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The purpose of this study was to clarify the subcutaneous structures involved in the morphology of the gluteal region for clinical application.Thirty-seven formalin-fixed cadavers and one soft-fixed cadaver were used in this study. Gluteal tissue was removed from five formalin-fixed cadavers. A horizontal section and sections parallel to the long axis of the body were made from the excised tissue, and the subcutaneous fat was removed to observe the fibrous structure within the subcutaneous fat. Two formalin-fixed cadavers and one soft-fixed cadaver were used to perform conventional gross anatomical dissection and histological examination. On 30 formalin-fixed cadavers, the thickness of the subcutaneous fat was measured in various areas of the buttocks.The thickness of subcutaneous fat was thicker in the center of the buttocks and thinner on the lateral buttocks. Superficial fascia (SF) was found only in the upper buttock, being indistinct in the lower buttock. In the sacral and coccygeal areas, the dermis was tightly adhered to the bone as a single mass. Fibers arose from around the iliac crest to the SF. On the medial side of the gluteal fold, a strong fiber arose from the sciatic tubercle and inserted into the gluteus maximus and dermis.By identifying the characteristic subcutaneous structures of the gluteal region, we were able to identify the anatomical structures that shape the three-dimensional morphology of the buttocks. These findings may be useful in surgical treatments such as improving the buttock shape. This article is protected by copyright. All rights reserved.

The uterine artery (UA) is an arterial branch of the internal iliac artery in women, usually arising from the anterior division of the internal iliac artery. However, due to the high variability in the anatomy of the UA, embolization of this vessel may be challenging. Therefore, the objective of this meta-analysis was to provide physicians with transparent data on the anatomy of the UA, using the available data in the literature. Databases such as PubMed, Scopus, Embase, Web of Science, and Google Scholar were searched to find all the relevant studies regarding the UA. A total of 16 articles met the required criteria. The UA was found to originate most frequently from the internal iliac artery as the pooled prevalence was set to be 61.72% (95% CI: 41.31%-80.31%). A pooled prevalence of the UA originating from the umbilical artery was established at 13.93% (95% CI: 2.76%-30.44%). A pooled prevalence of the UA originating from the inferior gluteal artery was set to be 5.22% (95% CI: 0.00%-15.44%). In conclusion, we believe that this is the most accurate and up-to-date study regarding the highly variable anatomy of the UA. The UA originates most frequently from the internal iliac artery (61.72%), however, other origins, such as from the umbilical artery (13.93%) or the inferior gluteal artery (5.22%) may occur. It is hoped that the results of the present meta-analysis will be a helpful tool for surgeons performing pelvic or gynecological surgeries.

Anatomy of the superior labial frenulum (SLF), at first glance, seems to be well established. However, existing studies on the SLF lack description of the incisivus labii superioris (ILS), which cannot be ignored when discussing the SLF. We believe that thorough understanding of the SLF necessitates the anatomical knowledge of the ILS. This study aimed to elucidate the anatomical relationship between the orbicularis oris (OO), ILS, and SLF. A total of 20 formalin fixed human cadaveric specimens were used for gross anatomical and/or histological observation. For histological observation, all specimens were stained with Masson-trichrome. The SLF was a mucosal fold between the gingival mucosa and alveolar mucosa with connective tissue deep to it. The connective tissue attached to the alveolar bone in the junction between the right and left ILS. Skeletal muscle fibers other than orbicularis oris was found in one specimen, which were considered the ILS. During a frenulectomy, removal of the connective tissue bundle is required to prevent recurrence of the high SLF insertion.

The characteristics of the superficial musculoaponeurotic system (SMAS), including the morphology of each part and the connection between tissues, remain controversial. The purpose of this study is to clarify the anatomy of the SMAS using our new dissection method. In this study, six hemi-sides of heads from formalin-preserved cadavers were used. Three were used for creating a horizontal section and three were used for creating the section along the axial line perpendicular to the surface of the skin, resulting in a gradual change from the coronal section at the lateral to the sagittal section at the median. The resected head was cut into slices with widths of 7 mm. The stretched tissue dissection method was performed by fixing a tissue slice to a board and pulling the skin outward to stretch the soft tissue. Blunt dissection was then performed under a microscope. The SMAS comprises three layers: superficial, intermediate, and deep. The superficial layer is a thin membrane directly connecting to the septa in the subcutaneous fat. The deep layer is the connective tissue in contact with the sub-SMAS structure. The layer surrounded by the superficial and deep layer of the SMAS is the intermediate layer, containing connective tissue, adipose tissue, and facial muscles. The detailed findings of the SMAS obtained using this method resolve theoretical discrepancies and provide important insight for the field of facial surgery.

The term Metaverse ("meta" defined as beyond, transcendence or virtuality, and "verse" meaning universe or world) denotes a "virtual reality space" for anatomy teaching. To ascertain how many anatomists are familiar or are using this adjunct in teaching, we conducted a short survey at the 2022 annual meeting of the American Association of Clinical Anatomists (AACA). Interestingly, only six respondents (9.4%) had used a Metaverse for teaching anatomy. Moreover, the vast majority of attendees were anatomy educators or basic science faculty, but not practicing physicians/surgeons or other actively practicing health care professionals; a group where this technology has been used much more commonly. The present manuscript was authored by anatomy educators, practicing physicians and other actively practicing health care professionals with backgrounds in diverse medical fields, that is, anatomists, medical doctors, physician assistants, dentists, occupational therapists, physical therapists, chiropractors, veterinarians, and medical students. Many of these authors have used or have been exposed to a Metaverse in the clinical realm. Therefore, the aim of the paper is to better understand those who are knowledgeable of a Metaverse and its use in anatomy education, and to provide ways forward for using such technology in this discipline.

