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Objective To explore the clinical efficacy of pararectus approach combined with 3D printing technique for the surgical treatment of partial acetabular fractures. Methods We retrospectively evaluated 33 (20 males and 13 females) patients with acetabular fractures in the period of June 2017 to December 2018. According to Judet and Letournel classification: 11 cases were of anterior column fracture, 10 cases were of double column fracture, seven fractures were of the anterior column with posterior half transverse, three fractures were of transverse fracture, and two cases were of "T" fracture. For all cases, 3D printing is used to print the acetabular model. Pre-bent reconstruction plates from the model were placed to fixate fractures via the pararectus approach. Results Thirty-three patients (mean age 48 years; range, 35-63 years), included 20 men and 13 women, were treated successfully with open reduction and internal fixation by the pararectus approach. Surgery duration was 203 min on average (range: 135-245 min), and intra-operative bleeding was 1030 mL on average (range: 450-1400 mL). All patients were followed-up for 12-18 months (average,14 months); two patients (6.0%) developed postoperative ossifying myositis, and there are no obvious symptoms at present; one patient (3.0%) developed postoperative wound infection, and the wound completely improved by secretion culture, enhanced dressing, and effective antibiotics; all the acetabular fractures united after 12 to 16 weeks (average,13 weeks). According to the modified Merle d'Aubigne and Postel scoring system to assess the hip function: excellent in 22 cases (66.7%), good in seven cases (21.2%), and fair in four cases (12.1%). Conclusions In the treatment of partial acetabular fractures, the pararectus approach combined with 3D printing technique can achieve effective reduction and fixation, decrease intraoperative hemorrhage, shorten operation time, and the internal fixation position can be properly adjusted during the operation by looking directly at the model.

A new, three-dimensional geometric morphometric approach was assessed to study the effect of developmental temperature on fish heart shape utilizing geometric morphometrics of three-dimensional landmarks captured on digitally reconstructed zebrafish hearts. This study reports the first three-dimensional analysis of the fish heart and demonstrates significant shape modifications occurring after three developmental temperature treatments (TD = 24, 28 or 32°C) at two distinct developmental stages (juvenile and adult fish). Elevation of TD induced ventricle roundness in juveniles, males and females. Furthermore, significant differences that have not been described so far in heart morphometric indices (i.e., ventricle sphericity, bulbus arteriosus elongation and relative location, heart asymmetry) were identified. Sex proved to be a significant regulating factor of heart shape plasticity in response to TD. This methodology offers unique benefits by providing a more precise representation of heart shape changes in response to developmental temperature that are otherwise not discernable with the previously described two-dimensional methods. Our work provides the first evidence of three-dimensional shape alterations of the zebrafish heart adding to the emerging rationale of temperature-driven plastic responses of global warming and seasonal temperature disturbances in wild fish populations and in other ectothermic vertebrates as well (amphibians and reptiles).

Introduction Morton's neuroma is an entrapment neuropathy of the third common plantar digital nerve, caused by the deep transverse metatarsal ligament (DTML). Minimally invasive or percutaneous surgery is a very common procedure, but surgical effectivity of this technique remains controversial. The goal of our study was to prove the effectiveness and safety of a new ultrasound‐guided technique for DTML‐release in a cadaver model. Materials, Methods, and Results The DTML was visualized in 10 fresh frozen donated body to science‐feet (eight male and two females, five left and five right) using an US device (GE Logic R7; 13 MHz linear probe, Madrid, Spain). Consecutively, minimally invasive ultrasound‐guided surgery was performed. Exclusion criteria of the donated bodies to science were previous history of forefoot surgery and space occupying mass lesions. The complete release of the ligament was achieved in all specimens without damage of any important anatomical structures as proven by anatomical dissection. Conclusions The results of this study indicate that our novel approach of an ultrasound‐guided release of the DTML is safer and more effective compared to blind techniques. The DTML could reliably be visualized and securely cut through a dorsal, minimally invasive surgical incision of only 2 mm.

