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Dissertation on
MORPHOLOGICAL AND MORPHOMETRIC STUDY OF
FORAMEN OVALE AND FORAMEN SPINOSUM IN
ADULT HUMAN DRY SKULLS
Submitted in partial fulfillment for
M.D. DEGREE EXAMINATION
BRANCH- XXIII, ANATOMY
Upgraded Institute of Anatomy
Madras Medical College and Rajiv Gandhi Government General
Hospital,
Chennai - 600 003
THE TAMILNADU Dr.M.G.R. MEDICAL UNIVERSITY
CHENNAI – 600 032
TAMILNADU
MAY-2018
CERTIFICATE
This is to certify that this dissertation entitled “MORPHOLOGICAL
AND MORPHOMETRIC STUDY OF FORAMEN OVALE AND
FORAMEN SPINOSUM IN ADULT HUMAN DRY SKULLS” is a bonafide
record of the research work done by Dr.M.K.PUNITHA RANI, Post graduate
student in the Institute of Anatomy, Madras Medical College and Rajiv Gandhi
Government General Hospital, Chennai-03, in partial fulfillment of the
regulations laid down by The Tamil Nadu Dr.M.G.R. Medical University for the
award of M.D. Degree Branch XXIII-Anatomy, under my guidance and
supervision during the academic year from 2015-2018.
The Dean, Madras Medical College & Rajiv Gandhi Govt. General Hospital, Chennai Chennai – 600003.
Dr. Sudha Seshayyan, M.B.B.S., M.S., Director & Professor, Institute of Anatomy, Madras Medical College, Chennai– 600 003.
ACKNOWLEDGEMENT
I wish to express exquisite thankfulness and gratitude to my most
respected teachers, guide, Dr. Sudha Seshayyan, M.S., Director and
Professor, Institute of Anatomy, Madras Medical College, Chennai – 3, for
their invaluable guidance, persistent support and quest for perfection which
has made this dissertation take its present shape.
I am thankful to Dr. R. Narayana Babu, M.D., DCH, Dean, Madras
Medical College, Chennai – 3 for permitting me to avail the facilities in this
college for performing this study.
My heartfelt thanks to Dr. B. Chezhian, Dr.V.Lokanayaki and
Dr.B.Santhi, Associate Professors, Dr.V.Lakshmi, Dr.T.Anitha,
Dr.P.Kanagavalli, Dr.J.Sreevidya, Dr.Elamathi Bose, Dr.S.Arrchana,
Dr.B.J.Bhuvaneshwari, Dr. E. Mohana Priya, Dr.S.Keerthi, Dr.P.R
Prefulla Assistant Professors, Institute of Anatomy, Madras Medical
College, Chennai – 3 for their valuable suggestions and encouragement
throughout the study.
I earnestly thank my seniors, Dr. V. Srinivasan, Dr.K.Suganya
Dr.S.Saravanan and Dr.G.Gohila who have been supportive and
encouraging throughout the study.
I extend my heartfelt thanks to my colleagues, Dr.N.Bama,
Dr. K. Lavanya Devi, Dr. S.Valli and junior post graduate students for
their constant encouragement and unstinted co-operation.
I am especially thankful to Mr.R.A.C.Mathews and
Mr. E.Senthilkumar, technicians, who extended great support for this
study and all other staff members including Mr.Jagadeesan, Mr.Maneesh
Mr.Narasimhalu and Mr. Devaraj for helping me to carry out the study.
I thank my parents, Dr. M.Krishnamurthi & Mrs.M.P.Neela , my
parents in law, Dr.P.S.Subramaniam & Dr. A.Rajagowri who have
showered their choicest blessings on me and supported me in my every step.
I am grateful beyond words to my husband Dr.S.Rajanand , my
daughter R. Renuka and my sister M.K. Hemalatha who in all possible
ways supported me in making this study a reality.
Above all, I thank the Almighty, who has showered his blessings on
me and helped me complete this study successfully.
PLAGIARISM CERIFICATE
This is to certify that this dissertation work titled
“MORPHOLOGICAL AND MORPHOMETRIC STUDY OF FORAMEN
OVALE AND FORAMEN SPINOSUM IN ADULT HUMAN DRY
SKULLS” of the candidate Dr.M.K.PUNITHA RANI with registration
Number 201533003 for the award of M.D ANATOMY in the branch of
XXIII. I personally verified the urkund.com website for the purpose of
plagiarism Check. I found that the uploaded thesis file contains from
introduction to conclusion pages and result shows 1 percentage of
plagiarism in the dissertation.
Guide & Supervisor sign with Seal.
LEGEND
FO - Foramen ovale
APD - Anteroposterior diameter
MLD - Mediolateral Diameter
FS - Foramen spinosum
FV - Foramen Vesalius
MMA - Middle meningeal artery
“p” value - Probability of observing the difference by chance
S.D - Standard deviation
CONTENTS
SL. NO TITLE PAGE
NO
1. INTRODUCTION 1
2. AIM OF THE STUDY 5
3. REVIEW OF LITERATURE 8
4. EMBRYOLOGY 38
5. MATERIALS AND METHODS 41
6. OBSERVATION 44
7. DISCUSSION 61
8. CONCLUSION 85
9. BIBLIOGRAPHY 88
Introduction
1
INTRODUCTION
The inferior surface of the skull, the base of the cranium (basis cranii
externa, norma basilaris) is complex: which extends from upper incisor teeth
anteriorly to the superior nuchal lines of the occipital bone posteriorly.62 Base of
the skull are pierced by numerous foraminae for the passage of vessels and nerves.
Knowledge about the foraminae in the base of the skull is of utmost
importance considering the delicate neurovascular structures that traverse
through their narrow terrain.
Foramen Ovale and Foramen spinosum are two important foraminae
present in the infra temporal surface of the greater wing of the sphenoid bone.
Foramen ovale lies close to the upper end of posterior margin of lateral pterygoid
plate. It is located medial to the Foramen spinosum and lateral to the Foramen
lacerum on the infra temporal surface of the greater wing of sphenoid bone.
(Fig-1)
Formen ovale is typically oval in shape and the neurovascular structures
transmitted through this foramen are
Mandibular division of the trigeminal nerve
Lesser petrosal nerve
Accessory meningeal branch of Maxillary artery
2
An emissary vein which connects the pterygoid venous plexus present in
the infratemporal fossa to the cavernous sinus.
In the infratemporal surface of the greater wing of sphenoid, anteromedial
to the spine of sphenoid is the small Foramen spinosum. The angle of the greater
wing of sphenoid bone can be recognized from the presence of spine of sphenoid
on it.16 The spine of the sphenoid is related laterally to auriculotemporal nerve and
medially to chorda tympani nerve.46
Foramen spinosum is round in shape and transmits the middle meningeal
artery and a recurrent meningeal branch of the mandibular nerve (nervus
spinosus).
Foramen of Vesalius (Spheniodal Emissary Foramen) is an inconstant
foramen located anteromedial to foramen ovale and lateral to the scaphoid fossa in
the base of skull.(fig-2) When present, it transmit emissary vein communicating
pterygoid venous plexus in the infratemporal fossa to the cavernous sinus in the
middle cranial fossa10. The importance of the foramen is that it offers a pathway
for the spread of infection from an extracranial source to cavernous sinus that
leads to cavernous sinus thrombosis.
Canaliculus innominatus (Canal of Arnold) is a tiny inconstant foramen
situated between Foramen ovale and Foramen spinosum. If present, it transmit
lesser petrosal nerve instead of Foramen ovale33.
3
Fig 1 : Base of the skull
FORAMEN OVALE
FORAMEN SPINOSUM
4
Fig 2 : Foramen of Vesalius
Aim of the study
5
AIM OF THE STUDY
Foramen ovale is an important foramen located on the infratemporal
surface of the greater wing of sphenoid bone. The location of Foramen ovale in
the transition zone, between intracranial and extracranial structures makes it an
important site for various invasive surgical and diagnostic procedures.
Trigeminal Neuralgia or “tic doulourex”, described by the French surgeon
Nicholas Andre in 1756 is characterized by a temporary paroxysmal lancinating
pain in the trigeminal nerve distribution which is typically confined to one side of
the face but may be bilateral in rare cases52. Foramen ovale provides ease of
access for microvascular decompression by percutaneous trigeminal rhizotomy
the procedure of choice for the treatment of Trigeminal Neuralgia.
Electroencephalographic analysis of Seizure can be done by placing the
electrode through Foramen Ovale into the subdural compartment. These
electrodes are used to lateralize ictal onsets in patients undergoing temporal
lobectomy and Amygdalohippocampectomy. This technique provides sufficient
neurophysiological information in patients for selective
amygdalohippocampectomy53.
Tumours involving the cavernous sinus which is difficult to diagnose
radiologically, histopathological diagnosis may require in such case Foramen
ovale facilitates percutaneous biopsy of cavernous sinus. The accuracy of
6
percutaneous biopsy of cavernous sinus through foramen ovale is 84%. This
procedure is necessary, prior to decisions involving open surgical, radio-surgical
or radiotherapeutics treatment modalities.
Computed tomography guided trans-facial Fine needle Aspiration
Cytology through foramen ovale is used to diagnose Squamous cell carcinoma,
Meningoma, Meckel’s cave lesions.
Foramen ovale is also common route for the spread of nasopharyngeal
carcinoma into cranial cavity.
Foramen spinosum is an important landmark for microsurgical procedures
involving middle cranial fossa and infratemporal fossa.
Foramen spinosum is clinically important in surgeries of middle meningeal
artery as a graft such as bypass with pterous part of internal carotid artery (ICA)
or middle meningeal artery to posterior cerebral artery (PCA).
Incidence of Foramen of Vesalius is variable. Hence its presence is
clinically important for anatomist, radiologist and neurosurgeons during diagnosis
and various microsurgical approaches at the base of the skull.
The knowledge of morphology and morphometry of Foramen ovale and
Foramen spinosum as well as their variations would be of great value to
Neurologist, Radiologist and Neurosurgeons for planning and management of
surgeries involving the above foraminae.
7
The Aim of the present study is to analyze the morphology and
morphometry of Foramen ovale and Foramen spinosum.
The parameters studied are
1. Maximum anteroposterior diameter of the Foramen Ovale.
2. Maximum mediolateral diameter of the Foramen Ovale.
3. Shape of the Foramen Ovale
4. Bony Outgrowth around the margins of the Foramen Ovale
5. Presence or Absence of the Foramen Spinosum
6. Maximum anteroposterior diameter of the Foramen Spinosum.
7. Maximum mediolateral diameter of the Foramen Spinosum.
8. Shape of the Foramen Spinosum.
9. Duplication of Foramen spinosum
10. Position of the Foramen spinosum in relation to the spine of the sphenoid.
11. Incidence of the Foramen of Vesalius.
Review of Literature
8
REVIEW OF LITERATURE
ANTEROPOSTERIOR DIAMETER OF THE FORAMEN OVALE
(APD)
Yanagi et al (1987) 66 studied Foramen ovale of 220 adult skulls and
stated that the average maximal length as 7.48mm and average minimal length of
Foramen ovale as 4.17mm.
