Pterygospinous Bar Research Articles

COMPLETE AND INCOMPLETE BONY BRIDGES NEAR FORAMEN OVALE WITH POTENTIAL SURGICAL AND CLINICAL IMPLICATIONS

Objectives: Pterygospinous or Pterygoalar ligaments may pose mandibular nerve compression by when present near foramen ovale. The presence of ossified pterygospinous or pterygoalar ligaments might cause trouble to surgeons in performing percutaneous rhizotomy for trigeminal neuralgia, electroencephalographic procedures, or taking biopsy from cavernous sinus tumors. The present study aims to find the incidence and specific morphological variations related to the ossification of pterygospinous and pterygoalar ligaments. Methods: The study was conducted on 200 dried adult human cadaveric skull of unknown age and sex in the department of Anatomy, Mahatma Gandhi Medical College and Hospital, Jaipur. Skulls were obtained from different medical colleges of the Rajasthan region. The study included fully dried, intact, adult human skull bones with no structural defects. Damaged, fractured, skull with the developmental anomaly, injured or pathologically malformed skull especially at or near the foramen ovale on either side were excluded from the study. Ossification of pterygospinous and pterygoalar bar was studied on both sides. Statistical analyses were performed using SPSS Version 26 software. Results: Ossified ligaments were studied in 400 sides of 200 skulls. The ossification of pterygospinous bar was observed in 53 cases (13.25%). The pterygospinous bar was complete in twelve (3%) cases and incomplete in 41 cases (10.25%). The ossified pterygoalar ligament was observed in 62 cases (15.5%). Ossification was complete in 15 cases (3.75%) and incomplete in 47 cases (11.75%). Conclusion: Ossification of pterygospinous and pterygoalar bars was observed in skulls obtained from medical colleges in the Rajasthan region. Knowledge of such morphological variations of the skull base will improve the therapeutic outcomes in the treatment of trigeminal neuralgia.

Sphenoidal Foramen Ovale in the Slovenian Population: An Anatomical Evaluation with Clinical Correlations.

The foramen ovale (FO) is a crucial feature of the skull base, serving as a passage for clinically important neurovascular structures. The present study aimed to provide a comprehensive morphometric and morphologic analysis of the FO and highlight the clinical significance of the anatomical characterization. A total of 267 FO were analyzed in skulls obtained from deceased inhabitants of the Slovenian territory. The anteroposterior (length) and the transverse (width) diameters were measured using a digital sliding vernier caliper. Dimensions, shape, and anatomical variations of FO were analyzed. The mean length and width of the FO were 7.13 and 3.71 mm on the right side and 7.20 and 3.88 mm on the left side. The most frequently observed shape was oval (37.1%), followed by almond (28.1%), irregular (21.0%), D-shaped (4.5%), round (3.0%), pear-shaped (1.9%), kidney-shaped (1.5%), elongated (1.5%), triangular (0.7%), and slit-like (0.7%). In addition, marginal outgrowths (16.6%) and several anatomical variations were noted, including duplications, confluences, and obstruction due to a complete (5.6%) or incomplete (8.2%) pterygospinous bar. Our observations revealed substantial interindividual variation in the anatomical characteristics of the FO in the studied population, which could potentially impact the feasibility and safety of neurosurgical diagnostic and therapeutic procedures.

BILATERAL COMPLETE FORAMEN OF CIVININI ON ARTIFICIALLY DEFORMED SKULL

The study aimed to investigate the foramen of Civinini using craniological material. 75 skulls were examined, foramen of Civinini was found on one artificially deformed female skull (1.3%) from a catacomb burial, dated I-VII centuries AD. The study used cranioscopic and craniometric methods. Artificial deformation of the skull was classified according to Georg K. Neumann (1942) and was identified as parallelo-fronto-occipital, subtype-saddle-like depression. The skull was metopic; the metopic suture length was 111.11 mm. The initial segment of the metopic suture, 5.26 mm long, was weakly serrated. The Foramen of Civinini was complete and bilateral. The length of the left foramen of Civinini was 3.77 mm, the width was 3.48 mm. The foramen spinosum was absent on the left side; in the basal norm, the pterygospinous bar divided the foramen ovale into two parts, as it were. The length of the right foramen of Civinini was 4.14 mm, the width was 6.19 mm, in other words, the size of the foramen was larger than that of the left one. As on the left side, the pterygospinous bar divided the foramen ovale into two parts in the basal norm.

