Morphologic Analysis of Facial Foramina in Three Facial Types: A Study on Dry Skulls and CT-Scans

doi:10.21203/rs.3.rs-3087858/v1

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Research Article

Morphologic Analysis of Facial Foramina in Three Facial Types: A Study on Dry Skulls and CT-Scans

https://doi.org/10.21203/rs.3.rs-3087858/v1

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Purpose

To estimate the morphometric characteristics of the facial foramina in three facial types according to the upper facial index.

Methods

The study was conducted on fifty-two dry adult human skulls and 60 computed tomography. Based on the upper facial index all samples were divided into Euryene, Mesene, and Leptene types of face. The distance between middle facial line (MFL) and supraorbital foramen/supraorbital notch (SOF/SON), infraorbital foramen (IOF), and mental foramen (MF) were measured in all types and overall. Indications of the distances between the collateral facial foramina were obtained. In addition, the distances between SOF/SON and IOF, IOF and MF were estimated. The standard statistical analysis was performed.

Results

In overall, the mean distance SOF/SON-MFL was 19.6 ± 2.4 mm, IOF-MFL 21.9 ± 2.5 mm, and MF-MFL 21.6 ± 2.1 mm. The average distance between the collateral supraorbital foramina was 44.2 ± 6.4 mm, between the infraorbital foramina 47.9 ± 4.2 mm, and 43.6 ± 2.5 mm between the mental foramina, respectively. The distances supraorbital foramen-infraorbital foramen and infraorbital foramen-mental foramen in the present study was found to be 41.5 ± 3.2 mm and 61.2 ± 4.9 mm, respectively.

Conclusion

The data obtained may be particularly helpful while performing surgical operations, local anaesthesia, or aesthetic procedures in the projection of facial foramina.

supraorbital foramen

infraorbital foramen

mental foramen

facial type

craniometry

The supraorbital foramen (SOF) or supraorbital notch (SON), the infraorbital (IOF) and the mental foramina (MF) are three essential paired orifices in the facial part of the skull. Each of these foramina has a specific anatomical position, shape, and size defined in many earlier studies [1, 3, 10, 20, 26]. In the SOF/SON, IOF, and MF, the corresponding blood vessels and nerves pass supplying the blood and nerve fibers to diverse structures of the human face [3, 5, 10, 11].

Detailed knowledge of variations of the facial foramina is imperative for avoiding injury of the nerves or blood vessels [1, 7] and allows a precise approach during dental implantation, maxillofacial surgery, biopsies, scar revisions and other cosmetic cutaneous procedures [10, 26], and anaesthetic procedures [2, 21].

Many studies were devoted to examining morphometric individualities of SOF/SON, IOF, MF in representatives of different ages [15], gender [2, 5], and ethnic groups [6, 25, 30] including their dependencies on climatic conditions [24]. However, there are very little data in the literature about the anatomical features of the facial foramina in humans with different facial types. Therefore, this study aimed to estimate the morphometric parameters of facial foramina in relation to the facial type.

The study was based on the measurements of 52 dry adult human skulls of known gender and age as well as on 60 computed tomography (CT) scans of East Ukrainian humans without facial bone pathology. The study material was taken from the Department of Human Anatomy and the Museum of Kharkiv National Medical University, Ukraine. All morphometric measurements were performed according to the recommendations of Vallois [27]. Dry skull measurements were made using both the sliding and spreading callipers. Measurements of the CT scans were performed using the Anatomage table© and its software Launching Table 6.0 Application© and the DICOM Vidar Dicom Viewer 3.0© program. Each measurement was performed twice, and their average was taken.

Morphometric studies of dry skulls and CT scans involved the identification of the upper facial height and facial breadth as illustrated in Fig. 1.

The obtained morphometric parameters were used for the calculation of the upper facial index (UFI) by applying the following formula:

$$\text{U}\text{F}\text{I}=\frac{n-pr}{\text{z}\text{y}-\text{z}\text{y}} \times 100\%$$

Depending on the UFI, all skulls and CT scans were referred into three facial types (Table 1).

Table 1

Classification of the face according to the UFI value
Facial type	The upper facial index range
Euryene (broad face)	45-49.9
Mesene (round face)	50-54.9
Leptene (long face)	55-59.9

The distances between the facial foramina and the median facial line (MFL) were measured. In addition, the measurements of distances between SOF/SON, IOF and MF on the right and left sides were conducted for each skull and CT scan (Fig. 2.)

