Examination of anatomical features of zygomaticofacial foramen in children: A 3d reconstruction study

Background Considering the implications of surgical fixation techniques such as plating, screwing, or wiring in pediatric zygomatic fractures, a detailed understanding of the zygomaticofacial foramen (ZFF) anatomy in children may help reduce intraoperative complications particularly injury to the zygomaticofacial nerve, which passes through the ZFF. Objective The aim of the present study is to examine the morphometric and morphological features of the ZFF in the pediatric population. Methods Before the study commenced, approval was obtained from Gaziantep University Clinical Research Ethics Committee (Approval number: 2024/177). Cone-beam computed tomography (CBCT) images of 119 patients who applied to Gaziantep University Faculty of Dentistry, Department of Oral and Maxillofacial Radiology for any reason were retrospectively examined with Radiant DICOM Viewer program. The presence, number, localization and distances to certain anatomical points of ZFF were measured. The ZFF was classified based on the number of foramina. To determine the localization of the foramen, the lateral surface of zygomatic bone was divided into four quadrants using two reference lines. These quadrants were designated as a, b, c, and d in a clockwise direction from the inferomedial to the superomedial region. Statistical analyses were performed with SPSS 24.0 package program and p < 0.05 was considered statistically significant. Results A total of 119 children (male: 65, female: 54; mean age: 13.14 ± 3.24) CBCT images (238 sides) were examined. In the classification based on the number of foramina, the absence of any foramen was defined as Type 0 (106, 44.5%); the presence of one, two, and three foramina was classified as Type I (91, 38.2%), Type II (35, 14.7%), and Type III (6, 2.5%), respectively. The mean distance between ZFF-orbit and ZFF-temporozygomatic suture was greater in male than in female (p = 0.006, p = 0.009, respectively). The mean distance between ZFF-frontozygomatic suture was greater in female (p = 0.032). The distances between ZFF-zygomaticomaxillary suture and lowest point of zygomatic bone were significantly different between age groups (p = 0.026, p = 0.004, respectively). Conclusion The findings of the present study indicate that the zygomaticofacial foramen (ZFF) is most frequently located in region c and rarely in region b. Based on this observation, region b may represent a safer zone for surgical interventions in this area. The findings of the present study may help to minimize complications in surgeries and invasive procedures involving the zygoma region in children.