Morphometric Study of Supraorbital & Infraorbital

Home , Supraorbital foramen

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

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.

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.

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.

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 has been documented by Berry

19755and Bergman et al4. The supernumerary foramina may interfere while giving block anaesthesia, and in treating neurological deficits.

A dermatome is a predictable area of skin innervated by a nerve. With the exception of a small area of skin over the angle of mandible, the skin of face is supplied by three divisions of Trigeminal nerve. Within each of these three regions, predictable areas of skin are innervated by specific branches of each division. Clinically, this dermatomal distribution is essential for pain management. Intraoral injection of anaesthetics for dental procedures not only affects the teeth but also the surrounding soft tissues and skin. Dental clinicians routinely test the profoundness of the anaesthesia by testing the effects on the skin

8 and soft tissues based on this dermatomal distribution. This also explains the pattern of pain that results from Herpes zoster (Shingles), which affects the ophthalmic division.

DISTRIBUTRION OF TRIGEMINAL NEURALGIA

Herpes varicella virus or chickenpox, generally infects children. After the initial infection the virus becomes dormant and resides in the ganglia of nerves.

As we grow older or the immune system becomes weakened, the virus becomes active again and spreads along the path of the nerves. The skin innervated by the nerves, becomes red, develops a blistering rash, is itchy and can become

9 extremely painful. Knowing the dermatome pattern allows the clinician to assess which specific nerve or nerves are affected.

The two branches of the frontal nerve namely supraorbital and supratrochlear nerves are commonly involved in Herpes zoster infection. Readily accessible supraorbital and supratrochlear nerves are used for Central nervous system stimulation through a painful stimulus (Michele Brignole 2007). However,

Wilkinson HA(1999)51 states that blocking of infraorbital nerve is also useful for treating intractable and pharmacologically unresponsive Trigeminal neuralgia.

The supraorbital nerve is clinically important as it causes neuralgia especially, ‘swimmers neuralgia’. Swimmer wearing goggles have also seen to have symptom of headache and neuralgia which is often more in persons having supraorbital notch rather than foramen because of nerve more exposed.

Damage of supraorbital neurovascular bundle is an important complication reported with varying frequency during anterior orbital approach, fronto-glabellar reconstruction flap, blepharoplasty, and Graves disease surgery. Damage can also occur in supraorbital nerve block for procedures like closure of facial wounds, treatment of migraine and chronic paroxysmal hemicranias. The injury of supraorbital vessels and nerve may lead to complications such as haematoma formation in the subgaleal plane and anaesthesia. When injecting Botulinum toxoid to treat hyperactive musculature around the nose, care should be taken to avoid infiltration or deposition in the vicinity of supraorbital nerves. Irritation,

10 entrapment and compression of the supraorbital nerve have been considered as frontal triggers of migraine headaches.

The supraorbital foramen region is used for supraorbital nerve blocks for carrying out procedures such as closure of wounds, biopsies and other facial cosmetic procedures hence a thorough knowledge of this region is necessary for the clinicians to effectively anaesthetize the supraorbital nerve.

A knowledge of the exact location of the supraorbital notch and foramen is essential for prevention of supraorbital neuralgia, and entrapment neuropathies which can result from injury due to excessive dissection or scarring, close to the neurovascular bundle.

Similarly the position of infraorbital foramen is essential for maxillo-facial surgeon in the treatment of Lefort’s fracture and for anaesthetists in regional block anaesthesia. In blow out fracture of orbit, the floor of the orbit is particularly susceptible, which usually occurs in thin region along the infraorbital canal. Surgery on the floor of the orbit care must be taken not to elevate the periosteum anterior to the rim for more than about 4mm, as this may injure the neurovascular structures passing around that area16.

Since the exact location and assessment of Supraorbital and Infraorbital foramina are important for clinicians this present study was done to find a reliable landmark to locate and assess the morphology of both the foramina and morphometry of Infraorbital foramen. The data obtained was analysed statistically.

Thereby this study aims ;

 To study the Morphology and Morphometry of Supraorbital foramen or

notch and Infraorbital foramen.

 To determine the anatomical landmark to locate these two foramina.

 Number of Accessory foramen in relation to these two foramina.

And the observations are applied in the following clinical scenarios;

In cases of Le Fort II and III and nasoethmoidal complex fractures, while making an incision in the glabellar or nasal bridge region for exposure of nasal, lacrimal bone, care should be taken to avoid injury to the supraorbital and supratrochlear nerves. In cases of panfacial trauma, when a bicoronal incision is done for the treatment of fracture of frontal bone, nasoethmoidal complex, zygomatic complex, zygomatic arch the nerves should be carefully freed from the notch or foramen to avoid injury.

Operative procedures on maxillary teeth that donot violate the surrounding gingiva generally only require infiltration anaesthesia along the roots of the teeth.

However, there are occasions when infiltration anaesthesia may not be the best choice. For example inflammed or chronically infected tissue are more difficult to anaesthetize, because diffusion of the anaesthetic is impeded. Multiple injections of several teeth in the same arch could cause discomfort for the patient after the anaesthesia wears away. Procedures such as extractions and crown preparation require additional injections. Therefore nerve block would be a better approach.

Middle superior alveolar nerve although not always present, it is necessary to give the injection for procedures of the maxillary premolar and mesiobuccal root of the first molar as a precaution. The needle is inserted in the mucobuccal fold above the second premolar tooth and advanced vertically approximately 6-

12mm to reach its target area.

Anterior superior alveolar nerve block will anaesthetize the maxillary central incisors, the lateral incisors, the canine teeth and their labial gingiva and the upper lip. The needle is placed in the mucobuccal fold above the lateral incisor and directed towards the apex of the canine tooth.

Precaution- The tissue above the mucobuccal fold and between the facial muscles and the periosteum is sparse. Injecting too large a volume of anaesthetic too quickly would be initially painful to the patient. As for all injections aspirate

15 blood. There is also crossover of nerve fibres to the central incisors from the opposite side and additional injections may be required.

Pavel Michalek states that Infraorbital nerve block is used for intraoperative and postoperative analgesia in nasal and oral surgical procedures as well as in chronic pain settings. One of the modes practised is the supraperiosteal injection used for the maxillary teeth to anaesthetize the terminal nerve branches in the area of treatment. The needle of an aspirating syringe is placed into the mucobuccal fold (vestibular fornix) above the roots of each tooth. Because the cortical bone is thin and porous along the maxillary arch, the anaesthetic drug can infiltrate through the bone to reach the nerves and, this technique is called as subperiosteal or infiltration anaesthesia. Additional injections are administered for the palatal gingiva, the periodontal ligament and the interdental gingiva for dental procedures that require anaesthesia to soft tissues.

DJ Kleier et al14 suggested a technique involving infiltrating an anaesthetic solution in an area defined by dropping a vertical line from the palpable supraorbital notch to about 10-15mm below the infraorbital margin. The nerve blocks are preferred when full anaesthesia is not achieved, such as in infections or to prevent discomfort in a patient who would require multiple injections for procedures on more than one tooth18.

Embryology

EMBRYOLOGY

The skull consists of two parts- the neurocranium and the splanchnocranium (viscerocranium). The neurocranium covers and protects the brain; the splanchnocranium forms the facial skeleton. In the process of evolution, the neurocranium is inversely proportional to the splanchnocranium; this means that when the neurocranium enlarges, the splanchnocranium is progressively reduced.

The skull is developed from the mesenchyme surrounding the developing brain. The mesenchyme comes into close relationship with the following structures which also contribute to the development of skull:

a) Cranial to the first cervical somite there are four occipital somites. The

mesenchyme arising from the sclerotomes of these somites helps to form

part of the base of the skull in the region of the occipital bone.

b) The developing internal ear (otic vesicle) and the region of the developing

nose are surrounded by mesenchymal condensations called the otic and

nasal capsules respectively. These capsules also take part in forming the

mesenchymal basis of the skull.

c) The first branchial arch is closely related to the developing skull. It soon

shows two subdivisions called the mandibular and maxillary processes.

The frontal and parietal bones are formed in relation to mesenchyme covering the developing brain. The maxilla, zygomatic, palatine and part of the temporal bones are formed by intramembranous ossification of the mesenchyme of the maxillary process.

The mesodermal core of each branchial or visceral arch presents a cartilaginous bar. The cartilaginous bars of the first arch , and the dorsal part of the second arch enter into the development of the facial skeleton.

The bony orbit develops from the mesenchyme that encircles the optic vesicle in early embryonic development. Individual bones develop from a complex series of ossifications of two types - Endochondral and Membranous.

The orbital rim is rounded and thickened and serves to protect the eye from fascial impacts. The superior rim is the most prominent owing to expansion of the underlying frontal sinus. The medial third of the superior rim is interrupted by a notch or foramen for the supraorbital neurovascular bundle. The inferior rim is composed of the maxillary bone medially and the zygomatic bone laterally. The infraorbital foramen is located 4 to 10 mm below the central portion of the rim34.

Aim of the study

AIM OF THE STUDY

Nerve blocks are the predominant regional anaesthetic technique in head and neck regions. Because of the closeness of cranial nerves to many vital structures, meticulous placement of needle are required. To minimise the nerve damage, supraorbital and infraorbital foramina are identified in relaltion to various bony landmarks in this study. Therefore these foramina can be reached effectively with the knowledge of the morphometry of supraorbital and inforaorbital foramina.

The aim of the study is to determine the landmarks that would provide the most reliable and predictable indicators of the position of the supraorbital, infraorbital foramina in human skulls of varying age groups using an electronic digital calliper device, which would provide clinicians with suitable modifications in technique to accommodate these variations.

