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 Table of Contents  
ORIGINAL ARTICLE
Year : 2014  |  Volume : 3  |  Issue : 3  |  Page : 122-127

Morphology and morphometry of infra orbital foramen in South Indian adult dry skulls


1 Associate Professor of Anatomy, K S Hegde Medical Academy, Mangalore, Karnataka, India
2 1 MBBS Student, K S Hegde Medical Academy, Mangalore, Karnataka, India

Date of Web Publication21-Jan-2020

Correspondence Address:
K Vishal
Associate Professor of Anatomy, K S Hegde Medical Academy, NITTE University, Mangalore- 575 018, Karnataka
India
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Source of Support: None, Conflict of Interest: None


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  Abstract 


Background: The infra orbital foramen (IOF) situated below infra-orbital margin (IOM) transmits infraorbital nerve and infra- orbital vessels. The knowledge of the dimension, shape and direction of the IOF has important implications in various surgical and anaesthetic procedures. This will avoid iatrogenic injury to neurovascular bundle emerging from the IOF. Material and methods: Sixty adult dry skulls of unknown sex from the Department of Anatomy and Department of Forensic Medicine were used. IOF on both sides of skulls were assessed for the shape and direction by inspection. The vertical and horizontal diameter of the IOF was measured using a digital Vernier caliper to the nearest millimeters and the results were statistically analyzed. Results: The shape of the IOF was vertically oval in majority of the skulls (37.5%) and was semi lunar shaped in 10.83% of the skull. The IOF was directed infero- medially in about 52.5% of the cases and was directed medially in 6.67% of the cases. The mean transverse diameter was 2.96mm and the mean vertical diameter was 3.7mm. All the above results were compared with studies of previous workers. Conclusion: The present study confirms that there is racial as well as regional variation in the shape and dimensions of IOF, thus emphasizing the need to have morphometric data for South Indian population.

Keywords: maxillary nerve, infra orbital nerve, anaesthesia, maxillofacial surgery


How to cite this article:
Vishal K, Vinay K V, Johncy I P. Morphology and morphometry of infra orbital foramen in South Indian adult dry skulls. Natl J Clin Anat 2014;3:122-7

How to cite this URL:
Vishal K, Vinay K V, Johncy I P. Morphology and morphometry of infra orbital foramen in South Indian adult dry skulls. Natl J Clin Anat [serial online] 2014 [cited 2022 Aug 11];3:122-7. Available from: http://www.njca.info/text.asp?2014/3/3/122/297371




  Introduction Top


Infra orbital foramen (IOF) is situated on the anterior surface of maxilla about 1cm below the infra orbital margin (IOM). Infra orbital vessels and nerves emerge out through the IOF. The infra orbital nerve is the continuation of maxillary division of trigeminal nerve. It is entirely sensory in nature. It supplies the skin and mucous membranes derived from the maxillary process of the embryonic period[1],[2],[3]. It emerges out from IOF after passing through infra orbital canal and appears on the face. It terminates by dividing into palpebral, nasal and labial branches to supply skin over the lower eyelid, conjunctiva, lateral aspect of external surface of nose, upper lip, ala of the nose and the premolar teeth. Infra orbital vessels, branches of maxillary arteries supply the area surrounding IOF. Large variations in the dimensions, shape and size of the IOF have been reported in the literature. Several authors have worked on the morphometric assessment of IOF[4],[5],[6],[]7. This foramen has been used as various reference points, e.g. to determine the morphometric variations of the orbit[8] and variations in size[9],[10],[11],[12] and symmetry.[13],[14] The fracture of zygomatic complex are one of the most common facial injuries. Sakavicius reported a 64.4% incidence of infra orbital nerve injury associated with zygomatic-complex fracture[15],[16]. Hence the knowledge of the morphology of IOF is important for providing the guidance in local anesthesia in maxillofacial, plastic surgical operations and radio ablative neurotomy procedures[14],[17],[18].

Since there are very few studies done on South Indian population, the present study was undertaken to analyze the shape, size and direction of the IOF in South Indian dry adult skulls of unknown sex.


  Materials and Method Top


Sixty adult dry skulls of unknown sex were collected & studied at the department of Anatomy and department of Forensic Medicine. These skulls belong to the South Indian population. The skulls with damaged foramen or fractures were excluded from the present study. IOF on right and left sides of skull were measured separately for shape, direction and dimensions. The shape of the foramen was noted as circular, horizontally oval, vertically oval or semilunar [Figure 1]. The direction of opening of foramen was noted as infero-medial, medial or inferior by inspection [Figure 2]. After placing the skull in anatomical position both the vertical and horizontal diameter of the IOF was measured using digital vernier calipers (Mitutoyo Corp, Japan) with an accuracy of up to 0.1 mm. The mean and standard deviations (mean ± SD) of the measurements were calculated. All the measurements were done in millimeters and the results were analyzed statistically.
Figure 1: Showing different shapes of Infra orbital foramen (IOF)

