Study of anatomical variance of the zygomaticofacial foramen and determination of reliable reference points for surgery

25 Sep 2017

Dissection onto the facial aspect of the zygoma is common in procedures of the midface for traumatic injury, craniofacial deformity and cosmesis. These procedures carry risk of injury to the neurovascular structures exiting the zygomaticofacial foramen (ZFF). The purpose of the current study was to map the ZFF, and to determine reliable reference points from which to identify the ZFF pre- and peri-operatively. Secondarily, we aimed to compare ZFF anatomy between sexes and geographical populations. 429 adult skulls from 9 geographic locations were used in the study. A cross-line laser was superimposed onto each zygoma to generate consistent landmarks (lines 1 and 2) from which to measure the ZFF, and the number of ZFF on each zygoma was documented. The location and frequency of ZFF differed significantly between geographic populations, but not between sexes. Of all 858 sides, 0 foramina were found in 16.3%, 1 foramen in 49.8%, 2 foramina in 29%, 3 foramina in 3.4% and 4 foramina in 1.4%. 93% of foramina were found within a 25mm diameter zone (ZFF zone) centred at 5mm anterior to the intersection of lines 1 and 2 on the right zygoma, and 94% were found within equivalent measurements on the left. Using these landmarks, we propose a novel method of identifying a ZFF zone irrespective of sex or geographic population. This technique may be of use in preventing iatrogenic damage to the ZFF neurovascular bundle during procedures of the midface and in local nerve block procedures.