The National Ribat University Faculty of Graduate Studies...
Transcript of The National Ribat University Faculty of Graduate Studies...
بسم هللا الرحمن الرحيم
The National Ribat University
Faculty of Graduate Studies & Scientific Research
Anatomical Variation of Infraorbital Foramen
in Patients Attending Radiology Department At The National
Ribat University Hospital
Thesis Submitted in Partial Fulfillment Required for the MSc in Human & Clinical
Anatomy
By: Amira Izzeldin O. Eltay
Superviser: Prof. Tahir Osman Ali
2015
الآيةن { ار لآايت لويل الألباب ا موات والرض واختالف الل يل والن (190) يف خلق الس
موات والرض ين يذكرون هللا قياما وقعودا وعىل جنوبم ويتفك رون يف خلق الس ال
}(191) الن ار رب نا ما خلقت هذا ابطال س بحانك فقنا عذاب
آل معران{ }آ
إلهداءا لونتني مي التيأالذي رسمني و أبي الى
رب ارحمهما كما رب ياني صغيرا
Acknowledgement:
I would like to express my sincere gratitude to my Supervisor Prof. Tahir Osman
Ali for the continuous support of my MSc study and research, for his patience,
motivation, enthusiasm, and immense knowledge. His guidance helped me during all
the time of research and writing of this thesis. I could not have imagined having a
better supervisor for my MSc study.
I would like to thank the rest of the staff in the MSc programe Dr.Kamal Eldin
Elbadawi, Dr.Abbas Ghareeb Allah, Dr.Yasser Seddig & Dr.Hayder Debi for their
encouragement, & motivation.
I would like to thank Radiology Department at The National Ribat University
Hospital and specially Tech.: Mohamed Oshik & Emam Mohamed for technical
support in CT measurements.
My sincere thanks also go to Faculty of Dentistry in The National Ribat University
& specially Department of Periodontology for their encouragement understanding,
kindness, & offering me time to do my MSc duties.
Finally, I would like to thank my lovely Family & Friends who were always there
cheering me up and standing by me through the good & bad times.
Abstract
Introduction: The aim of this study is to document the anatomical variations of
infraorbital foramen (IOF) in shape, the frequency of accessory foramen, & in
relation to the infraorbital rim (IOR) and piriform aperture (PA) which is necessary
in clinical situations that require regional nerve blocks.
Methods: A total of 30 adult normal brains CT (3D) were studied. In CT (3D) the
IOF location was measured with IOR and PA as reference points. The orientation &
vertical relation to upper teeth of the foramen was noted. The presence of accessory
foramen was taken in consideration
Results: 70% of infra-orbital foramina were directed inferiorly. Accessory
infraorbital foramina were not found. The mean distance between the IOR and IOF
was 8.53 mm on the right side and 8.61 mm on the left side. The mean distance
between the IOR & PA on the right side was 15.49 mm and 15.69 mm on the left
side.
Conclusion: Knowledge of the anatomical characteristics of IOF locations,
directions and its accessory foramina may have important implications in blocking
the infraorbital nerve for surgical and local anaesthetic planning.
ةالدراس ملخص
العين في الشكل و عدد مرات سفلللحفره ا إن الهدف من هذه الدراسة هو توثيق التباين التشريحي :مقدمة
لتي ا وهو أمر ضروري في الحاالت السريرية االنف و فتحة فتها من حافه العين السفليالتكرار و تحديد مسا
.للوجه أ جراحي تتطلب تدخأل
ةحاف ذتن و اخالعي سفلاس موقع الحفره للراس و قي من التصوير المقطعي ةحال 30 درست :األساليب
العمودية باألسنان وعالقتها ةالحفر اتجاه ةمالحظمع االنف كنقاط مرجعية للقياس ةالعين السفلي و فتح
العلوية
افة المسكان متوسط ةلم يتم العثور علي الحفر الثانويلالسفل , كما ةموجه من الحاالت %70 كانت :النتائج
مم 15.69لفتحت االنف ةالمسافة من الحفرو متوسط مم 8.61 العين السفلي ةلحاف ةمن الحفر
يةافضالموقع واالتجاهات و الحفر اال ن فيما يخصالعي سفلا ةللحفر التشريحية الخصائص معرفة :الخاتمه
في هذه المنطقة الجراحة للتخدير و في التخطيط هامة آثار اله
List of tables
Tables Titles Page
2-1 Comparison of parameters measured with other studies. 9
4-1 Distribution of gender in this study.
