Bony landmarks of the medial orbital wall: An anatomical study of ethmoidal foramina

The study determines the distribution patterns of ethmoidal foramina (EF) evaluate how they are affected by gender or bilateral asymmetry, and highlights the surgical implications on the anatomical landmarks of the orbit. Two hundred and forty‐nine dry orbits were assessed. The number and pattern of EF were determined and distances between the anterior lacrimal crest (ALC), anterior (AEF) middle (MEF), posterior (PEF) ethmoidal foramina and between PEF and the optic canal (OC) were measured. The patterns of EF were classified as type I (single foramen) in 4 orbits (1.6%), type II (double foramina) in 152 (61%), type III (triple foramina) in 71 (28.5%), and type IV (multiple foramina) in 22 orbits (16.4%). Two orbits were found with five EF and a single orbit with six EF. A significant gender difference was observed for ALC‐AEF distance (P ≤ 0.03), in males 23.53 ± 2.86 (20.67–26.39) versus females 22.51 ± 3.72 (18.79–26.23) mm. Bilateral asymmetry was observed for ALC‐AEF distance (P ≤ 0.01). The distances ALC‐AEF and ALC‐PEF varied significantly according to EF classification (P ≤ 0.03 and P ≤ 0.02). The navigation ratio from ALC‐AEF, AEF‐PEF, and PEF‐OC, in Greek population was “23‐10‐4 mm”. A variation in the number of EF was found, ranging from 1 to 6, with the first report of sextuple EF. Although measures were generally consistent across genders and side, there are significant differences across ethnicities. These findings suggest that surgeons must consider population differences in determining the anatomical landmarks and navigation points of the orbit. Clin. Anat. 570–577, 2014. © 2013 Wiley Periodicals, Inc.     

在X线平片上利用头颅骨性标志定位前,后连合

在50个成人颅脑标本上,标出前、后连合后摄X线正、侧位片,在侧位片上利用不同的颅骨骨性标志共作出8组直角坐标系,分别测出各组中前、后连合中点的坐标值,相互进行比较从而选出定位前、后连合最合适的坐标系.在正位片上则分别测量原点至颅前窝底和两眶上缘连线的距离,以及颅顶内面至颅前窝底和两眶上缘连线的距离,经直线回归分析,定出原点和左右向的冠状轴,以完成三向的立体坐标系.     

Quantitative morphometry of the orbit in Chinese adults based on a three-dimensional reconstruction method

The three‐dimensional (3D) reconstruction technique serves as a practical tool in diagnosis, surgical planning, and outcome prediction of plastic and reconstructive surgery. In our study, the morphologic features of the Chinese adult orbit were described by 11 anatomic parameters using a 3D reconstruction technique. Sixty‐four Chinese adults were selected randomly from patients who had undergone craniofacial computed tomography (CT) scans to diagnose conditions other than craniofacial or orbital deformations. The morphologic parameters of orbit such as bony orbital volume, orbital foramen area and orbital rim perimeter were measured on 3D models using this technique. Differences between the two orbits and between the two sexes were investigated. The method of measurement showed high reproducibility of results. No difference between the two orbits was found. There were significant differences between men and women in all anatomic parameters other than orbital height. In men and women, respectively, mean bony orbital volume was 26.02 and 23.32 mL, mean orbital foramen area 11.80 and 11.10 cm², mean orbital rim perimeter 12.65 and 12.20 cm, mean orbital height 33.35 and 33.22 mm, mean orbital width 40.02 and 38.00 mm; mean orbital floor length 47.93 and 46.18 mm, mean orbital roof length 52.93 and 50.89 mm, mean medial orbital wall length 46.43 and 44.41 mm, mean lateral orbital wall length 48.38 and 46.91 mm, mean intraorbital distance 27.18 and 25.11 mm, mean extra‐orbital distance 98.77 and 93.69 mm. It is concluded that the measurements of these orbital parameters could be obtained from a 3D reconstruction method. The two orbits were symmetric based on orbital volume and other anatomic parameters. Orbital size was significantly smaller in women than in men; orbital height, however, was similar. The findings of the present study allow for quantification of the orbital features of Chinese adults and provide parameters for preoperative planning and prediction of postoperative outcome.     

