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Microsurgical anatomy around the foramen of Luschka in relation to intraoperative recording of auditory evoked potentials from the cochlear nuclei.

Three cadaveric heads were dissected to investigate the microsurgical anatomy around the foramen of Luschka. It was found possible to place a recording electrode in proximity to the cochlear nuclei by inserting it in the lateral recess of the fourth ventricle through the foramen of Luschka. In operations of the cerebellopontine angle using the retromastoid approach, access to the foramen of Luschka and the lateral recess is obtained by retracting the biventral lobule of the cerebellum in a caudal-rostral direction under a caudal-rostral/medial field of vision. The craniectomy might need to be enlarged a few millimeters in the caudal direction. A wick electrode can be inserted in the lateral recess beneath the choroid plexus in a rostromedial direction and to a depth of approximately 3 to 5 mm from the foramen of Luschka without excessive retraction of the cerebellum. The optimum position for the recording electrode is in the triangle formed by the axis of the cochlear nerve and the glossopharyngeal nerve and by the lip of the foramen of Luschka. The caudal retromastoid approach is more suitable than the translabyrinthine technique for recording from the cochlear nuclei as well as for implantation of stimulating electrodes into the cochlear nuclei for use as hearing prostheses.

Cadaver↗

Head-turned rear impact causing dynamic cervical intervertebral foramen narrowing: implications for ganglion and nerve root injury.

OBJECT: A rotated head posture at the time of vehicular rear impact has been correlated with a higher incidence and greater severity of chronic radicular symptoms than accidents occurring with the occupant facing forward. No studies have been conducted to quantify the dynamic changes in foramen dimensions during head-turned rear-impact collisions. The objectives of this study were to quantify the changes in foraminal width, height, and area during head-turned rear-impact collisions and to determine if dynamic narrowing causes potential cervical nerve root or ganglion impingement. METHODS: The authors subjected a whole cervical spine model with muscle force replication and a surrogate head to simulated head-turned rear impacts of 3.5, 5, 6.5, and 8 G following a noninjurious 2-G baseline acceleration. Continuous dynamic foraminal width, height, and area narrowing were recorded, and peaks were determined during each impact; these data were then statistically compared with those obtained at baseline. The authors observed significant increases (p < 0.05) in mean peak foraminal width narrowing values greater than baseline values, of up to 1.8 mm in the left C5-6 foramen at 8 G. At the right C2-3 foramen, the mean peak dynamic foraminal height was significantly narrower than baseline when subjected to rear-impacts of 5 and 6.5 G, but no significant increases in foraminal area were observed. Analysis of the results indicated that the greatest potential for cervical ganglion compression injury existed at C5-6 and C6-7. Greater potential for ganglion compression injury existed at C3-4 and C4-5 during head-turned rear impact than during head-forward rear impact. CONCLUSIONS: Extrapolation of present results indicated potential ganglion compression in patients with a non-stenotic foramen at C5-6 and C6-7; in patients with a stenotic foramen the injury risk greatly increases and spreads to include the C3-4 through C6-7 as well as C4-5 through C6-7 nerve roots.

Acceleration↗

Transcatheter closure versus medical therapy of patent foramen ovale and presumed paradoxical thromboemboli: a systematic review.

BACKGROUND: The optimal strategy to prevent recurrent presumed paradoxical emboli in patients with patent foramen ovale is unknown. PURPOSE: To synthesize the current knowledge about and qualitatively assess the relative benefits of transcatheter closure versus medical therapy for patent foramen ovale. DATA SOURCES: English-language and foreign-language journals listed in the MEDLINE database from January 1985 to July 2003 were systematically searched. Secondary sources were also used. STUDY SELECTION: Secondary prevention studies of transcatheter closure or medical therapy for patent foramen ovale were required to include at least 10 patients followed for more than 1 year and to report recurrent neurologic events. DATA EXTRACTION: Data from published studies were manually extracted and summarized. DATA SYNTHESIS: Ten studies of transcatheter closure (1355 patients) and 6 studies of medical therapy (895 patients) for patent foramen ovale were included. Overall, the 1-year rate of recurrent neurologic thromboembolism with transcatheter intervention was 0% to 4.9%, and the incidence of major and minor complications was 1.5% and 7.9%, respectively. Medical management was associated with a 1-year recurrence rate of 3.8% to 12.0%. However, limitations resulting from uncontrolled data, nonstandardized definitions, vigilance of follow-up, and baseline imbalances preclude definitive conclusions about the superiority of a particular approach. General differences in study samples included older age, greater proportion of men, and higher prevalence of diabetes and smoking among medically treated patients. Patients undergoing treatment with a transcatheter device were more likely to have had multiple thromboembolic events at baseline. CONCLUSION: Transcatheter closure of patent foramen ovale may prevent a substantial proportion of cryptogenic strokes. Randomized clinical trials are needed.

