Development and Applicability Evaluation of the Foramen Ovale Puncture Guide

Objective: To develop foramen ovale puncture guide with computer-aided design and manufacturing techniques, and to evaluate its accuracy and safety. Study Design: Pilot case study. Material and Methods: The guide was fabricated with stereolithographic appliance according to 3D CT image-based virtual foramen ovale puncture plan. The guide that equipped with an elongated hole located lateral to maxillary second molar for inducing a path of the needle into the trigeminal cave was placed into cadaver's oral cavity and fixed to the upper teeth. The needle attached stopper for a desired depth in accordance with the trigeminal ganglion was inserted into the hole. After puncture using the guide, cadaver's head was scanned to obtain postoperative CT images for evaluating the accuracy. To confirm the safety of the guide, we dissected the head, and examined the relationship between the needle and anatomical structures on the path. Results: The guide accurately induced a needle to reach the trigeminal ganglion through the foramen ovale. Before reaching the foramen ovale, the needle passed through the lateral pterygoid muscle. The branches of the mandibular nerve or maxillary artery were not damaged on the path of the needle. Conclusions: Our results of this preclinical study provide a novel technique for accurate and safe foramen ovale puncture. This easy, inexpensive, replicable, and safe method may be used as a guide in radiofrequency rhizotomy and percutaneous balloon compression.