The present study was conducted to ascertain the shape, size, presence of accessory foramina, direction, and the precise position of the infraorbital foramen (IOF) in relation to the inferior orbital margin (IOM), anterior nasal spine (ANS), nasion (Na), maxillary teeth, and supraorbital foramen/notch (SOF/N) in adult skulls in a Sri Lankan population. Fifty-four skulls (42 males and 12 females) were analyzed. The IOF was oval in shape (38.6% and 36.3% on the right and left side, resp.) in a majority of skulls. The direction of the IOF was mostly medially downward (48.6%). Accessory foramina were found in 7.4% of the skulls. The infraorbital foramina were located at a mean distance of 6.52 ± 2.03 mm and 7.30 ± 1.57 mm, vertically below the IOM on the right and left side, respectively; 33.81 ± 2.68 mm and 34.23 ± 2.56 mm from the ANS on the right and left side, respectively; and 42.37 ± 3.52 mm and 42.52 ± 3.28 mm from the Na on the right and left side, respectively. In relation to the upper teeth the majority of IOF (37.5% and 55.9% on the right and left side, resp.) were located in the same vertical axis as the tip of the buccal cusp of the maxillary second premolar tooth.
Significant variations exist in the occurrence, form, and position of supraorbital nerve exits through the frontal bone. Detailed knowledge of the positional variations of supraorbital exits is important to ensure safe and successful regional anesthesia, and to avoid iatrogenic nerve injuries during surgery of the orbitofacial region. Supraorbital nerve exits from 116 sides of 58 dry intact adult skulls (37 male and 21 female) in a Sri Lankan population were examined to determine the morphological features and the precise position in relation to the facial midline, temporal crest of frontal bone, and frontozygomatic suture. A majority of supraorbital nerve exits existed as notches (73.8%) and the rest as foramina (26.2%). Accessory exits were seen in 18.9% skulls. Of the skulls examined, 55.1% displayed bilateral supraorbital notches, 8.6% had bilateral supraorbital foramina, and 36.3% had a notch on one side and a foramen on the contralateral side. In males, the supraorbital nerve exit was located 23.64±3.49 mm laterally from the facial midline, 27.86±2.76 mm medially from the temporal crest of the frontal bone, 28.66±2.56 mm from the frontozygomatic suture, and 2.12±1.07 mm above the supraorbital margin in the case of a foramen, and in females 22.69±3.28 mm laterally from the facial midline, 26.32±3.02 medially from temporal crest of frontal bone, 27.29±3.05 from the frontozygomatic suture, and 2.99±1.49 mm above the supraorbital margin when it existed as a foramen. The observations made in this study will be useful when planning a supraorbital nerve block and surgery in the supraorbital region.
Child abuse is a sensitive topic among many medical practitioners and the diagnosis of this entity requires awareness about conditions which can mimic physical child abuse. Here, the authors present a case of a 13-year-old school non-attendee who was referred due to multiple scars, over areas prone to accidental as well as non-accidental injury, who underwent medicolegal examination due to suspicion of physical child abuse. On further inquiry, it was discovered that she had easy bruising and poor wound healing. A diagnosis of Ehlers-Danlos syndrome was established and physical child abuse was excluded. This case emphasizes the importance of identifying conditions which may confound the diagnosis of physical child abuse. This is of utmost importance in avoiding adverse legal and psycho-social implications on the child, family and society.
The practice of forensic medicine and pathology in Sri Lanka is based on the British model. Medical students during their third and fourth years receive approximately 50 hours of lectures and tutorials in forensic medicine and pathology and then undergo an examination. After completing an internship, these doctors are sent to various hospitals throughout Sri Lanka where they may be asked to perform medicolegal examinations on victims and suspects in rape cases, persons suspected of being under the influence of drugs and/or alcohol, and, injured live patients. As well, they may be asked to perform medicolegal autopsies. Depending upon their experience, some medical officers may be designated as judicial medical officers and appointed full time to do medicolegal work. Up until 1980, judicial medical officers with at least 2 years of work experience were allowed to obtain their postgraduate qualifications in the United Kingdom. However, since 1981 and the establishment of its own Postgraduate Institute of Medicine in Colombo, Sri Lanka, medical officers are offered 2 postgraduate programs in forensic medicine and pathology, a diploma in legal medicine and a doctorate in medicine (forensic medicine). After completing the doctorate in forensic medicine, doctors are allowed to train abroad for a further year in an approved center. Upon return they can then be appointed as consultant judicial medical officers. The practice of forensic medicine and pathology in Sri Lanka is unique and vibrant. However, due to the country's prevailing civil war, the practice of forensic medicine and pathology is suboptimal.
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