Showing papers in "Surgical and Radiologic Anatomy in 2015"
TL;DR: This decline in anatomy in medical education is hazardous not only to the medical profession but also to society and reforms consisting of balanced rescheduling of medical curricula and optimum resource allocation have been proposed to improve the standard of education of doctors.
Abstract: Purpose
The continuous decrease in teaching time, the artificially created scarcity of competent anatomical faculties and a reduced allocation of resources have brought about the decline of anatomy in medical education. As a result of this, anatomical knowledge and the standard of medical education have fallen with consequences including safety in clinical practice. The aim of the present study is to analyze this declining phase of anatomy and its impact on medical education and to consider corrective measures.
73 citations
TL;DR: The rate of ON protrusion is lower in the SEA population, whereas the rates of ON dehiscence, ICA dehISCence and ICA protrusion fall within the range of international averages.
Abstract: Failure of a surgeon to understand the local variations of the anatomical landmarks of the sphenoid sinus is a potential risk factor to cause damage to the optic nerve (ON) or internal carotid artery (ICA) that lies on the walls of the sphenoid sinus. The aim of this study was to identify the anatomical variants of the sphenoid sinus and its related surrounding structures among the Southeast Asian (SEA) population, based on computed tomography (CT) scans. This cross-sectional study analyzed 300 CT scans of the brain, paranasal sinuses (PNS), and head and neck (H&N) at a tertiary referral centre in Malaysia utilizing the Osirix software. The images were reconstructed into 1 mm cuts on bone window. Demographic details and scan findings were documented in a standardized data collection sheet. The rates of ON dehiscence, ICA dehiscence and ICA protrusion in the SEA population were 7.0, 3.0 and 10.0 %, respectively. The rate of ON protrusion was 2.3 %. There was no statistically significant relationship (p > 0.05) noted on Chi-square test, between anterior clinoid process (ACP) pneumatization and ON protrusion. The rate of Onodi cells in our population was 14.3 %. The average vertical distance of the ostia from the roof of the posterior choanae was 1.42 cm (±0.32). The horizontal distance of the ostia from the anterior end of the superior turbinate was 1.58 cm (±0.41) and the oblique distance of the ostia from the anterior nasal spine was 5.35 cm (±0.48). Independent t tests showed that there is a statistically significant difference between the means of each of these parameters (p < 0.001) and their international averages. The rate of ON protrusion is lower in the SEA population, whereas the rates of ON dehiscence, ICA dehiscence and ICA protrusion fall within the range of international averages. In our population, ACP pneumatization is not related to ON protrusion. The distance of the ostia from given landmarks was significantly shorter than in other studies.
41 citations
TL;DR: Despite the acknowledged limitation owing to the varied terminology used to describe this accessory muscle group, the significant differences found between the aggregate frequency estimates of each muscle do not support the hypothesis that both muscles are variants of a same structure.
Abstract: The denomination of “accessory peroneal muscle” (APM) refers usually to two muscles: the peroneus quartus (PQua) and the peroneus digit quinti (PQui) which were believed to be variants of a same muscle. Their morphology and prevalence show high variation in relevant literature mainly owing to the diverse terminology used to describe this muscle group. The aim of this meta-analysis is to generate more accurate description and frequency of those muscles. A total of 46 studies (3,928 legs/ankles) met the inclusion criteria. The aggregate results were: (a) a true APM prevalence of 16 % with 10.2 % for PQua vs. 34.3 % for PQui; (b) a crude prevalence of 16.6 % for PQua vs. 21.5 % for PQui; (c) a bilateral prevalence of 1.73 % for PQua vs. 12.5 % for PQui; (d) the PQua was significantly more prevalent in Indian populations compared to all other ancestries, and the PQui is significantly more prevalent in Europeans and Americans compared to Japanese and Korean populations; (e) though a tendency for higher frequency was found in males and on the right specimens, no significance was found for gender and side; for (f) the “surgical” occurrence of PQua in studies dealing with peroneal tendon surgery was 5.5 % where peroneal tendon pathology seems to be not associated with the presence of an APM; (g) the MRI prevalence of APM was 10.6 %; (h) APMs took origin from peroneus brevis in 60 %, from the distal fibula in 36 % and from other structures in 4 %; (i) APMs took insertion on retrotroclear eminence of the calcaneum in 53.4 %, on peroneal trochlea in 6.6 %, merged with a peroneal tendon in 9.3 %, and inserted on the extensor apparatus of the 5th toe in 18.4 %. Despite the acknowledged limitation owing to the varied terminology used to describe this accessory muscle group, the significant differences found between the aggregate frequency estimates of each muscle do not support the hypothesis that both muscles are variants of a same structure.
40 citations
TL;DR: The measurements conducted around nasopalatine canal provided useful information prior to implant placement in the anterior maxilla as well as linear and volumetric measurements using CBCT images.