Background Despite the integral role of cephalometric analysis in orthodontics, there have been limitations regarding the reliability, accuracy, etc. of cephalometric landmarks tracing. Attempts on developing automatic plotting systems have continuously been made but they are insufficient for clinical applications due to low reliability of specific landmarks. In this study, we aimed to develop a novel framework for locating cephalometric landmarks with confidence regions using Bayesian Convolutional Neural Networks (BCNN). Methods We have trained our model with the dataset from the ISBI 2015 grand challenge in dental X-ray image analysis. The overall algorithm consisted of a region of interest (ROI) extraction of landmarks and landmarks estimation considering uncertainty. Prediction data produced from the Bayesian model has been dealt with post-processing methods with respect to pixel probabilities and uncertainties. Results Our framework showed a mean landmark error (LE) of 1.53 ± 1.74 mm and achieved a successful detection rate (SDR) of 82.11, 92.28 and 95.95%, respectively, in the 2, 3, and 4 mm range. Especially, the most erroneous point in preceding studies, Gonion, reduced nearly halves of its error compared to the others. Additionally, our results demonstrated significantly higher performance in identifying anatomical abnormalities. By providing confidence regions (95%) that consider uncertainty, our framework can provide clinical convenience and contribute to making better decisions. Conclusion Our framework provides cephalometric landmarks and their confidence regions, which could be used as a computer-aided diagnosis tool and education.

Effective epidural needle placement and injection involves accurate identification of the midline of the spine. Ultrasound, as a safe pre-procedural imaging modality, is suitable for epidural guidance because it offers adequate visibility of the vertebral anatomy. However, image interpretation remains a key challenge, especially for novices. A deep neural network is proposed to automatically classify the transverse ultrasound images of the vertebrae and identify the midline. To distinguish midline images from off-center frames, the proposed network detects the left-right symmetric anatomic landmarks. To assess the feasibility of the proposed method for midline detection, a data set of ultrasound images was collected from 20 volunteers, whose body mass indices were less than 30. The data were split into two segments, for training and test. The performance of the proposed method was further evaluated using fourfold cross validation. Moreover, it was compared against a state-of-the-art deep neural network. Compared with the gold standard provided by an expert sonographer, the proposed trained network correctly classified 88% of the transverse planes from unseen test patients. This capability supports the first step of guiding the placement of an epidural needle.

The brachial plexus is an intricate anatomic structure with an important function: providing innervation to the upper extremity, shoulder, and upper chest. Owing to its complex form and longitudinal course, the brachial plexus can be challenging to conceptualize in three dimensions, which complicates evaluations in standard orthogonal imaging planes. The components of the brachial plexus can be determined by using key anatomic landmarks. Applying this anatomic knowledge, a radiologist should then be able to identify pathologic appearances of the brachial plexus by using imaging modalities such as MRI, CT, and US. Brachial plexopathies can be divided into two broad categories that are based on disease origin: traumatic and nontraumatic. In the traumatic plexopathy group, there are distinct imaging findings and management methods for pre- versus postganglionic injuries. For nontraumatic plexopathies, having access to an accurate patient history is often crucial. Knowledge of the timing of radiation therapy is critical to diagnosing post-radiation therapy brachial plexopathy. In acute brachial neuritis, antecedent stressors occur within a specific time frame. Primary and secondary tumors of the brachial plexus are not uncommon, with the most common primary tumors being peripheral nerve sheath tumors. Direct extension and metastasis from primary malignancies such as breast and lung cancer can occur. Although diagnosing a brachial plexus anomaly is potentially perplexing, it can be straightforward if it is based on foundational knowledge of anatomy, imaging findings, and pathologic features. ©RSNA, 2020.

