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Adel Elnashar, Smruti K. Patel, Almaz Kurbanov, Kseniya Zvereva, Jeffrey T. Keller and Andrew W. Grande

resulting in a pterygoalar bar ( A , arrow ) formed in 7.8% of skulls. In such cases, the cannula passed through the pterygoalar foramen above the bar before entering the FO. Pterygoalar bar visually obscured FO in 3% of foramina and restricted access to FO in 1.5% of foramina. The pterygospinous (Civinini) ligament runs from the spine of Civinini of the lateral pterygoid plate to the sphenoidal spine medial to the foramen spinosum. Although complete ossification of the pterygospinous ligament formed a pterygospinous bar ( B , arrow ) in 8% of specimens, this did not

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Tomasz Matys, Tariq Ali, Fulvio Zaccagna, Damiano G. Barone, Ramez W. Kirollos and Tarik F. Massoud

of specimens ( Table 1 ). A recent meta-analysis demonstrated that a completely ossified pterygoalar bar was present in 4.4% of dried skulls, while partial ossification was seen in 8.4%. 25 The pterygospinous ligament ossifies more frequently, with complete or partial ossification seen in up to 5.8% or 22% of specimens, respectively ( Table 1 ). Ossification is not related to aging and probably represents a phylogenetic remnant 5 , 6 , 26 of interest to anatomists and anthropologists alike. 19 TABLE 1. Prevalence of pterygoalar and pterygospinous bars in

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Akshay Sharma, Gabrielle E. Rieth, Joseph E. Tanenbaum, James S. Williams, Nakao Ota, Srikant Chakravarthi, Sunil Manjila, Amin Kassam and Bulent Yapicilar

reliability . Psychol Bull 86 : 420 – 428 , 1979 10.1037/0033-2909.86.2.420 18839484 38 Snyderman CH , Pant H , Carrau RL , Prevedello D , Gardner P , Kassam AB : What are the limits of endoscopic sinus surgery?: the expanded endonasal approach to the skull base . Keio J Med 58 : 152 – 160 , 2009 10.2302/kjm.58.152 19826209 39 Srisopark SS : Ossification of some normal ligaments of the human skull which produce new structures: the pterygospinous and pterygoalar bars and foramina, and the caroticoclinoid foramen . J Dent Assoc Thai 24 : 213