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Figure 2: Showing different directions of Infra orbital foramen (IOF)

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  Results Top


[Table 1] shows the various shapes of IOF. Majority of the IOF were vertically oval in shape (37.5%). The semilunar shaped IOF was the least common type found. The horizontally and vertically oval shaped IOF was more common on left side [Table 1]. The circular and semilunar shaped IOF were more common on right side [Table 1].
Table 1: Shape of infra orbital foramen (IOF) on right and left side

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[Table 2] shows the direction of IOF. Most of the IOF were directed inferomedial and inferiorly. Medially directed IOF were very few. Inferomedially directed IOF were more common on left side [Table 2]. The IOF directed medially and inferiorly were more on right side.
Table 2: Direction of infra orbital foramen on right and left side

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[Table 3] shows the transverse and vertical diameter of IOF on right & left side. The mean transverse diameter was 2.95 mm on right side and 2.98mm on left side. The mean vertical diameter was 3.52 mm on right side and 3.93 mm on left side. The student t test is done the results shows significant value.
Table 3: Dimensions of infra orbital foramen (n=60)

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  Discussion Top


Many authors have observed the shape of IOF in different geographical areas. These results regarding foramen shapes are indicative of different osteoblastic and osteoclastic activities after birth[19],[20]. A large body of evidence shows a clear racial variation in the morphometry of the IOF among different populations[21]. Information on skull foramina size and symmetry is becoming increasingly important because of the advancements in radiologic techniques such as magnetic resonance imaging (MRI) and computed tomography (CT). These methods are making difficult diagnoses of pathologic conditions of skull foramina possible[11],[13]. The [Table 4] shows the comparison of shapes of IOF among the studies done by different authors[9],[19],[20],[21],[22],[23],[24]. Majority of the IOF were oval shaped IOF in all the studies except in studies done by Kazkayasi et al[24], In the present study also majority of the IOF were oval shaped (60%). The results of the study by Ilayperuma et al[21]was comparable to our data regarding the shape of IOF.
Table 4: Comparison of shape of IOF by different authors

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The anatomical characteristics of facial foramina like IOF is important during certain endoscopic procedures. The IOF contains the infraorbital nerve and vessels[20].

The IOF was directed infero medially in majority of the cases in all the studies which was also observed in the present study (52.5%). The results of our study was very close to the findings of Boopathi et al.,[20] [Table 5] since both these studies were done in South Indian population. Medially directed IOF was present in very less numbers when compared with other types. The same was also observed in the present study.
Table 5: Comparison of direction of IOFby different authors

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The mean transverse diameter of IOF was 2.96 mm in the present study which was similar to the study done by Shaik et al.,[16] [Table 6]. The mean transverse diameter of IOF in the study carried out by Boopathi et al.,[20] was less when compared to the present study. The mean transverse diameter of IOF in the study carried out by Rajani[19] and Apinhasmit et al.,[23] was more when compared to the present study.
Table 6: Comparison of transverse and vertical diameters of IOF by different authors

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The mean vertical diameter of IOF was 3.7 mm which was similar to the study carried out by Rajani[19] [Table 6]. The mean vertical diameter of IOF in the study carried out by Boopathi et al.,[20] and Shaik et al.,[16] was less when compared to the present study. When the dimensions of the present study were compared with studies on North Indians and Thai skulls, showed wide variations. Thus, the dimensions have racial variations.


  Conclusion Top


The findings of the present study will be helpful to clinicians, anatomists, morphologists and researchers as a ready reference to dimensions, shape and direction of IOF in South Indian population. The results of the present study can help surgeons and anaesthetists to prevent iatrogenic injuries to structures in and around IOF. It also assists surgeons to localize the foramen avoiding injury to neurovascular bundle and facilitate surgical, local anaesthetic and other invasive procedures.

Acknowledgements

HODs, Department of Anatomy and Forensic Medicine, K.S. Hegde Medical Academy. Dr.Sanjeev Badiger, Professor, Department of Community Medicine, K.S. Hegde Medical Academy.



