Morphometric studies of supraorbital foramen, infraorbital foramen and mental foramen in a thai population related with nerve blocks / Estudios morfométricos del foramen supraorbitario, foramen infraorbitario y foramen mental en una población tailandesa relacionados con bloqueos nerviosos

SUMMARY: The aim of this study was to study the anatomical landmarks and variations of supraorbital, infraorbital, and mental foramina. One hundred and sixty Thai dry skulls were randomly selected from the Forensic Osteology Research Center. The distances of the parameters were measured by using Vernier caliper. The supraorbital foramen could be found in a notch form 13.8 %, single supraorbital foramen accounted for 82.5 %, and supraorbital foramen with an accessory foramen represented 3.8 %. Single infraorbital foramen was found 90.0 %, and infraorbital foramen with an accessory foramen represented 10.0 %. Single mental foramen was observed 96.6 %, and the frequency of mental foramen with an accessory foramen was determined 3.4%. The majority of infraorbital foramina (48.0 %) was detected above the second premolar area. 19.0 % of the infraorbital foramina was seen in the region between the first premolar and the second premolar, and 22.8 % of the infraorbital foramina was located between the second premolar and the first molar. The infraorbital foramen is anatomically positioned above the first molar (10.2 %). The majority of mental foramina (53.5 %) can be identified below second premolar area. The region between the first premolar and the second premolar is the site for the mental foramen 26.0 % of the total variations. The region between the second premolar and the first molar is the site for the mental foramen 16.9 % of the total variations. The mental foramen is approximately situated below the first molar (3.6 %). The present study of anatomical variations of various foramina demonstrates a useful application in cosmetic and ophthalmic plastic surgery. The findings could improve the efficacy of the surgeons and accuracy for the indicated localization of these foramina during maxillofacial operations and local anesthetic procedures.

RESUMEN: El objetivo de este estudio fue estudiar los puntos de referencia anatómicos y las variaciones de los forámenes supraorbitario, infraorbitario y mental. Ciento sesenta cráneos secos tailandeses fueron seleccionados al azar del Centro de Investigación de Osteología Forense. Las distancias de los parámetros se midieron utilizando un calibre Vernier. El foramen supraorbitario se pudo encontrar en forma de muesca el 13,8 %, el foramen supraorbitario único representó el 82,5 % y el foramen supraorbitario con un foramen accesorio representó el 3,8 %. El foramen infraorbitario único se encontró en un 90,0 % y el foramen infraorbitario con un foramen accesorio representó el 10,0 %. Se observó foramen mental único 96,6 % y se determinó la frecuencia de foramen mental con foramen accesorio 3,4 %. La mayoría de los forámenes infraorbitarios (48,0 %) se detectaron por encima del área del segundo premolar. El 19,0 % de los forámenes infraorbitarios se observó en la región entre el primer premolar y el segundo premolar, y el 22,8 % de los forámenes infraorbitarios se ubicó entre el segundo premolar y el primer molar. El foramen infraorbitario se ubica anatómicamente por encima del primer molar (10,2 %). La mayoría de los forámenes mentales (53,5 %) se pudieron identificar inferior al área del segundo premolar. La región entre el primer premolar y el segundo premolar es el sitio del foramen mental 26,0 % de las variaciones totales. La región entre el segundo premolar y el primer molar es el sitio del foramen mental 16,9 % del total de variaciones. El foramen mental se sitúa aproximadamente por debajo del primer molar (3,6 %). El presente estudio de variaciones anatómicas de estos forámenes demuestra una aplicación útil en la cirugía plástica y oftálmica. Los hallazgos podrían mejorar la eficacia de los cirujanos y la precisión para la localización de estos forámenes durante las operaciones maxilofaciales y los procedimientos anestésicos locales.

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.

Morphometric analysis of infraorbital foramen using cone beam computed tomography in a cohort of Sri Lankan adults / Análisis morfométrico del foramen infraorbitario mediante tomografía computarizada de haz cónico en una cohorte de adultos de Sri Lanka

SUMMARY: Infraorbital foramen (IOF) located bilaterally within the maxillary bone about 1 cm inferior to the infraorbital margin is a vital landmark when delivering local anesthesia and during surgical interventions in the midface region. A total of 122 infraorbital foramina in 61 cone beam computed tomographic (CBCT) images of 32 females and 29 males in the age range of 17 to 32 were analyzed to determine the shape, direction, presence of accessory foramina, size and the precise position of IOF in relation to the inferior orbital margin (IOM), maxillary midline (MM), lateral nasal wall (LNW), alveolus (ALV) and maxillary teeth in a group of Sri Lankan people. The IOF was oval in shape (80.3 % and 88.5 % on the right and left side, respectively) in a majority of individuals. The infraorbital foramina were located at a mean distance of 5.56 ± 3.95 and 4.91 ± 2.08 mm, below the IOM on the right and left side, 27.13 ± 2.6 and 26.99 ± 2.73 on the right and left side from the mid maxillary line, 11.96 ± 3.45 mm and 12.18 ± 3.35 from the LNW on the right and left side and 29.59 ± 3.59 and 29.65 ± 3.28 above the alveolar crest on the right and left side. There were no statistically significant differences between the left and right sides or between sexes. Majority of IOF (37.5 % and 55.9 % on the right and left side, respectively) were located in the vertical plane passing though the maxillary second premolar tooth.