Biswabina Ray, Nirupama Gupta et al (2005) 8 studied 35 dried human
skulls and reported that the APD on the right and left sides as 7.46mm and
7.01mm respectively.
Arun et al (2006)5 conducted a study on 25 skulls and reported that the
maximum APD of FO as 9.8 mm and the minimal APD as 2.9mm.
Osunwoke E.A et al (2010) 44in their study of 87 dry skulls of adults,
reported that APD of FO were 7.01 + 0.10 mm on the right and 6.89 + 0.09 mm
on the left side respectively.
Namita A Sharma et al (2011)40 reported the mean APD of FO among 50
dry skulls as 7.05mm.
Somesh M.S et al (2011) 59conducted a study on 82 dry skulls and
reported that the APD of FO was 7.65mm on the right and 7.56mm on the left
sides respectively.
9
Daimi S.R. et al (2011) 12 studied 90 dry skulls and stated that mean APD
of FO as 6.60mm on the right side and 6.26mm on the left sides respectively.
Desai S.D. et al (2012) 14 in their study of 125 dry skulls reported that the
mean APD of FO on the right side as 8.14 mm +1.42mm and on the left side as
7.98+1.89mm respectively.
Agarwal Deepa Rani et al (2012)1 studied 50 dry skulls and reported that
mean APD of FO were 7.11mm and 7.13mm on the right and left sides
respectively.
Ambica wadhwa et al (2012) 3 analyzed 30 dry adult human skulls and
reported that the mean APD of Foramen ovale on the Rt side was 6.5mm and as
that on the Lt side was 6.8mm respectively.
Nirupama Gupta et al (2013) 43 in their study of 35 dried skulls reported
that the mean APD of FO were 7.28 mm and 6.48 mm on the right and left sides
respectively.
Kulkarni Saurabh et al (2013)30 conducted a study on 100 skulls and
reported that maximal and minimal APD of FO as 9mm and 5mm respectively.
Jyothsna Patil et al (2013) 20 studied 52 dry human skulls and reported
that APD of FO on the right side was 7.0 + 2.17mm and left side was 6.8 +
1.40mm respectively.
10
Chandra Philips et al (2013)11 conducted a study on 50 dry adult skulls
and reported that the mean APD of FO on the right side was 7.27mm and the
mean APD of FO on the left side was 7.46mm respectively.
Roma Patel et al (2014)53 analyzed 100 human dry skulls and found that
APD of Rt FO was 6.6mm and APD of Lt FO was 6.5mm respectively.
Magi Murugan et al (2014)35 in their study of the FO of 250 skulls
reported that Rt APD and Lt APD were 8.9mm & 8.5mm respectively.
Phalguni Srimani et al (2014) 47analyzed 40 adult dry skulls and found
that Rt APD and Lt APD were 7.75mm and 7.70mm respectively.
Karishma et al (2015) 26conducted a study on 60 skulls and reported that
the mean APD of the right side was 6.71mm and the mean APD of the left side
was 5.74mm respectively.
Kanyata, D et al (2015)23 studied 200 adult dry skulls and observed that
APD of Rt side FO was 7.70 mm and APD of Lt side FO was 7.68mm
respectively.
Mohammad Muzammil et al (2015)38 conducted a study on 100 adult
human skulls and stated that the range of the APD of Foramen ovale on the Rt
side was 3 to 7.5mm and on the Lt side was 2 to 7mm.
11
Raval, Binita et al (2015) 51 in their study on 150 dry adult skulls stated
that the mean value of APD on Rt side was 7.53±1.75mm and the mean value of
APD on Lt side was 7.41± 1.53mm.
Karthiga, Thenmozhi et al (2016)26 studied 40 dry adult human skulls
and observed that the mean APD of Foramen ovale on Rt side was 8.6mm and on
the Lt side was 8.3mm respectively.
Suniti Raj et al (2016)61 analyzed 50 adult dry skulls and reported that the
mean APD of Rt FO was 7.6 mm( male) and 8mm (female) and mean APD of
Lt FO was 7.5mm(male) and 8mm(female) respectively.
Richard winn .H 52 in his textbook, Youmans Neurological Surgery stated
that the average length of Foramen ovale was 7.46+1.41mm.
Lattupalli Hema et al (2016)32 studied 100 dry skulls and reported that the
mean APD of Rt FO was 5 mm and the mean APD of Lt FO was 5.05mm.
Shikha sharma et al (2016) 57conducted a study on 45 dry adult skulls
and reported that the maximum APD of Foramen ovale on the Rt side was
between 5mm to 9mm.and on the Lt side between 5mm to 8mm.
Konstantinos et al (2017)29analyzed 195 adult dry skulls of the Greek
population and reported that the mean value of APD of Foramen ovale as 7.63+
1.17mm on Right side and 7.48+1.20mmon the left side.
12
Poornima B et al (2017) 49 conducted a study on 100 adult dry skulls and
reported that the mean APD of Rt FO as 6.4mm and that of Lt FO as 6.5mm
respectively.
Sadananda Rao et al (2017)55 in their study of the foramina of skull base
in 50 dry skulls observed that APD of Rt FO was 7.24mm and the Lt FO was
7.11mm respectively.
Ashwini et al (2017)6 analyzed 55 dry human skulls and reported that the
average APD of Right side Foramen ovale was 6.59mm and APD of Left side
Foramen ovale was 6.38mm respectively.
MEDIOLATERAL DIAMETER OF THE FORAMEN OVALE (MLD)
Biswabina Ray et al (2005)8 conducted a study on 35 skulls and reported
that MLD on the right side was 3.21mm while that on the left side as 3.29mm.
Osunwoke E.A et al (2010)44 studied 87 dry skulls of Nigerian population
and reported that MLD on the right side and left side were 3.37mm and 3.33mm
respectively.
Namita A Sharma et al (2011)40 analyzed 50 dry human skulls and
observed that MLD of FO was 3.9mm.
Somesh M.S et al (2011) 59in their study of 82 skulls and reported that the
MLD of FO were 5.12mm & 5.244 on the right side and left side respectively.
13
Daimi S.R. et al (2011)12 conducted a study on 90 dry skulls and stated
that the mean MLD of Rt FO was 3.70mm and of Lt FO was 3.34mm
respectively.
Richard winn .H (2011)52 in his textbook, Youman’s Neurological
surgery stated that the average width of Foramen ovale was 3.21+1.02mm.
Desai S.D et al (2012)14 studied 125 dry skulls and reported that mean
MLD of Rt FO was 5.26mm and MLD of Lt FO was 5.88mm respectively.
Agarwal Deepa Rani et al (2012) 1in their study of 50 dry skulls reported
that MLD were 3.44mm and 3.37mm on the right and left sides respectively.
Ambica wadhwa et al (2012) 3analyzed 30 dry adult human skulls and
reported that the mean MLD of Foramen ovale on the Rt side as 3.7mm and the
mean MLD of Foramen ovale on the Lt side as 4 mm respectively.
Nirupama Gupta et al (2013)43 conducted a study on 35 dried skulls and
reported that MLD of Rt FO was 3.57mm and MLD of Lt FO was
3.50mmrespectively.
Kulkarni Saurabh et al (2013)30 studied 100 dry skulls and reported that
maximum MLD of FO was 5.5mm and minimal MLD of FO was 2.5mm
respectively.
14
Jyothsna Patil et al (2013)20 analyzed 100 human dry skulls and observed
that MLD of Rt FO was 5mm and Lt FO was 4.70mm respectively.
Roma Patel et al (2014) 53 conducted a study on 100 human dry skulls and
reported that MLD of Rt FO was 3.6mm and MLD of Lt FO was 3.5mm
respectively.
Chandra Philips et al (2013)11 in their study of 50 dry skulls said that Rt
MLD and Lt MLD were 3.18mm and 3.21mm respectively.
Magi Murugan et al (2014) 35analyzed 250 dry adult skulls and reported
that MLD of Rt and Lt FO were 3.9mm and 3.7mm respectively.
Phalguni Srimani et al (2014) 47 conducted a study on 40 adult dry skulls
and found that MLD of Rt FO was 3.41mm and MLD of Lt FO was 3.56mm
respectively.
Kanyata D et al (2015) 23 studied 200 adult dry skulls and reported that
MLD of Rt FO was 4.24mm and MLD of Lt FO was 4.28mm respectively.
Lattupalli Hema et al (2016) 32in their study of 100 dry human skulls and
reported that the mean MLD of Rt FO was 3.75mm and the mean MLD of Lt FO
as 2.65mm.
15
Suniti Raj et al (2016) 61analyzed 50 adult dry skulls and reported that the
mean MLD of Rt FO was 4.4 mm( male) and 4mm (female) , mean MLD of Lt
FO was 4.1mm (male) and 4mm(female) respectively.
Shikha Sharma et al (2016) 57in their study observed that the MLD of
FO on Rt side and Lt side ranges from 2mm to 4mm.
Poornima B et al (2017) 49 in their study on 100 adult dry skulls ,
reported that the mean MLD of Rt FO was 3.50mm and the mean MLD of Lt FO
was 3.54mm.
Sadananda Rao et al (2017) 55 studied 50 dry human skulls and reported
that MLD of Rt FO was 3.75 + 0.71mm and MLD of Lt FO was 3.75 + 0.67mm.
Ashwini et al (2017) 6 analyzed 55 dry human skulls and reported that
the average MLD of Rt side Foramen ovale was 4.8mm and MLD of Lt side
Foramen ovale was 4.59mm..
16
ANTERO POSTERIOR DIAMETER OF THE FORAMEN SPINOSUM.
(APD)
Lawrence E. et al (1994)33 in their study examined 123 CTscan images of
temporal bone and observed that the length of FS ranges from 2 to 4mm.
Osunwoke E.A et al (2010)44 conducted a study on 87 dry human adult
skulls of southern Nigerian population and reported that mean APD of Rt FS was
2.34 +0.05mm and mean APD of Lt FS was 2.36+ 0.05 mm respectively.
Anju Lata Rai et al (2012) 4in their study of 35 Skulls said that the mean
APD of foramen Spinosum were 3.31+0.84mm and 3.73+ 0.63mm on the left and
right side respectively.
Agarwal Deepa Rani et al (2012)1 studied 50 dry skulls and reported that
mean APD of Right Foramen spinosum was 2.42+0.05 mm and left Foramen
spinosum was 2.37+ 0.05mm respectively.
Desai S.D et al (2012)15 analyzed 125 dry human skulls and reported that
the maximum and minimum APD of Foramen Spinosum were 2.92+ 0.65mm and
2.12+ 0.45mm.
Jeyanthi Krishnamurthy et al (2013) 19in their study of 50 dry human
skulls said that the mean APD of Rt FS and Lt FS were 2.58mm and 2.35mm
respectively.
17
Phalguni Srimani et al (2014) 47 analysed 40 adult dry skulls and found
that APD of Right Foramen spinosum was 2.01+0.31mm and APD of Left
Foramen spinosum was 2.03+ 0.29mm respectively.
Raval Binita et al (2015)51 studied 150 adult human skulls and reported
that mean APD of Rt side FS was 2.49±0.60mm and APD of Lt side FS was 2.55
± 0.70mm respectively.
