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The aim of this study was to analyse the vertical location of the posterior superior alveolar artery (PSAA) using a reliable new reference plane regardless of tooth and alveolar bone, and to measure the diameter in each posterior tooth region, which is of relevance to lateral sinus floor elevation surgery. A total of 270 sinuses in 139 patients were examined in this study. The A-plane was defined by A-point and the bilateral jugal points on reconstructed three-dimensional images. The distance from the PSAA to the defined plane was measured in four regions: first premolar (P1), second premolar (P2), first molar (M1), and second molar (M2). The average distance of the PSAA above the plane in the P1, P2, M1, and M2 regions was determined to be 10.24mm, 7.35mm, 5.47mm, and 7.23mm, respectively. The PSAA was found to run above the plane in 97.4% of sinuses, below the plane in 1.1%, and on the plane in 1.5%. In conclusion, the new plane is useful for intraoperative location of the PSAA. According to the study findings, the area below the reference plane can be considered safe for lateral approach sinus surgery in terms of preserving the integrity of the PSAA.

Background Distal-ulna stump (DUS) instability often occurs when performing a distal radioulnar joint (DRUJ) arthroplasty. Recent studies suggest that the distal interosseous membrane (DIOM) reinforces the triangular fibrocartilage complex, providing additional stability to the DRUJ. The aim of this study was to determine whether the DIOM stabilizes the ulnar stump. Methods Twenty fresh-frozen random forearms were dissected. The presence of a distal oblique bundle (DOB) was recorded and measured. The radius was fixed to a vise and the ulna kept free. The DRUJ was fixed with a lag screw. A bone slice was removed by transverse ulna osteotomies 10 and 15 mm proximal to the DRUJ. A 10-N force was applied to the ulna in dorsal and volar directions. Displacements were measured. The DIOM was then transected, and maneuvers and measurements were repeated and compared. Results A distinct distal membrane was present in 70% and a cord-like DOB in 30%. The mean length was 29 mm. Its origin was proximal to the sigmoid notch; its insertion was on the distal third of the ulna, at its lateral border. This attachment is comprised between 39 and 48 mm proximal to the ulnocarpal joint. Initial displacements averaged 22 mm dorsally and 13 mm volarly. After DIOM transection, ulnar translocation increased to 31 mm dorsally and 19 mm volarly. Conclusion In DRUJ arthroplasties, the DIOM does not appear to be a stabilizer of the DUS beneath a useful threshold. Its retaining effect occurs only after an initial 22-mm dorsal displacement, which we consider not clinically admissible. Therefore, in DRUJ arthroplasties, some augmentation might be advisable.

A girl born by normal vaginal delivery at 34 weeks’ gestation was noted to have a discrete midline scalp swelling from birth. This parieto-occipital lesion was non-tender, non-pulsatile and measured 10 mm in diameter. At 4 weeks of age, the lesion remained similar in size and had developed a

Osteoglophonic dwarfism, also known as osteoglophonic dysplasia (OD), is an uncommon skeletal dysplasia with an autosomal dominant mode of inheritance, which equally affects boys and girls. OD is saliently featured by craniosynostosis, dysmorphic facial features, impacted mandibular teeth, rhizomelic limb shortening and non-ossifying fibromas habitually at the metaphyseal regions, which usually disappear after skeletal maturity. The long bones in OD are portrayed by this distinguishable ‘hollowed-out’ appearance with metaphyseal cystic defects that have a natural history of spontaneous resolution. We report a case of a rare and unusual presentation of OD in a 23-year-old woman whom has been diagnosed with OD during her early childhood. She presented with a progressively enlarging right thigh swelling associated with pain for the past 1 year. Her right femur plain radiograph revealed diffuse lysis of the whole femur with cortical thinning. MRI revealed multiple bilateral femur benign cystic lesion synonymous with a severe spectrum of OD. She was started on a trial of oral bisphosphonates, which led to a significant improvement in pain.

Ganglion cysts are the most common soft tissue tumor of the hand and wrist, affecting pediatric and adult populations. Despite their frequency, there is no consensus within the literature regarding the best management of pediatric wrist ganglia, and there are few recent publications examining this topic. We provide an up-to-date literature review examining the current issues and controversies in the management of pediatric wrist ganglia.

A 14-year-old female presented with progressive diminution of vision in the right eye. She had left-sided loss of vision since 1 year of age. The patient had aggressive behaviour with irrelevant talking. She was intellectually disabled and had a history of delayed motor and language milestones. On

Odontogenic choristomas are a rare and recently classified entity, defined as neoplasms containing tissues of odontogenic derivation, found in abnormal locations and usually diagnosed in the early age. The authors report a unique case of a 79-year-old patient who presented to our attention for a skin lesion in the right cheek with no history of trauma or recent dental procedures, that underneath presented an indolent tooth-like structure inside the soft tissue of the right cheek, which at the histological study resulted to be an odontogenic choristoma. This rare histopathological diagnosis should be considered when a hard lesion is present in the head and neck region.