14
4-2 Number of infraorbital foramen.
14
4-3 Shape of infraorbital foramen.
15
4-4 Direction of opening of the IOF on the right side. 16
4-5 Direction of opening of the IOF on the left side.
17
4-6 Distance of IOF from anatomical landmark.
18
4-7 Vertical orientation of the IOF in relation to the upper
teeth.
18
5-1 Comparison of reported measurements from the IOF to
the IOR. 23
5-2 A comparison of reported measurements from the IOF to
the PA 24
5-3 Comparison of presents of the accessory infraorbital
foramen 25
5-4 Comparison of IOF in relation to its vertical orientation
with the maxillary teeth 26
List of figures
Figures Title Page
1.1 A 3-dimensional model of the skull 4
2.1 Shows the soft tissue landmarks 8
3.1 Skull showing measured parameters. 11
3.2 Schematic draw of the morphometric parameters 12
4-1 Shape of infraorbital foramen 15
4-2 Direction of opening of the IOF in the right side 17
4-3 Direction of opening of the IOF in the left side. 17
4-4 Vertical orientation of the IOF in relation to the upper
teeth 19
Abbreviations
CT : Computed tomography
3D : Three dimensional
IOF : Infraorbital Foramen
IOR : Infraorbital Rim
PA : Piriform Aperture
ION : Infraorbital Nerve
FM : Facial midline
Rt : Right side
Lt : Left side
List of Contents
Title Page
Alayh I
Dedication I I
Acknowledgement I I I
Abstract (English) IV
Abstract (Arabic) V
Lists of figures V I
Lists of tables V I I
Lists of abbreviations V I I I
List Contents IX-X
Chapter I: Introduction, Objectives
1.1 Introduction 1-2
1.2 Justification 3
1.3 Objectives 5
1.3.1. General objective 5
1.3.2.Specific objectives: 5
Chapter II: Literature Review
2.1. Literature review 6-9
Chapter III: Material & Methods
3.1. Study design: 10
3.2. Study area 10
3.3. Study population 10
3.4. Study duration 10
3.5. Sample size & Sampling 10
3.6. Data collection tools and technique 11
3.7. Data analysis 11
Chapter IV: Result
4.1. Results 13 - 19
Chapter V: Discussion
5.1 Discussion 20 - 26
Chapter VI
Conclusions & Recommendations
6.1.Conclusions 28
6.2.Recommendations 29
Chapter VII References
References 30-31
Appendix
Data collection sheet
Chapter I
Introduction & Objectives
1.1 Introduction
The infraorbital foramen (IOF) is one of the most important facial foramina.(1) It is
an anatomical structure with an important location, through which the infra orbital
vessels and nerve exits(2) , which are responsible for the vascular-nervous supply to
important areas of the face.(1) Infraorbital nerve (ION) is a one of three cutaneous
branches of the maxillary division of the trigeminal nerve.(1) The other branches
include the zygomaticofacial nerve and the zygomaticotemporal nerve. Infraorbital
artery is a branch of the third part of the maxillary artery. It runs through the inferior
orbital fissure, orbit, and then the IOF. Here it gives off the anterior superior alveolar
artery which supplies the anterior teeth and the anterior part of the maxillary sinus.
