open access
Three-dimensional anatomy of the transantral intraseptal infraorbital canal with the use of cone-beam computed tomography
, 2, 1, 1
Affiliations- “Carol Davila” University of Medicine and Pharmacy of Bucharest, Bucharest, Romania
- Division of Anatomy, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
open access
Abstract
The transantral or ectopic infraorbital canal (IOC) courses diagonally through the maxillary sinus (MS), thereby being exposed to risk during a number of surgical procedures. A few prior reports have presented evidence of a septa-embedded IOC, albeit only on single-plane slices. We identified this extremely rare variation of the IOC during a retrospective study of the cone-beam computed tomography files of 2 patients. In the first case, which involved a 34-year-old female patient, the canals and septa within the MS were bilaterally asymmetrical. On the right side, the sinus roof was attached to a short transverse septum that was traversed by the IOC, while the left sinus featured an oblique large septum that divided it into antero-superior and posterior chambers. The left IOC was embedded within the septum rather than within the orbital floor above the septum. In the second case, which concerned a 36-year-old male patient, the left MS featured an almost completely oblique/vertical septum that divided it into anterior and posterior chambers and also embedded the respective IOC, which was thus absent from the orbital floor. In both cases, infraorbital recesses in the anterior chambers of the MS were found that, if not documented on three-dimensional (3D) renderisations, could have been misidentified as infraorbital (Haller) cells. To the best of our knowledge, this is the first report to document the 3D anatomy of an extremely rare variant, namely a septum-embedded transantral IOC. Such a variant, if not adequately documented preoperatively, could divert the transmaxillary corridors down false paths or else expose the IOC to damage during surgical procedures involving access to tumours.
Abstract
The transantral or ectopic infraorbital canal (IOC) courses diagonally through the maxillary sinus (MS), thereby being exposed to risk during a number of surgical procedures. A few prior reports have presented evidence of a septa-embedded IOC, albeit only on single-plane slices. We identified this extremely rare variation of the IOC during a retrospective study of the cone-beam computed tomography files of 2 patients. In the first case, which involved a 34-year-old female patient, the canals and septa within the MS were bilaterally asymmetrical. On the right side, the sinus roof was attached to a short transverse septum that was traversed by the IOC, while the left sinus featured an oblique large septum that divided it into antero-superior and posterior chambers. The left IOC was embedded within the septum rather than within the orbital floor above the septum. In the second case, which concerned a 36-year-old male patient, the left MS featured an almost completely oblique/vertical septum that divided it into anterior and posterior chambers and also embedded the respective IOC, which was thus absent from the orbital floor. In both cases, infraorbital recesses in the anterior chambers of the MS were found that, if not documented on three-dimensional (3D) renderisations, could have been misidentified as infraorbital (Haller) cells. To the best of our knowledge, this is the first report to document the 3D anatomy of an extremely rare variant, namely a septum-embedded transantral IOC. Such a variant, if not adequately documented preoperatively, could divert the transmaxillary corridors down false paths or else expose the IOC to damage during surgical procedures involving access to tumours.
Keywords
maxillary nerve; infraorbital nerve; antrum of Highmore; canalis sinuosus; cone-beam computed tomography
About this articleTitle
Three-dimensional anatomy of the transantral intraseptal infraorbital canal with the use of cone-beam computed tomography
Journal
Issue
Article type
Case report
Pages
649-653
Published online
2019-10-09
Page views
1199
Article views/downloads
931
DOI
Pubmed
Bibliographic record
Folia Morphol 2020;79(3):649-653.
Keywords
maxillary nerve
infraorbital nerve
antrum of Highmore
canalis sinuosus
cone-beam computed tomography
Authors
L. Cârstocea
M. C. Rusu
C. Pascale
M. Săndulescu
References (10)- Açar G, Özen KE, Güler İ, et al. Computed tomography evaluation of the morphometry and variations of the infraorbital canal relating to endoscopic surgery. Braz J Otorhinolaryngol. 2018; 84(6): 713–721.
- Elnil H, Al-Tubaikh JA, El Beltagi AH. Into the septum I go, a case of bilateral ectopic infraorbital nerves: a not-to-miss preoperative sinonasal CT variant. Neuroradiol J. 2014; 27(2): 146–149.
- Ference EH, Smith SS, Conley D, et al. Surgical anatomy and variations of the infraorbital nerve. Laryngoscope. 2015; 125(6): 1296–1300.
- Jakhere S, Kalmath V, Chillalshetti U. ctopic infra orbital nerves: case series of a dangerous normal variant. Acta Med Indones. 2018; 50(1): 66–69.
- Jones FW. The anterior superior alveolar nerve and vessels. J Anat. 1939; 73(Pt 4): 583–591.
- Krennmair G, Ulm C, Lugmayr H. Maxillary sinus septa: incidence, morphology and clinical implications. J Craniomaxillofac Surg. 1997; 25(5): 261–265.
- Mailleux P, Desgain O, Ingabire MI. Ectopic infraorbital nerve in a maxillary sinus septum: another potentially dangerous variant for sinus surgery. JBR-BTR. 2010; 93(6): 308–309.
- Pommer B, Ulm C, Lorenzoni M, et al. Prevalence, location and morphology of maxillary sinus septa: systematic review and meta-analysis. J Clin Periodontol. 2012; 39(8): 769–773.
- Rusu MC, Sava CJ, Ilie AC, et al. Agger Nasi Cells Versus Lacrimal Cells and Uncinate Bullae in Cone-Beam Computed Tomography. Ear Nose Throat J. 2019; 98(6): 334–339.
- Sava CJ, Rusu MC, Săndulescu M, et al. Vertical and sagittal combinations of concha bullosa media and paradoxical middle turbinate. Surg Radiol Anat. 2018; 40(7): 847–853.
