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

Authors

  • RITUBHI MEHTA Department of Anatomy, Mahatma Gandhi Medical College and Hospital, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, Rajasthan, India. https://orcid.org/0009-0005-6292-9071
  • JAGMOHAN SHARMA Department of Anatomy, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
  • PANKAJ KUMAR SINGH Department of Anatomy, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
  • PRABHJOT KAUR CHHABRA Department of Anatomy, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India https://orcid.org/0009-0006-3951-8191

DOI:

https://doi.org/10.22159/ajpcr.2024.v17i5.50142

Keywords:

Foramen ovale, Pterygoalar bar, Pterygospinous bar, Trigeminal neuralgia

Abstract

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.

Downloads

Download data is not yet available.

References

Natsis K, Piagkou M, Skotsimara G, Totlis T, Apostolidis S, Panagiotopoulos NA, et al. The ossified pterygoalar ligament: An anatomical study with pathological and surgical implications. J Craniomaxillofac Surg. 2014 Jul 1;42(5):e266-70. doi: 10.1016/j. jcms.2013.10.003, PMID 24290255

Coussens AK, Wilkinson CR, Hughes IP, Morris CP, van Daal A, Anderson PJ, et al. Unravelling the molecular control of calvarial suture fusion in children with craniosynostosis. BMC Genomics. 2007 Dec 12;8(1):458. doi: 10.1186/1471-2164-8-458, PMID 18076769

Tubbs RS. Anatomy, Imaging and Surgery of the Intracranial Dural Venous Sinuses. Netherlands: Elsevier Health Sciences; 2019. p. 251.

Piagkou M, Demesticha T, Piagkos G, Georgios A, Panagiotis S. Lingual nerve entrapment in muscular and osseous structures. Int J Oral Sci. 2010 Dec;2(4):181-9. doi: 10.4248/IJOS10063, PMID 21404967

Kavitha Kamath B, Vasantha K. Anatomical study of pterygospinous and pterygoalar bar in human skulls with their phylogeny and clinical significance. J Clin Diagn Res. 2014;8(9):AC10-3. doi: 10.7860/ JCDR/2014/9326.4888, PMID 25386415

Pearce JM. Henry Gray’s anatomy. Clin Anat. 2009;22(3):291-5. doi: 10.1002/ca.20775, PMID 19280653

Saran RS, Ananthi KS, Subramaniam A, Balaji MT, Vinaitha D, Vaithianathan G. Foramen of civinini: A new anatomical guide for maxillofacial surgeons. J Clin Diagn Res. 2013 Jul;7(7):1271-5. doi: 10.7860/JCDR/2013/5100.3115, PMID 23998043

Rosa RR, Faig-Leite H, Faig-Leite FS, Moraes LC, Moraes ME, Filho EM. Radiographic study of ossification of the pterygospinous and pterygoalar ligaments by the Hirtz axial technique. Acta Odontol Latinoam. 2010;23(1):63-7. PMID 20645646

Das S, Paul S. Ossified pterygospinous ligament and its clinical implications. Bratisl Lek Listy. 2007;108(3):141-3. PMID 17682541

Kapur E, Dilberović F, Redzepagić S, Berhamović E. Variation in the lateral plate of the pterygoid process and the lateral subzygomatic approach to the mandibular nerve. Med Arh. 2000;54(3):133-7. PMID 11117007

Antonopoulou M, Piagou M, Anagnostopoulou S. An anatomical study of the pterygospinous and pterygoalar bars and foramina - their clinical relevance. J Craniomaxillofac Surg. 2008;36(2):104-8. doi: 10.1016/j. jcms.2007.05.009, PMID 18280174

Yadav A, Kumar V, Niranjan R. Pterygospinous bar and foramen in the adult human skulls of North India: Its incidence and clinical relevance. Anat Res Int. 2014;2014:286794. doi: 10.1155/2014/286794, PMID 24963408

von Lüdinghausen M, Kageyama I, Miura M, Alkhatib M. Morphological peculiarities of the deep infratemporal fossa in advanced age. Surg Radiol Anat. 2006;28(3):284-92. doi: 10.1007/s00276-006- 0078-z, PMID 16470343

Chakravarthi K, Babu K. An anatomical study of the pterygo-alar bar and porus crotaphitico buccinatorius. Int J Health Sci. 2012;1(3):3-9. 15. Jansirani DD, Mugunthan N, Anbalagan J, Sudha Rao SS. A study on ossified pterygospinous and pterygoalar ligaments in Indian skulls. Natl J Basic Med Sci. 2012;3(2):103-8.

Chakravarthi K, Nelluri V, Gandrakota R. Abnormal bone outgrowths and osseous structures around the foramen ovale may leads to mandibular compression or entrapment neuropathy. Int J Bioassays. 2013;2:922-5.

Suazo GI, Zavando MD, Smith RL. Anatomical study of the pterygospinous and pterygoalar bony bridges and foramens in dried crania and its clinical relevance. Int J Morphol. 2010;28(2):405-8.