The myopectineal orifice (MPO) is a weak area at lower part of the anterior abdominal wall that directly determines the mesh size required in inguinal hernia repair. However, MPO data have mainly been acquired from measurements of cadavers or anesthetized patients. Furthermore, there are very few reports on the measurement of the MPO in Chinese patients. The present study aimed to use three-dimensional visualization technology to measure the MPO in live non-anesthetized Chinese patients, and to use this information to indicate the appropriate mesh size required for inguinal hernia repair. In this study, we used the parameters of the MPO and the pelvis that were measured in 40 patients with peripheral arterial disease of the lower limb arteries (80 inguinal regions) using Medraw software (Image Medraw Technology Co., Ltd., China). The result showed that the average width and height of the MPO were 5.71 ± 0.99 cm and 4.96 ± 0.69 cm, respectively (5.22 ± 0.77 cm and 5.13 ± 0.63 cm in males, and 6.20 ± 0.95 cm and 4.80 ± 0.71 cm in females). The average projected area of the MPO was 16.06 ± 4.37 cm2 on the left, and 15.61 ± 4.10 cm2 on the right (P > 0.05). Three-dimensional visualization was used to measure the area, width, and height of the MPO in living non-anesthetized Chinese patients. MPO area was correlated with age, but not with pelvic parameters.

Objectives A series of constant anatomical structures were used as guide targets for screw placement to improve the accuracy of cortical screw placement and reduce surgical injury and fluoroscopy radiation. The most commonly used angles and distances between the cortical bone screw insertion point and the lateral margins of the isthmus were selected as the contents of the questionnaire. Methods A total of 40 physicians were selected to determine the specific values for each angle and distance. Screw placements were performed on four dry and six wet lumbar spine specimens according to the proposed anatomical target guidance technique. A total of 100 cortical bone trajectories were evaluated using X‐ray and CT scanning of the specimens to verify the practicability, accuracy, and safety of the anatomical target guidance technique in screw placement. Results The average deviation rates for angle and distance determination were 105.5% and 14.33%, respectively, indicating a significant difference between the estimated and actual values from other angles (P, Due to the inaccuracy of the traditional methods in determining the angle of screw insertion, a series of spinal intrinsic anatomical landmarks visually observed were set up as orientation targets to guide cortical bone trajectory (CBT) insertion process through the relationship between the insertion point and landmarks. X‐ray and CT scan results demonstrated that the use of constant anatomical structures as guide targets could assist the placement of CBT and reduce surgical injury and fluoroscopy radiation.

Purpose to examine the accuracy and reproducibility of the femoral axial offset measured from the retrocondylar plane by computed tomography (CT). Bone specimens of the femur of 15 males and 15 females were analyzed. CT imaging was performed and data of the coordinates were collected (center of femoral head, center of an ellipse around greater trochanter, center of an ellipse around the base of femoral neck, posterior edge of great trochanter, and both posterior condyles). The angle between the line connecting center of the femoral head and center of an ellipse around greater trochanter and the line connecting both posterior condyles was set as anteversion 1. The angle between the line connecting the center of femoral head and center of an ellipse around base of the femoral neck and the line connecting both posterior condyles was set as anteversion 2. The femoral axial offset was measured from the retrocondylar plane. Measurements were performed three times on the same subject, and intrarater reliability (ICC) was determined. In addition, interrater reliability (ICC) was determined by comparing data from three raters. The mean value for anteversion 1 was 20.1° for males and 22.7° for females. The values for anteversion 2 were 16.0° and 19.9° for males and females, respectively. Offset was 34.0 and 33.4 mm in males and females, respectively. Intrarater ICC and interrater ICC exceeded 0.81 for both methods, suggesting that the method of measurement was reliable. Accuracy and reproducibility of the measurement of femoral axial offset from the retrocondylar plane were high., Journal of orthopaedic research, 39(7), pp. 1383-1389; 2020