A morphometric study of the inferior orbital fissure using three‐dimensional anatomical landmarks: Application to orbital surgery

The inferior orbital fissure (IOF) is an important structure during orbital surgery, however, neither its anatomical features nor the procedures necessary to expose the IOF have been examined in detail. A morphometric analysis of the IOF was performed on 232 orbits using computer software. The longest and shortest borders of the IOF were 18.2 ± 4.9 and 1.9 ± 1.3 mm, respectively. The outer and the inner angles were 138.9 ± 32.7° and 38.4 ± 24.7°, respectively. The perimeter of the IOF was 50.6 ± 13.5 mm and its area was 61.3 ± 39.1 mm². Eight types of IOF were observed. Type 1 IOF was observed in 42.2% and the Type 2 IOF was identified in 15.9%. A statistically significant relation was found between the longest edge and area and the widest edge and area of the IOF. The findings of our study suggest that the removal of the lateral wall should begin inferiorly, just lateral to the IOF and extended superolaterally. These data may be useful during surgical approaches to the orbit. Clin. Anat. 22:649–654, 2009. © 2009 Wiley‐Liss, Inc.     

The definitions of three‐dimensional landmarks on the human face: an interdisciplinary view

The analysis of shape is a key part of anatomical research and in the large majority of cases landmarks provide a standard starting point. However, while the technology of image capture has developed rapidly and in particular three‐dimensional imaging is widely available, the definitions of anatomical landmarks remain rooted in their two‐dimensional origins. In the important case of the human face, standard definitions often require careful orientation of the subject. This paper considers the definitions of facial landmarks from an interdisciplinary perspective, including biological and clinical motivations, issues associated with imaging and subsequent analysis, and the mathematical definition of surface shape using differential geometry. This last perspective provides a route to definitions of landmarks based on surface curvature, often making use of ridge and valley curves, which is genuinely three‐dimensional and is independent of orientation. Specific definitions based on curvature are proposed. These are evaluated, along with traditional definitions, in a study that uses a hierarchical (random effects) model to estimate the error variation that is present at several different levels within the image capture process. The estimates of variation at these different levels are of interest in their own right but, in addition, evidence is provided that variation is reduced at the observer level when the new landmark definitions are used.     

The cranio-orbital foramen, the groove on the lateral wall of the human orbit, and the orbital branch of the middle meningeal artery

The cranio-orbital foramen, a foramen in the lateral wall of the orbit, contains an anastomosis between the anterior branch of the middle meningeal artery and the lacrimal artery. Previous workers have speculated that the groove starting either from the cranio-orbital foramen or the lateral extremity of the superior orbital fissure contains the anastomotic artery. We investigated the cranio-orbital foramen and the groove on the lateral wall of the orbit in a series of 170 dried adult human skulls, and the course of the orbital branch of the middle meningeal artery in 74 specimens from 37 cadavers. We observed the cranio-orbital foramen in 141 skulls (82.9%). It was unilateral in 55 (32.4%) and bilateral in 86 (50.6%) skulls. The groove on the lateral wall of the human orbit was observed in 122 skulls (71.8%). It was unilateral in 40 (23.5%) and bilateral in 82 (48.2%). The groove on the lateral wall of the orbit started from the cranio-orbital foramen in 20 skulls (11.8%). The orbital branch of the middle meningeal artery was found in 48 cadaveric specimens (64.9%): 32 (43.2%) passed through the cranio-orbital foramen and 12 (16.2%) passed through the superior orbital fissure. In four specimens (5.4%), orbital branches of the middle meningeal artery passed through both the superior orbital fissure and the cranio-orbital foramen. The anatomy of the cranio-orbital foramen and the course of the orbital branch should be well known by surgeons reconstructing the anterior base of the skull, the orbit after orbital base surgery, and during excision of meningiomas.     

