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Objective: This study aimed to investigate morphometric properties of the cranial aperture (CA) of the optic canal. Methods: Cone-beam computed tomography images of 400 individuals (200 males and 200 females) aged 37.32 +/- 15.87 years were retrospectively examined to assess the morphometry and morphology of the CA. Results: The height and width of CA were found as 4.22 +/- 0.74 mm and 7.27 +/- 1.15 mm, respectively. The distances between the CA and the midsagittal line, the anterior and lateral boundaries of the anterior skull base were measured as 5.77 +/- 1.32 mm, 64.97 +/- 6.36 mm, and 41.00 +/- 4.05, respectively. The angle of the optic canal in the sagittal plane was measured as 7.57 degrees +/- 3.95 degrees, whereas in the horizontal plane as 38.96 degrees +/- 4.36 degrees. The aperture shape was defined as the tear-drop (413 foramina, 51.62%), triangular (180 foramina, 22.50%), oval (158 foramina, 19.75%), round (30 foramina, 3.75%), and polygonal (19 foramina, 2.38%). Conclusions: The authors observed that the diameters, and angulations of the CA may change relative to gender and the shape. The anatomic features of CA are important for the positioning of the patient's head, the choice of the appropriate surgical approach or equipment, and the detection of anatomical landmarks during interventions. In this context, our dataset may be beneficial for surgeons helpful as a reference for radiological evaluations.

OBJECTIVES The study aimed to display the growth pattern of the tympanic ring in fetal cadavers of 20-30 weeks of gestation. METHODS In the study, 32 temporal bones of 16 fetuses (8 males, 8 females) of 24.62 ± 3.44 weeks of gestation were dissected to measure the height (TRH), width (TRW), and perimeter (TRP) of the annulus, and the width (TNW) of the opening part of the annulus at the level of the tympanic notch. RESULTS The TRH, TRW, TRP, and TNW were measured as 8.25 ± 1.04 mm, 7.64 ± 1.08 mm, 24.93 ± 3.40 mm, and 4.01 ± 0.91 mm, respectively. The parameters were similar at the seventh and eighth months of gestation; therefore, there was no variation from the seventh month. Linear function was calculated as y = 1.328 + 0.281 x weeks (P < .001) for the TRH, y = 1.284 + 0.258 x weeks (P < .001) for the TRW, y = 3.367 + 0.876 x weeks (P < .001) for the TRP, and y = -0.603 + 0.188 x weeks (P < .001) for the TNW. CONCLUSION The parameters (TRH, TRW, TRP, and TNW) did not alter from the seventh month in utero. The linear functions (which represent the growth pattern of the parameters) of the tympanic ring may be useful for ear professionals to guess the annulus diameters, and to diagnose growth retardation and probable congenital anomalies in utero during sonographic imaging.

The aim of this study was to determine the incidence and morphometric and morphological characteristics of fossa navicularis (FN) on cone beam computed tomography (CBCT) images of healthy adults MATERIALS AND METHODS: CBCT images of 900 individuals (450 males, 450 females, over the age of 18) admitted to Gaziantep University, Dentistry Faculty were retrospectively examined. The incidence and shape of FN were determined. Transverse diameter (TDFN), sagittal diameter (SDFN), depth in transverse section (DFNT), depth in sagittal section (DFNS), and the shortest distance between the deepest point of FN and intracranial cavity (FNI) were measured.FN was detected in 122 (59 males and 63 females) of 900 (13.56%) CBCT images. No statistically significant difference was observed between gender and the incidence of FN. SDFN, TDFN, DFNS, DFNT and FNI were measured as 4.04 ± 1.71, 4.28 ± 1.34, 1.79 ± 0.68, 2.34 ± 0.85, and 6.76 ± 2.23 mm, respectively. Besides, FN was described as oval in 95 of 122 (77.87%) cases, while as round in 27 (22.23%) cases.The incidence of FN is rare; however, it may be responsible for serious consequences by causing infections from the nasopharynx to the intracranial cavity. As far as we know, the distance between the deepest point of FN and the intracranial cavity was measured for the first time in the literature with this study.

The study aimed to examine morphometric properties of the round window (RW) and oval window (OW) and to show their relation with the tympanic nerve (the Jacobson’s nerve, JN) in human fetuses from the otologic surgeon’s perspective. Thirty temporal bones of 15 fetal cadavers (8 males, 7 females) aged with 24.40 ± 3.71 weeks were included in the study. The height, width and surface area of the RW and OW and also distance from the JN to the OW and RW were measured. The height, width and surface area of the RW in this work were measured as 1.48 ± 0.25 mm, 1.57 ± 0.37 mm, and 2.05 ± 0.69 mm2, respectively. The RW was detected as round-shaped (8 cases, 26.7%), oval-shaped (15 cases, 50%), and dome-shaped (7 cases, 23.3%). The height, width and surface area of the OW were measured as 1.42 ± 0.26 mm, 2.90 ± 0.44 mm, and 3.63 ± 0.74 mm2, respectively. The OW was observed as oval-shaped (15 cases, 50%), kidney-shaped (10 cases, 33.3%), D-shaped (4 cases, 13.3%), and trapezoid-shaped (1 case, 3.3%). The JN was found 1.21 ± 0.60 and 1.18 ± 0.54 mm away from the RW and OW, respectively. This study containing morphological data about the shapes, diameters and area of the RW and OW may be useful to predict surgical difficulty, and to select implants of suitable size preoperatively for the windows. Knowing the relationship between the JN and the windows can be helpful to avoid iatrogenic injuries of the nerve.