Chest computed tomography (CT) has been the preferred imaging modality during the pandemic owing to its sensitivity in detecting COVID-19 infections. Recently, a large number of COVID-19 imaging datasets have been deposited in public databases, leading to rapid advances in COVID-19 research. However, the application of these datasets beyond COVID-19-related research has been little explored. The authors believe that they could be used in anatomical research to elucidate the link between anatomy and disease and to study disease-related alterations to normal anatomy. Therefore, the present study was designed to investigate the prevalence of six well-known anatomical variants in the thorax using open-access CT images obtained from over 1000 Iranian COVID-19 patients aged between 6 and 89 years (60.9% male and 39.1% female). In brief, we found that the azygos lobe, tracheal bronchus, and cardiac bronchus were present in 0.8%, 0.2%, and 0% of the patients, respectively. Variations of the sternum, including sternal foramen, episternal ossicles, and sternalis muscle, were observed in 9.6%, 2.9%, and 1.5%, respectively. We believe anatomists could benefit from using open-access datasets as raw materials for research because these datasets are freely accessible and are abundant, though further research is needed to evaluate the uses of other datasets from different body regions and imaging modalities. Radiologists should also be aware of these common anatomical variants when examining lung CTs, especially since the use of this imaging modality has increased during the pandemic.

Brain herniation is one of the most feared complications of many neurological pathologies. However, current understanding of the mechanisms behind brain herniation syndromes is poor. By investigating the correlations between raised intracranial pressure (ICP) and herniation of the cerebellar tonsils, we hope to develop a model that can be used to study intracranial fluid dynamics and its effects on brain tissue. This will facilitate evaluation of patients with elevated ICP and development of novel treatments including surgical approaches for decompressing the posterior cranial fossa and upper cervical spine. A standard suboccipital surgical approach was used to expose the foramen magnum and observe movements of the cerebellar tonsils in fresh cadavers. A urinary Foley catheter balloon in the parietal extradural space was used to simulate a mass effect while ICP was monitored. The baseline anatomy differed widely among the cadaver specimens. However, and overall, we found that as ICP rises, the cerebellar tonsils descend through the foramen magnum at a rate of 0.3 mm per 1 mmHg increase in ICP. A mean descent of 6.2 mm was observed for a mean ICP increase of 17 mmHg. In this cadaveric study, we present a method and model for exploring brain herniation syndromes in the context of ICP changes. This could allow for further models to study the effects of other neuropathologies on the cerebellar tonsils, including posterior cranial fossa mass lesions and cerebellar hemorrhage.

The number of citations a journal article receives can be used to represent its impact on its field. The aim of the current study was to identify and characterize the top 100 cited articles in journals related to anatomy. The Journal Citation Report database was searched to identify journals categorized as anatomy and morphology. The top 15 most highly cited journals were selected for review. The articles from these journals were then sorted by "Times Cited". The timeline used was 1976-2001. The top 100 most cited articles were extracted for analysis. Articles were excluded if they focused on basic scientific research or animal studies. Fifteen journals were identified based on our criteria using the Journal Citation Report database and the articles were sorted by most cited; 916 anatomy articles were screened to select the top 100 cited since 1976. Among the selected articles, 46 were published in Journal of Anatomy, 13 in Clinical Anatomy, 12 in Microscopy Research and Technique, 11 in Surgical and Radiologic Anatomy, seven in Brain StructureFunction, five in Annals of Anatomy - AnatomischerAnzeiger, three in Anatomical Record - Advances in Integrative Anatomy and Evolutionary Biology, two in Cells Tissues Organs, and one in Developmental Dynamics. Our study identified the top 100 journal articles in anatomy with a clinical and surgical focus. This compilation of articles could help anatomists and clinicians familiarize themselves with impactful research included in terms of study type and field of anatomy, journal of publication, and recurring authors.

Although superior gluteal nerve (SGN) injury can have significant morbidity, to date, surgical strategies for its repair are scant in the literature. Specifically, neurotization options have not been explored. To address this deficiency in the literature, the current cadaveric feasibility study was performed. Via a transgluteal approach on 16 cadaveric sides, the proximal sciatic nerve and the entrance of the SGN into the gluteus medius and minimus were identified. Additionally, branches from the sciatic nerve to the hamstring muscles were traced proximally to confirm their position in relation to the sciatic nerve as a whole. These branches were cut at the level of the ischial tuberosity and teased away from the sciatic nerve proximally to the greater sciatic foramen and transferred superolateral to the SGN. The diameter of each nerve branch was measured as well as its available length for reaching the SGN. All branches of the sciatic nerve to the hamstring muscles arose from the anteromedial part of the nerve. The mean diameters of the branches to the semimembranosus, semitendinosus, and biceps femoris muscles were 2.1, 1.9, and 1.5 mm, respectively. The mean diameter of the SGN was 3.1 mm and the mean distance from this entrance point to the ischial spine was 7.2 cm. The mean length of the donor nerve was 8.5 cm. Based on our study, use of a tibial-innervated hamstring branch as a donor for nerve transfer to the SGN is feasible.