A re‐examination and re‐evaluation of salamander orbital glands

The amphibian integument contains numerous multicellular glands. Although two of these, the nasolabial and orbital glands and the associated nasolacrimal duct (NLD), have historically received considerable attention, interpretation of the original observations can be problematic in the context of current literature. Salamanders, in particular, are frequently regarded as at least indicative of aspects of the morphology of the common ancestor to all extant tetrapods; hence, an understanding of these glands in salamanders might prove to be informative about their evolution. For this study, the orbitonasal region of salamanders from three families was histologically examined. Three themes emerged: (1) examination of the effect of phylogeny on the nasolabial gland and NLD revealed a combination of features that may be unique to plethodontid salamanders, and may be correlated to their nose‐tapping behavior by which substances are moved into the vomeronasal organ; (2) ecology appears to impact the relative development of the orbital glands, but not necessarily the nasolabial gland, with smaller glands being present in the aquatic species; (3) the nomenclature of the salamander orbital gland remains problematic, especially in light of comparative studies, as several alternate possibilities are viable. From this nomenclatural conundrum, however, it could be concluded that there may be a global pattern in the location of tetrapod orbital gland development. Molecular questions in terms of ontogeny and genetic homology affect the nature of the debate on orbital gland nomenclature. These observations suggest that rather than reflecting an ancestral condition, salamanders may instead represent a case of specialized, convergent evolution. Anat Rec, 296:1789–1796, 2013. © 2013 Wiley Periodicals, Inc.     

Stereophotogrammetric surface anatomy of the anterior cruciate ligament's tibial footprint: Precise osseous structure and distances to arthroscopically-relevant landmarks

Background

While femoral tunnel malposition is widely recognized as the main technical error of failed anterior cruciate ligament (ACL) surgery, tibial tunnel malposition is likely underrecognized and underappreciated.

Prevalence and prediction of re‐experiencing and avoidance after elective surgical abortion: a prospective study

Objective: This study investigated short‐term re‐experiencing and avoidance after elective surgical abortion. In addition, it was prospectively investigated whether peritraumatic dissociation and pre‐abortion dissociative tendencies and alexithymia predict re‐experiencing and avoidance. Method: In a prospective observational design, Dutch‐speaking women presenting for first trimester elective surgical abortion completed self‐report measures for dissociative tendency and alexithymia. Peritraumatic dissociation was measured immediately post‐abortion. Re‐experiencing and avoidance were measured 2 months post‐abortion. Results: Participants reported moderately elevated levels of re‐experiencing and avoidance that exceeded a clinical cut‐off point for 19.4% of the participants. Peritraumatic dissociation predicted intrusion and avoidance at 2 months. In addition, avoidance was predicted by the alexithymic aspect of difficulty describing feelings. Conclusions: Re‐experiencing and avoidance after elective surgical abortion represent a significant clinical problem that is predicted by peritraumatic dissociation and alexithymia. Psychological screening and intervention might be a useful adjunct to elective abortion procedures. Copyright © 2008 John Wiley & Sons, Ltd.     

Fine-needle aspiration diagnosis of enterogenous cyst of the orbit: A case report

Enterogenous cyst is a benign lesion derived from misplaced endodermal epithelium. We report the aspiration cytology findings of an orbital cyst from a 32-year-old woman. The smears contain benign-appearing cuboidal glandular cells with focal mucinous features. Carcinoembryonic antigen level in the cyst fluid was markedly elevated. These findings are consistent with recurrence of the enterogenous cyst initially diagnosed 7 years earlier. Diagn. Cytopathol. 16:450–453, 1997. © 1997 Wiley-Liss, Inc.     