Objective This study was aimed to obtain data on the dimensions of the optic foramen in human fetuses for early childhood surgeries. Methods Twenty-five formalin-fixed fetuses (16 boys and 9 girls) with average age 21.68 ± 3.12 gestational weeks (range, 16-28 weeks) in the inventory of Anatomy Department, Faculty of Medicine were included in the study. The surface area, width, and height of the optic foramen were bilaterally measured using a digital image analysis software. Results The forms of the optic foramen were described as oval shaped (72%, 36 foramina) and round shaped (28%, 14 foramina). The surface area, width, and height of the optic foramen were found as 2.40 ± 1.02 mm, 1.83 ± 0.59 mm, and 1.58 ± 0.36 mm, respectively. The measurements of the parameters related to the optic foramen were not statistically different in terms of sides and sexes (P > 0.05). Linear functions for the height, width and surface area of the optic foramen were calculated as: y = 0.711 + 0.040 × weeks, y = -0.019 + 0.086 × weeks, and y = -0.400 + 0.129 × weeks, respectively. Conclusion The linear functions in this study can be used to estimate the dimensions of the optic foramen. The calculated regression equations, representing the growth dynamic of the optic foramen showed that the surface area, width, and height were increasing according to gestational ages between 16 and 28 weeks. Microanatomical knowledge related to the optic foramen may be beneficial for surgeons to avoid iatrogenic injury in infants and for anatomists to understand the development of the fetal skull base.

Objective The main objective of the study was to show the morphologic features of optic strut (OS) and prechiasmatic sulcus (PS) in the fetal skull base with a surgical anatomical perspective. Methods Twenty-three fetal cadavers (9 female, 14 male) with an average age of 21.70 ± 3.12 (range: 16–28) weeks of gestation in the inventory of the Anatomy Department were included in the study. Measurements were made with a digital image analysis software and goniometer. Results The sulcal length, interoptic distance, planum length, and sulcal angle were detected as follows: 3.91 ± 0.74 mm, 6.88 ± 1.04 mm, 6.55 ± 1.51 mm, and 24.52 ± 9.51°, respectively. Considering the location of the posteromedial margin of OS according to PS, OS was identified as the sulcal in 56.5% (13 cases), postsulcal in 30.4% (7 cases), and asymmetric in 13% (3 cases). According to the sulcal length and angle, PS was identified as type 1 in 26.1% (6 cases), type 2 in 21.7% (5 cases), type 3 in 30.4% (7 cases), and type 4 in 21.7% (5 cases). Conclusions Our findings suggest that the sulcal length and angle reach adult size in utero. Taking into account the fetal and the gathered adult measurements, the high percentage of steep angle compared to flat angle show that after birth, PS become more flat, probably depending on the variations of the sphenoid sinus pneumatization. Thus, more studies conducted on the alterations in PS and OS types relative to the pneumatization are needed in terms of patient positioning, selection of appropriate surgical approach, and intraoperative decision-making.

Persistent left superior vena cava (PLSVC) is one of the cardiac system abnormalities with a 0.3-0.5% incidence and caused by inadequate obliteration of the left anterior cardinal vein during embryonic development. Prognosis of PLSVC is generally assumed to be good if it is not accompanied by other cardiac system abnormalities. During the routine ultrasound control of a patient at 25th week of pregnancy at the Obstetrics and Gynecology Department of Mersin University, PLSVC anomaly was detected in an intrauterine fetus. Then, intrauterine death occurred and after removal of the deceased fetus, PLSVC diagnosis was confirmed by autopsy. According to the autopsy findings, right superior vena cava (SVC) and azygos vein were found in normal course. PLSVC opened into the right atrium via enlarged coronary sinus. There was no connection between the two SVCs. On the left side of posterior mediastinum, instead of hemiazygos or accessory hemiazygos veins, a vein symmetrical to azygos was opened into PLSVC, similar to the one on the right. No other cardiac anomaly associated with PLSVC or any other pathology in the other parts of body that could be responsible for death was discovered during autopsy. There was no evidence indicating that PLSVC played any role in intrauterine exitus of the present case. However, as mentioned in the literature, the ectopic beats in the atrium wall of patients with isolated PLSVC and enlarged coronary sinus may lead to pathologies in the conduction system of the heart. Considering the intrauterine death of an isolated PLSVC case associated with cardiac conduction pathologies, we recommend that the common assumption of 'isolated PLSVC is not associated with death' should be reviewed by studies on large series and even intrauterine cases should be closely monitored for cardiac arrhythmia.

No prior publication studying the biomechanical and histological properties of cadavers fixed with Logan or modified Logan solution (MLS) was found in the literature. It was aimed in this study to compare MLS fixation and other cadaver preservation procedures regarding the use in basic histological studies, anatomy education and surgical trainings. This study was placed on 35 male 17-week-old Wistar Albino rats. MLS fixated tissues were systematically compared with 10% formalin (F10), saturated salt solution (SSS), Thiel and frozen/thawed (FT) tissues. Organoleptic (color, appearance, flexibility, odor, etc.), morphometric (e.g. length, width and cross-sectional area), biomechanical (Young's modulus, stiffness, maximum load, etc.) and histological (tendon and muscle fiber integrity, nuclear prominence, blur in microscopy, etc.) analyses were conducted. Organoleptic properties of Thiel and SSS fixated muscles and tendons were better preserved than F10 and MLS. No significant difference was observed in gross morphometric properties (e.g. length, width and cross sectional area) following any of the cadaver and tissue preservation techniques. MLS and F10 was observed to increase the stiffness, Young's modulus and maximum load parameters of the tendons. Thiel and SSS fixated tendons had similar mechanical properties to fresh and FT tendons. No effect of fixation solutions on tendons is observed in the histological analysis regarding fiber integrity, nuclear prominence, blur in microscopy, shrinkage of tissues. Thiel solution was observed to distort fiber integrity, nuclear prominence and blur the microscopy of muscle tissue. Thiel and SSS fixated muscles and tendons were observed to absorb more stain with Masson's trichrome staining and appear as darker red. No muscle and tendon shrinkage due to fixative solutions was observed with our fixation method. Pondering the organoleptic (color, appearance, consistency, odor, etc.) and biomechanical analyses (stiffness, Young's modulus, etc.), Thiel and SSS fixed cadavers are more suitable for purposes as surgical trainings and development of new surgical procedures. However, the change in the micro-anatomical structure of the muscles, especially with the Masson's trichrome staining, caused by these two solutions should not be overlooked.

