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RESEARCH ARTICLE
Study of Foramen Vesalius and its Clinical Implications
Sisira
Padavala
1st yr BDS, Saveetha Dental College and
Hospitals, Saveetha University, Chennai
*Corresponding Author E-mail:
ABSTRACT:
Study of foramen Vesalius and its
clinical implications
Foramen
Vesalius also called as the emissary sphenoidal foramen is an inconstant
foramen located anteromedial to the foramen ovale opening near the scaphoid
fossa. An emissary vein passes through this foramen and communicates with the
cavernous sinus. The purpose of this study is to evaluate to evaluate the
incidence of the foramen Vesalius in dry human skulls
and to analysis its clinical significance. The study sample consists of 50 dry
human skulls available from the department of anatomy at Saveetha Dental
College and Hospitals .the incidence of foramen Vesalius will be noted.
Anatomical variations of foramen Vesalius can be explained due to developmental
reasons. The detailed anatomical structure is required in clinical situations
and surgery involving this foramen and the emissary veins passing through it.
KEY
WORDS: Turnover rate-pain-sexual
dimorphism-mandibular-age group-permanent canine.
INTRODUCTION:
There
are lots of Foramens in the base of the skull. They establish communications
between extracranial and intracranial structures through blood vessels and
nerves passing through the foramen. There are a few foramens in the skull
called emissaries because they allow the passage of emissary veins that carry
blood between internal and external structures of the skull [1]. One such
foramen at the base of the skull in the sphenoid bone called sphenoid emissary
foramen or ‘foramen Vesalius’ is unstable. It is situated anteromedial to
foramen ovale.This is an inconstant foramen that allows the passage of emissary
vein (vein and vesalius) the pterygoid plexus to
cavernous sinus. It opens below and lateral to the scaphoid fossa.It is not
always present on both sides of the sphenoid bone [1]. Numerous studies were
conducted to assess the importance of this foramen and promoting a better
understanding of the morphology of the structure and its importance in the
spread of infections from extracranial source intracranially and also in
neurosurgical technics.
Lang
reported that a small nerve (nervoulussphenoidalislateralis) may also pass
through the foramen into cavernous sinus [2].
MATERIALS AND
METHODS:
For
the present study 50 dry adult skulls were used. The skulls belong to the
Department of Anatomy at Saveetha Dental College and Hospitals. Each was
studied for the foramen of Vesalius on each side .Incidence of skulls with the anomaly, the anomaly unilaterally and bilaterally, in the
presence of the right and left sides was recorded.
RESULTS:
For
the present study 50 dry adult skulls were used. The skulls belong to the
Department of Anatomy at Saveetha Dental College and Hospitals. Each was
studied for the foramen of Vesalius on each side and recorded. On observation,
Foramen Vesalius was found on 1 side (Unilateral)(Right)
out of the 100 sides of 50 skulls. The incidence was 2%.
Observation of Foramen Vesalius on the
right side of this skull:
Various Skulls Observed:
DISCUSSION:
Sphenoid
bone is formed by presphenoid and postsphenoidcenters at 17 weeks and 14 weeks
respectively with an additional contribution from the orbitosphenoid and
alisphenoid centers at 16 weeks and 15 weeks respectively [2].Foramen Vesalius
represents the site of fusion between the alatemporalis, membrane bone and
medial cartilaginous. The importance of this foramen is that it allows the
passage of the vein of Vesalius which is an emissary vein. Emissary veins
connect the intracranial venous sinuses and the extracranial veins. They
potentially pass through the space between the pericranium and galea
aponeurotica. As the emissary vein passing through this foramen connects the
pterygoid venous plexus with cavernous sinus, the infected thrombus may reach
cavernous sinus [3].Emissary veins may convey the infected thrombus from the
exterior to the interior of the cranial cavity. Septic thrombosis may occur
through dissemination by septic embolism. Most commonly infection spreads to
the contralateral cavernous sinus through the circular sinus [4].
Trigeminal
neuralgia is characterized by peroxysms of shock pain which presents short
duration and is recurrent in the somato sensory distribution of one or more
branches of the trigeminal nerve. Compression of trigeminal nerve by a vascular
loop may be the cause of trigeminal neuralgia. For treatment of trigeminal
neuralgia the trans-ovale approach by rhizotomy associated to Fluoroscopy to
guide a needle puncture to the trigeminal impression is used [5].
The
needle is placed at the third branch of the trigeminal nerve while reaching the
foramen ovalewhile treating .The needle may faultily penetrate the sphenoidal
emissary foramen with the puncture of cavernous sinus. Proximity of the
sphenoidal emissary foramen to foramen ovale increases the likelihood of errors
in some techniques to treat trigeminal neuralgia. In fact the distance between
these two foramens is very less.
CONCLUSION:
The
emissary sphenoidal foramen is not constant and is noteworthy not only due to
its anatomical knowledge but also because of its presence in the region where
neurosurgical procedures are applied in addition to the presence of vein of
Vesalius passing through this foramen and its role in infection spreading.
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Rossi AC,Freire AR,Prado FB,Caria PHF,Botacin PR. Morphological
characteristics of Foramen of Vesalius and its relationship with clinical
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Gupta N, Ray B, Ghosh S. Anatomic characteristics of foramen Vesalius.
Kathmandu University Medical Journal (2005) Vol. 3, No. 2, Issue 10, 155-158.
3.
Hussain SahebShaik , Muralidhar P Shepur , S.D Desai, S.T Thomas, G F
Maavishettar, Haseena S. Study of foramen vesalius in South Indian skulls.
Indian Journal of Medicine and Healthcare Vol.1 No.1 Apr 2012.
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Implications”. Journal of Evidence Based Medicine and Healthcare; Volume1,
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Freire, A. R.; Rossi, A. C.; de Oliveira, V. C. S.; Prado, F. B.;
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31(1):287-292, 2013