Henceforth I would like to analyse the morphometry of supraorbital and infraorbital foraminain adult human whole skull under the following parameters;

1. Frequency of occurrence of the Supraorbital notch or Supraorbital foramen.

2. Height of the Supraorbital foramen from the supraorbital margin, if present.

3. The distance between Supraorbital foramen and the nasion in nasal mid-line.

4. The distance between Supraorbital foramen and the temporal crest of frontal

bone.

5. Presence or absence of accessory supraorbital foramina.

6. Shape of the Infraorbital foramen.

7. The distance between Infraorbital foramen (IOF) and the Infraorbital margin.

8. The distance between Infraorbital foramen and the Piriform aperture (PA) in

the bony skeleton of external nose.

9. Transverse & vertical diameters of the Infraorbital foramen.

10. Location of infraorbital foramen in relation to premolars and 1st molar.

11. Presence or absence of accessoryinfraorbital foramen.

Materials and methods

MATERIALS AND METHODS

STUDY MATERIALS

The present study was done on 100 Adult dry human skulls of Indian origin (200 sides) obtained from the Institute of Anatomy, Madras Medical

College, Chennai-03. The measurements and observations were recorded using

Digital vernier caliper, plain paper and marker pen.

STUDY METHODS

The measurements related to the foramina were taken using Vernier caliper. The datas were computed and analyzed statistically.

INCLUSION CRITERIA

 Adult dried human whole skulls are included irrespective of sex.

EXCLUSION CRITERIA:

 Deformed and malformed bones are excluded in bone study.

Parameters studied:

The morphometric measurements of the foramina are taken using Digital vernier calliper under the following parameters;

Frequency of occurrence of the Supraorbital notch or Supraorbital foramen is observed in all skulls on both the sides.

Height of the foramen from the supraorbital margin - It is the distance between the lowest point of Supraorbital foramen (SOF) and the Supraorbital margin.

The distance between Supraorbital foramen and the nasal mid-line - It is measured from the medial margin of the foramen to the point of intersection of nasal midline.

The distance between Supraorbital foramen and the temporal crest- It is measured from the lateral margin of the foramen to the ipsilateral temporal crest of frontal bone.

Presence or absence of accessory supraorbital foramina.

Shape of the Infraorbital foramen - Observations are recorded as round, oval or semilunar.

The distance between Infraorbital foramen (IOF) and the Infraorbital margin - It is measured from the superior-most point of the foramen to the infraorbital margin.

The distance between Infraorbital foramen and the Piriform aperture (PA) -

It is measured from the medial margin of the foramen to the ipsilateral margin of piriform aperture.

Transverse & vertical diameters of the Infraorbital foramen- Width and height of the foramen are measured on either side.

Varied locations of the foramen -It is observed in relation to the premolars and 1st molar.

Presence or absence of accessory infraorbital foramina.

Review of literature

REVIEW OF LITERATURE

Cousins MJ (2009)12 states that regional anaesthesia for head and neck procedures have a long and successful history. Important advantages of regional anaesthetic technique include decrease in intraoperative and postoperative opioid use, as well as less stressful perioperative experience. He also insists that the landmarks for regional anaesthesia should be relatively constant, easily located and mostly predictable.

For this reason, the present study was done under the following parameters derived from the analysis of previous literatures.

FREQUENCY OF OCCURRENCE OF THE SUPRAORBITAL NOTCH

OR SUPRAORBITAL FORAMEN.

In a study by Webster RC,et al50on 111 skulls, supraorbital notches in

49.07% were reported bilaterally and foramina were observed bilaterally in

25.93%. Also unilateral notches in 26% and foramina in 25% were observed.

Chung MS et al11in 124 Korean skulls (male 35, female 18, unknown sex

71) concluded the existence of 28.9% foramina and 69.9% notch.

Saylam Cet al42used foramen and notch synonymously and found 26.6% foramina and71.6% notches in 50 cadavers and 200 crania of 500 samples.

Agthong Set al1 reported significant sex and side differences in 110 Asian adult skulls and observed 3.6% foramina.

Cheng AC et al10 in58 (116 sides) Chinese skulls observed 54.1 % notch and 45.9% foramina.

In a study by Apinhasmit W et al2 50% notch, 17% foramina and 33% both notch and foramina are recorded in 106 Thai skulls.

Dr.Sivavadivel Swaminathan, et al45 in 65 skulls (130 sides) of Dravidian

Population of Southern India reported more of supraorbital notch 52.3% and

31.2% foramina .

Priya Roy Pet al40 in 120 Maharastrian Skulls observed 37.3% notch, 12% foramina and 13.3% both.

HEIGHT OF THE FORAMEN FROM SUPRAORBITAL MARGIN :

Webster RC et al50 observed the mean distance of supraorbital foramen from supraorbital margin as 1.56mm in 111 human skulls.

Agthong S et al1 pointed that the distance of supraorbital foramen from supraorbital margin as 5mm in 110 skulls which is slightly at a higher range compared to others.

Apinhasmit W et al2 found the height of supraorbital foramen from supraorbital margin as 3.15mmin 106 Thai skulls.

Indian author Gupta T et al21 reported the mean distance of supraorbital foramen from supraorbital margin as 2.5mm in 79 skulls.

THE DISTANCE FROM THE NASAL MID-LINE

Webster RC et al50recorded the mean distance of supraorbital foramen from nasal midline as 32.02mm in 111 skulls.

Chung MSet al11 in 124 Korean skulls reported the mean distance as

22.7mm.

Agthong S et al1 found the mean distance as 24.75 mm in 110 skulls.

Cheng AC et al10 in 58 (116 sides) Chinese skulls observed the mean distance of supraorbital margin from nasal midline as 24.56mm

Apinhasmit W et al2observed the mean distance of supraorbital margin from nasal midline as 25.14mmin 106 Thai skulls.

In a study by Gupta T et al21 the mean distance was observed to be 23.9mm in 79 Indian skulls.

Jeong SM et al27concluded the mean distance of supraorbital margin from nasal midline as 29mm in 83 skulls.

THE DISTANCE FROM THE TEMPORAL CREST OF FRONTAL BONE:

In a study on 106 Thai skulls by Apinhasmit W et al2 it was found that the mean distance of supraorbital margin from temporal crest was 26.57mm.

Gupta T et al21 stated the mean distance of supraorbital foramen from temporal crest as 30mm in 79 skulls.

In a study on 80 adult human skulls by Bruno ramos et al observed the mean distance as 23.73mm in males and 23.49mm in females.

Dr.Sivavadivel Swaminathan, et al45 in 65 skulls (130 sides) of Dravidian population of southern india observed the mean distance as 28.5mm.

Priya Roy P et al40in 120 Maharashtrian skulls stated the mean distance as

23.8mm.

ACCESSORY SUPRAORBITAL FORAMINA

Saylam et al42 found only 2% accessory foramina in 50 cadavers and 200 crania of 500 samples.

Agthong S et al1 observed 3.6% accessory foramina in 110 skulls.

In a study by Gupta Tet al21 noted 14% accessory foramina in 79 skulls.

SHAPE OF THE INFRAORBITAL FORAMEN

Kazkayasi et al31 reported variations in shape of the infraorbital foramen in ten cadavers as round, oval, or semilunar in 40%, 30%, and 30% of cases respectively.

In astudy by Ilayperuma I25et al observed on the right side as Triangular in

18.2%, oval in 38.6%, semilunar in 29.6%, round in 13.6% foramina and on the left side as triangular in 19.1%, oval in 36.3%, semilunar in 27.6%, round in

17.0% in 40 subjects (20 males and 20 females).

Singh R et al44 2011, observed 40% oval foramina & 34.5% round foramina in 55 skulls (110 sides).

DISTANCES FROM THE INFRAORBITAL MARGIN:

Triandafilidi et al49described the position of the infraorbital foramen in 55 male crania and observed the mean distance from the infraorbital margin as

7.19mm.

Hindy A. M. and F.Abdel- Raouf23 found the mean distance as 6.10mm in

30 Egyptian adult skulls and 15 adult human cadavers.

In a study by Chung MS et al11in 124 Korean skulls (male 35, female 18, unknown sex 71) noted the mean distance from the infraorbital margin as

8.60mm.

Canan S et al9concluded the mean distance from the infraorbital margin as8.30mm (women); 10.90mm (men) in 119 crania and 229 maxilla.

Aziz SR et al3studied in Forty-seven cadavers (94 sides) the mean distance from the infraorbital margin as 7.80mm (women); 8.50mm (men).

Kazkayasi et al31observed the mean distance as 6.70mm in 10 cadaver heads (20 sides).

Karakas et al30 studied the location of the infraorbital foramen in sixty two orbits obtained from thirty one skulls of adult male caucasians and noted the mean distance from the infraorbital margin as 6.7 (± 1.9) mm.

Elias et al17 using two hundred and ten adult caucasian skulls reported the mean distance from the infraorbital margin as 6.71 mm and 6.83 mm on the right and left sides respectively.

Macedo VCet al36observed the mean distance as 6.37mm in sixty-four sides of thirty-two human skulls.

Oliveira et al37 noted the mean distance from the infraorbital margin as

6.80mm in 242 crania ( 148 male and 94 female).

DISTANCE FROM PIRIFORM APERTURE

Hindy.A.M. and F.Abdel-Raouf23 observed the mean distance from the piriform aperture as 17.23 mm in 30 Egyptian adult skulls and 15 adult human cadavers.

In a study by Kazkayasi M et al31 the mean distance from the piriform aperture was notedas 14.70 mm in 10 cadaver heads (20 sides).

Elias et al17using two hundred and ten adult Caucasian skulls reported on the mean distance from the piriform aperture as 13.28 mm on the right side and

13.31 mm on the left side.

In a study on sixty-four sides of thirty-two human skulls Macedo VC36 et al found the mean distance from the piriform aperture as 17.67 mm .