神经内镜硬膜下岩前入路中2种Kawase三角相关骨性解剖标志定位方法的应用解剖学观察

目的 探讨神经内镜硬膜下岩前入路中2种Kawase三角相关骨性解剖标志的定位方法,为临床应用提供解剖学依据。方法 （1）选取成人干性颅骨标本16具,在颅骨上标记弓状隆起最高点（A）、岩尖（P）、岩浅大神经沟最外侧缘点（B）、棘孔最外侧缘点（C）、卵圆孔最外侧缘点（D）、三叉神经压迹最外侧缘点（E）、破裂孔的最外侧缘点（F）及岩骨嵴外侧缘-横窦前缘交汇点（J）。硬膜下岩前入路定位方法a：以A点为参照点,P点、J点连线（PJ）为基线,过A点作PJ的平行线AP₁,过B、C、D、E、F点做AP₁的垂线,交点为B₁、C₁、D₁、E₁、F₁。测量AB、AC、AD、AE、AF、BB₁、CC₁、DD₁、EE₁、FF₁的长度,利用三角函数计算∠BAP₁、∠CAP₁、∠DAP₁、∠EAP₁、∠FAP₁的角度。定位方法b：以A点为参照点,AP为基线,测量AB、AC、AD、AE、AF、AP的长度,利用三角函数计算∠BAP、∠CAP、∠DAP、∠EAP、∠FAP的角度。（2）选取湿性尸头标本2具,女1具、男1具,年龄47岁、61岁。在2具湿性尸头标本分别模拟神经内镜硬膜下岩前入路手术,术中分别根据2种定位方法在干性颅骨标本上测量的相关角度、线段长度定位B、C、D、E、F点的位置。依据解剖标志点的定位,在Kawase三角安全范围内显露Kawase三角,磨出骨窗。观察从悬吊完硬膜至切开Kawase三角硬膜的操作时间,测量骨窗的大小。观察2种定位方法模拟手术操作中有无损伤或离断岩浅大神经、三叉神经下颌支、岩上窦,以评估2种定位方法的临床适用性。结果 （1）定位方法a测量的AB、AC、AD、AE、AF、BB₁、CC₁、DD₁、EE₁、FF₁的长度分别为（11.41±1.22）、（23.99±1.17）、（30.36±1.60）、（22.22±2.95）、（32.08±2.29）、（3.92±0.82）、（10.82±1.53）、（10.88±1.73）、（1.10±1.23）、（2.24±2.10）mm,∠BAP₁、∠CAP₁、∠DAP₁、∠EAP₁、∠FAP₁的角度分别为：20.1°±4.0°、26.8°±4.9°、21.0°±4.8°、2.8°±5.0°、4.0°±4.0°。定位方法b测量的AB、AC、AD、AE、AF、AP的长度分别为（11.03±2.36）、（22.11±2.92）、（24.66±3.00）、（19.10±2.94）、（29.46±2.57）、（29.83±3.37）mm,∠BAP、∠CAP、∠DAP、∠EAP、∠FAP的角度分别为51.0°±12.7°、47.0°±7.6°、40.1°±4.1°、23.9°±5.9°、16.6°±3.0°。（2）2具湿性尸头标本模拟神经内镜硬膜下岩前入路,均顺利完成解剖标志点的定位,充分显露Kawase三角安全范围,完成骨窗磨除。操作过程中无岩浅大神经、三叉神经下颌支、岩上窦及周围神经血管的离断或损伤。方法a,悬吊完硬膜至切开Kawase三角硬膜的操作时间分别为5 min 48 s、6 min 47 s,磨出骨窗的大小分别为27.90 mm×41.08 mm、34.24 mm×46.26 mm;方法b,悬吊完硬膜至切开Kawase三角硬膜的操作时间分别为4 min 7 s、4 min 57 s,磨出骨窗的大小分别为24.54 mm×33.72 mm、28.14 mm×41.4 mm。结论 在神经内镜硬膜下颞下岩前入路手术中,以弓状隆起最高点为参照点,以弓状隆起最高点与岩尖连线为基线,能够精准定位术中Kawase三角的相关骨性结构,该定位方法更适用于临床手术操作。     

Myoepithelial carcinoma of the orbit: a clinicopathological and histopathological study

