A Morphological Analysis of Foramen Ovale and Foramen Lacerum in terms of Percutaneous and Endoscopic Endonasal Approaches
Morphological Analysis of Foramen Ovale and Foramen Lacerum
Keywords:Foramen ovale, Percutaneous approach, Foramen lacerum
Aims: It is clinically extremely important to determine the surrounding structures and variations of the foramen ovale, the region where mandibular nerve blockade is performed during percutaneous and endoscopic endonasal procedures. Therefore, this study was conducted to guide clinicians in determining and choosing the surgical method to be applied, especially percutaneous and endoscopic endonasal approaches, by investigating the relationship between foramen ovale, foramen lacerum and pterygoid processes on morphological basis.
Materials and Methods: The study was conducted with 56 skulls (right and left, 112 in total). In the lower view of the skull base, the horizontal relationship between the FO and the posterior border of the base of the lateral pterygoid processes was taken into account. Skulls with injuries to the lateral plate of the pterygoid process or FO on both sides were excluded.
Results: When the position of the foramen ovale relative to the processus pterygoideus lateralis was evaluated; the most common type II (medial type) was on the right with a rate of 30.3%, and type III (direct type) was on the left with a rate of 23.3%. The lowest rate was type IV. The foramen lacerum was in direct relationship with the medial pterygoid process posteromedially at a rate of 50%.
Conclusion: The fact that the foramen ovale is far from the foramen lacerum and pterygoid processes may make surgical procedures risky, as it will make it difficult to detect the origin of the mandibular nerve.
Bokhari ZH, Munira M, Samee SM, Tafweez R. A Morphometric Study of Foramen Ovale in Dried Human Skulls 2017;(11)4: 9-13.
Bazroon AA, Singh P. Anatomy, Head and Neck, Foramen Lacerum,” StatPearls, (Online). 2022. Available: https://pubmed.ncbi.nlm.nih.gov/31082070.
Kantola VE, McGarry GW, Rea PM. Endonasal, transmaxillary, transpterygoid approach to the foramen ovale: radio-anatomical study of surgical feasibility J. Laryngol. Otol. 2013; 127(11):1093–1102. doi: 10.1017/S0022215113002338.
Wang WH. The foramen lacerum: surgical anatomy and relevance for endoscopic endonasal approaches J. Neurosurg 2018;131(5):1571–1582. doi: 10.3171/2018.6.JNS181117.
Somesh MS. A morphometric study of foramen ovale. Turk. Neurosurg 2011;21(3):378–383. doi: 10.5137/1019-5149.JTN.3927-10.2.
Iwanaga J, Patra A, Ravi KS, Dumont AS, Tubbs RS. Anatomical relationship between the foramen ovale and the lateral plate of the pterygoid process: aLLPication to percutaneous treatments of trigeminal neuralgi. Neurosurg. Rev 2022;45(3):2193–2199. doi: 10.1007/s10143-021-01715-x.
Elnashar A, Patel SK, Kurbanov A, Zvereva K, Keller JT, Grande AW. Comprehensive anatomy of the foramen ovale critical to percutaneous stereotactic radiofrequency rhizotomy: cadaveric study of dry skulls. J. Neurosurg 2019;132(5):1414–1422, doi: 10.3171/2019.1.JNS18899.
Broggi G, Franzini A, Lasio G, Giorgi C, Servello D. Long-term results of percutaneous retrogasserian thermorhizotomy for "essential" trigeminal neuralgia: considerations in 1000 consecutive patients. Neurosurgery 1990;26(5):783-6, doi: 10.1097/00006123-199005000-00008.
Boduc E, Ozturk L. Morphometric Analysis and Clinical Importance of Foramen Ovale. Eur. J. Ther., 2021;27(1):45–49, doi: 10.5152/eurjther.2021.20059.
