Infraorbital foramen location in dry human skulls

The objective of this study was to determine the mean distance between the infraorbital foramen and the infraorbital margin, as well as the mean distance between the infraorbital foramen and the piriform aperture on both sides of dry human skulls, with the aim of improving the efficiency in clinical situations, such as surgery and anesthetic procedures. Two hundred ninety-five skulls were used (590 sides), located in the Frankfurt Plane through a craniostat. The measurements were collected by two distinct operators, with a dry tip compass and carried to a caliper. The general mean obtained between the infraorbital foramen and the infraorbital margin was 6.37 mm (±1.69 mm), with a mean of 6,28 mm (±1.79 mm) on the right side and 6.45 mm (±1.76 mm) on the left side. The general mean obtained between the infraorbital foramen and the piriform aperture was 17.67 mm (±1.95 mm), being 17.75 mm (±2.10 mm) on the right side and 17.60 mm (±2.04 mm) on the left side. There were statistically significant differences between the right and left distances of the infraorbital foramen and the infraorbital margin, verified by the Student's-t test. The results of this study allow a more precise location of the infraorbital foramen, particularly as regards the infraorbital margin, since this distance is of relevant importance as a repair point during surgical procedures involving this anatomical structure.

Morphological and Biometric Study of the Infraorbital Foramen (E2-Sibai Point) in Adult Skulls

The objective of this work was to study the morphology and biometry of the infraorbital foramen (FIO), variations in its shape, size and number as well as to obtain measurements of its location. 60 dry skulls were analyzed. The test of Qui-quadrant and the T Test were used in measurements with a 5% significance. On the right side, the FIO was measured at a distance of 6.49(+/- 1.68) mm from the lower, 39.65(+/- 3) mm from the upper, 17.7(+/- 2.97) mm from the medial and 20.46(+/- 2.9) mm from the lateral margin of the orbit; its pear-shaped opening distance was 13.67(+/- 2.17) mm. On the left side, the distance of the FIO to the lower margin of the orbit was 6.52(+/- 1.82) mm; to the upper margin was 39.9(+/- 2.62) mm and to the lateral and medial margin were 17.93(+/- 2.58) mm and 21.12(+/- 3) mm, respectively; its distance to the pear-shaped opening was 14.26(+/- 1.83) mm. It was found predominately in an oval shape, in 39 (65%) of the skulls, on both sides. Accessory foramens were present in 11 samples on the right and in 15 samples on the left side. The FIO was most frequently found on the side of, or laterally to the sagittal plane that passes through the middle of the supraorbital foramen/incisures, in 38 skulls (63.3%) on the right side and in 45 skulls (75%) on the left and middle to the zigomatic-maxillary suture, in 41 skulls (68.3%) on right and in 42 skulls (70%) on the left side, besides being most frequently found in a region between the first and second premolars, in 22 skulls (36.7%) on the right side and in 17 skulls (28.3%) on the left.

Anterior superior alveolar nerve (ASAN): A morphometric-anatomical Analysis

The anterior superior alveolar nerve (ASAN) is a branch of the infraorbital nerve. Only few studies have morphometrically evaluated the course of the ASAN. Midfacial segments of ten hemisectioned fresh adult cadaver heads were dissected to uncover the anterior wall of the maxilla. Specimens were subsequently decalcified and the bone overlying the ASAN was removed under a microscope to expose the ASAN. Its branching pattern from the infraorbital nerve was recorded, and the course of the ASAN within the anterior wall of the maxillary sinus was morphometrically assessed measuring distances to predefined landmarks using a digital caliper. A distinct ASAN was observed in all specimens. It arose lateral (six cases) or inferior (four cases) from the infraorbital nerve. The point of origin was located at a mean distance of 12.2 ± 5.79 mm posterior to the infraorbital foramen. The ASAN was located on average 2.8 ± 5.13 mm lateral to the infraorbital foramen. After coursing medially, the ASAN ran inferior to the foramen at a mean distance of 5.5 ± 3.07 mm. When approaching the nasal aperture, the loop of the ASAN was on average 13.6 ± 3.07 mm above the nasal floor. The horizontal mean distance from the ASAN to the nasal aperture was 4.3 ± 2.74 mm halfway down from the loop, and 3.3 ± 2.60 mm at the floor of the nose, respectively. In conclusion, the present study evaluated the course of the ASAN relative to the infraorbital foramen and nasal aperture. This information is helpful to avoid damage to this anatomical structure during interventions in the infraobrital region of the maxilla. Further, knowledge of the course of the ASAN and of its bony correlate (canalis sinuosus) may be valuable in interpreting anesthetic or radiologic findings in the anterior maxilla.

