Anat Cell Biol.  2022 Mar;55(1):55-62. 10.5115/acb.21.208.

Localization of infraorbital foramen and accessory infraorbital foramen with reference to facial bony landmarks: predictive method and its accuracy

• Suntiruamjairucksa J
• Chentanez V

• KMID: 2527669
• DOI: http://doi.org/10.5115/acb.21.208

Abstract

The infraorbital nerve block is used for mid-facial anesthesia. We aim to determine the location of infraorbital foramen (IOF) and accessory infraorbital foramen (AIOF) with reference to anterior nasal spine (ANS) and the lowest point of zygomaticomaxillary junction (Z) and assess the accuracy of the predictive method. Two hundred and sixteen dry skulls were examined. A reference line was drawn from ANS to Z (line A) and its length was measured (distance A). The location of IOF was predicted by using the mean vertical distance from IOF to line A (line B) which was 15.14±1.99 mm and the mean ratio of the distance between ANS and the intersecting point of line B and line A (distance D) to distance A (D:A) which was 63.35%±3.90%. Eighty-six AIOFs were found. Most of them located superomedial to IOF, except for 3 AIOFs which located in the inferolateral position. For localization the AIOF, the mean vertical distance was 19.34±3.36 mm and the mean ratio was 51.8%±5.90%. No statistically significant difference of the predicted distances for both foramens was found between sex and sides. The accuracy of the predictive method was assessed in 15 embalmed cadavers. Predicted IOFs were 50% accurate and the mean distance error of the predicted IOF was 1.10±1.44 mm lateral and 0.59±1.39 mm inferior to the exact IOF. Therefore, this study provides an alternative method for localization of IOF and AIOF which could be useful in clinical settings.

Keyword

Anatomic landmarks; Nerve block; Reference standards; Reference standards

Figure

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  Fig. 1 Picture of skull illustrates the value of main parameters of IOF and AIOF with reference to the horizontal line from ANS to Z (unit: millimeters). A, distance from ANS to Z; AIOF, accessory infraorbital foramen; ANS, anterior nasal spine; B, vertical distance from the middle-upper edge of IOF to the line A; C, vertical distance from the middle-upper edge of AIOF to line A; D, horizontal distance from ANS to the intersecting point of the vertical line from IOF with line A; D:A, percentage of the ratio of distance D to distance A; E, horizontal distance from ANS to the intersecting point of the vertical line from AIOF with line A; E:A, percentage of the ratio of distance E to distance A; IOF, infraorbital foramen; X, horizontal distance between IOF and AIOF; Y, vertical distance between IOF and AIOF; Z, the lowest point of zygomaticomaxillary junction.

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  Fig. 2 Scatter plotted graph shows the location of the accessory infraorbital foramen (blue dot) with reference to the infraorbital foramen. AIOF, accessory infraorbital foramen; IOF, infraorbital foramen; X, horizontal distance between IOF and AIOF; Y, vertical distance between IOF and AIOF.

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  Fig. 3 Picture of left midface of a male cadaver showing the same location of both predicted IOF and the exact IOF (tip of red pin). The predicted AIOF was lateral to the exact AIOF. Dark green pin, location of the predicted distance D (distance A multiplied with the percentage of D:A); light green pin, location of the predicted distance E (distance A multiplied with the percentage of E:A); red pin, location of the predicted IOF; blue dot, the location of the predicted AIOF; blue pin, location of the anterior nasal spine. AIOF, accessory infraorbital foramen; AION, accessory infraorbital nerve; ANS, anterior nasal spine; IOF, infraorbital foramen; ION, infraorbital nerve; Z, the lowest point of zygomaticomaxillary junction; black line, the line between ANS and the lowest point of zygomaticomaxillary junction.

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  Fig. 4 Illustration describing the predictive method for localization of IOF in clinical practice. (A) Mark the location of ANS at the uppermost part of philtrum at the level of nostrils and Z at the lowest bony prominence of cheek. Draw line A between ANS and Z. (B) Mark at the medial two-thirds of line A (black dot line). (C) Draw perpendicularly with and above line A at approximately 15 mm. (D) Mark the location of predicted IOF. A, distance from ANS to Z; ANS, anterior nasal spine; IOF, infraorbital foramen; Z, the lowest point of the zygomaticomaxillary junction.

• 

  Fig. 5 Illustration describing the predictive method for localization of AIOF in clinical practice. (A) Mark the location of ANS at the uppermost part of philtrum at the level of nostrils and Z at the lowest bony prominence of cheek. Draw line A between ANS and Z. (B) Mark at the middle of line A (black dot line). (C) Draw perpendicularly with and above line A at approximately 19 mm. (D) Mark the location of predicted AIOF. A, distance from ANS to Z; AIOF, accessory infraorbital foramen; ANS, anterior nasal spine; Z, the lowest point of the zygomaticomaxillary junction.

Reference

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