RESUMEN: El foramen infraorbitario (FIO) ubicado bilateralmente dentro de la maxila, aproximadamente 1 cm inferior al margen infraorbitario, es un punto de referencia vital cuando se administra anestesia local y durante intervenciones quirúrgicas en la región media de la cara. Se analizaron un total de 122 forámenes infraorbitarios en 61 imágenes de tomografía computarizada de haz cónico (CBCT) de 32 mujeres y 29 hombres en un rango etario de 17 a 32 años para determinar la forma, dirección, presencia de forámenes accesorios, tamaño y posición precisa de FIO en relación con el mar- gen orbitario inferior (MOI), la línea mediana maxilar (MM), la pared nasal lateral (PNL), el alvéolo (ALV) y los dientes maxilares en un grupo de personas de Sri Lanka. En la mayoría de los adultos se observó que el FIO tenía forma ovalada (80,3 % y 88,5 % en el lado derecho e izquierdo, respectivamente) Los forámenes infraorbitarios se ubicaron a una distancia media de 5,56 ± 3,95 y 4,91 ± 2,08 mm, por debajo del MOI en los lados derecho e izquierdo; 27,13 ± 2,6 y 26,99 ± 2,73 en el lado derecho e izquierdo desde la línea maxilar mediana, 11,96 ± 3,45 mm y 12,18 ± 3,35 de la PNL en el lado derecho e izquierdo y 29,59 ± 3,59 y 29,65 ± 3,28 por encima de la cresta alveolar en los lados derecho e izquierdo. No hubo diferencias estadísticamente significativas entre los lados izquierdo y derecho o entre sexos. La mayoría de IOF (37,5 % y 55,9 % en el lado derecho e izquierdo, respectivamente) se ubicaron en el plano vertical que pasa por el segundo premolar maxilar.

Correlation analysis of infraorbital foramen with related anatomical structures / Análisis de correlación del foramen infraorbitario con estructuras anatómicas relacionadas

The anatomical localization of foramen infraorbitale (FOI) and its relationship with ambient structures are of great importance for clinicians and surgeons. This study was performed on seventy five skulls, and the distance between FOI to important anatomical formations, angular position of the zygomatic bone and the relationship between these parameters were investigated on both sides. The distance of FOI to margo infraorbitalis (MI), apertura piriformis (AP) and spina nasalis anterior (SNA), upper face height (UH) and upper face width (UW) were measured. Zygomatic bone triangle angles (SA, PA, IA) and porion-nasion-spina nasalis anterior angle (PNS) were measured from lateral view of the skull. While there was no significant difference between right and left measurement except for PA (p=0.03), the distance from FOI to MI is showed a very high degree positive correlation between the right and left sides, the distance from the FOI to AP was weak correlated only right side.

La localización anatómica del foramen infraorbitario (FIO) y su relación con las estructuras adyacentes son de gran importancia para los médicos y cirujanos. Este estudio se realizó en setenta y cinco cráneos, y se investigó la distancia entre FIO a formaciones anatómicas importantes, la posición angular del hueso cigomático y la relación entre estos parámetros en ambos lados. Se midió la distancia de FIO al margen infraorbitario (MI), apertura piriforme (AP) y espina nasal anterior (ENA), altura superior de la cara (AC) y ancho superior de la cara (AC). Los ángulos del triángulo óseo cigomático y el ángulo anterior porion-nasion-epina nasal se midieron desde la vista lateral del cráneo. Si bien no hubo una diferencia significativa entre la medición derecha e izquierda, a excepción AP (p = 0,03), la distancia de FIP a MI mostró una correlación positiva de alto grado entre los lados derecho e izquierdo, la distancia de FIO a AP fue débil correlacionado solo en el lado derecho.

Computed tomography evaluation of the morphometry and variations of the infraorbital canal relating to endoscopic surgery / Computed tomography evaluation of the morphometry and variations of the infraorbital canal relating to endoscopic surgery

Abstract Introduction: The course of the infraorbital canal may leave the infraorbital nerve susceptible to injury during reconstructive and endoscopic surgery, particularly when surgically manipulating the roof of the maxillary sinus. Objective: We investigated both the morphometry and variations of the infraorbital canal with the aim to show the relationship between them relative to endoscopic approaches. Methods: This retrospective study was performed on paranasal multidetector computed tomography images of 200 patients. Results: The infraorbital canal corpus types were categorized as Type 1: within the maxillary bony roof (55.3%), Type 2: partially protruding into maxillary sinus (26.7%), Type 3: within the maxillary sinus (9.5%), Type 4: located anatomically at the outer limit of the zygomatic recess of the maxillary bone (8.5%). The internal angulation and the length of the infraorbital canal, the infraorbital foramen entry angles and the distances related to the infraorbital foramen localization were measured and their relationships with the infraorbital canal variations were analyzed. We reported that the internal angulations in both sagittal and axial sections were mostly found in infraorbital canal Type 1 and 4 (69.2%, 64.7%) but, there were commonly no angulation in Type 3 (68.4%) (p < 0.001). The length of the infraorbital canal and the distances from the infraorbital foramen to the infraorbital rim and piriform aperture was measured as the longest in Type 3 and the smallest in Type 1 (p < 0.001). The sagittal infraorbital foramen entry angles were detected significantly smaller in Type 3 and larger in Type 1 than that in other types (p = 0.003). The maxillary sinus septa and the Haller cell were observed in 28% and 16% of the images, respectively. Conclusion: Precise knowledge of the infraorbital canal corpus types and relationship with the morphometry allow surgeons to choose an appropriate surgical approach to avoid iatrogenic infraorbital nerve injury.

