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Download PDF File Folia Morphol. Vol. 78, No. 2, pp. 331–343 DOI: 10.5603/FM.a2018.0084 O R I G I N A L A R T I C L E Copyright © 2019 Via Medica ISSN 0015–5659 journals.viamedica.pl Morphometric evaluation and surgical implications of the infraorbital groove, canal and foramen on cone-beam computed tomography and a review of literature İ. Bahşi1, M. Orhan1, P. Kervancioğlu1, E.D. Yalçin2 1Department of Anatomy, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey 2Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Gaziantep University, Gaziantep, Turkey [Received: 25 June 2018; Accepted: 8 August 2018] Background: The purpose of this study is to evaluate the anatomy, morphometry, and variations of infraorbital groove (IOG), infraorbital canal (IOC) and infraorbital foramen (IOF) on the cone-beam computed tomography (CBCT) images and to investigate their relations with surrounding structures. Methods: IOG, IOC and IOF were evaluated retrospectively in CBCT images of 75 female (F) and 75 male (M) cases with a range of 18–65 years (F: 37.62 ± ± 13.55, M: 37.53 ± 15.87) by Planmeca Romexis programme. IOG, IOC and IOF were examined bilaterally (300 sides) in the cases. The 13 parameters were measured on these images in axial, sagittal and coronal planes. Results: There was a very weak positive correlation between the age and the angle between IOC and IOG (p = 0.015, r = 0.198), there was a weak positive correlation between the age and skin thickness (p = 0.001, r = 0.281), and there was no correlation between the age and other parameters. A total of 21 (7%) IOCs were detected in maxillary sinus, bilaterally in 6 cases and unilaterally in 9 cases (5 on the left, 4 on the right). In 1 case, bilaterally, IOC was separated 2 canals while running anteriorly in the maxillary sinus. The larger one was directed to IOF in its normal course and the smaller one was directed to lateral wall of nasal cavity and opened to the inferior nasal meatus in front of the opening of nasolacrimal duct. Conclusions: We suggest that the parameters found in the present study may facilitate prediction of the location of the infraorbital nerve. Knowledge of this exact position in relation to easily measurable parameters may decrease the risk of infraorbital nerve injury during surgical approaches directed to this region and might serve as a guide during local anaesthetic interventions for dentistry, ophthalmology, plastic surgery, rhinology, neurosurgery and dermatology. (Folia Morphol 2019; 78, 2: 331–343) Key words: cone-beam computed tomography, infraorbital foramen, infraorbital canal, infraorbital groove, infraorbital nerve blockage Address for correspondence: Dr. İ. Bahşi, Department of Anatomy, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey, tel: +90 342 360 60 60/74070, fax: +90 342 472 07 18, e-mail: [email protected] 331 Folia Morphol., 2018, Vol. 78, No. 2 INTRODUCTION CBCT images with no pathology of 75 female and Infraorbital groove (IOG), located on the inferior 75 male subjects aged 18–65 years were selected wall of the orbit and at the orbital surface of the randomly. The images of patients who were admitted body of maxilla, begin from the inferior orbital fissure to Gaziantep University Faculty of Dentistry for any posteriorly and continues as infraorbital canal (IOC) reason were evaluated retrospectively by Planmeca anteriorly and IOC opens to the middle of the face Romexis (Planmeca, Helsinki, Finland) programme. through the infraorbital foramen (IOF). Infraorbital On the images with artefact that prevents detection nerve (ION) and vessels pass through IOG, IOC and and measurement of reference points; maxillary sinus spread from IOF [70, 74]. ION is responsible for the pathologies that may affect maxilla, IOG, IOC and sensory innervation of upper cheek skin, maxillary IOF size; cases with developmental, metabolic or sinus mucosa, maxillary incisor, canine and premolar inflammatory jaw disease were not included in the teeth, occasionally mesiobuccal root of first molar study. IOG, IOC and IOF were examined bilaterally tooth and adjacent buccolabial gingiva and perios- (300 sides) in the cases. The following 13 parameters tium, the skin and conjunctiva of the inferior eyelid, were measured on these images in axial, sagittal and part of the nose, and the skin and mucosa of the coronal planes (Fig. 1). upper lip [52]. Anaesthesia of the ION may be performed on Axial: interventions such as surgical procedure of the facial — 1: The angle between the IOC and the sagittal region involving nose soft tissues, cheek, lower eyelid plane (Fig. 1A) and maxillary premolar, canine and incisive teeth, Sagittal: orbital floor fracture treatment, nasal bone fracture — 2: The angle between the IOC and the axial plane reduction, scar revisions, cosmetic cutaneous proce- (Fig. 1B) dures and polypectomy [51, 55, 74]. ION blockage — 3: The angle between IOC