Abstract: Purpose
To establish (nasopalatine canal) NPC morphology and obtain linear and volumetric measurements using CBCT images.
37 citations
TL;DR: Physicians performing injection treatments such as botulinum toxin type A and dermal filler injection to the posterior frontal area should be aware of the various distributions of the Fbr.
Abstract: Background
The frontal branch of the superficial temporal artery (Fbr) is vulnerable to damage triggered by iatrogenic manipulation by both dermal filler and BoNT-A injection. The purpose of this study was to elucidate the branching pattern of Fbr and to determine its location and course on the lateral border of the frontal belly of the occipitofrontalis muscle (FB).
36 citations
TL;DR: The absence of no attachment and FDL tendon to the FHL between the two tendons in the foot may be more frequent than previously reported.
Abstract: Purpose
The purpose of the study was to describe the anatomical variations of the connection between the flexor hallucis longus (FHL) and flexor digitorum longus (FDL) tendons in the knot of Henry in Asians, and quantify the length of FHL tendon graft with different incisions.
32 citations
TL;DR: An understanding of the limitations of ultrasound combined with more frequent and thorough use of MRCP before surgical intervention could prevent serious complications of laparoscopy in patients with double gallbladder disease or intraoperatively.
Abstract: Duplicate gallbladder is a rare congenital abnormality of the hepatobiliary system that has an incidence of roughly 1 in 4000. Many surgical studies have demonstrated that congenital anomalies of the gallbladder and anatomical variations of its position are associated with an increased risk of complications after laparoscopic cholecystectomy. Using ultrasound, MRCP and 3D reconstructions, we report a case of a 29-year-old female who was incidentally revealed to have a duplicated gallbladder. A review of the literature surrounding this variant, its anatomical classifications and relevance to surgical practice is included. The double gallbladder is a rare congenital condition that is often not considered in the differential diagnosis for a patient with gallbladder disease or intraoperatively. At present, it is only detected via pre-operative imaging in 50 % of cases, but an understanding of the limitations of ultrasound combined with more frequent and thorough use of MRCP before surgical intervention could prevent serious complications of laparoscopy in these patients.
30 citations
TL;DR: It is concluded that sternal acupuncture should be planned in the region of corpus—previous CT should be done to rule out this variation, and the acupuncture technique which prescribes a safe superficial-oblique approach to the sternum is strongly recommended.
Abstract: Due to inadvertent cardiac or great vessel injury, sternal foramina may pose as a great hazard during sternal puncture. They can also be misinterpreted as osteolytic lesions in cross-sectional imaging of the sternum. The distribution of these variations differs between populations, but data from Brazilians are scarcely reported. Therefore, this study aimed to verify the frequency of midline sternal foramen and double-ended xiphoid process, as developmental variations, in order to avoid fatal complications following sternal puncture of sternal acupuncture treatment. A total of 114 chest computed tomograms were evaluated. The frequency of midline sternal foramen in a complication risk bearing feature is of approximately 10.5%. The double-ended xiphoid process was present in 17.5%. We conclude that sternal acupuncture should be planned in the region of corpus-previous CT should be done to rule out this variation. Furthermore, we strongly recommend the acupuncture technique which prescribes a safe superficial-oblique approach to the sternum.
30 citations
TL;DR: The renal vein variations are not unusual, particularly in the RRV, but the renal vein anatomy can be well depicted by MDCT angiography and anomalies of the LRV are more complex than those of theRRV.
Abstract: To estimate the incidence, anatomical feature as well as type of the renal vein variation with multidetector computed tomography (MDCT) in an adult population. A total of 1,452 patients who underwent MDCT angiography were retrospectively evaluated for the presence (number, length, origination, destination, branching pattern and course) of the renal vein variation. χ² test was used to compare the incidence of variations in left and right renal veins and the incidence of variations in each side renal vein between males and females. Renal vein variations were observed in 358 patients (24.7 %, 358/1,452), which included 103 patients (7.1 %, 103/1,452) with left renal vein (LRV) variations, 279 patients (19.2 %, 279/1,452) with right renal vein (RRV) variations and 24 patients (1.7 %, 24/1,452) with bilateral renal vein variations. The frequency of RRV variations was significantly higher than that of LRV variations (p 0.05). According to the morphology of the renal vein, we classified LRV variations into five types: type I, circumaortic LRV (2.1 %, 31/1,452); type II, retroaortic LRV (2.1 %, 30/1,452); type III, abnormal reflux (1.7 %, 24/1,452); type IV, late venous confluence of LRV (0.9 %, 13/1,452); type V, rare type (0.3 %, 5/1,452), and RRV variations into three types: type 1, additional renal vein (18.7 %, 271/1,452); type 2, abnormal reflux (0.4 %, 6/1,452); type 3, rare type (0.1 %, 2/1,452). The renal vein variations are not unusual, particularly in the RRV. Anomalies of the LRV are more complex than those of the RRV. The renal vein anatomy can be well depicted by MDCT angiography. Our new classification of the renal vein variations will improve the recognition of the renal vein morphology preoperatively.
