بسم هللا الرحمن الرحيم

The National Ribat University

Faculty of Graduate Studies & Scientific Research

Anatomical Variation of Infraorbital Foramen

in Patients Attending Radiology Department At The National

Ribat University Hospital

Thesis Submitted in Partial Fulfillment Required for the MSc in Human & Clinical

Anatomy

By: Amira Izzeldin O. Eltay

Superviser: Prof. Tahir Osman Ali

2015

الآيةن { ار لآايت لويل الألباب ا موات والرض واختالف الل يل والن (190) يف خلق الس

موات والرض ين يذكرون هللا قياما وقعودا وعىل جنوبم ويتفك رون يف خلق الس ال

}(191) الن ار رب نا ما خلقت هذا ابطال س بحانك فقنا عذاب

آل معران{ }آ

إلهداءا لونتني مي التيأالذي رسمني و أبي الى

رب ارحمهما كما رب ياني صغيرا

Acknowledgement:

I would like to express my sincere gratitude to my Supervisor Prof. Tahir Osman

Ali for the continuous support of my MSc study and research, for his patience,

motivation, enthusiasm, and immense knowledge. His guidance helped me during all

the time of research and writing of this thesis. I could not have imagined having a

better supervisor for my MSc study.

I would like to thank the rest of the staff in the MSc programe Dr.Kamal Eldin

Elbadawi, Dr.Abbas Ghareeb Allah, Dr.Yasser Seddig & Dr.Hayder Debi for their

encouragement, & motivation.

I would like to thank Radiology Department at The National Ribat University

Hospital and specially Tech.: Mohamed Oshik & Emam Mohamed for technical

support in CT measurements.

My sincere thanks also go to Faculty of Dentistry in The National Ribat University

& specially Department of Periodontology for their encouragement understanding,

kindness, & offering me time to do my MSc duties.

Finally, I would like to thank my lovely Family & Friends who were always there

cheering me up and standing by me through the good & bad times.

Abstract

Introduction: The aim of this study is to document the anatomical variations of

infraorbital foramen (IOF) in shape, the frequency of accessory foramen, & in

relation to the infraorbital rim (IOR) and piriform aperture (PA) which is necessary

in clinical situations that require regional nerve blocks.

Methods: A total of 30 adult normal brains CT (3D) were studied. In CT (3D) the

IOF location was measured with IOR and PA as reference points. The orientation &

vertical relation to upper teeth of the foramen was noted. The presence of accessory

foramen was taken in consideration

Results: 70% of infra-orbital foramina were directed inferiorly. Accessory

infraorbital foramina were not found. The mean distance between the IOR and IOF

was 8.53 mm on the right side and 8.61 mm on the left side. The mean distance

between the IOR & PA on the right side was 15.49 mm and 15.69 mm on the left

side.

Conclusion: Knowledge of the anatomical characteristics of IOF locations,

directions and its accessory foramina may have important implications in blocking

the infraorbital nerve for surgical and local anaesthetic planning.

ةالدراس ملخص

العين في الشكل و عدد مرات سفلللحفره ا إن الهدف من هذه الدراسة هو توثيق التباين التشريحي :مقدمة

لتي ا وهو أمر ضروري في الحاالت السريرية االنف و فتحة فتها من حافه العين السفليالتكرار و تحديد مسا

.للوجه أ جراحي تتطلب تدخأل

ةحاف ذتن و اخالعي سفلاس موقع الحفره للراس و قي من التصوير المقطعي ةحال 30 درست :األساليب

العمودية باألسنان وعالقتها ةالحفر اتجاه ةمالحظمع االنف كنقاط مرجعية للقياس ةالعين السفلي و فتح

العلوية

افة المسكان متوسط ةلم يتم العثور علي الحفر الثانويلالسفل , كما ةموجه من الحاالت %70 كانت :النتائج

مم 15.69لفتحت االنف ةالمسافة من الحفرو متوسط مم 8.61 العين السفلي ةلحاف ةمن الحفر

يةافضالموقع واالتجاهات و الحفر اال ن فيما يخصالعي سفلا ةللحفر التشريحية الخصائص معرفة :الخاتمه

في هذه المنطقة الجراحة للتخدير و في التخطيط هامة آثار اله

List of tables

Tables Titles Page

2-1 Comparison of parameters measured with other studies. 9

4-1 Distribution of gender in this study.