All measurements were performed bilaterally, recorded in millimeters and tabulated. Standard statistical methods were applied to the evaluated data and presented as mean ± standard deviation (SD) and range. A comparison of data between the left and right sides and between different facial types was assessed using the Mann-Whitney test for a sample size of less than 30 and the Kolmogorov-Smirnov test for a sample size of more than 30. The obtained p-values were numbered according to the compared pairs with different types of faces: p1 – for the Euryene-Mesene pair; p2 – for Mesene-Leptene and p3 – for Euryene-Leptene, respectively. Statistical differences were considered when the p-value was less than 0.05.

A comparison between the obtained data from the dry skulls with the data of the CT images and their relation to the gender or age of humans was omitted in the present study.

Based on the upper facial index, the examined samples were referred into three facial types as shown in Table 2.

Table 2

Distribution of facial types among the studied specimens
	Dry skulls (n = 52)		CT scans (n = 60)		Total (n = 112)
	n	%	n	%	n	%
Euryene	17	32.7	13	21.7	30	26.8
Mesene	20	38.5	34	56.6	54	48.2
Leptene	15	28.8	13	21.7	28	25

From all the analyzed 112 specimens, 26.8% (n = 30) had Euryene, 48.2% (n = 54) - Mesene, and 25% (n = 28) - Leptene facial types. The average UFI was 47.1 ± 2.8 in Euryene, 52.5 ± 1.4 in Mesene, and 57.3 ± 1.9 in Leptene types. (Fig. 3).

In the present study, we examined the occurrence of SOF/SON, IOF and MF on both sides among all the specimens. The incidence of SOF and SON among the three facial types is summurized in Table 3. The double SOF was established in three dry skulls and two CT scans. The accessory infraorbital foramen (aIOF) was detected in nine cases and the accessory mental foramen (aMF) in five samples. The additional SOF, aIOF, and aMF were excluded from the measurements.

Table 3

Number of SOF or SON in samples with different types of face
	Side	Facial type						Total
		Euryene (n = 30)		Mesene (n = 54)		Leptene (n = 28)		Total
		n	%	n	%	n	%	n	%
SOF	Right	10	16,6	16	14,8	12	21,4	38	34
SOF	Left	9	15	14	13	6	10,7	29	26
SON	Right	20	33,3	38	35,2	16	28,6	74	66
SON	Left	21	35	40	37	22	39,3	83	74

The SON was more usual than the SOF: on the right side SON was present in 66% while SOF only in 34%, and on the left SON was found in 74% while SOF in 26%.

The value of the distances between the facial foramina and the MFL among all samples was detected and represented in Table 4.

Table 4

Table summarizing the distance between the facial foramina and MFL among all the specimens
Measured distance	Side	Samples	Mean ± SD (mm)	Range (mm)	p-value
SON/SOF-MFL	Right	112	19.6 ± 2.8	13.5–30.2	0.96
SON/SOF-MFL	Left	112	19.5 ± 1.9	16.6–23.5	0.96
	Overall	224	19.6 ± 2.4	13.5–30.2
IOF-MFL	Right	112	22.0 ± 2.9	6.9–27.5	0.51
IOF-MFL	Left	112	21.9 ± 1.9	19.0–28.0	0.51
	Overall	224	21.9 ± 2.5	6.9–28.0
MF-MFL	Right	112	20.8 ± 1.8	16.3–23.8	< 0.01
MF-MFL	Left	112	22.3 ± 2.1	16.5–26.2	< 0.01
	Overall	224	21.6 ± 2.1	16.3–26.2

The average distance between SOF/SON and MFL in all samples with different facial types is specified in Table 5. The lowest sizes were found in specimens with Leptene type of face (18.8 ± 1.9 mm), and the highest ones were in Euryene (20.1 ± 3.2 mm). The comparison between facial types found no significant differences (p₁ = 0.77; p₂ = 0.16; p₃ = 0.21).

