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The presence of the eminentia orbitalis in the os zygomaticum of hindu skulls.

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The Presence of the Eminentia Orbitalis in the
0 s Zygomaticum of Hindu Skulls
LIBERATO J. A. DIDIO 1
The investigation of ethnical differences
in the eminence located on the orbital surface of the zygomatic bone in Man, led us
to verify the frequence of this eminence in
the collection of Hindu skulls in the Department of Anatomy of the University of
Washington School of Medicine.
LITERATURE
Whitnall (’11 and ‘32) described a
small prominence which he termed orbital
tubercle or lateral palpebral tubercle on
the orbital surface of the frontal process
of the molar bone, just within the orbital
margin, lying about 11mm below the frontozygomatic suture where this cuts the
orbital margin. The eminence is a blunt
pyramid, spine-shaped or a diffuse swelling; it is recognizable by sight but best
appreciated by touch, inserting the finger
tip deeply between the orbital margin and
the eyeball opposite to the lateral commissure of the eyelid and rubbing the finger
up and down. By this means its presence
can be identifled in the living, and it is
often better marked in the right orbit.
In 2,000 human skulls, comprising 23
races (sic), Whitnall found the tubercle
present in over 95% of the cases. The
degree of development appeared to be an
individual variation and not a racial characteristic. The tubercle was also found in
chimpanzee and gorilla skulls. Several
structures which inserted in the tubercle
were indicated.
Buschkowitsch (’27) observed the tubercle in skulls of Russians, Ukrainians
and Chinese. He examined 419 skulls,
383 of adult individuals and 36 of fetuses,
newborns, and children to the age of puberty. He found that the distance between
the tubercle and the frontozygomatic suture was 5-7 mm. He pointed out that a
marginal tubercle can cause difficulties in
the determination of the “ektokonchion.”
Three types of tubercles were described :
small ( 2 mm long and 1.5 mm high),
medium (more developed than the small
one) and large (sometimes 4 mm high).
He found the tubercle present in 72% of
the males and in 54% of the females,
after considering it absent when it was
sensible only to touch. No difference between sides was noted and he stated that
the tubercle was less common before puberty than in the adult.
Kangas (’28) examined 1,026 skulls of
males and 324 of females of different races
and peoples, devoting special attention to
Lapps and Finns. He also described types
of tubercles. In Lapps the tubercle was
present in 88.7% (males, 89.2% and females, 84.9% ) and in Finns it was present
in 90.5% (males, 91.9% and females,
85.9%). Most of the tubercles were not
well developed. In general, the tubercle
was more developed in the males. It was
absent in 13% of the females, in 8.9% of
the males and in 9.9% in the total.
Ono (’28) referred to a prominence for
the insertion of the ligamentum palpebrale
externum. He did not cite any paper on
the subject and wrote: ‘<Inthe most anterior portion of the external wall (of the
orbit), at its mid-point, there is found a
salience of varied size that is the point of
insertion of the external palpebral ligament.” The size of the prominence in both
sexes was almost the same and after measurement in skulls of individuals above 20
years old, the results were: large and medium-sized prominences, about 25% of
each; small-sized ones, about 30%; and
indistinct or not present, 20%. In a table
lHead of the Department of Anatomy, Faculdade
de Medicina da Universidade de Minas Gerais, Belo
Horizonte, Brazil. Visiting Professor.
Horizonte.
Professor, with a fellowship
Rockefeller Foundation,
m the Department
from the ‘Rockefeller
Focndation, h
of Anatomy University of Washington School of
Medicine, Se‘attle.
31
32
LIBERATO J. A. DIDIO
he presented the results on 109 males and
55 females; the prominence existed in
about 80 % .
Tomita (’35) studied the tuberculum
orbitale in 476 skulls of northern Japanese: 438 (263 males and 175 females)
over 20 years old, and 38 (21 males and
17 females) between 2 and 19 years old.