An 11-year-old girl was brought to us with complaints of restriction of movements of the left shoulder and a deformity of the back for the past 1 year, which had gradually progressed over 1 year. The child was yet to attain menarche. On examination, her physical development was found to be Tanner

Weaver’s bottom, popularly known as ischial bursitis, is a highly unusual entity affecting adults and older populations. Ischial bursitis is an inflammation of the ischial bursa and fluid collection and associated changes in the hamstring muscle complex (HMC). The ischial bursa lies near the

The cerebrofacial metameric syndromes are a group of congenital syndromes that result in vascular malformations throughout specific anatomical distributions of the brain, cranium and face. Multiple reports of patients with high-flow or low-flow vascular malformations following a metameric distribution have supported this idea. There has been much advancement in understanding of segmental organization and cell migration since the concept of metameric vascular syndromes was first proposed. We aim to give an updated review of these embryological considerations and then propose a more detailed classification system for these syndromes, predominately incorporating the contribution of neural crest cells and somitomeres to the pharyngeal arches.

Summary Objective The diffusion characteristics of water molecules were measured in the vocal folds of canines exhibiting unilateral vocal fold paralysis and unilateral cricoarytenoid joint dislocation. These characteristics were used in conjunction with a histological examination of the microstructural changes of vocal fold muscle fibers to explore the feasibility of diffusion tensor imaging (DTI) in distinguishing unilateral vocal fold paralysis and unilateral cricoarytenoid joint dislocation as well as evaluating microstructural changes. Methods Ten beagles were randomly divided into three groups: four in the unilateral vocal fold paralysis group, four in the unilateral cricoarytenoid joint dislocation group, and two in the normal group. Unilateral recurrent laryngeal nerve resection was performed in the vocal fold paralysis group. Unilateral cricoarytenoid joint dislocation surgery was performed in the dislocation group. No intervention was performed in the normal group. Four months postintervention, the larynges were excised and put into a magnetic resonance imaging (MRI) system (9.4T BioSpec MRI, Bruker, German) for scanning, followed by an analysis of diffusion parameters among the different groups for statistical significance. After MRI scanning, the vocal folds were cut into sections, stained with hematoxylin and eosin, and scanned digitally. The mean cross-sectional area of muscle fibers, and the mean diameter of muscle fibers in the vocal folds were calculated by target detection and extraction technology. Mean values of each measurement were used to compare the differences among the three groups. Pearson correlation analysis was performed on the DTI parameters and the results from histological section extraction. Results The paralysis group had significantly higher Fractional Anisotropy (FA) compared to the dislocation group and normal group (P = 0.004). The paralysis group also had a significantly lower Tensor Trace value compared to the dislocation group and normal group (P = 0.000). The average cross-sectional area of vocal fold muscle fibers in the paralysis group was significantly smaller than the dislocation group and normal group (P = 0.000). Pearson correlation analysis yielded values of, r = -0.785, P = 0.01 between the average cross-sectional area of vocal muscle fibers and FA, and values of r = 0.881, P = 0.00 between Tensor Trace and the average cross-sectional area of vocal muscle. Conclusion FA and Tensor Trace can be used as effective parameters to reflect the changes of microstructure in vocal fold paralysis and cricoarytenoid joint dislocation. DTI is an objective and quantitative method to effectively evaluate unilateral vocal fold paralysis and unilateral cricoarytenoid joint dislocation, also capable of noninvasively evaluating vocal fold muscle fiber microstructure.

Introduction: Phantom limb pain (PLP) as neuropathic pain affects the life of amputees. It is believed an efficient PLP treatment should consider the underlying neurological mechanisms. Hereby, we investigated brain activity in PLP and its relationships to the psychological and cognitive dimensions of chronic pain. We investigate differences in resting brain activities between amputees with and without pain. We hypothesize significant differences in the motor cortex and parietal cortex activity that are related to pain perception. Also, we hypothesize two groups have significant differences in cognitive and psychological components. Methods: Behavioral assessment (psychological status, life satisfaction, and pain level) and EEG signals of 19 amputees (12 without pain and 7 with pain) were recorded. Data were statistically compared between the two groups. Also, the association between behavioral and neurophysiological data was computed. Results: The results showed a significant decrease in the pain group for the beta and gamma waves, as well as, for the theta and delta waves in the posterior temporal on both sides, during the eye-open condition. The eyes-closed condition showed that the delta waves were decreased on the right side of the cortex. Also, data showed a significant difference in the correlation of pain features with brain waves between the two groups. Conclusion: Significant differences were mostly observed in regions related to pain perception rather than the motor cortex. This can be due to the learned strategies to deal with pain and the degree of pain. Results showed maladaptive cognitive processes had a relationship with brain wave activities. According to the result of brain wave activities, it seems that cognitive factors have a role in the experience of PLP rather than neuroplasticity through amputation.

Knowledge of anatomical variations can be of use to clinicians and surgeons when, for example, viewing images of a patient or performing operations. Such knowledge can minimize the risk of iatrogenic complications. Herein, we present a case of a variant atlantomastoid muscle. The muscle was identified on the left side in an adult cadaver. The muscle's measurements and anatomical relationships are presented as well as a review of salient literature. We hope that increased knowledge of anatomical variants in the suboccipital region can improve patient care.