Somesh M.S et al (2015) 60conducted a study on 82 dry human skulls and
reported that the mean APD of Rt FS was 3.45+ 0.637mm and mean APD of Lt
FS was 3.339+0.66mm respectively.
Manavalan et al (2015) 37analyzed 40 dry adult human skulls and reported
that the mean APD of Rt FS was 3.96+0.60mm and mean APD of Lt FS was
4.25+0.67mm respectively.
Lazarus et al (2015)34 conducted a study on 100 dry human skulls and
reported that mean APD of Rt FS and Lt Fs were 2.46+0.72 and 2.54+ 0.76mm
respectively.
Lattupalli Hema et al (2016)32 in their study of 100 dry skulls reported
that the mean APD of Rt FS and Lt FS were 2.25mm and 2.1mm respectively.
18
MEDIOLATERAL DIAMETER OF FORAMEN SPINOSUM (MLD)
Lawrence E. et al (1994)33 in their study examined 123 CTscan images
of temporal bone and stated that the average MLD of FS was between 1.5 to
3mm.
Osunwoke E.A et al (2010)44 conducted a study on 87 dry skulls and
reported that the MLD of Rt FS was 1.66+0.03mm and MLD of Lt FS was
1.61+0.03mm respectively.
Agarwal Deepa Rani et al (2012) 1 analyzed 50 dry human skulls and
observed that the MLD of Rt FS and Left FS were 1.68+0.03mm and
1.65+0.03mm respectively.
Anju Lata Rai et al (2012) 4 studied 35 dry skulls and reported that the
MLD of Rt FS was 1.8+0.41mm and MLD of Lt FS was 1.5+0.27mm
respectively.
Jeyanthi Krishnamurthy et al (2013)19 conducted a study on 50 dry
human skulls and reported that MLD of Rt FS was 2.18mm and Lt FS was
2.02mm
19
Phalguni Srimani et al (2014)47 analyzed 40 dry human skulls and found
that MLD of Rt FS was 1.65+0.25mm and MLD of Lt FS was 1.70+0.19mm
respectively.
Somesh M.S et al (2015)60 conducted a study on 82 dry human skulls and
reported that MLD of Rt FS and Lt FS were 2.68mm and 2.67mm respectively.
Manavalan et al (2015) 37analyzed 40 human skulls and reported that
MLD of Rt FS was 2.21mm and MLD of Lt FS was 2.18mm respectively.
Lattupalli Hema et al (2016)32 analyzed 100 dry human skulls and stated
that MLD of Rt FS and Lt FS were 3.55mm and 1.75mm respectively.
20
SHAPES OF FORAMEN OVALE
Peter L Williams 46 in his Grays Textbook of Anatomy stated that the shape of
Foramen ovale was oval.
Biswabina Ray et al (2005) 8 did a study on 85 human skulls (dry) and reported
his findings as
Oval- 61.4%,
almond 34.2% ,
round 2%
slit 1%.
Arun kumar et al (2006) 5 reported the following shape of FO
Oval-40%
Round-14%
Slit like-12%
Irregular-24%
Triangular-6%
Somesh M.S. et al (2011)59 analyzed 82 dry skulls and observed the following
findings
Oval- 56%
almond shape-28.65%
round -10.97%
irregular shape- 3.65%
21
Daimni S.R. et al (2011) 12conducted a study on 90 human skulls and stated that
shape of FO was
Oval – 29.87%
Round – 12.5%,
elongated – 10.41%,
Slit – 1.04% respectively.
Richard winn .H(2011)52 in his textbook, Youmans Neurological surgery
stated that the shape of FO is typically oval, yet it can be almond shaped, round or
slit-like.
Desai S.D. et al (2012) 14 analyzed 125 dry human skulls and observed that most
prevalent shape as
oval -62.80%
almond – 23.20%,
round 11.81%
irregular 2.19%
Ambica wadhwa et al (2012) 3 analyzed 30 dry adult human skulls and reported
that the shape of Foramen ovale was
oval -70%
almond -15%
round -10%
slit – 5%
22
Nirupama et al (2013) 43 studied 35 human skulls and reported their observation
as
Oval - 54.29%,
almond -35.71%,
round – 8.57%
slit like shape - 1.43%.
Chandra Philips et al (2013)11 studied 50 dried human skulls and observed the
following finding as
oval -68%,
almond - 30%,
round - 1%
D-shape- 1%.
Karan Bhagwawan et al (2013) 24 analyzed 100 dry adult human skulls and
reported that the most common shape was
oval – 76.5%
almond – 10.5%
round – 7%
Slit-6%.
23
Roma Patel et al (2014)53 studied 100 skulls and stated that Oval shape was
common based on the following findings
oval 59.5%
almond 12%
round 27.5%, & slit like shape- 1%.
Magi Murugan et al (2014)35 analyzed 250 dry human skulls and observed the
prevalence as
Oval shape - 69%,
almond shape - 29%
round - 2%.
Deepti Anna et al (2015) 13conducted 30 dry adult human skulls and observed the
following pattern
Oval - 80%,
Almond – 12%
Round-7%
Slit-2%
Raval Binita et al (2015) 51 in their study of 150 dry skulls observed that
Foramen ovale was
oval shape 76.5%
irregular shape 13.5% ,
almond shape 7.5%,
round shape 1.5% & triangular 1%.
24
Suniti Raj et al (2016)61 analyzed 50 human skulls and reported the following
oval shape 66%
almond 22%
D shaped 2%
slit like 4%
round 3% & irregular 3%
Lattupalli Hema et al (2016) 32 studied 100 human dry skills and stated that oval
shape was most common followed by almond, round and slit shapes.
oval 59.5%
almond 12%
round 27.5%, & slit like shape- 1%.
Poornima B et al (2017) 49 conducted a study on 100 adult dry skulls and
observed that
Oval - 60%
almond - 25%.,
round -13%
slit - 2%
Ashwin N.S. et al (2017)6 analyzed 55 dry human adult skulls and reported the
following observation
oval - 69.09%.,
almond-9.09%
irregular -14.5%
round 7.27%.
25
BONY OUT GROWTH AROUND THE MARGIN OF FORAMEN OVALE
Biswabina Ray et al (2005)8 studied 35 skulls and reported that bony
plate was seen in 12.8% of cases, spine in 4.2% , spur in 2.8% & tubercle in
4.2%.
Osunwoke et al (2010)44 did a study on 87 skulls and observed a bony
spur in one skull which partially divided the foramen into two components.
Damini et al (2011)12 studied 90 skulls and observed that bony spur was
seen in 6.66% of cases.
Somesh et al (2011) 59 studied 80 skulls and observed that 7 skulls (2 Left
side and 5 Right side) showed the presence of spine on the margin of Foramen
ovale. Presence of tubercle was observed in 5 skulls (2 Left side & 3 Right side).
Khan AA et al (2012) 27studied 25 skulls and observed the presence of
bony spine in 2 skulls.
Ambica wadhwa et al (2012)3 conducted a study on 30 skulls and reported
that 10% showed the presence of bony plate and spine in 1.6% and tubercle in
5% of skulls studied.
Nirupma et al (2013)43 in their study on 35 skulls reported that margins of
FO showed spines in 4.2%, tubercles in 5.7%, and bony plate in 8.5%.
26
Chandra Philips et al (2013)11 did a study on 50 skulls and reported
spines as being present in 4.2%,bony plate in 12.8%,and tubercle in 4.2% of
skulls.
Phalguni srimani et al (2014)47 in their study observed the presence of
bony out growth in the form of spine and absence of bony spur.
Deepti et al (2015)13 in their study on 30 skulls observed that the incidence
of bony plate, spine and tubercle were 11.6%, 13% &6% respectively.
Suniti raj et al (2016)61 studied 50 Indian skulls and stated that bony out
growth around the margin of FO were as follows bony plate-38%, spine-7%,
septa-2% and tubercle-5%.
Poornima et al (2017)49 did a study on 100 skulls and reported that
incidence of various bony out growth around the margin of FO was spine-11%,
bony plate-10% & tubercle-5% respectively.
Ashwini et al (2017)6 studied 55 skulls and observed that presence of
spines in 4 skulls and bony spurs in 7 skulls.
Sadananda et al (2017) 55 in their study on 50 skulls and reported that 8%
of skulls showed the presence of tubercle around the margin of FO while 4% of
skulls showed the presence of spine.
27
VARIOUS SHAPES OF FORAMEN SPINOSUM
Osunwoke et al (2010) 44in their study of 87 dry human adult skulls observed that
the shape of FS to be either circular or Oval, with only one being of an irregular
shape.
Anju et al (2012) 4 conducted a study on 35 skulls, the most common shape of FS
observed were
round -57% on Rt side and 51.4% on Lt side,
Oval 34 .2% on Rt side and 31.4% on Lt side
pinhole -5.7% (Rt side) & 8.5% (Lt side)
irregular -2.8% (Rt side) & 2.8% (Lt side)
Lanapari kwathai et all (2012) 31 observed that out of 103 skulls studied, the
shape of FS was as follows
round -49.5%
oval -39.8%
irregular- 10. 7%
Desai S.D. et al (2012)15 conducted a study on various shapes of FS in 125 skulls
and found them to be as round (52%), Oval (42%) and irregular (16%).
28
Jeyanthi Krishnamurthy(2013)19 reported that out of 50 skulls the shape of FS
were
round - 55%
oval- 40%
irregular 2% .
Lazarus et al (2015) 34 reported that out of 100 skulls, the shapes of FS were
round -50%
Oval- 43.2%
Irregular-6.8%
Somesh M.S. et al (2015)60 conducted study on 82 dry human adult skulls and
observed the following
round -53.65%
oval -35.36%
Pinhole-6.70%
Irregular -4.26%
Manavalan et al (2015)37 in their study of 40 dry human adult skulls, the
common shape of FS encountered were
round -52.5%
oval 30%
Irregular-12.5%
Pin hole -2.5%.
29
Raval Binita et al (2015)51 in their study on 150 adult dry skulls observed that
the shapes of Foramen Spinosum were
round 84%
oval 4%
irregular 12%
Lattupalli Hema et at (2016)32 reported that out of 100 dry human skulls, the
various shape of FS were
round 52.5%,
oval 11.5%,
pinhole 16%
irregular 20%.
30
POSITION OF THE FORAMEN SPINOSUM IN RELATION
TO SPINE OF SPHENOID.
Frazer´s (1965)16 in his Textbook of Anatomy of Human Skeleton quoted
that the Foramen spinosum lies in front of spine of the sphenoid.
J.C Brash and E B Jamieson (1937)10 in Cunningham’s textbook of
Anatomy stated that Foramen spinosum lies anteromedial to spine of sphenoid.
Jeyanthi Krishnamurthy et al (2013)19 analyzed 50 dry human skulls and
stated that the position of FS was antero medial to spine of sphenoid in 96% as
against being 4% lateral to spine of sphenoid.
Manavalan et al (2015) 37 reported that out of 40 adult human skulls the
position of the FS in relation to spine of sphenoid was found to be normal in 25%
of total skulls (Rt side -30% and Lt side 33.75%) studied, while 26.25% and
3.75% of skulls showed position of FS lateral and medial to spine of sphenoid
respectively.