The Incidence of Atlanto-Occipitalization and Additional Foramina Present in The Dry Skulls of Nepalese Population

Introduction: Atlanto-occipitalization(AOZ) is one of the congenital anomalies related to craniovertebral synostosis. The clear understanding of its anatomical features and cranial foraminal variants plays a critical role in finding the possible coping mechanism with its pathogenesis such as segmental instability or neurologic deficits.
 Objective: This study aimed to investigate the incidence of occipitalization of Atlas and related variant foramina, as the baseline awareness of these conditions among the Nepalese population is yet to be documented.
 Methodology: A retrospective study was performed for the total 86 dry skulls available in the department of Anatomy in Katmandu University of Medical Sciences, Institute of Medical Science, and B.P. Koirala Institute of Health Sciences. The skulls were examined thoroughly to evidence the occurrence of cranio-vertebral variations.
 Result: Out of 86 human adult skulls, 2 cases (2.32 %) were found with partial AOZ presenting posterior spina bifida close to the midline. Sphenoidal emissary foramen (SEF) was also observed in 17 skulls (19.76 %), an additional foramen lying anteromedial to the foramen ovale. Moreover, one of the skulls (1.16 %) was found with the presence of pterygospinous bar creating an additional foramen ‘foramen of Civinini’ in the lateral pterygoid plate of the sphenoid bone.
 Conclusion: The incidence of AOZ and pterygospinous bar seems to be quite low as compared to the cases of SEF. However, the knowledge of such variations and the presence of additional foramina carry great significance for orthopedists and neurosurgeons to have prognostic implications and an accurate surgical approach.

Ossified Ligament at the base of Adult Human Dry Skull in North Indian Population: Pterygospinous and Pterygoalar Bar and Foramina

Background Ossification of ligaments at base of skull is not uncommon. The pterygospinous ligament (Civinini's ligament) is formed by pterygoid fascia which runs between the posterior margin of the lateral plate of pterygoid process and angular spine of undersurface of greater wing of the sphenoid. Ossification of this ligament forms a bony bridge (Civinini's bar) that connects spine of sphenoid with inferior surface of the greater wing, to create the pterygospinous foramen (Civinini's foramen). Pterygo alar ligament (Hyrtl-Calori's ligament) is a thin bundle of dense connective tissue extending from the root of lateral plate of the pterygoid process to infratemporal surface of the greater wing. Ossification of this ligament results in the appearance of a bony bridge, called the pterygoalar bar, which occasionally forms a pterygo alar foramen (porus crotaphitico-buccinatorius). The purpose of this study is to calculate the incidence of ossification of these ligaments and assess morphometrically the pterygospinous and pterygo alar bar and foramina. The knowledge of variations in the anatomy of the pterygospinous bar is important for clinical procedures done by anesthetists, dentists and maxillo-facial surgeons. Objective To study the incidence and morphometry of Pterygospinous(PS) and Pterygo alar (PA) bar and resultant accessory foramina at the base of adult human dry skulls in the North Indian population. Method We studied 94 sides of 47 adult human dry skulls of unknown sex for presence of pterygospinous and pterygo alar bar and foramen on both sides. These skulls were studied for incidence, location, degree of ossification and relation of bar with foramen ovale and foramen spinosum. All the measurements were made using digital Vernier calipers. Result 2 of 94 sides (2.12 %) showed the presence of completely ossified PS bar on both sides along with presence of PS foramen on both sides. In 1 of 94 sides we identified the presence of PA bar and foramen (1.06%). The mean length and width of the PS bar on the right side was 11.23 mm and 1.59 mm and on the left side was 9.15 mm and 2.20 mm respectively. The PS foramen were infero- medial to foramen ovale on both the sides of the skull and its mean horizontal and vertical diameter was calculated to be 7.12 mm and 4.06 mm respectively on the right side and 12.18 mm and 8.31 mm respectively on the left side. The PA bar had a mean length and width of 1.82 mm, 3.60 mm respectively. Position of the Foramen spinosum(FS) was lateral in respect to the PS bar on the right side while on the left side it was lying medial to it. Conclusion We conclude that the incidence of PS bar was 2.12 % amongst the 94 sides of skulls we studied and for PA was 1.06 %. A Korean study observed 1.4 % completely ossified PS ligament in 51 sides of the skulls. Completely Ossified PA ligament was 2.8 % in 24 sides of skull. In our study we observed the Position of FS in respect to PS bar has not been mentioned by many of the literatures with the same study conducted in different regions.