The supracondylar process is a nonpathological projection from the distal humerus that in some patients, can result in compression of regional neurovascular structures, for example, median nerve. Since the first description of the supracondylar process in 1818, it has also been a focus of anthropological study because of its possible relevance to human origins and relationships to other species. Although its overall incidence is low, it is more common in races of European descent. It is particularly interesting for anatomists and anthropologists, but knowledge of its anatomical relationships and effect on pathological processes helps in the diagnosis and treatment of supracondylar process syndrome. One of the most detailed descriptions of this variant process stems from the work of Buntaro Adachi. Herein, a translation of his findings is provided and a review of the supracondylar process and its potential pathological presentations presented.

Introduction In this review, cases of herpes zoster (HZ) infection following receipt of COVID-19 vaccines will be analyzed. We also present two cases of oral HZ following the COVID-19 vaccine and discuss this clinical anatomy. Materials and methods A database search using PubMed was conducted in August 2021 and twenty articles were found to be eligible for review. Patient data and vaccine information were analyzed. In addition, two cases of oral HZ infection following the receipt of COVID-19 vaccines are presented. Results A total of 399 cases were identified. The affected dermatomes mimicked the regular distribution of HZ. For the dermatomes of the face, the various reports used different ways to describe the areas involved; CNV, CNV1, CNV2, CNV3, lower jaw, forehead, and under the eyebrow (CNV, 2 cases; CNV1, 4 cases; CNV2, 3 cases; CNV3, 3 cases). Some patients who had a history of varicella zoster virus (VZV) vaccination had HZ following the COVID-19 vaccination. Two patients with oral HZ following vaccination were found to have involvement of the greater palatine nerve. Conclusions Vaccine-related HZ cases have been reported worldwide. Although many studies with a larger number of cases are ongoing, detailed information can be obtained from case reviews as reported herein. This article is protected by copyright. All rights reserved.

We aimed to localize the pharyngeal branches of the pharyngeal plexus to preclude postoperative complications such as dysphagia resulting from injury to those branches. Cranial nerves IX and X and the sympathetic trunk were dissected on 10 sides in the necks of embalmed adult cadavers of European descent to identify the pharyngeal branches so that anatomical landmarks could be identified and injury thereby avoided. In all sides, the pharyngeal branches originated from the glossopharyngeal and vagus nerves and the superior cervical ganglion and entered the posterior pharyngeal wall at the C2-C4 levels within 10 mm medial to the greater horn of the hyoid bone. All pharyngeal branches were anterior to the alar fascia. Based on our anatomical study, vagus nerve branches to the pharyngeal muscles enter at the C3/C4 vertebral levels. Such knowledge might help decrease or allow surgeons to predict which patients are more likely to develop dysphagia after cervical spine surgery.

The COVID-19 pandemic has brought difficult times to anatomy educators and medical/dental students. Under normal circumstances, gross anatomy classes give students opportunities to touch and observe human bones and cadaveric tissues, thus enhancing their understanding; such morphology is difficult to learn from textbooks alone. As many studies have shown, three-dimensional (3D) technologies used in online lectures can serve as alternatives to real specimens for providing knowledge of anatomy. However, such technologies are often expensive. The goal of this study was to create 3D anatomy models for online lectures using a free cellphone app. Free application software (Qlone) was used to create 3D anatomical models. The extracranium and intracranium of adult skull, fetal skull, mandible, temporal bone, second cervical vertebra, and ilium were all scanned and exported to the computer in 3D format. A total of 53 anatomical structures were evaluated by nine observers. Although the 53 structures used in this study did not include all the structures that students need to learn, visibility was good/acceptable for most of the 53. The free and simple 3D scanning app used in this study could enable anatomy educators to provide better content to students during online lectures.

Introduction The general principles of anatomical terminology indicate that the "mandibular canal" should be named the "inferior alveolar canal" as it accommodates the inferior alveolar neurovascular bundles. Therefore, we performed a Delphi study to evaluate the current understanding and use of the terminology in different geographical regions and areas of expertise and to determine the appropriate terminology for this bony canal. Methods A Delphi panel was formed and questions sent and answered via email about: field of expertise (anatomy, oral surgery/oral and maxillofacial (OMF) surgery, oral radiology/OMF radiology, plastic surgery, ENT surgery, or dentistry with the exception of oral/OMF surgery and oral/OMF radiology), years of experience in the field of expertise, country currently working in, "what is the name of the bony canal that contains the inferior alveolar neurovascular bundle," and "what should the structure above be called, in general?" Results A total of 52 participants responded to the questionnaire. Half or more of the experts in anatomy, oral/OMF surgery, and ENT/Plastic surgery considered "mandibular canal" to be the most appropriate name for this bony canal. In contrast, more than half of all experts in oral/OMF radiology and dentistry, i.e., most fields of dentistry, considered "either mandibular canal or inferior alveolar canal" to be the appropriate name. Conclusions The results of the Delphi study and general principles suggest that an alternative term for the "mandibular canal" should be "inferior alveolar canal." This article is protected by copyright. All rights reserved.