Background: This study investigated the lumbosacral plexus (LSP) nerve root thickness and ligamentum flavum (LF) thickness and correlated them with age and sex. These findings provided a useful data for spinal nerve root micro-anastomosis surgery and lumbar decompression surgery. Materials and methods: This retrospective study was conducted with 350 individuals with ages ranging from 21 to 80 years of age under magnetic resonance imaging (MRI) to evaluated the possible cause of a lower back pain. Results: According to the morphometric measurements of the LSP root thickness, the diameter gradually increased from L1 to S1. L1 has the thinnest root (3.9 ± 0.81 mm) while S1 has the thickest root (5.45 ± 0.8 mm). The measurements revealed inconsiderable differences in the LSP thickness in relation to age, sex in the study population. Regarding the LF, the thickness of the LF was found to be insignificantly increase with age. Besides, the LF thickness was inconsequentially higher in female. The mean thickness of the right LF at different spinal levels was measured (L2-L3 = 3.19 ± 0.27, L3–L4 = 3.38 ± 0.11 mm, L4–L5 = 3.71 ± 0.29 mm, and L5–S1 = 3.64 ± 0.21 mm). The mean thickness of the left LF was non significantly higher. Conclusions: The LSP root and LF thicknesses not related to age or sex.

Variations of the nerves of the forearm can lead to unexpected clinical findings during physical examination. Additionally, surgery in this region might encounter and potentially damage the nerve in such patients. Here, we present a case of a high split of the median nerve and discuss the findings of the case as well as review salient reports in the literature. Knowledge of such a variation can be important in patient diagnosis and treatment.

Detailed knowledge of the anatomy and different variations of the superficial branch of the radial nerve could be of great importance not only to anatomists but also to clinicians. A predominant radial nerve supply to the dorsum of the hand is rare. Herein, we present an unusual case of unilateral sensory innervation of the dorsal hand found during routine anatomical dissection of a 72-year-old at death male Caucasian cadaver. We also present a brief discussion of the reported variation and emphasize its potential clinical implications.

The biceps brachii is located in the anterior compartment of the arm, which can show numerous morphological variations. During anatomical dissection, an interesting additional muscle was found: the third head of the biceps brachii originated from the short head of the same muscle. The 97.77 mm long muscle belly was directed medially over the arm and then passed into the common tendon (15.97 mm), which thereafter split into aponeurosis and tendon. The 26.33 mm aponeurosis passed and joined the fascia of the forearm. The tendon of the third head of the biceps brachii then gave rise to the ulnar head of the pronator teres muscle. Such an accessory structure could cause neurovascular compression involving the brachial artery and median nerve. Knowledge of the morphological variability of this region is essential not only for anatomists but also for clinicians.

The external carotid artery (ECA) is the major blood supply for structures in the head and neck. Typically, it has eight separate branches; but there are many anatomical variations, making it difficult to predict surgical outcomes and complications without three-dimensional imaging. This case study focuses on a cadaver with multiple anatomical variations in the ECA, i.e., lingual, facial, occipital, ascending pharyngeal, and posterior auricular arteries, found during routine dissection of the right cadaveric neck. We also discuss the incidences of several other anatomical variations of the ECA branches and their surgical implications and potential complications.

Background: The aims are to evaluate the morphometry of the sellar region and propose a safety window on the floor of the sella turcica for the transsphenoidal approach in a Hispanic population. Materials and methods: We retrospectively analyzed 150 computed tomographic angiography sellar region images from asymptomatic patients. The images were evaluated intraobservatory by an expert radiologist. We measured: intercarotid distance of cavernous segment; depth of sella turcica; skull base angle; anterior distance, the distance between anterior spinal nasal and floor of the sella turcica; posterior distance, the distance between anterior spinal nasal and posterior wall of the sella turcica; anterior surgical angle, formed between the floor of the nostril and superior limit of the anterior wall of the sella turcica; and posterior angle, formed between the floor of the nostril and the inferior limit of the posterior wall of the sella turcica. Results: Safety window was based on two measures: the intercarotid distance and depth. The mean of the safety window is 151.13 mm 2 and 147.60 mm 2 for men and women respectively. The intercarotid distance was 17.83 mm. The depth of the sella turcica was 8.46 mm. The skull base angle was 112.13 grades. The anterior distance was 76.34 mm. The posterior distance was 87.59 mm. The anterior surgical angle was 32.76 grades. The posterior surgical angle was 87.59 grades. Conclusions: The surgical approach space is smaller in females. It could significate a more complicated surgery in this population. Anatomical understanding could reduce complications in hospitals without a neuronavigation system. The project was previously reviewed and approved by the local ethics and research committees of the University with the approval number AH19-00002 on April 25, 2019.

Background: Among the factors ensuring successful completion of such minimally invasive procedures as cardiac implantable electronic device (CIED) implantation and central venous catheter (CVC) placement are the morphometry and topography of the vessels used for cardiac lead or catheter advancement. Venous access through the left clavipectoral triangle makes use of the left brachiocephalic vein (BCV). The purpose of this study was to present the radiology images of various individual forms of this vessel observed during CIED implantation procedures. Methods: Our analysis included 100 venography recordings illustrating the left BCV, obtained during de novo CIED implantation procedures. We assessed the mediastinal course of the left BCV, with its natural angles, including angle α (in the middle section of the vessel) and the two angles created by the left BCV and the left subclavian vein (angle β) and the left BCV and the superior vena cava (angle γ). Results: The mean values of angle α tended to be higher (approximately 141°) than those of the two remaining angles (γ and β), which were comparable at 123° and 127°, respectively. An increase in mean angle α values were accompanied by increased mean angle γ and β values (p = 0.05), with only 5% of β and γ angles, in total, having values close to those of a right angle (90 ± 10o). Conclusions: Individual variability of left BCV topography and morphology comes from developmental formation of the physiological angle in the middle section of this mediastinal vessel’s course. The presence of near-right angles along the course of left BCV may potentially result in injuries to the vessel during intravascular procedures.

