George Sofidis

The osseous structures in the infratemporal fossa: foramen ovale, bony spurs, ossified ligaments and their contribution to the trigeminal neuralgia

Dear Editor, The etiology of the trigeminal neuralgia (TGN) varies. The paper of Liang et al. [2] was focused on the compression points of the trigeminal nerve intracranially. In addition, the entrapment of the mandibular nerve (MN) at the foramen ovale (FO) is a primary cause of the TGN. The incidence of TGN is higher on the right side [1, 4] and in females [1]. The FO is located in the infratemporal surface of the greater wing of the sphenoid bone, posterolateral to the foramen rotundum. It transmits the MN, the accessory meningeal artery, a venous plexus (connecting the cavernous sinus with the pterygoid venous plexus) and, sometimes, the lesser petrosal nerve [2, 9]. Occasionally, the FO may be compartmentalized by a bony spur situated antero-medially [5] or may be covered by bony bridges appearing after the partial or complete ossification of the pterygospinous (Pts) and pterygoalar (Pta) ligaments that are stretched between the lateral pterygoid plate and the greater wing of the sphenoid bone in the outer surface of the skull base [3] (Fig. 1). The FO morphometry and the ossified ligaments in the infratemporal fossa may cause pressure or mechanical irritation at the MN resulting in TGN [6]. With this letter we would like to share our experience regarding the FO morphometric details in 116 Greek adult dry (63 male and 53 female) skulls originated from the Departments of Anatomy of Medical Schools of Aristotle University (Thessaloniki) and National and Kapodistrian University (Athens). The antero-posterior length and transverse width of the FO were determined using a digital sliding caliper (0.01 mm precision). The surface area of the foramina was calculated using Radinsky’s formula (1967): (π×length×width) / 4. In addition the FO shape was classified into oval, almond, round and irregular types. All skulls were investigated in the infratemporal fossa for the existence of either an incomplete or complete Pts or Pta bar. The descriptive statistics are summarized in Table 1. The foramen was typically oval (62.1 % on the right and 49.1 % on the left), almond (24.1 % on the right and 14.7 % on the left), round (6.9 % on the right and 8.6 % on the left), and irregular (19.8 % on the right and 14.7 % on the left side). No correlation was found between the FO shape and the gender. Male skulls had a larger FO than the female (regarding the surface area, p=0.012 on the right and p=0.04 on the left). The FO width was statistically significant smaller on the right side (p=0.02). Several authors mentioned that the right-sided foramina are narrower than the left-sided, but they found no statistically significant difference [5, 7]. Based on the topographic location of the structures passing through the FO, its width is the main parameter that affects the MN. The findings of our study contribute to the hypothesis This study has not been presented to any congress

Chondroepitrochlearis: an abnormal muscle that may affect axillary lymphadenectomy

Professor Mellick is to be complimented for his biographical sketch of Sir Kenelm Digby, the exceptionally talented 17th-century polymath who dabbled in medicine among many other things. Digby lived in a tumultuous time when science as we now know had begun to emerge. Much has been written about Digby and his extraordinary accomplishments. He was the subject of the Wilkinson Lecture at Worcester College, Oxford, in 2005. This was given by Lesley Le Claire, the scholarly former college librarian. Le Claire had access to the treasure trove of Digbiana in the college. The college holds nearly all of Digby’s publications and many of them are first editions. The erudite lecture added some further insights into the life of this man for most (?all) seasons. As a Catholic, Digby could not become either a full member of Oxford or of one of its colleges. Neither could he take a degree. However, in the early 17th century, provisions were made for Catholics to attend Gloucester Hall, Oxford, an organization with a chequered Benedictine-linked history and which later evolved into Worcester College. It was at Gloucester Hall that Digby came under the influence of the mathematician Thomas Allen who dubbed him ‘the Mirandola of his age’, an extraordinary anointment for the intellectually precocious 15-year-old. Le Claire records that Digby was far from alone in his contention that the Powder of Sympathy was efficacious in promoting wound healing. He also stated, ‘The fact that healing often did occur has a simple explanation. Digby insisted that the wound itself should be kept absolutely clean with no application of the extremely dubious ointments in current use. Unwittingly, he was aiming at asepsis – a lesson that our modern hospitals are having to re-learn’. Le Claire makes a notable point in his observation that ‘Perhaps his greatest legacy is to the world of literature – not only at the material level of his generosity to libraries and his patronage of contemporary writers – but also in a more subtle sense: his vivid personality caught the imagination of writers long after his death’. It is well recorded that Digby more than dabbled in epicurean delights of the table and this may well have contributed to his eventually fatal trouble with ‘the stone’. Nevertheless, the Englishspeaking world is, perhaps unknowingly, forever indebted to this bon vivant for it was he who was ‘the first to recommend bacon and eggs for breakfast’ – still the unbeatable, gustatory quinella with which to start the day. References

Bilateral lingual-facial trunk: anatomic and clinical implications.

Common origin of lingual and facial artery is a relatively frequent anatomic varia-tion. Instead, bilateral lingual-facial trunk has been described only sparsely in the literature. In this report authors describe and analyse a case of bilateral common lingual-facial trunk in the context of its anatomical, clinical and embryological implications. We also describe possible consequences in performance of elective and emergent surgical operations and modification in surgical techniques that should be considered. We believe that surgeons should be suspicious for this variations existence and keep alternative solutions in their armentarium.