14

4-2 Number of infraorbital foramen.

14

4-3 Shape of infraorbital foramen.

15

4-4 Direction of opening of the IOF on the right side. 16

4-5 Direction of opening of the IOF on the left side.

17

4-6 Distance of IOF from anatomical landmark.

18

4-7 Vertical orientation of the IOF in relation to the upper

teeth.

18

5-1 Comparison of reported measurements from the IOF to

the IOR. 23

5-2 A comparison of reported measurements from the IOF to

the PA 24

5-3 Comparison of presents of the accessory infraorbital

foramen 25

5-4 Comparison of IOF in relation to its vertical orientation

with the maxillary teeth 26

List of figures

Figures Title Page

1.1 A 3-dimensional model of the skull 4

2.1 Shows the soft tissue landmarks 8

3.1 Skull showing measured parameters. 11

3.2 Schematic draw of the morphometric parameters 12

4-1 Shape of infraorbital foramen 15

4-2 Direction of opening of the IOF in the right side 17

4-3 Direction of opening of the IOF in the left side. 17

4-4 Vertical orientation of the IOF in relation to the upper

teeth 19

Abbreviations

CT : Computed tomography

3D : Three dimensional

IOF : Infraorbital Foramen

IOR : Infraorbital Rim

PA : Piriform Aperture

ION : Infraorbital Nerve

FM : Facial midline

Rt : Right side

Lt : Left side

List of Contents

Title Page

Alayh I

Dedication I I

Acknowledgement I I I

Abstract (English) IV

Abstract (Arabic) V

Lists of figures V I

Lists of tables V I I

Lists of abbreviations V I I I

List Contents IX-X

Chapter I: Introduction, Objectives

1.1 Introduction 1-2

1.2 Justification 3

1.3 Objectives 5

1.3.1. General objective 5

1.3.2.Specific objectives: 5

Chapter II: Literature Review

2.1. Literature review 6-9

Chapter III: Material & Methods

3.1. Study design: 10

3.2. Study area 10

3.3. Study population 10

3.4. Study duration 10

3.5. Sample size & Sampling 10

3.6. Data collection tools and technique 11

3.7. Data analysis 11

Chapter IV: Result

4.1. Results 13 - 19

Chapter V: Discussion

5.1 Discussion 20 - 26

Chapter VI

Conclusions & Recommendations

6.1.Conclusions 28

6.2.Recommendations 29

Chapter VII References

References 30-31

Appendix

Data collection sheet

Chapter I

Introduction & Objectives

1.1 Introduction

The infraorbital foramen (IOF) is one of the most important facial foramina.(1) It is

an anatomical structure with an important location, through which the infra orbital

vessels and nerve exits(2) , which are responsible for the vascular-nervous supply to

important areas of the face.(1) Infraorbital nerve (ION) is a one of three cutaneous

branches of the maxillary division of the trigeminal nerve.(1) The other branches

include the zygomaticofacial nerve and the zygomaticotemporal nerve. Infraorbital

artery is a branch of the third part of the maxillary artery. It runs through the inferior

orbital fissure, orbit, and then the IOF. Here it gives off the anterior superior alveolar

artery which supplies the anterior teeth and the anterior part of the maxillary sinus.

(1, 2)

IOF is situated bilaterally on the maxillary bone, found below the inferior margin of

the orbit.(2) It is an important anatomical landmark that provides excellent analgesia

for the closure of simple lacerations, biopsies, scar revisions, maxillofacial

procedures, as well as various endoscopic and cosmetic cutaneous procedures.(3)