Table 5

The distances between the SON/SOF and MFL in samples with diverse facial types
Facial type	Side	Samples	Mean ± SD (mm)	Range (mm)	p-value
Euryene	Right	30	20.3 ± 4.0	17.3–30.2	0,43
Euryene	Left	30	20.1 ± 1.7	17.5–21.8	0,43
	Overall	60	20.1 ± 3.2	17.3–30.2
Mesene	Right	54	19.7 ± 2.4	14.1–24.3	0,79
Mesene	Left	54	19.7 ± 2.1	16.6–23.5	0,79
	Overall	108	19.7 ± 2.2	14.1–24.3
Leptene	Right	28	19.7 ± 2.4	14.1–24.3	0,63
Leptene	Left	28	18.7 ± 1.2	17.1–21.5	0,63
	Overall	56	18.8 ± 1.9	14.1–24.3

The IOF-MFL distance in different facial types is summarized in Table 6. The minimal mean was in samples with the Leptene facial type (21.1 ± 1.6 mm), and the maximal – in Euryene (22.6 ± 2.5 mm). There was a significant difference in the Mesene-Leptene pair (p₂ = 0.007) and Euryene-Leptene pair (p₃ = 0.03) and no significant difference in the Euryene-Mesene pair (p₁ = 0.93)

Table 6

The distances between the IOF and MFL in samples with diverse facial types
Facial type	Side	Samples	Mean ± SD (mm)	Range (mm)	p-value
Euryene	Right	30	22.7 ± 2.4	20.3–27.5	1,0
	Left	30	22.5 ± 2.7	19.0–28.0	1,0
	Overall	60	22.6 ± 2.5	19.0–28.0
Mesene	Right	54	22.2 ± 3.5	6.9–27.4	0,39
	Left	54	22.0 ± 1.7	18.9–24.8	0,39
	Overall	108	22.1 ± 2.7	6.9–27.4
Leptene	Right	28	21.2 ± 1.6	18.0-23.9	0,88
	Left	28	21.1 ± 1.6	18.5–23.1	0,88
	Overall	56	21.1 ± 1.6	18.0-23.9

The value of the distance between MF and MFL was also determined (Table 7). The mean was changing from 21.1 ± 1.5 mm (Leptene) to 22.0 ± 1.8 mm (Euryene). There was a significant difference in the Mesene-Leptene pair (p₂₌0.05) and no differences in other pairs of specimens (p₁ = 0.88; p₃ = 0.13).

Table 7

The distances between the MF and MFL in samples with diverse facial types
Facial type	Side	Samples	Mean ± SD (mm)	Range (mm)	p-value
Euryene	Right	30	21.3 ± 1.6	19.0-23.5	0,048
Euryene	Left	30	22.8 ± 2.0	19.3–26.2	0,048
	Overall	60	22.0 ± 1.8	19.0-26.2
Mesene	Right	54	20.9 ± 2.1	16.3–23.8	0,004
Mesene	Left	54	22.4 ± 2.3	16.5–26.1	0,004
	Overall	108	21.7 ± 2.2	16.3–26.1
Leptene	Right	28	20.3 ± 1.3	18.2–22.6	0,01
Leptene	Left	28	21.8 ± 1.7	19.9–25.6	0,01
	Overall	56	21.1 ± 1.5	18.2–25.6

The average meanings of the measured distances between SOF/SON, IOF, MF, and MFL in humans with different facial types are presented in Fig. 4.

Furthermore, the average distances between the corresponding right and left SOF/SON, IOF and MF among all the samples and with distribution relative to the facial type were established and displayed in Table 8 and Figs. 5–7.

Table 8

The distances between the collateral facial foramina among all the specimens
Measured distance	Samples	Mean ± SD (mm)	Range (mm)
SOF/SON- SOF/SON	112	44.2 ± 6.4	36.2–68.6
IOF-IOF	112	47.9 ± 4.2	36.4–60.5
MF-MF	112	43.6 ± 2.5	38.8–49.8

The mean distance between the right and left SOF/SON reached the lowest value in Leptene (43.5 ± 3.3 mm), and the highest value was estimated in Euryene (45.4 ± 8.4 mm). Statistical analysis did not show a significant difference between pairs of the specimens (p₁ = 0.73; р₂=0.61; р₃=0.88).