(1, 2)
IOF is situated bilaterally on the maxillary bone, found below the inferior margin of
the orbit.(2) It is an important anatomical landmark that provides excellent analgesia
for the closure of simple lacerations, biopsies, scar revisions, maxillofacial
procedures, as well as various endoscopic and cosmetic cutaneous procedures.(3)
Precise knowledge of the location of reference points in this area provides important
data in local anesthesia and in maxillofacial and plastic surgical operations.(2) The
importance of the incidence and lateralization of the IOF is also evident in facial
surgical procedures. The recognition of the presence of double or triple foramen is
essential when the appropriate amount of anesthesia is applied, or it can be
inappropriate.(2) Information on skull foramen size and symmetry is increasingly
important because of the advancements in radiologic techniques such as magnetic
resonance imaging and computed tomography. These methods are making difficult
diagnoses of pathologic conditions of skull foramina possible. (2) Gruber (1878) was
the first person who evaluated the morphometric assessment of the infraorbital
foramen and reported the presence of accessory supranumerarios foramena which he
propounded as an important variable in anaesthetic valuation (4) & he described the
presence of 5 independent foramens in the end of the infraorbital canal. (4, 5)
1.2. Justification
Recently the local anaesthesia procedures for infraorbital nerve as well as surgery
for this area has been increasing for a diverse multiplicity of reasons, maxillofacial
surgeries (6) rhinoplasty (3), & even aplastic surgery in general (6) that all turned into
common surgeries which need to be brought to a safe end up with the least
complications. Fig (1.1)
Good understanding of the anatomy before the procedure, gives the surgeon enough
idea to take decision on the type of proper incision to be applied generally. The exact
knowing of the position of the infraorbital foramen & number of accessory foramina
is critically important to avoid traumatic and surgical injuries to the infraorbital nerve
and vessels, (6) taking into account its anatomical variability and the potential
irreversible damage that may result as a post-operative complication.(7)
Functional and cosmetic deformities result from injury to the infraorbital
neurovascular due to paralyzed musculature which is clearly evident when patient
smiles, phonates , or chews & loss of sensation to the upper lip & parts of the check,
usually associated with a severe psychological impact on the affected patient.(6) As
a matter of fact such complications could have been avoided if proper technique was
applied during surgery, based on thorough and detailed anatomical knowledge about
anatomical position of IOF.
Figure 1.1: This 3-dimensional model of the skull shows representative
measurements from the infraorbital foramen to the anatomic landmarks. Blue
shading denotes the safe zone; red shading denotes the danger zone.
1.3 Objectives
General objective:
Anatomical Variation of infra orbital foramen
Specific objectives: are to
1. Document the variability in the position of the infraorbital foramen with relation
to infraorbital rim (IOR) and piriform aperture (PA).
2. Analyze the variability in shape, of the infraorbital foramen
3. Study the frequency of accessory infraorbital foramen.
Chapter II
Literature Review
2.1 Literature Review
A sound knowledge of the location of the IOF will be helpful in providing a safer
performance of clinical procedures such as regional anaesthesia as in the case of
repair of cleft lip and other maxillofacial surgeries, and to determine the acupuncture
point in case of treating trigeminal neuralgia and external access to the maxillary
sinus – Caldwell-Luc operations. (6)
The IOF was present on both sides of the maxilla, (1, 4, 5) the presence of multiple IOF
was observed. (1) On the right side of the maxilla, 14 crania presented two foramina.
On the left side, there were nine crania with two foramina; three crania with three
foramina; and one cranium with four foramina. (1) & only one cranium presented
multiple foramina bilaterally (1) The most common shape of infraorbital foramen
found is oval (39%) (4, 7, 8, 9)
followed by semilunar (27%). Round shaped foramen was found in 22% of skulls,
& triangle shaped foramen was in 12 %.(7) IOF has a relatively big diameter
compared to the supraorbital foramen. (3) & it was less than 2 mm in size. (10) Ukoha
etal (11) have proposed that IOF area reflects differences in global temperature climes,
where populations in colder climates are hypothesized to have larger infraorbital
