Greater Wing Of Sphenoid Bone Research Articles

MORPHOMETRIC VARIATION OF FORAMEN OVALE IN DRY ADULT SKULL OF INDIAN POPULATION WITH CLINICAL CORRELATIONS

Objective: The present study aim is to evaluate morphology and morphometric measurements of foramen Ovale present in the Greater wing of Sphenoid bone of the Middle Cranial fossa of the Skull base, using Digital sliding Vernier caliper. The anatomical knowledge of Foramen Ovale and it’s variations are of great help to neurosurgeons, oncologists and radiologists while performing any diagnostic and surgical interventions into and nearby foramen to deal with unavoidable complications as Tic douloureux. Methods: This study was done in 35 dried Human skulls taken from the Department of Anatomy, GBCM, Dehradun, India. The length and the width of the Foramen Ovale were measured. The different shapes of the foramen were also seen. All data collected was subjected to Statistical analysis using Student’s T-test. Results: In the present study, Incidence of Oval shape foramen Ovale was maximum, followed by Elongated shape. There were no statistical differences between the mean length and mean width on the two sides of Foramen Ovale. Conclusion: The vast knowledge of different shapes and sizes of foramen Ovale to Neurosurgeons and Oncologists helps to operate with least invasive procedures to avoid clinical manifestations.

Exophthalmos and hemiheadache caused by osteoma in the greater wing of sphenoid bone: an extremely rare case report.

A 53-year-old woman complained of hemiheadache, exophthalmos in the right eye, and limitation in lateral eye movements progressing to diplopia in the past 2 months. The physical examination of the rest systems was unremarkable. The radiological investigations revealed a hyperdense lesion arising from the right greater wing of the sphenoid bone and compressed on the orbit's components and eye muscles, which caused proptosis. The radiological findings suggested osteoma and the tumor was excised by craniotomy. The patient gets rid of the symptoms and the follow-up for 6 months was uneventful. Even hemiheadache, exophthalmos, limitation in eye movements, and diplopia are unfamiliar findings in osteoma, they may be its manifestations. Also, MRI is used as a diagnostic method with computed tomography scan in intracranial osteoma. These cases are treated by craniotomy. Even though osteoma is a benign tumor, it may form in unusual locations and cause unexpected symptoms. So, it should be a differential diagnosis in skull bony tumors. Also, it should be treated when exists in sensitive places to avoid irreversible outcomes.

Spontaneous cerebrospinal fluid fistula secondary to hyper-pneumatized paranasal sinuses and skull base: two case reports

BackgroundSpontaneous cerebrospinal fluid (CSF) fistulas occur due to various reasons other than well-identified causes such as trauma, neoplasia or infection. Various contributory factors are attributed to formation of spontaneous CSF leaks such as idiopathic intracranial hypertension leading to prominent arachnoid granulations. Further, presence of hyper-pneumatized paranasal sinuses or the skull base weakens the bone and predisposes to development of spontaneous defects and further fistulas. This case report highlights two cases of spontaneous CSF leaks associated with hyper-pneumatized petrous bone and sphenoid sinus.Case presentationA 26-year-old female patient with history of right rhinorrhea with imaging evidence of bilateral hyper-pneumatized petrous bones and a bony defect in the right petrous bone on computed tomography (CT). Subsequent CT cisternography demonstrated CSF leak extending into the right pneumatized petrous apex cells, Eustachian tube, middle ear cavity, aditus, antrum and mastoid air cells. Pooling of contrast in the right nasal cavity and ethmoid cells was also seen. A 49-year-old female patient with history of right rhinorrhea with features of hyper-pneumatization of sphenoid bone involving right greater wing of sphenoid bone and bilateral pterygoid process with a bony defect in the right greater wing of sphenoid was demonstrated on CT. Corroborative magnetic resonance imaging (MRI) brain Constructive interference in steady state (CISS) sequence revealed a meningoencephalocele. Additionally, a suspicious focal dehiscence was observed in the right cribriform plate CSF pockets herniating into right ethmoid sinus.ConclusionHyper-pneumatized petrous bone and paranasal sinuses can be attributed as a risk factor for formation of spontaneous CSF leaks.

