining other races. We evaluated the three-dimensional computed tomography (3D-CT) images of human faces using multidetector computed tomography (MDCT). METHODS: A total of 395 adults (232 men and 163 women) were enrolled and the 3D-CT images of their faces were reviewed in this study. In this study, the data from the images included the presence, shape, width and distance from the nasion to the supraorbital foramina/notches. ANOVA was used to assess the main effects of gender and side (right or left foramen/notch), and comparisons of the means were done by paired t-test. RESULTS: The most common shapes in Koreans were a single notch (39.5%) on the right hand side and a single foramen (42.3%) on the left hand side. The incidence of a single foramen in Koreans was high compared to other races. The mean foramen diameter was 2.34 +/- 0.78 mm, and the mean distance from the nasion was 27.19 +/- 4.03 mm. The mean notch diameter was 3.37 +/- 1.71 mm, and the mean distance from the nasion was 23.42 +/- 2.45 mm. CONCLUSIONS: This is the first study on the variations of supraorbital foramina/notches in Koreans using 3D-CT images of faces. The anatomic characteristics of the supraorbital foramina/notch will help in performing nerve blocks and maxillofacial surgery.

A study of supraorbital notches and foramina in Gujarati human skulls.

The anatomy of the supraorbital notches and foramina has been studied in 249 human skulls. Of 233 skulls, 35.62% had bilateral supraorbital notches, 21.45% had bilateral supraorbital foramina and 16.73% had a notch on one side and a foramen on other side. In present study, total 13 types of combinations were found. The average distance from the nasion to the supraorbital notch/ foramen was 24.30 mm( 16.74-31.86) on right side and 23.73 mm (15.78-31.86) on left side. The exit point can be significantly cephaled to the orbital rim. Knowledge of the anatomy of the region is important for those doing forehead and brow lift surgeries in order to avoid injuring the neuro-vascular bundle passing through these notches/foramina.