The COVID-19 pandemic and mandatory social distancing has brought challenges to anatomy educators who generally need in-person classes. The purpose of this study is to share the experience of a distant online lecture on a surgical procedure and related anatomy in a three-dimensional (3D) virtual reality (VR) workspace and to compare it with reported teaching methods, that is, an in-person class and a Zoom online class. The lecture was delivered by three authors of this article in a VR workspace that enables people to meet through VR. The lectures were about combinations of dental surgical procedures and related clinical anatomy. Physically, the attendees could have been located anywhere in the world, so lecturers joined from the United States and the attendees were all from Japan. VR environment and its flexibility enabled attendees to join the lecture actively, helping them to gain understanding of the surgical procedure and anatomy more efficiently. The use of VR technology with a live communication tool demonstrated in this study has several advantages over previous education methods, although there are still technical issues or disadvantages that need to be addressed. Development of the technology and app/software is required so that more data can be processed at higher speed. Use of VR technology with a live communication tool could be an alternative teaching method. Its overall advantages are a closer look at the slides/monitor and concurrent observation of the multiple assets in various directions by multiple attendees. These advantages cannot be achieved by any other teaching method without VR assets with the workspace provided by Spatial. Even during the mandatory social distancing due to the COVID-19 pandemic, this could enable us to foster 3D understanding of surgery and related anatomy. Further study is now needed to evaluate the effectiveness of this newly proposed teaching method by comparing it with traditional in-person and online classes with a live communication tool.

Lower third molar removal is the most commonly performed dental surgical procedure. Nevertheless, it is difficult to ensure that all the informed consent forms given to patients are based on the best evidence as many newer publications could change the conclusions of previous research. Therefore, the goal of this review article is to cover existing meta-analyses, randomized control trials, and related articles in order to collect data for improved and more current informed consent.

This second installment of The Effects of Obesity on the Human Body considers the nervous, respiratory, and lymphatic systems. Those with obesity face countless psychological hurdles in addition to the respiratory burden and widespread inflammation that can suppress the immune system, resulting in the accumulation of excess fluid in body tissues.

Obesity is a worldwide issue that many global health authorities consider a growing epidemic. Having a positive correlation between increases in the industrialization of processed foods and sedentary occupations as well as a lack of access to healthcare in poorer socioeconomic areas, obesity is a multifactorial disease affecting several organ systems. The tendency for obesity to cause detrimental changes to the human body is a focal point for healthcare providers to establish more effective clinical treatment and management plans. Implementing comprehensive global educational programs to decrease the prevalence of this unforgiving disease is imperative for a healthier future. Herein, we have provided a comprehensive review of the health effects of obesity upon the human body for the interest of many practicing clinicians managing this health crisis.

The coronavirus disease 2019 (COVID‐19) pandemic has had enormous effects on anatomy education. During the pandemic, students have had no access to cadavers, which has been the principal way to learn anatomy since the 17th century. As it is difficult to predict future access to cadavers for students or in‐person classes, anatomy educators are encouraged to revisit all possible teaching methods in order to develop innovations. Here, we review anatomy education methods to apply to current and future education. This article is protected by copyright. All rights reserved.

Clinical management of constipation has evolved from the prescription of dietary supplements, to potent stimulant laxatives, to corrective surgeries for organic blockage. Yet constipation does not respond to a one-size-fits-all treatment. In recent decades, the Bristol Stool Form Scale and Rome III diagnostic criteria have allowed for algorithmic diagnosis, yet these criteria could benefit from further extension and meaningful discussion. This review incorporates pertinent clinical updates and uses the anatomy and physiology of constipation as helpful signposts for the practicing clinician.

Research within the anatomical sciences often relies on human cadaveric tissues. Without the good will of these donors who allow us to use their bodies to push forward our anatomical knowledge, most human anatomical research would come to a standstill. However, many research papers omit an acknowledgement to the donor cadavers or, as no current standardized versions exist, use language that is extremely varied. To remedy this problem, 20 editors-in-chiefs from 17 anatomical journals joined together to put together official recommendations that can be used by authors when acknowledging the donor cadavers used in their studies. The goal of these recommendations is to standardize the writing approach by which donors are acknowledged in anatomical studies that use human cadaveric tissues. Such sections in anatomical papers will not only rightfully thank those who made the donation but might also encourage, motivate, and inspire future individuals to make such gifts for the betterment of the anatomical sciences and patient care.

The use of social media opens content to the general public and, as a result, places images of cadaveric dissection in an open forum. This raises the question: should the general public have access to such material? A survey was conducted examining whether the general public should have access to gross cadaveric dissection images and videos for educational purposes via social media. Both medical and laypersons were queried. Questions included in the survey considered whether images were too graphic, whether online cadaveric content should be age-restricted, and whether consent by the deceased was necessary. A link to the survey was accessible to 63,562 followers through the Seattle Science Foundation's Facebookpage for 3 weeks. Among 300 responders, 89% (267/300) agreed that portrayals of cadaveric specimens/dissection on social media should be accessible by the general public for anatomical education, and 84.67% (254/300) stated that cadaveric dissection is not too graphic for untrained eyes. There was agreement by 60.33% (181/300) that an age restriction should be in place for the viewing of cadaveric dissection on social media, and 39.33% (253/300) of responders suggested restriction to 18 years and older. No statistically significant association was noted between a prior or current history of anatomy education and the frequency of positive responses to the survey questions. Social media is an innovative tool for dispensing anatomical education. The use of cadaveric images and videos provides accessibility to the general public who wish to learn more about human anatomy and their own body. Clin. Anat. 32:1033-1041, 2019. © 2019 Wiley Periodicals, Inc.