Cardiac Catheterization↗

[Anatomical study of the thyroid foramen in human larynx: a study of 100 dissections].

The foramen thyroideum was systematically studied on the specimen of larynx of 50 fresh corpses. Among the one hundred dissections performed, the foramen thyroideum was noted only in one specimen (2 foramen). It was symmetrical not only in the position but also in the diameter. In both of these cases, the foramen thyroideum always contains few vessels and nerves. It's possible physiological role and the origin of the contents of the foramen thyroideum are discussed based on the research literature.

Adolescent↗

Foramen mandibulae as an indicator of successful conduction anesthesia.

Comparative measurements were made of 144 orthopantomographs in 50 patients with successful and 94 patients with unsuccessful inferior alveolar nerve block anesthesia. The results show that the bony lingula is prominent in 28.5% of all patients, or in 56.0% of those with unsuccessful anesthesia. The variables mandibular notch vs. mandibular foramen (MN-MF) and the anterior ramus ridge vs. mandibular foramen (ARR-MF) show greater distances in the group of patients with successful anesthesia, while the variables of posterior ramus ridge vs. mandibular foramen (PRR-MF) and mandibular angle vs. mandibular foramen (MA-MF) were greater in the group of patients with unsuccessful anesthesia (p > 0.05). It is concluded that the variability in position of the mandibular foramen among others may be responsible for an occasional failure of inferior alveolar nerve block.

Adult↗

[Diagnosis and treatment of brain tumors in jugular foramen region].

OBJECTIVE: To analyze the diagnosis and treatment of brain tumors in jugular foramen region. METHODS: 22 patients with brain tumor in jugular foramen region who had been diagnosed and treated from 1996 to 2000. Considerable literature was reviewed. RESULTS: Tumor imaging technique showed masses of different shapes in unilateral jugular foramen region. All of the 22 patients underwent operation via different approaches. Total removal of the tumor was achieved in 20 patients and subtotal removal in 2. Pathological examination confirmed the diagnosis of neurinoma in 13 patients, tumor of glomus jugulare in 4, meningioma in 3, chordoma in 1, and metastatic tumor in 1. Only one patient died after operation. The mortality rate was as low as 4.5%. CONCLUSION: The most common tumors in jugular foramen region are neurinoma, tumor of glomus jugulare, and meningioma. Surgery is effective in treatment of brain tumor in jugular foramen region.

Adolescent↗

[The effect of instrumentation on original apical foramen shape using steel vs niti rotatory: computerized analysis].

BACKGROUND: A fundamental requirement to obtain a correct endodontic preparation depends on the respect, during cleaning and shaping, of the original morphology of the apical foramen, (AF), so that the filling material will form a complete seal. METHODS: In our previous studies, in order to verify if this presumption was respected using rotary NiTi instruments with cutting tip, we instrumented extracted teeth characterised by a different degree of root curvatures. Using a standardized system to replace the sample, the original shape of the apical foramen of each tooth was recorded using a computerised technique and then compared to the shape after instrumentation. The data showed differences on AF shapes depending on the degree of root canal curvatures. In fact, the teeth with straight canals showed the least alterations on the original AF shape; on the contrary, the teeth with curved canals showed apical foramen enlargement or transportation. Therefore, in the current study we aimed to compare the in vitro effects of stainless steel, (Flexofile, Dentsply Maillefer, Baillaigues, Switzerland), vs NiTi safe cutting tip (Quantec SC, (Tycom Dental, Irvine CA, U:S.A.), vs NiTi non cutting tip, (Quantec LX, Tycom Dental, Irvine CA, U:S.A.), instrumentation on original apical foramen shape. We used NiTi instruments according to standard technique suggested by Tycom, and hand steel files, to instrument the apical third, according to the Crown-Down technique. Working length was fixed at -0.5 from AF. RESULTS AND CONCLUSIONS: Our results suggested that in the presence of accentuated canal curves rotary Niti, with cutting tip, cause significantly more enlargement of the AF area. At the same time, we also observed that NiTi rotary files, with both cutting and non-cutting tip, cause eccentric enlargement of AF in curved canals. Therefore, NiTi engine-driven instruments should be used carefully in the presence of accentuated canal curves to avoid enlargement or transportation of AF, probably because rotary NiTi files may slip out of operative control, leaving a mark on the foramen shape. In the presence of severe curves, we suggest modifying the operative sequences by alternating rotary NiTi with hand NiTi or stainless steel instruments, especially in the preparation of apical third.

