Foramen Caecum of Anterior Cranial Fossa

Int J Biol Med Res.2019 ;10(3):6788-6789 Int J Biol Med Res www.biomedscidirect.com Volume 10, Issue 3, July 2019

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Original article Foramen Caecum of anterior cranial fossa: variation and clinical significance Raman deep Kaur, *Dr Anshu Sharma, Dr Kanchan Kapoor Demonstrator, Government Medical College and Hospital, Chandigarh, 160030 Associate professor, Government Medical College and Hospital, Chandigarh, 160030 Professor, Government Medical College and Hospital, Chandigarh, 160030

A R T I C L E I N F O A B S T R A C T

Keywords: Foramen caecum is a usually small blind foramen present just anterior to Crista galli. If it is Anterior cranial fossa patent it gives passage to a vein. The present study was under taken to observe variation in the Crista galli Foramen caecum number, patency, and size of the foramen caecum and bifurcation of Crista galli. Study was done Emissary vein on 49 dry skulls, with normal base of skull from Department of Anatomy, Government medical college, Chandigarh. Foramen caecum was found in 42 skulls. Only one skull had no foramen caecum. In 41 cases foramen ended blind but in one case it was found patent. There were numerous small foramina in one case. In two cases foramen caecum was very small as just short of complete obliteration. In remaining 38 dry skulls it showed presence of normal size foramen caecum. Bifurcation of Crista galli was not observed in any of the cases. Foramen caecum is important because in patent cases, infections of the nose and nearby areas can be transmitted to the meninges and brain through the emissary vein.

1. Introduction The frontal crest of the frontal bone ends below in a small tract not included. The sex and origin of the skull could not be which is converted into a foramen, the foramen cecum (or ascertained as skulls were part of the skeleton bought from foramen caecum), by articulation with the Ethmoid [1]. The market. The objective behind the study is to make an observation foramen cecum varies in size in different subjects, and is of presence/ absence, patency and number of the foramen caecum frequently impervious. When open, it transmits the emissary vein in human skull of the region. Bifurcation of crita galli near the from the nose to the superior sagittal sinus. This has clinical foramen cecum was also noted importance in that infections of the nose and nearby areas can be 3. RESULTS transmitted to the meninges and brain from what is known as the danger triangle of the face[2, 3]. Among the 43 dry skull bones foramen caecum was found in all cases but one. It was found patent in one case. There were Other studies described the location of foramen caecum in the numerous small foramina in one case. In two cases foramen frontal bone [2,4] . Anteriorly this foramen is limited by the frontal caecum was very small as just short of complete obliteration. In bone while posteriorly by the front part of Crista galli. The lateral remaining 38 dry skulls it showed presence of normal size margins are limited by the Ethmoid ala[5]. Foramen caecum gives foramen caecum (Table1, Fig1). Bifurcation of Crista galli was not passage to emissary vein/ veins which t connects the extra cranial observed in any of the cases venous system with the intracranial venous sinuses. Different types of emissary veins are posterior condyloid, mastoid, occipital and parietal emissary vein and these emissary veins have an imperative role in selective cooling of the head. It also serves as route for the transfer/carry infections into the cranium[6]. 2. MATERIALS AND METHOD For the present study on foramen caecum 43 dry skulls were taken from Department of Anatomy, Government medical college, Chandigarh. The skull with broken base and deformed shape were

* Corresponding Author : Dr Anshu Sharma Fig 1 A – normal size Foramen cecum, B Small size Foramen Associate professor, Government Medical College and Hospital Cecum, C multiple Foramen cecum , D Patent Foramen Chandigarh, 160030.Email [email protected] Cecum Mob – 9646121530 c Copyright 2011. CurrentSciDirect Publications. IJBMR - All rights reserved. Raman deep Kaur et.al/Int J Biol Med Res.10(3):6788-6789 6789

Table 1. Showing presence/absence, Number size and patency. [6]. Williams PL, Bannister LH, Berry MM,et al.eds Gray's Anatomy. 38th ed. New York: Churchill Livingstone; 1995: 569 Foramen Caecum No of cases Presence 43 [7]. Antonia Di Leva. Emiliano Bruner, Thomas Haidar, Luigi F Rodella. John M . MICHAEL d. Cusimano. Manfred Tschabitscher. Skull base embryology: A Absence Nil multidisciplinary view. Child nerv Syst 2014; 30:991-1000. Normal size, single 38 Small , obliterated, single 2 [8]. Thewissen JGM. Mammalian frontal diploic vein and the human foramen cecum. Anat Rec 1989;223: 242-44 Numerous 1 Patent, single 1 [9]. Husimen TA, Schneider JF, Kellenberger CJ, etal. Developmental nasal midline masses in children: Neuro radiological evaluation. Eur Radiol 2004;14:248-249 4. Discussion [10]. Barkovich A. Congenital malformations of the brain and skull: Pediatric The Anatomical knowledge of foramen caecum is important for Neuro imaging. Philadelphia: Lippincott Williams and understanding cause of several mid face and midline pathologic wilkins;2005:2005:308 conditions of head as well as for planning surgical procedures for [11]. Boyad Gi. The Emissiary Foramina of the cranium in the man and them. anthropoids. J Anat 1930; 65:108-21

During embryologic development, the foramen caecum contains a dural diverticulum which extends from the anterior cranial fossa to the dermal surface of the nose[7]. Normally, the dural diverticulum undergoes complete involution and the foramen cecum fills in with fibrous tissue and variably ossifies [8]. In a study by Hughs etal It was seen that ossification of the anterior cranial base at variable period in early few years. By the end of third year the anterior skull base was 100% ossified[1]. Thus, the foramen cecum is frequently found in infants, uncommonly in children, and rarely in adults where <1.5% of foramina remain open2.

In a study by Husiman TA[9]it was observed the foramen cecum persisted (giving passage to remnant of diverticulum) extending from a midline opening anterior to Crista galli. In earlier study by Barkowitch [10] a widened foramen cecum was interpreted as an intracranial extension. Along with the wide foramen cecum bifid crita galli was also found. It rarely transmits emissary venous channel (intra- or extra cranial) to the nasal cavity. This vein of foramen cecum is also described as vein connecting the nasal and paranasal mucosa to the superior sagittal sinus [9].

Vein of foramen cecum is normally found in animal like Mole [ 11].

5. Conclusion A variety of midline nasal pathologies may occur along this transient embryologic communication like foramen cecum. It is always good to take help of imaging modalities like MRI in such cases to rule out any intracranial extension before doing any surgical interventions. 6. References

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[3]. Gray H, Lewis WH, Warren H. (1918) Anatomy of Human Body. In Lewis WH 20th Edition Philadelphia Lea & Febiger pp: 1396.

[4]. Chen J, Engelen L (2012) Food oral processing: Fundamentals of eating and sensory perception. Wiley-Blackwell pp: 408.

[5]. Foramen Cecum. Dr Danial bell, Dr Prashant Mudgal. Radiopedia c Copyright 2019 BioMedSciDirect Publications IJBMR - ISSN: 0976:6685. 2019march 6 (cited 11march 2019) available at Radiopedia.org All rights reserved.