Laporan Kasus: Variasi Anatomi Foramen Pterygoalare Berukuran Kecil

Haamid Hasan Haikal; Gamael Marcel; Fanny Michelle

doi:10.36452/jkdoktmeditek.v30i2.3158

Authors

Haamid Hasan Haikal Departemen Anatomi, Fakultas Kedokteran, Universitas Indonesia, Jakarta, Indonesia
Gamael Marcel Fakultas Kedokteran, Universitas Indonesia, Jakarta, Indonesia
Fanny Michelle Fakultas Kedokteran, Universitas Indonesia, Jakarta, Indonesia

DOI:

https://doi.org/10.36452/jkdoktmeditek.v30i2.3158

Keywords:

Ala major ossis sphenoidei, kompresi, Divisio anterior nervi mandibularis, Processus pterygoideua, Foramen pterygoalare

Abstract

Lubang-lubang pada Basis cranii merupakan struktur penting yang menghubungkan area intrakranial dan ekstrakranial. Beberapa lubang, seperti Foramen ovale dan Foramen spinosum, dapat ditemukan dekat dengan Processus pterygoideus dan Ala major ossis sphenoidei. Naskah ini melaporkan adanya variasi anatomi berupa Foramen pterygoalare yang terletak di antara Processus pterygoideus dan Ala major ossis sphenoidei. Di Indonesia, belum ada laporan kasus yang menyampaikan temuan tersebut. Struktur tulang pembatasnya tebal dan jelas, dan diprediksi merupakan hasil proses penulangan Ligamentum pterygoalare yang tuntas. Lubangnya berukuran panjang 3,5 mm dan lebar 2,5 mm di sebelah kanan, sedangkan di sebelah kiri berukuran panjang 3,5 mm dan lebar 2 mm, di mana diameter tersebut tergolong kecil jika dibandingkan dengan temuan lainnya. Lubang tersebut lazimnya dilalui oleh Divisio anterior nervi mandibularis. Foramen pterygoalare yang berukuran kecil dapat berimplikasi pada kompresi saraf tersebut sehingga fungsinya terganggu, meliputi gangguan otot pengunyahan, gangguan sensoris pada gingiva buccal posterior rahang bawah, dan gangguan lainnya. Selain itu, keberadaan Pterygoalare bar juga dapat menghalangi tindakan, seperti anestesi blok saraf yang berdekatan. Direkomendasikan penelitian Basis cranii kering, kadaver, dan analisis radiologi lebih lanjut untuk menentukan implikasi klinis tersebut.

References

Standring S. Gray’s anatomy: the anatomical basis of clinical practice. 42nd ed. Elsevier; 2021:566–7 p.

Ryu SJ, Park MK, Lee UY, Kwak HH. Incidence of pterygospinous and pterygoalar bridges in dried skulls of Koreans. Anat Cell Biol [Internet]. 2016 Jun 1;49(2):143–50. Available from: https://doi.org/10.5115/acb.2016.49.2.143

Čirić D, Kapur E, Talović E. Ossification of the pterygospinous and pterygoalar ligaments and their clinical relevance. Folia Med Fac Med Univ Saraeviensis. 2017;52(1):9–15.

Piagkou M, Demesticha T, Piagkos G, Georgios A, Panagiotis S. Lingual nerve entrapment in muscular and osseous structures. Int J Oral Sci [Internet]. 2010;2(4):181–9. Available from: https://doi.org/10.4248/IJOS10063

Chakravarthi K K, Sarath Babu K, Siddhartha P. An anatomical study of the Pterygo-alar bar and Porus crotaphitico buccinatorius. International Journal of Medical and Health Sciences. 2012;1(3):3–9.

Touska P, Hasso S, Oztek A, Chinaka F, Connor SEJ. Skull base ligamentous mineralisation: evaluation using computed tomography and a review of the clinical relevance. Insights Imaging [Internet]. 2019 Dec 1;10(55):1–10. Available from: https://doi.org/10.1186/s13244-019-0740-8

Iwanaga J, Clifton W, Dallapiazza RF, Miyamoto Y, Komune N, Gremillion HA, et al. The pterygospinous and pterygoalar ligaments and their relationship to the mandibular nerve: Application to a better understanding of various forms of trigeminal neuralgia. Annals of Anatomy [Internet]. 2020 May 1;229:151466. Available from: https://doi.org/10.1016/j.aanat.2020.151466

Daimi SR, Siddiqui AU, Gill SS. Analysis of foramen ovale with special emphasis on pterygoalar bar and pterygoalar foramen. Folia Morphol. 2011;70(3):149–53.

Galdames IS, Zavando Matamala DZ, Smith RL. Anatomical study of the Pterygospinous and Pterygoalar bony bridges and foramens in dried crania and its clinical relevance. Int J Morphol [Internet]. 2010;28(2):405–8. Available from: http://dx.doi.org/10.4067/S0717-95022010000200012.

Rossi AC, Freire AR, Manoel C, Prado, Botacin PR, Caria, et al. Incidence of the ossified pterygoalar ligament in Brazilian human skulls and its clinical implications. J Morphol Sci. 2011;28(1):69–71.

