The sphenoidal tubercle (SphT), also known as pyramidal tubercle or infratemporal spine projects from the anterior end of the infratemporal crest of the greater sphenoidal wing. As it masquerades the lateral entrance in the pterygopalatine fossa it could obstruct surgical corridors or the access for anaesthetic punctures. The SphT is, however, an overlooked structure in the anatomical literature. During a routine cone beam computed tomography study in an adult male patient we found bilateral giant SphTs transforming the infratemporal surfaces of the greater wing into veritable pterygoid foveae. Moreover, on one side the SphT appeared bifid, with a main giant partition, of 9.17 mm vertical length, and a secondary laminar one. The opposite SphT had 14.80 mm. In our knowledge, such giant and bifid SphTs were not reported previously and are major obstacles if surgical access towards the pterygopalatine fossa and the skull base is intended. (Folia Morphol 2019; 78, 4: 893-897) Key words: greater wing of the sphenoid bone, pterygopalatine fossa, cone beam computed tomography, infratemporal fossa, maxillary nerve
BACKGROUND. The infraorbital recess of the maxillary sinus can reach in front of the nasolacrimal duct to become prelacrimal recess. During a routine Cone Beam CT (CBCT) study of a male patient of 72 years old, there were bilaterally found infraorbital maxillary air cells (IMACs) resulted after the almost complete closure of infraorbital recesses of the maxillary sinuses. Only that on the left side was reaching in front of the nasolacrimal canal. The closure of each infraorbital recess leaded to a narrow draining passage opened in the terminal end of the maxillary infundibulum, thus proximal to the maxillary sinus ostium. On the left side, a small cell of the lacrimal bone was interposed between the IMAC drainage pathway and the nasolacrimal canal. On the right side, the nasolacrimal canal was communicating with the ethmoidal infundibulum. Such an anatomic variation in the infraorbital angle of the maxillary sinus can impede the endoscopic procedures which use the anterior lacrimal pathway.
This study aims to assess the frequency of the lingual foramina and canals relative to their location on the mandibular cortical plate and also to closely inspect the course of the lingual canals inside the mandibular body using 3D reconstruction of the evaluated area. A retrospective study was conducted with 55 cone bean computed tomography (CBCT) scans in order to analyze the location, number, course and anastomosing pattern of the lingual canals. A total number of 165 lingual canals (LCs) were recorded from 55 patients, as follows: 94 median (MLC), 16 paramedian (PLC) and 55 lateral lingual canals (LLC). MLCs were a constant finding in all 55 patients (100% of the cases), PLCs were present in 15 patients (27.3% of the cases), and LLCs were identified in 35 patients (63.3% of the cases). The anastomosing pattern of the MLC, in which a supraspinous canal anastomosed with an infraspinous canal, was found in 10.9% of the cases (6 of 55 patients),. The LLCs were anastomosed with the mandibular incisive canal (MIC) in 56.3% of the cases (31 of 55 LLCs) and with the mandibular canal (MC) in 3.6% of the cases (2 of 55 LLCs). CBCT revealed itself to be a reliable tool for evaluating the intramandibular topography of the LCs. The anastomosing pattern of the lingual canals might raise the question whether the LCs could be responsible for incomplete anesthesia after conventional mandibular block by carrying sensory innervation from the mylohyoid nerve to the inferior alveolar nerve.
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