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Morphometric Study of Supraorbital & Infraorbital

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Morphometric Study of Supraorbital & Infraorbital Dissertation on MORPHOMETRIC STUDY OF SUPRAORBITAL & INFRAORBITAL FORAMINA Submitted in partial fulfillment for M.D. DEGREE EXAMINATION BRANCH-XXIII, ANATOMY Upgraded Institute of Anatomy Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai -600 003 THE TAMILNADU Dr.M.G.R. MEDICAL UNIVERSITY CHENNAI – 600 032 TAMILNADU MAY – 2020 CERTIFICATE This is to certify that this dissertation entitled “MORPHOMETRIC STUDY OF SUPRAORBITAL & INFRAORBITAL FORAMINA” is a bonafide record of the research work done by Dr. J. JAYANTHI, Post graduate student in the Institute of Anatomy, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai-03, in partial fulfillment of the regulations laid down by The Tamil Nadu Dr.M.G.R. Medical University for the award of M.D. Degree Branch XXIII-Anatomy, under my guidance and supervision during the academic year from 2017-2020. Dr. R. JAYANTHI, MD., FRCP (Glasg) Dr. B. CHEZHIAN, M.S., DEAN, Director & Professor, Madras Medical College & Institute of Anatomy, Rajiv Gandhi Govt. General Hospital, Madras Medical College, Chennai Chennai– 600 003. Chennai – 600003. ACKNOWLEDGEMENT I wish to express exquisite thankfulness and gratitude to my most respected teacher, guide Dr. B. Chezhian, Director & Professor, Institute of Anatomy, Madras Medical College, Chennai-3, for his invaluable guidance, persistent support and quest for perfection which has made this dissertation take its present shape. I am thankful to Dr. R. Jayanthi, MBBS, MD, Dean, Madras Medical College, Chennai – 3 for permitting me to avail the facilities in this college for performing this study. My heartfelt thanks to Dr.V.Rajapriya, Dr.P.Kanagavalli, Associate Professors, Dr.Elamathi Bose, Dr.S.Arrchana, Dr.B.J.Bhuvaneshwari, Dr.B.Mohanapriya, Dr.S.Keerthi, Dr.P.R.Prefulla, Dr.M.K.Punitha Rani, Dr.N.Bama, Dr.K.Lavanya Devi, Dr. Samuel Frank Stephen, Dr. B.Arun Prasath, Dr.N.Sridharan, Mrs.S.Nirmala, Assistant Professors, Institute of Anatomy, Madras Medical College, Chennai – 3 for their valuable suggestions and encouragement throughout the study. I earnestly thank my seniors, Dr.H.Geetha Sangeetha, Dr.S.Elavarkuzhali, Dr.P.Mythili, Dr.P.Soundarya who have been supportive and encouraging throughout the study. I extend my heartfelt thanks to my colleagues Dr.M.Srimuthalage, Dr.P.Valanthi Vardhini and Dr.P.Christabel Divya for their constant encouragement and unstinted co-operation. I am especially thankful to Mr.R.A.C.Mathews and Mr. E.Senthilkumar, technicians, who extended great support for this study and all other staff members including Mr.Jagadeesan, Mr.Manesh, Mr.Kabali and Mr. Devaraj for helping me to carry out the study. I thank my parents, parents in law & brother who have showered their choicest blessings on me and supported me in my every step. I am grateful beyond words to my husband and son who in all possible ways supported me in making this study a reality. Above all, I thank the Almighty, who has showered his blessings on me and helped me complete this study successfully. PLAGIARISM CERTIFICATE This is to certify that this dissertation work titled “MORPHOMETRIC STUDY OF SUPRAORBITAL & INFRAORBITAL FORAMINA” of the candidate Dr. J. JAYANTHI, with registration number 201733002 for the award of M.D. in the branch of ANATOMY. I have personally verified the urkund.com website for the purpose of plagiarism check. I found that the uploaded thesis file contains from introduction to conclusion pages and result shows 8 Percentage of plagiarism in the dissertation. Guide and Supervisor sign with seal LEGEND 1. SOF - Supraorbital foramen 2. IOF - Infraorbital foramen 3. IOM - Infraorbital margin 4. PA - Piriform aperture 5. TC - Temporal crest 6. et al - and others CONTENTS Sl. PAGE TITLE NO NO 1. INTRODUCTION 1 2. EMBRYOLOGY 17 3. AIM OF THE STUDY 19 4. MATERIALS AND METHODS 21 5. REVIEW OF LITERATURE 25 6. OBSERVATION 34 7. DISCUSSION 52 8. CONCLUSION 74 9. BIBLIOGRAPHY 77 Introduction INTRODUCTION A number of foramina and fissures exist between the orbit and the middle cranial fossa, sinuses and face to allow the entrance and exit of vessels and nerves that supply the globe and orbital structures46 .Supraorbital foramen is situated along the supraorbital margin present in the frontal bone at the junction of lateral two-thirds & medial one-third. This foramen transmits the supraorbital vessels and supraorbital nerve, which can be rolled against the bone. Supraorbital nerve is a branch of frontal nerve, which in turn is a branch of ophthalmic division of Trigeminal nerve . 