Tran TL, Broholm H, Daugaard S, Fugleholm K, Poulsgaard L, Prause JU, Kennedy SM, Heegaard S. Myoepithelial carcinoma of the orbit: a clinicopathological and histopathological study. APMIS 2010; 118: 324–30. Two cases of invasive myoepithelial carcinoma arising from the paranasal sinuses and invading the orbit are presented. Patient 1, a 53‐year‐old man, had a 3‐month history of proptosis, pain and epiphora of the right eye. The second patient, a 24‐year‐old man, had for a week been complaining of protrusion of his left eye and of orbital pain. Computed tomography scan and magnetic resonance imaging revealed tumour masses in the frontal, ethmoidal and maxillary sinuses with invasion of the orbit and the frontal lobe. Biopsies from both cases showed spindle and epithelioid tumour cells. Mitotic figures were frequent. Immunohistochemical staining showed positive reaction for bcl‐2, calponin, cytokeratins, CD99, S100, muscle‐specific antigen, smooth muscle antigen and vimentin. The Ki‐67 index was between 30–50% and 5–25%, respectively. Ultrastructurally, intermediate filaments, perinuclear tonofilaments and desmosomes were present. Based on these findings, a diagnosis of myoepithelial carcinoma of mixed cell type in both cases was evident. Both patients died shortly after the diagnosis was made even though both underwent radical surgery. Myoepithelial carcinoma of the paranasal sinuses is very rare and only six cases have been reported previously. We present the first two cases of myoepithelial carcinoma in the paranasal sinuses with invasion of the orbit. This is also the first report of myoepithelial carcinoma arising in the ethmoidal sinus.     

The effects of morphine on basal neuronal activities in the lateral and medial pain pathways

Numerous studies indicate that morphine suppresses pain-evoked activities in both spinal and supraspinal regions. However, little is known about the effect of morphine on the basal brain activity in the absence of pain. The present study was designed to assess the effects of single-dose morphine on the spontaneous discharge of many simultaneously recorded single units, as well as their functional connections, in the lateral pain pathway, including the primary somatosensory cortex (SI) and ventral posterolateral thalamus (VPL), and medial pain pathway, including the anterior cingulate cortex (ACC) and medial dorsal thalamus (MD), in awake rats. Morphine (5 mg/kg) was administered intraperitoneally before the recording. Naloxone plus morphine and normal saline injections were performed respectively as controls. The results showed that morphine administration produced significant changes in the spontaneous neuronal activity in more than one third of the total recorded neurons, with primary activation in the lateral pathway while both inhibition and activation in the medial pathway. Naloxone pretreatment completely blocked the effects induced by morphine. In addition, the correlated activities between and within both pain pathways was exclusively suppressed after morphine injection. These results suggest that morphine may play different roles in modulating neural activity in normal vs. pain states. Taken together, this is the first study investigating the morphine modulation of spontaneous neuronal activity within parallel pain pathways. It can be helpful for revealing neuronal population coding for the morphine action in the absence of pain, and shed light on the supraspinal mechanisms for preemptive analgesia.     

The normal and variant clinical anatomy of the sensory supply of the orbit

Orbital and retro‐orbital pain are relatively common clinical conditions that are associated with such disorders as trigeminal, lacrimal, and ciliary neuralgia, cluster headaches, paroxysmal hemicrania, inflammatory orbital pseudotumor, trochleitis, and herpetic neuralgia ophthalmicus, thus making the nerves supplying the orbit of great clinical importance. Surprisingly, how pain from this region reaches conscious levels is enigmatic. Classically, it has been assumed that pain reaches the ophthalmic division of the trigeminal nerve (V₁) and travels to the descending spinal trigeminal nucleus. However, exactly where the receptors for orbital pain are located and how impulses reach V₁ is speculative. In this project, we reviewed all of the reported connections between the orbital nerves and V₁ in order to understand how pain from this region is transmitted to the brain. We found reported neural connections to exist between cranial nerve (CN) V₁ and CNs III, IV, and VI within the orbit, as well as direct neural branches to extra‐ocular muscles from the nasociliary, frontal, and supraorbital nerves. We also found reported neural connections to exist between the presumed carotid plexus and CN VI and CN V₁, CN VI and CN V₁ and V₂, and between CN V₁ and CN III, all within the cavernous sinus. Whether or not these connections are sympathetic or sensory or some combination of both connections remains unclear. An understanding of the variability and frequency of these neural connections could lead to safer surgical procedures of the orbit and effective treatments for patients with orbital pain. Clin. Anat. 27:169–175, 2014. © 2014 Wiley Periodicals, Inc.     

