Puncture of Foramen Ovale Cranium in Computed Tomography Three-Dimensional Reconstruction

Abstract

The study aimed to provide the anatomic data for puncture of foramen ovale cranium in oral cavity. We scan 100 volunteers' skull on computed tomography who have no lesion of skull base, of which the images were for three-dimensional reconstruction. The following observations and measurements were carried out: the shape, size of foramen ovale cranium, and the angle and length of puncture line. The results we got are the following: foramen ovale cranium appears as oval, kidney shape, round, pear shape, and strip shape. Foramen ovale diameter is 8.20 ± 1.54 mm, and width is 4.08 ± 0.73 mm for men and 4.23 ± 0.79 mm for female. The distance from the center of foramen ovale to the maxillary second molar is 51.65 mm for male and 48.77 mm for female. The puncture line is from the center of foramen ovale to the maxillary second molar. The angle of the puncture line with the vertical plane, which is through the midpoint of supraorbital margin and the infraorbital margin, is 40.27 degrees for men and 37.31 degrees for women. The angle of the puncture line with the horizontal plane is 49.37 degrees for men and 52.26 degrees for women. The angle of the puncture line with the sagittal plane is 3.78 degrees. All data between the left and right sides have no statistically significant difference (P > 0.05), but the diameter, the length of the puncture, and the angle of puncture line with the horizontal and vertical have significant differences on sex (P < 0.01). The anatomic character of the foramen ovale cranium has important value on the accuracy of puncture for the treatment of trigeminal neuralgia.

Angular Relationship Between the Foramen Ovale and the Trigeminal Impression

“…A few studies have addressed cannulation angles; however, most reported the angulation relative to the axial plane. 35–39 Yao et al 36 measured angular relationships between the FO and TI via CT scan in a population of 120 individuals, presumably Chinese, by using the sagittal plane as a reference. Their study measured the angle between the center of the FO and boundaries of the TI.…”

“…For example, the angle between the surgical tool and the axial plane has been reported to be 49.37 degrees for men and 52.26 degrees for women. 35 Huo et al 37 noted that the approach angle ranged from 38.47°–51.89° with an average of 46.09° relative to the Reid line, which deviates from the axial plane (i.e. Frankfort horizontal line or orbitomeatal line) by approximately 7° to 10°.…”

“…Despite many reports regarding the treatment of TN via percutaneous procedures, only a few have documented angles by which surgical tools are introduced to the FO. 35–39 Most of the studies that have reported the approach angle of the surgical tool have reported angles relative to the axial plane or Reid line, but not the coronal or sagittal planes. 35–39 Yao et al 36 documented the angle between the center of the FO and the trigeminal impression (TI) relative to the coronal / sagittal planes in a population of 120 individuals (presumably Chinese) via CT scan.…”

“…35–39 Most of the studies that have reported the approach angle of the surgical tool have reported angles relative to the axial plane or Reid line, but not the coronal or sagittal planes. 35–39 Yao et al 36 documented the angle between the center of the FO and the trigeminal impression (TI) relative to the coronal / sagittal planes in a population of 120 individuals (presumably Chinese) via CT scan. However, aside from the study by Yao et al, 36 there is little information regarding the angular relationship of the FO and TI in relation to the coronal and sagittal planes.…”

Orientation of the Foramen Ovale

“…34–38 In 2013, Huo et al 36 described that “[t]he angle of introducing the cannula ranged from 15.17°–35.48° rotation to the midline with an average of 26.24° and 38.47°–51.89° angulation to the Reid line with an average of 46.09°.” In 2014, Huo et al 37 noted that “[t]he angle of introducing the cannula ranged from 15.32° to 35.48° rotation to the midline (average 25.18°) and 38.47°–51.89° angulation to the Reid line (average 46.17°).” Zhu et al 38 noted that “[t]he horizontal component of the angle between the needle axis and y axis should be more than 22 degrees in women and 20 degrees in men to avoid the injury of arteria meningea media.” Yao et al 35 noted that the angle formed by a line connecting the center of the foramen ovale with the medial edge of the trigeminal impression and the sagittal plane was an average of 6.62°. They noted that the angle formed by a line connecting the center of the foramen ovale with the lateral edge of the trigeminal impression was an average of 50.74°.…”