Objective: To investigate microanatomic organizations of the extratemporal facial nerve and its branches, hypoglossal nerve, sural nerve, and great auricular nerve. Methods: Nerve samples were dissected in 12 postmortem autopsies, and histomorphometric analyses were conducted. Results: There was no significant difference between the right and left sides of the nerve samples for the nerve area, fascicle area, number of fascicles and average number of axons. The lowest mean fascicle number was found in the hypoglossal nerve (4.9 ± 1.4) while the highest was in great auricular nerve (11.4 ± 6.8). The highest nerve area (3,182,788 ± 838,430 μm2), fascicle area (1,573,181 ± 457,331 μm2) and axon number (14,772 ± 4402) were in hypoglossal nerve (p < 0.05). The number of axons per unit nerve area was higher in the facial nerve, truncus temporofacialis, truncus cervicofacialis and hypoglossal nerve, which are motor nerves, compared to the sural nerve and great auricular nerve, which are sensory nerves (p < 0.05). The number of axons per unit fascicle area was also higher in motor nerves than in sensory nerves (p < 0.05). Conclusion: In the present study, it was observed that each nerve contained a different number of fascicles and these fascicles were different both in size and in the number of axons they contained. All these variables could be the reason why the desired outcomes cannot always be achieved in nerve reconstruction.

Hoof wall separation disease (HWSD) is a genetic defect in Connemara ponies characterised by separation and cracking of the dorsal hoof wall. The disease can result in chronic inflammation, severe lameness and laminitis. Affected ponies typically show clinical signs within the first six months of life. The disease is inherited as an autosomal recessive trait. The genetic mutation is a frameshift mutation in the gene

Background Intraosseous ganglia of the carpal bones are uncommon with sparse publications to guide treatment. The purpose of this study was to review a single-institution experience to determine the outcomes of patients with surgically treated intraosseous carpal ganglia. Methods Skeletally mature patients with intraosseous carpal ganglia between 1995 and 2016 treated operatively were identified. Demographic information, clinical data, and radiographic studies were evaluated. Results Thirty-three ganglia in 31 patients were identified. Intraosseous ganglia were located in the lunate (23), scaphoid (9), and trapezoid (1). Patients who presented with pathologic fracture or collapse had larger intraosseus ganglia than those presenting with pain alone. Surgery significantly improved pain. Patients treated with debridement with autograft bone graft had a higher consolidation rate compared with allograft bone but no difference in pain. Conclusions Patients with large or symptomatic lesions can be treated successfully with curettage and debridement, which leads to relief of pain. The use of bone grafting remains controversial.

Lipomas are benign fatty tumours composed of mature adipocytes that are ubiquitous in their presence. When fibrous septa are present, these are called fibrolipoma.[1][1] Usually located subdermally, sometimes they may be subfascial.[2 3][2] These are further classified as parosteal, interosseous

Background: The relationship between anterior cruciate ligament (ACL) injury and anatomical structures is still a topic of debate. Purpose: The aim of this study was to compare knee geometry in demographically matched ACL-injured and ACL-intact athletes. Methods: We conducted a case-control study comparing 2 groups, each consisting of 55 professional athletes (44 men and 11 women): 1 group with complete ACL tears (cases) and 1 group with intact ACLs (controls). The groups were compared using magnetic resonance imaging (MRI) in terms of intercondylar notch geometry, tibial plateau characteristics, and ACL volume. Results: Among cases and controls, we found the cases had lower notch width (20.24 ± 2.68 mm vs. 22.04 ± 2.56 mm, respectively) and notch width index (0.29 ± 0.03 vs. 0.31 ± 0.03, respectively). The mean ACL volume in the cases (1181.63 mm3 ± 326 mm3) was also lower than in controls (1352.61 mm3 ± 279.84 mm3). The parameters of tibial slope geometry were comparable between groups. In addition, women had lower ACL volume than men (1254 ± 310 mm3 vs. 890 ± 267 mm3, respectively) and higher medial posterior tibial slope (4.76 ± 2.6 vs. 6.63 ± 1.83, respectively). Among cases, women had narrower notch width than men (16.9 ± 2.42 mm vs. 21.08 ± 2.03 mm). However, notch width index was comparable between male (0.3 ± 0.02) and female (0.28 ± 0.03) cases. Conclusion: Our findings suggest that narrow notch width and low ACL volume may enhance the risk of ACL injury among athletes. There was no association found between posterior tibial slope and ACL injury between athletes with injured ACLs and controls. Further study is indicated.

