Folia Morphol.

Vol. 83, No. 2, pp. 412–416

DOI: 10.5603/fm.95734
ORIGINAL ARTICLE Copyright © 2024 Via Medica
ISSN 0015–5659
eISSN 1644–3284
journals.viamedica.pl

A morphometric and morphological analysis

of the foramen magnum, hypoglossal canal
and occipital condyles in a select South African
population
Seth Hendricks1, Sundika Ishwarkumar2 , Pamela Pillay1
1
Department of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences, College of Health Sciences,
University of KwaZulu-Natal, Durban, South Africa
2
Department of Human Anatomy and Physiology, Faculty of Health Sciences, University of Johannesburg, South Africa

[Received: 25 May 2023; Accepted: 21 July 2023; Early publication date: 9 November 2023]

Background: The foramen magnum is a centralised structure found at the base

of the skull. This orifice is a passageway that allows secondary structures, such
as the medulla oblongata and meninges, to pass through. The occipital condyles
are small structures on either side of the foramen magnum, forming the cranio-
vertebral joint. The hypoglossal canal is an orifice located on the occipital canal,
providing a passageway for hypoglossal nerves. The study aimed to document
the morphology and morphometry of the foramen magnum, occipital condyles
and hypoglossal canals within a South African population.
Materials and methods: Fifty skulls (n = 50) were randomly selected from the
Department of Clinical Anatomy, School of Laboratory Medicine and Medical
Sciences, University of KwaZulu-Natal. This study investigated the morphological
and morphometric parameters of the foramen magnum, occipital condyles and
hypoglossal canal. The morphometric parameters were measured using a digital
Vernier calliper. The data was statistically analysed using SPSS, and a p-value of
<0.05 was deemed statistically significant.
Results: The mean length and width of the foramen magnum was found to be
35.19 mm and 27.77 mm, respectively. The mean index of the foramen mag-
num was 1.3, which indicated that the foramen magnum was predominantly
oval-shaped within the selected sample. The occipital condyles have a mean
length and width of 21.73 mm and 12.87 mm, respectively. Furthermore, the
most prevalent shape of the occipital condyles was oval. The mean length and
width of the hypoglossal canals were 5.14 mm and 3.87 mm, respectively. While
the most prevalent shape of the hypoglossal canal was oval and round on the
right and left sides, respectively.
Conclusions: The findings of this study may assist in reducing the risk of injury
and mortalities during trans-condylar approach procedures. (Folia Morphol 2024;
83, 2: 412–416)

Keywords: foramen magnum, occipital condyle, hypoglossal canal,

morphological, morphometric, trans-condylar approach

Address for correspondence: Dr. Sundika Ishwarkumar, Department of Human Anatomy and Physiology, Faculty of Health Sciences, University
of Johannesburg, Doornfontein Campus P.O Box 524 Auckland Park South Africa, 2006 Johannesburg, South Africa; e-mail: sishwarkumar@uj.ac.za
This article is available in open access under Creative Common Attribution-Non-Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0) license, allowing to download
articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially.

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 Seth Hendricks et al., Morphometric and morphological analysis of the foramen magnum, hypoglossal canal and occipital condyles