He considered two types of tubercle: (+)
when it was evident and (
) when the
basis was 5 mm long (sic) or more. When
he was not sure of the prominence by sight
he considered it missing. The tubercle was
present more frequently in males (57.1 %
or 150 of 263 skulls) than in females
(41.2% or 72 of 175 skulls). The tubercle
was Materally present in 42.2% of the
males and in 34.3% of the females. He
drew the conclusion that a relation to the
race should exist, pointing out the high
frequency of occurrence in Europeans, the
low frequency in Chinese and the medium
frequency in northern Japanese, and asked,
“As the palpebral type is a racial characteristic, would this also be true of the
tubercle?”
Tomita stated that the tubercle on the
right side was larger than the one on the
left side and also was larger in males than
in femdes. The tubercle was more frequent in adults. However, it was found
to be present bilaterally in a 4-year-old boy
and unilaterally on the right side in a 10year-old boy. Above 14 years the tubercles
were recognized in two cases of 16-yearolds, one case of 17 years and two cases of
18 years, a l l girls.
DiDio (’42) studied the frequency and
shape of the prominence, which he preferred to name eminentia orbitalis, on 285
human skulls of 101 Whites (78 males and
23 females), 45 Negroes (29 males and
16 females), 62 Mulattoes (48 males and
14 females), 4 Indians and 46 Japanese
(38 males and 8 females), in Brazil. He observed the eminence by palpation in 90%
of 100 living individuals (80 Whites and 20
Negroes), all adult males. He found the
eminence present in 89.12% of the skulls
(91% in the males and 82% in the females). It was more frequently bilateral
(222 cases) than unilateral (32 cases),
and it was situated 10.5 mm below the
frontozygomatic suture where this cuts
the orbital margin. The eminence was 1-3
++
mm high, 1-2 mm distant from the margin. The marginal situation was rare. The
eminence was shown also in a radiogram.
No relationship between morphology of the
eminence and race was noticed. The eminence was more rarely present in early
ages and it appeared to be more developed
in males than in females.
Besides the reference to Cunningham
(’16) quoted by Buschkowitsch, among the
textbooks which we had the opportunity
to read, Whitnall‘s description was found
in Gray (’20); Augier (’31) in Poirier and
Charpy; Jameson (’31) in Robinson and
Cunningham; Wood-Jones and Buchanan
(’49); Lockhart (’51) in Brash and Cunningham; Paturet (’51); West (’51) in
Brash and Cunningham; Hollinshead (’58)
who names “the slight projection” as “the
zygomatic tubercle or orbital tubercle of
Whitnall”; Goss and Gray (’59). Whitnall’s and Buschkowitsch’s data are cited
by Eisler (’30) and by Winckler (’39) who
is the author of the chapter on the Anatomy and Histology of the orbit and accessories of the eyeball in Baillart, Coutela,
Redslob and Velter. The illustration of
the presence of a “tubercle” is given by
Grant (’52) in the figure 733 (B) of his
Method of Anatomy. Terry and Trotter
(’53) in Schaeffer and Morris indicate
Whitnall’s orbital tubercle and under variations of the zygomatic bone present DiDio’s data on the orbital eminence. Bassett
(’54) illustrates the tubercle in stereographs of the orbit and shows the insertion
on it of the structures mentioned by Whitnall.
MATERIAL AND METHOD
Skulls of 163 adult Hindus from Calcutta, including 103 males and 60 females,
were studied. The orbital surface of the
zygomatic bone was examined visually and
by palpation for the presence or absence
of an eminence near the orbital margin.
The orbital eminence (eminentia orbitalis) was classified according to its size
into “small,” “medium,” or “large.” It was
considered “small” in all specimens in
which it was not clearly visible and in
which its presence was best determined by
palpation. If the base was approximately
3 mm in diameter and the height of the
eminence was 2 mm or less, it was classi-
EMINENTIA ORBITALIS IN HINDU SKULLS
33
with their observations in human skulls.
With the present investigation a recorded
total of 4,857 skulls have been examined
for the presence of the orbital eminence.
Also in not a few textbooks the orbital
eminence is already mentioned.
This prominence, which Whitnall proposed to name the “orbital or palpebral
lateral tubercle,” according to its form,
does not deserve the denomination “tuOBSERVATIONS
bercle.” It displays several shapes and
The orbital eminence is located on the among them the most predominant is a
orbital surface of the frontal process of slight projection with a large bottom or a
the zygomatic bone just within the orbital roughness, sometimes only perceptible by
margin and about 1 cm below the fronto- touching. As a matter of fact, in the present series a true tubercle was observed only
zygomatic suture.
