The ZMF: Is it a reliable intraoperative guide for the IOF?

Abstract

Intraoperative localization of the inferior orbital fissure (IOF) is necessary when making an osteotomy across the zygomatic bone while performing an orbito-zygomatic craniotomy. The zygomatico-facial foramen (ZMF) may serve as good reference point for locating the IOF. In this study, the position of the ZMF was assessed and its location in relation to the IOF was measured in 78 skulls. The ZMF was present in 83.3% of the skulls and when present, was related to the lateral end of the IOF in all cases. The mean distance of the ZMF from the IOF was 15.6 mm, and the mean distance between the ZMF and the fronto-zygomatic suture was 25.9 mm. In skulls where the ZMF was absent, the mean distance of the inferior orbital rim (at the level of IOF) from the fronto-zygomatic suture (20.7 mm) could be used for determining the position of the IOF. The IOF could thus be located approximately 15-16 mm medial to the ZMF in the same transverse plane. The location of the ZMF could also be used as a landmark for determining the inferior limit of the orbito-zygomatic craniotomy.

Anatomical study of the zygomaticofacial foramen and zygomatic canals communicating with the zygomaticofacial foramen for zygomatic implant treatment: a cadaver study with micro-computed tomography analysis

“…Because the ZFN and the ZTN, which are branches of the zygomatic nerve, are located within the zygomatic bone, it is difficult to determine their courses. Most previous studies investigated numbers and locations of zygomatic foramina in dry skulls by macroscopic observation [ 16 - 25 ]. In the present study, the canal connecting the orbital, temporal, or lateral surfaces of the zygomatic bone was defined as the zygomatic canal on micro-CT images, and the openings of the foramina of the zygomatic canal were defined as ZOF, ZTF, and ZFF respectively.…”

“…Therefore, the location of the ZFF, where the ZFN emerges, is considered to be an important area to pay attention to when reflecting a mucoperiosteal flap around the cheek region. Previous studies have mainly reported numbers and locations of zygomatic foramina using dry skulls [16][17][18][19][20][21][22][23][24][25], with some reporting anatomical findings of the ZFN exiting the zygomatic foramen [26]. Recently, there has also been a report that involved observation of the zygomatic canal using micro-computed tomography (CT) analysis of seven cadavers [27].…”

“…Recently, there has also been a report that involved observation of the zygomatic canal using micro-computed tomography (CT) analysis of seven cadavers [ 27 ]. Although these anatomical reports have provided knowledge that enables the prevention of iatrogenic injuries during surgical procedures [ 18 - 22 ], there are few reports of anatomical studies focusing on zygomatic implant treatment.…”