VERTICAL AND TRANSVERSE DIAMETERS:

S. Boopathi et al7observed the vertical and transverse diameters as 2.79mm and 2.73mm respectively in 80 dry South Indian adult human skulls.

Singh R44et al noted the average diameter of the foramen in 110 sides as

3.23mm vertically and 3mm transversely.

Bhart and M. G. Purani6 recorded the vertical and transverse diameters as

3.23mm and 3.28mm respectively in one hundred dry human skulls of unknown gender.

In a study on 64 adult north Indian dry human crania Singh P.Agarwal et al43 recorded the vertical & transverse diameters as 3.75mm and 3.52mm respectively.

LOCATION OF INFRAORBITAL FORAMEN:

In a study by Hindy A. M. and F. Abdel-Raouf23 50% of infraorbital foramina were noted opposite the 2nd premolar, 15% opposite the 1st premolar and

15 % between the 1st premolar and 2nd premolar in 30 Egyptian adult skulls and

15 adult human cadavers.

Agthong S et al1 observed 53.8% foramina opposite the 2nd premolar,

31.6% between 1st and 2nd premolar and 12.7 % between the 2nd premolar and 1st molarin 110 skulls.

Ilayperuma I et al25on adult Sri Lankan skulls found55.56% foramina opposite the 2nd premolar, 29.63% between 1st and 2nd premolar and 11.11 % between the 2nd premolar and 1st molarin 40 subjects (20 males and 20 females).

ACCESSORY INFRAORBITAL FORAMINA:

In a study by Kazkayasi, M. et al31 accessory infraorbital foramina were noted in 5.7% of 10 cadaver heads (20 sides).

C. Bressan et al8recorded accessory foramina in 4.7% in 1064 skulls .

Oliveira et al37found accessory foramina in 21.6% of 242 crania ( 148 male and 94 female).

M. Tezer et al48 observed accessory foramina in 7% of45 human dry skulls and 20 disarticulated maxillae.

Gaur KK et al19observed accessory foramina in 4% of Sixty adult dry skulls of unknown sex.

Lokanayaki V35 found accessory foramina in 8% of 100 adult skulls.

Observation

OBSERVATION

The morphometric analysis of Supraorbital and Infraorbital foramina were studied in 100 adult human skulls (200 sides) and the present study revealed the following observations:

1. FREQUENCY OF OCCURRENCE OF THE SUPRAORBITAL NOTCH OR SUPRAORBITAL FORAMEN. (Fig no: 1, 2 , Chart no: 1, Table no: 1)

In the present study supraorbital notch of the total 200 sides were found on

167 sides i.e., 83.5% ( 82 right and 85 left) and the supraorbital foramen were noted on 33sides i.e., 16.5% (18 right and 15 left).

CHART NO 1 : FREQUENCY OF OCCURENCE OF THE SUPRAORBITAL NOTCH OR FORAMEN

17%

Supraorbital notch Supraorbital foramen

83%

TABLE NO 1: FREQUENCY OF OCCURENCE OF THE SUPRAORBITAL NOTCH OR FORAMEN

OBSERVATION R L

SON 82 85

SOF 18 15

2. DISTANCE OF SOF FROM SUPRAORBITAL MARGIN: (Fig no: 3, Chart no: 2, Table no: 2)

The average height of the foramen from the supraorbital margin observed on the total 200 sides were 2.33mm (right 2.45mm and left 2.22mm) with the maximum and minimum values of 4.6mm and 1.1mm respectively.

CHART NO 2 : DISTANCE OF SOF FROM SUPRAORBITAL MARGIN

4.5

3.5

mm 3

2.5

1.5

0.5

0 Maximum value Minimum value Mean

TABLE NO 2 : DISTANCE OF SOF FROM SUPRAORBITAL MARGIN

Bone Bone Bone Bone Bone R L R L R L R L R L No. No. No. No. No. 1 - - 21 - - 41 - - 61 - - 81 - -

2 - 3.9 22 - - 42 4.6 3.6 62 - - 82 - -

3 - - 23 - - 43 1.4 - 63 - - 83 - -

4 3.2 - 24 1.1 - 44 - - 64 - - 84 - -

5 - 2.6 25 - - 45 4.4 2.9 65 - - 85 - -

6 4.1 3.0 26 - - 46 - - 66 - - 86 - -

7 4.4 2.9 27 - - 47 - - 67 - - 87 - -

8 - 1.2 28 - - 48 - - 68 - - 88 - -

9 1.4 - 29 - - 49 - 1.4 69 - - 89 - -

10 - - 30 - - 50 - - 70 - - 90 - -

11 - - 31 1.1 - 51 - 1.4 71 - - 91 - -

12 - - 32 - - 52 - - 72 - - 92 - -

13 - - 33 1.6 1.9 53 - - 73 - - 93 - -

14 - 2.6 34 - - 54 - - 74 2 1.8 94 - -

15 - - 35 - - 55 - - 75 - - 95 - -

16 - - 36 - - 56 - - 76 - - 96 - -

17 - - 37 - - 57 - - 77 3.2 - 97 1.9 2.1

18 1.2 - 38 - - 58 - - 78 - - 98 - -

19 2.1 1.2 39 2.4 1.4 59 2.3 - 79 - - 99 - -

20 - - 40 - - 60 1.8 1.6 80 - - 100 - -

R L MEAN VALUE 2.45mm 2.22mm

3. DISTANCE OF SOF/SON FROM NASAL MIDLINE: (Fig no: 4, Chart no: 3, Table no: 3)

The average distance of the supraorbital foramen from the nasion on nasal mid-line were 21.95mm (right 22mm and left 21.9mm) with the maximum and minimum value of 32mm and 15.9mm respectively on the total 200 sides.

DISTANCE FROM NASAL MIDLINE 35

0 Maximum value Minimum value Mean

TABLE NO : 3 DISTANCE FROM NASAL MIDLINE

Bone Bone Bone Bone Bone R L R L R L R L R L No. No. No. No. No. 1 32 29.7 21 27.1 26.9 41 30.5 32.4 61 31 33 81 29.7 29.5

2 30.4 31.4 22 26.9 24.8 42 25.7 32.2 62 31.2 26.2 82 27.4 27.1

3 27.7 29.1 23 26.9 27.9 43 30.4 31.1 63 28.7 28.5 83 30.8 28.4

4 35.7 36.3 24 25.7 25.2 44 27.7 29.1 64 24.4 24.9 84 27.9 27.7

5 32.8 32 25 25.9 26.4 45 36.8 32.1 65 30 32.1 85 30.7 30.5

6 30.7 30.1 26 26.7 26.5 46 27.6 25.8 66 33.2 28.2 86 31 33.1

7 36.8 32.1 27 26.4 26.1 47 27.9 28.0 67 32.9 34.6 87 33.2 29.2

8 25.4 27.7 28 29.8 27.4 48 27.4 28.7 68 29.5 33.4 88 33.3 32.2

9 25.8 25.1 29 26.9 26.7 49 26.8 24.1 69 26 26.5 89 29.8 32.6

10 25.1 25.7 30 26.7 26.5 50 26.7 28.1 70 28.5 29.6 90 30.9 33.6

11 26.6 25.9 31 25.4 25.9 51 29.8 30.6 71 27.6 25.8 91 33.5 35.4

12 27.8 25.1 32 25.2 26.1 52 25.7 26.2 72 23.1 21.5 92 26.9 28.9

13 26.5 27.6 33 23.9 25.1 53 23.1 23.7 73 22.1 20.5 93 27.4 26.1

14 26.1 23.8 34 26.1 27.9 54 24.6 22.8 74 23.4 22.9 94 31.8 27.4

15 27.5 28.6 35 27.7 29.1 55 28.1 27.8 75 27.2 27.9 95 24.2 26.1

16 26.6 24.8 36 30 32.1 56 27.9 26.9 76 23.7 25.1 96 25.7 26.5

17 24.1 22.5 37 33.2 28.2 57 24.4 25.1 77 33.7 34.3 97 24.4 25.9

18 24.1 22.5 38 34.3 33.2 58 30.8 28.4 78 22.1 22.7 98 29 32.1

19 25.4 24.9 39 30.8 32.6 59 26.3 27 79 28.6 26.8 99 33.2 27.2

20 24.2 23.9 40 31.9 33.6 60 22.9 24.1 80 24.1 23.9 100 31.9 30.6

R L MEAN VALUE 22mm 21.9mm

4. THE DISTANCE FROM THE TEMPORAL CREST: (Fig no: 5, Chart no: 4, Table no: 4)

The average distance of the supraorbital foramen from the Temporal crest on frontal bone were 28.18mm ( right 28.25mm and left 28.12mm) with the maximum and minimum value of 37mm and 20.7mm respectively in this present study on 200 sides.