arteries to warm the face, and therefore larger infraoribital foramina, than equatorial
populations. (11)
Some papers report that the infraorbital nerve (ION); infraorbital artery and a vein
are transmitted through the IOF. (1) Other anatomical works suggest that only the ION
and infraorbital artery exit the foramen. (2)
The position of the IOF with respect to the maxillary teeth varied from the interval
between the canine and 1st premolar to the 1st molar (10) but in most of the cases it
was vertically oriented to the 2nd premolar teeth. (4, 6, 9) Aziz etal (12) found it the in the
same vertical plane with the first premolar (12)
The average distance between the IOF and the infraorbital rim was approximately
8.61±1mm, in men and 8.25±1mm. (2, 9) The piriform opening of the nose is an easily
palpable border on the face which can be conveniently used to locate the infraorbital
foramen (13) with average distance in men 17.43±1mm, & 15.69±1mm in women. (2,
9)
IOF are not absolutely symmetrical and may present pair bilateral and or unilateral
opening.(14) The skull that showed multiple foramina all had ipsilateral double
foramina (4). In Cisneiros de Oliveira et al (1) study only one cranium presented with
multiple foramina bilaterally. The presence of the accessory foramen may intervene
with the anesthesia, thus, they suggest that accessory foramen must be considered in
the anaesthesial evaluation and be remembered during the procedures used for the
localization of the foramen.(14)
In the functional analysis performed on the maxillary bone showed that the
occurrence of variation in the width and length of the IOF was dependent on the type
of dentition. The authors have highlighted three points from the IOF: the increase of
the foramen on posterior direction when the downward, forward, and lateral growth,
of the maxillary bone; the IOF is a fixed point of reference to the other maxillary
structures; and a relation between the orientation of the IOF with changes in the
maxillary bone growth. (1) Schwartz (15) also justified the variability of the IOF with
the embryological development of the upper jaw and the dentition.
The location of the IOF has frequently been determined in numerous studies
examining the skulls devoid of soft tissue structures.(1,2,4,5,9,10,13) However the location
of IOF has not been well defined on cadavers according to standard and easily visible
anatomical landmarks. The position of the IOF was determined in reference to the
lateral edge of the ala of the nose, medial and lateral palpebral commissures. All
these three soft tissue landmarks were then connected to each other forming a
triangular shaped region. (16) In most of the cases the IOF was located on the line
which is connecting the lateral palpebral commissure to the ala
of the nose. (16) figure (2.1)
Fig. (2.1): The soft tissue landmarks (lateral edge of the ala of the nose, medial and
lateral palpebral commissures) and the triangular shaped region formed by
connecting all these three soft tissue landmarks were shown. Arrow indicates the
infraorbital foramen which is located on the line connecting the lateral palpebral
commissure to the ala of the nose in this case.
Table (2.1): Showing comparison of parameters measured with
other studies.
Studies
Sample
size
Distance
between the
IOF & IOR
Distance
between the
IOF & PA
Shape Accessory
foramina
Cisneiros (1) 242 Skulls 8 mm *** *** 10.7%.
Ilayperuma (4) 108 skulls M: 10.56 ± 1.74
F: 9.02 ± 1.58 ***
Oval
57.41
%
3.70%
Elias, M.G (5) 210 skulls 6,71±1.70 mm 13,28±2.17
mm *** 50%
Raschke R (6)
44 CT of
hemifaces
M: 8.61 mm
F: 8.25 mm
M:17 mm
F :15.69 mm *** ***
Singh (7) 110 IOF 6.12±1 mm
Rt.
15.31mm
Lt.15.80 mm
*** ****
Ekambaram(9) 100 IOF
M: 7.60 ± 1.07
F: 7.11 ± 1.02
**** Oval
39% 11%
Aggarwal A (10) 67 skulls 6.33 ± 1.39 mm 15.19 ± 1.70
mm
Oval
81.95
%
21% of
the hemi-
skulls
Aziz SR (12) 47cadavers
M: 8.5 mm
F: 7.8 mm
*** *** 15%
Saini K. (13) 100 skulls 6.7 ± 1.67) mm 17.4 ± 2.43
mm. *** 5.64 %
Chapter III
Material & Methods
3. Material & methods
Study design:
A descriptive cross sectional study
Study area
Data will be collected from Radiology Department, The National Ribat
University Hospital.
Study population
Brain 3d Computed Tomography.
Study duration
From August to December 2015.
Sample size & Sampling
A Total of (60 foramena) 30 adult normal brains CT (3D) collected from the
Department of Radiology, Ribat University Hospital will be used for this study.
Both sides of skull CT will be assessed regarding number, shape, and orientation
of the infraorbital foramen recorded by direct visual inspection by the researcher.