Clinically relevant landmarks of the frontotemporal branch of the facial nerve: A three‐dimensional study

The frontotemporal branch of the facial nerve (FTN) is vulnerable during craniofacial surgeries due to its superficial course and variable distribution. Surface landmarks that correlate with the underlying course of the FTN can assist in surgical planning. Estimates of the course of FTN commonly rely on Pitanguy's line (PL), which utilizes variable soft‐tissue landmarks. The purpose of this study was to evaluate palpable surface landmarks to predict the course and distribution of FTN using 3D modeling. Fifteen half‐heads were used. In five formalin‐embalmed specimens, surface topography was obtained using a FARO® scanner and landmarks corresponding to PL, porion, supraorbital notch, frontozygomatic and zygomaticotemporal sutures, and supraorbitomeatal line (SOML) and infraorbitomeatal line (IOML) were demarcated/digitized using a Microscribe? digitizer. A preauricular flap was raised, and branches of FTN were isolated and digitized. The data were reconstructed into 3D models (Geomagic®/Maya®) to quantify landmarks. In 10 Thiel‐embalmed specimens, four independent raters identified/palpated and pinned the frontozygomatic and zygomaticotemporal sutures and PL. Data were collected and analyzed using the same protocol as in the first part of the study. Landmarking of PL was inconsistent between raters and not representative of FTN distribution. The easily identifiable surface landmarks defined in this study, a line 12 mm anterior to the porion along the SOML and IOML and a line joining the zygomaticotemporal and frontozygomatic sutures, comprehensively captured the distribution of FTN. The raters found a mean of 21 ± 2 branches between the lines out of a total of 22 ± 2 branches. These landmarks may be used clinically to avoid injury to FTN. Clin. Anat. 25:858–865, 2012. © 2012 Wiley Periodicals, Inc.     

Cytologic evaluation of tumors of the orbit and ocular adnexa: An analysis of 84 cases studied by the “squash technique”

The cytologic features of 84 ophthalmic lesions were evaluated using the squash technique at the time of frozen section. Of the 84 lesions, 55 were located in the orbit, 17 in the lacrimal gland, and 12 in the ocular adnexa. Lymphoid lesions comprised most of the cases (n=47). In this group, 34 cases were malignant lymphomas and 13 were lymphoid hyperplasias. Inflammatory/granulomatous lesions and mesenchymal tumors comprised eight cases each. Epithelial neoplasms of the soft tissues of the orbit, lacrimal gland and eyelid constituted 12 cases, of which eight were malignant and four were benign. A total of nine cases were due to neurogenic tumors, neuroendocrine neoplasms, and melanocytic tumors. The squash technique provides a means to evaluate the architectural and cytologic details of ophthalmic lesions, without the intrinsic problem of frozen section artifact. We believe that the squash technique is a simple, quick, and useful method for the diagnosis of orbital/adnexal lesions. © 1994 Wiley-Liss, Inc.     

Projections from visual cortical area 19, the posterior medial lateral suprasylvian area and the lateral posterior-pulvinar complex of the thalamus to areas 17 and 18 in young kittens

Retrogradely transported horseradish peroxidase (HRP) or HRP conjugated to wheat germ agglutinin was used to demonstrate projections from area 19, the posterior medial lateral suprasylvian area (PMLS) and the lateral posterior-pulvinar complex (LP-PC) of the thalamus to areas 17 and 18 of the visual cortex in young kittens. Areas 17 and 18 in kittens, as in adult cats, receive association fibres from cells lying mainly in deep cortical laminae in area 19 and PMLS, and projections from the LP-PC of the thalamus.