The eminence was found in 157 of the twice. Figure 1 shows one of these speci163 skulls examined, an incidence of mens.
The percentages of incidence of the emi96.3% -C- 1.5. These skulls included 100
males and 57 females. The eminence was nentia orbitalis varied with each author.
absent in 6 subjects ( 3 male, 3 female) or These are recorded below in chronological
in 3.7% -C- 1.5. In the male skulls 97% -t- order :
1.7 showed the eminence and in the female
%
skulls the observed incidence was 95% Whitnall (2,000 skulls)
over 95
k 2.8.
Buschkowitsch (419 skulls)
63=
80.1
The eminence was clearly visible in 139 Kangas (1,350skulls)
80
skulls (85.3% 2.8 of total number) and Ono (164 skulls)
(476 skulls)
49.153
was palpable in 17 others (10.4%C 2.4). Tomita
DiDio (285 skulls and
In one female skull it was visible on the
100 living individuals)
89.56*
96.3k 1.5
DiDio (163 skulls)
right and palpable on the left (0.6%
0.6).
In all cases exhibiting an orbital emiThe relatively low percentages recorded
nence it was found bilaterally. It was sym- by Buschkowitsch and Tomita, probably
metrical in size in 117 instances (71.8% are due to the omission of “palpable” emik 3.5 of 163 skulls), figures 1, 2, 3. The
nences as positive cases. We think that a
right eminence was larger in 27 cases slight prominence of a bony surface can(16.6% -+ 2.9) and the left side predomi- not be disregarded even though it is not
nated in 13 cases (8% 2.1), figure 4. recognizable with the naked eye. In many
The orbital eminence was “small” in 79 cases an appropriate incidence of light percases (48.5% 3.9 of 163), “medium” mits one to identify a little roughness of
in 61 (37.4% 3.8) and “large” in 17 the bone at the indicated site. The omis(10.4% 3- 2.4).
sion of palpation as a means for detecting
In 6 cases of the 163 (3.7% 1.5) the the prominence can only be justified if the
eminence was crossed by the frontozygo- investigation is to be limited to the recordmatic suture (figs. 5, 6). It was very near ing of typical “tubercles.” But, as far as we
the orbital margin or on the margin in 83 are concerned, the recognition of a differcases (50.9% 3.9).
entiated area receiving the insertions of the
structures mentioned by Whitnall and Ono
DISCUSSION
must include the detection by the finger
Since Whitnall’s first indication of the of a roughness of the bony surface. With
frequent presence of the prominence on
%Arithmeticalaverage between 72% in the males
the orbital surface of the zygomatic bone,
54% in the females (adults only).
several papers have appeared on the same and
8 Arithmetical average between 57.1% (males) and
41.2%
(females).
subject. The authors of the papers on the
4Arithmetical averace between the data on the
orbital eminence covered almost the world skulls and those on the lidng.
fied as “medium.” Eminences with larger
dimensions were identified as “large.”
The relation of the eminence to the margin of the orbit and to the frontozygomatic
suture was observed.
The photographs which are included in
this paper were taken after carbon powder
was spread around the eminence, principally behind it, to increase contrast.
*
*
*
*
*
*
*
34
LIBERATO J. A. DIDIO
this criterion, the high percentage of the
presence of the eminence is confirmed, and
it can be considered as a constant characteristic of the zygomatic bone. This is true
even excluding the 10.4% 2 2.4 of palpable eminences as we still obtain high percentage of presence: 85.9%.
Our data are more related to the part of
Whitnall’s material, i.e., 122 Indian and
Afghan skulls, in which he obtained an
incidence of 88% 2.9 (the standard deviation was calculated by us). This compares with 96.3% 2 1.5 in the present series of Hindu skulls.