Morphometric Analysis and Variation of Pterion, Asterion and Lambda in Dry Human Skulls and Its Sexual Dimorphism

Introduction: Pterion is a H- shaped sutural junction of the frontal, parietal, squamous part of the temporal and greater wing of sphenoid bone. Asterion is a sutural junction of lambdoid, parietomastoid and occipitomastoid sutures. Lambda is the junction where lambdoid sutures and sagittal sutures meet. These sutures play an important role in infants' brain development. Flexibility of these allows the bones to overlap and hence it can pass through the brain canal easily without any damage to the brain.
 Aim: To analyse pterion asterion and lambda of dry human skulls morphologically and morphometrically and determine its sexual dimorphism.
 Materials and Methods: 40 dry human skulls were collected from the department of Anatomy of Saveetha dental college and hospitals. By excluding abnormal and damaged skulls, 20 skulls were studied. Out of 20 skulls, 11 were male skulls and 9 were female skulls. On investigation, Pterion was classified into four types: Sphenoparietal, stellate, Epipteric and Frontotemporal. Asterion was classified into types: Type-1 and Type-2 based on the presence and absence of wormian bones respectively. Lamda was classified into two types: Normal and Abnormal. Statistical analysis was done by SPSS software. Paired Sample T test was used to analyse the data.
 Results: Percentage of occurrence of different types of pterion in males and females: Sphenoparietal (59.09 % of males and 59.09 % of females), Stellate (27.7% of males and 22.2% of females), Epipteric (99% of males and 16.6% of females) and Frontotemporal (45.5% of males and 5.5% of females). Different types of Asterion: Type-1 (13.63% of males and 16.66 % of females and Type -2 (86.63% of males and 83.33% of females). Different types of Lambda: Normal (90.9% of males and 94.4% of females), Abnormal (9% of males and 5.55% of females).
 Conclusion: In the present study, there was no correlation between the male and female skulls in the presence of Pterion, Asterion and Lambda. Therefore these cannot be used as reliable parameters for determining sexual dimorphism.

MORPHOMETRIC ANALYSIS OF LARGER OPENINGS OF THE GREATER WING OF THE HUMAN SPHENOID BONE

Analysis of the anatomical characteristics of openings in the greater wing of the sphenoid bone (round, oval and spinous opening - FR, FO and FS) has a clinical significance in surgical and diagnostic procedures. The aim of the study was to examine the morphological and morphometric characteristics of the round, oval and spinous openings in the human skulls. The research was conducted on 20 skulls housed at the Institute of Anatomy of the Faculty of Medicine in Nis. The skulls were numerated, and the openings were photographed against the ruler with a Canon A470 camera. Photo processing and morphometric analysis (measuring the length and width of the FR, FO and FS) were performed using ImageJ software. The average length of the FR on the right was 3.14 ± 0.77 mm and 3.44 ± 0.65 mm on the left, width on the right was 2.38 ± 0.58 mm, 2.61 ± 0.55 mm on the left; length of the FO on the right was 5.88 ± 0.88 mm, 5.50 ± 1.06 mm on the left, width on the right was 2.70 ± 0.58 mm, 2.82 ± 0.68 mm on the left; length of the FS on the right was 1.65 ± 0.27 mm, 1.73 ± 0.49 mm on the left, width on the right was 1.32 ± 0.32 mm, and 1.20 ± 0.39 mm on the left. The t-test of independent samples determined no statistically significant difference neither between the parameters on both sides, nor between the measured parameters of the same openings. A moderate positive correlation existed between FS length and width on the left, FR length and width on the right and between FS widths on both sides; a negligible positive correlation between the length and width of FO on the right and between lengths of the FS on both sides; a weak positive correlation existed between other measured parameters.

Management of Galassi type 3 Arachnoid cyst- A Case Report

Arachnoid cyst is a benign congenital lesion which can be located in various regions like; suprasellar, sylvian, posterior fossa, spine & so on. The most common location of arachnoid cyst is the middle fossa or sylvian fissure usually behind the greater wing of sphenoid bone (50%). Here we are presenting a case of a 59 year-old woman brought to the emergency department with history of sudden onset loss of consciousness associated with generalized tonic clonic seizure. CT-scanning of head showed Galassi type 3 arachnoid cyst. She was managed with fenestration and partial marsupialization of cyst with excellent outcome.

