Foramen caróticoclinoideo en cráneos humanos: incidencia, morfometría y sus implicaciones clínicas

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.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 variation292427431Das, S., Suri, R., Kapur, V., Ossification of caroticoclinoid ligament and its clinical importance in skull-based surgery (2007) São Paulo Med. J, 125, pp. 351-353Dodo, Y., Ishida, H., Incidence of nonmetric cranial variant in several population samples from East Asia and North America (1987) J. Anthrop. Soc. Nippon, 95, pp. 161-167Dolenc, V.V., A combined epi and subdural direct approach to carotidophthalmic artery aneurysms (1985) J. Neurosurg, 5, pp. 667-672Donald, P.J., (1998) Surgery of the Skull Base, , Philadelphia, Lippincott- RavenErturk, M., Kayalioglu, G., Govsa, F., Anatomy of the clinoidal region with special emphasis on the caroticoclinoid foramen and interclinoid osseous brid- ge in a recent Turkish population (2004) Neurosurg. 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Anat, 25, pp. 241-246Reisch, R., Vutskits, L., Filippi, R., Patonay, L., Fries, G., Perneczky, A., Topographic microsurgical anatomy of the paraclinoid carotid artery (2002) Neurosurg Rev, 25, pp. 177-183Sekhar, L.N., Akin, O., Anatomical study of the cavernous sinus emphasizing operative approaches and related vascular and neural reconstruction (1987) Neurosurg, 21, pp. 806-816Seoane, E., Rhoton, A.L., Oliveira, E., Microsurgical anatomy of the dural collar (carotid collar) and rings around the clinoid segment of the internal carotid artery (1998) Neurosurg, 42, pp. 869-886Sicher, H., du Brul, E.L., (1977) Oral Anatomy, , 6ed. Rio de Janeiro, Guanabara KooganStandring, S., Overview of the Development of the Head and Neck Head: Skull and Mandible Gray's anatomy: The anatomical basis of clinical practice, p. 2005. , New York, ElsevierEl foramen caróticoclinoideo es una estructura inconstante formada por la unión de la procesos clinoides anterior y medio. El objetivo de este estudio fue revisar la incidencia y la morfometría del foramen caróticoclinoideo en cráneos humanos brasileños y discutir sus implicaciones clínicas. Se utilizaron 80 cráneos humanos secos, de ambos sexos, determinando tres variables: sexo y lados derecho e izquierdo. La morfometría se realizó con un cáliper manual midiéndose el diámetro máximo del foramen. La incidencia de cráneos con al menos un foramen fue de 8,5%. El 8,5% de los cráneos presentó un foramen en el lado derecho y el 2,5% en el izquierdo. El 2,5% de los cráneos presentó un foramen bilateral y el 6,25% un foramen unilateral. En relación al sexo, los forámenes se encontraron en el 5% de los cráneos de hombres y el 12,5% de los cráneos de mujeres. El diámetro máximo de esta estructura presentó en promedio, valores de 5,23 mm; 5,18 mm en el lado derecho y 5,35 mm en el izquierdo; 5,30 mm en cráneos de hombres y 5.18 mm en cráneos de mujeres. Las características anatómicas de este foramen deben ser consideradas debido a las implicaciones clínicas asociadas a la neurocirugía, como la eliminación del proceso clinoides y a síntomas como cefaleas producto de alteraciones en la arteria carótida interna en esta región. En conclusión, el conocimiento de esta estructura mejora el diagnóstico y tratamiento de las complicaciones clínicas relacionadas con esta variació

Morphological study of the anatomical variations of anterior belly of digastric muscle in Brazilian cadavers

Background: Cases of variations in anterior belly of the digastric muscle must be carefully identified to avoid misinterpretations and assist in the correct surgical or aesthetic procedure and help in the teaching of Anatomy. The aim of this study was to describe the anatomical variations of anterior belly of digastric muscle in Brazilian cadavers. Materials and methods: Thirty-one human heads were selected, from adult cadavers (18 to 80 years, 29 males and 2 females). The morphology of the anterior belly of the digastric muscle was observed, identifying the possible anatomical variations that were characterized and classified according to the amount of muscle bellies, fiber direction and place of origin and insertion. The morphometric measurements were performed using a digital caliper. To analyze the data obtained, photographic documentation, anatomical description and individual morphometric description of each muscle belly were performed. The incidence of anatomical variation was obtained in percentage (%). Results: The anatomical variation of the anterior belly of the digastric muscle was present in 6 cadavers (19.31%; 1 female and 5 male). All anatomical variations presented an accessory belly to the anterior belly. However, these accessory bellies were configured differently in the location, direction of muscle fibers and in their dimensions (length and width). Conclusions: The gross anatomy of the anterior belly of the DM and their variations is important to assist in surgical procedures, pathological or diagnostic function. In addition, asymmetrical variations in the submental region must be carefully identified to avoid misinterpretations

Foramen tympanicum prevalence in the population of southeastern of Brazil: a morphological study in computed tomography scans