Classification of the eminence into types
was first undertaken by Buschkowitsch,
followed by Kangas, Ono, Tomita and DiDio. We preferred to consider “visible”and
“palpable” orbital eminences. According to
the size of the base and to the height
reached by the apex, we subdivided the
orbital eminences into “large,” “medium”
and “small.” The small-sized (which included the “palpable”eminences) occurred
in 48.5% 3.9 and the medium-sized in
37.4% zk 3.8. Both predominated over the
large-sized eminences, 10.4% .t 2.4.
The marginal situation of the orbital
eminence has anthropological importance,
as stated by Buschkowitsch, in that it can
be a source of error in the determination
of the orbital width, if it is measured from
its apex and not from its base. Eminences
near or on the margin were found in the
present series of skulls in 50.9% A 3.9
indicating that attention must be paid to
this fact and that Whitnall’s description
“just within” the orbital margin is not applied to all cases.
As a rule, the eminence is located below
the frontozygomatic suture, which is more
or less horizontal. In 6 cases (3.7% t 1.5),
however, the suture extended obliquely
downward and posteriorly from the orbital
margin to cross the area of the orbital eminence. This arrangement has not been
previously noted.
The distance between the eminence and
the frontozygomatic suture, where this cuts
the orbital margin, was about 11 mm in
Whitnall’s cases, only 5 to 7 mm in Buschkowitsch’s observations and 10.5 mm in
those of DiDio (’42). Between the minimum given by Buschkowitsch and the
maximum indicated by Whitnall we found
*
*
all the orbital eminences of the present
investigation.
Bilateral eminences were found by Tomita in only 42.2% of the males and in
34.3% of the females, while DiDio’s (’42)
material showed 222 cases of bilateral presence to 32 unilateral ones (19 on the right
side and 13 on the left side). Our present
data are more in agreement with the latter, as we have seen bilateral orbital eminences in all cases.
The difference of size of the eminence
according to the side was indicated by
Whitnall, who wrote that it is better
marked in the right orbit (without numerical data). This was affirmed by Tomita.
Buschkowitsch and DiDio (’42) disagree
with this stating that there is no difference
between the sides. The present data are
consistent with those of the latter, as both
sides had symmetrical eminences (71.8%
3.5) more frequently than asymmetrical
ones (the one on the right side being larger
than the one on the left side in 16.6% .t
2.9 of the cases and the contrary in 8%
2.1).
In the males the orbital eminence is larger
than in the females, according to Buschkowitsch, Kangas, Tomita and DiDio (’42).
Ono, however, found no significant sexual
differences in size of the eminence. The
reported incidence according to sex is as
follows :
*
Males
Buschkowitsch
(mostly Russians)
Kangas (Lapps)
Kangas (Finns)
Tomita
(northern Japanese)
DiDio
(’42, mostly Brazilians)
DiDio (Hindus)
Females
%
%
72
89.2
91.9
54
87.7
85.9
57.1
41.2
91
82
97.7 -+ 1.7 95 2 2.8
As indicated, the greatest differences
were found by Buschkowitsch and by Tomita. In our material the difference was
not significant.
The degree of development of the orbital
eminence was considered an individual
variation and not an ethnical characteristic by Whitnall, who had a great number
of skulls of diverse origin. The inclusion
of 500 skulls of Europeans in only one
‘‘race,” criticized by Buschkowitsch, does
EMINENTIA ORBITALIS IN HINDU SKULLS
not disturb the afore-mentioned statement,
owing to the high percentages in all human
groups. In the group of Chinese skulls, we
can disregard the relatively low incidence
found by Buschkowitsch (50% of 8 skulls
had orbital eminence) in a small series of
skulls if we recall that Whitnall observed
a larger number of Chinese (86), finding
a high percentage (99% ) of presence of
the eminence. This comparison raises the
issue of the criteria used by authors in the
interpretation of their data. It suggests,
for instance, that Tomita’s statement on
ethnical differences is also debatable. The
figures given by Ono show a higher frequency (80%) than those of Tomita
(49.1% as an average between his data on
males and on females): this would imply
that the Japanese studied by Ono were different from the northern Japanese examined by Tomita. However, inasmuch
as the incidence is high in many different
human groups studied by the other authors, it appears improbable that there is
a difference among the Japanese. It is
almost sure that the individual subjectivism of the investigation exerted a great influence upon the results. In any case, we
are able to conclude that there is no ethnical difference in the presence of the orbital
eminence.