The frontal nerve is the largest branch of the ophthalmic nerve. This nerve gives rise to two terminal branches, the supraorbital (SON) and supratrochlear nerves (STN). To the best of our knowledge, there are no reports describing the detailed proximal course of these nerves while inside the orbit. Therefore, the goal of this study was to clarify the anatomy of the SON and STN inside and at their exit from the orbit. Twenty sides from ten fresh-frozen cadavers were used in this study. Intra and extra orbital dissections were performed to observe the course of the SON and STN. Additionally, measurements of the nerves were made at these locations. The course of the SON and STN inside the orbit was classified into three groups depending on the STN branching pattern from the SON. The group without any branch from the SON and STN inside the orbit was the most common. The exit points of these nerves were via the supraorbital notch, foramen, or neither a notch nor foramen. A distinct fibrous band was consistently found tethering the nerve except in specimens with nerves traversing a bony foramen. The mean diameters of the SON and STN were 1.3 ± 0.2 and 0.7 ± 0.1 mm, respectively. The results of this study further our knowledge of the course and morphology of the SON and STN and might be useful for better understanding and potentially treating some forms of migraine headache due to SON or STN compression/entrapment. Clin. Anat. 33:332-337, 2020. © 2019 Wiley Periodicals, Inc.

The genitofemoral nerve is a branch of the lumbar plexus originating from the ventral rami of the first and second lumbar spinal nerves. During routine dissections of this nerve, we have occasionally observed that the genital branch of the genitofemoral nerve gave rise to the femoral branch, and the femoral branch of the genitofemoral nerve gave rise to the genital branch. Therefore, this study aimed to investigate the aforementioned distributions of the genitofemoral nerve in a large number of cadaveric specimens. Twenty-four sides from fourteen fresh-frozen cadavers derived from nine males and five females were used in this study. For proximal branches of the genitofemoral nerve, that is, as they first arise from the genitofemoral nerve, the terms "medial branch" and "lateral branch" were used. For the final distribution, the terms "genital branch" and "femoral branch" were used. On eight sides (33.3%) with nine branches, one or two branch(s) from either the medial or lateral branch became coursed as the femoral or genital branches (five became femoral and four became genital branches). Our study revealed that the distribution of the genitofemoral nerve is more complicated than previously described. The "medial branch" and "lateral branch" that we have used in the present study for describing the proximal branches of the genitofemoral nerve are more practical terms to describe the genitofemoral nerve. Clin. Anat. 32:458-463, 2019. © 2019 Wiley Periodicals, Inc.

Air insufflation has been used for various surgical procedures such as during laparoscopy. We hypothesized that the use of pressurized air might enable cadaveric dissection to differentiate smaller veins better than traditional dissection techniques. In three fresh-frozen cadavers, the inferior vena cava (IVC) and right or left femoral veins were exposed just distal to the inguinal ligament and a needle placed into one of them. Pressurized air was then placed into the cannulated femoral vein using an air compressor. In all specimens, the IVC and most of its tributaries, both left and right sides, were clearly insufflated. When the IVC was traced superiorly by resecting the diaphragm through the caval foramen, the right atrium and ventricle were also found to be dilated. Additionally, venous variants that would have not been obvious without dilatation of the IVC were identified. Air dissection of the venous system in fresh-frozen cadavers aids in anatomical dissection. Such a model might also serve as a surgical training model and teaching tool as it better mimics life-like anatomy and physiology. We term this technique "cadaveric air dissection." Clin. Anat. 32:566-572, 2019. © 2019 Wiley Periodicals, Inc.

Dyspareunia can be described as continuous unremitting or intermittent pain associated with intercourse. It can be classified based on the location of the pain - entry or deep dyspareunia, or based on when the pain was first experienced - primary or secondary dyspareunia. There are different causes of dyspareunia and some of the most important causes include the following: vulvodynia, postpartum dyspareunia, endometriosis, inadequate vaginal lubrication or arousal, and other anogenital causes such as hemorrhoids and anal fissures. In this review, our objective is to apply the anatomical knowledge of dyspareunia to patient care, increase awareness among clinicians about the diverse etiology of dyspareunia and ensure that the whole patient, not just the pain of dyspareunia is being treated as the causes of dyspareunia can be due to various pathologies. Clin. Anat., 31:1013-1017, 2018. © 2018 Wiley Periodicals, Inc.

The inferior gluteal nerve has been traditionally described as a solely motor branch innervating the gluteus maximus. However, during routine dissection of the gluteal region, a cutaneous branch of the inferior gluteal nerve was identified. As the gluteal region is vulnerable to the development of pressure ulcers and iatrogenic injury with for example, surgical approaches and injection therapies, a comprehensive understanding of its cutaneous innervation is important. Therefore, the aim of this study was to elucidate the anatomy of this cutaneous branch of the inferior gluteal nerve in a series of cadavers. Twelve sides from six fresh-frozen cadaveric specimens were dissected. When a cutaneous branch was identified piercing the gluteus maximus, its origin from the inferior gluteal nerve was verified and the diameter and length of it measured. Additionally, for localization, the distance from the midline to the exit point of the cutaneous branch from the gluteus maximus was measured. One to two cutaneous branches were identified as arising from the inferior gluteal nerve on nine sides (75%). The branch(es) were usually located in the lower outer quadrant of the gluteus maximus. These branches had a mean distance of 12.5 cm from the midline. Their mean diameter and length was 0.7 mm and 28.6 cm, respectively. On all sides with a cutaneous branch of the inferior gluteal nerve, the skin over the posterior aspect of the greater trochanter was innervated by superior and inferior cluneal nerves and supplemented by cutaneous branch(es) of the inferior gluteal nerve. Side or sex was not a predictor of the presence of a cutaneous branch of the inferior gluteal nerve. To our knowledge, a cutaneous branch derived from the inferior gluteal nerve has not been previously described. Based on our cadaveric findings, the majority of individuals will have the area of skin over the greater trochanter innervated by this nerve. Therefore, surgeons and pain specialists should be aware of its presence and might develop surgical procedures that help avoid it or develop technical advances that target it for various pain syndromes in this area. We propose naming these cutaneous branches the lateral cluneal nerves, which would necessitate renaming the middle cluneal nerves to medial cluneal nerves. Clin. Anat. 31:937-941, 2018. © 2018 Wiley Periodicals, Inc.