Morfometria dos forames mandibular, mentual e infraorbital de Lobo-guará Chrysocyon brachyurus, Illiger, 1815 aplicada a bloqueios anestésicos

CHAPTER II - The Chrysocyon brachyurus is the biggest South American canid which has a high frequency of dental injuries, both in wild and captivity. Thus, veterinary procedures are necessary to preserve the feeding capacity of hundreds of captive specimens worldwide. The aim of this study was to study the mandibular morphometry of maned wolf with emphasis on the establishment of anatomic references to the anesthetic blockage of the inferior alveolar and mental nerves. Therefore, 15 measurements in 22 hemimandibles of C. brachyurus adults were taken. For extra-oral technique of blockage of the inferior alveolar nerve at the level of the mandibular foramen, it is stated that the needle should be advanced, close to the medial surface of the mandibular ramus, by 11.4 mm perpendiculary from the palpable concavity. Alternatively, the needle can be introduced for 30.4 mm from the angular process at 20-25 degrees angle with the ventral margin. For blocking only the mentual nerve, it is recommended the introduction of needle for 10 mm, close to the lateral aspect of the mandibular body, at the level of the lower first premolar. The mandibular foramen showed similars position, size and symmetry in the maned wolfs specimens examined. The comparison of the data with those available for other carnivores reflects the necessity for determining these anatomical references specifically for each species.

Percutaneous patent foramen ovale closure : outcomes with the Premere and Amplatzer devices

BACKGROUND: Transcatheter closure of patent foramen ovale (PFO) has rapidly evolved as the preferred management strategy for the prevention of recurrent cerebrovascular events in patients with cryptogenic stroke and presumed paradoxical embolus. There is limited outcome data in patients treated with this therapy particularly for the newer devices. METHODS: Data from medical records, catheter, and echocardiography databases on 70 PFO procedures performed was collected prospectively. RESULTS: The cohort consisted of 70 patients (mean age 43.6 years, range 19 to 77 years), of whom 51% were male. The indications for closure were cryptogenic cerebrovascular accident (CVA) or transient ischemic attack (TIA) in 64 (91%) and peripheral emboli in two (2.8%) patients and cryptogenic ST-elevation myocardial infarction in one (1.4%), refractory migraine in one (1.4%), decompression sickness in one (1.4%), and orthodeoxia in one (1.4%) patient, respectively. All patients had demonstrated right-to-left shunting on bubble study. The procedures were guided by intracardiac echocardiography in 53%, transesophageal echocardiography in 39%, and the remainder by transthoracic echo alone. Devices used were the Amplatzer PFO Occluder (AGA Medical) (sizes 18-35 mm) in 49 (70%) and the Premere device (St. Jude Medical) in 21 (30%). In-hospital complications consisted of one significant groin hematoma with skin infection. Echocardiographic follow-up at 6 months revealed that most patients had no or trivial residual shunt (98.6%), while one patient (1.4%) had a mild residual shunt. At a median of 11 months' follow-up (range 1 month to 4.3 years), no patients (0%) experienced further CVA/TIAs or paradoxical embolic events during follow-up. CONCLUSION: PFO causing presumed paradoxical embolism can be closed percutaneously with a low rate of significant residual shunting and very few complications. Recurrent index events are uncommon at medium-term (up to 4 years) follow-up.

Morphometric analysis of the thoracic intervertebral foramen osseous anatomy in adolescent idiopathic scoliosis using low dose computerized tomography

Introduction. The dimensions of the thoracic intervertebral foramen in adolescent idiopathic scoliosis (AIS) have not previously been quantified. During posterior approach scoliosis correction surgery pedicle screws may occasionally breach into the foramen. Better understanding of the dimensions of the foramen may be useful in surgical planning. This study describes a reproducible method for measurement of the thoracic foramen in AIS using computerized tomography (CT). Methods. In 23 pre-operative female patients with Lenke 1 type AIS with right side convexity major curves confined to the thoracic spine the foraminal height (FH), foraminal width (FW), pedicle to superior articular process distance (P-SAP) and cross sectional foraminal area (FA) were measured using multiplanar reconstructed CT. Measurements were made at entrance, midpoint and exit of the thoracic foramina from T1/T2 to T11/T12. Results were correlated with potential dependent variables of major curve Cobb Angle measured on X-ray and CT, Age, Weight, Lenke classification subtype, Risser Grade and number of spinal levels in the major curve. Results. The FH, FW, P-SAP and FA dimensions and ratios are all significantly larger on the convexity of the major curve and maximal at or close to the apex. Mean thoracic foraminal dimensions change in a predictable manner relative to position on the major thoracic curve. There was no significant correlation with the measured foraminal dimensions or ratios and the potential dependent variables. The average ratio of convexity to concavity dimensions at the apex foramina for entrance, midpoint and exit respectively are FH (1.50, 1.38, 1.25), FW (1.28, 1.30, 0.98), FA (2.06, 1.84, 1.32), P-SAP (1.61, 1.47, 1.30). Conclusion. Foraminal dimensions of the thoracic spine are significantly affected by AIS. Foraminal dimensions have a predictable convexity to concavity ratio relative to the proximity to the major curve apex. Surgeons should be aware of these anatomical differences during scoliosis correction surgery.

