Zygomaticofacial, zygomaticoorbital and zygomaticotemporal foramina: Anatomical study

Abstract

The zygomatic nerve may be disrupted when elevating periorbita from the lateral wall during orbital surgery, and care should be taken to prevent injury to this nerve during lateral orbitotomy approaches to access intraorbital soft-tissue tumors. Furthermore, the precise introduction of anesthetics to the zygomaticoorbital (ZO), zygomaticofacial (ZF) and zygomaticotemporal (ZT) foramina could be important data for the plastic and reconstructive surgeon operating in the area. The aim of the present study was to investigate the morphologic and topographic anatomy, and variations of the ZO, ZF and ZT. The present study was performed using 200 dry human skulls. The ZF, ZO and ZT foramina varied from being absent to as many as four small openings. We classified each of these foramina as types I-V for single, double, triple, quadruple and absent foramina, respectively. The relative frequency was as follows: type I, ZO 50%, ZF 40%, ZT 30%; type II, ZO 20%, ZF 15%, ZT 15%; type III, ZO 10%, ZF 5%, ZT 5%; type IV, ZO 3%, ZF 1%, ZT-; and type V, ZO 17%, ZF 39%, ZT 50%. A detailed knowledge of the anatomic morphometry of this area is necessary for a surgeon when performing maxillofacial surgery and regional block anesthesia. Anatomic variations in this area may be present and a surgeon must take this into consideration so as to increase surgical success.

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

“…The absence of the ZMF has been reported to be 9.1% in Koreans (Hwang et al, 2007), 21.8% in Indians (Mangal et al, 2004), 21.5% in Caucasians (Martins et al, 2003), and 39% in a mixed cohort, chiefly Caucasians (Loukas et al, 2008).…”

“…Some authors have suggested that the zygomatico-facial (ZMF) may be used as a landmark for locating the IOF (Chanda and Nanda, 2002;Gonzales et al, 2002;Martins et al, 2003). Although there are many studies regarding the incidence and number of the ZMF in literature (Mangal et al, 2004;Loukas et al, 2008), only a few of them have presented the pertinent metrical data for finding the IOF (Martins et al, 2003). It was the purpose of this study to collect the morphometric details of the relevant parameters and to determine the reliability of the ZMF for locating the lateral end of the IOF.…”

Zygomaticofacial, zygomaticoorbital, and zygomaticotemporal foramina

“…Interestingly, we released a very similar exploration of the zygomaticofacial, zygomaticoorbital, and zygomaticotemporal foramina (Loukas et al, 2008). We congratulate their efforts in conveying how surgeons operating in this area should possess knowledge of the prevalence of the zygomaticofacial foramen with respect to its utilization as a landmark.…”

Skull

“…There were none in 15.6%, one in 44.4%, two in 28.1%, three in 6.3%, four in 4.4%, and five in 1.3% of sides. Loukas et al (2008) studied 200 dry human skulls for zygomaticofacial (ZF), zygomaticoorbital (ZO) and zygomaticotemporal (ZT) foramina. All three foramina varied from absence to as many as four small openings.…”