For the treatment of the moderate leg length discrepancy (2–6 cm) in children surgeons use temporal growth plate (GP or epiphyseal cartilage) block with plates and screws. Objective: to study morphological changes in distal femur growth plate of rabbits under bilateral temporal block with non-locking plates and screws. Methods: we blocked distal GP of the right femur of 9 rabbits (8 weeks old). On 3rd, 5th and 7th weeks histological study of the distal femoral growth plate of both femurs with morphometry was made. Results: in 3rd weeks after surgery the height of the GP on the operated side was decreased in lateral and medial parts in 2.06 and 1.98 times (p, Для лечения умеренной разницы (2–6 см) длины нижних конечностей у детей используют временное блокирование зоны роста (ЗР или эпифизарный хрящ) пластинами с винтами.Цель: исследовать морфологические изменения ЗР дистального отдела бедренной кости кроликов при ее двустороннем блокировании неблокируемыми пластинами с винтами.Методы: блокировали дистальную ЗР правой бедренной кости 9 кроликов в возрасте 8 нед. Через 3, 5 и 7 нед. выполнен гистологический анализ (с морфометрией) дистальных отделов обеих бедренных костей.Результаты: через 3 нед. после операции высота кости с блокированием была сниженной в латеральном и медиальном отделах в 2,06 и 1,98 раза (p, Для лікування помірної різниці (2–6 см) довжини нижніх кінцівок у дітей використовують тимчасове блокування наросткової зони (НЗ або епіфізарний хрящ) пластинами з гвинтами.Мета: дослідити морфологічні зміни НЗ дистального відділу стегнової кістки кроликів в умовах її двобічного блокування неблокованими пластинами з гвинтами.Методи: блокували дистальну НЗ правої стегнової кістки 9 кроликів у віці 8 тижнів. Через 3, 5 і 7 тижнів виконаний гістологічний аналіз (з морфометрією) дистальних відділів обох стегнових кісток.Результати: через 3 тижні після операції висота кістки з блокуванням була зниженою в латеральному та медіальному відділах у 2,06 і 1,98 разу (p

Background: Men over the age of 40 are more likely to develop benign prostatic hyperplasia (BPH). BPH is characterized by proliferation of the prostatic epithelium and stroma. Selenium nanoparticles (SeNPs), is an essential metalloid mineral and antioxidant. In this study, SeNPs were tested for their potential protective and curative impacts on BPH in rats. Materials and methods: 50 male Sprague-Dawley rats were randomly divided into five groups: Group I (Control group); Group II (Orchiectomized group): bilateral orchiectomy was conducted on rats; Group III (BPH group): testosterone (TE) enanthate injection was used to induce BPH; Group IV (Protective group): rats were given SeNP before subjecting rats to BPH; Group V (Curative group): rats were succumbed to BPH, followed by administration of SeNP. Measurement of prostate specific antigen (PSA) and TE in serum was performed and prostates were weighed and prepared for histological, immunohistochemical and ultrastructural examination. Results: In the BPH group, serum TE- and PSA-levels, as well as prostate weight, increased significantly and significant decreases in the protective and curative groups. Reduced acinar lumen, expansion of stroma and epithelial hyperplasia were noticed in the BPH group, which were ameliorated significantly both in protective and curative groups. There was an increase in PCNA immunoreaction in the BPH group and a decrease in both the protective and curative groups. On TEM of BPH group, the nuclei appeared irregular with dilated endoplasmic reticulum, loss of cell boundaries and apical microvilli. The protective group showed more improvement than the curative group. Conclusions: The effects of SeNPs on BPH induced by TE in rats, were both protective and curative, although the protective effects were more pronounced.

Background Sentinel node biopsy in vulvar cancer is associated with much less morbidity than inguinofemoral node dissection. Our study focused on describing the morphology of superficial lymphatic drainage of the vulva and its relationship to regional nodes, which may facilitate orientation during surgery. Materials and methods In 24 female cadavers, injections of patent blue (at various localizations mediallyunilaterally and bilaterally) were used to visualize the lymphatic drainage of the vulva. After dissection of lymphatic vessels and nodes, their course was documented by photograph and then analyzed. Subsequently, a map of vulvar superficial lymphatics was created. Results The cutaneous and subcutaneous tissue of the vulva primarily drained to superficial inguinal nodes. There was no evidence of a solitary lymph node that drained the unilateral vulva. Each area of the vulva drained to its own lymph node, which was variably localized in the subcutaneous groin around the great saphenous vein. Anastomoses between individual inguinal superficial lymph nodes are likely. Right-left symmetry in the course of lymphatic collectors was not detected. Natural drainage of the medial and paramedial areas to contralateral inguinal nodes was also not detected. The drainage pattern to ipsilateral inguinal nodes was consistent in cadavers without evidence of vulvar disease and may be applicable in the early stages of vulvar cancer. Conclusions There was no evidence of a solitary node that drained the unilateral vulva. Each part of the vulva may drain to a corresponding lymph node in a different localization of the groin. The surgeon should take this variability into account.

