[Variation in the lateral plate of the pterygoid process and the lateral subzygomatic approach to the mandibular nerve].

OBJECTIVES: The objective of this work is studying wariable anatomy formations at the posterior border of the pterygoid process lateral plate of the sphenoid hobe (lig. et foramen pterygospinale, lig. et foramen crotaphitico-buccinatorium), and its statistical processing considering sex, age and sides of studied sculls.
MATERIAL AND METHODS: At 305 sculls of mature persons of both sexes (167 males and 138 females) we studied incompletely ossificated lig. pterygospinale, opening of the same name which has become by its full ossification, incompletely ossificated lig. crotaphitico-buccinatorium and opening made by it's complete ossification, and position of this structures in relation to foramen ovale.
RESULTS: Incompletely ossificated lig. pterygospinale was found at 12 sculls on both sides or 3.93% (8 male's and 4 female's sculls). One-sidedly, on the right one, incompletely ossificated lig. pterygospinale was found at 14 sculls (4.59%), and on the left side at 19 sculls (6.22%). Incompletely ossificated lig. pterygospinale, present on both sides of sculls, was in the case of persons older than 50 (9 sculls or 75%). Pterygospinous opening which has become by complete ossification of lig. pterygospinale was found on both sides at 4 sculls (1.31%), two of them were male's and two of them female's sculls. In alll four cases persons were older than 40. Pterygospinous opening found on the left side was present at only 3 sculls (0.98%) and on the right side at 4 sculls (1.31%). Pterygospinous opening was present one-sidedly, every time, in the case of male's sculls. Incompletely ossificated lig. crotaphitico-buccinatorium, meaning incomplete opening, was found at 17 sculls on both sides (5.57%). 10 of them were male persons' sculls, and 7 of them females'. On the right side, incompletely ossificated lig. crotaphitico-buccinatorium was found at 11 sculls (3.60%)--6 male's and 5 female's, and on the left side at 16 sculls (5.24%). Foramen crotaphitico-buccinatorium was found on both sides only at 12 sculls (0.97%)--one male's and one female's. Foramen crotaphitico-buccinatorium was found on the left side at 8 sculls (3.90%) and, on the right side, this opening was found at 3 sculls (0.98%). Incompletely of completely ossificated lig. pterygospinale, located laterally from foramen ovale, was found at 5 sculls (5 male's and 1 female's) or 1.63%, and in the other case, incopletely or completely ossificated lig. crotaphitico-buccinatorium laterally from foramen ovale was found at 7 sculls (5 male's and 2 female's) or 2.29%.
CONCLUSION: While applying conductive anaesthesia on mandibular nerve by lateral subzygomatic route, variable ossificated formations at lateral plate's posterior border of pterygoid process should be kept in mind. It is possible that a needle, at a depth of 35 mm, comes across incompletely or completely ossificated lig. pterygospinale et crotaphitico-bucciantorium. Based on ours anatomy research we concluded that these formations are more oftenly present on males aged over 50, and that one-sided presence is more often on the left side. Ossificated formations which were the object of our research are not an obstacle to high-quality applying of conductive anaesthesia on trigeminale ganglion et mandibular nerve each time when they exist, but only when they are located laterally from foramen ovale, what appeared at 12 sculls (3.93%) in our case.