Objective This study intended to analyze alterations in ischiofemoral space (IFS) dimensions in normal children between the ages of 1 and 18 years for the ischiofemoral impingement. Materials and methods This study retrospectively focused on computed tomography images of 360 hips of 180 (90 boys and 90 girls) pediatric subjects (mean age: 9.50 +/- 5.20 years, range: 1-18 years) without any hip disorders to measure IFS, femoral neck angle (FNA), and ischial angle (IA). Results Mean IFS, FNA, and IA were measured as 14.64 +/- 7.24 mm, 34.61 +/- 11.47 degrees, and 131.52 +/- 4.22 degrees, respectively. IFS increased in children aged between 1 and 18 years, whereas FNA and IA decreased. IFS was similar in infancy and early childhood periods but then increased up to postpubescent period. FNA decreased proportionally from birth, whereas IA decreased in an irregular pattern. Linear functions were detected as y = 3.451 + 1.178 x years for IFS, as y = 48.555 - 1.468 x years for FNA, and as y = 132.535 - 0.107 x years for IA. Conclusion Our findings indicate that IFS tends to increase in size with age during childhood but decreases with further aging. Therefore, age-specific values for IFS, FNA, and IA may be beneficial for clinicians and radiologists for the diagnosis of ischiofemoral impingement.

Introduction: A cadaveric experimental investigation aimed to show the rupture pressure of the tympanic membrane (TM) for otologists to evaluate its tensile strength. Methods: Twenty adult ears in 10 fresh frozen whole cadaveric heads (four males, six females) mean age 72.8 (SD 13.8) years (range 40–86) were studied. The tensile strength of the TM was evaluated with bursting pressure of the membrane. The dimensions of the membranes and perforations were measured with digital imaging software. Results: The mean bursting pressure of the TM was 97.71 (SD 36.20) kPa. The mean area, vertical and horizontal diameters of the TM were 57.46 (16.23) mm2, 9.54 (1.27) mm, 7.99 (1.08) mm respectively. The mean area, length and width of the perforations were 0.55 (0.25) mm2, 1.37 (0.50) mm, and 0.52 (0.22) mm, respectively. Comparisons of TM dimension, bursting pressure, and perforation size by laterality and gender showed no significant differences. The bursting pressure did not correlate (positively or negatively) with the TM or perforation sizes. Conclusions: The TM can rupture during activities such as freediving or scuba diving, potentially leading to serious problems including brain injuries. Studying such events via cadaveric studies and data from case studies is of fundamental importance. The minimum experimental bursting pressures might better be taken into consideration rather than average values as the danger threshold for prevention of TM damage (and complications thereof) by barotrauma.

Aim Chiasma tendinum (Camper’s chiasm) is of great importance in the delicate movements and stability of the fingers and takes place poorly in the literature. This study aims to reveal the morphometric details of the chiasma tendinum in relation with pulleys and other relevant structures. Materials and methods Palm and 2nd to 5th fingers of 10 (6 male, 4 female) formalin fixed cadavers were used bilaterally. After determining the superficial reference points on the fingers, the skin and the tendon sheath were incised, and then measurements of chiasma tendinum and related tendons were performed. The measurements were analyzed with respect to fingers, genders, and sides. Finally, the types of chiasma tendinum were identified and then grouped as symmetrical, asymmetrical, and pseudo chiasm. Results Pulley and chiasma tendinum positions were correlated with finger length (p Conclusion Findings related to the prediction of location of the pulleys and chiasma tendinum according to the superficial signs, awareness of cases where one of the two arms of the flexor digitorum superficialis is extremely thin and no fiber exchanges that may be risk factors for spontaneous tendon rupture may help provide more accurate approaches in relevant clinical applications.

To present the quantitative development of the geniculate ganglion (GG) in foetal cadavers.This study focused on 60 temporal bones of 30 (15 female and 15 male) foetuses aged 18?30 weeks of gestation (mean age, 22.83 ± 3.49 weeks) to measure the length, width and area of the GG.According to gestational weeks and months, the ganglion length (1.21 ± 0.41 mm), width (1.03 ± 0.28 mm) and area (1.24 ± 0.61 mmsup2/sup) did not change. In terms of sexes or sides, ganglion dimensions were not significantly different. Positive correlation was found between the length and width (p=0.033, r=0.276), between the length and area (p0.001, r=0.762) and between the width and area (p0.001, r=0.622). Linear functions were calculated for the ganglion area (y=0.355 + 0.039 × weeks), length (y=0.636 + 0.025 × weeks) and width (y=0.634 + 0.017 × weeks).The ganglion size did not change in foetal cadavers aged 18?30 weeks of gestation. This finding may be important for anatomists and embryologists in performing morphometric studies and understanding the development of the GG and for neurootologists and neurosurgeons in achieving greater success in skull base surgeries.

This study aimed to peruse anatomic features of the cranial aperture of the optic canal (CAOC) for obtaining an extended morphometric dataset in children. Computed tomography images of 200 children were included in this retrospective work to analyze the shape, location and diameters of the CAOC. The CAOC area, width and height were observed as 17.53 ± 2.80 mm2, 6.12 ± 0.84 mm, and 4.35 ± 0.64 mm, respectively. The angle of the optic canal in axial plane was found as 39.28 ± 5.13°, while in sagittal plane as 16.01 ± 6.76°. The distance between the CAOC and the midsagittal line was 7.17 ± 1.48 mm. The CAOC was measured as 54.04 ± 5.23 mm and 42.55 ± 3.28 mm away from the anterior and lateral boundary of the anterior skull base, respectively. The CAOC shape was described as the tear-drop (186 foramina, 46.5%), triangular (156 foramina, 39%), oval (47 foramina, 11.8%), and round (11 foramina, 2.8%). The depth, angle and diameter measurements belonging to the CAOC were changing according to its shape or demographic data (e.g., sex and age). Therefore, preoperative radiologic evaluation containing the shape, location and size of the CAOC should be considered by multidisciplinary operating teams in terms of surgical interventions such as implant positioning.