 
  References Top

1.
Williams PL, Bannister LH, Berry MM, Collins P, Dyson M, Dussek JE and Ferguson MWJ (Eds). Exterior of the skull. Gray’s anatomy 38th edition, Churchill Livingstone, New York. 1995:609-612.  Back to cited text no. 1
    
2.
Hu KS, Kwak J, Koh KS, Abe S, Fontaine C, Kim HJ. Topographic distribution area of the infraorbital nerve. Surg Radiol Anat. 2007; 29:383-388.  Back to cited text no. 2
    
3.
Chrcanovic BR, Henrique M, Nogueira, Abreu G, Anto’nio Lui’s Neto Custo’dio. A morphometric analysis of supraorbital and infraorbital foramina relative to surgical landmarks. Surg Radiol Anat. 2011; 33:329-335.  Back to cited text no. 3
    
4.
Gruber W. A hook-shaped termed Fortsatzchen over and above the infraorbital foramen. Arc Pathol Anat Physiol Klin Med. 1878; 72:494-6.  Back to cited text no. 4
    
5.
Gozdziewski S, Nizankowski C, Kindlik R. The morphological analysis of human canalis infraorbitalis and foramen infraorbitale. Anat Anz. 1979; 145:517-27.  Back to cited text no. 5
    
6.
Chung MS, Kim HJ, Kang HS, Chung IH. Locational relationship of the supraorbital notch or foramen and infraorbital and mental foramina in Koreans. Acta Anat. 1995; 154:162-6.  Back to cited text no. 6
    
7.
Testut L, Latarjet A. Tratado de anatorma humana. Barcelona, Salvat 1954.  Back to cited text no. 7
    
8.
Karakas P, Bozkir MG, Oguz O. Morphometric measurements from various reference points in the orbit of male Caucasians. Surg Radiologic Anat. 2002; 24 (6): 358-62.  Back to cited text no. 8
    
9.
Kazkayasi M, Ergin A, Ersoy M, et al., Certain anatomical relations and the precise morphometry of the infraorbital foramen - canal and groove: an anatomical and cephalometric study. Laryngoscope 2001;111:609-14.  Back to cited text no. 9
    
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Bolini P, Del Sol M. ConsideragSes anatomicas sobre o canal e o sulco infra-orbital. Rev Bras Oftalmol. 1990; 49(2): 113-6.  Back to cited text no. 10
    
11.
Bergman RA, Thompson SA, Afifi AK, Saadeh FA. Compendium of Human Anatomic Variation: Catalog, Atlas and World Literature. Baltimore. Urban & Schwarzenberg, 1988. http://www.anatomyatlases.org/ AnatomicVariants/SkeletalSystem/Images/126.shtml  Back to cited text no. 11
    
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Berry AC. Factors affecting the incidence of non- metrical skeletal variants. J Anat. 1975; 120(3): 519- 535.  Back to cited text no. 12
    
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Elias MG, Silva RB, Pimental ML. Morphometric analysis of the Infraorbital foramen and accessories foraminas in Brasillian skulls. Int J Morphol. 2004; 22(4): 273-8.  Back to cited text no. 13
    
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Sakavicius D, Juodzbalys G, Kubilius R, Sabalys GP. Investigation of infraorbital nerve injury following zygomaticomaxillary complex fractures. J Oral Rehabil 2008;35:903-16.  Back to cited text no. 15
    
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Shaik HS , Shepur PS, Desai SD, Thomas ST, Maavishettar GF, Haseena S, Morphometric analysis of Infra orbital foramen position in South Indian skulls, Indian J. Innovations Dev. July 2012. http:// iseeadyar.org/ijid.html.  Back to cited text no. 16
    
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Triandafilidi E, Anagnostopoulou S, Soumila M. The infraorbital foramen (the position of the infraorbital foramen in man). Odontostomatol proodos.1990; 44: 87-91.  Back to cited text no. 18
    
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Rajani S. Morphometric analysis of infraorbital foramen in Indian dry skulls. Anat Cell Biol. 2011; 44(1): 79-83.  Back to cited text no. 19
    
20.
Boopathi S, Chakravarthy MS, Dhalapathy S, Anupa S. Anthropometric analysis of the Infraorbital foramen in a South Indian population. Singapore Med J. 2010; 51(9): 730-735.  Back to cited text no. 20
    
21.
Ilayperuma I, Nanayakkara G, Palahepitiya N. Morphometric analysis of the infraorbital foramen in adult Sri Lankan skulls. Int. J. Morphol. 2010; 28(3): 777-782.  Back to cited text no. 21
    
22.
Gour KK, Nair S, Trivedi GN, Gupta SD. Anthro pometric measurements of infraorbital foramen in dried human skulls. Int J Bio Med Res. 2012;3 (3): 20032006.  Back to cited text no. 22
    
23.
Apinhasmit W, Chompoopong S, Methathrathip D, Sansuk R, Phetphunphipat W. Supraorbital notch/ foramen, Infraorbital foramen and mental foramen in Thais: anthropometric measurements and surgical relevance. J Med AssocThai. 2006; 89:675- 82.  Back to cited text no. 23
    
24.
Kazkayasi M, Ergin A, Ersoy M, Tekdemir I, Elhan A. Microscopic anatomy of the Infraorbital canal, nerve and foramen. Otolaryngol Head Neck Surg. 2003; 129: 692-7.  Back to cited text no. 24
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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