A rare anatomical variation in foramen of Vesalius: A useful guide for maxillofacial surgeons

Background: Foramen of vesalius is an inconstant foramen that gives passage to an emissary vein that connects pterygoid venous plexus with cavernous sinus. It lies in the anteromedial side of the foramen ovale. Foramen ovale allows the passage for the mandibular branch of trigeminal nerve, the main site for the trigeminal rhizotomy. The presence and description of anatomical variations about the foramen of Vesalius is important during the surgical procedure on the trigeminal nerve which may injure the emissary vein in the foramen leading to intracranial bleeding. Objectives: The aim of the present study is to report the presence and to enlighten the anatomical variations of foramen vesalius which may serve as a guideline for surgeons. Methods: The study was conducted on 100 dry adult human skulls collected from the department of anatomy at Panimalar medical college hospital & research institute Chennai. The skulls were viewed both extracranially and intracranially to identify the presence of foramen of vesalius. The presence and variation of the foramen was noted and discussed. Result: A total of about 200 sides of 100 skulls were studied. Among them 20% of the skull showed presence of foramen of Vesalius bilaterally, 25% unilaterally and one particular skull showed doubled opening on the left side with the presence of a bony septum. This is a rare variation which was less documented in the literature. Conclusion: The knowledge of variations in foramen of Vesalius may help the surgeons for safer planning and execution of the trigeminal rhizotomy technique.

Paradoxical Malignant Embolism, Brief Review

During gestation period the oxygenated maternal blood is transferred to the embryo via the placenta and umbilical cord into the right atrium. It is further transferred through an interatrial shunt to the left atrium, the Foramen Ovale, and distributed to the embryonic body. The foramen is closed after the birth, but remains occasionally patent, permitting embolization through a right to left shunt. This is transferring thrombi, fat, cement and bony spikes, air, and occasionally malignant tissue. This brief review is on the malignant embolization.

Evaluation of Anatomoradiological Findings on Trigeminal Neuralgia Patients Using Computed Tomography and Cone-Beam Computed Tomography

The study aimed to establish and evaluate anatomoradiological landmarks in trigeminal neuralgia patients using computed tomography (CT) and cone-beam CT. CT images of 40 trigeminal neuralgia (TN) and 40 healthy individuals were retrospectively analyzed and enrolled in the study. The width and length of the foramen rotundum (FR), foramen ovale (FO), foramen supraorbitale, and infraorbitale were measured. The distances between these foramen, between these foramen to the median plane, and between the superior orbital fissure, FO, and FR to clinoid processes were also measured bilaterally. Variations were evaluated according to groups. Significant differences were found for width and length of the foramen ovale, length of the foramen supraorbitale, and infraorbitale between TN and control subjects (p < 0.05). On both sides, FO gets narrower and the length of the infraorbital and supraorbital foramen shortens in the TN group. In most of the control patients, the plane which passes through the infraorbital and supraorbital foramen intersects with impression trigeminale; 70% on the right-side, and 67% in the left-side TN groups. This plane does not intersect with impression trigeminale and deviates in certain degrees. The determination of specific landmarks allows customization to individual patient anatomy and may help the surgeon achieve a more selective effect with a variety of percutaneous procedures in trigeminal neuralgia patients.