Prakash K, Saniya K, Honnegowda T, Ramkishore H, Nautiyal A. Morphometric and Anatomic Variations of Foramen Ovale in Human Skull and Its Clinical Importance Asian J. Neurosurg 2019;14(4):1134–1137, doi: 10.4103/AJNS.AJNS_243_19.
Yousuf S, Tubbs RS, Wartmann CT, Kapos T, Cohen-Gadol AA, Loukas M. A review of the gross anatomy, functions, pathology, and clinical uses of the buccal fat pad. Surg. Radiol. Anat 2010;32(5):427–436, doi: 10.1007/S00276-009-0596-6
Patel SK, Liu JK. Overview and history of trigeminal neuralgia. Neurosurg Clin N Am 2016;27(3):265–276. doi: 10.1016/j.nec.2016.02.002
Henson CF, Goldman HW, Rosenwasser RH, Downes MB, Bednarz G, Pequignot EC, Werner-Wasik M, Curran WJ, Andrews DW. Glycerol rhizotomy versus gamma knife radiosurgery for the treatment of trigeminal neuralgia: an analysis of patients treated at one institution. Int J Radiat Oncol Biol Phys 2005;63(1):82-90. doi: 10.1016/j.ijrobp.2005.01.033.
Xu R, Xie ME, Jackson CM. Trigeminal Neuralgia: Current Approaches and Emerging Interventions. J Pain Res. 2021;3(4):3437-3463. doi: 10.2147/JPR.S331036
Iwanaga J, Clifton W, Dallapiazza RF, Miyamoto Y, Komune N, Gremillion HA, Dumont AS, Tubbs RS. he pterygospinous and pterygoalar ligaments and their relationship to the mandibular nerve: aLLPication to a better understanding of various forms of trigeminal neuralgia. Ann Anat 2020;229:151466.
Zdilla MJ, Ritz BK, Nestor NS. Locating the foramen ovale by using molar and inter-eminence planes: a guide for percutaneous trigeminal neuralgia procedures. J Neurosurg 2019;132(2):624–630.
Peris-Celda M, Graziano F, Russo V, Mericle RA, Ulm AJ. Foramen ovale puncture, lesioning accuracy, and avoiding complications: microsurgical anatomy study with clinical implications. J Neurosurg 2013;119(5):1176–1193.
Nayak SR, Saralaya V, Prabhu LV, Pai MM, Vadgaonkar R, D’Costa S. Pterygospinous bar and foramina in Indian skulls: Incidence and phylogenetic significance. Surg Radiol Anat 2007;29(4):5–7.
Berlis A, Putz R, Schumacher M. Direct CT measurements of canals and foramina of the skullbase. Br J Radiol 1992;65: 653–661.
Reymond J, Charuta A, Wysocki J. The morphology and morphometry of the foramina of the greater wing of the human sphenoid bone. Folia Morphol (Warsz). 2005;64(3):188-93. PMID: 16228954.
Iwanaga J, Singh V, Ohtsuka A, Hwang Y, Kim HJ, Moryś J, Ravi KS, Ribatti D, Trainor PA, Sanudo JR, Apaydin N, Şengül G, Albertine KH, Walocha JA, Loukas M, Duparc F, Paulsen F, Del S, M., Adds P, Hegazy A, Tubbs RS. Acknowledging the use of human cadaveric tissues in research papers: recommendations from anatomical journal editors. Clin Anat 2021;34(1):2–4.
Iwanaga J, Badaloni F, Laws T, Oskouian RJ, Tubbs RS. Anatomic study of extracranial needle trajectory using Hartel technique for percutaneous treatment of trigeminal neuralgia. World Neurosurg 20181;110:245–e248.
Gatto LAM, Tacla R, Koppe GL, Junior ZD. Carotid cavernous fistula after percutaneous balloon compression for trigeminal neuralgia: endovascular treatment with coils. Surg Neurol Int 2017; 8:36.
How to Cite
Copyright (c) 2023 Chronicles of Precision Medical Researchers
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.