The work aimed to compare fetal and adult tympanic membrane (TM) sizes for understanding dimensional development from intrauterine life to adulthood. Fifty-six temporal bones (18 fetuses, 10 elderly adults, half male and half female in each group) were included in this study. Using a digital image software, the TM height, width and area were measured. The mean area, height and width of the TM in adults were found as 58.84 ± 22.01 mm2, 9.06 ± 1.33 mm, and 8.10 ± 1.43 mm, respectively. Moreover, the mean area, height and width of the TM in fetuses were measured as 47.62 ± 12.57 mm2, 8.22 ± 1.12 mm, and 7.25 ± 1.15 mm, respectively. The TM dimensions were increasing in fetuses between 20–32 weeks of gestation. However, the TM dimension was statistically similar at the 7th month, the 8th month and adult periods. The TM height was greater than its width in fetuses and adults. The calculated regression equations of the TM parameters in fetuses may be used to estimate its size. The TM size did not change from the 7th gestational month, and thus the membrane reached adult diameter in fetal life. The TM height and width showed a very wide range; therefore, we thought that the 12 mm (the height) × 10 mm (the width) graft might be ideal dimension during the repair of the TM perforations.

This study aimed to establish an extended morphometric dataset regarding the stapedius muscle for anatomists and otologists. The tympanic cavity of ten cadavers (five females, five males) aged with 75.70 ± 13.75 years was bilaterally dissected. Morphometric properties of the stapedius muscle (i.e., its muscular belly and tendon) and its relationship with the neighborhood structures including the facial nerve was evaluated. The length of the entire stapedius muscle was found as 4.80 ± 1.13 mm. The depth between the entrance of the external auditory canal and stapedius muscle was measured as 18.23 ± 2.30 mm. The incudostapedial joint and stapedial tendon were found to be 1.66 ± 0.25 mm and 1.18 ± 0.19 mm away from the facial nerve, respectively. The stapedial tendon length was standardized as five types: Type 1, extremely short tendon (under 0.5 mm), 5% of cases; Type 2, short tendon (between 0.5 and 1 mm), 30% of cases; Type 3, normal tendon (between 1 and 2 mm), 55% of cases; Type 4, long tendon (between 2 and 2.5 mm), 10% of cases; and Type 5, extremely long tendon (above 2.5 mm), no cases. Our findings showed that the stapedius tendon size in adults was quite similar to fetuses. Therefore, probably entire muscle dimension does not alter after birth. Considering the concordance between direct anatomic (our findings) and radiologic measurements (literature findings) of the stapedius muscle, preoperative radiological evaluation may be important for otologists in terms of the choice of surgical tools such as diamond burr sizes. Due to the lack of standardization regarding the evaluation of the stapedius tendon size (i.e., extremely short or extremely long), we defined the tendons below 0.5 mm as extremely short (Type 1) and above 2.5 mm as extremely long (Type 5).

Purpose To investigate the characteristics of the prechiasmatic sulcus in children aged between 1–20 years. Methods Patient files of 200 children admitted to the university hospital on 2019 were analyzed, retrospectively. The computed tomography images of patients were used to obtain anatomical knowledge containing prechiasmatic sulcus types and dimensions. Results The measurements related to the sulcal length (6.94 ± 1.25 mm) and sulcal angle (31.01 ± 18.13°) showed that the sulcal length did not alter in children between 1 and 20 years, whereas the sulcal angle did not vary from infancy to prepubescent period, but it was decreasing in postpubescent period. In 29 patients, the sulcal length was observed to divide into 2 parts with an evident angle. The interoptic distance and planum length were found as follows: 14.70 ± 2.85 mm and 14.84 ± 4.12 mm, respectively. The order of PS types was observed as type 4 (26.5%, 53 cases) > type 2 (26%, 52 cases) > type 1 (24%, 48 cases) > type 3 (23.5%, 47 cases). Conclusions The sulcal length did not vary in children, whereas the sulcal angle decreased with an irregular pattern. The sulcal angle decreased after prepubescent period, possibly due to the sphenoid sinus pneumatization and spheno-occipital synchondrosis. The sulcal length angle mostly in infants and young children may cause surgical orientation difficult during the resection of tumors using transcranial approaches.

Purpose The main objective of this study was to display the morphologic properties of the anterior clinoid process (ACP) in human fetuses in term of early childhood surgeries. Methods Twenty-four (10 females and 14 males) fetal cadavers aged from 16th to 28th weeks of gestation (at mean, 21.54 ± 3.11 weeks) were included in the present study. The dimensions of ACP were measured with a digital image analysis software. Results Taking into account the length, width, and angle of ACP, it was classified as Type 1 in 20.83% (10 cases), Type 2 in 10.42% (5 cases), Type 3 in 10.42% (5 cases), Type 4 in 2.08% (1 case), Type 5 in 8.33% (4 cases), Type 6 in 16.67% (8 cases), Type 7 in 8.33% (4 cases), and Type 8 in 22.92% (11 cases). According to the attachment site of the optic strut (OS) relative to ACP, OS was identified as the anterior 3/5 in 16.67% (8 cases), anterior 4/5 in 68.75% (33 cases), and posterior 1/5 in 14.58% (7 cases). Neither right-left nor male-female significant differences were observed between the quantitative values belonging to ACP and OS. Conclusion The percentage of the most complex and challenging type of ACP (the long, narrow, and narrow-angled ACP) in fetuses was found to be close to adults. Thus, routine adult surgical procedures such as anterior clinoidectomy might be successfully used in young children and infants. The attachment site of OS relative to ACP in adults was more anterior according to fetuses probably due to postnatal development such as the pneumatization of the sphenoid bone. In this regard, for pediatric neurosurgeons to avoid iatrogenic injuries and to select appropriate surgical approaches, further studies conducted on the attachment of OS relative to ACP in children are needed.