CHART NO 4 ; THE DISTANCE FROM THE TEMPORAL CREST 40

mm 20

0 Maximum value Minimum value Mean

TABLE NO : 4 THE DISTANCE FROM THE TEMPORAL CREST

Bone Bone Bone Bone Bone R L R L R L R L R L No. No. No. No. No. 1 19.8 22 21 20 21.2 41 20.5 19.8 61 21.7 23.2 81 23.6 24

2 22.2 24.6 22 21.7 22.7 42 27.6 23.9 62 20.3 21.8 82 20.9 21.9

3 22.4 24 23 17.9 17.9 43 23.3 21.8 63 22.6 23 83 22.4 23.8

4 20.5 15.9 24 21.7 21.1 44 22.4 24 64 19.9 18.8 84 21.2 20.7

5 23.2 22.9 25 20.3 19.7 45 27.6 27.1 65 20.7 22.2 85 24.6 24

6 27.7 28.9 26 20.6 21 46 22.5 23.7 66 22.3 23.8 86 21.7 23.2

7 27.6 27.1 27 19.9 20.9 47 21 22.2 67 23.2 24.4 87 22.3 24.8

8 24.2 20.7 28 21.4 22.8 48 25.2 21.7 68 21.5 18.8 88 20.6 17.7

9 20.8 20.1 29 20.2 19.7 49 22.5 24.1 69 20.6 21 89 23.3 23.1

10 21.7 20.1 30 20.6 21 50 22.6 19.5 70 21.6 21.3 90 21.2 23.4

11 23.4 23.0 31 20.9 19.8 51 23.3 22.1 71 22.5 23.7 91 25.5 24.8

12 23.5 25.1 32 21.7 20.4 52 20.3 20 72 22.9 24.4 92 17.9 18.9

13 21.5 17.7 33 24.9 24.5 53 19.7 18.1 73 18.9 20.4 93 20.9 20.9

14 22.1 25.1 34 22.4 19.8 54 19.5 20.7 74 22.6 20.1 94 23.4 22.8

15 20.6 20.3 35 23.6 20.5 55 21.1 22.3 75 24.3 24.9 95 22.7 20.4

16 21.5 22.7 36 20.7 22.2 56 18.9 19 76 18.4 20 96 19.6 21

17 23.9 25.4 37 22.3 23.8 57 20.9 21.9 77 22.5 17.9 97 21.9 19.8

18 23.9 25.4 38 20.6 18.7 58 22.4 23.8 78 19.7 18.1 98 23.7 22.2

19 25.6 23.1 39 24.3 23.1 59 22.7 21.3 79 23.5 24.7 99 22.3 22.8

20 20.3 20.9 40 22.2 23.4 60 22.9 23.5 80 18 17.2 100 22.2 20.4

R L MEAN VALUE 28.25mm 28.12mm

5. ACCESSORY SUPRAORBITAL FORAMINA: (Fig no: 6, Chart no: 5, Table no: 5)

In this present study on 200 sides in adult dry human skulls accessory foramina were observed to be in14 skulls (right-6 and left -8).

CHART NO 5 ; ACCESSORY SOF

Present Absent

93%

TABLE NO : 5 ACCESSORY SOF

R L ACCESSORY SOF 6 8

6. SHAPE OF THE INFRAORBITAL FORAMEN: (Fig no: 7,8 , Chart no: 6, Table no: 6)

The shape of the infraorbital foramen observed on the total 200 sides were

53.5% round, 28% oval, 18.5% semilunar. To be more precise, on the right side

54% round 28% oval 18% semilunar and on the left side53% round 28% oval

19% semilunar.

CHART NO 6 ; SHAPE OF THE IOF

19%

Circular oval 53% Semilunar 28%

TABLE NO : 6 SHAPE OF SOF

SHAPE OF SOF % R L

ROUND 54 53

OVAL 28 28

SEMILUNAR 18 19

7. DISTANCE FROM THE INFRAORBITAL MARGIN: (Fig no: 9, Chart no: 7, Table no: 7)

The average distance of the foramen from the infraorbital margin observed on the total 200 sides were 4.13mm ( right 4.08mm and left 4.18mm ) with the maximum and minimum value of 8.5mm and 1.8mm respectively.

CHART NO 7 ; DISTANCE FROM THE INFRAORBITAL MARGIN 9

5 mm 4

0 Maximum value Minimum value Mean

TABLE NO : 7 DISTANCE FROM THE INFRAORBITAL MARGIN

Bone Bone Bone Bone Bone R L R L R L R L R L No. No. No. No. No. 1 3 2.9 21 2.3 2.1 41 3.1 3.8 61 3.3 2.7 81 3.3 3

2 4.2 5.4 22 3 4.3 42 2 2.7 62 3.5 3.2 82 2.3 2.1

3 3 4.3 23 2.8 3.2 43 3.9 5 63 2 2.2 83 2.4 2.4

4 7.8 8 24 2.8 3.2 44 7.4 8.5 64 1.9 2.2 84 3.4 3.2

5 7 8.5 25 3.2 4 45 2.4 2.4 65 3.5 2.8 85 2 2.7

6 6 5.3 26 3.2 2.7 46 7.8 7.6 66 2.2 2.4 86 7.1 7.2

7 7.3 7.2 27 2.4 2.4 47 3.2 2.7 67 3.1 3.8 87 2.4 2.4

8 3.9 3.2 28 1.9 2.2 48 7.3 7.8 68 4.1 3.2 88 7.8 7.6

9 2.3 2.4 29 2.5 2 49 3.6 2.9 69 2.3 2 89 3.2 2.7

10 3 3.8 30 2.5 2 50 4.5 5.8 70 7.2 8.5 90 7.3 7.8

11 3.4 3.1 31 3 3.2 51 7.5 6.7 71 3.9 3 91 3.6 2.9

12 3.4 3 32 7 8.5 52 7 5.5 72 2.9 3.4 92 4.9 5.8

13 3.2 3 33 3.7 3.6 53 3.2 4.2 73 2.8 3.2 93 7.5 5.7

14 3.3 3.5 34 3.9 4.5 54 4.6 5.3 74 2.5 2.8 94 6.7 5.5

15 4 3.2 35 3.4 3.2 55 3 3.2 75 7.8 8.3 95 3.6 4

16 2.7 3.4 36 4.2 4.5 56 2 2.2 76 4.5 3.9 96 4.8 5

17 3.3 2.8 37 3.7 4.4 57 6.2 5.3 77 4.9 5.8 97 1.8 2.2

18 4.7 5.8 38 7.8 8 58 3.2 3.1 78 4.5 3.2 98 6.1 5.3

19 3.2 3.8 39 3 3.2 59 3.2 4 79 2.5 2.9 99 3 3

20 2.4 2.7 40 4.5 3.9 60 8 7.6 80 7 7.2 100 2.2 2

R L MEAN DISTANCE 4.08mm 4.18mm

8. DISTANCE FROM PIRIFORM APERTURE: (Fig no: 10, Chart no: 8, Table no: 8)

The average distance of the foramen from the piriform aperture observed on the total 200 sides were 17.51mm ( right 17.52mm and left 17.51mm ) with the maximum and minimum value of 19.8mm and 12.5mm respectively.

Chart no 8 ; DISTANCE FROM PIRIFORM APERTURE 25

0 Maximum value Minimum value Mean

TABLE NO : 8 DISTANCE FROM PIRIFORM APERTURE

Bone Bone Bone Bone Bone R L R L R L R L R L No. No. No. No. No. 1 14.3 14.1 21 17.9 17.6 41 17.9 19.6 61 18.9 19.3 81 17.7 17.9

2 15.9 15.4 22 14.3 13.9 42 18 19.3 62 18.5 17.9 82 17.9 17.6

3 14.3 13.9 23 18.0 19.3 43 17.1 18 63 17.2 16.9 83 19.4 18.3

4 15.6 15.4 24 18 17.7 44 15.5 17.2 64 17.2 16.9 84 18 17.9

5 17.6 17.6 25 18.9 18.2 45 19.4 18.3 65 18.5 18 85 18 19.3

6 17.1 17.5 26 18.9 17.7 46 16.8 17.9 66 18.3 18.6 86 18.6 18.5

7 16.6 16.5 27 19.4 18.3 47 18.9 19.3 67 16.5 17.8 87 19.4 18.3

8 19.4 18.3 28 17.2 16.9 48 17.6 17.1 68 19.8 17.8 88 16.8 17.9

9 18 18.6 29 17.6 17.8 49 16.9 17.5 69 17.9 17.6 89 18.9 19.3

10 16.5 17.8 30 17.6 17.8 50 16.6 15.5 70 17.6 17.7 90 17.6 17.1

11 18.9 19 31 18 18.6 51 17.2 16.2 71 19.4 18.3 91 16.9 17.5

12 17.7 17.9 32 17.6 17.6 52 14.5 14.8 72 16.8 17.5 92 17.6 15.5

13 18.9 19 33 16.6 16.7 53 18.6 18.2 73 18 19.3 93 17.2 15.2

14 17.7 17.9 34 18 18.1 54 12.5 17 74 17.6 17.8 94 14.5 14.8

15 19.8 17.8 35 18 17.9 55 18.2 17.7 75 15.6 15.4 95 18.9 18.2

16 16.8 17.6 36 17.4 16.3 56 17.2 16.6 76 18.1 18 96 12.5 17.1

17 18.5 18 37 18.1 18.7 57 17 17.5 77 17.6 15.5 97 17.2 16.9

18 18.7 19.1 38 15.6 15.4 58 18.9 19 78 19.8 17.8 98 17.1 17.5

19 17.6 16.5 39 18 18.6 59 17.6 16.5 79 17.6 17.8 99 18.9 19

20 18.2 18.1 40 18.1 18 60 16.9 17.9 80 16.6 16.5 100 17.6 17.8

R L MEAN DISTANCE 17.52mm 17.51mm

9. VERTICAL AND TRANSVERSE DIAMETERS: (Fig no: 11, 12, Chart no: 9, Table no: 9A&B)

The vertical and transverse diameters observed on the total 200 sides were

2.39mm& 2.31mm ( right 2.37mm & 2.25mm and left 2.42mm& 2.37mm) with the maximum and minimum value of 8.1mm & 8.6mm and 0.8mm & 0.4mm respectively.