29 citations
TL;DR: There exists no real area of anatomical safety in the temporal region, it seems, however, possible to define areas of relative safety that would be of great help for the surgeon or the morphologist wishing to approach pathologies of this region.
Abstract: The temporal branch of the facial nerve, a particularly important branch in facial expression, is commonly exposed to surgical trauma. The frontal branch is the most important branch of the temporal branch in the clinical point of view. However, it does not really define in the international nomenclature. The objective of this study was to clearly identify this branch, to perform a cartography of the crossing areas of this branch; and therefore to define statistically a zone of safety within the fronto-temporal region. We used 12 fresh cadavers to perform 24 facial nerve dissections. After the identification of the facial nerve, the branches of the temporofacial trunk were identified, dissected and followed till their penetration. We measured the relationship of the frontal branch with the zygomatic arch, temporal vessels and lateral border of the orbit. We conducted a statistical study to assess the risk of injury of this branch within the temporal region. We observed an important variability in the distribution of this branch in the temporal region. We defined three zones of decreasing safety at the level of three interest landmarks: at the level of the inferior part of the zygomatic arch, we estimated an elevated risk of nerve injury (>85 %) from 22.6 to 26.06 mm in front of the tragus; at the level of the superior part of the zygomatic arch, we estimated an elevated risk of nerve injury (>85 %) from 27.46 to 30.43 mm in front of the tragus; at the level of the lateral border of the orbit, we estimated an elevated risk of nerve injury (>85 %) from 16.20 to 19.17 mm behind this landmark. There exists no real area of anatomical safety in the temporal region. It seems, however, possible to define areas of relative safety that would be of great help for the surgeon or the morphologist wishing to approach pathologies of this region.
29 citations
TL;DR: The development of the DF in later stages of fetal development may result from the mechanical stress on the increased volumes of the mesorectum, seminal vesicle, prostate and vagina and/or enlarged rectum and be considered as a tension-induced structure rather than a fusion fascia.
Abstract: Although several studies have reported that the peritoneum does not contribute to the formation of a fascia between the urogenital organs and rectum, Denonvilliers' fascia (DF), a fascia between the mesorectum and prostate (or vagina) in adults, is believed to be a remnant of the peritoneum. Remnants of the peritoneum, however, were reportedly difficult to detect in other fusion fasciae of the abdominopelvic region in mid-term fetuses. To examine morphological changes of the pelvic cul-de-sac of the peritoneum, we examined 18 male and 6 female embryos and fetuses. A typical cul-de-sac was observed only at 7 weeks, whereas, at later stages, the peritoneal cavity did not extend inferiorly to the level of the prostatic colliculus or the corresponding structure in females. The cul-de-sac had completely disappeared in front of the rectum at 8 weeks and homogeneous and loose mesenchymal tissue was present in front of the rectum at the level of the colliculus at 12-16 weeks. We found no evidence that linearly arranged mesenchymal cells developed into a definite fascia. Therefore, the development of the DF in later stages of fetal development may result from the mechanical stress on the increased volumes of the mesorectum, seminal vesicle, prostate and vagina and/or enlarged rectum. Therefore, we considered the DF as a tension-induced structure rather than a fusion fascia. Fasciae around the viscera seemed to be classified into (1) a fusion fascia, (2) a migration fascia and (3) a tension-induced fascia although the second and third types are likely to be overlapped.
TL;DR: An anatomic comparison of AP versus EEEA is presented to describe the limits of these both approaches helping the choice of the optimal surgical route for petroclival tumors, with the conclusion that the AP should be preferred for radical removal of middle-sized petrous apex intradural tumors like meningiomas.
Abstract: Since the petroclival region is deep-seated with close neurovascular relationships, the removal of petroclival tumors still represents a fascinating surgical challenge. Although the classical anterior petrosectomy (AP) offers a meaningful access to this petroclival region, the expanded endoscopic endonasal approach (EEEA) recently leads to overcome difficulties from trans-cranial approaches. Herein, we present an anatomic comparison of AP versus EEEA. We aim to describe the limits of these both approaches helping the choice of the optimal surgical route for petroclival tumors. Six fresh cadaveric heads were harvested and injected with colored latex. Each approach was step-by-step detailed until its final surgical exposure. The AP provided a narrow direct supero-lateral access to the petroclival area that can also reach the cavernous sinus, the retrochiasmatic region and perimesencephalic cisterns. However, this corridor anterior to the internal acoustic meatus passed on each side of the trigeminal nerve. Moreover, tumor extensions toward the foramen jugularis, inside the clivus or behind the internal acoustic meatus were difficult to control. The EEEA brought a straightforward access to the clivus but the petrous apex was hidden behind the internal carotid artery. Several variants were described: a medial transclival, a lateral through the Meckel’s cave and an inferior trans-pterygoid route. Elsewhere, tumor extension behind the internal acoustic meatus or above the tentorium could not be satisfactorily assessed. PA and EEEA have their own limits in reaching the petroclival region in accordance with the tumor characteristics. The AP should be preferred for radical removal of middle-sized petrous apex intradural tumors like meningiomas. The EEEA would be of interest for extradural midline tumors like chordomas or for petrous apex cysts drainage.
