Three-dimensional non contrast computed tomography analysis of the infraorbital foramen: Anatomical landmarks and clinical implications

Objectives: Precise localization of the infraorbital foramen (IOF) is crucial in maxillofacial surgery, regional anesthesia, and esthetic procedures, as even minor deviations may lead to neurovascular complications or suboptimal outcomes. Conventional reliance on surface landmarks and two-dimensional imaging is limited by anatomical variability. With the advent of non-contrast computed tomography (NCCT) and cinematic volume rendering technology, accurate three-dimensional visualization of craniofacial structures is now feasible. This study aimed to establish population-specific, landmark-based three-dimensional reference data for IOF localization in a North Indian adult cohort using NCCT, with cinematic volume rendering utilized to enhance anatomical visualization. Materials and Methods: A retrospective analysis was performed using NCCT scans of 200 North Indian adults (100 males and 100 females) obtained from a tertiary care center. Bilateral linear measurements were recorded from the IOF to the inferior orbital margin (IOM), lateral piriform margin, and maxillary occlusal plane. Stratified analyses were conducted based on age and sex. Statistical significance was set at p < 0.05. Results: The mean IOF-IOM distance was 0.75 ± 0.10 cm bilaterally. Mean distances to the lateral piriform margin and occlusal plane ranged from 1.56 to 1.59 cm and approximately 3.70 cm, respectively. Males demonstrated significantly greater measurements than females across all landmarks ( p < 0.01). The IOF was most frequently vertically aligned with the maxillary second premolar across all age and sex groups. No statistically significant age-related variations were observed. Accessory infraorbital foramina were identified in 8.5% of cases, demonstrating consistent spatial distribution patterns relevant to infraorbital nerve block planning. Conclusion: This in vivo three-dimensional imaging study provides population-specific anatomical reference data for localizing the IOF in North Indian adults. The recognition of additional infraorbital foramina underscores the importance of CT-based anatomical evaluation to reduce the risk of anesthetic failure and surgical complications. While sex-related differences were evident, IOF-IOM positioning remained stable across age groups. These findings support the reliability of the IOM as a surgical and anesthetic landmark within this population, while underscoring the need for caution when extrapolating to other ethnic groups.