Evaluation of the Presence and Distribution of Zygomaticofacial Foramen by Cone Beam Computed Tomography in the Central Anatolian Population
Abstract
Objective: This study aimed to investigate the presence, number, and bilateral distribution of the zygomaticofacial foramen (ZFF) in a Central Anatolian population using cone-beam computed tomography (CBCT), and to evaluate potential sex-related differences in its anatomical characteristics.
Materials and Methods: A total of 550 CBCT images from patients aged 16–85 years (273 males, 277 females) were analyzed. High-quality CBCT images were included, while patients with craniofacial anomalies, trauma, or orthodontic treatments were excluded. Image evaluation was performed using OnDemand 3D Imaging Software, and statistical analyses were conducted using SPSS (version 22.0). Chi-square analysis was used to compare ZFF presence and distribution between sexes and sides.
Results: At least one ZFF was present in 211 patients, while 339 patients had no foramen. On the right side, one foramen was observed in 117 patients, two in 40, and three in six. On the left side, 1 foramen was detected in 136 patients, 2 in 20, and 3 in 3. A statistically significant difference was found with respect to foramen presence between the right and left sides (p<0.001). However, no significant difference was observed between sexes (p>0.05).
Conclusions: CBCT imaging effectively identifies anatomical variations of ZFF, assisting in preoperative planning for maxillofacial surgeries. The findings highlight the importance of considering individual anatomical differences during surgical interventions. Further large-scale, multi-center CBCT studies are needed to explore ethnic variations in ZFF anatomy.
Keywords: anatomical variation, cone-beam computed tomography, maxillofacial radiology, maxillofacial surgery, zygomaticofacial foramen
Keywords
anatomical variation; cone beam computed tomography maxillofacial radiology maxillofacial surgery zygomaticofacial foramen
References
- 1. Aksu F, Ceri NG, Arman C, Zeybek FG, Tetik S. Location and incidence of the zygomaticofacial foramen: an anatomic study. Clin Anat 2009;22(5):559-562.
- 2. Deana NF, Alves N. Frequency and location of the zygomaticofacial foramen and its clinical importance in the placement of zygomatic implants. Surg Radiol Anat 2020;42(7):823-830.
- 3. Zhao Y, Chundury RV, Blandford AD, Perry JD. Anatomical Description of Zygomatic Foramina in African American Skulls. Ophthalmic Plast Reconstr Surg 2018;34(2):168-171.
- 4. Connor SE, Tan G, Fernando R, Chaudhury N. Computed tomography pseudofractures of the mid face and skull base. Clin Radiol 2005;60(12):1268-1279.
- 5. Kim HS, Oh JH, Choi DY, Lee JG, Choi JH, Hu KS, et al. Three-dimensional courses of zygomaticofacial and zygomaticotemporal canals using micro-computed tomography in Korean. J Craniofac Surg 2013;24(5):1565-1568.
- 6. Kawata K, Ide Y, Sunohara M. Anatomical study of the zygomaticofacial foramen and zygomatic canals communicating with the zygomaticofacial foramen for zygomatic implant treatment: a cadaver study with micro-computed tomography analysis. Anat Cell Biol 2024;57(2):204-212.
- 7. Loukas M, Owens DG, Tubbs RS, Spentzouris G, Elochukwu A, Jordan R. Zygomaticofacial, zygomaticoorbital and zygomaticotemporal foramina: anatomical study. Anat Sci Int 2008;83(2):77-82.
- 8. Del Neri NB, Araujo-Pires AC, Andreo JC, Rubira-Bullen IR, Ferreira Júnior O. Zygomaticofacial foramen location accuracy and reliability in cone-beam computed tomography. Acta Odontol Scand 2014;72(2):157-160.
- 9. Chanda A, Nanda A. Anatomical study of the orbitozygomatic transsellar-transcavernous-transclinoidal approach to the basilar artery bifurcation. J Neurosurg 2002;97(1):151-160.