TL;DR: It is indicated that the anterior and middle facets are fused more frequently in tali than in calcanei, and combinations of different CSTJ facet types (A–B, B–C) exist over 40 % of feet.
Abstract: Articular facets of the clinical subtalar joint (CSTJ) were analyzed using a total of 118 (right 57, left 61) dry, paired calcanei and tali from 68 Korean adult cadavers. The CSTJ facets were classified into the following three types depending on their continuity: type A, all three facets are separated; type B, the anterior and middle facets are partially connected; and type C, the anterior and middle facets are fused to form a single facet. The continuity between the anterior and middle facets was represented by the degree of separation (DS), which ranged between 2.00 (type A) and 1.00 (type C). Type A was most common (39.0 %) in calcanei and rarest (11.0 %) in tali. Matching of calcaneus-talus pairs yielded five combined types: A-A (11.0 %), A-B (28.0 %), B-B (18.6 %), B-C (13.6 %), and C-C (28.8 %). The mean DS was slightly greater in calcanei (1.53) than in tali (1.32), and decreased in the order of types A-A, A-B, B-B, B-C, and C-C. The intersecting angles between the anterior and middle facets, which are related to the mobility of the CSTJ, were inversely related to the DS. These findings indicate that the anterior and middle facets are fused more frequently in tali than in calcanei, and combinations of different CSTJ facet types (A-B, B-C) exist over 40 % of feet. Our results indicate that types with a smaller DS (such as B-C and C-C) are relatively mobile but less stable compared to those with a greater DS (such as A-A and A-B).
TL;DR: The ILA and HLA should be differentiated according to the location of their origin rather than their terminating areas, and the significance of the HLA in the vascularization of the lower lip is clarified.
Abstract: Background The inferior labial artery (ILA) and horizontal labiomental artery (HLA) can be regarded as the main arteries used in the lower lip pedicle for the perioral reconstruction. However, the courses of the ILA and HLA are described in diverse ways, and there is no obvious standard for distinguishing between them. The aim of this study was to elucidate the distribution patterns of the ILA and HLA, and the significance of the HLA in the vascularization of the lower lip. Materials and methods Sixty-three hemifaces from 18 Korean and 19 Thai cadavers were used in this study. The distribution patterns of the arteries of the lower lip area were classified based on the assumption that the HLA travels in the middle of the lower lip area, while the ILA runs along the lower lip border. The arterial distribution pattern of the HLA was classified into three types (I-III): type I, where the HLA ran horizontally in the lower lip area; type II, where the HLA curved upward to the vermilion border of the lower lip; and type III, where the HLA bifurcated into two branches. The ILA was also classified into three types (A-C): type A, where the ILA was not observed; type B, ILA was ramified from facial artery at the level of mouth corner; and type C, ILA arose from the superior labial artery (SLA) and supplied the lower lip vermillion border. Results Types I, II, and III were observed in 52.4 % (33/63), 39.7 % (25/63), and 7.9 % (5/63) of cases, respectively; and types A, B, and C were observed in 52.4 % (33/63), 36.5 % (23/63), and 11.1 % (7/63) of cases. Consideration of the two artery classifications together revealed seven types: type IA (14.3 %, 9/63), type IB (28.6 %, 18/63), type IC (9.5 %, 6/63), type IIA (30.2 %, 19/63), type IIB (7.9 %, 5/63), type IIC (1.6 %, 1/63), and type III (7.9 %, 5/63). The distance between the HLA and the midpoint between the mouth corner and the inferior mandibular margin was 0.4 ± 3.1 mm (mean ± SD) inferior to this point. Conclusion The ILA and HLA should be differentiated according to the location of their origin rather than their terminating areas. The HLA could be considered as the main artery supplying the lower lip mucosa.
TL;DR: Many variations exist in the running patterns of the branching pattern of the popliteal artery, which will be beneficial to radiologist for the evaluation of CT angiograms and interventional vascular procedures, and to vascular surgeons for various surgical approaches.