31
ABSENCE OF FORAMEN SPINOSUM
Lawrence et al (1994)33 conducted a study based on high resolution CT
scan images of 123 cases and observed absence of FS to be 3.2%.
Mandavi et al (2009)36 reported that out of 312 skulls only 0.3% showed
an absence of FS .
Osunwoke et al (2010)44 conducted a study on 87 adult human skulls and
observed FS was present in all specimens studied.
Anju Lata Rai et al (2012)4 studied 35 dried human skulls and reported
the absence of foramen Spinosum in 2.85% of skulls.
Khan A.A. et al (2012)27 conducted a study on 25 dried human skulls and
observed the absence of FS in 2% of the skulls.
Karan Bhagwawan Khairnar et al (2013)24 of 100 skulls studied, the
absence of FS was found to be 0.5%.
Kulkarni surabha et al (2013) 30in their study of 100 human dry skulls
reported the absence of FS as 2.5%.
32
Jeyanthi Krishsnamurthy et al (2013)19conducted study on 100 dry
skulls and reported that the absence of FS was only 2%.
Lazarus L et al (2015)34 reported that out of 100 dry human skulls, only
2% of cases showed absence of foramen spinosum.
Manavalan et al (2015)37 in their study on 40 adult human skulls
observed the absence of Foramen spinosum to be 2.5%.
Somesh M.S et al(2015)60 observed the absence of FS in 2.5% of the 82
dry adult human skulls studied.
Shikha Sharma et al (2016)57 analyzed 45 adult human dry skulls and
reported that the absence of FS as 4.44%.
33
DUPLICATION OF FORAMEN SPINOSUM
Lawrence et al (1994)33 in their study conducted on high resolution CT
123 cases observed duplication of FS in only one case.
Jerzy Reymond et al(2005)18 analyzed 100 adult human skulls and
reported that duplication of FS was not seen in their study.
Mandavi et al (2009)36 conducted study on 312 skulls and reported that
the duplication of FS was 2.56%.
Osunwoke et al (2010)44 conducted study on 87 dry adult human dry
skulls of Nigerian population and said that there was no duplication of FS.
Anju et al(2012)4 conducted study on 35 skulls and found that the
percentage of duplication of FS was 2.85%.
Khan et al (2012) 27conducted study on 25 dry adult skulls and reported
that the incidence of duplication of FS was 2%.
Desai et al (2012)15 in their study on 125 adult human skulls observed that
there was no duplication of FS.
34
Jeyanthi et al (2013)19 conducted study on 50 human adult skulls and
observed that there was no duplication of FS.
Kulkarani et al (2013)30analyzed 100 adult dry human skulls and
observed that there was no duplication of FS.
Karan Bhagwawan Khairnar et al (2013)24 conducted study on 100 adult
human skulls and reported that the incidence of duplication of FS was 3%.
Lazarus et al (2015)34 analyzed 100 dry human adult skulls and observed
that the incidence of duplication of FS account for 2.5%.
Somesh et al (2015) 60conducted study on 82 skulls and reported that the
duplication of FS was not seen.
Manavalan et al (2015)37 analysed 40 adult human dry skulls and
observed that duplication of FS was 3.75%.
35
INCIDENCE OF FORAMEN OF VESALIUS
Boyd et al (1930) 9 observed that the incidence of FV was 36.5%.
Bilateral- 14.7% and unilateral-21.8%.
Peter l. willams (1995)46 in “Gray”s Anatomy stated the emissary
sphenodial foramen exists on one side or both sides in 40% of skulls.
Lawrence et al (1994)33 in their study in high resolution 123 CT reported
that unilateral incidence of FV is seen in 80% cases.
Kodama et al (1997)28 in their study of 400 skulls reported that the
incidence of FV account for 21.8%.
Gupta et al (2005) 17in their study reported that the incidence of FV was
32.85%, Bilateral-22.85%, unilateral-20%
Reymond et al (2005)18 analyzed 100 adult skulls and reported that the
incidence of FV was 17%.
Kale et al (2009) 21in their study observed that the incidence of FV was
45% out of 347 skulls. Unilateral-19.9%, bilateral-25.1%.
Rossai et al (2010)54 in their study stated that the incidence of Foramen
Vesalius account for 40% and it was observed bilaterally-13.75% and unilaterally-
26.25%
36
Praveen singh et al (2011)50 analyzed 103 dry human adult skulls and
observed that the incidence of foramen Vesalius was 20%.
Shaik et al(2012) 56 analyzed 250 samples and observed that the presence
of FV account for 36%. Bilateral- 24% and Unilateral- 16%.
Vipavadee chaisuksunt et al ( 2012) 64conducted study on 377 skulls and
reported that the incidence of FV account for 25.9%.
Neha Gupta et al (2014)41 in their study of 200 dry human skulls observed
that presence of FV account for 34%, unilateral-20% and bilateral- 14%.
Nirmala et al (2014) 42conducted a study on 180 dry adult human skulls
and reported that the incidence of FV account for 50%, bilateral-23.3%,
unilateral-16.67% (Lt side) & 10% ( Rt side).
Phalguni Srimani et al (2014) 47conducted study on 40 dry adult skulls
and reported that the incidence of FV was 5%.
Ozer et al (2014)45 in their study observed that the incidence of FV was
34.8%.bilateral distribution -9.3% and unilateral-25.5%.
Ajit Pal Singh et al (2015) 2analyzed 28 dry adult skulls and reported that
incidence of FV was 57.1%, bilateral -28.5%, unilateral -28.5% (Rt side) and
7.10% (Lt side).
37
Murlimanju BV et al (2015)39 in their study observed that incidence of
Foramen Vesalius account for 37.2%. it was observed unilaterally as 20.5% and
bilaterally -16.7 %.
Surekha D. Jadhav et al ( 2016) 63 in their study on 250 skulls reported
that the presence of FV was28.8% , bilateral-11.2%, unilateral-17.6%
Konstantinos Natsis et al (2017) 29analyzed 195 dry adult human skulls
of Greek population and observed that incidence of foramen Vesalius was 40%,
Bilateral-21.5% & unilateral-18.5%.
Embryology
38
EMBRYOLOGY
The skull consists of a protective case around the brain known as the
Neurocranium and the viscerocranium or splanchnocranium that makes up the
jaw skeleton.65 Most of the bones at the base of the skull are performed in
cartilage which is known as chondrocranium.
The membranous neurocranium consists of dermal bones and corresponds
to cranial vault, and it is not preformed in cartilage.
In the basal region of the developing skull, cartilage is first laid and later
replaced by bone. The cartilage appears as discrete condensations forming a
definite pattern. The following regions of cartilaginous condensations in the
basal regions may be recognized are
i. a parachordal region , from the region of caudal end of hindbrain to the
hypophsis.
ii. a prechordal or trabecular region in front of the notochord.
iii. cartilagenous sense capsule; auditory, olfactory and optic.
39
Fig
3 : T
hree
stag
es in
the
deve
lopm
ent o
f the
neu
ral p
ortio
ns o
f the
cho
ndro
cran
ium
rig
ht si
de
in C
is a
late
r st
age
than
the
left
side
.
40
The greater wing of sphenoid(ali sphenoid) has intramembranous) has
intramembranous and endochonrdal components ; endochondral part initially
differentiates as cartilage surroundings the mandibular branch of trigeminal nerve
forming Foramen ovale.(Fig-3)
At 22 weeks, Foramen ovale is seen as a discrete foramen. In the 7th month
of fetal life, the perfect ring shaped formation is observed as earliest and at 3 years
after birth the latest.
Foramen spinosum can be seen as a well defined ring shape which is seen
between 8th months to 7 years after birth.66
Materials and Methods
41
MATERIALS AND METHODS
STUDY MATERIALS
100 human adult dry skulls of unknown sex.
Digital vernier caliper
Flexible wire
STUDY METHOD
Dry Skull Method.
SPECIMEN COLLECTION
Hundred human adult dry skulls of unknown sex available in the Institute
of Anatomy, Madras Medical College were used for this study.
INCLUSION CRITERIA :
1. Adult human dry skulls of unknown sex.
2. Third molar tooth erupted
3. Well defined skull sutures.
EXCLUSION CRITERIA
Damaged Skulls with un identifiable features of Foramen Ovale and
Foramen Spinosum.
42
The following measurements were made with the use of digital vernier caliper
with a precision of 0.1mm.
1. Maximum antero posterior diameter of the Foramen Ovale.
The distance between the anterior most and posterior most points of the
Foramen Ovale which corresponds to the length of the Foramen Ovale.(Fig-4)
2. Maximum mediolateral diameter of the Foramen Ovale
The distance between the medial most and lateral most points of the
Foramen Ovale that corresponds to the breadth of the Foramen Ovale.(Fig-5)
3. Maximum anteroposterior diameter of the Foramen Spinosum.
This corresponds to the length of the Foramen Spinosum.(Fig-6)
4. Maximum mediolateral diameter of the Foramen Spinosum
This corresponds to the breadth of the Foramen spinosum(Fig-7)
The following morphological parameters were observed by naked eye
examination
5. Shape of the Foramen Ovale:-
The Shape of the Foramen Ovale was analyzed by naked eye examination.
Various shapes were oval, almond, round or slit.
43
6. Bony Outgrowth around the margins of the Foramen Ovale :-
Analyzed by the presence of bony out growth like spur, bony plate, Spine
or tubercle around the margin of the Foramen Ovale
7. Incidence of the Foramen of Vesalius
Analyzed by the presence of Foramen of Vesalius which is situated antero
medial to the Foramen Ovale.
8. Shape of the Foramen spinosum :
Various shapes of the Foramen spinosum were analyzed as round, oval,
pinhole or irregular shape.
9. Position of the Foramen spinosum in relation to the spine of the sphenoid :
Analyzed on both sides of skulls for the position of Foramen spinosum in
relation to the spine of the sphenoid.
10 Presence or Absence of the Foramen spinosum :
Analyzed bilaterally for presence or absence of Foramen spinosum .
11. Duplication of the Foramen spinosum :
Analysed bilaterally for presence of duplication of Foramen spinosum.
All the parameters were analyzed at the base of the skull on both sides. The
mean, range and standard deviation of each parameter were computed and
analyzed statistically.
Observation
44
OBSERVATION
100 adult human dry skulls were studied and observations were recorded
as per their morphological and morphometric parameters.