Resumo: Introdução: O trajeto do canal infraorbitário pode predispor o nervo infraorbitário a lesões durante cirurgias reconstrutoras e endoscópicas com manipulação do teto do seio maxilar. Objetivo: Investigamos a morfometria e as variações do canal infraorbitário e objetivamos demonstrar a relação entre elas, visando as abordagens endoscópicas. Método: Este estudo retrospectivo foi realizado em imagens de tomografia computadorizada multidetectora de seios paranasais de 200 pacientes. Resultados: Os tipos de corpos do canal infraorbitário foram categorizados como Tipo 1; inseridos no teto ósseo maxilar (55,3%), Tipo 2; projetando-se parcialmente dentro do seio maxilar (26,7%), Tipo 3; dentro do seio maxilar (9,5%), Tipo 4; localizado anatomicamente no limite externo do recesso zigomático do osso maxilar (8,5%). A angulação interna e o comprimento do canal infraorbitário, os ângulos de entrada do forame infraorbitário e as distâncias relacionadas à localização do forame foram medidos e suas relações com as variações do canal infraorbitário foram analisadas. Observamos que as angulações internas em ambos os cortes sagital e axial foram encontradas em sua maioria em canais infraorbitários Tipo 1 e 4 (69,2%, 64,7%) e, no geral, não houve angulação no canal Tipo 3 (68,4%) (p < 0,001). O comprimento do canal infraorbitário e as distâncias desde o forame infraorbitário até o rebordo infraorbitário e a abertura piriforme foram medidos e os mais longos foram identificadas no Tipo 3 e os mais curtos no Tipo 1 (p < 0,001). Os ângulos de entrada do forame infraorbitário em projeção sagital foram significativamente menores no Tipo 3 e maiores no Tipo 1, em relação aos outros tipos (p = 0,003). Septos nos seios maxilares e as células de Haller foram observados em 28% e 16% das imagens, respectivamente. Conclusão: O conhecimento preciso dos tipos de corpo do canal infraorbitário e a relação com a morfometria permitem que o cirurgião escolha uma abordagem cirúrgica apropriada para evitar lesões iatrogênicas do nervo infraorbitário.

A comparison of anatomical measurements of the infraorbital foramen of skulls of the modern and late Byzantine periods and the golden ratio / Comparación de las medidas anatómicas del foramen infraorbitario en cráneos de la época bizantina tardía, edad moderna y la proporción áurea

The aim of this study was to examine the morphometric characteristics of the infraorbital foramen of skulls of people living in modern society and in the late Byzantine period, to ascertain the symmetry or asymmetry of the two halves of the skulls by measuring the linear distance between various landmarks, to evaluate at the conformity between the infraorbital foramen and the golden ratio by calculating the ratios between these linear distances, and to set out the differences or similarities between the skulls of these different periods. It was found in the study that the morphometric characteristics of the infraorbital foramen in skulls of the modern period were 47.05 % circular, 41.17 % oval and 11.76 % atypical (semilunar and triangular) on the right, and 70.58 % circular and 29.41 % oval on the left, while those of the Byzantine period were 46.06 % circular and 53.3% oval on the right, and 50% circular and 50 % oval on the left. It was found that the measurements across the infraorbital foramen of the Byzantine skulls averaged 2.93±1.05 mm and 3.15±1.03 mm on the right side and 2.62±0.97 mm and 3.16±0.68 mm on the left vertically and horizontally respectively, and those of the modern period measured 2.32±0.50 mm and 3.00±0.92 mm on the right and 2.48±0.45 mm and 2.76±0.65 mm on the left vertically and horizontally respectively. The ratio between the distances from the outer orbital wall of the IOF to the sagittal plane and the piriform aperture were 1.46±0.25 mm and 1.40±0.21 mm for left and right respectively for the Byzantine skulls, and 1.24±0.24 mm and 1.29±0.42 mm for the modern skulls. A significant difference was found between the ratio obtained and the golden ratio for each of the periods (modern and Byzantine) (p<0.005). A comparison of anatomical characteristics of the infraorbital foramen of people living at different historical periods is important for anthropologists and knowing morphological types and amassing knowledge on the proportional calculation of location is important for dentistry, maxillofacial surgery and algology.