This study is intended to obtain the algebraic growth dynamics of the gracilis in fetuses and determine the variations of neurovascular pedicle(s) of the gracilis, to aid infant surgeries. Forty fetuses (19 males and 21 females) were included in the study. Gestational mean age of the fetuses was 22.40 ± 2.67 (range, 18-28) weeks. Numerical values were obtained using a digital caliper and a digital image analysis software. Linear functions for the surface area, width, anterior, and posterior margin lengths of the gracilis were calculated, respectively, as: y = -289.307 + 20.501 × age (weeks), y = -7.113 + 0.622 × age (weeks), y = -24.421 + 3.434 × age (weeks), and y = -24.397 + 3.314 × age (weeks). In addition, length and width of the gracilis tendon were calculated as y = -6.676 + 0.934 × age (weeks) and y = -0.732 + 0.074 × age (weeks), respectively. Parameters of the gracilis had no statistically significant difference regarding side and sex (P > 0.05). In all the specimens, the gracilis was innervated by the anterior branch of the obturator nerve. Blood supply of the gracilis was identified to be derived from 1 single artery in 38 sides of total 80 (47.5%), from 2 arteries in 36 (45%) and from 3 arteries in 6 (7.5%). In 74 sides (92.5%), the nerve was superficial to the main artery, whereas in 6 sides (7.5%), it was deeper. The data of the present study could be beneficial for surgeons in infant surgeries to treat conditions such as obstetrical brachial plexus paralysis, facial palsy, or anal incontinence. Linear functions can be utilized to better evaluate the growth course of the gracilis in fetuses and to predict the dimensions thereof. Additionally, comprehending the structure and recognizing the variations of the gracilis nerves and arteries can help to protect the neurovascular pedicle(s) of the gracilis during the operations.

Background: In neonatal and early childhood surgeries such as meningomyelocele repairs, closing deep wounds and oncological treatment, tensor fasciae lata (TFL) flaps are used. However, there are not enough data about structural properties of TFL in foetuses, which can be considered as the closest to neonates in terms of sampling. This study’s main objective is to gather data about morphological structures of TFL in human foetuses to be used in newborn surgery. Materials and methods: Fifty formalin-fixed foetuses (24 male, 26 female) with gestational age ranging from 18 to 30 weeks (mean 22.94 ± 3.23 weeks) were included in the study. TFL samples were obtained by bilateral dissection and then surface area, width and length parameters were recorded. Digital callipers were used for length and width measurements whereas surface area was calculated using digital image analysis software. Results: No statistically significant differences were found in terms of numerical value of parameters between sides and sexes (p > 0.05). Linear functions for TFL surface area, width, anterior and posterior margin lengths were calculated as y = –225.652 + 14.417 × age (weeks), y = –5.571 + 0.595 × age (weeks), y = –4.276 + 0.909 × age (weeks), and y = –4.468 + 0.779 × age (weeks), respectively. Conclusions: Linear functions for TFL surface area, width and lengths can be used in designing TFL flap dimensions in newborn surgery. In addition, using those described linear functions can also be beneficial in prediction of TFL flap dimensions in autopsy studies.

PurposeThe main objective of the study was to examine the use of teres major (TM) as a flap in the pediatric surgeries from an anatomical perspective by: (1) revealing the growth dynamics of the developing TM; (2) assessing the possible interconnecting structures between TM and latissimus dorsi (LD); (3) exposing the innervation patterns of TM in human fetuses.MethodsStudy was conducted on 50 fetuses (26 females and 24 males), on a mean gestational age of 22.863.21 (range 18-30) weeks. All the measurements were collected with a digital caliper and a digital image analysis software. Additionally, structural relations between TM and LD were examined in detail and further classified.ResultsNo significant difference of side and sex was detected on TM measurements (p>0.05). Linear functions for the surface area, width, length of the superior and inferior margins of TM were detected as follows: y=-257.142+18.334xage (weeks), y=-5.497+0.545xage (weeks), y=-1.621+1.068xage (weeks), and y=-2.147+1.284xage (weeks), respectively. As classified in five types, a number of 33 muscular or tendinous connections between TM and LD were detected. Musculo-tendinous slips from TM to triceps brachii (TB) were evident in four sides. Innervation of TM was observed to be providing by the lower subscapular nerve in all the cases.Conclusion p id=Par4 First, linear functions, representing the developing fetal morphometry obtained by our study can be adapted for estimating the morphometric of this muscle in early childhood. Besides, acknowledging the diverse appointments of TM with the surrounding muscles such as LD and TB may facilitate the prevention of neurovascular structures and the application of surgical procedures during tendon transfers. In brief, our findings are highly potent to bring the attention of pediatric surgeons.