Precise knowledge of the location of reference points in this area provides important

data in local anesthesia and in maxillofacial and plastic surgical operations.(2) The

importance of the incidence and lateralization of the IOF is also evident in facial

surgical procedures. The recognition of the presence of double or triple foramen is

essential when the appropriate amount of anesthesia is applied, or it can be

inappropriate.(2) Information on skull foramen size and symmetry is increasingly

important because of the advancements in radiologic techniques such as magnetic

resonance imaging and computed tomography. These methods are making difficult

diagnoses of pathologic conditions of skull foramina possible. (2) Gruber (1878) was

the first person who evaluated the morphometric assessment of the infraorbital

foramen and reported the presence of accessory supranumerarios foramena which he

propounded as an important variable in anaesthetic valuation (4) & he described the

presence of 5 independent foramens in the end of the infraorbital canal. (4, 5)

1.2. Justification

Recently the local anaesthesia procedures for infraorbital nerve as well as surgery

for this area has been increasing for a diverse multiplicity of reasons, maxillofacial

surgeries (6) rhinoplasty (3), & even aplastic surgery in general (6) that all turned into

common surgeries which need to be brought to a safe end up with the least

complications. Fig (1.1)

Good understanding of the anatomy before the procedure, gives the surgeon enough

idea to take decision on the type of proper incision to be applied generally. The exact

knowing of the position of the infraorbital foramen & number of accessory foramina

is critically important to avoid traumatic and surgical injuries to the infraorbital nerve

and vessels, (6) taking into account its anatomical variability and the potential

irreversible damage that may result as a post-operative complication.(7)

Functional and cosmetic deformities result from injury to the infraorbital

neurovascular due to paralyzed musculature which is clearly evident when patient

smiles, phonates , or chews & loss of sensation to the upper lip & parts of the check,

usually associated with a severe psychological impact on the affected patient.(6) As

a matter of fact such complications could have been avoided if proper technique was

applied during surgery, based on thorough and detailed anatomical knowledge about

anatomical position of IOF.

Figure 1.1: This 3-dimensional model of the skull shows representative

measurements from the infraorbital foramen to the anatomic landmarks. Blue

shading denotes the safe zone; red shading denotes the danger zone.

1.3 Objectives

General objective:

Anatomical Variation of infra orbital foramen

Specific objectives: are to

1. Document the variability in the position of the infraorbital foramen with relation

to infraorbital rim (IOR) and piriform aperture (PA).

2. Analyze the variability in shape, of the infraorbital foramen

3. Study the frequency of accessory infraorbital foramen.

Chapter II

Literature Review

2.1 Literature Review

A sound knowledge of the location of the IOF will be helpful in providing a safer

performance of clinical procedures such as regional anaesthesia as in the case of

repair of cleft lip and other maxillofacial surgeries, and to determine the acupuncture

point in case of treating trigeminal neuralgia and external access to the maxillary

sinus – Caldwell-Luc operations. (6)

The IOF was present on both sides of the maxilla, (1, 4, 5) the presence of multiple IOF

was observed. (1) On the right side of the maxilla, 14 crania presented two foramina.

On the left side, there were nine crania with two foramina; three crania with three

foramina; and one cranium with four foramina. (1) & only one cranium presented

multiple foramina bilaterally (1) The most common shape of infraorbital foramen

found is oval (39%) (4, 7, 8, 9)

followed by semilunar (27%). Round shaped foramen was found in 22% of skulls,

& triangle shaped foramen was in 12 %.(7) IOF has a relatively big diameter

compared to the supraorbital foramen. (3) & it was less than 2 mm in size. (10) Ukoha

etal (11) have proposed that IOF area reflects differences in global temperature climes,

where populations in colder climates are hypothesized to have larger infraorbital

arteries to warm the face, and therefore larger infraoribital foramina, than equatorial

populations. (11)

Some papers report that the infraorbital nerve (ION); infraorbital artery and a vein

are transmitted through the IOF. (1) Other anatomical works suggest that only the ION

and infraorbital artery exit the foramen. (2)

The position of the IOF with respect to the maxillary teeth varied from the interval

between the canine and 1st premolar to the 1st molar (10) but in most of the cases it

was vertically oriented to the 2nd premolar teeth. (4, 6, 9) Aziz etal (12) found it the in the

same vertical plane with the first premolar (12)