Unilateral congenital glaucoma may be the earliest presenting sign of orbitofacial neurofibromatosis and intracranial lesions: a case series

Purpose The aim was to report a number of cases initially presenting with unilateral congenital glaucoma within the first year of life that subsequently were found to be associated with the orbitofacial variant of neurofibromatosis-1 (NF1) as well as with variable intracranial lesions. Patients and methods The records of 340 patients presenting with unilateral congenital glaucoma were retrospectively reviewed to identify patients who subsequently developed orbitofacial NF ipsilateral to the glaucoma or other manifestations of NF1. All clinical, radiological, or histopathological data for enucleated globes, if available, were reviewed. Results Seven patients were identified with a mean age at presentation of 4.3±5.4 months. They presented with unilateral buphthalmos and high intraocular pressure with subtle proptosis and/or lid swelling. The mean age at NF1 diagnosis was 23.14±18.5 months. Initial imaging reports were either read as ‘normal’ or described a lesion near the cavernous sinus (CS): CS thrombosis, clival meningioma, histiocytosis, carotid cavernous fistula, or CS hemangioma. Once the diagnosis of NF1 was made, subsequent imaging studies (computed tomography and/or MRI) showed a defect at the greater wing of sphenoid bone (all patients); neurofibroma involving the CS, orbit, and nearby intracranial and subcutaneous structures to varying degrees (all patients); and hamartomas at the level of the basal ganglia (six patients). Associated intracranial lesions were sphenoid wing meningioma, optic nerve glioma, and trigeminal schwannoma. Histopathology of two enucleated eyes showed glaucomatous changes with prominent ciliochoroidal hyperplasia in one case and a ciliary body schwannoma in another. Conclusion In newborns with unilateral congenital glaucoma, the differential diagnosis should include NF1. Targeted radiologic examinations may reveal diagnostic signs and decrease disease morbidity. The glaucoma surgeon may opt for earlier aggressive intervention in this potentially blinding disease.

Случай двусторонних дефектов латеральных карманов клиновидной пазухи

Spontaneous defects of the lateral recess of the sphenoid sinus result from the incomplete junction of the greater wing of sphenoid bone with the basisphenoid. This anomaly is known as the lateral craniopharyngeal canal or Sternberg’s canal. However, the exact mechanisms of formation of the lateral recess defects are still under-explored and cause much controversy. The progressive erosion of the skull base in patients with high intracranial pressure and highly pneumatized sphenoid sinus may result in generation of defects through which the intracranial content penetrates. In this article, we present a rare case of the development of bilateral meningocele of the lateral recess of the sphenoid sinus with recurrent bilateral liquorrhea. A female patient P, 38 years old, visited our clinic with the complaints of clear nasal discharge from different halves of the nose when the head was bent forward. A computer cisternography showed that the patient had bilateral meningocele of the lateral recesses of the sphenoid sinus. The patient underwent the surgery of endoscopic endonasal plasty of complex skull base defects in the lateral recesses of the sphenoid sinus on the left and right under the control of the Medtronic fusion navigation system. There were no complaints in the postsurgical period, the patient was discharged on the 6th day after surgery.

English

Osteochondroma / osteocartilagenous exostosis is a cartilage-capped exophytic lesion that arises from the cortex of bone. It constitutes 20 - 50% of all benign tumours and 10 - 15% of all bone tumours, but it is actually a developmental lesion rather than a true neoplasm. An osteochondroma in the maxillo- facial region, however, is rare. In this anatomical area, the tumour is most often reported in association with the coronoid process. Osteochondroma of the mandibular condyle is rare and only 37 documented cases have so far been reported in the English language literature. I report a case of osteochondroma of the mandibular condyle and describe the characteristic OPG and CT features of this condition. INTRODUCTION: Osteochondroma (OC) of the mandibular condyle is a relatively rare condition that causes a progressive enlargement of the condyle, usually resulting in facial asymmetry, temporomandibular joint (TMJ) dysfunction, and malocclusion. Radiographically, there is a unilaterally enlarged condyle usually with an exophytic outgrowth of the tumor from the condylar head. I present a case of a left mandibular condylar OC that created a malocclusion, and TMJ Dysfunction. lesion was fairly well circumscribed with thin cortex. Left mandibular condyle was not seen separately. The patient was adviced CT scan for further evaluation. Saggital and coronal CT images revealed a large globular, mixed bone density condylar mass arising from left mandibular condyle (Figures 2 and 3). The lesion was extending superiorly into the articular fossa, but the cortical bone of the fossa was intact. The cortex of the tumor was continuous with that of the normal condylar bone. The pattern of the trabecular bone of the tumor blended with the intramedullary host bone. There was an evidence of pseudoarthosis formation with greater wing of sphenoid bone with thinning of greater wing. The lesion was reaching up to pterygoid process with compression and thinning of pterygoid process. Mandibular condyle was displaced laterally by the lesion. Tumor excision was performed. Histopathologic examination revealed a nodular lesion having cartilaginous cap and mature bone tissue beneath, consistent with osteochondroma. DISCUSSION: Osteochondroma is a benign tumour of the appendicular skeleton arising from the metaphyseal regions of long bones, most commonly seen in the second and third decade of life. Osteochondromas are not common in the mandibular condylar region. Review of the literature indicates that patients with these tumours present mainly in the fourth decade with mean age of 39.7 years and a male to female ratio of 1:1.5. Clinical findings associated with osteochondroma of

