Infraorbital canal variants and its clinical and surgical implications. A systematic review.

BACKGROUND: Recent literature highlights anomalous cranial nerves in the sinonasal region, notably in the sphenoid and maxillary sinuses, linked to anatomical factors. However, data on the suspended infraorbital canal (IOC) variant is scarce in cross-sectional imaging. Anatomical variations in the sphenoid sinuses, including optic, maxillary, and vidian nerves, raise interest among specialists involved in advanced sinonasal procedures. The infraorbital nerve's (ION) course along the orbital floor and its abnormal positioning within the orbital and maxillary sinus region pose risks of iatrogenic complications. A comprehensive radiological assessment is crucial before sinonasal surgeries. Cone-beam computed tomography (CBCT) is preferred for its spatial resolution and reduced radiation exposure. OBJECTIVE: The aim of this study was to describe the prevalence of anatomical variants of the infraorbital canal (IOC) and report its association with clinical condition or surgical implication. METHODS: We searched Medline, Scopus, Web of Science, Google Scholar, CINAHL, and LILACS databases from their inception up to June 2023. Two authors independently performed the search, study selection, data extraction, and assessed the methodological quality with assurance tool for anatomical studies (AQUA). Finally, the pooled prevalence was estimated using a random effects model. RESULTS: Preliminary results show that three types are prevalent, type 1: the IOC does not bulge into the maxillary sinus (MS); therefore, the infraorbital foramen through the anterior wall of MS could be used for identification of the ION. Type 2: the IOC divided the orbital floor into medial and lateral aspects. Type 3: the IOC hangs in the MS and the entire orbital floor lying above the IOC. From which the clinical implications where mainly surgical, in type 1 the infraorbital foramen through the anterior wall of MS could be used for identification of the ION, while in type 2, since the lateral orbital floor could not be directly accessed an inferiorly transposition of ION is helpful to expose the lateral orbital wall directly with a 0 scope; or using angled endoscopes and instruments, however, the authors opinion is that direct exposure potentially facilitates the visualization and management in complex situations such as residual or recurrent mass, foreign body, and fracture located at the lateral aspect of the canal. Lastly, in type 3, the ION it's easily exposed with a 0° scope. CONCLUSIONS: This systematic review identified four IOC variants: Type 1, within or below the MS roof; Type 2, partially protruding into the sinus; Type 3, fully protruding into the sinus or suspended from the roof; and Type 4, in the orbital floor. Clinical recommendations aim to prevent nerve injuries and enhance preoperative assessments. However, the lack of consistent statistical methods limits robust associations between IOC variants and clinical outcomes. Data heterogeneity and the absence of standardized reporting impede meta-analysis. Future research should prioritize detailed reporting, objective measurements, and statistical approaches for a comprehensive understanding of IOC variants and their clinical implications. Open Science Framework (OSF): https://doi.org/10.17605/OSF.IO/UGYFZ .

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.