Incidence and clinical relevance of pterygospinous bar and pterygoalar bridges in dry human skulls

Incidence and clinical relevance of pterygospinous bar and pterygoalar bridges in dry human skulls

Analysis of Clinical Significance of the Pterygospinous and Pterygoalar Bars.

Presence of ossified structures at the skull base near the sphenoid bone in the infra temporal fossa are clinically significant. We studied the incidence of pterygospinous bar (PSB) and pterygoalar bar (PAB) in 140 dried human skulls. The incidence of pterygospinous bar was 22% and pterygoalar bar was 11%. An unusual large pterygspinous foramen was present in one of the skulls on the left side. Clinical significance of these bars are reviewed.

Study of Pterygospinous and Pterygoalar Bars in Relation to Foramen Ovale in Dry Human Skulls

Abstract Background Anatomical knowledge of bony bridges around the foramen ovale may be helpful for diagnostic and invasive neurosurgical procedures like electroencephalogram analysis, trigeminal rhizotomy, biopsy of cavernous sinus tumors, and mandibular nerve block.Lateral pterygoid plate forms an important landmark for mandibular anesthesia; therefore, any variation related to lateral pterygoid plate is likely to create confusion during the maneuver of anesthesia. Aims and Objective The aim of the study was to explore any bony obstacle within and around Foramen ovale. Obstacles in form of ossified complete or incomplete ligaments. Additional foramina formed by ligaments or any bony enlargement might disturb the structures passing through the Foramen ovale. Methods Around 530 dried crania (from medical colleges in Uttarakhand and Uttar Pradesh) were observed to find ossified ligaments and foramen formed by them. Crania associated with bilateral enlarged lateral pterygoid plate other than the average width of 1.5 cm were included in this study. Length of ligaments and width of pterygoid plate were measured by digital Vernier calipers. Results Out of 530 crania, unilateral 52 ossified pterygospinous ligament (incomplete 31 and complete 21) were observed. Among them some rare variation was found along with ossified pterygospinous and pterygoalar ligament, one cranium along with unilateral pterygospinous bar was also having bar within foramen ovale, forming an accessory osseous compartment, found to be rare kind of variation. Another unilateral complete pterygospinous bar was enclosing two foramens instead of one. Only single cranium was found to have pterygoalar bar, related medial to foramen ovale. One cranium was associated with bilateral enlarged lateral pterygoid plate (i.e., 2.5 cm) was also found to be obliterating the space, that is, retropharyngeal and parapharyngeal space for surgeons. Conclusion This study would provide the anatomical knowledge of these bony bridges around the foramen ovale and may be helpful for diagnostic and neurosurgical procedure like microvascular decompression by percutaneous trigeminal rhizotomy for trigeminal neuralgia, percuatneous biopsy of cavernous sinus tumor and mandibular nerve block by lateral subzygomatic route. Thus, lateral pterygoid plate forms an important landmark for mandibular anesthesia.

An anatomical study of the pterygospinous bar and foramen of Civinini.