Dental Alloys↗

Detection of right to left shunting through a patent foramen ovale in Japanese patients with ischemic stroke by transesophageal echocardiography using a standardized Valsalva maneuver.

We attempted to clarify the usefulness of transesophageal echocardiography performed using a standardized Valsalva maneuver to detect the presence of a patent foramen ovale in Japanese patients with ischemic stroke. Four hundred ninety six patients with ischemic stroke who were admitted to the Yokohama City Brain and Stroke Center between September 1999 and February 2002 were enrolled for the study. All the enrolled patients underwent transesophageal echocardiography with contrast injection and color Doppler imaging. During the procedure, a standardized Valsalva maneuver was performed to induce right to left shunting through a patent foramen ovale. Other related structural abnormalities, such as atrial septal aneurysm and the Chiari network anomaly, were also detected by the test. Transesophageal echocardiography without the Valsalva maneuver revealed a functional right to left communication in only 8.2% of the ischemic stroke patients, whereas the procedure conducted using a standardized Valsalva maneuver to provoke shunting revealed a patent foramen ovale in 15.3% of the patients. The presence of an atrial septal aneurysm or the Chiari network anomaly was not sensitive or specific enough to predict the presence of a patent foramen ovale as diagnosed by transesophageal echocardiography using the standardized Valsalva maneuver. Our results suggest that the standardized Valsalva maneuver is a safe and useful technique to detect the presence of a patent foramen ovale, which is potentially known to be associated with paradoxical embolism.

Aged↗

Anatomy of the intervertebral foramen.

The intervertebral foramen serves as the doorway between the spinal canal and periphery. It lies between the pedicles of neighboring vertebrae at all levels in the spine. A number of categorization schemes have been attempted to describe the boundaries of the intervertebral foramen. No uniform agreement has been made on which classification best describes this area. Studies of the nerve root canals have clearly noted variations in the angle of take-off from the thecal sac, length of the nerve root, and placement of the dorsal root ganglion from different lumbar levels. The nerve root canal receives a dual blood supply from central and peripheral sources. The dorsal root ganglion also has a dual vascular supply that aids in preventing damage to this vital foraminal structure. The presence of ligamentous structures within the foramen has been demonstrated by a number of recent studies. These ligaments serve a protective and organizational role for the neurovascular structures of the foramen. A thorough knowledge of the intervertebral foramen will allow the understanding of the pathological and degenerative changes that cause compression or injury to these foraminal structures.

Journal Article↗

Electronic determination of root canal length by newly developed measuring device. Influences of the diameter of apical foramen, the size of K-file and the root canal irrigants.

A new electronic root canal measuring device called "ENDEX" which is able to determine the root canal length under moistened conditions using a relative value of different alternative electric currents is discussed in this study. This study is designed to investigate the efficiencies of the new device, in vitro, with respect to change in the root canal environment; namely the influence of the size of K-file, the diameter of the apical foramen and the various root canal irrigants. According to the present study, it was confirmed that the location of the apical foramen was clearly detected under moistened root canal with saline solution using any size of K-file. The locations of the tip of K-files were 0.5 mm inside the apical foramen when the relative value displayed 0.3 Volt, so that the apical constriction could not disturb during root canal measurement. One of the big problem with prior electrical measurement devices was not being able to determine the canal length under moistened conditions. However with this improved device, intracanal irrigants, such as saline, 5% NaOC1, 14% EDTA and 3% H2O2 did not interfere in detecting apical foramen irregardless of the size of K-file and the size of the apical foramen.

Dental Pulp Cavity↗

Formation and early prenatal location of the human mental foramen.

The formation and early prenatal location of the human mental foramen was investigated on 43 human fetuses. Histochemical methods supplemented by macroscopic visualization were used. Similar studies on the mental foramen were not available in the literature. The study demonstrated constancy in the developmental sequence of the bony structures in the region of the mental foramen. The formation of the mental foramen was described and related to general developmental parameters such as CRL and CNO values (skeletal maturity indexes of the hand and foot). The study indicated that the very early position of the mental foramen was in the region of the interstitial bone between the primary canine and the primary first molar. A positional change in the dorsal direction was described during the first half of the prenatal period.

Age Determination by Skeleton↗

[Intracranial neurinoma of jugular foramen--report of a case and reference, its clinical manifestations (author's transl)].