Using low dose computerized tomography to morphometrically analyse the thoracic intervertebral foramen osseous anatomy in adolescent idiopathic scoliosis

INTRODUCTION The dimensions of the thoracic intervertebral foramen in adolescent idiopathic scoliosis (AIS) have not previously been quantified. During posterior approach scoliosis correction surgery pedicle screws may occasionally breach into the foramen. Better understanding of the dimensions of the foramen may be useful in surgical planning. This study describes a reproducible method for measurement of the thoracic foramen in AIS using computerized tomography (CT). METHODS In 23 pre-operative female patients with Lenke 1 type AIS with right side convexity major curves confined to the thoracic spine the foraminal height (FH), foraminal width (FW), pedicle to superior articular process distance (P-SAP) and cross sectional foraminal area (FA) were measured using multiplanar reconstructed CT. Measurements were made at entrance, midpoint and exit of the thoracic foramina from T1/T2 to T11/T12. Results were correlated with potential dependent variables of major curve Cobb Angle measured on X-ray and CT, Age, Weight, Lenke classification subtype, Risser Grade and number of spinal levels in the major curve. RESULTS The FH, FW, P-SAP and FA dimensions and ratios are all significantly larger on the convexity of the major curve and maximal at or close to the apex. Mean thoracic foraminal dimensions change in a predictable manner relative to position on the major thoracic curve. There was no significant correlation with the measured foraminal dimensions or ratios and the potential dependent variables. The average ratio of convexity to concavity dimensions at the apex foramina for entrance, midpoint and exit respectively are FH (1.50, 1.38, 1.25), FW (1.28, 1.30, 0.98), FA (2.06, 1.84, 1.32), P-SAP (1.61, 1.47, 1.30). CONCLUSION Foraminal dimensions of the thoracic spine are significantly affected by AIS. Foraminal dimensions have a predictable convexity to concavity ratio relative to the proximity to the major curve apex. Surgeons should be aware of these anatomical differences during scoliosis correction surgery.

Seguimiento a largo plazo de pacientes sometidos a cierre percutáneo de foramen oval y comunicación interauricular

Objetivo: Describir los eventos ocurridos en el seguimiento a largo plazo de pacientes llevados a cierre percutáneo de FOP y CIA con dispositivo Amplatzer® Materiales y métodos: Estudio de seguimiento en donde se seleccionó una cohorte histórica de pacientes llevados a cierre percutáneo del FOP y CIA con dispositivo Amplatzer desde el año 2001 hasta el 2013, De los 92 (100%) pacientes intervenidos, se realizó seguimiento clínico a 55 (60%) pacientes, y 37 (40%) pacientes no se pudieron contactar, se revisaron registros médicos y se realizarón entrevistas telefónicas. Resultados: La edad promedio de los pacientes fue de 58 años, con una mediana de 62 años, el 73% de las intervenciones fueron realizadas en mujeres. Se realizaron 30 (55%) cierres percutáneos de CIA y 25 (45%) cierres de FOP, se presentaron dos complicaciones secundarias al procedimiento 3.6% (reacción alérgica y hematoma hepático), el diámetro del defecto septal fue 15 mm (DE 9),y una mediana de 16 mm, El tamaño del dispositivo implantado fue de 40 mm (DE 3.9 mm) (13 mm y 34 mm). El seguimiento registró un tiempo promedio de 44 meses (DE 28,6), (7-114 meses) con una mediana de 36 meses, no se registraron eventos, la probabilidad de supervivencia de este grupo de pacientes fue del 100% y la probabilidad de muerte fue del 0%.