The average distance between the IOF and the infraorbital rim was approximately

8.61±1mm, in men and 8.25±1mm. (2, 9) The piriform opening of the nose is an easily

palpable border on the face which can be conveniently used to locate the infraorbital

foramen (13) with average distance in men 17.43±1mm, & 15.69±1mm in women. (2,

9)

IOF are not absolutely symmetrical and may present pair bilateral and or unilateral

opening.(14) The skull that showed multiple foramina all had ipsilateral double

foramina (4). In Cisneiros de Oliveira et al (1) study only one cranium presented with

multiple foramina bilaterally. The presence of the accessory foramen may intervene

with the anesthesia, thus, they suggest that accessory foramen must be considered in

the anaesthesial evaluation and be remembered during the procedures used for the

localization of the foramen.(14)

In the functional analysis performed on the maxillary bone showed that the

occurrence of variation in the width and length of the IOF was dependent on the type

of dentition. The authors have highlighted three points from the IOF: the increase of

the foramen on posterior direction when the downward, forward, and lateral growth,

of the maxillary bone; the IOF is a fixed point of reference to the other maxillary

structures; and a relation between the orientation of the IOF with changes in the

maxillary bone growth. (1) Schwartz (15) also justified the variability of the IOF with

the embryological development of the upper jaw and the dentition.

The location of the IOF has frequently been determined in numerous studies

examining the skulls devoid of soft tissue structures.(1,2,4,5,9,10,13) However the location

of IOF has not been well defined on cadavers according to standard and easily visible

anatomical landmarks. The position of the IOF was determined in reference to the

lateral edge of the ala of the nose, medial and lateral palpebral commissures. All

these three soft tissue landmarks were then connected to each other forming a

triangular shaped region. (16) In most of the cases the IOF was located on the line

which is connecting the lateral palpebral commissure to the ala

of the nose. (16) figure (2.1)

Fig. (2.1): The soft tissue landmarks (lateral edge of the ala of the nose, medial and

lateral palpebral commissures) and the triangular shaped region formed by

connecting all these three soft tissue landmarks were shown. Arrow indicates the

infraorbital foramen which is located on the line connecting the lateral palpebral

commissure to the ala of the nose in this case.

Table (2.1): Showing comparison of parameters measured with

other studies.

Studies

Sample

size

Distance

between the

IOF & IOR

Distance

between the

IOF & PA

Shape Accessory

foramina

Cisneiros (1) 242 Skulls 8 mm *** *** 10.7%.

Ilayperuma (4) 108 skulls M: 10.56 ± 1.74

F: 9.02 ± 1.58 ***

Oval

57.41

%

3.70%

Elias, M.G (5) 210 skulls 6,71±1.70 mm 13,28±2.17

mm *** 50%

Raschke R (6)

44 CT of

hemifaces

M: 8.61 mm

F: 8.25 mm

M:17 mm

F :15.69 mm *** ***

Singh (7) 110 IOF 6.12±1 mm

Rt.

15.31mm

Lt.15.80 mm

*** ****

Ekambaram(9) 100 IOF

M: 7.60 ± 1.07

F: 7.11 ± 1.02

**** Oval

39% 11%

Aggarwal A (10) 67 skulls 6.33 ± 1.39 mm 15.19 ± 1.70

mm

Oval

81.95

%

21% of

the hemi-

skulls

Aziz SR (12) 47cadavers

M: 8.5 mm

F: 7.8 mm

*** *** 15%

Saini K. (13) 100 skulls 6.7 ± 1.67) mm 17.4 ± 2.43

mm. *** 5.64 %

Chapter III

Material & Methods

3. Material & methods

Study design:

A descriptive cross sectional study

Study area

Data will be collected from Radiology Department, The National Ribat

University Hospital.

Study population

Brain 3d Computed Tomography.

Study duration

From August to December 2015.

Sample size & Sampling

A Total of (60 foramena) 30 adult normal brains CT (3D) collected from the

Department of Radiology, Ribat University Hospital will be used for this study.

Both sides of skull CT will be assessed regarding number, shape, and orientation

of the infraorbital foramen recorded by direct visual inspection by the researcher.