Abstract: To date the anatomy of the popliteal artery variations using multidetector-row computed tomography angiography (MD CTA) was not assessed. The objective of this study is to establish 3D CT anatomy of the popliteal artery variations. A total of 126 lower limbs that underwent CTA using 64-detector MDCT were retrospectively reviewed. The anatomical variations of the distal popliteal artery branching were assessed. Ninety-seven lower limbs (83.6 %) had the usual branching pattern (type 1 A) with tibialis anterior artery (TA) arising first followed by the tibial-peroneal trunk, which then gives rise to the tibialis posterior artery (TP) and peroneal artery. Variations in popliteal branching pattern were seen in 19 (16.4 %) limbs. The commonest variation was first branch of the TP in 5 (4.4 %) of the limbs (type 1 C) or high origin with anterior course of popliteus muscle of the TA in 5 (4.4 %) limbs (type 2 A II). Many variations exist in the running patterns of the branching pattern of the popliteal artery. Knowledge of the branching pattern of the popliteal artery will be beneficial to radiologist for the evaluation of CT angiograms and interventional vascular procedures, and to vascular surgeons for various surgical approaches. MD CTA provides noninvasive means of assessing distal popliteal artery variations.
TL;DR: This is the first evidence-based anatomical review, which addresses the frequency of EDBM in humans, and non-significant association was found between EDBM presence and ancestry, gender or side.
Abstract: Extensor digitorum brevis manus (EDBM) is a rare variant extensor muscle of the dorsum of the hand, which constitutes a diagnostic challenge in clinical practice. The aims of the review are to provide a better estimate of the frequency of EDBM and its association with variables such as ancestry, gender, laterality and side. Twenty-six studies met the inclusion criteria. The pooled rates of the meta-analyses yielded the following values: (a) an overall crude cadaveric prevalence of 4 %, (b) an overall true cadaveric prevalence of 2.5 %, (c) a true cadaveric prevalence of 2.6 % in European ancestry, (d) a true cadaveric prevalence of 2.3 % in Asian ancestry (2.07 % in Japanese and 4.2 % in Indian), (e) a bilateral occurrence in 26.3 %. Non-significant association was found between EDBM presence and ancestry, gender or side. The EDBM muscle was inserted on the index in 77 % of cases and on the long finger in the remaining 23 %. This is the first evidence-based anatomical review, which addresses the frequency of EDBM in humans.
TL;DR: Female subjects have a higher incidence of variations in the anterior communicating artery complex, and there is aHigher incidence of anterior communicating arteries aplasia among women.
Abstract: Purpose
The anatomy of the anterior communicating artery complex plays a critical role in surgical treatment of anterior cerebral circulation aneurysms. A thorough description of vascular variations of the anterior communicating artery complex seems to be lacking. The aim of this study was to describe the anatomical variations of the anterior communicating artery complex.
TL;DR: To dissect the musculocutaneous nerve between 18 and 75 % of the distance between the coracoid process and the lateral epicondyle to identify the motor terminal branches to the biceps brachii and the brachialis muscle, sparing sensory branches.
Abstract: Purpose
Spastic flexion deformity of the elbow is mainly mediated by the biceps brachii and the brachialis muscles, innervated by the musculocutaneous nerve. Selective neurectomy of the musculocutaneous nerve showed promising results to relieve excessive spasticity in the long term but lacks of a consensual surgical strategy. The aim of the study was to describe the distal branching pattern of the motor branches of the musculocutaneous nerve in an attempt to develop guidelines for surgery.
TL;DR: The sensory distribution in the dorsum of the hand is variable; however, understanding the most common innervation pattern and appreciating the possible variations to this pattern is important to avoid errors in interpretation of conduction velocity studies, mis diagnosis of nerve pathology signs and symptoms and inappropriate treatments.
Abstract: The sensory distribution in the dorsum of the hand was investigated in 150 formalin-fixed hands with the aim of outlining the most common innervation pattern of the superficial branch of the radial nerve (SBRN), dorsal branch of the ulnar nerve (DBUN) and the lateral antebrachial cutaneous nerve (LABCN). Although variable, the most common pattern found was SBRN innervation to the dorsal surface of the lateral 2½ digits and DBUN innervation to the dorsal surface of the medial 2½ digits. Dual innervation due to communicating branches or nerves overlapping was found in 41 cases. All-radial supply to the dorsum of the hand was found in ten cases. The LABCN was closely associated, and occasionally overlapped, with the SBRN. There were significant differences in the sensory distribution of the dorsum of the right and left hands of the same cadaver. The sensory distribution in the dorsum of the hand is variable; however, understanding the most common innervation pattern and appreciating the possible variations to this pattern is important to avoid errors in interpretation of conduction velocity studies, misdiagnosis of nerve pathology signs and symptoms and inappropriate treatments.