- 10. Iwanaga J, Badaloni F, Watanabe K, Yamaki KI, Oskouian RJ, Tubbs RS. Anatomical study of the zygomaticofacial foramen and its related canal. J Craniofac Surg 2018;29(5):1363-1365.
- 11. Mangal A, Choudhry R, Tuli A, Choudhry S, Choudhry R, Khera V. Incidence and morphological study of zygomaticofacial and zygomatico-orbital foramina in dry adult human skulls: the non-metrical variants. Surg Radiol Anat 2004;26(2):96-99.
- 12. Martins C, Li X, Rhoton AL Jr. Role of the zygomaticofacial foramen in the orbitozygomatic craniotomy: anatomic report. Neurosurgery 2003;53(1):168-172.
- 13. de Gouvêa Carvalho CF, de Souza Tolentino E, Herreira-Ferreira M, Iwaki LCV, Chicarelli M. Anatomical in vivo study of variations in zygomatic bone: pneumatization and foramina. Acta Sci Health Sci 2023;45:e58021.
- 14. Khalid S, Iwanaga J, Loukas M, Tubbs RS. Bilateral absence of the zygomatic nerve and zygomaticofacial nerve and foramina. Cureus 2017;9(7):e1505.
- 15. Ferro A, Basyuni S, Brassett C, Santhanam V. Study of anatomical variations of the zygomaticofacial foramen and calculation of reliable reference points for operation. Br J Oral Maxillofac Surg 2017;55(10):1035-1041.
- 16. Krishnamurthy A, Roshni S, Murlimanju BV, Nayak SR, Jiji PJ, Somesh SM, et al. Foramina on the zygomatic bone: its clinical significance. Clin Ter 2011;162(5):419-421.
- 17. Ellis E 3rd, Perez D. An algorithm for the treatment of isolated zygomatico-orbital fractures. J Oral Maxillofac Surg 2014;72(10):1975-1983.
- 18. Lehtinen V, Pyötsiä K, Snäll J, Toivari M. Zygomatico-orbital fracture-dislocation in surgical treatment: novel 3-dimensional software automated analysis. J Oral Maxillofac Surg 2020;78(8):1372-1381.
- 19. Haylaz E, Geduk G, Şeker Ç, İçen M. Retrospective Evaluation of Maxillofacial Fractures with Cone-Beam Computed Tomography. Cumhuriyet Dent J 2022;25(3): 246-251
- 20. Moro SA, Thomé G, Padovan LEM, da Silva RD, Tiossi R, Fontão F. A zygomatic bone study using virtual dental implant planning software. J Oral Implantol 2022;48(3):171-176.
- 21. Pons M, Louvrier A, Bertin E, Meyer C. Intraoperative cone beam assessment after reduction of zygomatic fractures helps in taking a decision on associated orbital floor fractures. J Stomatol Oral Maxillofac Surg 2022;123(5):576-580.
- 22. Guo X, Gao Y, Zhang F, Wang M, Tian X, Huang Q, et al. Assessment of mandibular retromolar space in adults with regard to third molar eruption status. Clin Oral Investig 2023;27(2):671-680.
Orta Anadolu Popülasyonunda Konik Işınlı Bilgisayarlı Tomografi ile Zygomaticofacial Foramen'in Varlığı ve Dağılımının Değerlendirilmesi
Abstract
Amaç: Bu çalışmada, Orta Anadolu popülasyonunda zigomatikofasiyal foramenin (ZFF) varlığı, sayısı ve bilateral dağılımı konik ışınlı bilgisayarlı tomografi (KIBT) kullanılarak araştırılmış ve anatomik özelliklerindeki olası cinsiyete bağlı farklılıklar değerlendirilmiştir.