The minimum value of the mean IOF-IOF distance was established in Leptene samples (47.2 ± 3.8 mm), and the maximum value was found in Euryene (48.7 ± 4.0 mm). The statistical comparison between the facial types found no significant differences (p₁ = 0.86; p₂ = 0.20; p₃ = 0.17).

The corresponding mean MF-MF distance was changing from 43.3 ± 2.5 mm (Leptene) to 43.9 ± 1.9 mm (Euryene). There was no significant difference in all pairs of specimens (p₁ = 0.85; p₂ = 0.64; p₃ = 0.23).

The value of the distances between SOF/SON and IOF, as well as IOF-MF without distribution relative to facial type is specified in Table 9.

Table 9

*The distances between the facial foramina among all the specimens*
Measured distance	Side	Samples	Mean ± SD (mm)	Range (mm)	p-value
SON/SOF-IOF	Right	112	40.8 ± 2.9	31.8–49.5	0,07
SON/SOF-IOF	Left	112	41.2 ± 3.5	31.7–57.2	0,07
	Overall	224	41.5 ± 3.2	31.7–57.2
IOF-MF	Right	112	60.7 ± 4.5	49.5–71.2	0,23
IOF-MF	Left	112	61.7 ± 5.4	48.1–77.0	0,23
	Overall	224	61.2 ± 4.9	48.1–77.0

We also estimated the range of the distances between SOF/SON and IOF on the right and left sides in specimens with different types of a face (Table 10).

Table 10

Table summarising the distance between the SOF/SON and the IOF related to the type of face
Facial type	Side	Samples	Mean ± Standard Deviation (mm)	Range (mm)	p-value (t-test)
Euryene	Right	30	40.7 ± 4.1	31.8–49.5	0,35
	Left	30	40.2 ± 2.2	35.8–43.6	0,35
	Overall	60	40.5 ± 3.3	31.8–49.5
Mesene	Right	54	41.7 ± 2.2	34.6–45.7	0,98
	Left	54	41.4 ± 3.5	31.7–48.5	0,98
	Overall	108	41.6 ± 2.9	31.7–48.5
Leptene	Right	28	42.9 ± 2.3	36.8–47.6	0,05
	Left	28	41.8 ± 4.4	32.6–57.2	0,05
	Overall	56	42.3 ± 3.5	32.6–57.2

The value of the distance between the SOF/SON and IOF was variable in samples with different facial types and gradually increased from Euryene (40.5 ± 3.3 mm) to Leptene (42.3 ± 3.5 mm). Statistical analysis found no significant differences between the right and left sides. Comparison of the pairs with various facial types established the significant differences in the Euryene-Mesene pair (p₁ < 0.01) and the Euryene-Leptene pair (p₃ = 0.025).

The average distances between the IOF and MF in Euryene, Mesene and Leptene facial types were 58.8 ± 5.0 mm, 61.6 ± 3.9 mm, and 62.1 ± 6.1 mm, respectively. There were significant differences in the pairs of Mesene-Leptene and Euryene-Leptene pairs (p₁ = 0.01; p₃ = 0.02), and no differences in the pair of Mesene-Leptene pair (p₂ = 0.48) and between the right and left sides of the face (Table 11).

Table 11

Table summarising the distance between the IOF and MF related to the type of face.
Facial type	Side	Samples	Mean ± Standard Deviation (mm)	Range (mm)	p-value (t-test)
Euryene	Right	30	58.6 ± 4.7	49.5–64.5	0,71
Euryene	Left	30	58.9 ± 5.5	48.1–66.0	0,71
	Overall	60	58.8 ± 5.0	48.1–66.0
Mesene	Right	54	60.9 ± 3.5	50.7–67.3	0,18
Mesene	Left	54	62.2 ± 4.1	51.3–71.8	0,18
	Overall	108	61.6 ± 3.9	50.7–71.8
Leptene	Right	28	61.7 ± 5.5	49.5–71.2	0,68
Leptene	Left	28	62.5 ± 6.8	48.5–77.0	0,68
	Overall	56	62.1 ± 6.1	48.5–77.0

The mean distances between facial foramina in specimens with different types of face are displayed in Fig. 8.

The issue of morphological pattern and morphometry of the SOF/SON, IOF and MF has been in the scope of long-term scientific examinations. Some authors estimated morphological parameters of one or two facial foramina, while others examined them in a complex. The materials studied so far include dry skulls, cadaver material, as well as CT images and scans (Table 12).