The pterygospinous ligament extends from the posterior free margin of the lateral pterygoid plate till the spine of the sphenoid. The ligament may ossify partly or completely leading to the formation of the pterygospinous bar. A complete ossification of the ligament results in the formation of the foramen of Civinini. Presence of the complete or incomplete pterygospinous bar may lead to a difficulty in passing the needle during anaesthesia for the trigeminal neuralgia or the bar may also compress the mandibular nerve and its branches to cause lingual numbness, pain and speech impairment. Presence of the complete or incomplete pterygospinous bar and the foramen of Civinini were studied in 55 dried adult skulls and 20 sphenoid bones. Partial or complete ossification of the pterygospinous ligament was seen in 17.33% skulls. One skull showed the presence of bilateral complete pterygospinous bar while another skull had the unilateral complete pterygospinous bar on right side. Two skulls and one sphenoid had bilateral incomplete pterygospinous bar while seven skulls and one sphenoid bone had unilateral incomplete pterygospinous bar. In three cases, the bar was passing just below the foramen ovale. The pterygospinous bar when present medial to the foramen ovale may not have much clinical significance but when the bar is present just below the foramen ovale, it may cause a compression of the mandibular nerve and its branches and may also obstruct the passage for the transoval approach to the neighbouring regions.

An Anatomical Study of Occurrence of Pterygospinous Bar in Indian Skulls

Background: Pterygospinous ligament is present at the base of the skull that may sometimes get ossified to form bony bars that are related to the foramen ovale. Aim: This study aims at finding the prevalence of pterygospinous bar among Indian skulls present in Saveetha Dental College. Method: The study was done in 40 adult human dry skulls from. The skulls were checked for the presence of pterygospinous bar and was analysed for the problems it might cause due to its presence. Result: Among 40 skulls, pterygospinous bar is present only among 3 skulls which is 8% of the skulls. Conclusion: Pterygospinous bar is present only in a small fraction of skulls. The foramen ovale is related to it and its presence may lead to the compression of the contents passing through the foramen.

Pterygospinous Bar and Foramen in the Adult Human Skulls of North India: Its Incidence and Clinical Relevance

Study of skulls has attracted the attention of anatomists since ages and sporadic attempts have been made to study skulls from time to time. Talking about the pterygoid processes of sphenoid bone, the irregular posterior border of lateral pterygoid plate usually presents, towards its upper part, a pterygospinous process, from which the pterygospinous ligament extends backwards and laterally to the spine of sphenoid. This ligament sometimes gets ossified as pterygospinous bar and a foramen is then formed, named pterygospinous foramen, for the passage of muscular branches of mandibular nerve. The present study was undertaken to observe the incidence and status of pterygospinous bony bridge and foramen, its variations, and clinical relevance in the adult human skulls of North India. For this purpose, 500 skulls were observed, belonging to the Anthropology Museum of Department of Anatomy, GSVM Medical College, Kanpur. Pterygospinous bars were found to be present in 51 skulls (10.2%), out of which completely ossified pterygospinous bony bridges were present in 20 skulls (4%) while 31 skulls (6.2%) had incompletely ossified pterygospinous ligaments. Such variations are of clinical significance for radiologists, neurologists, maxillofacial and dental surgeons, and anaesthetists, too.

Anatomical Study of Pterygospinous and Pterygoalar Bar in Human Skulls with their Phylogeny and Clinical Significance.

Pterygospinous and pterygoalar ligaments present at the cranial base may sometimes get ossified leading to the formation of complete or incomplete bony bars in relation to foramen ovale. These are of clinical importance because these may obliterate the foramen ovale causing mandibular neuralgia. They may cause trouble in performing thermocoagulation and anaesthesia for trigeminal neuralgia. They may pose surgical difficulty in approaching the retro and parapharyngeal spaces and hence the anatomy of these bony bars is very important. The present study was conducted in 100 dry human skulls of unknown sex to know the incidence, side, degree of ossification (complete/ incomplete) and relation of the pterygospinous and pterygoalar bars to the foramen ovale. Pterygospinous and pterygoalar bars were seen in 41 skulls which were classified into Type I (26.83%), Type II (58.54%) and Type III (14.63%) based on the presence of pterygospinous bar, pterygoalar bar or both together. Pterygospinous bars were seen in 17 skulls of which, one skull (5.88%) had complete and 16 skulls (94.12%) showed incomplete bars. Out of the 30 skulls with pterygoalar bars, complete bar was seen in one (3.33%) and incomplete in 29 skulls (96.67%). These bars were seen more on the left side of the skull than on the right. They were in close relation to the foramen ovale; the pterygospinous bar was inferior or medial to foramen ovale and pterygoalar bar was lateral, inferior or medial to the foramen ovale. The presence of the pterygospinous and pterygoalar bars cause variety of symptoms due to neurovascular entrapment and also obstruct surgical approaches to the base of skull. Hence the anatomical knowledge of these osseous bars is essential for anaesthetists, radiologists, dentists and neurosurgeons to increase the success of diagnostic evaluation and surgical approaches to the cranial base.