Extraforaminal vertebral anomalies involve entry at cervical transverse foramina other than at C6 and can appear with other anatomic variations along the V2 segment. Such unexpected vessel courses can have implications on surgical planning. We sought to evaluate the incidence of anomalous V2 segment entries, as well as their associations with vessel dominance, medialization, and C7 pedicle width.We conducted a retrospective study on 1000 consecutive computed tomography angiograms, documenting level and laterality of vessel of entry, as well as vertebral dominance patterns. Patients with rostral C4 anomalies were assessed for medialization. The pedicle widths ipsilateral to caudal C7 anomalies were compared with those of contralateral and matched controls.A total of 157 patients were identified with extraforaminal entries, with 25 having bilateral findings. The most common alternative entry was at C5 (70.3%), followed by C4 (17.6%) and C7 (11.5%). Among patients with unilateral anomalies, there was an increased representation of contralateral vertebral dominance, relative to ipsilateral dominance (79.6% vs 20.4%, P0.0001). Among anomalous C4 entries, vertebral medialization was seen along the right (35%) and left sides (23.1%) spanning C6-T1. Among C7 anomalous entries there was no statistical difference in pedicle width.Extraforaminal anomalies may be more frequent than previously reported and are important considerations during subaxial cervical spine surgery planning. Particular attention should be paid to the contralateral dominance pattern within this subgroup. In patients with anomalous V2 segment entries, adherence to the standard, anatomic landmarks remains desirable.

The facial analysis permits many investigations, some of the most important of which are craniofacial identification, facial recognition, and age and sex estimation. In forensics, photo-anthropometry describes the study of facial growth and allows the identification of patterns in facial skull development, for example, by using a group of cephalometric landmarks to estimate anthropological information. Previous works presented, as indirect applications, the use of photo-anthropometric measurements to estimate anthropological information such as age and sex. In several areas, automation of manual procedures has achieved advantages over and similar measurement confidence as a forensic expert. This manuscript presents an approach using photo-anthropometric indexes, generated from frontal faces cephalometric landmarks of the Brazilian population, to create an artificial neural network classifier that allows the estimation of anthropological information, in this specific case age and sex. This work is focused on four tasks: (i) sex estimation on ages from 5 to 22 years old, evaluating the interference of age on sex estimation; (ii) age estimation from photo-anthropometric indexes for four age intervals (1 year, 2 years, 4 years, and 5 years); (iii) age group estimation for thresholds of over 14 and over 18 years old; and; (iv) the provision of a new data set, available for academic purposes only, with a large and complete set of facial photo-anthropometric points marked and checked by forensic experts, measured from over 18,000 faces of individuals from Brazil over the last 4 years. The proposed binary classifier obtained significant results, using this new data set, for the sex estimation of individuals over 14 years old, achieving accuracy values higher than 0.85 by the F1 measure. For age estimation, the accuracy results are 0.72 for the F1 measure with an age interval of 5 years. For the age group estimation, the F1 measures of accuracy are higher than 0.93 and 0.83 for thresholds of 14 and 18 years, respectively.

Background The prevalence of a bovine aortic arch configuration is higher in patients treated for thoracic aortic aneurysms and type B dissection; its prevalence in aortic isthmic trauma has not been described. Methods A case control study was performed comparing consecutive patients treated at our institution for acute isthmic aortic transection after blunt trauma between 2002 and 2019 and a control group of consecutive sex-matched individuals undergoing imaging for nonaortic disease. Imaging and clinical findings were reviewed. Subjects were divided into bovine and nonbovine groups and prevalence was compared. The length of the aortic segment between the left subclavian artery (LSA) and the next proximal great vessel was measured in the control population and a comparison was performed between bovine and nonbovine aortic arch subjects. Results Thirty-three consecutive (30 male) patients were reviewed, 66 individuals (60 male) were included in the control group. A higher incidence of bovine arch in trauma patients was found: 57.6% vs. 34.8% (P = 0.007). The median (range, mm) and mean (SD) distance between the bovine trunk and the LSA were 13 mm (2–27) and 12.4 mm (5.9), respectively, compared with 5 mm (1–27) and 7.8 mm (6.1) between the left common carotid and LSA in nonbovine aortic arches (P Conclusion A higher incidence of bovine arch in patients reaching out for surgical treatment for traumatic isthmic aortic transection was found in our population. Clinical interpretation of this finding can lead to several alternatives. Confirmation with larger series and data on prevalence of this anatomic variation in nonsurvivors is needed to provide a better understanding of this finding.