El objetivo fue examinar las características morfométricas de los forámenes infraorbitarios en cráneos de personas que viven en la sociedad moderna y aquellas que vivieron en el periodo bizantino tardío, para determinar la simetría o asimetría de las dos mitades de los cráneos. Se realizó la medición de la distancia lineal entre varios puntos de referencia, para evaluar la conformidad entre el foramen infraorbitario (FO) y la proporción áurea, mediante el cálculo de la relación entre esas distancias lineales, así como las diferencias y similitudes entre los cráneos de estos períodos. En relación a las características morfométricas, se encontraron en cráneos de la época moderna FO circulares (47,05%), ovalados (41,17 %) y atípicos (semilunar y triangular) en un 11,76 %, del lado derecha, y en el lado izquierdo estos porcentajes correspondieron a circulares (70,58 %) y ovalados (29,41%). Por su parte, los cráneos del período bizantino presentaron FO circulares (46,06 %) y ovalados (53,3 %) del lado derecho, mientras que del lado izquierdo fueron circulares (50 %) y ovalados (50 %). Se encontró que las medidas del FO de los cráneos bizantino tuvo un promedio de 2,93±1,05 mm y 3,15±1,03 mm en el lado derecho, y 2,62±0,97 mm y 3,16±0,68 mm a la izquierda, vertical y horizontal, respectivamente; y en el período moderno midieron 2,32±0,50 mm y 3,00±0,92 mm a la derecha y 2,48±0,45 mm y 2,76±0,65 mm a la izquierda, en medidas verticales y horizontales respectivamente. La relación entre las distancias de la pared orbitaria exterior del FO al plano sagital y la apertura piriforme fue de 1,46±0,25 mm y 1,40±0,21 mm, a izquierda y derecha respectivamente, para los cráneos bizantinos; y 1,24±0,24 mm y 1,29±0,42 mm para los cráneos modernos. Se encontró una diferencia significativa entre la proporción obtenida y la proporción áurea para cada uno de los períodos (moderno y bizantino) (p <0,005). La comparación de las características anatómicas del FO de individuos que vivieron en diferentes períodos históricos es valioso para los antropólogos y los conocimientos sobre el cálculo proporcional de la ubicación del FO son importantes en la odontología, cirugía maxilofacial y el estudio del dolor.

Morphometric study on the infraorbital foramen in relation to sex and side of the cranium in northeastern Brazil / 대한해부학회지

Detailed knowledge of the possible anatomical and morphometric variations of the infraorbital foramen (IOF) is important for ensuring safe and successful regional anesthesia, and for avoiding iatrogenic nerve injuries during surgery on the middle third of the face. To conduct a morphometric study on the IOF, correlating this with sex and side of the cranium. Two hundred forty-two crania were used (148 male and 94 female). Measurements were made with the aid of digital calipers with precision to 0.01 mm. Presence of foramina and their multiplicity was also observed. The data were analyzed descriptively and analytically. Statistical significance was stipulated as 5% (P≤0.05). The IOF was found bilaterally in all the crania, and 26 of them presented multiplicity. The distance from the IOF to the anterior nasal spine was greater in males on both sides (P<0.001). Statistical differences between the sexes were also seen in relation to the following morphometric variables: height of the left IOF (P=0.007), width of the right IOF (P=0.004), and width of the left IOF (P=0.008), and the measurements were also larger among males. The IOF was present in all the crania and on both sides. It was morphometrically larger in males, on both sides.

Anthropometric Measurements of Infraorbital Foramen and its Anatomic Variations in Dried Human Skulls.

Aim: This study was to determine the distance between IOF and IOM, IOF and pyriform aperture,the presence of accessory foraminae, orientation and location in relation with teeth on both the sides. Materials and Methods: Fifty dried human skulls (100 sides) irrespective of age and sex were used for this study. The distance between the IOF and IOM and the distance between the IOF and pyriform aperture were measured by using manual vernier calliper. The orientation, location in relation with teeth and presence of accessory foramina were observed macroscopically. Observations and Discussion: Accessory foramina may give complications during anaesthetization of this region. The mean distance between the IOF and infraorbital margin was 22.6mm and 15.2mm on the left and right side respectively. Mean distance between I.O.F and pyriform aperture was 26.2mm and 25.8mm on the left and right side respectively. In 30% skulls the IOF were directed vertically downward on the right side and in 38% on the left side. In 66% downward medially on the right side and 56% on the left side and in4% skulls medially on the right side and 6% on the left side. The majority of IOF were oriented to second premolar teeth on the right side and between second premolar and first molar on the left side.Accessory foraminae were found in 6% of skulls. The results of our study may be helpful during surgical procedures in the maxillary region in reduction of Lefort fracture, and giving regional nerve block.

Accessory Infraorbital Foramen And Morphometric Localization Of Infraorbital Foramen In North Indian Region.

Abstract: Background: Aim of present study was to note the frequency of accessory infraorbital foramen in north Indian population and to determine the distance of infraorbital foramen from various anatomical landmarks in adult dry human crania. Methodology: 64 adult north Indian dry human crania of unknown age and gender were analysedfor the presence ofaccessoryinfraorbital foramen and their unilateral or bilateral prevalence was calculated.Shortest distance between the infraorbital foramen from midline, pyriform margin, nasion, infraorbital margin, anterior nasal spine and frontozygomatic suture was measuredon both sides in each craniawith Vernier caliper accurate to 0.1 mm for linear measurement.Observations thus made were compiled and tabulated followed by comparison using appropriate statistical tests. Results: Prevalence of accessory infraorbital foramen is 7.81%, while bilateral prevalence of accessory infraorbital foramen is only 1.56 %, however unilaterally accessory infraorbital foramen is present in 6.25% (2.34 % on right side and 3.9 % on left side). Mean shortest distance of infraorbital foramen from midline was 34.78 ± 3.19mm, while mean shortest distance between the infraorbital foramen to the pyriform margin was 21.26 ± 2.78 mm.Mean shortest distance of infraorbital foramen to the nasion andinfraorbital marginwas 44.95 ± 4.62mm. and 6.58 ± 1.59 mm respectively.Mean shortest distance of infraorbital foramen to the anterior nasal spine and frontozygomatic suture was 36.63 ± 3.16mm.and 35.62 ± 1.98 mm respectively. Conclusion: The knowledge of the distances from surgically encountered anatomic landmarks may be of assistance in locating these important maxillofacial neurologic structures during many procedures. Understanding the location of these foramina will also assist the clinician in performing local anesthetic blocks.