TL;DR: Iliac venous variations are frequently seen on MDCT and can be classified into 8 types, which varied according to right- or left-side variation and the status of smaller connecting veins.
Abstract: To determine the prevalence of iliac venous variations and to classify the variations using multidetector computed tomography (MDCT). MDCT images of 2,488 patients were retrospectively reviewed. Iliac venous variations were documented and classified with regard to internal iliac vein (IIV) drainage patterns, the presence of interiliac communicating veins and inferior vena cava (IVC) anomalies associated with iliac venous variations. The variation prevalence rates were analyzed and calculated. The incidence of iliac venous variations was 20.9 %, and these were classified into eight types: normal, 79.1 % (type 1); high joining of the IIV to the ipsilateral external iliac vein, 8.7 % (type 2); the IIV joining to the contralateral common iliac vein (CIV), 2.3 % (type 3); IIVs forming a common trunk, 0.9 % (type 4); communicating vein from the IIV to the contralateral CIV or IIV, 7.8 % (type 5); double IVC with or without a connecting vein, 0.9 % (type 6); left IVC, 0.1 % (type 7); and fenestration of the CIV, 0.4 % (type 8). There were subtypes which varied according to right- or left-side variation and the status of smaller connecting veins. No statistical difference in the prevalence rate was found between men and women (p = 0.365). Iliac venous variations are frequently seen on MDCT and can be classified into 8 types.
TL;DR: The ethmoidal foramen clearly represents an area of least resistance in the anterior part of the olfactory cleft, which could predispose to anterior skull base cerebrospinal fluid leaks and meningoceles.
Abstract: Purpose
The olfactory cleft has garnered interest since the advent of endoscopic skull base surgery. Its precise anatomy, however, is still partially unknown. According to Rouviere, an “ethmoidal foramen” is located in its antero-medial part and contains a process of the dura mater. In a more lateral and anterior location, a second foramen, the “cribroethmoidal foramen”, contains the anterior ethmoidal nerve. The aim of this study was to verify the existence of these elements and to establish landmarks for surgery.
TL;DR: The functional connectivity between brain regions mediating reward, autonomic and cognitive processing provides insight into understanding why listening to music is one of the most rewarding and pleasurable human experiences.
Abstract: Music is a universal feature of human societies over time, mainly because it allows expression and regulation of strong emotions, thus influencing moods and evoking pleasure. The nucleus accumbens (NA), the most important pleasure center of the human brain (dominates the reward system), is the ‘king of neurosciences’ and dopamine (DA) can be rightfully considered as its ‘crown’ due to the fundamental role that this neurotransmitter plays in the brain’s reward system. Purpose of this article was to review the existing literature regarding the relation between music and the NA. Studies have shown that reward value for music can be coded by activity levels in the NA, whose functional connectivity with auditory and frontal areas increases as a function of increasing musical reward. Listening to music strongly modulates activity in a network of mesolimbic structures involved in reward processing including the NA. The functional connectivity between brain regions mediating reward, autonomic and cognitive processing provides insight into understanding why listening to music is one of the most rewarding and pleasurable human experiences. Musical stimuli can significantly increase extracellular DA levels in the NA. NA DA and serotonin were found significantly higher in animals exposed to music. Finally, passive listening to unfamiliar although liked music showed activations in the NA.
TL;DR: In the present review, a historical background was outlined, confirming that the Malgaigne’s definition of the cervical fascia as an anatomical Proteus is widely justified.
Abstract: The cervical fasciae have always represented a matter of debate Indeed, in the literature, it is quite impossible to find two authors reporting the same description of the neck fascia In the present review, a historical background was outlined, confirming that the Malgaigne's definition of the cervical fascia as an anatomical Proteus is widely justified In an attempt to provide an essential and a more comprehensive classification, a fixed pattern of description of cervical fasciae is proposed Based on the morphogenetic criteria, two fascial groups have been recognized: (1) fasciae which derive from primitive fibro-muscular laminae (muscular fasciae or myofasciae); (2) fasciae which derive from connective thickening (visceral fasciae) Topographic and comparative approaches allowed to distinguish three different types of fasciae in the neck: the superficial, the deep and the visceral fasciae The first is most connected to the skin, the second to the muscles and the third to the viscera The muscular fascia could be further divided into three layers according to the relationship with the different muscles
TL;DR: Three-dimensional reconstructions were obtained by post-processing the MRI images and will be used to perform pre-surgical simulations by settings a generic model that can be adapted to the different localization of the human body in a procedural way.
