Position of Nutrient Foramen on Fibula, Its Variations and Distance From the Styloid Process and Its Clinical Application in Fibular Flap in a Mandibular Reconstruction

Abstract

The main aim of the present work is to study the position and variation in nutrient foramen in relation to styloid process and its distance from the the styloid process which is most important in a fibular flap during mandibular reconstruction. Fibula is one of the long bones present on the lateral side of leg. It receives its own neuro‐vascular bundle apart from the muscles attached to it. The upper end of the fibula with its nutrient artery and nerve entering its nutrient foramen along with muscles attached to it is preferred in most of the mandibular reconstruction and is called as fibular flap. While doing the fibular flap, care is being taken to avoid damage to neuro‐vascular bundle to fibula. The aim of the present work is study the position of nutrient foramen and its distance from the styloid process. The nutrient artery to fibula arises from the peroneal artery which winds around the neck of fibula and descends down along the fibula deep Flexor Hallucis Longus. Near the middle of fibula, it gives off nutrient artery which enters the nutrient foramen, and ramify within the fibula. The study has been carried out in 50 dry specimen (fibula) and radiological study has been carried out in 30 normal individuals. Various parameters like position and direction of nutrient foramen, distance from the styloid process were studied in the dry fibula and the same study was carried out in the radiology of fibula of normal individuals. The results have been tabulated and compared between the dry specimen and the normal individuals. These results were later correlated with the clinical application while tracing the nutrient foramen with the artery during mandibular reconstruction.