CHART NO 9 ; VERTICAL & TRANSVERSE DIAMETERS 10

mm 5 Vertical diameter 4 Transverse diameter

0 Maximum Minimum Mean value value

TABLE NO : 9A VERTICAL DIAMETER

Bone Bone Bone Bone Bone R L R L R L R L R L No. No. No. No. No. 1 2.4 2.3 21 2.1 1.4 41 1 1.8 61 1.1 0.8 81 1.7 1.8

2 2.1 3.3 22 1.7 2.0 42 0.9 1.9 62 1.3 2.6 82 2.8 2.2

3 1.7 2.0 23 1.1 0.8 43 4.8 4.5 63 1.8 2.3 83 1.3 1.8

4 2.2 3.2 24 1.3 1.1 44 5.4 5 64 1.8 2.2 84 1.3 2.7

5 2.5 2.4 25 1 0.8 45 1.6 1.2 65 1.2 1.9 85 0.9 1.9

6 2.3 2.1 26 1.2 0.8 46 5.3 4.9 66 3.2 1.8 86 1.3 1.4

7 1.3 1.4 27 1.3 1.8 47 1 0.8 67 1 1.3 87 1.6 1.8

8 7.9 8.1 28 1.8 1.8 48 4.9 4.6 68 1.2 1.3 88 4.7 4.2

9 2 1.8 29 1.9 2 49 3.9 4 69 2.2 1.4 89 1 0.8

10 1.1 1.3 30 1.7 1.9 50 5.3 4.5 70 2.8 2.4 90 4.9 4.6

11 1.2 1.4 31 1.6 1.8 51 3.9 4.6 71 7.6 8.1 91 3.9 4.6

12 1.1 2 32 2.5 2.4 52 4.9 5 72 1 1.2 92 3.2 3.7

13 1.8 1.4 33 1.5 1.7 53 1.4 0.8 73 1.9 2.2 93 3.9 3.7

14 1 1.8 34 1.9 2.4 54 4.7 5 74 2 1.9 94 4.9 5

15 1.2 1.3 35 1.3 1.9 55 1.3 1.7 75 2.2 3.2 95 1.2 0.8

16 1.5 1.4 36 4.2 3.9 56 1.8 2.2 76 2.1 1.7 96 4.7 5

17 1.2 1.9 37 1.7 2.6 57 2.3 2 77 3.2 3.7 97 1.8 2.2

18 1.5 1 38 2.2 3.2 58 1.8 1.4 78 1.2 1.3 98 2.3 2.1

19 1.4 1.2 39 1.8 2.2 59 1.3 1.2 79 1.8 1.9 99 1.8 1.4

20 1.7 1.9 40 2.3 1.7 60 4.8 5.3 80 1.3 1.2 100 1.9 1.7

TABLE NO : 9B TRANSVERSE DIAMETER

Bone Bone Bone Bone Bone R L R L R L R L R L no., no., no., no., no., 1 2.2 3.4 21 1.6 1.9 41 0.9 1.4 61 1.1 1 81 1.8 1.1

2 2.2 3.4 22 1.9 2.4 42 3.8 4.7 62 1.2 2.1 82 1.6 2.9

3 1.9 2.4 23 0.9 0.4 43 5.1 4.9 63 2.3 2.7 83 1.2 1.7

4 2.3 2.3 24 1.6 1.2 44 1.7 1 64 2.5 2.7 84 1.2 2.1

5 1.9 1.3 25 0.8 0.6 45 4.8 4.3 65 1 1.1 85 0.9 1.4

6 1.5 2.9 26 0.8 1 46 1 1.2 66 2.8 1.7 86 1.7 1.3

7 1.9 1.3 27 1.2 1.7 47 4.2 4.5 67 1.9 1.2 87 1.7 1.9

8 8.6 7.9 28 2.2 2.3 48 4 4.1 68 1.1 1.2 88 4.1 3.6

9 2.8 1.7 29 1.7 1.9 49 4.8 4 69 1.5 1.9 89 1 1

10 1.9 1.2 30 1.9 2.1 50 3.7 4.5 70 1.9 1.3 90 4.2 4.7

11 1.1 1.3 31 2.2 2.2 51 4.7 4.8 71 8.4 7.9 91 4 4.7

12 1 1.8 32 1.6 1.8 52 0.8 0.9 72 1.1 1 92 2.8 3.1

13 1.8 1.2 33 1.7 2.1 53 5.3 4.9 73 1.9 1.7 93 4 3.6

14 1.2 1.1 34 1.2 2.1 54 1.1 1.2 74 2.1 1.9 94 4.9 4.8

15 1 1.2 35 3.5 4.5 55 2.8 2.7 75 2.3 2.8 95 0.6 1

16 1.3 1.1 36 1.6 2.1 56 1.5 2.9 76 1.6 1.9 96 5.2 4.9

17 1 1 37 2.3 2.3 57 1.9 1.2 77 2.7 3.1 97 2.8 3

18 0.7 1.2 38 2.6 2.8 58 1.2 1.8 78 1.1 1.2 98 1.5 2.9

19 1.3 1.8 39 1.8 1.9 59 4.2 4.9 79 1.9 2 99 1.8 1.2

20 1.9 2.4 40 1.8 2 60 4.2 4.9 80 1.8 1.3 100 2.1 1.9

MEAN DIAMETERS R L VERTICAL 2.37mm 2.42mm TRANSVERSE 2.25mm 2.37mm

10. LOCATION OF IOF:(Fig no: 13, Chart no:10, Table no: 10)

The location of the infraorbital foramen in this present study were noted to be 41% opposite the 1st premolar and 59% Opposite the 2nd premolar. To be more precise on the right side 39% opposite the 1st premolar& 61%opposite the 2nd premolar and on the left side43% opposite the 1st premolar& 57%opposite the 2nd premolar.

CHART NO 10 ; LOCATION OF IOF

41% Opposite the 1st premolar Opposite the 2nd 59% premolar

TABLE NO : 10 LOCATION OF IOF

LOCATION OF IOF R L

opposite the 1st premolar 39% 43%

opposite the 2nd premolar. 61% 57%

11. ACCESSORY IOF:(Fig no: 14, Chart no:11, Table no: 11)

Accessory infraorbital foramina observed on the total 200 sides were 7.

(right 5 and left 2).

CHART NO 11 ; ACCESSORY FORAMINA

Present Absent

97%

TABLE NO :11 ACCESSORY IOF

R L ACCESSORY IOF 5 2

Discussion

DISCUSSION

A clear knowledge of the location of supraorbital foramina is essential for clinicians in performing surgeries over supraorbital margin and in regional block anaesthesia. Therefore the exact location of the foramen in adult human dried skulls is measured under the following parameters in the present study and compared with previous studies.

FREQUENCY OF OCCURRENCE OF SUPRAORBITAL NOTCH OR FORAMEN

Notch Foramen Both Study Year (%) (%) (%)

Webster et al 1986 61.57 38.43 -

Chung et al 2003 69.9 28.9 -

Saylam et al 2003 71.6 26.6 -

Sithipian Agthong et al 2005 - 3.6 -

Cheng et al 2006 54.1 45.9 -

Dr.S.Swaminathan 2006 52.3 31.2 -

Apinhamist et al 2006 50 17 33

Priya roy P et al 2015 37.3 12 13.3

Present study 2019 83.5 16.5 -

FREQUENCY OF OCCURRENCE OF SUPRAORBITAL NOTCH OR FORAMEN 90

Notch (%) Foramen (%) Both (%)

In the present study the frequency of occurrence of the supraorbital notch were 83.5% and the supraorbital foramen were 16.5% which is closer in range to study on Saylam et al. The percentage of notch is found to be on a higher side than other studies.

DISTANCE OF SOF FROM SUPRAORBITAL MARGIN:

Distance of Study Year SOF from supraorbital margin in mm

Webster et al., 1986 1.56

Agthong et al., 2005 5

Apinhasmit et al., 2006 3.15

Gupta 2008 2.5

Present study 2019 2.33

Distance of SOF from supraorbital margin in mm 6

3 mm

0 Webster et Agthong et Apinhasmit et Gupta Present study al., al., al.,

In the present study the mean distance of SOF from supraorbital margin was 2.33mm closer to 2.5mm observed by Gupta et al. In the study done by

Agthong et al the distance is found to be much higher at 5mm.

DISTANCE OF SOF/SON FROM NASAL MIDLINE IN MM:

Distance of SOF/SON from Study Year nasal midline in mm

Webster et al., 1986 32.02

Chung et al 2003 22.7

Agthong et al., 2005 24.75

Cheng et al 2006 24.56

Apinhasmit et al., 2006 25.14

Gupta 2008 23.9

Jeong et al 2010 29

Present study 2019 21.95

Distance from SOF/SON to nasal midline 35

20 mm 15

In the present study the mean distance of SOF/ SON from nasal midline was 21.95mm which is closer in range to Chung et al observation. The highest range of 32.02mm was observed by Webster et al.

DISTANCE FROM SOF/SON TO TEMPORAL CREST:

Distance fromSOF/SON to Study Year Temporal crest in mm

Apinhamist W et al 2006 26.57

Gupta T et al 2008 30

Bruno ramos et al 2010 23.49

Dr.Sivavadivel 2013 28.5 Swaminathan

Priya Roy P et al 2015 23.8

Present study 2019 28.18

Distance from SOF/SON to Temporal crest in mm 35

20 m m 15

0 Apinhamist W Gupta T et al Bruno ramos et Dr.Sivavadivel Priya Roy P et Present study et al al Swaminathan al

In the present study the mean distance of SOF/ SON from the temporal crest was observed as 28.18mm which is closer in range with the study of

Dr. Sivavadivel swaminathan. The highest value being 30mm noted by

Gupta T et al.

ACCESSORY SUPRAORBITAL FORAMEN:

Study Year Accessory foramina (%)

Saylam et al 2003 2

Sithipian Agthong et al 2005 3.6

Tulika Gupta 2008 14

Present study 2019 7

Accessory foramina (%) 16

% 8

0 Saylam et al Sithipian Tulika Gupta Present study Agthong et al

In the present study the accessory foramina observed was 7%. The least observation being made by Saylam et al as 2%.