TABLE: 1. PERCENTAGE OF THE SHAPE OF FORAMEN OVALE
(n=100skulls) (Fig-8 A,B,C &D)
SHAPE PERCENTAGE
OVAL 57.5
ALMOND 17.5
ROUND 16
SLIT 9
CHART: 1. PERCENTAGE OF THE SHAPE OF FORAMEN OVALE
57.50%17.50%
16%9%
Oval
Almond
Round
Slit
45
TABLE: 2. PERCENTAGE OF THE SHAPE OF FORAMEN
SPINOSUM (n=100 skulls)(Fig-9A,B,C&D)
SHAPE PERCENTAGE
ROUND 59.5
OVAL 33.5
PINHOLE 3
IRREGULAR 2
ABSENCE 2
CHART: 2. PERCENTAGE OF THE SHAPE OF FORAMEN SPINOSUM
59.50%
33.50%
3% 2% 2%
Round
Oval
Pinhole
Irregular
Absence
46
TABLE: 3. BONY OUTGROWTH AROUND THE MARGIN OF
FORAMEN OVALE (n=100 skulls).(Fig-10A,B&C)
BONY OUT GROWTH RIGHT LEFT
BONY PLATE 8 8
TUBERCLE 6 6
SPINE 4 7
ABSENT 82 79
CHART: 3. BONY OUT GROWTH AROUND MARGIN OF
FORAMEN OVALE
0
10
20
30
40
50
60
70
80
90
BONY PLATE TUBERCLE SPINE ABSENT
Perc
enta
ge
RIGHT
LEFT
47
TABLE: 4. POSITION OF FORAMEN SPINOSUM IN RELATION TO
SPINE OF SPHENOID (n=100 skulls).(Fig-11)
POSITION RIGHT LEFT
ANTEROMEDIAL 96 97
MEDIAL 1 0
LATERAL 0 2
ABSENCE 3 1
CHART: 4. POSITION OF FORAMEN SPINOSUM IN RELATION TO
SPINE OF SPHENOID
0102030405060708090
100
ANTE
ROM
EDIA
L
MED
IAL
LATE
RAL
ABSE
NCE
Perc
enta
ge
RIGHT
LEFT
48
TABLE: 5. INCIDENCE OF FORAMEN of VESALIUS (n=100 skulls)
(Fig-12A&B)
Foramen Vesalius Right side Left side Bilateral
PRESENCE 8% 9% 5%
ABSENCE 92% 91% 95%
CHART- 5. INCIDENCE OF FORAMEN of VESALIUS
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Right side Left side Bilateral
PRESENCE
ABSENCE
49
TABLE: 6. INCIDENCE OF FORAMEN SPINOSUM (n=100skulls).(Fig-13)
INCIDENCE RIGHT LEFT
PRESENCE 97% 99%
ABSENCE 3% 1%
CHART: 6.INCIDENCE OF FORAMEN SPINOSUM
97
3
99
1
0102030405060708090
100
RIGHT LEFT
PRESENCEABSENCE
50
INCIDENCE OF DUPLICATION OF FORAMEN SPINOSUM
Out of 100 adult skulls, duplication of Foramen spinosum was not
observed in any skulls.
TABLE: 7 INCIDENCE OF DUPLICATION OF FORAMEN SPINOSUM
DUPLICATION OF FORAMEN SPINOSUM
RIGHT SIDE Nil
LEFT SIDE Nil
51
TABLE: 8. ANTEROPOSTERIOR DIAMETEROF THE FORAMEN
OVALE (Rt APD mm)
Number of skulls 100
Maximum 11.5
Minimum 5.35
Mean 7.64
Standard deviation 1.236
The whole range of values is shown in the histogram below
CHART 7 : ANTEROPOSTERIOR DIAMETER OF
FORAMEN OVALE-(Rt APD)
52
TABLE:9. ANTEROPOSTERIOR DIAMETER OF THE FORAMEN
OVALE (Lt APD mm).
Number of skulls 100
Maximum 9.66
Minimum 5.41
Mean 7.49
Standard deviation 0.989
The whole range of values is shown in histogram below
CHART 8 : ANTEROPOSTERIOR DIAMETER OF
FORAMEN OVALE ( Lt APD)
53
TABLE: 10. MEDIOLATERAL DIAMETER OF FORAMEN OVALE
(Rt MLDmm)
Number of skulls 100
Maximum 7.56
Minimum 2.8
Mean 5.098
Standard deviation 0.970
The whole range of values is shown in the histogram below.
CHART: 9. MEDIOLATERAL DIAMETER OF FORAMEN OVALE-
(RtMLD).
54
TABLE: 11.MEDIOLATERAL DIAMETER OF FORAMEN OVALE
(Lt MLDmm)
Number of skulls 100
Maximum 7.45
Minimum 3.69
Mean 5.24
Standard deviation 0.844
The whole range of values is shown in the histogram below
CHART:10. MEDIOLATERAL DIAMETER OF
FORAMEN OVALE (Lt MLD)
55
TABLE : 12. ANTEROPOSTERIOR DIAMETER OF THE FORAMEN
SPINOSUM (Rt APDmm)
Number of skulls 100
Maximum 4.44
Minimum 1.33
Mean 2.483
Standard deviation 0.628
The whole range of values is shown in the histogram below.
CHART:11. ANTEROPOSTERIOR DIAMETER OF FORAMEN
SPINOSUM (Rt APD)
56
TABLE:13. ANTEROPOSTERIOR DIAMETER OF THE FORAMEN
SPINOSUM (Lt APDmm).
Number of skulls 100
Maximum 4.23
Minimum 1.27
Mean 2.528
Standard deviation 0.594
The whole range of values is shown in the histogram below
CHART:12. ANTEROPOSTERIOR DIAMETER OF FORAMEN
SPINOSUM(Lt APD)
57
TABLE: 14.MEDIOLATERAL DIAMETER OF THE
FORAMEN SPINOSUM (Rt MLDmm)
Number of skulls 100
Maximum 2.26
Minimum 0.91
Mean 1.293
Standard deviation 0.338
The whole range of values is shown in the histogram below
CHART: 13.MEDIOLATERAL DIAMETER OF
FORAMEN SPINOSUM- (Rt MLD)
58
TABLE:15. MEDIOLATERAL DIAMETER OF THE FORAMEN
SPINOSUM (Lt MLDmm)
Number of skulls 100
Maximum 3.33
Minimum 0.88
Mean 1.446
Standard deviation 0.366
The whole range of values is shown in the histogram below
CHART:14. MEDIOLATERAL DIAMETER OF THE FORAMEN
SPINOSUM (Lt MLD)
59
TABLE: 16. COMPARISON BETWEEN THE ANTEROPOSTEROIR AND
MEDIOLATERAL DIAMETER OF RIGHT SIDE AND LEFT SIDE
FORAMEN OVALE OF DRY SKULLS ALONG WITH t-VALUE AND p-
VALUE.
STATISTICAL DATA Side N Mean
(mm) SD Std.Error Mean
t-value
p-value
Anteroposterior diameter
Right 100 7.6422 1.2355 .123558
1.267 0.208
Left 100 7.499 .98863 .098863
Mediolateral diameter
Right 100 5.098 .969513 .096951
1.949 0.054
Left 100 5.245 .843630 .084363
p-value is greater than significant value(0.05). Hence there is no
significant difference between the right side and left side APD and MLD of FO.
60
TABLE: 17. COMPARISON BETWEEN THE ANTEROPOSTEROIR AND
MEDIOLATERAL DIAMETER OF RIGHT SIDE AND LEFT SIDE
FORAMEN SPINOSUM OF DRY SKULLS ALONG WITH t-VALUE AND
p-VALUE.
STATISTICAL DATA Side N Mean
(mm) SD Std.Error Mean
t-value
p-value
Anteroposterior diameter
Right 100 2.483 .628146 .062815
0.578 0.565
Left 100 2.528 .594123 .059412
Mediolateral diameter
Right 100 1.292 .337902 .033790
3.523 0.001
Left 100 1.446 .366256 .036626
p- value(0.565) is greater than significant value(0.05). No significant
difference was observed between the right side and left side anteroposterior
diameter of Foramen spinosum.
p- value(0.001) is less than significant value(0.05).hence there is
significant difference between the right side and left side mediolateral diameter of
Foramen spinosum.
Discussion
61
DISCUSSION
The findings of the present study were compared with findings of other
similar studies conducted in different parts of India and other countries.
ANTEROPOSTERIOR DIAMETER (APD) OF FORAMEN OVALE.
Biswabina Ray, Nirupama Gupta et al (2005)8 studied 35 dried human
skulls and reported that APD on the right side and on the left sides were 7.46mm
and 7.01mm respectively.
Osunwoke E.A et al (2010)44 in their study of 87 dry skulls of southern
Nigerian population said that APD of FO were 7.01 + 0.10 mm and 6.89 + 0.09
mm on the right and left sides respectively.
Somesh M.S et al (2011) 59conducted study on 82 dry skulls and reported
that the APD of FO were 7.65mm and 7.56mm on the right and left sides
respectively.
Desai S.D. et al (2012) 14in their study of 125 dry skulls reported that the
mean APD of FO on the right side was 8.14 mm +1.42mm and on the left side
was 7.98+1.89mm respectively.
Chandra Philips et al (2013)11 conducted a study on 50 dry adult skulls
and reported that the mean APD of FO on the right side was 7.27mm and the
mean APD of FO on the left side was 7.46mm.
62
Phalguni Srimani et al (2014)47 analyzed 40 adult dry skulls and found
that Rt APD and Lt APD were 7.75mm and 7.70mm respectively.
Magi Murugan et al (2014)35 in their study of the FO of 250 skulls
reported that Rt APD and Lt APD were 8.9mm & 8.5mm respectively
Raval ,Binita et al (2015)51 in their study on 150 dry adult skulls stated
that the mean value of APD on Rt side was 7.53±1.75mm and the mean value of
APD on Lt side was 7.41± 1.53mm.
In the present study, the antero posterior diameter of right FO ranged from
5.35mm to 11.5mm with mean as 7.64mm±1.236mm. The antero posterior
diameter of left FO ranged from 9.66mm to 5.41mm with mean of
7.49mm±0.989mm. The mean Rt APD and Lt APD of the present study coincide
with values of previous studies.
63
TABLE: 18 COMPARISON OF ANTEROPOSTERIOR DIAMETER
(APD) OF THE FORAMEN OVALE
SI NO Authors Rt APD (mm)
Lt APD (mm)
1 Biswabina Ray et al (2005) 7.46 7.01
2 Osunwoke et al (2010) 7 6.89
3 Chandra Philips et al (2013) 7.27 7.46
4 Phalguni srimani et a l(2014) 7.75 7.70
5 Present study 7.64 7.49
CHART 15 ANTEROPOSTERIOR DIAMETER (APD) OF
FORAMEN OVALE
6.6
6.8
7
7.2
7.4
7.6
7.8
8
Biswabinaet al 2005
Osunwokeet al 2010
Chandra etal 2013
Phalguni etal 2013
Presentstudy
mm
Rt APD (mm)
Lt APD (mm)
64
MEDIOLATERAL DIAMETER (MLD) OF FORAMEN OVALE
Somesh M.S et al (2011)59 in their study of 82 skulls and reported that the
MLD of FO were 5.12mm & 5.24on the right side and left side respectively.
Daimi S.R. et al (2011)12 conducted a study on 90 dry skulls and stated
that the mean MLD of Rt FO was 3.70mm and of Lt FO was 3.34mm.
Desai S.D et al (2012)14 studied 125 dry skulls and reported that mean
MLD of Rt FO was 5.26mm and MLD of Lt FO was 5.88mm
Jyothsna Patil et al (2013)20 analyzed 100 human dry skulls and observed
that MLD of Rt FO was 5mm and Lt FO was 4.70mm.
Ashwini et al (2017)6 analyzed 55 dry human skulls and reported that the
average MLD of Rt side Foramen ovale was 4.8mm and MLD of Lt side Foramen
ovale was 4.59mm.