Table 12

The table indicates the examined facial foramina and the research material
Name of the first author of the study	Type of research material (quantity)	Ethnic group	Researched structure
Name of the first author of the study	Type of research material (quantity)	Ethnic group	SOF	IOF	MF
Present study	Dry skulls (52) CT scans (60)	Ukrainian	+	+	+
Aggarwal et al. ¹, 2015	Dry intact skulls (67)	Indian	-	+	-
Agthong et al. ², 2005	Dry skulls (110)	Asian	+	+	+
Ashwini et al. ³, 2011	Dry skulls (83)	South Indian	+	-	-
Aziz et al. ⁴, 2000	Cadavers (47)	European, African American, Hispanic	+	+	-
Chrcanovic et al. ⁵, 2011	Dry skulls (80)	Brazilian	+	+	-
Cutright et al. ⁶, 2003	Cadavers (80)	European, African American	+	+	+
Dixit et al. ⁷, 2014	Dry skulls (75)	North Indian	-	+	-
El Sheikh et al. ⁸, 2014	Dry skulls (59)	Egyptian	+	-	-
Gupta et al. ⁹, 2021	Dry skulls (72)	North Indian	+	+	-
Gupta¹⁰, 2008	Dry skulls (79)	North-West Indian	+	+	+
Hester et al. ¹¹, 2020	Cadavers (67)	Hispanic and European	+	+	+
Hong et al. ¹², 2022	CT scans (191)	South Korean	-	+	-
Ibrahim et al. ¹³, 2018	Postmortem CT scans of the skulls (104)	Malay, Chinese, Indian	+	-	-
Ilayperuma et al.¹⁴, 2014	Dry skulls (108)	Sri Lankan	+	-	-
Lim et al. ¹⁵, 2016	CT scans (137)	Korean	+	+	+
Macedo et al. ¹⁶, 2009	Dry skulls (295)	Brazilian	-	+	-
Moiseiwitsch¹⁷, 1997	Cadavers (105)	European, African American	-	-	+
Nanayakkara et al. ¹⁸, 2016	Dry skulls (54)	Sri Lankan	-	+	-
Przygocka et al. ²⁰, 2012	Dry skulls (32)	Polish	-	+	-
Siriwat Thunyacharoen et al. ²², 2022	Dry skulls (160)	Thai	+	+	+
Tezer et al.²³, 2014	Dry skulls (112)	Turkish	-	+	-
Tomaszewska et al.²⁴, 2012	Dry skulls (866)	Karelians and Saamis (309) Poles (151) Lithuanians (205) Italians, Greeks (201)	+	-	-
Turhan-Haktanır et al.²⁵, 2008	CT scans (399)	Turkish	+	-	-
Udhaya et al.²⁶, 2013	Dry mandibles (90)	South Indian	-	-	+
Voljevica et al.²⁸, 2022	Dry skulls (60)	Bosnia and Herzegovina	+	-	-
Woo et al.²⁹, 2013	CT scans (395)	South Korean	+	-	-

The supraorbital passage has two forms: a foramen and a notch. There are also several other variations of SOF and SON. For instance, bilateral foramen/notch or the presence of opposite structures on the left and right sides. Different researchers established different percentages of the prevalence of SOF and SON among their specimens. Most of them reported a significant predominance of the notches over the foramina (frequency of the notches ranging from 69.9 to 92.5%), which also corresponds to our results on the right side SON was present in 66% while SOF only in 34%, and on the left SON was found in 74% while SOF in 26% [3, 6, 13, 14, 15, 25, 29]. However, Thunyacharoen et al. [22] and Woo et al. [29] found a higher incidence of SOF than SON. Chrcanovic et al. reported a slight predominance of the foramina (52,5%) on the notches [5].

According to previous studies, the number of SOF, IOF and MF has evident variations. Each of the facial foramina can have one or more accessory foramen [5, 26, 29] with a different percentage ratio [12, 18, 19, 22]. The additional facial foramina may cause postoperative complications such as sensory deficits and partial nerve blockade [4].