Abstract: With a view to developing a tool for predicting the behavior of soft tissues during plastic surgery procedures, we looked for the existence of homologies in the overall pattern of organization of the skin/subcutaneous tissue complex between various body parts, using high-resolution in vivo imaging methods and data available in the literature. 3T MRI scanning sequences were performed using appropriate radiofrequency coils on the face, thorax, breast, abdomen and lower extremity of six healthy volunteers. The radiological findings were segmented and converted into volumetric data. The superficial and deep adipose tissue was found to be clearly separated by an intermediate layer called stratum membranosum or superficial fascia. This continuous layer covered all the anatomical parts of the body examined. It was found to have several components in the trunk and limbs and to form a continuous layer with the superficial muscular aponeurotic system in the face. A retaining connective network consisting of superficial and deep retinacula cutis detected in all the regions investigated sometimes formed more densely packed structures playing the role of skin ligaments. The results of a 3T MRI study on subcutaneous tissue showed the existence of a common pattern of organization of the skin–subcutaneous tissue complex in the various parts of the body studied. This general model is subject to quantitative variations and tissue differentiation processes promoting the sliding or contractility of the supporting tissue. Three-dimensional reconstructions were obtained by post-processing the MRI images and will be used to perform pre-surgical simulations by settings a generic model that can be adapted to the different localization of the human body in a procedural way.
TL;DR: This systematic review gathers the available data on the prevalence of EI tendon and its variation in the hand to help surgeons in correctly choosing the tendon to transfer in hand surgery.
Abstract: The tendon of the extensor indicis (EI) is frequently used to restore the loss of function in other digits. However, it shows many variations which include splitting of the extensor indicis proprius (EIP) into two or three distal slips, attachment to fingers other than the index such as the extensor medii proprius (EMP), attachment onto the index and the third finger such as the extensor indicis et medii communis, or attachment to both the index and the thumb such as the extensor pollicis et indicis (EPI). This systematic review gathers the available data on the prevalence of EI tendon and its variation in the hand. Twenty-nine cadaveric studies met the inclusion criteria with a total of 3858 hands. Meta-analysis results yielded an overall pooled prevalence estimate (PPE) of EI of 96.5 % and PPEs of 92.6, 7.2 and 0.3 % for the single-, double- and triple-slip EIP, respectively. The single-slip EIP is frequently inserted on the ulnar side of the extensor digitorum communis of the index (EDC-index) in 98.3 %. The double-slip EIP is located on the ulnar side of the EDC-index in 53.5 %, on its radial side in 17 % and on both sides in 28.7 %. Indian populations showed the highest rate of single-slip EIP and the lowest rate of double-slip EIP when compared to Japanese, Europeans and North Americans. The pooled prevalence of EMP, EMIC and EPI were 3.7, 1.6 and 0.75 %, respectively. Knowledge of the variants of the EI tendon and their prevalence should help surgeons in correctly choosing the tendon to transfer in hand surgery.
TL;DR: Mandibular lingual concavity dimensions were found to vary by age, location, and the presence/absence of teeth.
Abstract: The purpose of this study was to evaluate the prevalence of mandibular lingual concavities and to measure them using CBCT (Cone-Beam Computerized Tomography). In this study, CBCT scans of 200 patients requiring dental implants were assessed for lingual concavities. Reconstructed CBCT images were transferred as DICOM files to the 3D DOCTOR software program, and metric, volumetric, and surface area measurements were obtained. Two-way mixed ANOVA was used to model side (left/right, anterior), measurement type, and gender with side and type taken as within-subject variables, gender as between-subject variables, and age as a covariate. A comparison between the dentate and edentulous groups in the samples with lingual concavities was performed using an unpaired Student’s t test. Submandibular concavity mean depth and volume were found to be 2.4 mm and 130.7 mm3, whereas mean depth and volume of sublingual concavities were found to be 1.3 mm and 26.5 mm3. Significant inverse ratios were found between age and volume and between age and surface area (p 0.05). Mandibular lingual concavity dimensions were found to vary by age, location, and the presence/absence of teeth. Third party software can be used to generate 3-dimensional models that provide useful information about shape, size, and location of sublingual and submandibular concavities prior to implant placement.
TL;DR: An ideal approach for selective neurectomy of the FCU should start 4 cm above the medial epicondyle, and extend distally to 50 % of the length of the forearm or just to the point where the ulnar artery joins the nerve.