Caroticoclinoid foramen in human skulls: incidence, morphometry and its clinical implications

The caroticoclinoid foramen is an inconstant structure, formed by the union of the anterior and middle clinoid processes. The aim of this study was to perform an incidence and morphometry of the caroticoclinoid foramen in Brazilian human skulls and discuss its clinical implications. Eighty dry human skulls with sex distinction were used, and 3 groups of incidence were determined: General, sex, and sides. The morphometry was performed using a manual caliper and the major diameter of the foramina was measured; the values were also divided in general, according to sex and sides. The incidence of skulls with at least one foramen was 8.5%. According to the sides, 8.5% of the skulls showed foramen on the right side and 2.5% on the left. We found 2.5% of the skulls with bilateral foramen and 6.25% with unilateral foramen. In relation to sex, the foramens were found in 5% of male skulls and 12.5% of female skulls. The major diameter of this structure presented on mean, values of 5.23 mm on general, 5.18 mm on the right side and 5.35 mm on the left, 5.30 mm in male skulls and 5.18 mm in female skulls. The anatomical characteristics of this foramen should be considered in view of its clinical implications associated with neurosurgery as clinoid process removal, and symptoms as headache due to internal carotid artery alterations in this region. In conclusion knowledge of this structure supports the diagnosis and treatment of clinical complications related to this variation.

Incidence of retromolar foramen in human mandibles: ethnic and clinical aspects

The retromolar foramen allows the passage of the neurovascular bundles that contribute to nutrition and innervation of the pulp and periodontium of the lower teeth. Knowledge of this anatomical variation may prevent complications in the anesthesia and surgical procedures in this area and serve as an anatomical landmark for ethnic identification. The aim of this study was to evaluate the impact of the retromolar foramen in human mandibles of adult Brazilians and discuss the clinical and ethnic related to the presence of this foramen. Were evaluated 222 human mandibles, dry, adults, Brazilians, independent of gender. The evaluation was performed by two examiners who standardized search from a previous anatomical study. The mandibles were analyzed: the presence of the retromolar foramen (bilateral or unilateral), the presence of the foramen on right and left sides, and the number of foramens present on each side. It was found that 59 had at least one mandible retromolar foramens resulting in an incidence of 26.58%. The retromolar foramen was present unilaterally in 41 mandibles and 18 bilaterally, with incidences of 18.47% and 12.16% respectively. on the right side, the retromolar foramen was present in incidences of 16.22% and 18.92% respectively The analysis of the right side of the mandibles revealed that 47.46%, 21.21% and 3.03% had one, two and three foramens, respectively The left side showed 55.93%, 16.22% and 8.11% of the 222 mandibles with one, two and three retromolar foramens, respectively The incidence of retromolar foramen in the Brazilian population is significant and should be considered in the planning and execution of procedures in several areas of clinical practice dentistry in order to avoid complications. Moreover, it was found that the incidence of retromolar foramen contributes to differentiation of ethnic groups in the area of forensic anthropology.

Tissue reaction to Endométhasone sealer in root canal fillings short of or beyond the apical foramen

Objective: This study evaluated the response of periapical tissues to the endodontic sealer Endomethasone in root canal fillings short of or beyond the apical foramen. Material and Methods: Twenty root canals of premolars and incisors of 2 mongrel dogs were used. After coronal access and pulp extirpation, the canals were instrumented up to a size 55 K-file and the apical cemental barrier was penetrated with a size 15 K-file to obtain a main apical foramen, which was widened to a size 25 K-file. The canals were irrigated with saline at each change of file. The root canals were obturated either short of or beyond the apical foramen by the lateral condensation of gutta-percha and Endomethasone, originating 2 experimental groups: G1: Endomethasone/short of the apical foramen; G2: Endomethasone/beyond the apical foramen. The animals were killed by anesthetic overdose 90 days after endodontic treatment. The individual roots were obtained and serial histological sections were prepared for histomorphological analysis (H&E and Brown & Brenn techniques) under light microscopy. The following parameters were examined: closure of the apical foramen of the main root canal and apical opening of accessory canals, apical cementum resorption, intensity of the inflammatory infiltrate, presence of giant cells and thickness and organization of the apical periodontal ligament. Each parameter was scored 1 to 4, 1 being the best result and 4 the worst. Data were analyzed statistically by the Wilcoxon nonparametric tests (p=0.05). Results: Comparing the 2 groups, the best result (p<0.05) was obtained with root canal filling with Endomethasone short of the apical foramen but a chronic inflammatory infiltrate was present in all specimens. Conclusions: Limiting the filling material to the root canal space apically is important to determine the best treatment outcome when Endomethasone is used as sealer.