Treatment modalities in zygomatic complex fractures: A prospective short clinical study

Introduction: Zygomatic complex fractures or the tetrapod fractures are common to occur followed by the nasal bone fractures because of its prominent location. At the same time, it is difficult to obtain perfect reduction and contour postoperatively because of its complex involvement with four bones namely maxillary, temporal, orbital and greater wing of sphenoid bone. Various classifications have been put forward for better understanding and planning of treatment protocol. Aim: This study aims at comparing the following variables after reduction and fixation of fracture zygomatic complex; 1. Esthetics 2. Restoration of anatomical form 3. Occlusion 4. Function 5. Neurological deficits. Materials and Methods: Twenty patients were selected following a clinical and radiographic examination of fracture of the zygomatic complex. Reduction techniques used were Gillie's, Dingman's lateral eyebrow, and upper buccal sulcus approaches. Fixation was done at single-point or two-point or three-point protocol by transosseous wiring or miniplate osteosynthesis. Results: Among the twenty cases treated, all were males. Age distribution of the patients was between 20-60 years with a mean age of 39.5 years. There was facial asymmetry in four cases postoperatively and two among them did not follow postoperative instructions. Conclusions: Closed reduction namely Gillie's temporal approach was found to be the best reduction technique and the protocol of three point, miniplate fixation was effective in terms of stability and relapse.

The Foramen Ovale Morphometry of Sphenoid Bone in South Indian Population

The foramen ovale is an oval opening in the greater wing of sphenoid bone transmitting the mandibular nerve as its major content. It serves as an important landmark for neurosurgeons in certain procedures as to gain access to trigeminal nerve. Therefore, its topographic position in relation to adjacent bony landmarks provides useful tool during these procedures. To analyse the morphometric measurements of the foramen ovale among South Indian population. Morphometric analysis was carried out on 104 foramina ovalia of 52 dry human skulls from South India. Following dimensions of foramen ovale were measured: antero-posterior length, transverse width, distance (d(1)) from tubercle of root of zygoma to the centre of the foramen (CF) and distance (d(2)) from the midline of the base of the skull to CF. The mean antero-posterior length was 7.0±2.17mm on right side and 6.8±1.40mm on left side, mean transverse width was 5.0±0.42mm and 4.70±0.91mm on right and left side respectively. Mean d(1) was 32.58±1.72mm on right side and 32.75±1.76mm on left side. Mean d(2) was 25.83±1.26mm on right side and 25.08±1.31mm on left side. Regional variations in the morphometric measures may be useful in neurosurgical procedures like administration of anaesthesia involving the mandibular nerve.

Metastasis of greater wing of sphenoid bone in bronchogenic carcinoma: A unusual case report

Orbital metastasis in systemic cancer is known to occur and occurs in up to 7% of all systemic cancers. Orbital features typically present after the diagnosis of the primary tumor. In about 20% of cases, there is no known primary cancer at the time of presentation with orbital metastatic disease. Here we report a case of a 60-year-old male smoker, in whom proptosis, due to metastasis in greater wing of left sphenoid bone secondary to bronchogenic carcinoma, was the initial symptom. We could not find in literature metastasis to greater wing of sphenoid bone due to small cell carcinoma of lung.