The presence of multiple foramena will be checked and the most prominent
foramen will be considered as the primary structure for characterization. The
shape of the infraorbital foramen will be described as an oval, round, or triangular
in shape. The direction of opening of the IOF will recorded as medial, inferior or
inferiomedially.
The distance between the IOF and the infraorbital margin will be measured in
addition to the distance from IOF to the piriform aperture (PA). Figures (3.1, &
3.2)
Data collection tools and technique
A checklist will be used to collect the data to attain the study objectives. This will
be done by the researcher from brain CT (3D).
Data analysis
The data will be entered and analyzed by the software SPSS version 20.
Figure 3.1 Skull showing measured parameters. IOF-IOM: Vertical distance between upper margin of
infraorbital foramen and inferior orbital margin. IOF-AB: Vertical distance between lower
margin of infraorbital foramen and maxillary alveolar border. IOF-ML: Horizontal distance
between medial margin of infraorbital foramen and midline of skull. IOF-PA: Horizontal
distance between medial margin of infraorbital foramen and lateral margin of piriform aperture.
Fig. 3.2. Schematic draw of the morphometric parameters.
a) Transversal measure: a transversal plain that passes by the center of IOF and
gives the value of the distance between the medial border of IOF and the piriformis
opening making a 90؛ angle with sagittal measure; b) Sagittal measure: a sagital
plain which passes by the center of the IOF, parallel to the median sagittal plain and
was gives the value of the distance between the infraorbital margin and the superior
border of IOF.
Chapter IV
Results
4. Results
Thirty 3D normal brains CT were studied to evaluate IOF in both sides, a total of 60
foramina were seen in the study; 22 were adult males and 8 were females. (Table
4.1)
All the skulls studied displayed an IOF on both sides. A single infraorbital foramen
was present bilaterally in all 30 CT. (Table 4.2)
The infraorbital foramen was round in 70% & oval in 30%, no other shapes were
seen. (Table 4.3).
The foramena were directed inferiorly in 70%, inferomedially in 27.7% and medially
in 3.3 % on the right side. (Table 4.4). On the left side the IOF was directed inferiorly
in 73.3%, & 26.7% inferomedially. (Table 4.5).
The distance of the IOF was messured from anatomical landmark piriform aperture
(PA) and infraorbital rim. All meassurement were done in centemiter. The mean
distance between the IOF & the infraorbital rim was 0.853 cm with SD 0.222 on the
right side and 0.8610 cm with SD 0.1818 on the left side. Distance between the IOF
& piriform aperture on the right side 1.549 cm with SD 0.188, and 1.5697 cm with
SD 0.2778 on the left side. (Table 4.6).
Frequencies of the position of the infraorbital foramen in relation to the upper teeth
are shown in Table 4.7 and illustrated in Figure (4.7). The most common position for
the infraorbital foramen relative to the upper teeth was found to be in line between
the first and second upper premolars.
Table (4.1): Distribution of gender in this study.
Gender Frequency Percent
Male 22 73.3
Female 8 26.7
Total 30 100.0
Table (4.2): Number of infraorbital foramena.
Side Number of
foramen Frequency Percent
Right one 30 100
Left One 30 100
Table (4.3): Shape of infraorbital foramen.
Side Shape Frequency percent
Right
Oval 9 30
Round 21 70
Left
Oval 9 30
Round 21 70
Figure (4.1): Shape of infraorbital foramen.
Table (4.4): Direction of opening of the infraorbital foramen (Rt side).
levalFrequency
percent
0
10
20
30
40
50
60
70
Right side Left side
9
21
9
21
30
70
30
70
leval
Frequency
percent
Direction Frequency Percent
Inferior 21 70
Inferiomedial 8 26.7
Medial 1 3.3
Figure (4.2): Direction of opening of the infraorbital foramen (Rt side).
0
10
20
30
40
50
60
70
80
90
100
medial inferior inferiomedially
1
21
83.3
70
26.7
Percent
Frequency
Inferiomedial Inferior Medial
Table (4.5): Direction of opening of the infraorbital foramen Lt side.