Descriptive and Topographic Anatomy of Infraorbital Foramen and Its Clinical Implication in Nerve Block.

Introduction: The aim of this study is to document the morphological and topographical anatomy of the infraorbital foramen (IOF) in relation to the infraorbital rim (IOR) and piriform opening of the nose which is necessary in clinical situations that requires regional nerve blocks. Methods: A total of 100 Indian dry adult human skulls of unknown age and gender were studied. In each skull the IOF’s location was measured with IOR and piriform opening of the nose as reference points. The transverse and vertical diameters of the foramen were also measured. The orientation of accompanying groove and any accessory foramen was noted. Results: Majority of infra-orbital foramina were directed inferomedially on both the right (53.53 percent) and left (53.12 percent) sides. The overall combined distance between the IOR and IOF was 2 to 12 (6.7 ± 1.67) mm, the combined distance between piriformaperture and IOF was 11 to 23 (17.4 ± 2.43)mm. The overall combined vertical diameter was 2 to 7 (4.3 ± 0.95) mm. The overall combined transverse diameter was 1 to 5 (3.6 ± 0.84) mm. Eleven (5.64 percent) accessory infraorbital foramina were found. Conclusion: Knowledge of the anatomical characteristics of IOF locations, diameters, directions and its accessory foramina may have important implications in blocking the infraorbital nerve for surgical and local anaesthetic planning.

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.

A genderwise study on the morphometry of infraorbital foramen and its laterally in dry adult skulls of South Indian population.

Background: The infraorbital foramen is situated in the maxilla and it conveys infraorbital nerve and vessel, the knowledge of its morphometry and variations is therefore mandatory to do therapeutic infraorbital nerve block or any clinical procedures. Aims & Objective: To study the gender wise morphometry of infraorbital foramen and its laterality in dry adult skulls of south Indian population. Materials and Methods: In the present study we examined 100 infraorbital foramina and measured its distance with bony features adjacent to it and the shape, presence of accessory foramina were analysed in relation to gender. The infraorbital foramen was the landmark from which the distance between the following bony structures were examined; Nasion (NAS), Zygomatico-maxillary suture (ZMS), Anterior nasal spine (ANS), and the distance between the inferior orbital rim(IOR) to optic canal (OC), infraorbital foramen IOF), inferior and superior orbital fissure (IF & SF). The average mean and standard deviation were calculated for every measurement. Paired t – test was used to compare the parameters between sides and gender for each measurement. Results: The most common shape of infraorbital foramen found in the present study is oval (39%) followed by semilunar (27%). Round shaped foramen was found in 22% of skulls, triangle shaped foramen was found in 12% and accessory foramina were present in 11% of the skulls. In the present study, we found triangle shaped foramen in 12% skulls and also the number of accessory foramina was found to be higher which emphasise the need to take ethnicity into account as triangle shaped foramen is unique in south Indian population as affirmed by previous authors. Conclusion: The results show significance with respect to gender and side which makes the knowledge of its morphometry obligatory for clinical procedures.

Morphometric study of infraorbital foramen in dry human skulls.

Background & Objectives:To study the most precise location, shape and direction of infraorbital foramen in dry human skulls, in relation to Infraorbital Margin, Piriform Aperture(PA) and Upper Alveolar Margin(AM). Method: A total of one hundred dry human skulls of unknown gender were measured using digital calliper with Infraorbital Margin, Piriform Margin and Alveolar Margin as reference points. The location, shape, size, direction and number of accessory foramina were observed. Results: The mean distance between the Infraorbital Margin(IOM) and Infraorbital foramen(IOF) was 7.82mm. There was a statically significant difference on right and left sides. The mean distance between the IOF and the piriform aperture(PA) was 16.01mm. The overall vertical diameter of the IOF was 3.23±0.98mm (right) and 3.25±1.03mm (left ). The overall horizontal diameter of IOF was 3±0.76mm(right) and 3.28±0.99mm ( left).The majority of IOF were directed inferiomedially on both the right (51%) and left (50%) side. There was a superiomedially directed IOF in 1% of skulls, which was not mentioned in the previous literatures. Accessory foramina were found in 20% skulls. Interpretation & Conclusion: Infraorbital foramen is located close to important anatomical structures like orbit, nose, oromaxillary sinuses and upper teeth. The knowledge of anatomical characteristics of the location ,dimension, shapes, directions and number of accessory foramina have clinical implications in the infraorbital nerve block. This information should be kept in mind during local anaesthetic planning for surgeries in the field of Dentistry, ENT, Anaesthesia, Ophthalmology and Surgery.