Total Lateral Orbitotomy

Purpose: The goal of this study was to evaluate the safety and efficacy of performing a total lateral orbitotomy (TLO) to enhance the surgical exposure of the deep orbit.Materials and Methods: Ten orbits of five fresh-frozen cadaver heads were dissected to evaluate TLO surgical techniques. Through an eyelid approach, a bone flap extending from the supraorbital nerve to the infraorbital nerve was removed to enhance exposure to the orbital apex. The surgical exposure was further augmented by removing bone with the high-speed burr from the greater wing of sphenoid bone along the deep lateral wall. Anatomic landmarks that identified various compartments within the lateral wall and orbital roof were noted and measured. Five patients with posterior orbital tumors underwent TLO utilizing extended bone flaps and their surgical results and clinical outcomes were recorded.Results: The findings from this study demonstrate that the entire orbital rim from the supraorbital nerve to the infraorbital nerve may be removed without damaging critical neurovascular structures or creating a dural defect. Strategic removal of bone from the deep lateral wall can further enhance the exposure to the orbital apex. Five patients with deep orbital lesions underwent TLO with excellent surgical outcomes.Conclusions: By utilizing TLO techniques in a patient with a deep orbital lesion, the modern orbital surgeon can access the orbital apex safely and predictably through an eyelid approach.

Carotid cavernous fistula: a rare complication of facial trauma, surgeon should be careful

Carotid-cavernous fistula a rare complication of Maxillofacial trauma occurs especially due to fracture of greater wing of sphenoid bone. It is of a different type depending on the flow pattern, severity also follows the flow of blood from internal carotid artery to the cavernous sinus. It features gradual exopthalmos, decrease in vision, later death may ensue in case of high flow lesion. A timely diagnosis and proper referral to the Neurosurgeon and Interventional Radiologist can reduce the chances of cavernous sinus thrombosis. This paper presents two cases of facial trauma reported to our institution, later on diagnosed to be carotid cavernous fistula and their treatment. It also shows different type of CCF, etiology, diagnosis, and Maxillofacial surgeon's role in handling the facial trauma cases.

Orbital Langerhans Cell Histiocytosis in Adults

To report 3 patients with adult-onset orbital Langerhans cell histiocytosis (LCH). Retrospective interventional case reports. Three adult patients with orbital LCH. Case reports from 2 different clinics and review of the scientific literature. Clinical course and radiologic and histologic findings. Three healthy patients, aged 20 to 36 (mean, 27) years, presented with biopsy-proven unilateral orbital LCH. The initial presenting complaints were mainly orbital pain and headache with or without orbital swelling and minimal effect on ocular movements. There was radiologic evidence of disease centered on the greater wing of sphenoid bone in all cases. Biopsy via lateral canthotomy was performed with LCH confirmed based on histologic and immunohistochemical findings. There was no evidence of disease elsewhere on systemic investigations. One patient had curettage and intralesional corticosteroids, 1 patient had a craniotomy for more complete resection of the lesion, and the third patient was referred for radiotherapy. All patients achieved complete resolution of symptoms and signs. None of the patients demonstrated any evidence of distant or recurrent disease at follow-up. Orbital LCH in adults is a rare, usually unifocal, and relatively benign disease most commonly affecting the greater wing of sphenoid bone, where there is still active bone marrow in young adults. There is no consensus on cause or therapy, but our reported cases show that several treatment modalities are effective.

Primary Ewing‘s sarcoma of the greater wing of the sphenoid bone

Primary Ewing‘s sarcoma is an uncommon lethal tumour of the long bones and pelvic girdle mainly affecting children and young adults. An origin in the cranial bones is extremely rare. We report a unique case of primary involvement of the greater wing of sphenoid bone in a 16-year-old patient. Aggressive management using microsurgical resection, radiotherapy and chemotherapy was curative. Localized, primary Ewing‘s sarcoma of the cranial bones should be considered as a distinct clinicopathological entity with an extremely low rate of dural penetration and metastases, and with a relatively better prognosis as compared with those of long bones and pelvic girdle. In neurosurgical practice, primary Ewing‘s sarcoma of the cranial bones requires early aggressive management to achieve adequate long-term prognosis and cure.