INTRODUCTION of the hypoglossal canal to be 9.90 mm. However,

The foramen magnum, occipital condyles and Muthukumar et al. [7] recorded the mean length of
the first two cervical vertebrae are commonly re- the hypoglossal canal to be 12.60 mm, while the in-
ferred to as craniovertebral junction [10]. The fora- tracranial and extracranial diameters were 7.20 mm
men magnum is a large orifice located in the base and 7.90 mm, respectively.
of the skull, which provides a passageway for the Transcondylar surgery is a type of approach that
medulla oblongata, spinal cord and neurovascular involves the location and resection of lesions in the
structures that leave the skull [12]. The foramen area of the foramen magnum. This surgery is usually
magnum is surrounded by different parts of the performed through the atlantooccipital joint or the
occipital bone, i.e., two condylar, squamous and occipital condyles [8]. In addition, the hypoglossal
occipital parts [10, 12]. Variations in the shape of canal may also be linked to the transcondylar ap-
the foramen magnum exist, this variation may be proach, as in certain instances, lesions are found
due to fetal development, as the foramen, magnum within or around the hypoglossal canal [5]. Hence,
is one of the ossification centres [10]. The irregular knowledge of the morphometry of the canal and
shape of the foramen magnum may cause devel- its surrounding structures may assist during surgi-
opmental anomalies of the bone and soft tissues cal procedures [5]. Therefore, this study aimed to
at the craniovertebral junction [10]. According to document the morphology and morphometry of
literary reports, the most common foramen mag- the foramen magnum, occipital condyles and hy-
num shapes were round [3, 6]; oval [14], hexagonal poglossal canals within a South African population
[6] and tetragonal [10]. Farid and Fattah [4] found of KwaZulu-Natal.
an association between the oval morphology and a
mean length and width of 35.00 mm and 29.40 mm. MATERIALS AND METHODS
The occipital condyle is a distinctive skull structure
containing superior articular facets. The structure and Study design and selection criteria
location of the occipital condyle are developed so This study was conducted on fifty dry adult ca-
that the position is slightly oblique, with the anterior daveric skulls (n = 50) obtained from the Department
region situated more medially. The medial aspect of of Clinical Anatomy at the University of Kwa-Zulu
the occipital condyle is relatively roughened; this is Natal. The age, ancestry and sex of the skulls were
primarily due to the attachments of ligaments [11]. unknown. Ethical approval was obtained from the
The occipital condyles connect the vertebral col- Biomedical Research Ethics Committee (BREC Num-
umn and the cranium, forming the craniovertebral ber: BE362/19). Any skulls that were damaged or
joint. Associated structures of the occipital condyles deformed were excluded from this study.
include cranial nerves, glossopharyngeal and hypo-
glossal nerves, spinal nerves C1 and C2 and menin- Methodology
ges. Generally, the shape of the occipital condyles is Morphology
described as oval; however, Bayat et al. [2] described The morphology of foramen magnum, occipital
the occipital condyles as kidney-shaped. Farid and condyles and hypoglossal canals were observed in
Fataah [4] found that the occipital condyles had the selected sample using the following classification
a mean length and width of the occipital condyles to schemes:
be 23.05 mm and 14.90 mm in their Egyptian sample, 1. Foramen magnum:
respectively. While in the Indian population, the mean • oval-shaped,
length and width were recorded to be 23.60 mm • round-shaped,
and 14.70 mm, respectively [7]. Hence, these studies 2. Occipital condyle:
denote that population-specific differences regarding • kidney-shaped,
the morphology and morphometry of the occipital • oval-shaped,
condyle exist [4]. • round-shaped,
The hypoglossal canal is a crucial structure located 3. Hypoglossal canal:
near the occipital condyles at the anterolateral bor- • oddly shaped,
der of the foramen magnum [5]. Kizilkanat et al. [5], • oval-shaped,
when observing Turkish skulls, found the mean length • round-shaped.

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 Folia Morphol., 2024, Vol. 83, No. 2

Table 1. Morphology of foramen magnum Table 3. Morphology of hypoglossal canal

Shape Frequency Percentage [%] Shape Right Left
Oval 29 58.0 Frequency Percentage Frequency Percentage
Round 21 42.0 [%] [%]

Total 50 100.0 Oddly 3 6.0 5 10.0

shaped
Oval 27 54.0 22 44.0
Table 2. Morphology of occipital condyles Round 20 40.0 23 46.0
Total 50 100.0 50 100.0
Shape Right Left
Frequency Percentage Frequency Percentage
[%] [%]
Kidney- 5 10.0 8 16.0 and round-shaped occipital condyles were document-
-shaped ed in 16.0% and 20.0%, respectively (Table 2).
Oval 38 76.0 32 64.0
Round 7 14.0 10 20.0 Hypoglossal canal
Total 50 100.0 50 100.0 The right hypoglossal canal was observed to be
oval, round and oddly shaped in 54.0%, 40.0% and
6.0% of the specimens in this study, respectively
Morphometry (Table 3). The left hypoglossal canal was found to
In this study, each of the following morphometric be oddly shaped (10.0%), oval-shaped (44.0%) and
parameters was measured three times by the first round shaped (46.0%) (Table 3).
author in accordance with Farid and Fattah [6],
using a digital Vernier Calliper set to the precision Morphometry
of 0.01 mm: Foramen magnum
• length and width of the foramen magnum, In this study, the mean length and width of the
• bilateral length and width of the occipital condyles, foramen magnum were 35.19 mm and 27.77 mm,
• bilateral length and width of the hypoglossal canal. respectively (Table 4). The foramen magnum index
The foramen magnum index was calculated for was calculated to be 1.3, which denoted that the
each skull using the formula: Foramen magnum = oval-shaped foramen magnum was most prevalent
= foramen magnum length/ foramen magnum width. (Table 4).
If the Index is greater or equal to 1.2, then the mor-
phology of the foramen magnum is said to be oval. Occipital condyles
However, if it is less or equal to 1.2, then the foramen The mean length of the occipital condyle was
magnum has an asymmetrical shape [4]. 21.75 mm on the right side and 21.72 mm on the left
side in the selected South African sample (Table 5).
RESULTS While the mean width of the right and left occipital
Morphology condyle was 12.32 mm and 13.43 mm, respectively
Foramen magnum (Table 5).
The foramen magnum was predominantly oval-
-shaped in this study, with an incidence of 58.0%. This Hypoglossal canal
was followed by the round shape, with an incidence In this study, the hypoglossal canal had a mean
of 42.0% (Table 1). length of 4.59 mm on the right side and 5.68 mm
on the left side (Table 5). The mean width of the hy-
Occipital condyles poglossal canal was 3.79 mm and 3.94 mm on the
In the present study, the right occipital condyle right and left sides, respectively (Table 5).
was recorded to be oval-shaped in 76.0% of the spec-
imens, while in 10.0% and 14.0% of specimens, it was DISCUSSION
recorded to be kidney and round-shaped, respectively The surgeons must have a firm grasp of the anatom-
(Table 2). Similarly, the left occipital condyle was also ical landmarks during neuro-surgical procedures [12]. In
predominantly oval-shaped (64.0%), while the kidney particular, when performing transcondylar surgery and