1 The Trigeminal nerve is the major source of general sensory supply to the face, teeth and mucous membranes of the oral cavity, nasal cavity and paranasal sinuses. Postganglionic parasympathetic fibres arising from autonomic ganglia use branches of the three divisions of the trigeminal nerve as highways to reach their target organs. The Ophthalmic division of trigeminal nerve divides into lacrimal, frontal and nasociliary branches. Frontal branch of ophthalmic division of trigeminal nerve passes through the lateral compartment of superior orbital fissure and terminates as supraorbital nerve and supratrochlear nerve. The Ophthalmic nerve supplies the frontal region, upper eyelid and external surface of nose through the following branches- supraorbital nerve, supratrochlear nerve, infratrochlear nerve, lacrimal nerve and external nasal nerves. 2 Supraorbital nerve reaches the outer surface of skull by passing through the supraorbital foramen or notch. It supplies the skin of upper eyelid, forehead , anterior scalp and the mucous membrane of frontal sinus. The forehead is supplied from the orbit by the supraorbital and supratrochlear branches of ophthalmic artery. The larger supraorbital artery supplies the frontal sinus and anastomose with the superficial temporal artery establishing communication between internal and external carotid system. From 3 the forehead the supraorbital and supratrochlear veins pass to the medial canthus where they unite to form Angular vein. The inferior orbital margin is formed equally by the maxilla and maxillary process of zygomatic bone. The infraorbital foramen which transmits the infraorbital vessels and nerve, lies approximately 0.5cm below the middle of infraorbital margin46, but there are variations from 4-12mm 47,4. This foramen is 4 directed inferomedially41 and in it passes the nerve and vessels of the same name. it has a relatively big diameter if its compared to the supraorbital foramen and vary on the form and situation47,15,4. The infraorbital nerve is the continuation of the maxillary division of Trigeminal nerve13. The Maxillary division of Trigeminal nerve enters the pterygopalatine fossa through the foramen rotundum and gives off ganglionic branches that attach the pterygopalatine ganglion to maxillary nerve. Branches from the ganglion contains both the postganglionic parasympathetic fibres arising from the pterygopalatine ganglion and sensory fibres. The greater and lesser palatine 5 nerves supply the glands and mucosa of hard palate and soft palate. After entering the orbit through the inferior orbital fissure, the maxillary division becomes infraorbital nerve in the infraorbital canal of orbital floor. The infraorbital nerve enters the infraorbital canal along the orbital floor that opens onto the surface of the skull through infraorbital foramen32. As the nerve passes through the canal, in the midpoint it gives off the anterior superior alveolar nerve which travels through the canalis sinuosus in the anterior wall of maxillary sinus. The nerve supplies the mucosa of maxillary sinus and the roots and buccal gingiva of incisors and canine. In the absence of middle superior alveolar nerve it also supplies premolars. Terminal branches of anterior superior alveolar nerve cross the midline to the contralateral side and must be considered in cases of complete anaesthesia of the central incisors. About 30% of cases the Middle superior alveolar nerve branches from the infraorbital nerve as it passes along the floor of the Orbit46. The nerve when present passes through the lateral wall of the Maxillary sinus to innervate the mucosa of the maxillary sinus, the mesiobuccal root and gingiva of first molar and the roots and buccal gingiva of the premolars. 6 Infraorbital nerve emerges through its foramen and lies between levator labi superioris and the deeply placed levator anguli oris33. It immediately breaks into tuft of branches that radiate away from the foramen as nasal, superior labial and inferior palpebral nerves which supply the external nose, lower eyelid39 including conjunctiva and upper lip. 7 In the pterygopalatine fossa third part of maxillary artery gives infraorbital artery and passes through the infraorbital fissure and then continues along the floor of orbit in the infraorbital canal to emerge through infraorbital foramen on the face. Its middle and anterior superior alveolar branches supply maxillary Incisors and Canine teeth. The Infraorbital vein is formed by several veins that drain the face. It enters the infraorbital foramen and, along with the infraorbital artery and nerve, passes posteriorly through the infraorbital canal and groove. It receives branches from some structures in the inferior ophthalmic vein. The infraorbital vein drains into the pterygoid venous plexus. Both the Supra and Infra orbital foramina are sometimes double or even multiple, the supernumerary foramina being usually smaller and hence named Accessory. Presence of accessory foramina also
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