Background: The foramen tympanicum is located on the anteroinferior region of the external acoustic meatus and posteromedial to the temporomandibular joint in children between the first and the fifth year of life. It is considered an anatomical variation when it persists in adults. The aim of this study was to verify the prevalence as well as to characterize the foramen tympanicum in CT scans of the population from southeastern Brazil. Materials and methods: A total of 78 CT scans of dry human skulls were used, which were selected randomly regarding the ages, ranged from 15 to 100 years, and composed a total of 20 female and 58 males. The foramen tympanicum was identified in the images of the axial plane and confirmed in the images of the coronal and sagittal planes. The largest diameter (in mm) was obtained. The descriptive statistics (in %), Fisher's test and chi-square test (χ2) were performed to compare the prevalence of foramen tympanicum between sexes and sides. The probability value ≤ 0.05 was defined as a level of significance. Descriptive statistics were performed to verify the mean diameter of the foramen on the right and left sides of the skulls. Results: The prevalence of foramen tympanicum was higher in females (P = 0.0070), bilaterally, as the absolute values of females were lower in relation to males. Fisher's exact test showed that the prevalence of foramen tympanicum was significantly higher in females (45%) than in males (15.52%). On the right side, the mean axial diameter was 2.23 mm (range 0.93–3.75 mm). On the left side, the mean axial diameter was 2.22 mm (range 0.9–3.61 mm). Conclusions: The knowledge of anatomical variations is extremally valuable for an accurate diagnosis, treatment plan and prognosis and a thorough preoperative assessment

Morphological characteristics of foramen of Vesalius and its relationship with clinical implications

The aim of this study was to evaluate the incidence as well morphometry of the foramen of Vesalius in human skulls and analyzing their clinical importance. Dry human skulls (n = 80) and with gender distinction were used (40 male and 40 female). The results demonstrates an total incidence of 40%, 13.75% skulls with the bilateral presence of the foramen, 26.25% skulls with the unilateral presence of the foramen, 31.25% skulls with foramen only of the right side, 22.50% skulls with foramen only of the left side, 25% masculine skulls with at least 1 foramen and 52.25% skulls with at least 1 foramen. The morphometry showed an average diameter of 1.457 ± 1.043 mm on the right and 1592 ± 0938 mm to the left. The average distance to the foramen ovale was 1.853 ± 0.303 mm on the right side and 2.464 ± 0.311 mm on the left. It can be concluded that a deepened anatomical study of the foramen of Vesalius collaborates not only for anatomical knowledge of this structure, but also in clinical situations involving this foramen

Incidence of the mandibular accessory foramina in Brazilian population

In adults, the mandibular accessory foramina are variables and are located on the medial surface of the mandible in positions above or below of the mandibular foramen. The aim of this study was to evaluate the incidence of the mandibular accessory foramina in Brazilians human mandibles and discuss the clinical aspects related to the presence of these foramina. Were evaluated 222 mandibles, adults, irrespective of gender. Was observed that 27.93% and 43.24% of the mandibles presented at least one mandibular accessory foramina located on the medial surface in position below and above, respectively, of the mandibular foramen. Unilaterally, the mandibular accessory foramina were observed below and above of the mandibular foramen in 22.07% and 25.22%, of the mandibles, respectively, and 5.85% and 18.02% bilaterally, respectively. This study demonstrated that the incidence of mandibular accessory foramen in the Brazilian population is significant and should be considered in the planning and execution of procedures in several areas of dental clinical practice in order to avoid complications

Incidence of the ossified pterygoalar ligament in Brazilian human skulls and its clinical implications

The ossified pterygoalar ligament is formed between the lateral lamina of the pterygoid process and the infratemporal surface of the sphenoid bone or its greater wing and was not connected to the sphenoid spine. The aim of this study was to evaluate the incidence of the ossified pterygoalar ligament in Brazilian human skulls and analyzing its clinical importance. 183 Brazilian adult (between 30 to 60 years old) dry human skulls were evaluated. Was evaluated the incidence of skulls with complete or partial ossification of the pterygoalar ligament, bilaterally and unilaterally and in the presence on the right and left sides. Were found 5 skulls had the ossified pterygoalar ligament, resulting in an overall incidence of 2.73%. There was 1 skull in the presence of the incomplete ossification of the pterygoalar ligament, unilaterally and on the left side resulting in incidence of 0.54%. There were 4 skulls in the presence of the complete ossification of the pterygoalar ligament, unilaterally and on the right side resulting in incidence of 2.18%. The ossified pterygoalar ligament is a major cause of the entrapment of the lingual nerve or a branch of the mandibular nerve and may cause mandibular neuralgia. The incidence of the ossified pterygoalar ligament and the pterygoalar foramen is low in the Brazilian population. However, these structures have clinical significance as this ligament establish relationships with the ovale foramen and difficulty in accessing in this foramen in a therapeutic approach

Trigeminal neuralgia: Literature review

The trigeminal nerve, fifth equal of cranial nerves, a mixed nerve is considered by possessing motor and sensitive components. The sensitive portion takes to the Nervous System Central somesthesics information from the skin and mucous membrane of great area of the face, being responsible also for a neural disease, known as the Trigeminal Neuralgia. The aim of this study was to review the literature on the main characteristics of Trigeminal Neuralgia, the relevant aspects for the diagnosis and treatment options for this pathology. This neuralgia is characterized by hard pains and sudden, similar to electric discharges, with duration between a few seconds to two minutes, in the trigeminal nerve sensorial distribution. The pain is unchained by light touches in specific points in the skin of the face or for movements of the facial muscles, it can be caused by traumatic sequels or physiologic processes degenerative associate the vascular compression. Prevails in the senior population, frequently in the woman. In a unilateral way it attacks more the maxillary and mandibular divisions, rarely happens in a simultaneous way in the three branches of trigeminal nerve three branches