A morphological and biometric study of the infraorbital foramen (E2 - sibai point) in adult skulls / Estudio morfológico y biométrico del foramen infraorbital (Punto E2 - sibai) en cráneos de adultos

The objective of this work was to study the morphology and biometry of the infraorbital foramen (FIO), variations in its shape, size and number as well as to obtain measurements of its location. 60 dry skulls were analyzed. The test of Qui-quadrant and the T Test were used in measurements with a 5 percent significance. On the right side, the FIO was measured at a distance of 6.49(+/-1.68) mm from the lower, 39.65(±3) mm from the upper, 17.7(+/-2.97) mm from the medial and 20.46(+/-2.9) mm from the lateral margin of the orbit; its pear-shaped opening distance was 13.67(+/-2.17) mm. On the left side, the distance of the FIO to the lower margin of the orbit was 6.52(+/-1.82) mm; to the upper margin was 39.9(+/-2.62) mm and to the lateral and medial margin were 17.93(+/-2.58) mm and 21.12(+/-3) mm, respectively; its distance to the pear-shaped opening was 14.26(+/-1.83) mm. It was found predominately in an oval shape, in 39 (65 percent) of the skulls, on both sides. Accessory foramens were present in 11 samples on the right and in 15 samples on the left side. The FIO was most frequently found on the side of, or laterally to the sagittal plane that passes through the middle of the supraorbital foramen/ incisures, in 38 skulls (63.3 percent) on the right side and in 45 skulls (75 percent) on the left and middle to the zigomatic-maxillary suture, in 41 skulls (68.3 percent) on right and in 42 skulls (70 percent) on the left side, besides being most frequently found in a region between the first and second premolars, in 22 skulls (36.7 percent) on the right side and in 17 skulls (28.3 percent) on the left...

El objetivo de este trabajo fue estudiar la morfología y biometría del foramen infraorbitario (FIO), las variaciones en su forma, tamaño y número y además, determinó su ubicación.Se utilizaron 60 cráneos aplicándose las prueba de Chi-cuadrado y t student con una significancia del 5 por ciento.En el lado derecho, la distancia del FIO al margen inferior de la órbita fue de 6,49 (+/- 1,68) mm, 39,65 mm (+/- 3) al margen superior mm, 17,7 mm (+/- 2,97) al margen medial y 20,46 (+/- 2,9) y al margen lateral de la órbita, respectivamente. La distancia de apertura fue 13,67 (+/- 2,17) mm.En el lado izquierdo, la distancia del FIO al margen inferior de la órbita fue 6,52 (+/- 1,82) mm; al margen superior fue 39,9 (+/- 2,62) mm y a los márgenes lateral y medial fue 17,93 (+/- 2,58) mmy 21,12 (+/- 3) mm, respectivamente. La distancia a la abertura piriforme fue 14,26 (+/- 1,83) mm. Su forma era predominantemente ovalada, en 39 (65 por ciento) de los cráneos. Forámenes accesorios estaban presentes en 11 muestras en el lado derechoy en 15 muestras en el lado izquierdo.El FIO estaba localizado más frecuentemente lateral al plano sagital que pasa por el centro del foramen supraorbital. De estos casos, en 38 cráneos (63,3 por ciento) en el lado derecho y en 45 cráneos (75 por ciento) en el lado izquierdo.Los FIO estaban en el punto medio de la sutura cigomática-maxilar en 41 cráneos (68,3 por ciento) en el lado derecho y en 42 cráneos (70 por ciento) en el lado izquierdo. Los FIO estaban más frecuentemente localizados en relación al primer y segundo premolares, en 22 cráneos (36,7 por ciento) en el lado derecho y en 17 cráneos (28,3 por ciento) en el lado izquierdo...

Morphometric Analysis of the Supraorbital and Infraorbital Foramina Based on the Medial Canthus in Koreans / 체질인류학회지

Knowledge of the location of the maxillo-facial foramina is essential for regional nerve blocks and endoscopic surgical procedures to avoid nerve injury passing through these foramina. The purposes of this study were to determine the locations of the supraorbital foramen (SOF) and the infraorbital foramen (IOF) related to medial canthus (MC), and to analyze the morphology of these foramina. Thirty-two embalmed cadavers (64 sides, mean age: 64.1 years) and 33 dry skulls (66 sides) were used. The distances from the SOF, IOF, and MC to facial midline were directly measured on the cadavers using digital Vernier caliper. The vertical and horizontal distances of the SOF and IOF relative to the medial canthus were indirectly measured on the digital photographs using image analyzer software. The vertical and horizontal diameters of the IOF, and its location in relation to maxillary tooth were evaluated on the dry skull. Statistical analysis was performed using one-way ANOVA with declaration of significant difference when P<0.05. The mean distances of SOF, MC, and IOF to the facial midline were 24.13 mm, 15.00 mm, and 29.11 mm, respectively. The SOF was located 18.99 mm superior and 9.05 mm lateral to the medial canthus. The distance between the medial canthus and the SOF was 22.67 mm, and the vertical angle (Angle 1) between these structures was 24.36degrees superolaterally. The IOF was located 26.69 mm inferior and 13.53 mm lateral to the medial canthus. The distance between the medial canthus and IOF was 30.82 mm and the vertical angle (Angle 2) between these structures was 26.59degrees inferolaterally. In the this study, spraorbital notch (SON) was found more frequently than the SOF. The mean vertical and horizontal diameters of IOF were 3.36 mm, 3.45 mm, respectively. IOF was most commonly found in the same vertical plane with the second upper premolar. In conclusion, these results are important for performing local anesthetic, facial plastic surgery, and other invasive procedures in the forehead and periorbital region to prevent injury of neurovascular bundles passing through these foramina.