The following structures, as stated by
Whitnall, are inserted in the orbital eminence: ( 1) the lateral ‘lorn” of the aponeurosis of the m. levator palpebrae superioris; (2) the lacertus m. recti lateralis
or lateral check ligament; ( 3) the “suspensory ligament of the eyeball” of Lockwood;
and ( 4 ) the ligamentum palpebrae laterale. To illustrate these soft tissue structures a photograph from the work of Bassett is reproduced as figure 7.
CONCLUSIONS
The eminentia orbitalis of the 0s zygomaticum in 163 skulls of Hindus from Calcutta was found bilaterally in 157 cases
(96.3% -C 1.5); in 100 males (97% 2 1.7)
and in 57 females (95% -+ 2.8).
The eminentia orbitalis was visible in
139 skulls (85.3% -t 2.8) and palpable in
17 (10.4% 4 2.4); in one case (0.6% 2
0.6) it was visible at the right and palpable
at the left side.
35
Similar eminences on both sides (71.8%
& 3.5)
were more frequent than different
ones (in 16.6% 2.9 the right-sided eminence was larger than the left one and in
8%f:2.1 the left-sided one was larger than
the one on the opposite side).
Small-sized eminences (48.5% ‘r 3.9)
and medium-sized eminences (37.4% f
3.8) predominated over the large-sized
ones (10.4% ?z 2.4).
The orbital eminence is located on the
orbital surface of the frontal process of
the zygomatic bone, about 1 cm below the
frontozygomatic suture (from where it cuts
the orbital margin). It is found close to
the margin (45.4% 3.9) and on the margin (50.9% t 3.9). In a few cases the
suture crossed the orbital eminence (3.7%
2 1.5).
The constant occurrence of the eminentia orbitalis in skulls of different
peoples, being detectable in the living by
touch or by x-rays, the insertion on it of
several structures, and its importance in
Anthropology and in Ophthalmology justify the inclusion of its name in the official
anatomical nomenclature.
*
ACKNOWLEDGMENT
The author is indebted to Dr. David L.
Bassett, Professor of Anatomy, University
of Washington School of Medicine, for
valuable suggestions and for his kind collaboration in helping to write the manuscript and for providing one picture from
his Stereoscopic Atlas of Human Anatomy
(fig. 7).
LITERATURE CITED
Augier, M. 1931 Squelette cbphalique, in Poirier, P. et Charpy, A. Trait6 d’Anatomie humaine. Paris, Masson et Cie., Bdit., 46me. Bd.,
T. 1.
Bassett, D. L. 1954 A stereoscopic atlas of human anatomy. Section 11. The head and neck.
Portland, Ore., Sawyer’s Inc.
Buschkowitsch, W. J. 1927 Ueber das “Tuberculum orbitale” des Jochbeins des Menschen.
Anat. Anz., 63: 353457.
Cunningham 1916 In Buschkowitsch.
DiDio, L. J. A. 1942 Observapoes sobre o “tuberculo orbitario” de Whitnall no osso zigomatico de homem (com pesquisas no vivo).
Anais Fac. Med. S. Paulo, 18: 43-63.
Eisler, P. 1930 Die Anatomie des menschlichen
Auges, in Kunes Handbuch der Ophthalmologie. Berlin, 3. Springer, Bd. 1.
Goss, C. M., and H. Gray 1959 Anatomy of the
human body. Philadelphia, Lea & Febiger, 27th
ed.
LIBEWTO J. A. DIDIO
36
Grant, J. C. B. 1952 A method of anatomy.
Baltimore, Williams and Wilkins Co., 5th ed.
Gray, H. 1920 Anatomy descriptive and applied. London, Longmans, Green and Co., 21st
ed.
Hollinshead, W. H. 1958 Anatomy for surgeons. New York, Paul B. Hoeber, Inc.
Jameson, E. B. 1931 Osteology, in Robinson,
A., and D. J. Cunningham Textbook of Anatomy. New York, Oxford Univ. Press, 6th ed.
Kangas, T. 1928 Das Vorkommen des “Tuberculum orbitale” in menschlichen Schaedel, insbesondere bei Finnen und Lappen. Duodecim
(Helsinki) 68-74.