and IOG (Fig. 1C) may be performed for trigeminal neuralgia and post- — 4: IOC length (Fig. 1C) operative pain [2, 27]. It is known that ION paraes- — 5: IOG length (Fig. 1C) thesia may occur after surgical interventions [4, 54]. — 6: Vertical diameter of IOF (VD-IOF) (Fig. 1C) Bilateral ION blockage is a preferred local method for — 7: The distance between IOF and infraorbital mar- early repair of cleft lip, facial lacerations, rhinoplasty gin (IOF-IOM) (Fig. 1D) repair and endoscopic endonasal maxillary sinus sur- — 8: Skin thickness over IOF (skin thickness) (ST) geries [13, 31, 35, 48, 56]. It is important to know (Fig. 1D) the IOF neighbourhood for reducing complications in Coronal: placement of malar, submalar, or paranasal implants — 9: Transverse diameter of IOF (TD-IOF) (Fig. 1E) [61]. The risk of ION’s injury is high because it is dif- — 10: The distance between IOF and the mid-sagittal ficult to determine the localisation and the course of plane (IOF-ML) (Fig. 1E) the ION [4]. Although IOC is important, it is not clearly — 11: The distance between IOF and the lateral wall defined [79]. The pathway of ION is important for of the nasal cavity (IOF-LNW) (Fig. 1F) dentistry, ophthalmology, plastic surgery, rhinology, — 12: The distance between IOF and the occlusal neurosurgery and dermatology. For this reason, it is plane of the second premolar tooth (IOF-PM). substantial to know the morphometric properties of The distance between the transverse axis passing IOG, IOC, and IOF and their relations with surround- through the second premolar tooth level and the ing structures. IOF was measured in the images where the IOF The purpose of this study is to evaluate the anat- and the second premolar tooth were not in the omy, morphometry, and variations of IOG, IOC and same section (Fig. 1F) IOF on the cone-beam computed tomography (CBCT) — 13: The distance between IOF and vertical axis of images and to investigate their relations with sur- lateral rim of frontozygomatic suture (IOF-FZS) rounding structures. (Fig. 1G, H) MATERIALS AND METHODS Statistical analysis Before the study, permission was received from The data were evaluated statistically. The normality the Clinical Trials Ethics Committee. A total of 150 of data distribution was tested by the Shapiro-Wilk test. 332 İ. Bahşi et al., Evaluation of infraorbital groove, canal and foramen Figure 1. Thirteen parameters (abbreviations — see text) were measured on cone-beam computed tomography images in axial (A), sagittal (B, C, D) and coronal (E, F, G, H) planes. Student t test was used for comparison of variables with and the smaller one was directed to lateral wall of normal distribution in two independent groups, and nasal cavity and opened to the inferior nasal meatus paired t test was used for comparison of two depend- in front of the opening of nasolacrimal duct (Fig. 3). ent measures. The Pearson correlation coefficient was used when the relations between numerical variables DISCUSSION were tested. The SPSS 22.0 software package was used There are many bone [2, 12, 18, 20, 38, 45, 53, 57, in the analyses and p < 0.05 was accepted significant. 58, 60, 66, 68] and cadaver [6, 14, 25, 39, 44, 59, 66, 71] studies in which the relationship between morpho- RESULTS metry of IOG, IOC, and IOF and their relations to the In this study, IOG, IOC and IOF were evaluated bilat- surrounding structures have been examined. Kazkayasi erally in CBCT images of 75 female (F) and 75 male (M) et al. [38] evaluated 35 dry skulls both in bones and cases with a range of 18–65 years (F: 37.62 ± 13.55, cephalometric radiography. Lee et al. [43] evaluated the M: 37.53 ± 15.87). No significant mean age differ- computed tomography (CT) of the 42 dry skulls. In the ence existed between genders (p > 0.956). Thirteen literature, there are publications in which IOG, IOC or parameters were evaluated (Table 1). The parameters IOF are assessed with CT in the living person [34, 36, 42, were compared by gender; significant differences were 61, 67, 72, 78, 79]. There are few publications in which found in the IOC length (right [R]: p = 0.029, left [L]: these three structures have been evaluated like in this p = 0.021), in the IOF-IOM (R: p = 0.005, L: p = 0.012) study [34]. CT can show localisation and morphometry and in the VD-IOF (R: p = 0.001, L: p = 0.002). of the structures in three dimensions. Hwang et al. There was a very weak positive correlation be- [34] stated that CT mediated measurements were as tween the age and the angle between IOC and IOG effective as dry skull and cadaver measurements. The (p = 0.015, r = 0.198), there was also a weak posi- most important advantage of CT measurements in the tive correlation between the age and ST (p = 0.001, living person compared to dry skull and cadaver is that r = 0.281), and there was no correlation between the the gender and age of the cases are known precisely.
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