Verma RK, Rani A, Rani A, Chopra J, Pankaj AK, Kumar N, et al. Civinini bar: Incidence in North Indians and its clinical relevance. Natl J Clin Anat. 2013;2(3):128.

Skrzat J, Walocha J, Srodek R. An anatomical study of the pterygoalar bar and the pterygoalar foramen. Folia Morphol (Warsz). 2005;64(2):92-6. PMID 16121326

Rossi AC, Freire AR, Manoel C, Prado FB, Botacin PR, Caria PH. Incidence of the ossified pterygoalar ligamentin Brazilian human skulls and its clinical implications. Braz J Morphol Sci. 2011;28:69-71.

Peker T, Karaköse M, Anil A, Turgut HB, Gülekon N. The incidence of basal sphenoid bony bridges in dried crania and cadavers: Their anthropological and clinical relevance. Eur J Morphol. 2002;40(3):171-80. doi: 10.1076/ejom.40.3.171.16686, PMID 14566610

Shinde VS, Mallikarjun M, Patil R. A study on an ossified pterygospinous ligament. J Clin Diagn Res. 2011;5(5):978-9.

Singh AK, Niranjan R. Study of pterygospinous and pterygoalar bars in relation to foramen ovale in dry human skulls. Natl J Clin Anat. 2019;8(3):97-100. doi: 10.1055/s-0039-1698602

Erdogmus S, Pinar Y, Celik S. A cause of entrapment of the lingual nerve: Ossified pterygospinous ligament - a case report. Neuroanatomy. 2009;8:43-5.

Daimi SR, Siddiqui AU, Gill SS. Analysis of foramen ovale with special emphasis on pterygoalar bar and pterygoalar foramen. Folia Morphol (Warsz). 2011;70(3):149-53. PMID 21866524

Patnaik VV, Singla RK, Bala S. Bilateral pterygo-alar bar and porus crotaphitico buccinatorius: A case report. J Anat Soc India. 2001;50(2):161-2.

Shang Q, Lin F, Mu Q, Tan S, Wang H, Gao Y. Successful percutaneous cannulation of foramen ovale obstructed by completely ossified pterygoalar ligament using the Hartel approach: Two case reports. Med (Baltimore). 2023;102(25):e34102. doi: 10.1097/ MD.0000000000034102, PMID 37352068

Nayak SR, Saralaya V, Prabhu LV, Pai MM, Vadgaonkar R, D’Costa S. Pterygospinous bar and foramina in Indian skulls: Incidence and phylogenetic significance. Surg Radiol Anat. 2007;29(1):5-7. doi: 10.1007/s00276-006-0154-4, PMID 17164987

Tubbs RS, May WR, Apaydin N, Shoja MM, Shokouhi G, Loukas M, et al. Ossification of ligaments near the foramen ovale: An anatomic study with potential clinical significance regarding transcutaneous approaches to the skull base. Neurosurgery. 2009;65(6 Suppl):60-4.; discussion 64. doi: 10.1227/01.NEU.0000345952.64041.9C, PMID 19935003

Aggarwal B, Gupta M, Kumar H. Ossified ligaments of the skull. J Anat Soc India. 2012 Jun 1;61(1):37-40. doi: 10.1016/S0003- 2778(12)80010-4

Ebenraj TJ, Vishali N. Pterygospinous bar and multiple Civinini foramen- a rare anatomical variant and its clinical implications. Int J Curr Res Rev. 2014;6(10):126-33.

Goyal N, Jain A. An anatomical study of pterygoalar bar and its clinical relevance. CHRISMED J Health Res. 2015;2(4):333-6. doi: 10.4103/2348-3334.165744

Vaishali N, Ebenraj J, Rajathi G, Charanya N. Anatomical analysis of the abnormal bone outgrowth swith special emphasis on pterygoalar bar and ITSCROTAPH-ITICO buccinatorius foramen. Int J Anat Res;6(1.2):4963-7.

Kirwale VS, Sukre SB. Study of anatomical variations of foramen ovale and pterygoalar bar with it’s clinical significance. MIJOANT. 2020;14(1):1-5. doi: 10.26611/10011411

Sadashiv R, Managutti S, Kulkarni V, Kulkarni AV, Dixit U. Morphological measurements of innominate foramina and bony spurs along the base of sphenoid as a potential risk factor for neurovascular entrapment, radiological interpretation and surgical access. Malays J Med Sci. 2023;30(2):90-5. doi: 10.21315/mjms2023.30.2.8, PMID 37102056

Published

07-05-2024

How to Cite

MEHTA, R., J. SHARMA, P. K. SINGH, and P. K. CHHABRA. “COMPLETE AND INCOMPLETE BONY BRIDGES NEAR FORAMEN OVALE WITH POTENTIAL SURGICAL AND CLINICAL IMPLICATIONS”. Asian Journal of Pharmaceutical and Clinical Research, vol. 17, no. 5, May 2024, pp. 109-13, doi:10.22159/ajpcr.2024.v17i5.50142.

Issue

Section

Original Article(s)