The presence of multiple foramena will be checked and the most prominent

foramen will be considered as the primary structure for characterization. The

shape of the infraorbital foramen will be described as an oval, round, or triangular

in shape. The direction of opening of the IOF will recorded as medial, inferior or

inferiomedially.

The distance between the IOF and the infraorbital margin will be measured in

addition to the distance from IOF to the piriform aperture (PA). Figures (3.1, &

3.2)

Data collection tools and technique

A checklist will be used to collect the data to attain the study objectives. This will

be done by the researcher from brain CT (3D).

Data analysis

The data will be entered and analyzed by the software SPSS version 20.

Figure 3.1 Skull showing measured parameters. IOF-IOM: Vertical distance between upper margin of

infraorbital foramen and inferior orbital margin. IOF-AB: Vertical distance between lower

margin of infraorbital foramen and maxillary alveolar border. IOF-ML: Horizontal distance

between medial margin of infraorbital foramen and midline of skull. IOF-PA: Horizontal

distance between medial margin of infraorbital foramen and lateral margin of piriform aperture.

Fig. 3.2. Schematic draw of the morphometric parameters.

a) Transversal measure: a transversal plain that passes by the center of IOF and

gives the value of the distance between the medial border of IOF and the piriformis

opening making a 90؛ angle with sagittal measure; b) Sagittal measure: a sagital

plain which passes by the center of the IOF, parallel to the median sagittal plain and

was gives the value of the distance between the infraorbital margin and the superior

border of IOF.

Chapter IV

Results

4. Results

Thirty 3D normal brains CT were studied to evaluate IOF in both sides, a total of 60

foramina were seen in the study; 22 were adult males and 8 were females. (Table

4.1)

All the skulls studied displayed an IOF on both sides. A single infraorbital foramen

was present bilaterally in all 30 CT. (Table 4.2)

The infraorbital foramen was round in 70% & oval in 30%, no other shapes were

seen. (Table 4.3).

The foramena were directed inferiorly in 70%, inferomedially in 27.7% and medially

in 3.3 % on the right side. (Table 4.4). On the left side the IOF was directed inferiorly

in 73.3%, & 26.7% inferomedially. (Table 4.5).

The distance of the IOF was messured from anatomical landmark piriform aperture

(PA) and infraorbital rim. All meassurement were done in centemiter. The mean

distance between the IOF & the infraorbital rim was 0.853 cm with SD 0.222 on the

right side and 0.8610 cm with SD 0.1818 on the left side. Distance between the IOF

& piriform aperture on the right side 1.549 cm with SD 0.188, and 1.5697 cm with

SD 0.2778 on the left side. (Table 4.6).

Frequencies of the position of the infraorbital foramen in relation to the upper teeth

are shown in Table 4.7 and illustrated in Figure (4.7). The most common position for

the infraorbital foramen relative to the upper teeth was found to be in line between

the first and second upper premolars.

Table (4.1): Distribution of gender in this study.

Gender Frequency Percent

Male 22 73.3

Female 8 26.7

Total 30 100.0

Table (4.2): Number of infraorbital foramena.

Side Number of

foramen Frequency Percent

Right one 30 100

Left One 30 100

Table (4.3): Shape of infraorbital foramen.

Side Shape Frequency percent

Right

Oval 9 30

Round 21 70

Left

Oval 9 30

Round 21 70

Figure (4.1): Shape of infraorbital foramen.

Table (4.4): Direction of opening of the infraorbital foramen (Rt side).

levalFrequency

percent

0

10

20

30

40

50

60

70

Right side Left side

9

21

9

21

30

70

30

70

leval

Frequency

percent

Direction Frequency Percent

Inferior 21 70

Inferiomedial 8 26.7

Medial 1 3.3

Figure (4.2): Direction of opening of the infraorbital foramen (Rt side).

0

10

20

30

40

50

60

70

80

90

100

medial inferior inferiomedially

1

21

83.3

70

26.7

Percent

Frequency

Inferiomedial Inferior Medial

Table (4.5): Direction of opening of the infraorbital foramen Lt side.