In the present study, the mediolateral diameter of right FO ranged from
7.56mm to 2.8mm with mean as 5.09mm±0.97mm. The mediolateral diameter of
left FO ranged from 7.45mm to 3.69mm with mean of 5.24mm±0.84mm.The Rt
MLD and the Lt MLD values coincides with previous studies. In present study,
the mediolateral diameter of Lt side FO is greater than the Rt side FO.
65
TABLE:19 COMPARISON OF MEDIOLATERAL DIAMETER (MLD) OF
THE FORAMEN OVALE.
CHART:16 MEDIOLATERAL DIAMETER OF FORAMEN OVALE
Correct placement of needle is the essential component in complication
avoidance with percutaneous treatment for Trigeminal Neuralgia.
The dimensions of Foramen ovale are useful to neurosurgeons in planning
the skull base surgery.
0
1
2
3
4
5
6
7
Somesh etal(2011)
Desai et al(2012)
Jyosthna etal(2013)
Ashwini etal(2017)
Present study
mm
Rt MLD(mm)
Lt MLD(mm)
S. NO. AUTHORS Rt MLD
(mm) Lt MLD
(mm) 1 Somesh et al (2011) 5.12 5.2
2 Desai et al (2012) 5.26 5.88
3 Jyosthna Patil et al (2013) 5 4.70
4 Ashwini et al (2017) 4.83 4.59
5 Present study 5.09 5.24
66
SHAPE OF FORAMEN OVALE
Somesh et al (2011)59, observed that oval shape of FO as 56% followed by
almond, round and slit as 28.6%, 10.97%& 9% out of 82 dry skulls.
Anju et al (2013)4 reported that shape of FO as oval 54.29%, almond
5.71%, round 8.57% and slit 1.43%.
Roma Patel et al (2014)53 reported that shape of FO as oval in 59.5%,
almond 12%, round 27.5% and slit 1%.
Suniti Raj et al (2016)61 observed that most common shape of FO was
oval accounted for oval shape 66% , almond 22%, D shaped 2%,Slit like
2%,round3% and irregular 3%.
Poornima et al (2017) 49found that the most predominant shape of FO was
oval 60% followed by round13%, almond 25%and slit 2%.
Comparison was done with various studies showing the shape of Foramen
ovale and was tabulated.
In the present study, the various shapes of FO were observed. The most
common shape was oval which accounted for 57.5% followed by almond 17.5%,
round 16% and slit 9%. The present study coincides with previous studies.
67
The knowledge about various shapes of FO is clinically important
to .the neurosurgeons to perform procedure such as percutaneous trigeminal
rhizotomy for treatment of Trigeminal Neuralgia.52 This procedure in general aim
to reach the trigeminal nerve ganglion or sensory root through the foramen ovale.
The shape of FO is also important for electroencephalographic analysis of
seizures by placing the electrode through the foramen. This procedure is done to
lateralize ictal onsets in patients undergoing temporal lobectomy and
Amygdalohippocampectomy.53
The oval shape of FO facilitates the percutaneous biopsy of cavernous
sinus tumours which is necessary prior to decisions involving treatment
modalities for cavernous sinus tumours.
68
TABLE 20 COMPARISON OF SHAPES OF FORAMEN OVALE
SNO AUTHORS OVAL (%)
ALMOND (%)
ROUND (%)
SLIT (%)
1 Somesh et al (2011) 56 28.6 10.97 -
2 Anju et al (2013) 54.29 35.71 8.57 1.43
3 Roma Patel et al (2014) 59.5 12 27.5 1
4 Poornima et al (2015) 60 25 13 2
5 Present study 57.5 17.5 16 9
CHART: 17 SHAPE OF FORAMEN OVALE
0
10
20
30
40
50
60
70
Somesh etal(2011)
Anju etal(2013)
Roma Patelet al(2014)
Poornima etal(2015)
Presentstudy
Perc
enta
ge Oval
Almond
Round
Slit
69
BONY OUT GROWTH AROUND THE MARGIN OF FORAMEN OVALE
Biswabina Ray et al (2005)8 studied 35 skulls, reported that bony plate
was seen in 12.8% of skulls, spine seen in 4.2%, spur seen in 2.8% & tubercle
seen in 4.2%.
Ambica wadhwa et al (2012)3 did a study on 30 skulls and reported that
10% of skulls showed the presence of bony plate, 1.6% skulls showed spine and
5% of skulls showed presence of tubercle.
Nirupma et al (2013)43 in their study on 35 skulls reported that margins of
FO showed spines-4.2%, tubercles-5.7%, and bony plate-8.5%.
Deepti et al (2015)13 in their study stated that out of 30 skulls the
incidence of bony plate, spine and tubercle were 11.6%,13% &6% respectively.
Poornima et al (2017)49 did a study on 100 skulls and reported that
incidence of various bony out growth around the margin of FO was spine-11%,
bony plate-10% & tubercle-5%
In the present study, the bony out growth seen around the margins of
Foramen ovale were bony plate 8%, spine5.5% and tubercle6%. The
observation of present coincides with previous studies.
Hence the bony out growth around the margins of FO can interfere with the
percutaneous placement of needle or probe into the foramen and can also make it
difficult to approach the cranial base. The bony out growth can narrow the
70
foramen and can cause compression of structures passing through it which can
also lead to entrapment of mandibular nerve.
TABLE : 21 COMPARISON OF BONY OUT GROWTH AROUND THE
MARGINS OF FORAMEN OVALE.
SNO AUTHORS BONYPLATE SPINE TUBERCLE
1 Ambica wadha et al(2012 10% 1.6% 5%
2 Poornima etal(2017) 10% 11% 5%
3 Nirupama et al(2013) 8.5% 4.2% 5.7%
4 Present study 8% 5.5% 6%
CHART: 18 BONY OUTGROWTH AROUND MARGIN OF FORAMEN
OVALE
0%
2%
4%
6%
8%
10%
12%
Ambica etal(2012)
Poornimaetal(2017)
Nirupama etal(2013)
Present study
BONYPLATE
SPINE
TUBERCLE
71
ANTEROPOSTEROR DIAMETER OF FORAMEN SPINOSUM
Osunwoke E.A et al (2010)44 conducted a study on 87 dry human adult
skulls of southern Nigerian population and reported that mean APD of Rt FS was
2.34 +0.05mm and mean APD of Lt FS was 2.36+ 0.05 mm respectively.
Agarwal Deepa Rani et al (2012)1 studied 50 dry skulls and reported that
mean APD of Right Foramen spinosum was 2.42+0.05 mm and left Foramen
spinosum was 2.37+ 0.05mm
Jeyanthi Krishnamurthy et al (2013)19 in their study of 50 dry human
skulls said that the mean APD of Rt FS and Lt FS were 2.58mm and 2.35mm
respectively.
Raval Binita et al (2015)51 studied 150 adult human skulls and report
ed that mean APD of Rt side FS was 2.49±0.60mm and APD of Lt side FS was
2.55 ± 0.70mm
In the present study, the antero posterior diameter of right FS ranged from
4.44mm to1.33mm with mean as 2.483mm±0.628mm. The antero posterior
diameter of left FS ranged from4.23mm to 1.27mm with mean of
2.528mm±0.594mm. The mean Rt APD and Lt APD of the present study
coincide with values of previous studies.
72
TABLE :22 COMPARISON OF ANTEROPOSTERIOR DIAMETER OF
FORAMEN SPINOSUM
SNO AUTHORS Rt APD(mm) Lt APD(mm)
1 Jeyanthi et al( 2013) 2.58 2.35
2 Raval binita et al(2015) 2.49 2.55
3 Present study 2.48 2.52
CHART: 19 ANTEROPOSTERIOR DIAMETERS (APD) OF FORAMEN
SPINOSUM
2.2
2.25
2.3
2.35
2.4
2.45
2.5
2.55
2.6
Jeyanthi et al2013
Raval binita et al2015
Present study
mm
Rt APD(mm)
Lt APD(mm)
73
MEDIOLATERAL DIAMETER OF FORAMEN SPINOSUM
Osunwoke E.A et al (2010)44 conducted a study on 87 dry skulls and
reported that the MLD of Rt FS was 1.66+ 0.03mm and MLD of Lt FS was
1.61+0.03mm.
Agarwal Deepa Rani et al (2012)1 analyzed 50 dry human skulls and
observed that the MLD of Rt FS and Left FS were 1.68+0.03mm and
1.65+0.03mm
Phalguni Srimani et al (2014)47 analyzed 40 dry human skulls and found
that MLD of Rt FS was 1.65+0.25mm and MLD of Lt FS was 1.70+0.19mm.
Somesh M.S et al (2015)60 conducted a study on 82 dry human skulls and
reported that MLD of Rt FS and Lt FS were 2.68mm and 2.67mm respectively.
In the present study, the mediolateral diameter of right FS ranged from
2.26mm to0.91mm with mean as 1.293mm±0.338mm. The mediolateral
diameter of left FS ranged from3.33mm to 0.88mm with mean of
1.446mm±0.366mm. The mean Rt APD and Lt APD of the present study
coincide with values of previous studies.
The dimensions of Foramen spinosum may be helpful to neurosurgeons as
location of FS is important in surgeries which use middle meningeal artery as
graft in bypass surgeries such as anastomosis of MMA with petrous part of ICA
or with posterior cerebral artery.37
74
TABLE : 23 COMPARISON OF MEDIOLATERAL DIAMETER OF
FORAMEN SPINOSUM.
SNO Authors Rt MLD (mm)
Lt MLD (mm)
1 Osunwoke et al (2010) 1.66 1.61
2 Agarwal Deepa et al (2012) 1.68 1.65
3 Phalguni Srimani et al (2014) 1.65 1.70
4 Present study 1.29 1.44
CHART: 20 MEDIOLATERAL DIAMETER OF FORAMEN SPINOSUM
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8
Osunwoke etal 2010
Agarwal et al2014
Phalguni etal 2014
Presentstudy
mm
Rt MLD (mm)
Lt MLD(mm)
75
POSITION OF FORAMEN SPINOSUM IN RELATION TO SPINE OF
SPHENOID
Jeyanthi Krishnamurthy et al (2013)19 analyzed 50 dry human skulls and
stated that position of FS was antero medial to spine of sphenoid accounting for
96% and 4% lateral to spine of sphenoid.
In the present study, the position of FS was observed anteromedial in
96.5% of skulls. FS was seen lateral to spine of sphenoid in 1% of skulls and
medial to spine of sphenoid in 0.5% of skulls.
The position of FS is important for approaching the base of the skull.
Spine of sphenoid is related to chorda tympani nerve medially and
auriculotemporal nerve laterally . In Supratentorial hematomas, surgical procedure
includes a bone flap over the greater diameter of the clot, with exposure of FS.
So the knowledge about the relation of spine of sphenoid to FS is very helpful to
the neurosurgeons and even to radiologist to known about normal and abnormal
positions in CT and MRI studies.19
76
TABLE: 24 COMPARISON OF POSITION OF FORAMEN SPINOSUM
TO SPINE OF SPHENOID
SNO Authors Anteromedial Lateral Medial Absence
1 Jeyanthi et al (2013) 96% 4% - -
2 Present study 96.5% 1% 0.5% 2%
CHART: -21 POSITON OF FORAMEN SPINOSUM IN RELATION TO
SPINE OF SPHENOID
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Anteromedial Lateral Medial Absence
Jeyanthi et al 2013
Present study
77
SHAPE OF FORAMEN SPINOSUM
Desai S.D. et al (2012)15 Conducted a study on the shape of FS in 125
skulls and found them to be as being round (52%), Oval (42.%) and irregular
(16%).