Direction Frequency Percent
Inferior 22 73.3
Inferiomedial 8 26.7
Total 30 100.0
Figure (4.3): Direction of opening of the infraorbital foramen (Lt side)
0
10
20
30
40
50
60
70
80
90
100
inferior inferiomedially
22
8
73.3
26.7
Percent
Frequency
Inferiomedial Inferior
Table (4.6): Distance of IOF from anatomical landmarks
(Measurement by mm).
Side Distance between Mean mm Std. Deviation
Right
IOF --- IOR 0.853 0.222
IOF --- PA 1.549 0.188
Left
IOF --- IOR 0.8610 0.1818
IOF --- PA 1.5697 0.2778
Table (4.7):Vertical orientation of the IOF in relation to the upper teeth:
Side IOF in relation to Frequency Percent
Right Line between 1st & 2nd premolar 30 100
Left Line between 1st & 2nd premolar 30 100
Figure (4.4): Vertical orientation of the IOF in relation to the upper
teeth.
0
10
20
30
40
50
60
70
80
90
100
Frequency Percent
30
100
30
100
between lst @ 2endpremolar right side
between lst @ 2endpremolar left side
Between 1st & 2nd
premolar (Rt. side)
Between 1st & 2nd
premolar (Lt. side)
Chapter V
Discussion
5. Discussion
The Infraorbital foramen is the gate to the infraorbital nerve, vessels and the
knowledge of its position is very useful to the professionals who manipulate
the maxillary region as in acupuncture zygoma frature surgery, & in intra and
extra oral anesthesia. (2, 5, 14)
In literature, various soft tissue and bony landmarks were described as refrence
for the IOF. These include the nasal ala, medial and lateral palpebral
commissures,(16) the piriform aperture,(5, 6, 7, 10) the inferior orbital rim, (1, 4-7, 9, 10
) the vertical orientation to the Max, teeth 1st pre molar, (12) and the 2nd pre
molar tooth(3,10, 17) .
Regarding the distance from the IOF to the IOR it was significantly greater on
the left side & no significant difference was found in relation to sex and that
difference from the findings of Ekambaram (9) who reported that this distance
was significantly greater on the right side only in male crania. Aggarwal et al
(10) & Saini (13) reported a distance of 6.33 & 6.7 mm respectively. Both of those
measurements were smaller than what was found in the present study, which
was 8.5 mm this data was in accord to Aziz etal (12) & close to Cisneiros de
Oliveira (1) & Yaremchuk (17). Although Ukoha etal (11) did not make any
comparison of the IOF between the sexes, they reported that in Nigerian crania,
this foramen was significantly closer to the IOR on the right side than on the
left side. A detailed comparison of reported measurements from the IOF to the
IOR is shown in Table (5.1)
The piriform opening of the nose is an easily palpable border on the face which
can be conveniently used to locate the infraorbital foramen. (13) The mean
distance of the infraorbital foramen from the piriform aperture was 15.49 ±1
mm which was close to 15.56 mm reported by Singh (7) and different from that
of Saini (13) & Raschke etal (6) who reported 17.4 mm & 17±2 mm respectively.
Surgeons should consider the skew values to prevent surgical complications in
the head and neck region and the anesthetist should consider these values for
anesthetic failures of nerve block. (5,13 ) A detailed comparison of reported
measurements from the IOF to the PA will be shows in Table 5.2
The frequency of accessory infraorbital foramen shows changes with respect to
race. (13) In the present study a single infraorbital foramen was present
bilaterally in all 30 CT (100%). This data was in accord to Orhan etal (8) study.
Elias etal (5) found 21 single accessory foramina present bilaterally & 8 double
accessory foramen in the 210 Brazilian skulls studied. Where Saini etal (13)
reported out of the 100 skulls studied, 11 (5.64%) accessory infraorbital
foramina in 4 skulls these were found bilaterally. In Cisneiros de Oliveira study
only one cranium presented with multiple foramen bilaterally (1). Table 5.3
In the present study it was found that the most common position for the
infraorbital foramen in relation to the upper teeth was in line between the first
and second upper premolars. Whereas Ilayperuma etal (4) Raschke etal (6) Ukoha
etal (11) & Yaremchuk (17) reported vertical orientation to the 2nd premolar teeth
& Aziz etal (12) reported vertical orientation to the 1st premolar teeth. Table 5.4
shows comparison of IOF in relation to its vertical orientation with the
maxillary teeth.