Abstract: Precise knowledge of motor nerve branches is critical to plan selective neurectomies for the treatment of spastic limbs. Our objective is to describe the muscular branching pattern of the ulnar nerve in the forearm and suggest an ideal surgical approach for selective neurectomy of the flexor carpi ulnaris. The ulnar nerve was dissected under loop magnification in 20 upper limbs of fresh frozen cadavers and its branches to the flexor carpi ulnaris muscle (FCU) and to the flexor digitorum profundus muscle (FDP) were quantified. We measured their diameter, length and distance between their origin and the medial epicondyle. The point where the ulnar artery joined the nerve was observed. The position in which the ulnar nerve gave off each branch was noted (ulnar, posterior or radial) and the Martin-Gruber connection, when present, had its origin observed and its diameter measured. The ulnar nerve gave off two to five muscular branches, among which, one to four to the FCU and one or two to the FDP. In all cases, the first branch was to the FCU. It arose on average 1.4 cm distal to the epicondyle, but in four specimens it arose above or at the level of the medial epicondyle (2.0 cm above in one case, 1.5 cm above in two cases, and at the level of the medial epicondyle in one). The first branch to the FDP arose on average 5.0 cm distal to the medial epicondyle. All the branches to FDP but one arose from the radial aspect of the ulnar nerve. A Martin-Gruber connection was present in nine cases. All motor branches arose in the proximal half of the forearm and the ulnar nerve did not give off branches distal to the point where it was joined by the ulnar artery. The number of motor branches of the ulnar nerve to the FCU varies from 2 to 4. An ideal approach for selective neurectomy of the FCU should start 4 cm above the medial epicondyle, and extend distally to 50 % of the length of the forearm or just to the point where the ulnar artery joins the nerve.
TL;DR: The canalis sinuosus is a neurovascular canal, a branch of the infraorbital canal through which the anterior superior alveolar nerve passes, which is important for dental implant planning because of its proximity to the upper teeth.
Abstract: The canalis sinuosus (CS) is a neurovascular canal, a branch of the infraorbital canal through which the anterior superior alveolar nerve passes. There are no studies or case reports of anatomical variations related to this canal. A rare case of anatomical variation in the CS is reported that was detected by cone beam computed tomography done in a 47-year-old female as a pre-operative workup before dental implants. In this case, in the region slightly medial to tooth 23, a wide accessory branch from the CS was observed, running an intraosseous course in the inferior and posterior direction up to a foramen located in the hard palate, slightly medial in relation to tooth 23. The location of this branching, as well as its neurovascular component, is important for dental implant planning because of its proximity to the upper teeth. Identification of neurovascular bundles is fundamental to avoid complications for the patient.
TL;DR: ST shape and depth can influence surgical preference in cholesteatoma surgery and in the case of a shallower ST, an exclusive endoscopic exploration is chosen; whereas in the cases of a deeper ST, a retrofacial approach is usually preferred.
Abstract: To evaluate the morphology of the sinus tympani (ST) based on computed tomography (CT) scans (axial view), describing the findings in a cohort of 148 patients (296 ears), and classifying the prevalence according to our ST classification. To evaluate the surgical prevalence based on the type of ST. To calculate the sensibility and positive predictive value (PPV) of high-resolution computed tomography (HRCT) scans for ST involvement by cholesteatoma. Retrospective review of the radiologic database and surgical reports. In total, 98/296 (33.1 %) middle ears presented a radiologic morphology Type A; 185/296 (62.5 %) middle ears presented a radiologic morphology Type B; 13/296 (4.4 %) middle ears presented a radiologic morphology Type C; HRCT showed a sensibility of 91 %, specificity of 65 %, PPV of 68 % and negative predictive value (NPV) of 90 %. ST shape and depth can influence surgical preference in cholesteatoma surgery. In the case of a shallower ST, an exclusive endoscopic exploration is chosen; whereas in the case of a deeper ST, a retrofacial approach is usually preferred. HRCT scans demonstrated high sensibility and NPV for ST involvement by cholesteatoma.
TL;DR: The authors constantly found an effective link between the superior-lateral corner of the SSC tendon and a bundle of fibers coming from SS and CHL, which yields the “Comma Sign” in subscapularis tendon tears.
Abstract: Purpose The aim of the present study was to describe the precise anatomy of the so-called 'Comma Sign' which has been observed during arthroscopy in retracted subscapularis (SSC) tears. Methods Fourteen fresh cadaveric shoulders were prepared to obtain an articular view comparable to arthroscopic posterior portal view. A step-by-step dissection was carried out to verify the presence of any anatomic structure inserting directly on the lateral margin of the SSC tendon. A sequential detachment of the superior gleno-humeral ligament (SGHL), the coraco-humeral ligament (CHL), and the SSC tendon from their bony humeral insertions was performed. Under intra-articular and extra-articular view, the SSC and its connections with the supraspinatus (SS), the SGHL and the CHL were evaluated. Results The detachment of the CHL and the SGHL from the humerus did not reveal any structure directly inserted on the superior-lateral margin of the SSC tendon. However, when the SSC tendon was excised from the lesser tuberosity and pulled medially, a bundle of fibers, which inserted directly onto its superior-lateral edge, was constantly observed. Conclusions We constantly found an effective link between the superior-lateral corner of the SSC tendon and a bundle of fibers coming from SS and CHL. It became visible only after medial traction of the detached SSC. This structure yields the 'Comma Sign' in subscapularis tendon tears.