Gereç ve Yöntemler: 16-85 yaş aralığındaki 273 erkek, 277 kadın hastadan alınan toplam 550 KIBT görüntüsü analiz edilmiştir. Yüksek kaliteli KIBT görüntüleri çalışmaya dahil edilirken, kraniyofasiyal anomalileri, travma veya ortodontik tedavileri olan hastalar çalışma dışı bırakılmıştır. Görüntü değerlendirmesi OnDemand 3D Görüntüleme Yazılımı kullanılarak gerçekleştirilmiş ve istatistiksel analizler SPSS (sürüm 22.0) kullanılarak gerçekleştirilmiştir. Cinsiyetler ve taraflar arasında ZFF varlığını ve dağılımını karşılaştırmak için ki-kare analizi kullanılmıştır.
Sonuçlar: 211 hastada en az bir ZFF mevcutken, 339 hastada foramen yoktu. Sağ tarafta, 117 hastada bir, 40 hastada iki ve altı hastada üç deliğe rastlandı. Sol tarafta ise 136 hastada bir, 20 hastada iki ve üç hastada üç deliğe rastlandı. Sağ ve sol taraflar arasında deliğin varlığı açısından istatistiksel olarak anlamlı bir fark bulundu (p<0,001). Ancak cinsiyetler arasında anlamlı bir fark gözlenmedi (p>0,05).
Sonuçlar: KIBT görüntüleme, ZFF'nin anatomik varyasyonlarını etkili bir şekilde belirleyerek maksillofasiyal cerrahiler için ameliyat öncesi planlamaya yardımcı olur. Bulgular, cerrahi müdahaleler sırasında bireysel anatomik farklılıkların dikkate alınmasının önemini vurgulamaktadır. ZFF anatomisindeki etnik varyasyonları araştırmak için daha geniş ölçekli, çok merkezli KIBT çalışmalarına ihtiyaç vardır.
Anahtar Kelimeler: anatomik varyasyon, konik ışınlı bilgisayarlı tomografi, maksillofasiyal radyoloji, maksillofasiyal cerrahi, zigomatikofasiyal foramen
Keywords
anatomik varyasyon konik ışınlı bilgisayarlı tomografi maksillofasiyal radyoloji maksillofasiyal cerrahi zigomatikofasiyal foramen
References
- 1. Aksu F, Ceri NG, Arman C, Zeybek FG, Tetik S. Location and incidence of the zygomaticofacial foramen: an anatomic study. Clin Anat 2009;22(5):559-562.
- 2. Deana NF, Alves N. Frequency and location of the zygomaticofacial foramen and its clinical importance in the placement of zygomatic implants. Surg Radiol Anat 2020;42(7):823-830.
- 3. Zhao Y, Chundury RV, Blandford AD, Perry JD. Anatomical Description of Zygomatic Foramina in African American Skulls. Ophthalmic Plast Reconstr Surg 2018;34(2):168-171.
- 4. Connor SE, Tan G, Fernando R, Chaudhury N. Computed tomography pseudofractures of the mid face and skull base. Clin Radiol 2005;60(12):1268-1279.
- 5. Kim HS, Oh JH, Choi DY, Lee JG, Choi JH, Hu KS, et al. Three-dimensional courses of zygomaticofacial and zygomaticotemporal canals using micro-computed tomography in Korean. J Craniofac Surg 2013;24(5):1565-1568.
- 6. Kawata K, Ide Y, Sunohara M. Anatomical study of the zygomaticofacial foramen and zygomatic canals communicating with the zygomaticofacial foramen for zygomatic implant treatment: a cadaver study with micro-computed tomography analysis. Anat Cell Biol 2024;57(2):204-212.
- 7. Loukas M, Owens DG, Tubbs RS, Spentzouris G, Elochukwu A, Jordan R. Zygomaticofacial, zygomaticoorbital and zygomaticotemporal foramina: anatomical study. Anat Sci Int 2008;83(2):77-82.
- 8. Del Neri NB, Araujo-Pires AC, Andreo JC, Rubira-Bullen IR, Ferreira Júnior O. Zygomaticofacial foramen location accuracy and reliability in cone-beam computed tomography. Acta Odontol Scand 2014;72(2):157-160.