Although latissimus dorsi (LD) flaps are extensively used in a wide range of interventions, fetus studies on this subject are quite limited. This study aims to obtain detailed information about the morphometric features of LD, thoracodorsal artery (TDA) and nerve (TDN). The study was carried out on both sides of 50 formalin-fixed human fetuses (22 male/28 female) with a mean gestational age of 24.5 ± 4.7 (range 18–36) weeks, which were in the inventory of Anatomy Department of Mersin University Faculty of Medicine. Dimensions of LD, lengths and width of TDA and TDN were measured. Surface area of LD was calculated using digital image analysis software. All samples had LD muscle. Neither gender nor side-significant differences were observed in relation with the numerical data of LD, TDN and TDA. Linear function of surface area was calculated as “y = − 1767.532 + 114.582 × Age (weeks)”. LD was attached directly to the posterior part of iliac crest in 59 of 100 sides meanwhile in the rest 41, it was attached by the thoracolumbar fascia. TDA gave a branch to serratus anterior in 96 cases and 2 branches in 4 cases. TDN passed superficial to TDA in 84 and deep to TDA in 16 samples. TDN had bifurcation in 93, trifurcation in 6 and tetrafurcation in 1 side. Data obtained from this study can be useful for estimating the sizes of LD and related neurovascular structures, especially in neonate surgeries. Linear function of LD surface area can be helpful to design the flap dimensions in newborn surgeries. A throughout knowledge about the branching pattern of TDN and its location-wise relation with TDA should be kept in mind to prevent possible complications during harvesting LD flaps and TDN grafts.

This retrospective computed tomography (CT) study was aimed to assess the growth dynamic of the external aperture of the carotid canal (EACC) in children aged between 1 and 20 years. Two hundred patients (sex 100 females/100 males, average age 10.50 ± 5.77 years) with good head CT image quality were included in this study. CT images of the patients were used to obtain data related to the location, shape and dimension of EACC. EACC shapes were identified as oval shaped, round shaped, and tear-drop shaped in 58.3% (233 sides), 24% (96 sides) and 17.8% (71 sides), respectively. EACC length, disEACC–MSP (distance between EACC and midsagittal plane), and EACC width did not change from the prepubescence period; while, the disEACC–SC (distance between EACC and supramastoid crest) seemed to reach adult size in the postpubescence period. Linear functions for EACC length and width were calculated as: y = 5.453 + 0.091 × years, and y = 5.398 + 0.059 × years, respectively. The regression equations of the measured parameters representing the growth dynamic of EACC in children can be helpful to estimate its size, location and angulation, which suggest that the dimension and distances to certain anatomical landmarks seemed to reach adult size in different developmental periods. In this context, the findings of this study may seem to emphasize the importance of preoperative radiological evaluation on skull base, related to EACC, for multidisciplinary surgeon teams during childhood surgeries in terms of patients’ positioning, and the selection of appropriate surgical approach.

Objective The main aim of this study placed on cadavers was to compare the data related to geniculate ganglion (GG) dehiscence and dimension obtained from computed tomography (CT) with dissection values. Methods This study was conducted on 20 temporal bones obtained from 10 cadavers (4 female, 6 male) aged between 45 and 92 (71.50 ± 15.98) years. All the measurements related to GG dimension were performed with a CT scanner and microdissection. Results The size of GG including its area, length, and width did not show statistically significant differences in terms of sex, side, and assessment method (CT and cadaveric dissections). The dehiscent GG was observed in 6 (30%) and 5 (25%) out of 20 temporal bones in CT and cadaveric dissections, respectively. The presence and absence of GG dehiscence in CT and dissection were similar in 75%. Conclusions Our findings based on dissection data suggest that radiologic evaluation of dehiscent GG detection might be erroneous by 25%, which highlights that surgeons should be careful when lifting the dura to prevent GG injury during middle cranial fossa surgical approaches. On the other hand, there was no statistical difference between CT and dissection measurements related to GG dimension.

PURPOSE Latissimus dorsi (LD) flaps are frequently used in the prenatal meningomyelocele (MMC) repairs; on that basis, this study aims to reveal the morphometric features of LD, thoracodorsal artery (TDA) and nerve (TDN) in fetal cadavers with MMC defects, with an anatomical perspective. METHODS The study was conducted on 7 formalin-fixed human fetal cadavers (4 males and 3 females) with MMC defects, aged from 18 to 27 weeks of gestation. The size of LD, TDA, and TDN including their area, length, and width were measured by a digital caliper and digital image analysis software. Our direct measurements were compared with the corresponding estimations of a previous study in the literature which provides regression formulae based on gestational age. RESULTS The fetal cadavers with MMC had bilateral LD. No significant differences were found in the numerical data of anatomical structures between the sides or the sexes. LD size (ie, area, length and width) was approximately 3% to 10% smaller in the fetuses with MMC defects than that of the normal fetuses. Unilateral LD flap in a 22-week-old fetus with a large MMC was evaluated as insufficient to close the defects. CONCLUSION Ten percent shrinkage in the area of LD might be too critical to be disregarded by surgeons during the closure of MMC defects. The dimensional findings about LD (area, length, and width) may be helpful in planning of LD flap harvesting for the repairs of MMC.

OBJECTIVES: This study aimed to compare the right and left sides of the carotid foramen (CF) to determine its precise location according to certain anatomical landmarks. MATERIALS AND METHODS: Twenty human dry skulls were included in the study. A digital caliper and a digital image analysis software were used to obtain direct anatomical numerical values. Then, the same parameters on dry skulls were assessed with computed tomography (CT). RESULTS: CF was found to be round shaped (62.5%), oval shaped (32.5%), and tear-drop shaped (5%). In all cases, the position of CF was seen as just postero-laterally of the foramen lacerum. According to the jugular foramen, CF was seen to be anterior in 85% and antero-medial in 15% of the cases. Regarding the morphometric values of the surface area, the length and width of CF were observed to be 37.86±11.24 mm(2), 8.02±1.09 mm, and 6.86±0.90 mm at direct anatomical measurements and 39.69±10.07 mm(2), 7.89±1.14 mm, and 6.41±0.90 mm at CT, respectively. The angles between the supramastoid crest-CF-zygoma root and the supramastoid crest-CF-mastoid process were determined as 37.11±6.87° and 42.22±6.40° at direct anatomical measurements and 36.59±4.94° and 43.71±4.55° at CT, respectively. CONCLUSION: A significant difference in sides was not observed in relation with the numerical data of CF obtained from CT or from direct anatomical measurements of dry skulls. Moreover, a significant difference was not found between radiological and direct anatomical measurements. Therefore, precise radiological assessment of this region by an experienced neuroradiologist may be assumed as a fundamental need for successful surgeries of the skull base, in addition to thorough anatomical knowledge of neurootologists and neurosurgeons.