Direction Frequency Percent

Inferior 22 73.3

Inferiomedial 8 26.7

Total 30 100.0

Figure (4.3): Direction of opening of the infraorbital foramen (Lt side)

0

10

20

30

40

50

60

70

80

90

100

inferior inferiomedially

22

8

73.3

26.7

Percent

Frequency

Inferiomedial Inferior

Table (4.6): Distance of IOF from anatomical landmarks

(Measurement by mm).

Side Distance between Mean mm Std. Deviation

Right

IOF --- IOR 0.853 0.222

IOF --- PA 1.549 0.188

Left

IOF --- IOR 0.8610 0.1818

IOF --- PA 1.5697 0.2778

Table (4.7):Vertical orientation of the IOF in relation to the upper teeth:

Side IOF in relation to Frequency Percent

Right Line between 1st & 2nd premolar 30 100

Left Line between 1st & 2nd premolar 30 100

Figure (4.4): Vertical orientation of the IOF in relation to the upper

teeth.

0

10

20

30

40

50

60

70

80

90

100

Frequency Percent

30

100

30

100

between lst @ 2endpremolar right side

between lst @ 2endpremolar left side

Between 1st & 2nd

premolar (Rt. side)

Between 1st & 2nd

premolar (Lt. side)

Chapter V

Discussion

5. Discussion

The Infraorbital foramen is the gate to the infraorbital nerve, vessels and the

knowledge of its position is very useful to the professionals who manipulate

the maxillary region as in acupuncture zygoma frature surgery, & in intra and

extra oral anesthesia. (2, 5, 14)

In literature, various soft tissue and bony landmarks were described as refrence

for the IOF. These include the nasal ala, medial and lateral palpebral

commissures,(16) the piriform aperture,(5, 6, 7, 10) the inferior orbital rim, (1, 4-7, 9, 10

) the vertical orientation to the Max, teeth 1st pre molar, (12) and the 2nd pre

molar tooth(3,10, 17) .

Regarding the distance from the IOF to the IOR it was significantly greater on

the left side & no significant difference was found in relation to sex and that

difference from the findings of Ekambaram (9) who reported that this distance

was significantly greater on the right side only in male crania. Aggarwal et al

(10) & Saini (13) reported a distance of 6.33 & 6.7 mm respectively. Both of those

measurements were smaller than what was found in the present study, which

was 8.5 mm this data was in accord to Aziz etal (12) & close to Cisneiros de

Oliveira (1) & Yaremchuk (17). Although Ukoha etal (11) did not make any

comparison of the IOF between the sexes, they reported that in Nigerian crania,

this foramen was significantly closer to the IOR on the right side than on the

left side. A detailed comparison of reported measurements from the IOF to the

IOR is shown in Table (5.1)

The piriform opening of the nose is an easily palpable border on the face which

can be conveniently used to locate the infraorbital foramen. (13) The mean

distance of the infraorbital foramen from the piriform aperture was 15.49 ±1

mm which was close to 15.56 mm reported by Singh (7) and different from that

of Saini (13) & Raschke etal (6) who reported 17.4 mm & 17±2 mm respectively.

Surgeons should consider the skew values to prevent surgical complications in

the head and neck region and the anesthetist should consider these values for

anesthetic failures of nerve block. (5,13 ) A detailed comparison of reported

measurements from the IOF to the PA will be shows in Table 5.2

The frequency of accessory infraorbital foramen shows changes with respect to

race. (13) In the present study a single infraorbital foramen was present

bilaterally in all 30 CT (100%). This data was in accord to Orhan etal (8) study.

Elias etal (5) found 21 single accessory foramina present bilaterally & 8 double

accessory foramen in the 210 Brazilian skulls studied. Where Saini etal (13)

reported out of the 100 skulls studied, 11 (5.64%) accessory infraorbital

foramina in 4 skulls these were found bilaterally. In Cisneiros de Oliveira study

only one cranium presented with multiple foramen bilaterally (1). Table 5.3

In the present study it was found that the most common position for the

infraorbital foramen in relation to the upper teeth was in line between the first

and second upper premolars. Whereas Ilayperuma etal (4) Raschke etal (6) Ukoha

etal (11) & Yaremchuk (17) reported vertical orientation to the 2nd premolar teeth

& Aziz etal (12) reported vertical orientation to the 1st premolar teeth. Table 5.4

shows comparison of IOF in relation to its vertical orientation with the

maxillary teeth.