- 9. Chanda A, Nanda A. Anatomical study of the orbitozygomatic transsellar-transcavernous-transclinoidal approach to the basilar artery bifurcation. J Neurosurg 2002;97(1):151-160.
- 10. Iwanaga J, Badaloni F, Watanabe K, Yamaki KI, Oskouian RJ, Tubbs RS. Anatomical study of the zygomaticofacial foramen and its related canal. J Craniofac Surg 2018;29(5):1363-1365.
- 11. Mangal A, Choudhry R, Tuli A, Choudhry S, Choudhry R, Khera V. Incidence and morphological study of zygomaticofacial and zygomatico-orbital foramina in dry adult human skulls: the non-metrical variants. Surg Radiol Anat 2004;26(2):96-99.
- 12. Martins C, Li X, Rhoton AL Jr. Role of the zygomaticofacial foramen in the orbitozygomatic craniotomy: anatomic report. Neurosurgery 2003;53(1):168-172.
- 13. de Gouvêa Carvalho CF, de Souza Tolentino E, Herreira-Ferreira M, Iwaki LCV, Chicarelli M. Anatomical in vivo study of variations in zygomatic bone: pneumatization and foramina. Acta Sci Health Sci 2023;45:e58021.
- 14. Khalid S, Iwanaga J, Loukas M, Tubbs RS. Bilateral absence of the zygomatic nerve and zygomaticofacial nerve and foramina. Cureus 2017;9(7):e1505.
- 15. Ferro A, Basyuni S, Brassett C, Santhanam V. Study of anatomical variations of the zygomaticofacial foramen and calculation of reliable reference points for operation. Br J Oral Maxillofac Surg 2017;55(10):1035-1041.
- 16. Krishnamurthy A, Roshni S, Murlimanju BV, Nayak SR, Jiji PJ, Somesh SM, et al. Foramina on the zygomatic bone: its clinical significance. Clin Ter 2011;162(5):419-421.
- 17. Ellis E 3rd, Perez D. An algorithm for the treatment of isolated zygomatico-orbital fractures. J Oral Maxillofac Surg 2014;72(10):1975-1983.
- 18. Lehtinen V, Pyötsiä K, Snäll J, Toivari M. Zygomatico-orbital fracture-dislocation in surgical treatment: novel 3-dimensional software automated analysis. J Oral Maxillofac Surg 2020;78(8):1372-1381.
- 19. Haylaz E, Geduk G, Şeker Ç, İçen M. Retrospective Evaluation of Maxillofacial Fractures with Cone-Beam Computed Tomography. Cumhuriyet Dent J 2022;25(3): 246-251
- 20. Moro SA, Thomé G, Padovan LEM, da Silva RD, Tiossi R, Fontão F. A zygomatic bone study using virtual dental implant planning software. J Oral Implantol 2022;48(3):171-176.
- 21. Pons M, Louvrier A, Bertin E, Meyer C. Intraoperative cone beam assessment after reduction of zygomatic fractures helps in taking a decision on associated orbital floor fractures. J Stomatol Oral Maxillofac Surg 2022;123(5):576-580.
- 22. Guo X, Gao Y, Zhang F, Wang M, Tian X, Huang Q, et al. Assessment of mandibular retromolar space in adults with regard to third molar eruption status. Clin Oral Investig 2023;27(2):671-680.
Details
| Primary Language | English |
|---|---|
| Subjects | Oral and Maxillofacial Surgery, Oral and Maxillofacial Radiology |
| Journal Section | Research Article |
| Authors | |
| Submission Date | September 25, 2025 |
| Acceptance Date | February 27, 2026 |
| Publication Date | March 27, 2026 |
| DOI | https://doi.org/10.7126/cumudj.1779847 |
| IZ | https://izlik.org/JA29RN42EP |
| Published in Issue | Year 2026 Volume: 29 Issue: 1 |
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