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 Seth Hendricks et al., Morphometric and morphological analysis of the foramen magnum, hypoglossal canal and occipital condyles

Table 4. Morphometry of foramen magnum in the South African sample (in mm)
Sample Mean length Mean width FM index:
size (n) Length ± standard derivation Standard error Width ± standard derivation Standard error FM mean length/FM mean
width
50 35.19 ± 3.37 mm 0.78 27.77 ± 3.84 mm 0.71 1.3

Table 5. Morphometry of occipital condyles and hypoglossal canals in the South African sample (in mm)
Param- Sample Occipital condyle Hypoglossal canal
eters size
(n) Right Standard Left Standard Right Standard Left Standard
error error error error
Mean 100 21.75 ± 2.97 mm 0.55 21.72 ± 3.17 mm 0.57 4.59 ± 1.41 mm 0.20 5.68 ± 1.61 mm 0.24
length
Mean 100 12.32 ± 2.02 mm 0.34 13.43 ± 2.05 mm 0.36 3.79 ± 1.21 mm 0.18 3.94 ± 1.98 mm 0.28
width

occipital condyle drilling, the craniovertebral junction Occipital condyles

is an important landmark [9]. Therefore, it is impera- The right and left occipital condyles had a mean
tive to have extensive knowledge of the relationship length of 21.75 mm and 21.72 mm, and a mean
between the foramen magnum, occipital condyles and width of 12.32 mm and 13.43 mm, respectively. In
hypoglossal canal in different population groups [1]. comparison to the present study, Farid and Fataah
[4] reported a slightly larger mean length and width
Foramen magnum of the occipital condyles in the Egyptian population,
In this study, the mean length and width of the i.e., a mean length of 22.90 mm and 23.20 mm and
foramen magnum were recorded to be 35.19 mm and a width of 14.80 mm and 15.00 mm on the right and
27.77 mm, respectively. Similarly, Farid and Faataah left sides, respectively. Furthermore, Muthukumar et
[4] reported that the foramen magnum had a mean al. [7] found that the mean length and width of the
length of 35.00 mm, and a mean width of 29.40 mm occipital condyles were 23.60 mm and 14.70 mm,
in the Egyptian population. However, Muthukumar respectively. This indicates that population-speci­
et al. [7] documented that the length and width of fic differences may exist. In this study, the occipital
the foramen magnum in the Indian population was condyles were predominantly oval-shaped; however,
34.60 mm and 29.00 mm, respectively. In addition, Bayat et al. [2] documented that the kidney-shaped
Ulcay et al. [13] reported an observed mean length occipital condyles were most prevalent in the Iranian
and width of 35.81 mm and 28.14 mm in the Turkish population.
population. When observing the morphology of the
foramen magnum, the oval shape was most frequent- Hypoglossal canal
ly observed in this study, which correlated with the In this study, the right and left hypoglossal canals
study conducted by Ulcay et al. [13]. However, in the had mean length of 4.59 mm and 5.68 mm, respec-
Indian and Turkish population groups, the foramen tively. While the mean width of the hypoglossal canals
magnum was predominantly rounded in shape. Fur- is 3.79mm on the right side and 3.94 mm on the left
thermore, in this study, the foramen magnum index side in this study. However, Muthukumar et al. [7]
was calculated to be 1.3, which indicated that the documented that the mean length of the hypoglossal
foramen magnum was oval-shaped (> 1.2), which canal was 12.60 mm in the Indian population group.
correlated with the findings of Muthukumar et al. Kizilkanat [5] reported that the hypoglossal canal had
[7]. In contrast, Farid and Fataah [4] found that the a mean length of 9.90 mm in their study. In addition,
asymmetrically shaped foramen magnum (< 1.2) was the right hypoglossal canal was most frequently oval-
most prevalent in 60% of their sample, followed by -shaped, while the left was predominantly round in
the oval shape (> 1.2) with a 40% prevalence. this study.

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Limitations of the study 2. Bayat P, Bagheri M, Ghanbari A, et al. Characterization of

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head and foramen magnum circumferences in dry skulls
graphic data of the specimens was not accessible to
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