Discovery of ‘Coronoid Foramen’ by a Bengaluru surgeon Dr Nyer Firdoose could explain pain after LA
Dr Nyer Firdoose Chintamani Subhan, a maxillofacial and cleft surgeon from Bengaluru has published his original work on the unique discovery of ‘coronoid foramina’ bilaterally along with bilateral accessory foramina over the ‘lateral aspect of the ramus of the mandible,’ which has never been seen or documented in the literature so far in a live patient.
Dr Nyer Firdoose Chintamani Subhan was thinking along the lines of D. H. Lawrence “what the eye doesn’t see, and the mind doesn’t know, doesn’t exist," even if it does... while presenting his discovery of ‘foramina on the coronoid process’ and ‘accessory foramina on the lateral aspect of ramus’ of the mandible.
Dr Nyer Firdoose is a Maxillofacial and Cleft surgeon, Department of Oral & Maxillofacial Surgery, East Riyadh Specialized Centre, Saudi Arabia. His friends and colleagues call him a maxillofacial surgeon with an eagle's eye. He is also a researcher fascinated by the intricacies of human anatomy since his graduation days. For over a decade, Dr Nyer has been trying to unravel the mysteries of human anatomy.
What intrigued him the most was why some dental patients complain of pain despite receiving sufficient anaesthesia. His curiosity compelled him to go beyond the thirty-two teeth and look into the surrounding structures. The reason for ineffective anaesthesia or a lower pain threshold in some patients is either an improper technique used or the presence of additional nerves within the foramen. The latter is something that often goes unnoticed and is seldom taught during training years.
His search for the unique anatomic variants resulted in his chance finding in one of his patients - an extra opening in the lower jaw of that patient, not found in all individuals. The extra-opening in the bone, known as a foramen (foramina, plural), was present in the coronoid structure of lower jaw - confirmed by CBCT, facial scans and Steriolithograph models. Dr Nyer named his discovery as “Coronoid Foramen” and published it in the Journal of Surgical and Radiological Anatomy 2018 Feb titled - "Bilateral 'coronoid foramina' with accessory foramina on the 'Lateral aspect of Ramus' of the mandible: An unseen variance discovery in humans."
Dr Nyer says that after this unique finding, the pattern started repeating and he identified the Coronoid Foramen in as many as 30 cases including a few pediatric cases from all over the Middle East and South India. He hopes that his discovery could help the surgeons realise that foramina like these could be responsible for the variations they observe in the spread and aggressiveness of different infections and cancer metastasis. A thorough understanding of the anatomical variations may also help the surgeons to achieve haemostasis effectively in challenging situations.
Dr Nyer, who did his masters from Yenepoya Dental College, Mangalore is an innovator too. His innovation - Nyer-Zetractor, can be used for retraction, reflection and isolation of the surgical site simultaneously.