There are various reference points applied to describe the anatomical position of the facial foramina. The location of the SOF/SON in relation to the supraorbital margin and the respective cranial points were reported in previous studies [2, 3, 4, 10, 13, 29]. The different locations of the IOF in relation to the infraorbital margin, borders of the maxilla, and zygomaticomaxillary suture had described in the following studies [1, 2, 4, 6, 10, 11, 17, 18, 20] as well. Furthermore, researchers had reported variations in the position of the IOF with respect to the upper teeth [15, 18, 20, 22]. The position of the MF in relation to the inferior mandibular margin or to the lower teeth had several variations according to data from previous investigations [6, 10, 15, 17, 22, 26].

Contrarily, quite a large number of previous studies report the range and the mean of the distance from the facial openings to the midline of the face. The comparison of the observations made in the present study and the earlier findings is exposed in Table 13.

Table 13

Comparison of the distances from the facial foramina to the MFL obtained by different researchers
Name of the first author of the study	Distance (mm)
Name of the first author of the study	SOF/SON-MFL	IOF-MFL	MF-MFL
Present study	Overall: 19.6 ± 2.4 Euryene 20.1 ± 3.217 Mesene 19.69 ± 2.244 Leptene 18.84 ± 1.986	Overall: 21.9 ± 2.5 Euryene 22.60 ± 2.509 Mesene 22.12 ± 2.700 Leptene 21.11 ± 1.575	Overall: 21.6 ± 2.1 Euryene 22.01 ± 1.774 Mesene 21.67 ± 2.160 Leptene 21.06 ± 1.490
Aggarwal et al. ¹	-	25.69 ± 2.37 mm	-
Ashwini et al. ³	Right side:22.24 ± 0.40 Left side: 22.20 ± 0.39	-	-
Aziz et al. ⁴	Males: 27.7 ± 4.3 Females: 26.2 ± 3.2	Males: 26.5 ± 3.5 Females: 26.3 ± 3.3	-
Chrcanovic et al. ⁵	Males: 28.06 ± 5.24 Females: 26.45 ± 3.66	Males: 26.48 ± 2.58 Females: 24.67 ± 2.41
Cutright et al. ⁶	White male: 24.1 ± 0.4 Black male: 26.1 ± 0.9 White female: 22.3 ± 0.5 Black female: 25.5 ± 0.5	White male: 27.4 ± 0.5 Black male: 29.5 ± 0.5 White female: 24.5 ± 0.3 Black female: 26.4 ± 0.4	White male: 22.5 ± 0.4 Black male: 22.9 ± 0.6 White female: 20.5 ± 0.4 Black female: 21.9 ± 0.4
Dixit et al. ⁷	-	Right: 31.94 ± 4.88 Left: 31.94 ± 4.88 Total: 31.94 ± 4.88	-
El Sheikh et al. ⁸	Right side Male 20.9 ± 2.65 Female 20.0 ± 2.28 Left side Male 21.7 ± 4.0 Female 20 ± 2.99	-	-
Gupta¹⁰	Right side: 23.7 ± 3.0 Left side: 24.1 ± 3.4	Right side: 28.0 ± 2.8 Left side: 28.7 ± 2.5	Right side: 25.9 ± 5.2 Left side: 25.6 ± 4.9
Hester et al. ¹¹	25.3 ± 3.9	29.6 ± 4.4	25.6 ± 3.0
Hong et al. ¹²	-	Male Right 26.3 ± 2.3 Left 26.5 ± 2.1 Female Right 24.7 ± 2.6 Left 25.4 ± 1.7	-
Ibrahim et al. ¹³	Right side Male 26.27 ± 0.45 Female 25.97 ± 0.65 Left side Male 26.17 ± 0.52 Female 25.08 ± 0.48	-	-
Ilayperuma et al.¹⁴	Males 26.12 ± 3.89 Females 24.40 ± 2.76	-	-
Lim et al. ¹⁵	33.7 ± 5.5	37.1 ± 4.1	33.7 ± 3.8
Tezer et al.²³	-	Right 28.27 ± 2.38 Left 28.67 ± 2.59	-
Turhan-Haktanır et al.²⁵	Supraorbital foramen 29.3 ± 5.6 Supraorbital notch 22.5 ± 2.7	-	-
Udhaya et al.²⁶	-	-	25.29 ± 2.29
Voljevica et al.²⁸	24,12 ± 3,1	-	-