The aim of this work was to conduct a radiological micro-CT study and meta-analysis to determine the morphological features of the root canal anatomy of the maxillary molars. The radiological study included micro-CT scans of 110 maxillary first molars and 98 maxillary second molars. To identify articles eligible for inclusion in our meta-analysis, PubMed, Embase, and Web of Science were search comprehensively. The following data were extracted: study type (cadaveric, intraoperative or imaging), Vertucci types of canal configuration, presence/number of canals, roots, apical foramina, apical deltas, and inter-canal communications. The mesiobuccal root was the most variable with respect to canal configuration, type I being the most common configuration followed by type II and type IV. Type I was the most common canal configuration in the distobuccal and palatal root. Regarding the number of canals in the maxillary first and second molars, one canal was most prevalent in all roots of the three molars, except for the mesiobuccal root of maxillary first molar, in which two canals were most prevalent. The most prevalent number of roots in all maxillary molars was three. Knowledge of endodontic anatomy determines the parameters of root canal treatment and significantly affects the probability of success. It is therefore especially important to know the morphology of the root canal system in order to perform endodontic treatment correctly. Clin. Anat. 31:838-853, 2018. © 2018 Wiley Periodicals, Inc.

The aim of this radiological micro-CT study and meta-analysis was to determine the morphological features of the root canal anatomy of the mandibular molars. The radiological study included micro-CT scans of 108 mandibular first, 120 mandibular second, and 146 mandibular third molars. For our meta-analysis, an extensive search was conducted through PubMed, Embase, and Web of Science to identify articles eligible for inclusion. Data extracted included investigative method (cadaveric, intraoperative, or imaging), Vertucci type of canal configuration, presence/number of canals, roots, apical foramina, apical deltas, and intercanal communications. In the mesial roots of mandibular molars, the most frequent Vertucci type of canal configuration was type IV, except for the mandibular third molar where type I was most common. Type I was most common in the distal root. There were usually two canals in the mesial root and one in the distal root. Two was the most common number of roots, and a third root was most prevalent in Asia. One apical foramen was most common in the distal root and two apical foramina in the mesial root. Intercanal communications were most frequent in the mesial root. Knowledge of the complex anatomy of the mandibular molars can make root canal therapy more likely to succeed. We recommend the use of cone-beam computed tomography before and after endodontic treatment to enable the root anatomy to be accurately described and properly diagnosed, and treatment outcome to be assessed. Clin. Anat. 31:797-811, 2018. © 2018 Wiley Periodicals, Inc.

The minor salivary glands in the retromolar trigone have rarely been studied. The aim of this study was to better define the anatomy of the minor salivary glands in the retromolar trigone and establish the relationships between these and adjacent structures. The gland in the retromolar trigone was exposed and its relationships to surrounding structures were observed on 20 cadaveric sides. The boundaries of the gland included the superior pharyngeal constrictor muscle, the tendon of the buccinator muscle, and loose connective tissue. The gland was not continuous with the pterygomandibular or parapharyngeal spaces, but loose connective tissue was present between glands in the retromolar trigone and the medial pterygoid muscle. To our knowledge, this is the first study to describe the detailed anatomy of the minor salivary gland in the retromolar trigone. We suggest that the minor salivary gland in the retromolar trigone should be named the "retromolar gland." Clin. Anat. 31:462-465, 2018. © 2018 Wiley Periodicals, Inc.

Inflammatory etiologies are becoming increasingly recognized as explanations of some neuropathies, especially those occurring in the perioperative period. Although "brachial neuritis" is known to affect extraplexal nerves, accessory nerve palsy following median sternotomy has been attributed to stretch on the nerve. To better elucidate stretch as a potential cause, a cadaveric study was performed. Two patients who developed accessory nerve palsy following median sternotomy are presented to illustrate features consistent with the diagnosis of a perioperative inflammatory neuropathy. Five adult unembalmed cadavers underwent exposure of the bilateral accessory nerves in the posterior cervical triangle. A median sternotomy was performed and self-retaining retractors positioned. With the head in neutral, left rotation and right rotation, retractors were opened as during surgery while observing and recording any accessory nerve movements. The self-retaining sternal retractors were fully opened to a mean inter-blade distance of 13 cm. Regardless of head position, from the initial retractor click to maximal opening there was no gross movement of the accessory nerve on the left or right sides. Opening self-retaining sternal retractors does not appear to stretch the accessory nerve in the posterior cervical triangle. Based on our clinical experience and cadaveric results, we believe that inflammatory conditions, (i.e., idiopathic brachial plexitis) can involve the accessory nerve, and might be triggered by surgical procedures. Clin. Anat. 31:417-421, 2018. © 2017 Wiley Periodicals, Inc.