Localization of the Mental and Infraorbital Foramen with related to the Soft-tissue Landmarks

During maxillofacial surgery, the infraorbital and mental nerves are blocked at eac foramen to induce local anesthesia. This study examined the relative locations of the infraorbital foramen (IOF) and mental foramen (MF) based on soft-tissue landmarks. Twenty-eight hemifacial cadavers were dissected to expose the IOF and MF. The distances between the bilateral IOFs, the bilateral MFs, the alae of the nose (alares), and the corners of the mouth (cheilions) were measured directly on cadavers by using a digital vernier caliper. The vertical and horizontal distances of the IOF and MF relative to the alare and cheilion were measured indirectly on digital photographs using Adobe Photoshop (Adobe, CA, USA). The distance between the bilateral IOFs (58.09 +/- 4.04 mm) was longer than the distance between the bilateral MFs (50.32 +/- 1.93 mm). The distances between the bilateral alares and cheilions were 41.22 +/- 3.44 mm and 58.43 +/- 6.62 mm, respectively. The IOF was located 12.92 +/- 3.75 mm superior and 7.88 +/- 2.56 mm lateral to the alare, and the vertical angle (Angle 1) between these structures was 31.67 +/- 13.36degrees superolaterally. The MF was located 21.83 +/- 3.26 mm inferior and 5.56 +/- 3.37 mm medial to the cheilion, and the vertical angle (Angle 2) between these structures was 14.05 +/- 10.12degrees inferomedially. In conclusion, these results provide more detailed information about the locations of the IOF and MF relative to soft-tissue landmarks.

Morphometric analysis of infraorbital foramen in Indian dry skulls / 대한해부학회지

We analyzed the variability in position, shape, size and incidence of the infraorbital foramen in Indian dry skulls as little literature is available on this foramen in Indians to prevent clinical complications during maxillofacial surgery and regional block anesthesia. Fifty-five Indian skulls from the Department of Anatomy CSM Medical University were examined. The 110 sides (left and right) of the skulls were analyzed by measuring the infraorbital foramina distances from infraorbital margin and the piriform aperture on both sides. The vertical and horizontal dimensions were also measured. All measurements were taken with a compass transferred to calipers and analyzed statistically. The mean distances between the infraorbital foramen and the infraorbital margin on the right and left side were 6.12 mm and 6.19 mm, respectively. The mean distances between the infraorbital foramen and the piriform aperture were 15.31 mm and 15.80 mm on the right and left sides, respectively. The mean vertical dimensions on the right and left side were 3.39 mm and 3.75 mm, respectively. The mean horizontal dimensions on the two sides were 3.19 mm and 3.52 mm. These results provide detailed knowledge of the anatomical characteristics and clinical importance of the infraorbital foramina which are of paramount importance for surgeons when performing maxillofacial surgery and regional block anesthesia.

Morphometric analysis of the infraorbital foramen in adult Sri Lankan skulls / Análisis morfométrico de la fosa infraorbital en cráneos de singaleses adultos

Evidence supports a clear racial variation in the position of the infraorbital foramen. Therefore detailed knowledge of the population specific data on biometric features of the infraorbital foramen will facilitate therapeutic, diagnostic 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 infraorbital foramen with reference to surrounding anatomical landmarks in an adult Sri Lankan population. A total of one hundred and eight adult dry skulls were assessed to determine the number, shape, orientation, vertical and transverse diameters of the infraorbital foramen, transverse distance from the infraorbital foramen to the maxillary midline and the zygomatico-maxillary suture and the vertical distance from the infraorbital foramen to the infraorbital rim and supraorbital foramen. The position of the infraorbital foramen was determined in relation to the maxillary teeth and the supraorbital foramen.The findings indicated that the size of the infraorbital foramen and the mean distances from the infraorbital foramen to the maxillary midline, infraorbital rim and supraorbital foramen was significantly larger in males than in females. The modal position for the infraorbital foramen was in line with the long axis of the second upper premolar and the supraorbital and infraorbital foramina were lying in the same sagittal plane only in 24.07 percent of the skulls. The results highlight the racial and gender differences of the infra orbital foramen and emphasize the need for meticulous preoperative evaluation of the infraorbital foramen in patients who are candidates for maxillo-facial surgeries and regional block anesthesia.

En la posición del foramen infraorbitario se evidencia una clara influencia racial. Por tanto, un conocimiento detallado de los datos específicos de la población sobre las características biométricas del foramen infraorbitario facilitará la terapéutica, diagnóstico y manipulaciones quirúrgicas en la región maxilo-facial. El objetivo de este estudio fue, dilucidar las características morfológicas y anatómicas de la posición exacta del foramen infraorbitario, en una población adulta de Sri Lanka, con referencia a los forámenes que los rodean. Un total de 108 cráneos adultos secos fueron evaluados para determinar el número, forma, orientación, diámetros vertical y transversal del foramen infraorbitario, distancia transversal desde el foramen infraorbitario a la línea mediana del maxilar y la sutura cigomático-maxilar y la distancia vertical desde el foramen infraorbitario hasta el margen infraorbitario y al foramen supraorbitario. La posición del foramen infraorbitario se determinó en relación con los dientes superiores y al foramen supraorbital. Los resultados indicaron que el tamaño del foramen infraorbitario y las distancias medias desde éste a la línea mediana superior, reborde infraorbitario y al foramen supraorbitario fue significativamente mayor en varones que en mujeres. La posición modal para el foramen infraorbitario estuvo en línea con el eje longitudinal del segundo premolar superior, localizándose los forámenes supraorbitario e infraorbitario en el mismo plano sagital sólo en el 24,07 por ciento de los cráneos. Los resultados destacan las diferencias raciales y de género del foramen infraorbitario y enfatizan la necesidad de una evaluación preoperatoria meticulosa de este foramen en los pacientes que son candidatos a cirugías maxilofaciales en el bloqueo anestésico regional.

