title: Attempted validation of a method to locate entry and exit foramens of the branches of the trigeminal nerve; benefits for an original cephalometric analysis technique.
abstract: BACKGROUND
  Trigeminal analysis focuses on the skeletal entrance and exit orifices of the sensitive fibers of the trigeminal nerve. The aim of this study was to validate the techniques used to locate these landmarks as described by the creator of trigeminal analysis of the face.
  
  
  METHODS
  This descriptive study was performed on a dry human skull. Two tin balls forming markers R1 and R2 were fixed at random on the skull in a median sagittal position. Two headfilms of the skull were made. The first showed tin balls fixed at the entrance and exit foramens of the sensitive fibers of the trigeminal nerve. The second showed the foramens without the tin balls. The position of the reference point corresponding to the entrance and exit points of the trigeminal fibers was entered on a tracing made from the headfilm (without the balls on the foramens) by 16 operators using an ad hoc guide supplied by Crocquet. A comparison was made between the points as positioned by these operators and the true points as revealed by the X-rays of the balls on the first image (Gold Standard) by calculating the difference between their coordinates on an axis connecting R1 et R2 (X-axis) and the line perpendicular to it passing through R2 (Y-axis). Trigeminal cephalometric analysis was then performed on each of the tracings. The angles and linear values were compared. The validity of the positioning of the points and of the values provided by the analysis was demonstrated by the existence of a difference of less than 2units (mm or degrees).
  
  
  RESULTS
  No difference in the means between the trigeminal points found by the operators and the Gold Standard points represented by the X-rays of the balls placed on the foramens exceeded 2mm in absolute value on the Y-axis. On the X-axis, the differences greater than 2mm in absolute value related to: the supra-orbital notch (ESO) and the foramen ovale (FO) (2.12 and 8.19mm, respectively). The angles (ESO-TGR-TO) and (TGR-ESO-TSO) were the only ones to display differences exceeding 2° in absolute value between the two images.
  
  
  CONCLUSIONS
  The detection method advanced by Crocquet for the positioning of the eight points of reference used for analyzing the entrance and exit foramens of the trigeminal nerve is valid apart from the TO and ESO points. Consequently, the validity of the angle measurements involving these points is affected. Further research is required to confirm these findings. If necessary, new recommendations should be devised in order to improve the localization of the TO and ESO cephalometric points.
authors: Service d'Orthopédie Dento-Faciale, Département d'Odontologie, Faculté de Médecine, de Pharmacie et d'Odontologie, Université Cheikh Anta Diop, Dakar, Senegal. joediouf@hotmail.com
authors: Joseph Samba
authors: JS
authors: Diouf
authors: Alpha
authors: A
authors: Badiane
authors: Papa Ibrahima
authors: PI
authors: Ngom
authors: Max
authors: M
authors: Crocquet
authors: Lahcen
authors: L
authors: Ousehal
authors: Khady
authors: K
authors: Diop-Bâ
authors: Falou
authors: F
authors: Diagne
authors: Michel
authors: M
authors: Danguy
mesh_terms: D059925:Anatomic Landmarks; D002102:Cadaver; D002508:Cephalometry / Q000295:instrumentation / Q000379:methods*; D002680:Chin / Q000294:innervation; D005147:Facial Bones / Q000000981:diagnostic imaging / Q000294:innervation*; D006801:Humans; D008334:Mandible / Q000294:innervation; D009915:Orbit / Q000294:innervation; D021362:Palate, Hard / Q000294:innervation; D011859:Radiography; D012886:Skull / Q000000981:diagnostic imaging; D013100:Sphenoid Bone / Q000294:innervation; D014276:Trigeminal Nerve / Q000033:anatomy & histology* / Q000000981:diagnostic imaging