The incidence of round shaped infraorbital foramen was higher in present study

than that observed by Ilayperuma etal (4), Singh (7), Orhan K (8) Ekambaram etal

(9) & Aggarwal etal (10) those found an oval is the most common shape.

In the present study 70% of IOF were directed inferiorly & 27.7%

inferiomedially this data was in succession with Shaik etal (2) who report

inferiomedial direction is most common.

Table 5.1: Comparison of reported measurements from the IOF to the

IOR.

Study Specimen IOF – IOR

Cisneiros de Oliveira (1) Skull 8 mm

Ilayperuma (4) Skull M: 10.56 ± 1.74

F: 9.02 ± 1.58

Elias, M.G (5) Skull 6,71±1.70 mm

Aggarwal A (10) Skull 6.33 ± 1.39 mm

Saini K. (13) Skull 6.7 ± 1.67) mm

Ekambaram, G.(9) Skull

M: 7.60 ± 1.07

F: 7.11 ± 1.02

Aziz SR (12) Cadaver M: 8.5

F: 7.8

Raschke R (6)

CT

M: 8.61 mm

F: 8.25 mm

Yaremchuk M. (17) CT M:8,61± 0.64 mm

F: 8,25 ± 0.54 mm

Present study CT Rt. 8.53

Lt. 8.61

Table 5-2: A comparison of reported measurements from the IOF to the

PA

Study Specimen IOF – PA

Chrcanovic (3) Skull

M: 14.37 mm

F: 15.44 mm

Elias, M.G (5) Skull 13.28 mm

Singh, R (7) Skull 15.56 mm

Aggarwal A (10) Skull 15.19 mm

Saini K. (13) Skull 17.4 mm.

Raschke R (6)

CT

M:17 mm

F :15.69 mm

Yaremchuk M. (17) CT

M: 17,43 mm

F: 15,69 mm

Present study CT

Rt. : 15.49

Lt. :15.697

Table 5-3: Comparison of presence of the accessory infraorbital foramen

Study %

Cisneiros (1) 10.7%

Ilayperuma (4) 3.70%

Elias, M.G (5) 50%

Ekambaram(9) 11%

Aggarwal A (10) 21%

Aziz SR (12) 15%

Saini K. (13) 5.64 %

Orhan K (8) 0%

Present study 0%

Table 5-4: Comparison of IOF in relation to its vertical orientation with

the maxillary teeth

Study Orientation with teeth %

Aziz SR (12) First premolar ****

Ilayperuma (4) Second premolar 55.56 %

Aggarwal A (10) Second premolar 50%

Ukoha (11) 2nd premolar 46%

Yaremchuk(17) 2nd premolar ***

Present study Line between 1st & 2end premolar 100%

Chapter VI

Conclusion &

Recommendations \

6.1. Conclusion

The infraorbital rim, the piriform aperture, and the tip of the 2nd premolar cusps

are reliable anatomic landmarks that allow us to define a safe zone of dissection

in the midface.

Knowledge of the anatomical variation of IOF locations, directions and its

accessory foramina have important implications in blocking the infraorbital nerve

for surgical and local anaesthetic planning.

From the result there is slightly significant difference in position of IOF in both

sides Rt & Lt.

The most common position for the infraorbital foramen in relation to the upper

teeth was found to be in line between the 1st and 2nd upper premolars.

The most common shape of infraorbital foramen found in the present study is

oval.

6.2. Recommendations

Studies about anatomical variation of IOF in Sudan are not enough there for more

studies are needed to confirm these results.

The dentist and surgeons of head and neck have to know the exact position of

IOF.

The present findings are important for performing local nerve block and surgery

in the face in order to avoid injury to the neurovascular structures passing through

the foramen.

Possibility of accessory infraorbital foramen should be kept in mind during

clinical procedures.

The uses of these measurements are recommended that they will aid surgeons in

avoiding significant morbidity following any midface augmentation procedure.

Chapter VII

References

7. References

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