The present results of this study provide valuable information to assist the maxillofacial surgeon to locating the infraorbital nerves and vessels. This will help to avoid damage to these structures. The closest estimation of the location of the IOF should be used when designing access incisions to the orbital floor and rim and planning regional nerve blockade.

SHAPE OF THE INFRAORBITAL FORAMEN

Study Year Oval % Round % Semilunar %

Kazkayasi et al 2003 30 40 30

Ilayperuma I et al 2010 38.6/ 36.3 13.6/ 17 29.6/27.6

Ranjani singh et al 2011 40 34.5 -

Present study 2019 28 53.5 18.5

60 Shape of IOF

Oval % % 30 Round % Semilunar %

0 kazkayasi et al Ilayperuma I et al Ranjani singh et al Present study

In the present study the shape of the foramina observed were 28% oval,

53.5% round and 18.5% semilunar. Yet Wolff 53 (1997) states that it is usually oval in shape.

In other studies the percentage ranges between 30%-40 % oval , 13.6%-

40 % round and 27.6%-30% semilunar.

DISTANCE BETWEEN IOF AND IOM

Authors Year Distances (mm)

Chung 1955 8.60

Hindy and Raouf 1933 6.10

Triandafilidi et al 1990 7.19

8.30 (women); Canan 1999 10.90(men) 7.80 (women); Aziz 2000 8.50 (men)

Kazkayasi 2002 6.70

Karakas et al 2003 6.7

Elias et al 2004 6.71/6.83

Macedo 2008 6.37

Oliveria et al 2009 6.8

Present study 2019 4.13

Distances (mm) 12

mm 6

Distances (mm)

Zide BM et al (1998)54, 24 , states that the infraorbital margin has been used frequently to measure the locations of infraorbital foramen, and the distance between them is 4-10mm. In the present study the mean distance of IOF from

Infraorbital margin was observed as 4.13mm which is lesser than all other studies yet follows the range of Zide BM et al.

DISTANCE BETWEEN IOF & PA:

Distance between IOF & Authors Year PA (mm)

Hindy and Raouf 1993 17.23

Kazkayasi 2001 14.70

Elias et al 2004 13.28/13.31

Macedo 2008 17.67

Present study 2019 17.51

Distance between IOF & PA (mm) 20

mm 10 8

0 Hindy and Kazkayasi Elias et al Macedo Present Raouf study Distance between IOF & PA (mm)

In the present study the mean distance of IOF from piriform aperture was observed as 17.51mm which is similar to the observation made by Macedo et al.

VERTICAL AND TRANSVERSE DIAMETERS OF IOF

Vertical diameter Transverse Study Year (mm) diameter(mm)

Boopathi et al 2010 2.79 2.73

Singh et al 2011 3.75 3.52

Rajani singh et al 2011 3.23 3

Bharti et al 2013 3.23 3.28

Present study 2019 2.39 2.31

VERTICAL AND TRANSVERSE DIAMETERS OF IOF 4

3.5

2.5

2 mm

1.5

0.5

0 Boopathi et Singh et al Rajani singh Bharti et al Present al et al study Vertical diameter (mm) Transverse diameter(mm)

In the present study the mean vertical and transverse diameters of IOF was observed as 2.39mm and 2.31mm respectively which is in closer range with the observations of Boopathi et al.

LOCATION OF INFRAORBITAL FORAMEN

Opposite st Between the the Opposite Between 1 nd st the and 2 premolar Study Year 1 nd nd st 2 premolar 2 premolar and 1 molar premolar % % % %

Agthong et al 2001 - 53.8 31.6 12.7

Hindy et al 2016 15 50 15 -

Ilayperumal et al 2017 - 55.56 29.63 11.11

Present study 2019 41 59 - -

LOCATION OF INFRAORBITAL FORAMEN

60 Opposite the 1st premolar %

40 Opposite the 2nd

% premolar % 30

20 Between 1st and 2nd premolar % 10

0 Agthong et al Hindy et al Ilayperumal Present Between the 2nd et al study premolar and 1st molar %

In the present study the location of IOF was observed as 41% opposite the

1st premolar and 59% opposite the 2nd premolar, while the locations between 1st and 2nd premolar and between 2nd premolar and 1st molar are not observed.

ACCESSORY FORAMINA

Study Year Accessory foramina %

Kazkayasi M 2001 5.7

Bressan C 2004 4.7

Tezer 2011 7

KK Gaur 2011 4

Oliveria J 2012 21.6

Lokanayaki V 2013 8

Present study 2019 3

Accessory foramina % 25

Accessory foramina %

According to Hanihara and Ishida22 accessory foramina were more common in Northeast Asian skulls.

In the present study the accessory foramina observed was 3% which is closer to the observation of KK Gaur of 4%

Conclusion

CONCLUSION

In this study, measurements were made on adult cadaveric dry human skulls to determine the dimensions and location of the supraorbital and infraorbital foramina. The data may be useful to anaesthetists and surgeons for providing appropriate nerve blocks and planning the surgical flaps. The morphometric study of Supraorbital and Infraorbital foramina is of paramount importance for assessing their location in maxillofacial surgeries, nerve blocks and dental anaesthesia.

The study was conducted and results were tabulated and the following conclusions were drawn:

 The frequency of occurrence of supraorbital notch is higher than the foramina

at about 83.5% and the supraorbital foramina being 16.5%. A few skulls had

accessory foramen.

 The average height of the foramen from the supraorbital margin was 2.33mm.

 The average distance of the supraorbital foramen from the nasal mid-line was

21.95mm.

 The average distance of the supraorbital foramen from the temporal crest was

28.18mm.

 The shape of the infraorbital foramen were 53.5% Round, 28% oval, 18.5%

semilunar. Round being the predominant shape of the foramen and accessory

foramina were noted in few skulls

 The average distance of the foramen from the infraorbital margin was

4.13mm.

 The average distance of the foramen from the piriform aperture was 17.51mm.

 The vertical & transverse diameters were 2.39mm & 2.31mm.

 The location of infraorbital foramen were 41 %Opposite the 1st premolar and

59% Opposite the 2nd premolar. The predominant location of the foramen

being opposite the 2nd premolar.

Therefore, the results suggests that the supraorbital notch being higher in occurrence than foramen and the position of the supraorbital notch or foramen is not constant. The occurrence of accessory foramina is very common. Because of these variations of the exit of the supraorbital nerve and its branches, al the surgical procedures involving the supraorbital rim and adjoining areas have to be performed very carefully with the awareness of probabale variations.

The infraorbital foramina were found to be predominantly round in shape and mostly being located opposite the 2nd premolar. The morphometric measurements will facilitate the professionals to locate the neurovascular bundles

75 passing through the foramen and also assists in non-invasive as well as invasive surgical procedures.

The present study adds information to the literature concerning the morphometry of Supraorbital and Infraorbital foramina. The knowledge of distances of these foramina from surgically encountered landmarks in this study may facilitate surgical, diagnostic, therapeutic, local anaesthetic and other invasive procedures without causing any injury to the surrounding vital structures.