Jeyanthi et al (2013)19 reported that out of 50 skulls the shape of FS was
round - 55%, oval- 40% & irregular 2%
Somesh M.S. et al (2015)60 conducted study on 82 dry human adult skulls
and observed that round -53.65% oval -35.36% , Pinhole-6.70%, irregular-
4.26%.
In present study, the common shape of FS was round accounted for
59.5% followed by oval 33.5%, pinhole 3%, irregular 2% and absence 2%.
Variations in the shape of FS can affect the structures passing through it. Hence
knowledge about different shapes of FS is clinically important to neurologist and
radiologist.
78
TABLE: 25 COMPARISION OF SHAPES OF FORAMEN SPINOSUM
CHART : 22 SHAPES OF FORAMEN SPINOSUM
0
10
20
30
40
50
60
70
Desai et al 2012 Jeyanthi et al2013
Somesh et al2015
Present study
Perc
enta
ge Round
Oval
Pinhole
Irregular
S. NO Authors Round Oval Pinhole Irregular
1 Desai et al (2012) 52% 42% - 16%
2 Jeyanthi et al(2013) 55% 40% - 2%
3 Somesh et al(2015) 53.6% 35.6% 6.7% 4.26%
4 Present study 59.5% 33.5% 3% 2%
79
ABSENCE OF FORAMEN SPINOSUM
Anju Lata Rai et al (2012)2 studied 35 dried human skulls and reported
the absence of foramen Spinosum in 2.85% of skulls.
Kulkarni surabha et al (2013)30 in their study of 100 human dry skulls
reported the absence of FS as 2.5%.
Jeyanthi Krishsnamurthy et al (2013)19 conducted study on 100 dry
skulls and reported that absence of FS was only 2%.
Somesh M.S et al (2015)60 observed the absence of FS in 2.5% of the 82
dry adult human skulls studied.
In present study, the absence of FS observed as 2%. The present study
value coincides with previous studies. The absence of FS may occur when the
MMA arise from ophthalmic artery instead of Maxillary artery58.
80
TABLE: 26 COMPARISION OF ABSENCE OF FORAMEN SPINOSUM
SNo Authors Absence of FS (%)
1 Anju et al (2012) 2.85
2 Kulkarni et al(2013) 2.5
3 Jeyanthi et al(2013) 2
4 Somesh et al(2015) 2.5
5 Present study 2
CHART: 23 ABSENCE OF FORAMEN SPINOSUM
0
0.5
1
1.5
2
2.5
3
Anju et al2012
Kulkarni et al2013
Jeyanthi et al2013
Somesh et al2015
Presentstudy
Perc
entg
e
Absence of FS
81
DUPLICATION OF FORAMEN SPINOSUM
Jerzy Reymond et al (2005)18 analyzed 100 adult human skulls and
reported that duplication of FS was not seen in their study.
Mandavi et al ( 2009)36 conducted study on 312 skulls and reported that
the duplication of FS was 2.56%.
Osunwoke et al (2010)44 conducted study on 87 dry adult human dry
skulls of Nigerian population and said that there was no duplication of FS.
Karan Bhagwawan Khairnar et al(2013)24 conducted study on 100 adult
human skulls and reported that the incidence of duplication of FS was 3%.
In present study, out of 100 skulls duplication of FS was not seen in any
skulls. The present study coincides with the study done by Osunwoke et al and
Jercy Reymond et al.
82
TABLE: 27 COMPARISON OF DUPLICATION OF FORAMEN
SPINOSUM
SNO Authors Duplication of FS
1 Mandavi et al 2009 2.56%
2 Osunwoke et al(2010) 0%
3 Karan Bhagwan et al ( 2013) 3.5%
4 Present study 0%
CHART 24 DUPLICATION OF FORAMEN SPINOSUM
0
0.5
1
1.5
2
2.5
3
3.5
4
Madavi et al2009
Osunwoke etal 2010
Karan et al2013
Present study
Perc
enta
ge
Duplication of FS(%)
83
INCIDENCE OF FORAMEN OF VESALIUS
Jerzy Reymond et al (2005)18 analyzed 100 adult skulls and reported that
presence of Fv as 17%.
Neha Gupta et al (2014)41 in their study of 200 dry human skulls observed
that presence of FV account for 14%.
Phalguni Srimani et al ( 2014)47 conducted study on 40 dry adult skulls
and reported that the Presence of FV was 5%.
Ozer et al (2014)45 in their study observed that the presence of FV was
9.3%.
Surekha D. Jadhav et al (2016)63 in their study on 250 skulls reported that
the presence of FV was 11.2%.
In the present study, the presence of Foramen of Vesalius is 5% which
coincides with study done by Phalguni Srimani et al . The variation in the
incidence of FV may be due limitation of the study. Knowledge about the
presence of FV aid in respect to neurosurgeons to prevent iatrogenic unwanted
surgical trauma. The location of FV can affect the procedures involving FO.
Abberant placement of cannula can result in unintended neurovascular injuries.
84
TABLE: 28 COMPARISON OF INCIDENCE OF FORAMEN OF VESALIUS.
SNO Authors Presence of
FV(%) 1 Reymond et al 2005 17
2 Phalguni Srimani et al2013 5
3 Ozer et al 2014 9.3
4 Surekha et al 2016 11.2
5 Present study 5
CHART : 25 PRESENCE OF FORAMEN OF VESALIUS
0
2
4
6
8
10
12
14
16
18
Reymond etal 2005
Phalguni et al2013
Ozer et al2014
surekha et al2016
Present study
Perc
enta
ge
Presence of FV
Conclusion
85
CONCLUSION
The comprehensive Knowledge of morphology and morphometry of
Foramen ovale and Foramen spinosum is of paramount importance in the field of
neurosurgery as it facilitates the high levels of precision and accuracy needed in
various diagnostics as well as interventions involving base of the skull.
An effort has been made in this study to asses the Foramen ovale and
Foramen spinosum morphometrically and morphologically through this study.
The following conclusions were drawn
The anteroposterior diameter of Foramen ovale was 7.64±1.22mm on right
side and 7.49±0.98mm on the left side.
The mediolateral diameter of Foramen ovale was 5.09±0.96mm on the
right side and 5.24±0.83mm on the left side.
In the present study, the eponymous Foramen ovale was found to be oval
in 57.5%. almond in 17.5%, round in16% and slit like in 9%. Variations in
the shape of FO is taken into consideration during neuroimaging
techniques and skull base surgery.
86
The bony out growth around the margin of Foramen ovale were bony plate
8%, spine5.5% and tubercle6%. Such bony obstructions can interfere with
transcutaneous needle placement into FO. and also compress the
neurovascular structures traversing through it.
The anteroposterior diameter of FS was 2.48±0.62mm on the right side and
2.52mm±0.59mm on the left side.
The mediolateral diameter of FS was 1.29±0.33mm on the right side and
1.44±0.36mm on the left side.
The shape of FS was round accounted for 59.5% followed by oval 33.5%,
pinhole 3%, irregular 2% and absence 2%.
The absence of FS observed in the present study was 2%.The absence of
FS provides the knowledge that the Middle meningeal artery arise from
ophthalmic artery instead of maxillary artery.
In the Present study, 96.5% of FS was anteromedial to spine of sphenoid,
0.5% was medial to spine of sphenoid and 1% lateral to spine of
sphenoid.
87
There was no duplication of FS observed in the present study.
In the present study, the incidence of Foramen of Vesalius was 5%.
Though it is a small and inconstant foramina, the knowledge about the
occurrence of FV may assist neurosurgeons while performing
percutanous procedure through FO and avoid injury to the structure
passing through Foramen of Vesalius.
The anatomic Knowledge about Foramen ovale and Foramen spinosum
may be useful to neurosurgeons for planning the various skull base
surgeries. The findings will also be enlightening for Radiologist and
Clinical anatomist. .
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MASTER CHART
SKULL NO.
APD FO (mm)
MLD FO (mm)
SHAPES OF FO
BONY OUT GROWTH FV APD FS
(mm) MLD FS (mm) SHAPES FS
POSITION OF FS IN RELATION
TO SS P/A FS DUPLICATION
OF FS
Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt 1 8.12 7.69 5.07 4.73 R O A A A A 1.33 2.14 1.02 1.82 O R AM AM P P A A 2 7.81 8.52 5.26 5.54 AL O A A P P 3.05 2.96 1.91 2.53 O O AM AM P P A A 3 8.29 7.78 4.95 4.56 O AL A A A A 2.39 2.36 1.98 1.67 O PIN AM AM P P A A 4 7.35 6.68 4.04 3.82 O S A A A A 3.3 4.23 1.62 3.33 R R AM AM P P A A 5 8.17 7.2 5.14 6.24 O O BP A A A 2.05 2.82 1.03 1.52 O R AM AM P P A A 6 6.98 6.66 5.53 5.43 O R A A A A 1.92 2.03 0.91 1.34 IRR R AM AM P P A A 7 8.24 5.57 4.19 4.9 AL O A SP A A 2.43 2.21 1.32 1.48 O R AM AM P P A A 8 7.86 5.41 3.33 4.4 O S A A A A A 2.66 A 1.99 A R A AM A P A A 9 11.2 8.78 5.28 7.45 R AL A A A A A 3.82 A 2.15 A R A AM A P A A
10 8.48 7.1 3.78 5.37 O R A A A A 4.1 3.29 2.26 2 R PIN AM AM P P A A 11 7.32 6.93 5.43 4.12 O S A A A A 2.04 2.72 1.02 1.42 PIN R AM AM P P A A 12 9.55 8.23 6.51 5.14 AL O A A A A 4.44 2.91 1.78 1.4 R IRR AM AM P P A A 13 9.42 7.96 4.54 5.06 O O A A A A 2.05 2.26 2 2.52 R O AM AM P P A A 14 10.4 8.95 6.76 5.88 O O A A A A 3.57 3.36 1.37 1.57 R R AM AM P P A A 15 10.3 8.33 6.54 5.8 O AL T A A A 2.98 2.94 1.2 1.11 R R AM AM P P A A 16 8.3 7.99 4.51 5.06 O R A A A P 2.18 2.03 1.4 1.2 PIN R AM AM P P A A 17 9.12 8.22 5.42 6.21 AL O A T A A 2.76 3.18 1.58 2.2 R O AM AM P P A A 18 10.1 9.66 4.74 6.36 O O BP A A A 2.5 2.31 1.72 1.92 R R AM AM P P A A 19 8 7.8 4.67 4.85 O O A A A A 3.07 2.48 1.28 1.59 R PIN AM AM P P A A 20 7.55 9.48 4.57 7.31 O O A SP P A A 2.15 A 1.02 A R A AM A P A A 21 9.57 8.36 5.53 5.87 AL R A T A P 3.08 2.49 2.18 1.59 R R AM AM P P A A 22 7.12 7.42 4.57 4.72 O O A BP A A 2.52 A 1.34 A R A AM A P A A A 23 9.1 7.23 4.54 4.09 O R A A A A 2.62 2.03 1.03 1.02 PIN R AM AM P P A A 24 10.8 8.35 5.33 4.69 AL O BP A A A 2.5 2.61 1.24 1.83 R R AM AM P P A A 25 9.05 7.42 5.14 4.77 O AL A A A A 2.05 2.25 1.03 1.75 PIN R AM AM P P A A 26 8.65 5.86 4.71 4 O O A A A A 2.15 3.09 1.12 1.22 R R AM AM P P A A 27 7.44 6.18 4.13 4.79 O R A A A A 3.02 2.35 1.48 1.62 O R AM AM P P A A 28 10.5 8.61 5.74 4.79 R O A A A A 2.24 2.33 1.02 1.04 R PIN AM AM P P A A 29 7.44 8.12 4.24 5.43 AL O BP A A A 2 1.27 1 0.88 R R AM AM P P A A 30 8.05 7.1 4.34 5.42 O AL A SP A A 2.05 2.62 1.03 1.22 R R AM AM P P A A 31 7.06 7.01 4.13 4.79 O O A A A A 2.11 2.06 1.7 1.12 O R AM AM P P A A 32 6.48 8.07 3.62 3.74 O O T A A A 2.08 1.38 1.02 1.34 R R AM AM P P A A 33 8.35 7.08 5.72 4.91 AL R A A A A 2.6 1.4 1.04 1.48 R R AM AM P P A A
SKULL NO.