Although appealing from a reconstructive standpoint, the incorporation of the overlying skin in a serratus anterior muscle flap has not yet seen widespread use, due to considerations with its blood supply. In the present study, a systematic review of the literature has been performed, evaluating studies that investigated the vascular anatomy and variations of serratus anterior myocutaneous flap. The anatomy of the cutaneous blood supply, the size of the cutaneous territory, the design of the skin paddle and the reconstructive goals were analyzed. The results showed that the main blood supply originates from the intramuscular anastomoses between intercostal artery perforators and the serratus artery branch in the form of choke vessels. Complementary perfusion from true intramuscular vessel anastomoses or from direct serratus artery cutaneous perforators could contribute to the skin blood supply but only in 25% of the cases. The design of the flap is elliptical with its long axis over the harvested muscle slips and maximum width is approximately 6-8 cm. Α myocutaneous serratus anterior flap could be applied in a variety of reconstructive fields, most commonly for head and neck defects. A delay procedure would considerably enhance the perfusion of the cutaneous component and improve the overall viability of the flap.

Background: Venous anomalies of the lower extremity are a challenge when found as rare variations. Physicians should be aware of morphological variations in this region for correct diagnosis and management of diseases such as deep vein thrombosis. Materials and methods: During the routine dissection of the lower extremities of a Caucasian male cadaver, a case of persistent sciatic vein was found. Results: A persistent sciatic vein originating from the saphenopopliteal junction coursed proximally and laterally to enter into the adductor magnus muscle, at the right side. Running through the fibers of the adductor magnus anteriorly, the variant vein drained into the deep femoral vein just medial to the vastus medialis muscle. Conclusions: As being a rare congenital vascular anomaly, the persistent sciatic vein should be correctly diagnosed and defined during the radiologic assessments, surgical interventions and blockades for better outcomes and lesser complications.

Background: Diabetes, among multiple systemic harmful health issues, also may deteriorate normal regenerative and reparative functions of periodontium. The aim of this research was to study the role of periodontal ligament in tissue remodeling under the orthodontic appliance stimulation in two rat experimental models (healthy Wistar rats and Goto-Kakizaki, rodent model of non-obese type 2 diabetes). Materials and methods: It was defined four groups of rats: Wistar (n = 8) and Goto-Kakizaki (n = 8) control groups without orthodontic appliances, and Wistar (n = 16) and Goto-Kakizaki (n = 16) appliance groups with orthodontic appliances. After 42 days, rats were sacrificed and histopathology descriptive analysis about periodontal ligament and adjacent structures was performed as well as cellularity of periodontal ligament and Kappa curvature of tooth roots were measured. Results: Goto-Kakizaki control rats showed statistically significantly higher cellularity in comparison with Wistar control rats (p

The following urogenital and vascular anomalies were observed in the left kidney of an 81-year-old female cadaver during routine dissection: three extrarenal calyces; an accessory renal artery originating directly from the abdominal aorta; and a circumaortic renal vein. The typical renal anatomical structures were identified, from anterior to posterior, as the renal vein, renal artery, and ureter appearing near the hilum of the left kidney. After closer examination, three extrarenal calyces were observed exiting from the hilum of the left kidney to form the pelvis, then narrowed and became the ureter which descended 21.5 cm to empty into the bladder. The accessory renal artery originated from the lateral aspect of the abdominal aorta 7.3 cm below the aortic origin of the left renal artery. A corresponding accessary renal vein, identified as a circumaortic vein, left the hilum 4.5 cm below the left renal vein and travelled posterior to the abdominal aorta to drain into the inferior vena cava. Extrarenal calyces are rare among urogenital tract variations. They can be associated with embryological abnormalities such as renal ectopia, horseshoe kidney or malrotation as well as clinical manifestations such as pelviureteric junction obstruction and hydronephrosis. Compression of the accessory renal artery can cause decreased blood flow to the inferior pole of the left kidney, thereby causing fibrosis, atrophy, or renal failure. The retro-aortic path of the circumaortic renal vein has been associated with posterior nutcracker phenomenon, haematuria, left renal vein thrombus formation, and renal vein hypertension. This unique combination of a collecting system anomaly and extrarenal vessel variations could have significant implications in abdominal surgery.

Background: Os peroneum and os vesalianum are sesamoid bones that could be found within fibularis longus and brevis tendons, respectively. They are rarely a cause of lateral foot pain and are often identified as incidental radiographic findings. However, in the context of trauma, these sesamoids may be radiographically misinterpreted as fractures . This study aimed to evaluate the prevalence and normal morphological variants of os peroneum and os vesalianum. Materials and methods: Standard oblique lateral and/or anteroposterior radiographic views of 624 feet of adolescent and adult patients were retrospectively reviewed to determine the prevalence and anatomical variations of the os peroneum and os vesalianum.in relation to age and gender using plain radiography. Results: Os peroneum was found in 22% and os vesalianum. was found in 1.6%. Age was found to significantly correlate with the presence of os peroneum with the highest prevalence (30%) detected in the elderly group. Among 137 feet with os peroneum, 54.0% were between 4 and 8 mm, 67.2%% were close to the tubercle of cuboid, 32.8% were located at the level of calcaneocuboid joint, 81.8% were solitary, and 18.2% were bi/multipartite. Among 10 feet with os vesalianum., Type I was identified in 40% and Type II in 60%. Conclusions: Different anatomical variants of the lateral sesamoid bones of the foot have been described in this study. A thorough knowledge of normal anatomical variants is essential for proper diagnosis and management and can enhance our diagnostic skills in detecting these sesamoids.