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MASTER CHART 1

Distance of Supraorbital notch or Distance from SOF/SON to Distance from SOF/SON to SOF/ SON from supraorbital Accessory foramina S.No. foramen ( SON/ SOF) nasal midline in mm Temporal crest in mm margin in mm R L R L R L R L R L 1 SON SON - - 19.8 22 32.2 29.9 - - 2 SON SOF - 3.9 22.2 24.6 30.6 31.6 + - 3 SON SON - - 22.4 24 27.9 29.3 - - 4 SOF SON 3.2 - 20.5 15.9 35.9 36.5 - - 5 SON SOF - 2.6 23.2 22.9 33 32.2 - - 6 SOF SOF 4.1 3.0 27.7 28.9 30.9 30.2 - - 7 SOF SOF 4.4 2.9 27.6 27.1 37 32.3 + + 8 SON SOF - 1.2 24.2 20.7 25.6 27.9 - - 9 SOF SON 1.4 - 20.8 20.1 26 25.3 - - 10 SON SON - - 21.7 20.1 25.3 25.9 - - 11 SON SON - - 23.4 23.0 26.8 26.1 + + 12 SON SON - - 23.5 25.1 28 25.3 - - 13 SON SON - - 21.5 17.7 26.7 27.8 - - 14 SON SOF - 2.6 22.1 25.1 26.3 24 - - 15 SON SON - - 20.6 20.3 27.7 28.8 - - 16 SON SON - - 21.5 22.7 26.8 25 - - 17 SON SON - - 23.9 25.4 24.3 22.7 - - 18 SOF SON 1.2 - 23.9 25.4 24.1 22.7 - - 19 SOF SOF 2.1 1.2 25.6 23.1 25.6 25.1 - - 20 SON SON - - 20.3 20.9 24.3 24.1 - - 21 SON SON - - 20 21.2 27.3 27.1 - - 22 SON SON - - 21.7 22.7 27.1 25 - - 23 SON SON - - 17.9 17.9 26 27.7 - - 24 SOF SON 1.1 - 21.7 21.1 25.7 25.4 ++ + 25 SON SON - - 20.3 19.7 25.9 26.4 - - 26 SON SON - - 20.6 21 26.7 26.7 - - 27 SON SON - - 19.9 20.9 26.4 26.1 - - 28 SON SON - - 21.4 22.8 30 27.4 - - 29 SON SON - - 20.2 19.7 26.9 26.7 + + 30 SON SON - - 20.6 21 26.9 26.5 - - 31 SOF SON 1.1 - 20.9 19.8 25.6 25.9 - - 32 SON SON - - 21.7 20.4 25.2 26.3 - - 33 SOF SOF 1.6 1.9 24.9 24.5 23.9 25.3 - + 34 SON SON - - 22.4 19.8 26.3 27.9 - - Distance of Supraorbital notch or Distance from SOF/SON to Distance from SOF/SON to SOF/ SON from supraorbital Accessory foramina S.No. foramen ( SON/ SOF) nasal midline in mm Temporal crest in mm margin in mm R L R L R L R L R L 35 SON SON - - 23.6 20.5 27.9 29.3 - - 36 SON SON - - 20.7 22.2 30.2 32.3 - - 37 SON SON - - 22.3 23.8 33.2 28.2 - - 38 SON SON - - 20.6 18.7 34.5 33.4 - - 39 SOF SOF 2.4 1.4 24.3 23.1 31 32.8 - - 40 SON SON - - 22.2 23.4 31.9 33.8 - - 41 SON SON - - 20.5 19.8 30.7 32.6 - - 42 SOF SOF 4.6 3.6 27.6 23.9 25.9 32.4 - - 43 SOF SON 1.4 - 23.3 21.8 30.6 31.3 - - 44 SON SON - - 22.4 24 27.9 29.3 - - 45 SOF SOF 4.4 2.9 27.6 27.1 36.8 32.3 + + 46 SON SON - - 22.5 23.7 27.8 25.8 - - 47 SON SON - - 21 22.2 27.9 28.2 - - 48 SON SON - - 25.2 21.7 27.6 28.7 - - 49 SON SON - 1.4 22.5 24.1 26.8 24.3 - - 50 SON SON - - 22.6 19.5 26.9 28.3 - - 51 SON SOF - 1.4 23.3 22.1 30.1 30.8 - - 52 SON SON - - 20.3 20 25.9 26.4 - - 53 SON SON - - 19.7 18.1 23.3 23.9 - - 54 SON SON - - 19.5 20.7 24.8 22.8 - - 55 SON SON - - 21.1 22.3 28.3 27.8 - - 56 SON SON - - 18.9 19 27.9 27.1 - - 57 SON SON - - 20.9 21.9 24.6 25.3 - - 58 SON SON - - 22.4 23.8 30.8 28.4 - - 59 SOF SON 2.3 - 22.7 21.3 26.5 27.2 - - 60 SOF SOF 1.8 1.6 22.9 23.5 22.9 24.3 - + 61 SON SON - - 21.7 23.2 31.2 33.2 - - 62 SON SON - - 20.3 21.8 31.2 26.2 - - 63 SON SON - - 22.6 23 28.9 28.5 - - 64 SON SON - - 19.9 18.8 24.6 24.9 - - 65 SON SON - - 20.7 22.2 30.2 32.3 - - 66 SON SON - - 22.3 23.8 33.2 28.4 - - 67 SON SON - - 23.2 24.4 32.9 34.8 - - 68 SON SON - - 21.5 18.8 29.7 33.4 - - 69 SON SON - - 20.6 21 26.2 26.5 - - 70 SON SON - - 21.6 21.3 28.7 29.6 - - 71 SON SON - - 22.5 23.7 27.6 26 - - Distance of Supraorbital notch or Distance from SOF/SON to Distance from SOF/SON to SOF/ SON from supraorbital Accessory foramina S.No. foramen ( SON/ SOF) nasal midline in mm Temporal crest in mm margin in mm R L R L R L R L R L 72 SON SON - - 22.9 24.4 23.1 21.7 - - 73 SON SON - - 18.9 20.4 22.1 20.7 - - 74 SOF SOF 2 1.8 22.6 20.1 23.6 22.9 - - 75 SON SON - - 24.3 24.9 27.4 27.9 - - 76 SON SON - - 18.4 20 23.9 25.1 - - 77 SOF SON 3.2 - 22.5 17.9 33.9 34.3 - - 78 SON SON - - 19.7 18.1 22.1 22.9 - - 79 SON SON - - 23.5 24.7 28.6 27 - - 80 SON SON - - 18 17.2 24.1 23.9 - - 81 SON SON - - 23.6 24 29.9 29.7 - - 82 SON SON - - 20.9 21.9 27.6 27.1 - - 83 SON SON - - 22.4 23.8 30.8 28.6 - - 84 SON SON - - 21.2 20.7 27.9 27.9 - + 85 SON SON - - 24.6 24 30.7 30.6 - - 86 SON SON - - 21.7 23.2 31.2 33.1 - - 87 SON SON - - 22.3 24.8 33.4 29.2 - - 88 SON SON - - 20.6 17.7 33.5 32.2 - - 89 SON SON - - 23.3 23.1 29.8 32.8 - - 90 SON SON - - 21.2 23.4 30.9 33.8 - - 91 SON SON - - 25.5 24.8 33.5 35.6 - - 92 SON SON - - 17.9 18.9 26.9 28.9 - - 93 SON SON - - 20.9 20.9 27.6 26.1 - - 94 SON SON - - 23.4 22.8 31.8 27.6 - - 95 SON SON - - 22.7 20.4 24.2 26.3 - - 96 SON SON - - 19.6 21 25.7 26.7 - - 97 SOF SOF 1.9 2.1 21.9 19.8 24.6 25.9 - - 98 SON SON - - 23.7 22.2 29.2 32.3 - - 99 SON SON - - 22.3 22.8 33.4 27.4 - - 100 SON SON - - 22.2 20.4 32.1 30.8 - -