Our previous studies based on intraoral dissection of fresh cadavers demonstrated the fissure and loose connective tissues behind the mucosa between the incisivus labii inferioris (ILI) and buccinator (BM) muscles. However, this raised new questions about the relationship among these muscles, the fissure and the buccal space. To our knowledge, no pathway to the oral cavity from the buccal space has been previously demonstrated, although such a pathway would better explain some routes of infection. Therefore, the aim of this study was to clarify the relationship among the mimetic muscles attached to the mandible, the fissure, and the buccal space. Twenty sides from 10 fresh frozen adult cadaveric Caucasian heads were used. The relationships among the ILI, BM, mandible, and buccal space were investigated with dissection and fluoroscopy. In all specimens, the fissure between the lateral border of the ILI and the anterior border of the BM formed the entrance of a space (here termed the bucco-mandibular space), which corresponded to the buccal mucosa in the premolar region. The superior border of this space was formed by the platysma and associated fascia, which was continuous with the masseteric fascia. This fascia clearly separated this space from the buccal space, which was located lateral to the BM and superior to this space. Clin. Anat. 30:958-962, 2017. © 2017 Wiley Periodicals, Inc.

The sensory innervation of the inferior eyelid is mainly derived from the inferior palpebral branch (IPb) of the infraorbital nerve (ION). This study aimed to investigate another, to our knowledge, previously unknown branch, and elucidate its location and distribution. Twelve sides from seven fresh frozen cadaveric Caucasian heads were used in this study. The specimens were derived from two male and four female adult cadavers age. The diameter of the IPb of the ION (D1) and branch arising from the upper wall of the infraorbital canal (D2), and distance between the branching points of this branch and the anterior border of the orbit floor (L1) was measured. A branch to the lower eyelid was found arising from the infraorbital canal on the majority of sides. D1 ranged from 0.4 to 1.1 mm. The branch arising from the upper wall of the infraorbital canal was found 10 sides (83%). D2 ranged 0.6 to 1.0 mm. L1 ranged from 10.2 to 19.8 mm. All of the branches arising from the upper wall of the infraorbital canal (10 sides) primarily innervated to the inferior eyelid. We suggest this branch should be named the "posterior IPb" of the ION. Knowledge of this branch might decrease sensory loss following invasive procedures of the lower orbit. Clin. Anat. 30:835-838, 2017. © 2017Wiley Periodicals, Inc.

Chronic dry eye (keratitis sicca) is a significant problem that in certain populations can result in corneal desiccation and the potential for blindness. Therefore, novel treatments for such disorders might decrease patient morbidity. The present study aimed to investigate a potential treatment for chronic dry eye via a cadaveric feasibility study. On 10 cadaveric sides, the parotid gland branch of the auriculotemporal nerve (ATN) was identified and anastomosed to an anterior superficial temporal branch (STb) of this same nerve. The STb was then transposed anteriorly and sutured to the lacrimal gland. The parotid branch of the ATN was easily identified on all sides. The STb of the ATN was easily identified and mobilized on all sides. This latter nerve had adequate length to be moved to the ipsilateral lacrimal gland on all sides. Rerouting parotid gland secretomotor fibers to the superficial branch of the ATN and then moving this branch to the lacrimal gland is a feasible surgical maneuver based on our cadaveric study. Clinical studies are now necessary to show utility of this procedure in patients with chronic dry eye. Clin. Anat. 30:839-843, 2017. © 2017Wiley Periodicals, Inc.

Complications from anterior approaches to the cervical spine are uncommon with normal anatomy. However, variant anatomy might predispose one to an increased incidence of injury during such procedures. We hypothesized that left vertebral arteries that arise from the aortic arch instead of the subclavian artery might take a more medial path in their ascent making them more susceptible to iatrogenic injury. Fifty human adult cadavers were examined for left vertebral arteries having an aortic arch origin and these were dissected along their entire cervical course. Additionally, two radiological databases of CTA and arteriography procedures were retrospectively examined for cases of aberrant left vertebral artery origin from the aortic arch over a two-year period. Two cadaveric specimens (4%) were found to have a left vertebral artery arising from the aortic arch. The retrospective radiological database analysis identified 13 cases (0.87%) of left vertebral artery origin from the aortic arch. Of all cases, vertebral arteries that arose from the aortic arch were much more likely to not only have a more medial course (especially their preforaminal segment) over the cervical vertebral bodies but also to enter a transverse foramen that was more cranially located than the normal C6 entrance of the vertebral artery. Spine surgeons who approach the anterior cervical spine should be aware that an aortic origin of the left vertebral artery is likely to be closer to the midline and less protected above the C6 vertebral level. Clin. Anat. 30:811-816, 2017. © 2017Wiley Periodicals, Inc.

Physical examination of the abdomen is an essential skill. Knowledge of its clinical anatomy and application is vital for making diagnoses. Misinterpretation of anatomy during examination can have serious consequences. This review addresses understanding of the anatomy, methodology, and complications of abdominal physical examination. It includes particular reference to modern technology and investigations. Physical examination is performed for diagnostic purposes. However, the art of physical examination is declining as more and more clinicians rely on newer technology. This can have regrettable consequences: negligence, waste of time and resources, and deterioration of clinical skills. With a sound knowledge of clinical anatomy, and realization of the importance of physical examination of the abdomen, clinician, and patients alike can benefit. Clin. Anat. 30:352-356, 2017. © 2017 Wiley Periodicals, Inc.

In 1922, Paul Hecker, a French physician and Head of Anatomy at the Medical College of Strasbourg, published a sentinel thesis on the ligaments of the craniocervical junction based on a study of comparative anatomy. Unfortunately, this dissertation has been lost to history and until now, was unavailable in the English language. Herein, we present a translation of Hecker's work with an update in its nomenclature, which with modern imaging capabilities of the craniocervical junction is germane and timely. Clin. Anat. 30:322–329, 2017. © 2017 Wiley Periodicals, Inc.