Lockhart, R. D. 1951 Myology, in Brash, J. C.,
and D. J. Cunningham Textbook of Anatomy.
New York, Oxford Univ. Press, 9th ed.
Ono, R. 1928 Untersuchungen ueber die Orbita
von Japaner. Jap. J. Med. Sci., 1. Anatomy,
l ( 4 ) : 307-308.
Paturet, G. 1951 Trait6 d‘Anatomie humaine.
Paris, Masson et cie., bdit.
Terry, R. J., and M. Trotter 1953 Osteology, in
Schaeffer, J. P. and Morris, Human Anatomy.
New York, Blakiston Co., 11th ed.
Tomita, S. 1935 (On the tuberculum orbitale
of the zygomatic bone i n the Japanese.) (In
Japanese), Kanazawa daigaku igakubu kaibogaku kyoshitsu gyoseki), 20: 149-154.5
West, C. M. 1951 The skin and sensory organs, in J. C. Brash and D. J. Cunningham,
Textbook of Anatomy. New York, Oxford Univ.
Press, 6th ed.
Whitnall, S. E. 1911 On a tubercle on the
malar bone, and on the lateral attachments of
the tarsal plaes. Anat. Physiol., 54(4): 426432.
1932 The anatomy of the human orbit
and accessory organs of vision. New York, Oxford Univ. Press, 2nd ed.
Winckler, G. 1939 Anatomie et histologie de
l’orbite et des annexes du globe oculaire, in
Baillart, Coutela, Redslob, Velter. Trait6 d’Ophthalmologie, Paris, Masson et Cie., T. 1.
Wolff, E. 1940 The anatomy of the eye and
orbit. Philadelphia, Blakiston Co., 2nd ed.
Wood-Jones, F., and A. M. Buchanan 1949
Manual of Anatomy. London, Baillhre, Tindall
and Cox, 8th ed.
-
5 The author is. indebted to Mr. Shigueo Watanabe
for the lundness m translating Tomita’s paper.
PLATE 1
EXPLANATION OF FIGURES
1 Obs. 168 (male, adult, Hindus) - Eminentia orbitalis on the orbital
surface of the frontal process of the zygomatic bone. It has the shape
of a tubercle, near the orbital margin, medium-sized, the right side
similar to the left side.
2
Obs. 150 (male, adult, Hindu)-Eminentia
with large basis, both sides similar.
3 Obs. 91 (male, adult, Hindu)-Marginal
sized, both sides similar.
4
orbitalis, medium-sized,
eminentia orbitalis, medium-
orbitalis, near the orbital
Obs. 162 (male, adult, Hindu)-Eminentia
margin, large-sized; the left is larger than the right.
EMINENTIA ORBITALIS IN HINDU SKULLS
Liberato J. A. DiDio
PLATE 1
37
PLATE 2
E X P L A N A T I O N OF FIGURES
38
5
Obs. 88 (female, adult, Hindu)-Eminentia orbitalis, crossed a t both
sides by the frontozygomatic suture which extends downward from
point at which it cuts the orbital margin.
6
Obs. 115 (female, adult, Hindu)-Right orbital cavity. Lateral wall
seen anteriorly and from the left. The eminentia orbitalis (in the circle) is crossed by the frontozygomatic suture.
7
Dissection of the fasciae surrounding the anterior part of the eye,
including the following structures which attach laterally to the orbital
eminence: ( a ) lateral expansion of levator palpebrae superioris, ( b )
lateral check ligament, ( c ) lateral palpebral ligament, and ( d ) suspensory ligament of the eyeball. The picture is reproduced from a n
original stereoscopic Kodachrome photograph in D. L. Bassett, “A
Stereoscopic Atlas of Human Anatomy,” Section 11, reel 57, View 1 ,
published by Sawyer’s Inc., Portland, Oregon, 1954. Courtesy of David
L. Bassett, M.D. Copyright 1954, Sawyer’s, Inc., U.S.A.
EMINENTIA ORBITALIS IN HINDU SKULLS
Liberato J. A. DiDio
PLATE 2
39
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