This is the 28th case report of jugular foramen neurinoma in the world. A 24-year-old man was admitted to our hospital with complaints of dizziness and impaired balance. Neurological examination revealed IX, XI and XII cranial nerves and cerebellar involvements, e.g., Brun's-Cushing nystagmus, curtain sign on the left, weakness of the left sternocleidomastoid muscle and deviation of the tongue to the left, accompanied with atrophy. Choked discs and other signs of increased intracranial pressure were not recognized. There were no cerebellar symptoms except impaired balance and nystagmus. Lateral view of vertebral angiography showed that the posterior inferior cerebellar artery was displaced backward and upward, the basilar artery was imposed to the clivus, and the superior cerebellar artery was elevated. A-P view of vertebral angiography showed that the posterior inferior cerebellar artery was displaced to the left. Enlargement of the left jugular foramen was revealed especially by tomograms of horizontal section at the level of 0.3 cm below the external acoustic meatus and 0.5 cm behind the external acoustic meatus. The jugular foramen margins were smooth and somewhat sclerotic. We confirmed the diagnosis of the jugular foramen neurinoma on the left. Suboccipital craniectomy confirmed a huge tumor which covered the left jugular foramen and the bulk of which was in the cisterna magna. These findings were supposed to explain that the patient did not show increased intracranial pressure. The tumor was encapsuled with smooth and thin capsule. This tumor was totally removed and the postoperative course was uneventful. Histological diagnosis was neurinoma. We consider that this tumor arose on the IXth or XIth cranial nerve.

Adult↗

Anatomical variation in position of the greater palatine foramen in the adult human skull.

Sixty-five Nigerian and 34 Indian adult human skulls with full eruption of the 3rd molar teeth were examined to ascertain the location of the greater palatine foramen. The location of the foramen from the posterior border of the hard palate was quite consistent, being 0.35 cm in Nigerian and 0.37 cm in Indian skulls. The usually accepted description as opposite the upper 2nd molar was observed for only 13.1% of foramina in Nigerian skulls. The most common position of the foramen was found to be medial or opposite the 3rd maxillary molar, the next most common being between the 2nd and 3rd maxillary molars. The direction of opening of the foramen into the oral cavity was inferiorly in an anteromedial direction in 58.5% Nigerian and 91.1% Indian skulls. In 38.5% Nigerian skulls the opening was in an anterolateral direction. A bilaterally symmetric bony projection extending from the posterior margin of the foramen was observed in 24.6% of the Nigerian and 35.3% of Indian skulls. The palatal vault of was U-shaped in all instances, its height varying from flat to 0.3-0.8 cm.

Adult↗

[Presence of patent foramen ovale in different heart diseases: incidence in 211 consecutive patients studied by transesophageal echocardiography].

BACKGROUND: Contrast echocardiography during the decompression phase of the Valsalva manoeuvre in course of transesophageal echo study is the ideal method to identify patent foramen ovale. METHODS: In order to evaluate the incidence of patent foramen ovale in patients with different cardiac diseases we performed contrast injection in 211 consecutive pts submitted to TEE (Transesophageal Echocardiography) in our laboratory between march 1991 and march 1993. RESULTS: Fiftythree of 211 pts (25%) presented a patent foramen ovale. The incidence in the different cardiac diseases was as follows: 0% in rheumatic mitral disease, 23% in aortic valve disease, 17% in mitral and/or aortic valve prosthesis, 29% in congenital heart disease other than interatrial septal defect, 44% in mitral valve prolapse and 92% in atrial septal aneurysm. CONCLUSIONS: This study indicates that patent foramen ovale is a common finding in different cardiac pathologies and frequent in mitral valve prolapse and even more in atrial septal aneurysm. In case of peripheral embolism of likely cardiac origin, the patency of the foramen ovale must be recognized, especially when these two latter cardiac anomalies are identified.

Aged↗

Histology of posterior scleral foramen in normal eyes: its possible role in optic nerve damage in chronic open angle glaucoma.

We examined the histologic features of the posterior scleral foramen in 27 enucleated eyes (16 during autopsy and 11 with choroidal malignant melanoma). The histologic findings of the posterior scleral foramen were similar to those in previous reports. The shape of the scleral foramen was either cylindrical or truncated, the latter occurring when the inner margin of the sclera projected with a crest-like edge pressing into the optic nerve. This configuration was encountered more frequently in the upper and lower temporal aspects of the scleral foramen in 10 eyes, while the nasal rim was free of such projection in all the eyes. We hypothesize that the effect of prolonged high intraocular pressure exerted on the axonal tissue against these crest-like edges of the non-distensible scleral foramen might be the major factor in the etiology of early arcuate nerve fiber bundle defects in primary open-angle glaucoma.