Background: This study aimed to investigate the incidence, number, diameter, and relative location of the parietal foramen (PF), as well as communication of intracranial and extracranial orifices and their direction, and sagittal suture morphology and length. Materials and methods: A total of 280 dry Chinese adult skull specimens from the Department of Anatomy, Southern Medical University, were observed and measured. The occurrence rate and quantity of the PF near the sagittal suture were recorded. The aperture of the PF, the vertical distance between PF and sagittal suture, and the linear distance between PF and lambda were measured using a vernier calliper. The length of the sagittal suture was measured by a flexible ruler, the direction and communication of intracranial and extracranial orifices were detected using a probe. Results : The total incidence of the PF was 82.86%, slightly more on the right side than on the left side. The single foramen type was the most. The mean diameter of the PF on the left and right sides were 1.02±0.72 mm and 1.07±0.67 mm, respectively, and the diameter of the PF on the sagittal suture was 1.77±0.44 mm. The mean vertical distance between the PF and the sagittal suture was 5.90±2.78 mm and 5.85±2.75 mm on the left and right sides, respectively. The shape of the sagittal suture in the PF area was primarily dentate shaped, with an average arc length of χ = 124.36±7.76 mm, of which the majority were completely healed type. The intracranial and extracranial communication was 39.97%, and the majority of the PF were anteromedial direction. Conclusions : The current study provided an anatomical basis for imaging diagnosis and neurosurgery by investigating the incidence, diameter, and relative location of the PF and intracranial and extracranial communication and direction.

Abnormal systemic vein development produces anomalous veins, which - in the case of persistent left superior vena cava and/or left brachiocephalic vein - exhibit considerable topographic and morphometric differences in comparison with their usual anatomy. The nature and extent of those developmental anomalies - detected during intravenous procedures, such as cardiac implantable electronic device (CIED) lead insertion or central venous catheter placement - may hinder the procedure itself and/or adversely affect its outcome, both at the stage of cardiac lead advancement through an abnormally shaped vessel and lead positioning within the heart. This may lead to problems in achieving optimal sensing and pacing parameters and in ensuring that the patient cannot feel the pacing impulses. These events accompanied a de novo CIED implantation procedure in the patient with a double superior vena cava and left brachiocephalic vein agenesis, who ultimately required reoperation.

Background: The foramen tympanicum is located on the anteroinferior region of the external acoustic meatus and posteromedial to the temporomandibular joint in children between the first and the fifth year of life. It is considered an anatomical variation when it persists in adults. The aim of this study was to verify the prevalence as well as to characterize the foramen tympanicum in CT scans of the population from southeastern Brazil. Materials and methods: A total of 78 CT scans of dry human skulls were used, which were selected randomly regarding the ages, ranged from 15 to 100 years, and composed a total of 20 female and 58 males. The foramen tympanicum was identified in the images of the axial plane and confirmed in the images of the coronal and sagittal planes. The largest diameter (in mm) was obtained. The descriptive statistics (in %), Fisher's test and chi-square test (χ2) were performed to compare the prevalence of foramen tympanicum between sexes and sides. The probability value ≤ 0.05 was defined as a level of significance. Descriptive statistics were performed to verify the mean diameter of the foramen on the right and left sides of the skulls. Results: The prevalence of foramen tympanicum was higher in females (P = 0.0070), bilaterally, as the absolute values of females were lower in relation to males. Fisher's exact test showed that the prevalence of foramen tympanicum was significantly higher in females (45%) than in males (15.52%). On the right side, the mean axial diameter was 2.23 mm (range 0.93–3.75 mm). On the left side, the mean axial diameter was 2.22 mm (range 0.9–3.61 mm). Conclusions: The knowledge of anatomical variations is extremally valuable for an accurate diagnosis, treatment plan and prognosis and a thorough preoperative assessment.

Background: The sella turcica volume is widely measured by the Di Chiro-Nelson method. The purpose is to compare the fidelity of a proposed volumetry method versus the Di Chiro-Nelson method, using Computed Tomography (CT) images. Materials and methods : Morphometric examination of 173 CT were included, of which 52.6% were female. The mean age was 53.2 ± 17.6 years. Considering the Di Chiro-Nelson method, two measurements were added for each axis in the CT evaluation: Length (Central, Left, and Right), Width (Central, Anterior, and Posterior), and Height (Central, Left, and Right). Results : The mean measurements were Length: Central 10.11 ± 1.44, Left 7.45 ± 1.67, Right 7.53 ± 1.59; Width: Central 12.27 ± 2.11, Anterior 10.99 ± 1.92, Posterior 10.10 ± 1.74; Height: Central 7.68 ± 1.38, Left 7.16 ± 1.35, Right 7.40 ± 1.41. A statistically significant difference between sex was found only in the anterior width (p=0.01). Using the proposed method, the volume was 342.2 ± 88.5 and 378. 6 ± 113.9 mm3 respectively between females and males (p=0.02) versus 476.1 ± 132.4 and 523.8 ± 186.0 mm3 (p=0.05) using the Di Chiro-Nelson’s method. Conclusions : Women had significantly smaller sella turcica volume than men. This proposed method considers the sella turcica as a not strictly symmetrical structure and indicates reduced variation between the maximum and minimum values, compared to the Di Chiro-Nelson’s. Our findings may be useful to reassess the volume of the sella turcica as the measurements indicate a higher precision.