Influence of apical foramen widening and sealer on the healing of chronic periapical lesions induced in dogs' teeth

Objective. The aim of this study was to evaluate the influence of apical foramen widening on the healing of chronic periapical lesions in dogs' teeth after root canal filling with Sealer 26 or Endomethasone.Study design. Forty root canals of dogs' teeth were used. After pulp extirpation, the canals were exposed to the oral cavity for 180 days for induction of periapical lesions, and then instrumented up to a size 55 K-file at the apical cemental barrier. In 20 roots, the cemental canal was penetrated and widened up to a size 25 K-file; in the other 20 roots, the cemental canal was preserved (no apical foramen widening). All canals received a calcium hydroxide intracanal dressing for 21 days and were filled with gutta-percha and 1 of the 2 sealers: group 1: Sealer 26/apical foramen widening; group 2: Sealer 26/no apical foramen widening; group 3: Endomethasone/apical foramen widening; group 4: Endomethasone/no apical foramen widening. The animals were killed after 180 days, and serial histologic sections from the roots were prepared for histomorphologic analysis. Scores were assigned according to preestablished histomorphologic parameters and analyzed statistically by Kruskal-Wallis and Mann-Whitney U tests.Results. Regarding new cementum formation, repair of cementum and bone resorption areas, presence of microorganisms, inflammatory cell infiltrate and periodontal ligament conditions, significantly better periapical healing was obtained when foramen widening was done and Sealer 26 was used.Conclusion. Apical foramen widening and calcium hydroxide-containing sealer were more favorable to the healing of chronic periapical lesions. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109:932-940)

Detection of the Vandibular Canal and the Mental Foramen in Panoramic Radiographs: Intraexaminer Agreement

The aim of this study was to evaluate the intraexaminer agreement in the detection of the mandibular canal roof (MCR) and mental foramen (MF) in panoramic radiographs. Forty panoramic radiographs of edentulous patients were used. Two calibrated examiners (A and B) read the images 2 times, for both sides independently, under blind conditions. The interval between the readings was 10 days. The intraexaminer agreement in the interpretation of MCR and MF was performed by kappa statistics with linear weighting (x). The intraexaminer agreement for the detection of MCR, in the left side, was good for both examiners (A: kappa = 0.67; B: kappa = 0.71). Related to the right side, it was found to be kappa = 0.47 and kappa = 0.62, respectively to A and B. The intraexaminer agreement for the detection of MF was good for both examiners interpreting the left side (A: kappa = 0.61; B: kappa = 0.63), and in relation to the right side, it was moderate (A: kappa = 0.51) and fair (B: kappa = 0.38). The intraexaminer agreement in the detection of MCR was good and from good to fair in the detection of MF.

Anatomic study of the mandibular foramen, lingula and antilingula in dry mandibles, and its statistical relationship between the true lingula and the antilingula

The authors verified the anatomical location of the mandibular foramen, lingula and antilingula in dry mandibles, aiming to obtain information that could be used when performing mandibular osteotomies. Forty-four mandibles (88 sides) were evaluated. The distances were measured using a sliding calliper, with the mandibles fixed in a reproducible position. Results showed that the mandibular foramen is on average 5.82 mm below the lingula. Regarding the statistical comparison between the mandibular foramen entrance and the anti lingula position, there is no correlation between the position of those two structures in the studied sample. The mandibular foramen is slightly posterior in relation to the centre of the ramus. The lingula is an important anatomic landmark for ramus surgery, and for determining the distance to the mandibular foramen entrance. The use of the antilingula as a landmark for the position of the vertical ramus osteotomy is not recommended.

Location of the mandibular foramen according to the amount of dental alveoli

The aim of this study was to analyze the anatomotopographic location of the mandibular foramen in the right and left ramus, and to verify the influence of the amount of dental alveoli on the foramen position. Thirty-five adult dry human mandibles of Araraquara Dental School, UNESP - São Paulo State University were assessed, with or without dental alveoli. Measurements were obtained, using a ruler and a digital caliper. The following distances were measured: Fl - distance between the lowest point of the mandibular incisure and the mandibular foramen (F point); FB - distance between the mandibular base and F point; FP - distance between the posterior margin of the ramus and F point; FA - distance between the anterior margin of the ramus and F point; FT - distance between the apex of the retromolar trigone and F point. The Mann-Whitney test was used to compare each measurement according to hemi-arch, and the Kruskal-Wallis test was used to analyze the influence of the presence of alveoli on the measures. For multiple comparison, Dunn's method was used. There was no statistically significant difference in the location of the mandibular foramen when compared to the right and left hemi-arches. The amount of dental alveoli influenced, significantly, only on FA and FP distances. Thus, it was concluded that the right and left mandibular ramus showed symmetry in the location of the mandibular foramen, and the amount of alveoli influenced on the distances of the anterior and posterior margins of the mandibular rams, in relation to the mandibular foramen.