Peker T, Karakose M, Anil A, Turgut HB, Gulekon N. The incidence of basal sphenoid bony bridges in dried crania and cadavers: Their anthropological and clinical relevance. Eur J Morphol [Internet]. 2002;40(3):171–80. Available from: https://doi.org/10.1076/ejom.40.3.171.16686

Antonopoulou M, Piagou M, Anagnostopoulou S. An anatomical study of the pterygospinous and pterygoalar bars and foramina - their clinical relevance. Journal of Cranio-Maxillofacial Surgery [Internet]. 2008 Mar;36(2):104–8. Available from: https://doi.org/10.1016/j.jcms.2007.05.009

Esen K, Özgür A, Balcı Y, Ten B. Pterygospinous and pterygoalar bars in children. Surgical and Radiologic Anatomy [Internet]. 2022 Mar 1;44(3):353–9. Available from: https://doi.org/10.1007/s00276-021-02853-z

Kamath BK, Vasantha K. Anatomical study of Pterygospinous and Pterygoalar bar in human skulls with their phylogeny and clinical significance. Journal of Clinical and Diagnostic Research [Internet]. 2014;8(9):AC10-3. Available from: https://doi.org/10.7860%2FJCDR%2F2014%2F9326.4888

Natsis K, Piagkou M, Skotsimara G, Totlis T, Apostolidis S, Panagiotopoulos NA, et al. The ossified pterygoalar ligament: An anatomical study with pathological and surgical implications. Journal of Cranio-Maxillofacial Surgery [Internet]. 2014;42:e266-70. Available from: https://doi.org/10.1016/j.jcms.2013.10.003

Oliveira KM, Almeida VL, López CAC, Brandão GT, Trancoso MGB, Oliveira MFS, et al. The Pterygospinous foramen (Civinini) and the Pterygoalar (Crotaphitico-Buccinatorius). Laboratory findings. Int J Morphol [Internet]. 2021;39(1):198–204. Available from: https://doi.org/10.4067/s0717-95022021000100198

Tubbs RS, May WR, Apaydin N, Shoja MM, Shokouhi G, Loukas M, et al. Ossification of ligaments near the foramen ovale: An anatomic study with potential clinical significance regarding transcutaneous approaches to the skull base. Neurosurgery [Internet]. 2009 Dec;65(ONS Suppl 1):ons60-4. Available from: https://doi.org/10.1227/01.neu.0000345952.64041.9c

Chouke KS. On the incidence of the foramen of civinini and the porus crotaphiticobuccinatorius in American whites and Negroes; observations on 1544 skulls. Am J Phys Anthropol [Internet]. 1946;4(2):203–26. Available from: https://doi.org/10.1002/ajpa.1330040215

Chouke KS. On the incidence of the foramen of civinini and the porus crotaphitico-buccinatorius in American whites and Negroes; observations on 2745 additional skulls. Am J Phys Anthropol [Internet]. 1947;5(1):79–86. Available from: https://doi.org/10.1002/ajpa.1330050108

Chouke KS. Injection of mandibular nerve and gasserian ganglion; an anatomic study. Am J Surg [Internet]. 1949;78(1):80–5. Available from: https://doi.org/10.1016/0002-9610(49)90187-7

Skrzat J, Walocha J, Środek R. An anatomical study of the pterygoalar bar and the pterygoalar foramen. Folia Morphol. 2005;64(2):92–6.

Rosa RR, Faig-Leite H, Faig-Leite FS, Moraes LC, Moraes MEL, Filho EM. Radiographi study of ossification of the pterygospinous and pterygoalar ligaments by the Hirtz axial technique. Acta Odontol Latinoam . 2010;23(1):63–7.

Lepp FH, Sandner M. Anatomic-radiographic study of ossified pterygospinous and “innominate” ligaments. Oral Anatomy and Embryology [Internet]. 1968;26(2):244–60. Available from: https://doi.org/10.1016/0030-4220(68)90262-4

Dodo Y. Non-metrical cranial traits in the Hokkaido Ainu and the Northern Japanese of recent times. J Anthrop Soc Nippon [Internet]. 1974;82(1):31–51. Available from: https://doi.org/10.1537/ase1911.82.31

Zakrzewska JM. Medical management of trigeminal neuralgia. British dental journal [Internet]. 1990;168(10):399–401. Available from: https://doi.org/10.1038/sj.bdj.4807208

Shaw JP. Pterygospinous and Pterygoalar Foramina: A Role in the Etiology of Trigeminal Neuralgia? Clinical Anatomy [Internet]. 1993;6:173–8. Available from: https://doi.org/10.1002/ca.980060308

Pękala PA, Henry BM, Pękala JR, Frączek PA, Taterra D, Natsis K, et al. The pterygoalar bar: A meta-analysis of its prevalence, morphology and morphometry. Journal of Cranio-Maxillofacial Surgery [Internet]. 2017 Sep 1;45(9):1535–41. Available from: https://doi.org/10.1016/j.jcms.2017.06.019

Loughner BA, Larkin LH, Mahan PE. Nerve entrapment in the lateral pterygoid muscle. Oral surgery, oral medicine, oral pathology [Internet]. 1990;69(3):299–306. Available from: https://doi.org/10.1016/0030-4220(90)90290-9