The lingual foramina and canals can be categorized as median or lateral based on their relation to the midline of the mandible. Investigation of the mandibular lingual region is often done with gross anatomical dissections of cadavers, 2D panoramic radiographic imaging, CT, and cone beam CT (CBCT). While gross studies are the most reliable at qualifying canal contents and course, CBCT proved to be superior to other radiographic techniques for visualizing lingual foramina and canals. The submental and sublingual arteries, and their branches are found in the lingual vascular canals. There is tremendous variation between individuals in terms of the course of the lingual canals and their anastomosis with other vascular canals. Performing the dental implantation procedures in the anterior and posterior regions of the mandible can result in perforation of the lingual cortex, which could injure the arteries that lie within the lingual canal. If hemorrhage occurs, it could lead to life-threatening upper airway obstruction. Pre-surgical investigation to identify the diameter of the lingual foramina and canal as well as their distance from the alveolar process might be necessary to prevent hemorrhage for all patients. Clin. Anat. 30:194-204, 2017. © 2017 Wiley Periodicals, Inc.

The transversus nuchae muscle appears inconsistently in the occipital region. It has gained attention as one of the muscles composing the superficial musculoaponeurotic system (SMAS). The purpose of this study was to clarify its detailed anatomical features. We examined 124 sides of 62 cadavers. The transversus nuchae muscle was identified when present and examined after it had been completely exposed. We also examined its relationship to the occipital cutaneous nerves.The transversus nuchae muscle was detected in 40 sides (40/124, 32.2%) of 26 cadavers; it was present bilaterally in 14 and unilaterally in 12. It originated from the external occipital protuberance; 43% of the observed muscles inserted around the mastoid process, and 58% curved upward around the mastoid process and became the uppermost bundle of the platysma. In one case, an additional bundle originated from the lower posterior border of the sternocleidomastoid muscle and coursed obliquely upward along with platysma. Ninety percent of the muscles ran below the sling through which the greater occipital nerve passed; 65% of the lesser occipital nerves ran deep to the muscle, and 55% of the great auricular nerves ran superficial to it. Our observations clarify the unique anatomical features of the transversus nuchae muscle. We found that it occurs at a rate similar to that described in previous reports, but its arrangement is variable. Further investigations will be performed to clarify its innervation and other anatomical features. Clin. Anat. 30:32-38, 2017. © 2016 Wiley Periodicals, Inc.

The extraocular muscles consist of the superior, inferior, lateral, and medial rectus muscles and the superior and inferior oblique muscles. This study aimed to create a new teaching model for demonstrating the function of the extraocular muscles. A coronal section of the head was prepared and sutures attached to the levator palpebral superioris muscle and six extraocular muscles Tension was placed on each muscle from a posterior approach and movement of the eye documented from an anterior view. All movements were clearly seen less that of the inferior rectus muscle. To our knowledge, this is the first cadaveric teaching model for demonstrating the movements of the extraocular muscles. This article is protected by copyright. All rights reserved.

The importance of the position of the lingual nerve in the oral cavity cannot be understated for dentists and oral surgeons. Therefore, the location of the lingual nerve with various positions of the tongue is important. However, most dental and medical students are taught oral cadaveric anatomy where tissues are fixed. Therefore, the focus of this article is to demonstrate how the lingual nerve moves based on tongue movement in fresh tissues and how this is important for dentists and oral surgeons. Clin. Anat. 30:467-469, 2017. © 2017 Wiley Periodicals, Inc.

Recent studies investigating accessory mental foramina using developments in diagnostic imaging have primarily defined the morphology of the foramina; however, few studies have described the structures passing through them. Additional clinical knowledge of the foramina is therefore required for preoperative diagnosis prior to surgery, including implant, periodontal and periapical surgery. In this study, we investigated the accessory mental foramina and the associated nerves and arteries in donated cadaveric mandibles using anatomical and radiological observation methods. We examined 63 mandibles with overlying soft tissue by cone-beam computed tomography and noted the existence of the accessory mental foramina. Mandibles with accessory mental foramina were subsequently analyzed. Additionally, the neurovascular bundles passing through these foramina were dissected using anatomical methods.The incidence of accessory mental foramina was 14.3%. The larger foramina tended to be located anteriorly or superiorly and proximal to the mental foramen, while the smaller foramina tended to be located posterosuperiorly and distal to the mental foramen. The mental foramen ipsilateral to the accessory mental foramen was smaller than the one contralateral to it. The comparatively distant and large accessory mental foramen included an artery.This study elucidated the relationship between accessory mental foramina and the associated nerves and arteries. We believe that the results will contribute to the clinical dentistry field.

Since three-dimensional computed tomography was developed, many researchers have described accessory mental foramina. The anatomical and radiological findings have been discussed, but details of accessory mental nerves (AMNs) have only been researched in a small number of anatomical and clinical cases. For this article, we reviewed the literature relating to accessory mental foramina (AMFs) and nerves to clarify aspects important for clinical situations. The review showed that the distribution pattern of the AMN can differ according to the position of the accessory mental foramen, and the reported incidence of AMFs differs among observation methods. A review of clinical cases also revealed that injury to large AMF can result in paresthesia. This investigation did not reveal all aspects of AMNs and AMFs, but will be useful for diagnosis and treatment by many dentists and oral and maxillofacial surgeons. Clin. Anat. 28:848–856, 2015. © 2015 Wiley Periodicals, Inc.