The incidence of round shaped infraorbital foramen was higher in present study
than that observed by Ilayperuma etal (4), Singh (7), Orhan K (8) Ekambaram etal
(9) & Aggarwal etal (10) those found an oval is the most common shape.
In the present study 70% of IOF were directed inferiorly & 27.7%
inferiomedially this data was in succession with Shaik etal (2) who report
inferiomedial direction is most common.
Table 5.1: Comparison of reported measurements from the IOF to the
IOR.
Study Specimen IOF – IOR
Cisneiros de Oliveira (1) Skull 8 mm
Ilayperuma (4) Skull M: 10.56 ± 1.74
F: 9.02 ± 1.58
Elias, M.G (5) Skull 6,71±1.70 mm
Aggarwal A (10) Skull 6.33 ± 1.39 mm
Saini K. (13) Skull 6.7 ± 1.67) mm
Ekambaram, G.(9) Skull
M: 7.60 ± 1.07
F: 7.11 ± 1.02
Aziz SR (12) Cadaver M: 8.5
F: 7.8
Raschke R (6)
CT
M: 8.61 mm
F: 8.25 mm
Yaremchuk M. (17) CT M:8,61± 0.64 mm
F: 8,25 ± 0.54 mm
Present study CT Rt. 8.53
Lt. 8.61
Table 5-2: A comparison of reported measurements from the IOF to the
PA
Study Specimen IOF – PA
Chrcanovic (3) Skull
M: 14.37 mm
F: 15.44 mm
Elias, M.G (5) Skull 13.28 mm
Singh, R (7) Skull 15.56 mm
Aggarwal A (10) Skull 15.19 mm
Saini K. (13) Skull 17.4 mm.
Raschke R (6)
CT
M:17 mm
F :15.69 mm
Yaremchuk M. (17) CT
M: 17,43 mm
F: 15,69 mm
Present study CT
Rt. : 15.49
Lt. :15.697
Table 5-3: Comparison of presence of the accessory infraorbital foramen
Study %
Cisneiros (1) 10.7%
Ilayperuma (4) 3.70%
Elias, M.G (5) 50%
Ekambaram(9) 11%
Aggarwal A (10) 21%
Aziz SR (12) 15%
Saini K. (13) 5.64 %
Orhan K (8) 0%
Present study 0%
Table 5-4: Comparison of IOF in relation to its vertical orientation with
the maxillary teeth
Study Orientation with teeth %
Aziz SR (12) First premolar ****
Ilayperuma (4) Second premolar 55.56 %
Aggarwal A (10) Second premolar 50%
Ukoha (11) 2nd premolar 46%
Yaremchuk(17) 2nd premolar ***
Present study Line between 1st & 2end premolar 100%
Chapter VI
Conclusion &
Recommendations \
6.1. Conclusion
The infraorbital rim, the piriform aperture, and the tip of the 2nd premolar cusps
are reliable anatomic landmarks that allow us to define a safe zone of dissection
in the midface.
Knowledge of the anatomical variation of IOF locations, directions and its
accessory foramina have important implications in blocking the infraorbital nerve
for surgical and local anaesthetic planning.
From the result there is slightly significant difference in position of IOF in both
sides Rt & Lt.
The most common position for the infraorbital foramen in relation to the upper
teeth was found to be in line between the 1st and 2nd upper premolars.
The most common shape of infraorbital foramen found in the present study is
oval.
6.2. Recommendations
Studies about anatomical variation of IOF in Sudan are not enough there for more
studies are needed to confirm these results.
The dentist and surgeons of head and neck have to know the exact position of
IOF.
The present findings are important for performing local nerve block and surgery
in the face in order to avoid injury to the neurovascular structures passing through
the foramen.
Possibility of accessory infraorbital foramen should be kept in mind during
clinical procedures.
The uses of these measurements are recommended that they will aid surgeons in
avoiding significant morbidity following any midface augmentation procedure.
Chapter VII
References
7. References
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