APD FO (mm)
MLD FO (mm)
SHAPES OF FO
BONY OUT GROWTH FV APD FS
(mm) MLD FS (mm) SHAPES FS
POSITION OF FS IN RELATION
TO SS P/A FS DUPLICATION
OF FS
Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt 34 6.02 5.62 3.56 3.69 O O A BP A A 2.24 3 1.48 1.28 R R AM AM P P A A 35 7.44 7.35 2.8 3.95 AL O SP A A A 2.4 2 1.42 1.4 R PIN AM AM P P A A 36 7.37 7.98 3.04 3.7 O AL A A A A 2.3 2 1.12 1.12 R R AM AM P P A A 37 6.32 8.2 3.04 3.82 R S A A A A 2.15 3 1.09 1.08 R R AM AM P P A A 38 6.87 7.88 3.62 3.84 O R A A A A 2.32 2 1.34 1.34 R R AM AM P P A A 39 6.89 7.48 4.54 4.48 O O A A P P 2.52 3 1.48 1.38 IRR R AM AM P P A A 40 8.35 7.34 4.56 4.82 AL O A T A A 2.62 2.34 1 1.12 PIN R AM AM P P A A 41 7.45 7.48 3.8 3.82 O AL A A P A 3.02 2.58 1.46 1.38 R O AM AM P P A A 42 7.65 7.68 4.04 4.02 O O A BP A A 3 3.48 1.12 1.34 R PIN AM AM P P A A 43 6.47 7.6 3.94 4.08 R R A A A A 2.98 2.68 1.36 1.48 O R AM AM P P A A 44 6.03 7.6 4.24 4.18 AL O T A A A 2.96 2.78 1.38 1.42 R R AM AM P P A A 45 5.83 8.02 3.9 4.02 O R BP A P A 2.8 3 1.36 1.4 R R AM AM P P A A 46 6.55 8.09 4.54 4.58 R O A A A A 3 3 1.3 1.38 R O AM AM P P A A 47 7.55 8.08 4.56 4.9 AL O A A A A 2.15 3.09 1.28 1.38 IRR R AM AM P P A A 48 7.95 8.08 4.78 5.18 R AL A BP A A 2.05 1.67 1.12 1.42 R R AM AM P P A A 49 8.35 8.12 4.98 5.12 O R A A A A 2.15 1.8 1.2 1.48 R R AM L P P A A 50 6.35 8.2 5.56 5.82 AL O A A A A 2.8 1.98 1.34 1.4 R R AM AM P P A A 51 6.02 8.04 4.54 4.7 R O A A A A 2 2 1.48 1.32 O R AM AM P P A A 52 6.13 8.3 4.56 4.82 S O A SP A P 2.15 2 1.48 1.48 R R AM AM P P A A 53 7.59 8.28 4.98 5.12 O O T A A A 2.62 2 1.36 1.32 R R AM AM P P A A 54 7.75 8.9 5.65 5.7 O R A A A A 2.52 2.46 1.32 1.3 PIN R AM AM P P A A 55 7.85 8.28 5.54 5.7 R O A A A A 2.42 2.6 1.32 1.32 R O AM AM P P A A 56 7.95 8.4 4.84 5.7 AL O BP A A A 2.32 2.78 1.46 1.36 R PIN AM AM P P A A 57 8.01 8.02 5.24 5.2 O O A A A A 2.02 2.8 1.56 1.48 R R AM AM P P A A 58 9.1 8.58 5.24 4.09 O R A A A A 2.15 2.88 1.12 1.32 R R AM AM P P A A 59 8.55 8.78 5.04 5.12 R O A A A A 2.05 2.78 1.08 1.2 O R AM AM P P A A 60 8.75 8.98 5.14 5.2 O O A SP A A 2.32 2.98 1.08 1 R R AM AM P P A A 61 8.45 9.02 5.24 5.02 AL O A A A A 2.42 2.87 1.78 1.56 R R AM AM P P A A 62 8.35 8.98 6.56 6.18 O AL A A P P 2.42 2.67 1.34 1.56 R R AM AM P P A A 63 5.35 7.02 6.68 6.7 R S A T A A 2.52 1.67 1.36 1.36 R O AM AM P P A A 64 6.35 6 6.8 6.7 O O SP A A A 2.6 1.8 1.38 1.48 IRR R AM AM P P A A 65 7.65 7.38 5.68 5.7 S R A BP A A 2.72 1.8 1.4 1.34 R R AM AM P P A A 66 6.01 6 5.8 5.7 AL O T A A A 2.82 1.8 1.12 1.3 R R AM AM P P A A 67 6.02 6.12 6.2 5.7 O O A BP A A 2.9 2 1.48 1.34 R R AM AM P P A A 68 6.47 5.98 5.68 5.7 O O A A A A 3 3 1.46 1.36 R R AM AM P P A A
SKULL NO.
APD FO (mm)
MLD FO (mm)
SHAPES OF FO
BONY OUT GROWTH FV APD FS
(mm) MLD FS (mm) SHAPES FS
POSITION OF FS IN RELATION
TO SS P/A FS DUPLICATION
OF FS
Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt 69 6.85 7.12 5.24 5.48 O O SP A A A 3 3.09 1.32 1.42 R R AM AM P P A A 70 7.75 7 5.34 5.58 AL O A A A A 3 3.02 1.28 1.48 R R AM AM P P A A 71 7.95 6.48 5.44 5.68 O R A A A A 2.05 3.09 1.26 1.22 R R AM AM P P A A 72 5.35 5.48 5.45 4.93 R O A A A A 2 2.9 1.28 1.12 R R AM AM P P A A 73 6.35 6.2 5.56 5.7 S S A A A A 2.6 2.88 1.46 1.6 R O AM AM P P A A 74 6.02 6 5.68 5.58 O O A BP A A 2.42 2.87 1.32 1.48 PIN R AM AM P P A A 75 6.47 6.4 5.9 4.7 AL O A A A A 2.42 2.67 1.46 1.78 R R AM AM P P A A 76 6.55 6.8 6.12 4.7 S O A A A A 2.4 2.8 1.36 1.12 R R AM AM P P A A 77 6.85 7 7.44 5.7 O P BP A A A 2.48 2.88 1.38 1.56 PIN R AM AM P P A A 78 7.55 7.4 7.56 6.58 AL P A A A A 2.36 1.8 1.36 1.7 IRR R AM AM P P A A 79 7.75 7.8 4.68 5.12 R P A SP A A 2.34 1.8 1.34 1.48 R R AM AM P P A A 80 7.95 7.8 5.01 5.18 O R A A A A 2.12 1.9 1.32 1.48 R R AM AM P P A A 81 7.95 7.8 5.02 5.16 O O A A A A 2.72 2 1.3 1.32 O O AM AM P P A A 82 6.02 6 5.24 5.7 O O A A A A 2.9 3 1.28 1.28 R R AM AM P P A A 83 9.05 6 5.24 5.82 O S T A A P 3 3 1.12 1.48 R R AM AM P P A A 84 8.35 7 4.88 5.7 S O A A A A 2.15 3 1.12 1.38 R R AM AM P P A A 85 7.35 7 5.12 5.7 O R A BP A A 2.48 3.08 1.12 1.48 PIN R M AM P P A A 86 6.85 7 5.56 5.7 S O A A A A 3 2.98 1.24 1.32 O R AM AM P P A A 87 6.65 7 5.56 5.7 O O A A A A 3 2.88 1.38 1.48 R R AM AM P P A A 88 6.95 7 5.56 5.38 O R A T A A 2.98 2.34 1.12 1.12 R R AM AM P P A A 89 6.15 6 6.68 6.58 O S A A A A 2.92 2.48 1.48 1.56 R R AM AM P P A A 90 6.25 7.12 3.8 4.69 AL O A A A A 2.84 2.78 1.36 1.56 R R AM AM P P A A 91 6.35 8 3.89 5.7 O AL SP A A A 2.64 2.78 1.12 1.48 R O AM AM P P A A 92 6.55 6 5.18 4.92 S O A A P P 2.88 2.78 1.14 1.6 R R AM AM P P A A 93 6.75 8 7.56 5.82 O O A A A A 2.8 2.8 1.12 1.32 R R AM AM P P A A 94 6.85 6 4.8 5.7 S R BP A A A 2.66 2.8 1.48 1.38 O PIN AM AM P P A A 95 6.95 7 5.04 5.7 O S A A A A 2.42 2.8 1.18 1.32 R R AM AM P P A A 96 7.05 7 5.02 5.7 AL O A SP A A 2.52 2.8 1.16 1.32 R IRR AM L P P A A 97 8.55 8 6.02 6.82 O O A A A A 2.62 3 1.16 1.48 IRR R AM AM P P A A 98 8.65 9.12 6.04 6.82 O AL A A A A 3 3 1.38 1.38 R O AM AM P P A A 99 8.75 9 6.56 6.56 O O A A A A 2.42 1.8 1.48 1.48 R R AM AM P P A A
100 8.85 8.8 6.68 6.7 S O A T P P 2.52 2 1.34 1.34 R R AM AM P P A A
KEY TO MASTER CHART FO - Foramen ovale
FS - Foramen spinosum
FV - Foramen of vesalius
APD - Anteroposterior diameter
MLD - Mediolateral diameter
Rt - Right side
Lt - Left side
R - Round
AL - Almond
O - Oval
S - Slit
BP - Bony Plate
SP - Spine
T - Tubercle
PIN - Pinhole
IRR - Irregular
SS - Spine of Sphenoid
AM - Anteromedial
M - Medial
L - Lateral
P/A - Presence / Absence
A - Absence
P - Presence