Chronic Disease↗

Macroscopic and morphometric investigation of the jugular foramen of the human skull.

The jugular foramen was examined in 70 Turks skulls. In 61.4% of cases the right jugular foramen was larger than the left. In 24.3% the left was larger and in 14.3% they were equal in size. Bony bridging was observed in 20% of cases and was not in 80%. In addition to, one tripartite jugular foramen was observed. Intracranial morphometric results of the jugular foramen showed no significant difference between right and left sides with respect to two transverse diameters (right 15.7 +/- 2.2 mm and left 15.0 +/- 2.3 mm). The largest sagittal diameter was larger on the right side than on the left (right 8.3 +/- 2.2 mm and left 7.3 +/- 1.4 mm). The shortest sagittal diameter was narrower on the right side than on the left side (right 3.9 +/- 1.1 mm and left 4.0 +/- 1.3 mm). External findings of the jugular foramen showed that the left side was longer in transverse diameter (right 16.0 +/- 2.5 mm and left 15.5 +/- 2.6 mm) and the right was longer in sagittal diameter (right 8.4 +/- 1.9 mm and left 7.6 +/- 1.7 mm).

Cephalometry↗

A study of infraorbital foramen, canal and nerve in adult Egyptians.

The infraorbital foramen, canal and nerve were examined in 30 Egyptian adult skulls and 15 adult human cadavers. The infraorbital foramen was single in 90% of cases and double in 10%. It was oval in 65% of cases and round in the remaining cases. It was directed downward, forward and medially in 60%, downward in 25% and medially in 15% of cases. The distance from the centre of the foramen to the inferior orbital margin was 6.1 +/- 2.4 mm and to the lateral nasal border was 14.7 +/- 2.7 mm. The infraorbital foramen was opposite the 2nd maxillary premolar in 50% of cases, opposite the 1st premolar in 15% and between the 1st and 2nd premolar teeth in 15% of cases. The length of the infraorbital canal was 28.8 +/- 2.9 mm and it showed an infraorbital groove in 60% of cases, a complete roof in 25% and a deficient roof leaving a short bony bridge in 15% of cases. The anterior superior alveolar nerve arose either from the middle third of the infraorbital nerve (in 10 out of 15 cases) or from its anterior third in the remaining 5 cases. The middle superior alveolar nerve was not apparent in 8 cases and it arose from the middle third of the infraorbital nerve in the remaining 7 cases. Radiographic study of the infraorbital foramen and canal on 15 adult dry skulls were also done using 3 different views for each skull. The panoramic view showed to be better than either of the lateral or the postero/anterior view.

Adult↗

Position of the mental foramen in adult black Zimbabwean mandibles: a clinical anatomical study.

OBJECTIVE: To provide some anatomical information on the shape, size, and position of the mental foramen among Black Zimbabweans that could be used as reference material by dental and other health practitioners during clinical practice in Zimbabwe. DESIGN: Cross sectional anatomical study. SETTING: Department of Anatomy, Faculty of Medicine, University of Zimbabwe, Mount Pleasant, Harare, Zimbabwe. SUBJECTS: 32 mandibles derived from adult Black Zimbabweans. MAIN OUTCOME MEASURES: The shape of the mental foramen, its relation to the lower teeth and its position in relation to the mandibular symphysis, the posterior border of the ramus of the mandible, the lower border of the mandible, and the alveolar margin. RESULTS: The shape of the mental foramen was round in 14 out of 32 mandibles (43.8%) and was oval in the remaining 18 (56.3%). The percentage of occurrence of the mental foramen was highest below the lower second premolar tooth on the right side (position 4) and posterior to it on the left side (position 5). In the vertical plane, the mental foramen lay slightly below the midpoint of the distance between the lower border of the mandible and the alveolar margin (44.1% and 45.5% for the right and left sides respectively). In the horizontal plane, it lay approximately one quarter (27.3% for the right and 27.4% for the left sides) of the distance from the mandibular symphysis to the posterior border of the ramus of the mandible. CONCLUSION: The percentage distribution of the mental foremen in relation to the lower teeth in the adult Black Zimbabwean mandible was at variance with that of other population groups. However, the quantitative position of the mental foremen was bilaterally symmetrical in the adult Black Zimbabwean mandible. The latter observation is of clinical significance to dental and other health practitioners in Zimbabwe with regards to the achievement of effective mental nerve block anaesthesia and the prevention of damage to the mental nerve during surgical procedures on the lower jaw.

Adult↗