The main aim of this retrospective computed tomography (CT) study was to examine the morphometric development of the geniculate ganglion (GG) in children aged between 1 and 18 years for surgical approaches. This study was placed on 41 patients (20 females and 21 males) including cochlear implantation cases aged from one to 18 (at mean, 6.44 ± 5.79) years. All the measurements belonging to the length, width and area of GG were performed with a CT scanner. The morphometric values of GG were not different in terms of sex or side, statistically (p > 0.05). The length (p = 0.155) of GG was not correlated with the increasing ages from one to 18 years; however, its area (p

BackgroundWe sought to describe the innervation patterns of the foot lumbrical muscles and their morphological properties in human fetuses and to define the communicating branches between the medial (MPN) and lateral (LPN) plantar nerves, which play a part in the innervation of those muscles.MethodsThirty formalin-fixed fetuses (13 male and 17 female) with a mean ± SD gestational age of 25.5 ± 3.8 weeks (range, 18–36 weeks) from the inventory of the Mersin University Faculty of Medicine Anatomy Department were bilaterally dissected. Innervation patterns of the lumbrical muscles and the communicating branches between the MPN and the LPN were detected and photographed.ResultsNo variations were seen in lumbrical muscle numbers. In the 60 feet, the first lumbrical muscle started directly from the flexor digitorum longus tendon in 48 and from the flexor hallucis longus slips in addition to the flexor digitorum longus tendon in 12. Fifty-five feet had the classic innervation pattern of the lumbrical muscles, and five had variations. No communicating branches were seen in 48 feet, whereas 12 had connections.ConclusionsThis study classified innervation patterns of the foot lumbrical muscles and defined two new innervation types. During surgeries on the foot and ankle in neonatal and early childhood terms, awareness of the communicating branches between the MPN and the LPN and innervation of the intrinsic muscles of the foot, such as the lumbrical muscles, might aid in preventing possible complications.

BackgroundComplications such as stricture, leakage, recurrent tracheoesophageal fistula and mucosal pouch are commonly seen in myotomy techniques used for long-gap esophageal atresia (LGEA) treatments. Therefore, we think that there is a clear need for other techniques which would enable us to create more robust and longer esophagus in such cases. In this study, we reviewed multiple V-myotomy (VM) technique and the differences of the said technique with Livaditis circular myotomy (LM) and Kimura spiral myotomy (KM) techniques using literature as an aid.Methods21 esophagus samples from 21 male lambs aged 12months were used in vitro for the study. All esophageal samples were matched to have a length of 120mm. Samples were divided into 3 groups of 7 and VM, LM and KM techniques were used in each group, respectively. Post-op esophagus lengths, elongation amount with each incision and perforation pressures were measured.ResultsPost-op esophageal lengths were measured as 227, 210 and 200mm for VM, LM and KM, respectively. Elongation amount per incision was measured as 5.1, 4 and 3.34mm, again in previous order of VM, LM, and KM. Finally, perforation pressure following VM, LM, and KM was measured as 460, 400, and 410mmHg.ConclusionVM was found to significantly increase total esophagus length and elongation per incision over LM and KM. In addition, VM was also shown to have a higher perforation pressure. Although in vivo live animal studies are required, we can say that VM can be used to create longer and robust esophagus.

The main objective of the study was to investigate the morphometric properties of the stapedial tendon (ST) for pediatric otosurgeons and anatomists. The present study was placed on 15 fetuses (8 females, 7 males) aged from 20 to 30 weeks of gestation (at mean, 24.27 ± 3.24 weeks) using the collection of the Anatomy Department of Medicine Faculty, Mersin University. All measurements were obtained with a digital image analysis software. In terms of male/female or right/left comparisons, no statistically significant difference was found in relation with the numerical data of ST. The surface area, length, and width of ST were detected as follows: 0.61 ± 0.15 mm2, 1.27 ± 0.30 mm, and 0.45 ± 0.08 mm, respectively. The absence of ST was observed in two fetuses with and without severe malformations. In another fetus with cleft lip and polydactyly, multiple abnormalities were bilaterally identified in the middle ear: (1) the absence of the incudostapedial joint and (2) the presence of an abnormal tissue attaching to the stapes. The abnormal tissue was determined to be irregular dense connective tissue using light microscope and electron microscope. Our findings showed that ST did not proportionally grow according to increasing gestational weeks. In the light of the numerical data, we thought that similar to stapes, ST attains the adult size in the fetal period. As ST anomalies may accompany severe malformations (e.g., cleft lip, polydactyly or syndactyly) that can be easily detected on observation by clinicians, we suggest that the detailed examination of middle ear in newborns should be taken into account for early diagnosis of conductive hearing loss to prevent any management delays.

The aim of present study was to reveal slip transfers related to flexor hallucis longus (FHL) and flexor digitorum longus (FDL) by dissection and to investigate detailed structure of chiasma plantare composed of FHL–FDL tendons and quadratus plantae (QP), with precise composition of the long flexor tendons of lesser toes by histological sections in human fetuses. Slip transfers related to FHL and FDL tendons were identified and the related morphometric measurements were taken with dissection in 28 formalin-fixed fetuses (25–40 weeks). Composition and restoration of chiasma plantare and long flexor tendons of lesser toes were traced histological by analyzing movements of the tissues on the sequential coronal sections in five fetuses in the third trimester. The numbers of layers constituting chiasma plantare and the muscles that formed layers were specified. Each of two to five flexor tendons arising from the chiasma plantare was analyzed regarding its formation and contribution of FHL slip. Slip transfers were found as FHL slip in 86% and cross-connections in 14%. The ratios of the slip width to that of FHL and FDL tendons were found higher than in adult literature. Variance in the involvement of slip to FDL and QP, formation and layering of chiasma plantare and formation of long flexor tendons from chiasma plantare were revealed and great similarities were found with data from dissection of adult in literature. Slip transfers between FHL and FDL tendons, and layering properties of chiasma plantare were largely finalized during intrauterine period, while structural changes in slip seem to continue in the later stages of life, possibly by the effects of growth and usage of the extremity. In addition to individual variations, investigating the contribution of FHL slip, FDL and QP to long flexor tendons by different methods in literature is also suggested to be responsible for some diversities of our histological study.