MASTER CHART 2

Distance between Distance between Vertical diameter Transverse diameter Accessory Shape of the foramen Location in relation to tooth S.No. IOF and IOM IOF & PA in mm of IOF in mm of IOF in mm foramina R L R L R L R L R L R L R L 1 Round Semilunar 3 2.9 14.3 14.1 2.4 2.3 2.2 3.4 II Premolar II premolar + - 2 Round Round 4.2 5.4 15.9 15.4 2.1 3.3 2.2 3.4 I Premolar I Premolar - + 3 Round Semilunar 3 4.3 14.3 13.9 1.7 2.0 1.9 2.4 II Premolar I Premolar - - 4 Round Oval 7.8 8 15.6 15.4 2.2 3.2 2.3 2.3 I Premolar I Premolar - - 5 Oval Oval 7 8.5 17.6 17.6 2.5 2.4 1.9 1.3 II Premolar II Premolar + - 6 Oval Semilunar 6 5.3 17.1 17.5 2.3 2.1 1.5 2.9 I Premolar I Premolar - - 7 Semilunar Round 7.3 7.2 16.6 16.5 1.3 1.4 1.9 1.3 II Premolar II Premolar - - 8 Semilunar Round 3.9 3.2 19.4 18.3 7.9 8.1 8.6 7.9 II Premolar II Premolar - - 9 Oval Round 2.3 2.4 18 18.6 2 1.8 2.8 1.7 I Premolar I Premolar - - 10 Semilunar Round 3 3.8 16.5 17.8 1.1 1.3 1.9 1.2 I Premolar I Premolar - - 11 Round Round 3.4 3.1 18.9 19 1.2 1.4 1.1 1.3 II Premolar II Premolar - - 12 Round Round 3.4 3 17.7 17.9 1.1 2 1 1.8 II Premolar II Premolar - - 13 Round Round 3.2 3 18.9 19 1.8 1.4 1.8 1.2 I Premolar I Premolar - - 14 Round Oval 3.3 3.5 17.7 17.9 1 1.8 1.2 1.1 I Premolar I Premolar - - 15 Round Round 4 3.2 19.8 17.8 1.2 1.3 1 1.2 I Premolar II Premolar - - 16 Round Round 2.7 3.4 16.8 17.6 1.5 1.4 1.3 1.1 I Premolar I Premolar - - 17 Round Oval 3.3 2.8 18.5 18 1.2 1.9 1 1 II Premolar I Premolar - - 18 Oval Round 4.7 5.8 18.7 19.1 1.5 1 0.7 1.2 I Premolar II Premolar - - 19 Round Semilunar 3.2 3.8 17.6 16.5 1.4 1.2 1.3 1.8 II Premolar I Premolar - - 20 Round Transversely 2.4 2.7 18.2 18.1 1.7 1.9 1.9 2.4 II Premolar II Premolar - - 21 Oval Semilunar 2.3 2.1 17.9 17.6 2.1 1.4 1.6 1.9 II Premolar II Premolar - - 22 Round Semilunar 3 4.3 14.3 13.9 1.7 2.0 1.9 2.4 II Premolar I Premolar - - 23 Round Oval 2.8 3.2 18.0 19.3 1.1 0.8 0.9 0.4 I Premolar II Premolar - - 24 Round Oval 2.8 3.2 18 17.7 1.3 1.1 1.6 1.2 II Premolar II Premolar - - 25 Round Round 3.2 4 18.9 18.2 1 0.8 0.8 0.6 II Premolar II Premolar - - 26 Oval Round 3.2 2.7 18.9 17.7 1.2 0.8 0.8 1 II Premolar I Premolar - - 27 Round Round 2.4 2.4 19.4 18.3 1.3 1.8 1.2 1.7 II Premolar I Premolar - - 28 Semilunar Semilunar 1.9 2.2 17.2 16.9 1.8 1.8 2.2 2.3 II Premolar I Premolar - - 29 Round Round 2.5 2 17.6 17.8 1.9 2 1.7 1.9 II Premolar II Premolar - - 30 Round Round 2.5 2 17.6 17.8 1.7 1.9 1.9 2.1 II Premolar II Premolar - - 31 Semilunar Semilunar 3 3.2 18 18.6 1.6 1.8 2.2 2.2 I Premolar II Premolar - - 32 Oval Oval 7 8.5 17.6 17.6 2.5 2.4 1.9 1.3 II Premolar II Premolar + - 33 Round Round 3.7 3.6 16.6 16.7 1.5 1.7 1.6 1.8 II Premolar II Premolar - - 34 Round Oval 3.9 4.5 18 18.1 1.9 2.4 1.7 2.1 I Premolar I Premolar - - Distance between Distance between Vertical diameter Transverse diameter Accessory Shape of the foramen Location in relation to tooth S.No. IOF and IOM IOF & PA in mm of IOF in mm of IOF in mm foramina R L R L R L R L R L R L R L 35 Round Oval 3.4 3.2 18 17.9 1.3 1.9 1.2 2.1 I Premolar II Premolar - - 36 Oval Semilunar 4.2 4.5 17.4 16.3 4.2 3.9 3.5 4.5 II Premolar II Premolar - - 37 Round Oval 3.7 4.4 18.1 18.7 1.7 2.6 1.6 2.1 II Premolar II Premolar - - 38 Round Oval 7.8 8 15.6 15.4 2.2 3.2 2.3 2.3 I Premolar I Premolar - - 39 Semilunar Semilunar 3 3.2 18 18.6 1.8 2.2 2.6 2.8 I Premolar II Premolar - - 40 Oval Round 4.5 3.9 18.1 18 2.3 1.7 1.8 1.9 II Premolar II Premolar - - 41 Semilunar Round 3.1 3.8 17.9 19.6 1 1.8 1.8 2 II Premolar I Premolar - - 42 Round Oval 2 2.7 18 19.3 0.9 1.9 0.9 1.4 I Premolar II Premolar - + 43 Oval Round 3.9 5 17.1 18 4.8 4.5 3.8 4.7 II Premolar II Premolar - - 44 Oval Round 7.4 8.5 15.5 17.2 5.4 5 5.1 4.9 II Premolar I Premolar - - 45 Round Round 2.4 2.4 19.4 18.3 1.6 1.2 1.7 1 II Premolar I Premolar + - 46 Oval Oval 7.8 7.6 16.8 17.9 5.3 4.9 4.8 4.3 I Premolar I Premolar - - 47 Round Round 3.2 2.7 18.9 19.3 1 0.8 1 1.2 II Premolar I Premolar - - 48 Oval Round 7.3 7.8 17.6 17.1 4.9 4.6 4.2 4.5 I Premolar II Premolar - - 49 Round Round 3.6 2.9 16.9 17.5 3.9 4 4 4.1 I Premolar II Premolar - - 50 Oval Oval 4.5 5.8 16.6 15.5 5.3 4.5 4.8 4 II Premolar II Premolar - - 51 Round Round 7.5 6.7 17.2 16.2 3.9 4.6 3.7 4.5 II Premolar II Premolar - - 52 Round Round 7 5.5 14.5 14.8 4.9 5 4.7 4.8 II Premolar II Premolar - - 53 Oval Round 3.2 4.2 18.6 18.2 1.4 0.8 0.8 0.9 II Premolar II Premolar - - 54 Semilunar Round 4.6 5.3 12.5 17 4.7 5 5.3 4.9 II Premolar I Premolar - - 55 Round Oval 3 3.2 18.2 17.7 1.3 1.7 1.1 1.2 II Premolar II Premolar - - 56 Semilunar Semilunar 2 2.2 17.2 16.6 1.8 2.2 2.8 2.7 II Premolar II Premolar - - 57 Oval Semilunar 6.2 5.3 17 17.5 2.3 2 1.5 2.9 I Premolar I Premolar - - 58 Round Round 3.2 3.1 18.9 19 1.8 1.4 1.9 1.2 I Premolar I Premolar - - 59 Round Semilunar 3.2 4 17.6 16.5 1.3 1.2 1.2 1.8 II Premolar I Premolar - - 60 Oval Oval 8 7.6 16.9 17.9 4.8 5.3 4.2 4.9 I Premolar I Premolar - - 61 Round Round 3.3 2.7 18.9 19.3 1.1 0.8 1.1 1 II Premolar I Premolar - - 62 Round Oval 3.5 3.2 18.5 17.9 1.3 2.6 1.2 2.1 I Premolar II Premolar - - 63 Semilunar Semilunar 2 2.2 17.2 16.9 1.8 2.3 2.3 2.7 II Premolar I Premolar - - 64 Semilunar Semilunar 1.9 2.2 17.2 16.9 1.8 2.2 2.5 2.7 II Premolar I Premolar - - 65 Round Oval 3.5 2.8 18.5 18 1.2 1.9 1 1.1 II Premolar I Premolar - - 66 Oval Round 2.2 2.4 18.3 18.6 3.2 1.8 2.8 1.7 I Premolar I Premolar - - 67 Semilunar Round 3.1 3.8 16.5 17.8 1 1.3 1.9 1.2 I Premolar I Premolar - - 68 Round Round 4.1 3.2 19.8 17.8 1.2 1.3 1.1 1.2 I Premolar II Premolar - - 69 Oval Semilunar 2.3 2 17.9 17.6 2.2 1.4 1.5 1.9 II Premolar II Premolar - - 70 Oval Oval 7.2 8.5 17.6 17.7 2.8 2.4 1.9 1.3 II Premolar II Premolar - - 71 Semilunar Round 3.9 3 19.4 18.3 7.6 8.1 8.4 7.9 II Premolar II Premolar - - 72 Round Round 2.9 3.4 16.8 17.5 1 1.2 1.1 1 I Premolar I Premolar - - Distance between Distance between Vertical diameter Transverse diameter Accessory Shape of the foramen Location in relation to tooth S.No. IOF and IOM IOF & PA in mm of IOF in mm of IOF in mm foramina R L R L R L R L R L R L R L 73 Round Oval 2.8 3.2 18 19.3 1.9 2.2 1.9 1.7 I Premolar II Premolar - - 74 Round Round 2.5 2.8 17.6 17.8 2 1.9 2.1 1.9 II Premolar II Premolar - - 75 Round Oval 7.8 8.3 15.6 15.4 2.2 3.2 2.3 2.8 I Premolar I Premolar - - 76 Oval Round 4.5 3.9 18.1 18 2.1 1.7 1.6 1.9 II Premolar II Premolar - - 77 Oval Oval 4.9 5.8 17.6 15.5 3.2 3.7 2.7 3.1 II Premolar II Premolar - - 78 Round Round 4.5 3.2 19.8 17.8 1.2 1.3 1.1 1.2 I Premolar II Premolar - - 79 Round Round 2.5 2.9 17.6 17.8 1.8 1.9 1.9 2 II Premolar II Premolar - - 80 Semilunar Round 7 7.2 16.6 16.5 1.3 1.2 1.8 1.3 II Premolar II Premolar - - 81 Round Oval 3.3 3 17.7 17.9 1.7 1.8 1.8 1.1 I Premolar I Premolar - - 82 Oval Semilunar 2.3 2.1 17.9 17.6 2.8 2.2 1.6 2.9 II Premolar II Premolar - - 83 Round Round 2.4 2.4 19.4 18.3 1.3 1.8 1.2 1.7 II Premolar I Premolar - - 84 Round Oval 3.4 3.2 18 17.9 1.3 2.7 1.2 2.1 I Premolar II Premolar - - 85 Round Oval 2 2.7 18 19.3 0.9 1.9 0.9 1.4 I Premolar II Premolar - - 86 Semilunar Round 7.1 7.2 18.6 18.5 1.3 1.4 1.7 1.3 II Premolar II Premolar - - 87 Round Round 2.4 2.4 19.4 18.3 1.6 1.8 1.7 1.9 II Premolar I Premolar + - 88 Oval Oval 7.8 7.6 16.8 17.9 4.7 4.2 4.1 3.6 I Premolar I Premolar - - 89 Round Round 3.2 2.7 18.9 19.3 1 0.8 1 1 II Premolar I Premolar - - 90 Oval Round 7.3 7.8 17.6 17.1 4.9 4.6 4.2 4.7 I Premolar II Premolar - - 91 Round Round 3.6 2.9 16.9 17.5 3.9 4.6 4 4.7 I Premolar II Premolar - - 92 Oval Oval 4.9 5.8 17.6 15.5 3.2 3.7 2.8 3.1 II Premolar II Premolar - - 93 Round Round 7.5 5.7 17.2 15.2 3.9 3.7 4 3.6 II Premolar II Premolar - - 94 Round Round 6.7 5.5 14.5 14.8 4.9 5 4.9 4.8 II Premolar II Premolar - - 95 Oval Round 3.6 4 18.9 18.2 1.2 0.8 0.6 1 II Premolar II Premolar - - 96 Semilunar Round 4.8 5 12.5 17.1 4.7 5 5.2 4.9 II Premolar I Premolar - - 97 Semilunar Semilunar 1.8 2.2 17.2 16.9 1.8 2.2 2.8 3 II Premolar II Premolar - - 98 Oval Semilunar 6.1 5.3 17.1 17.5 2.3 2.1 1.5 2.9 I Premolar I Premolar - - 99 Round Round 3 3 18.9 19 1.8 1.4 1.8 1.2 I Premolar I Premolar - - 100 Round Round 2.2 2 17.6 17.8 1.9 1.7 2.1 1.9 II Premolar II Premolar - -

Fig No. 1 : SUPRAORBITAL NOTCH Fig No. 2 - SUPRAORBITAL FORAMEN Fig No.3 - DISTANCE OF SOF FROM SUPRAORBITAL MARGIN Fig No. 4 - DISTANCE OF SOF FROM NASION Fig No. 5 - DISTANCE OF SOF FROM TEMPORAL CREST Fig No. 6 - ACCESSORY SOF Fig No. 7 - ROUND & OVAL IOF

Oval Round Fig No. 8 - SEMILUNAR IOF

Semilumar Fig No. 9 - DISTANCE OF IOF FROM IOM Fig No. 10 - DISTANCE OF IOF FROM PA Fig No. 11 - VERTICAL DIAMETER OF IOF Fig No. 12 - TRANSVERSE DIAMETER OF IOF Fig No. 13 - LOCATION OF IOF Fig No. 14 - ACCESSORY IOF