Civinini bar: incidence in North Indians and its clinical relevance

Abstract Background and aim: Ossified pterygospinous ligament is a major cause of the entrapment of the lingual nerve or a branch of the mandibular nerve and may cause mandibular neuralgia. It can also constitute an obstacle for the mandibular nerve block which is a preferred method for pain relief especially for the fractures of mandible or cancer patients. Systematic study of these bars in North Indian population is lacking. Therefore this study was carried out to see the incidence of ossified pterygospinous bars in North Indian population. Materials and methods : The present study was an attempt to find out the occurrence of ossified pterygospinous ligament (Civinini's bar) in 116 dried skulls of unknown sex were taken and the presence of ossified pterygospinous bar was noted. Results : It was observed that the ossified pterygospinous bars which is present between pterygospinous process of lateral pterygoid plate and spine of sphenoid also called as Civinini's bar can be divided into five types (Types I, II, III, IV, V). This bar encloses a foramen called as Civinini's foramen. A total incidence of 18.10% of various types of pterygospinous bars was observed, out of which 1.72% were Type I, 8.62%Type II, 3.45%Type III, 0% Type IV and 4.31 % were of Type V variety. Conclusion : Total prevalence of Civinini bar is 18.10% in North Indian population.The clinicians working on this area should be aware of this variation as its prevalence is quite high.

Foramen of civinini: a new anatomical guide for maxillofacial surgeons.

Study on Morphometric and radiological aspect on existence of foramen of civinini. Sphenoid bone comprises of some rare ossified ligaments, may encounter difficulty in surgical procedures. Incidence of Pterygospinous bars various with different racial groups and they are genetically controlled. Complete ossification of pterygospinous ligament form foramen of civinini. Entrapments of vessels or nerves may occur due to existence of pterygospinous bar. The bar may locate medially or inferiorly to formen ovale as seen in Hawaiian and lemurs. Co - existence of bar with the wide lateral pterygoid plate exhibits development of the bar from herbivore, carnivore and old world monkeys. Comparatively absence or small spine of civinini noted in new world monkeys, rodents and platyrrhines. Pterygospinousbar represents the phylogenetic remnant of Human beings. By using digital vernier caliper, the measurements of length, width of the pterygospinous bar and area of foramen of civinini including the length and breadth of lateral pterygoid plate were measured. Using X rays the radiological view was determined. In this study from 160 cases of skull and sphenoid bones revealed that complete and incomplete foramen of civinini in 1.25% and 7.5% of cases respectively. Peculiarly accessory foramen of civinini noticed in 1.25% of cases. Maximum area of foramen of civinini was 94.2mm(2). The maximum width of lateral pterygoid was noted as 19.6mm respectively. Mentocoronal view of skiagram clearly shows the bar. During Anaesthesia for trigeminal neuralgia may encounter difficult to pass the needle. The bar compress the mandibular nerve branches can cause lingual numbness, pain and speech impairment. Conductive anaesthesia on the mandibular nerve through the lateral subzygomatic route may be difficult to approach. Exploring the anatomical and clinical updates of pterygospinous bar may guide the surgeons and radiologists to overcome any difficulties in infratemporal and para or retropharyngeal regions.

Pterygospinous bar and foramina in Indian skulls: incidence and phylogenetic significance

Incomplete or complete ossification of the pterygospinous ligament is uncommon. Entrapment of mandibular nerve and its branches was reported due to this anatomical variation, when found. The aim of the present study is to investigate the incidence of the pterygospinous bony bridges in Indian dry skulls. A total of 416 adult dry skulls of Indian origin were studied. In 9.61% of the samples the pterygospinous bony bars were found, out of which 5.76% was complete and 3.84% was incomplete. Such variations are of clinical significance while dealing with mandibular nerve and its branches and various clinical symptoms related to it.

The pterygospinous bar in panoramic roentgenography

The pterygospinous bar in panoramic roentgenography