Bilateral variations and sexual dimorphism in morphometric parameters of infraorbital groove, canal and foramen in human foetuses / Variaciones bilaterales y dimorfismo sexual en los parámetros morfométricos del surco, canal y foramen infraorbitario en fetos humanos

Foetal anatomy seems to be highly promising developing speciality in the recent past. Maxilla is the key to facial skeleton. Its anatomy in general and bilateral variations along with sexual dimorphism in particular are of great surgical and forensic importance. Thirty two maxillae of sixteen human foetuses (21 wks to 34 wks) were considered to measure lengths of infraorbital groove and canal, widths of ends of infraorbital groove, diameters of infraorbital foramen and the distances of latter from infraorbital margin and nasal notch. Groups I (21-25 wks) and II (26-30 wks) foetuses were crucial for bilateral variations for most of the parameters. Distance between infraorbital foramen and nasal notch showed variations on two sides in maximum foetal groups. Infraorbital canal was found to be larger in groups II and III foetuses in females. Width of the posterior end of infraorbital groove was less in group I, equal in group II and more in group III in males. Sexual dimorphism was noticed in all the groups for the distance of infraorbital foramen from infraorbital margin. Distance of infraorbital foramen from nasal notch did not show sexual dimorphism in most of the groups except group I where value was more in males. Rule of generalized phenomenon of larger skeleton in male was not applicable in most of the groups.

La anatomía fetal, con su desarrollo en los últimos años, parece ser especialidad muy prometedora. El maxilar es la clave del esqueleto facial. Su anatomía en general y las variaciones bilaterales junto al dimorfismo sexual en particular, son de gran importancia quirúrgica y forense. Fueron estudiados 32 maxilares de 16 fetos humanos (21 semanas a 34 semanas) en los cuales se midió la longitud del surco y canal infraorbitario, anchos de los extremos de surco infraorbitario, diámetros del foramen infraorbitario y las distancias de este último desde el margen infraorbitario hasta la escotadura nasal. Las variaciones bilaterales en la mayoría de los parámetros fue en los grupos de fetos I (21-25 semanas) y II (26-30 semanas). La distancia entre el foramen infraorbitario y escotadura nasal mostró variaciones máximas en dos partes en los grupos de fetos. El canal Infraorbitario resultó ser más largo en los grupos II y III de fetos femeninos. El ancho del extremo posterior del surco infraorbitario fue menor en el grupo de fetos masculino I, igual en el grupo II y mayor en el grupo III. El dimorfismo sexual se observó en todos los grupos en la distancia desde el foramen infraorbitario hasta el margen infraorbitario. La distancia desde el foramen infraorbitario hasta la escotadura nasal no mostró dimorfismo sexual en la mayoría de los grupos a excepción del grupo I, donde el valor fue mayor en los hombres. La norma generalizada que el esqueleto más grande es del género masculino no fue aplicable en la mayoría de los grupos.

Morphometric analysis of infraorbital foramen and infraorbital canal in human feotuses / Análisis morfométrico del foramen infraorbitario y canal infraorbitario en fetos humanos

Literature regarding analysis of infraorbital foramen and canal exists in adult but it is scanty in foetuses. Morphometric measurements were performed in sixty maxillae dissected out from thirty human foetuses. The latter were divided into five groups on the basis of age i.e. groups I(<17 weeks IUL),II (17-20 weeks IUL), III (21-25 weeks IUL),IV (26-30 weeks IUL) and V (>30 weeks IUL).Four parameters considered were length of infraorbital foramen and canal and width of anterior and posterior ends of infraorbital foramen. Range of measurements between the smallest fetal group to largest fetal group for length of infraorbital foramen and canal and width at the anterior and posterior ends of infraorbital foramen were 4.01mm to 6.00 mm,0.67 mm to 2.60 mm,0.64 mm to 1.65 mm and 1.39 mm to 3.01 mm, respectively.The shape of the infraorbital foramen is maintained in most of the groups. Correlation coefficient analysis between measurements of lengths and aging foetuses is indicative of variable osteoblastic and osteoclastic activities. Enhanced osteoblastic activity seems to be an important phenomenon in postnatal life.

Existe literatura en relación con el análisis de foramen y canal infraorbitarios en adultos pero es escasa en fetos. Se realizaron mediciones morfométricas en 60 maxilares disecados de 30 fetos humanos. Los fetos fueron divididos en cinco grupos en función de la edad, es decir los grupos I (<17 semana VIU), II (17-20 semanas VIU), III (21-25 semanas VIU), IV (26-30 semanas VIU) y V (> 30 semanas VIU). Fueron considerados cuatro parámetros : longitudes del foramen y canal infraorbitario y anchos anterior y posterior de los extremos del foramen infraorbitario. El rango de las mediciones entre el grupo de fetos más pequeño al grupo más grande tanto de las longitudes del foramen y canal infraorbitario como los anchos de los extremos en la parte anterior y posterior del foramen infraorbitario fueron: 4.01mm a 6.00 mm, 0.67 mm a 2.60 mm, 0.64 mm a 1.65 mm y 1.39 mm a 3.01 mm, respectivamente. La forma del foramen infraorbitario se mantuvo en la mayoría de los grupos. El análisis del coeficiente de correlación entre las mediciones de longitudes y edades de los fetos, es indicativo de las variables de actividades osteoblástica y osteoclástica. El aumento de la actividad osteoblástica parece ser un fenómeno importante en la vida postnatal.