In the present study, we assessed the distances between the corresponding right and left SOF/SON, IOF and MF. We found that the mean of the SOF-SOF distance was 45.42 ± 8.388 (Euryene), 43.95 ± 6.599 (Mesene) and 43.47 ± 3.271 (Leptene); IOF-IOF distance was 48.66 ± 4.004 (Euryene), 48.10 ± 4.412 (Mesene) and 47.16 ± 3.796 (Leptene); and the MF-MF distance was 43.86 ± 1.960 (Euryene), 43.61 ± 2.685 (Mesene) and 43.34 ± 2.516 (Leptene). Gupta has found the mean distance between SOF/SON on both sides to be 45.8 ± 5.09 mm (range, 33.6–62.4 mm), the mean distance between the right and left IOF − 53.2 ± 4.3 mm (range, 45.2–63.4 mm) and 43.6 ± 7.7 mm (range, 8.0–49.8 mm) between collateral MF, respectively [10]. In the other study by Przygocka et al., the mean distance between two contralateral IOF was 53.98 ± 3.78 (range, 47.5–59.5 mm) [20]. In the study of Tezer et al., the average distance between the right and left IOF was is 56.85 ± 3.89 mm [23].

The present study estimated the variations of the distance between SOF/SON and IOF in relation to the facial type. Our results are in line with those obtained by previous studies. The comparison of our results with previous reports is shown in Table 14.

Table 14

Comparison of the SOF/SON-IOF distances established by different researchers
Name of the first author of the study	The obtained data
Present study	Overall: 41.5 ± 3.2 Euryene: 40.46 ± 3.263; Mesene: 41.56 ± 2.912 Leptene: 42.33 ± 3.506
Aziz et al. ⁴	43.3 ± 3.1 mm
Chrcanovic et al. ⁵	42.92 ± 3.11mm
Dixit et al. ⁷	42.02 ± 4.31 mm
Gupta S. et al. ⁹	40.86 ± 6.28 mm
Gupta¹⁰	41.8 ± 3.7 (range, 22.8–49.3mm)
Siriwat Thunyacharoen et al. ²²	Right side: 44.04 ± 3.42; Left side: 44.36 ± 3.14
Tezer et al.²³	Right side: 43.25 ± 3.37; Left side: 43.61 ± 3.42
Tomaszewska et al.²⁴	Right side: 42.36 ± 3.54; Left side: 43.00 ± 3.07

Surgical interventions in the areas of the facial openings always carry the risk of damage to vessels or nerves passing through them [4, 10, 15]. Therefore, many studies have been devoted to assist solve this issue. Different techniques of measurement have been proposed by many authors to determine the topographic and anatomical features of the facial foramina [4, 11, 12, 13, 15, 20].

Based on the findings of previous studies, it may be proposed to take into consideration the human age, gender, and ethnicity when surgical, cosmetic manipulations or transcutaneous anaesthesia are planned. Moreover, an equally important fact is the different distances between the left and right corresponding foramen in relation to the middle facial line. Our study demonstrates that the type of face also must be taken into account when the accurate location of the facial foramina is of pivotal clinical importance due to the safety and preservation of nerves and blood vessels passing through these foramina.

ACKNOWLEDGEMENTS

The authors sincerely thank those who donated their bodies to science so that anatomical research could be performed. Results from such research can potentially increase mankind's overall knowledge that can then improve patient care. Therefore, these donors and their families deserve our highest gratitude.

Ethical approval

The study had been conducted according to the principles expressed in the Declaration of Helsinki and approved by the ethical committee of the Kharkiv National Medical University, Kharkiv, Ukraine (protocol No. 7 dated September 11, 2018).

Conflict of interest

The authors declare that they have no competing interests.

Author contributions

Yuliia Onashko: Project development, Data collection and analysis, Manuscript writing and editing.

Oleg Vovk: Project development, Data managements, Manuscript editing.

Dainius Haroldas Pauza: Data managements, Manuscript writing and editing.

Andrii Shmarhalov: Manuscript writing and editing.

Stanislav Malakhov: Data managements, Manuscript writing and editing.

Funding

The authors received no funding for this project.

Data availability

The data sets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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No competing interests reported.

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Morphologic Analysis of Facial Foramina in Three Facial Types: A Study on Dry Skulls and CT-Scans

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