Irisin, a polypeptide hormone that is released from skeletal muscle in response to exercise found to improve endothelial functions, protect against endothelial injuries and change blood pressure which also affected blood vessels. The aim of this study is to study the histological changes of the rat thoracic aorta in response to irisin injection. Thirty rats were used. Then divided into two groups; the control group without irisin injection, and the irisin injected group was subdivided into four subgroups with different irisin concentrations (20, 40 and 160 nM, respectively) twice a week for four weeks, the control group and each subgroup consisted of 6 rats each. After 4 weeks all rats were sacrificed, and the descending thoracic aorta was treated for histological evaluation. Sections were stained with Hematoxylin and Eosin (H and E) and orcein stains. Morphometric measurement included: intima-media thickness (IMT), number of elastic lamellae and number of smooth muscle cells nuclei. Histological study has shown that intraperitoneal injection of different concentrations of irisin (20, 40 and 160 nM) in rats has increased intima-media thickness, number of smooth muscle cell's nuclei, and increase the number of elastic lamellae in media layer of the thoracic aorta in a dose dependent manner. Irisin has significantly affected the morphology of the wall of the rat thoracic aorta indicating a role for irisin in influencing the growth factors of the thoracic aorta walls and activate smooth muscle cells in the thoracic aorta layers.

Background: The peri-hilar branching pattern of renal arteries and variations such as accessory renal artery and early branching of the renal artery are important factors to be evaluated preoperatively to minimize potential complications during renal transplantation and renal surgeries. The present was done to study the perihilar branching pattern of the renal artery and variations of the renal artery in kidney donors. Materials and methods: 198 kidneys from 99 donors were analyzed using pre-operative CT renal angiograms prospectively, over 1 year 2 months. Results : Based on the branching pattern of primary and secondary branches of renal arteries, we identified 8 cardinal and 10 minor peri-hilar branching patterns. Type I (duplicated fork) peri- hilar branching pattern was the most found (70.2%) among 198 kidneys, followed by type II (triplicated fork) (19.2%) and type III (ladder) (10.6%). Duplicated fork pattern was common in both the right renal artery (75.7%) and left renal artery (64.6%) respectively. The prevalence of accessory renal artery was 39.4% with hilar artery at 21.2% and polar artery at 18.2%, and the prevalence of early division of renal artery was 20.2%. No statistical significance was associated between gender and laterality in the prevalence of both early division and accessory renal arteries (P > 0.05). Early division of renal artery was more frequent in females (28%) whilst accessory renal arteries were more common in males (40.7%). Conclusions: The present study showed a consistent peri-hilar branching pattern with high individual variability among Indian renal donors. The knowledge about the peri-hilar branching pattern as well as renal artery variations conferred by this study would greatly compliment urological surgeons during renal transplant surgeries.

Summary Though injuries to the distal tibiofibular (DTF) syndesmosis are commonly encountered in orthopedic and trauma settings, its anatomical structures have been poorly researched. The commonly overlooked DTF ligament injuries are known to cause chronic ankle pain, instability and post-traumatic osteoarthritis. Quantitative and morphological evidence synthesis has not been yet conducted. A meta-analysis was conducted to collect data from morphological studies to document more accurate details on the prevalence, size, and insertion sites of its components. The Checklist for Anatomical Reviews and Meta-Analyses (CARMA) was followed. Ten studies met the inclusion criteria with a total of 265 investigated ankles. The analysis demonstrated that the anterior and posterior tibiofibular ligaments along with the interosseous ligament were present in 100% of joints. The inferior transverse tibiofibular and the distal fascicle of the anterior tibiofibular ligament were the least prevalent with frequencies of 96% and 86.5%, respectively. The inferior transverse ligament was recorded as the longest ligament. The widest ligament was found to be the interosseous tibiofibular ligament at its fibular attachment. The thickest of the ligamentous components was the posterior tibiofibular ligament. While more cadaveric research is warranted, these results would help directing future biomechanical investigations and planning new research to further aid in diagnostic and therapeutic approaches to the injuries of the distal tibiofibular syndesmosis.

Venous fenestrations are rare and when present often are not pierced by regional nerves. Herein, we report an unusual case of a fenestrated superficial temporal vein (STV). Anterior to the external ear, where the STV and superficial temporal artery normally travel with the auriculotemporal nerve (ATN), the nerve was found to pierce the STV. The fenestration within the STV was approximately 0.35mm in diameter, and there was no sign of compression of the ATN as it traversed this vessel. Following the site of penetration of the STV by the ATN, the nerve had a normal course into the skin and surrounding fascia. To our knowledge, this is the first report of a fenestrated STV being pierced by the ATN. Such an anatomical variation might be considered by clinicians who treat patients with pathology of this region.

The canine epigastric organs, their locations and visualization of these components are essential for veterinary practice and anatomical research. Despite their importance, conflicts and discrepancies in the published material, to date, still exist, even in a species that has been studied extensively. The aim of this research was to undertake computed tomography, and anatomical sections from differing views and levels in addition to the ultrasound appearance of the main organs of the epigastria region. The epigastric organs, and associated anatomical features and landmarks that affected by stomach fullness were described in relation to their relative positions, visual appearance and general anatomy for both empty and filled stomachs. These features were not only described, but also compared against the published literature.