Objectives The main aim of the study was to examine the development and course of the facial nerve within fetal temporal bones from an anatomical and neuro-otological perspective. Methods The study was conducted on 32 temporal bones from obtained fetuses (7 females, 9 male), on a mean gestational age of 26.75 ± 4.36 (range, 20–34) weeks from the collection of the Anatomy Department of Medicine Faculty. All the measurements were collected with a digital image analysis software. Results Neither male/female nor right/left significant differences were observed in relation with the algebraic data of the segment lengths and angles of the facial nerve (p > 0.05). Linear functions for meatal, labyrinthine, tympanic, and mastoid segment lengths of the facial nerve were calculated as: y = −1.206 + 0.200 × Age (weeks), y = −1.868 + 0.153 × Age (weeks), y = −2.327 + 0.325 × Age (weeks), and y = −1.507 + 0.246 × Age (weeks), respectively. In addition, linear functions for first and second genu angles were calculated as: y = 105.475–0.117 × Age (weeks) and y = 140.446–0.042 × Age (weeks), respectively. Conclusion The regression equations and the scatter plot with increment curve, representing the growth dynamics of the facial nerve can be used for estimating its lengths and for understanding its development. The data suggest that there is a dramatic change transition from fetal life to the gathered data of adulthood in the length of meatal and mastoid segments as well as in the second genu angle; in addition, there is a partial change in the length of labyrinthine and tympanic segments as well as in the first genu angle.

The CHARGE syndrome characterized by coloboma, heart defects, atresia of the choanae, retarded growth, genitourinary hypoplasia, and ear anomalies is one of the rare syndromes. Although certain clinical issues (scapular winging, sloping shoulder, Sprengel's deformity, kyphosis and scoliosis) which could be related to abnormalities in musculoskeletal structures of the neck and shoulder have been identified in CHARGE syndrome, data on details of muscle anomalies seem to be quite limited in the literature. In this case report, bilateral multiple muscular abnormalities (agenesis of the trapezius, presence of the rhombo-atloid muscle, and presence of the bipartite rhomboid minor with superficial and deep parts) was presented in a fetus cadaver with atypical CHARGE syndrome to attract the attention of clinicians for definitive diagnoses and surgical reconstruction of the shoulders deformity such as scapular winging and Sprengel's deformity. By considering the previous studies, we propose that the absence of the trapezius, as well as the other muscle abnormalities around the neck and shoulder, should be revised as being a component of CHARGE syndrome.

Background:We sought to show the biomechanical and morphometric properties of flexor hallucis longus (FHL) and flexor digitorum longus (FDL) tendon grafts harvested by specific surgical approaches and to assess the contribution of FHL slips to the long flexor tendons of the toes.Methods:Thirteen fresh-frozen amputated feet (average age, 79 years) were dissected. The connections between the FHL and FDL tendons and the contribution of FHL slips to the long flexor tendons were classified. The biomechanical properties of the tendons and slips were measured using a tensile device.Results:The connections between the FHL and FDL tendons were reviewed in two groups. Group 1 had FHL slips (11 cases) and group 2 had cross-slips (two cases). The FHL slips joined the second and third toe long flexor tendon structures. Tendon length decreased significantly from the second to the fifth toe (P < .001). Apart from the second toe tendon being thicker than that of the fourth toe (P = .02) and Young's modulus being relatively smaller in the third versus the fourth toe tendon (P = .01), biomechanical and morphometric properties of second to fourth tendons were similar. Mechanical properties of those tendons were significantly different from fifth toe tendons and FHL slips. Morphometric and biomechanical properties of FHL slips were similar to those of the fifth toe tendon.Conclusions:Herein, FHL slips were shown to have biomechanical properties that might contribute to flexor functions of the toes. During the harvesting of tendon grafts from the FHL by minimally invasive incision techniques from the distal plane of the master knot of Henry, cutting slips between FHL and FDL tendons could be considered a cause of postoperative function loss in toes.

The relationship of facial nerve (FN) and its branches with the retromandibular vein (RMV) has been described in adults, whereas there is no data in the literature regarding this relationship in fetuses. The study was conducted to evaluate the anatomic relationships of these structures on 61 hemi-faces of fetuses with a mean age of 26.5 ± 4.9 weeks with no visible facial abnormalities. The FN trunk was identified at its emergence at the stylomastoid foramen. It was traced till its ramification within the parotid gland. In 46 sides, FN trunk ramified before crossing RMV and ran lateral to it, while in 8 sides FN trunk ramified on the lateral aspect of the RMV. In 3 sides, FN trunk ramified after crossing the RMV at its medial aspect. In only 1 side, FN trunk trifurcated as superior, middle, and inferior divisions and RMV lied anterior to FN trunk, lateral to superior division, medial to middle and inferior divisions. In 2 sides, FN trunk bifurcated as superior and inferior divisions. Retromandibular vein was located anterior to FN trunk, medial to superior division, lateral to inferior division in both of them. In 1 side, RMV ran medial to almost all branches, except the cervical branch of FN. Variability in the relationship of FN and RMV in fetuses as presented in this study is thought to be crucial in surgical procedures particularly in early childhood.