Facial weakness is a symptom commonly associated to lack of facial muscle control due to neurological injury. Several diseases are associated with facial weakness such as stroke and Bell's palsy. The use of digital imaging through mobile phones, tablets, personal computers and other devices could provide timely opportunity for detection, which if accurate enough can improve treatment by enabling faster patient triage and recovery progress monitoring. Most of the existing facial weakness detection approaches from static images are based on facial landmarks from which geometric features can be calculated. Landmark-based methods, however, can suffer from inaccuracies in face landmarks localization. In this study, We also experimentally evaluate the performance of several feature extraction methods for measuring facial weakness, including the landmark-based features, as well as intensity-based features on a neurologist-certified dataset that comprises 186 images of normal, 125 images of left facial weakness, and 126 images of right facial weakness. We demonstrate that, for the application of facial weakness detection from single (static) images, approaches that incorporate the Histogram of Oriented Gradients (HoG) features tend to be more accurate.

Background Recently, left bundle branch area pacing (LBBAP) has been shown to be feasible. However, the right ventricular (RV) implantation site for LBBAP remains elusive. We believe that the RV implantation site should be located at the posteromedial basal septum, and in this paper, we propose a new method to help guide lead implantation. The aim of this study is to demonstrate the feasibility of the proposed method. Methods The RV implantation site was positioned by a combination of a nine-grid system on fluoroscopy and the use of intracardiac echocardiogram (ICE) and then verified by ICE. Results Fifteen patients were enrolled for LBBAP using our method. The acute success rate was 86.7% (13/15), which demonstrated that our method is useful for assisting with lead implantation. According to ICE, the distance between the implantation site and apex (the front) and the distance between the implantation site and tricuspid annulus (the back) were 44.9 ± 10.7 and 33.2 ± 10.4 mm, respectively, and the ratio of the front and the back was 1.57 ± 0.80. The distance between the implantation site and the front junction point of the left-right ventricle (the upper) and the distance between the implantation site and the back junction point (the lower) were 33.4 ± 10.6 and 24.5 ± 10.2 mm, respectively. The ratio of the upper to the lower was 1.76 ± 1.36. These results suggest that the implantation site was at the posteromedial basal septum. The width of the QRS duration increased from 110.4 ± 33.1 ms at baseline to 114.1 ± 16.1 ms post LBBAP (P > 0.05). The operation time was 133 ± 32.9 min. The time of X-ray fluoroscopy was 21.2 ± 5.9 min. The mean time for lead positioning during LBBAP was 33.8 ± 16.6 min. During a follow-up of 3 months, the LBB capture threshold remained stable in 12 patients, except for one patient who had an increase in the LBB capture threshold to 3.0 v/0.4 ms. Conclusions Our preliminary results indicate that the posteromedial basal septum could be seen as the implantation site for LBBAP. As a technique for LBBAP, ICE is a useful method for assisting with lead implantation. It is feasible and safe to use a nine-grid system combined with ICE for LBBAP.

Background The diversity in definitions for the rectosigmoid junction is becoming a major obstacle in standardizing optimal treatment of rectal cancers. The study aimed to determine the average distance of the sigmoid take-off from the anal verge and its association with individual factors. Materials and methods Patients diagnosed with rectal and sigmoid colon cancer in our centre from January 2010 to December 2018 were retrospectively enrolled in the cancer group. The results of 200 controls without colorectal disease were also reviewed (normal group). The distance of different landmarks and margins of cancer from the anal verge were retrieved from computed tomography (CT), magnetic resonance imaging (MRI), and endoscopy findings. Results The cancer group comprised 635 patients (381 men, median age: 64 years). The average distances of the sigmoid take-off from the anal verge measured in CT and MRI were comparable (P = 0.483). On MRI, the average distance of the sigmoid take-off from the anal verge in the cancer group was comparable with that of the normal group (P = 0.070). Multivariate regression revealed that the distance of the sigmoid take-off from the anal verge was associated with the distances of the sacral promontory (P Conclusion The cancer distributions of patients varied widely with the application of different definitions. The point of sigmoid take-off is an intuitive landmark influenced by individual factors. The measurement of the sigmoid take-off by different researchers in both CT and MRI revealed good consistency. Further studies regarding the clinical significance of this definition are still needed.

The conventional hand tendon zones and subzones do not reflect the actual lengths covered by the involved locus of the tendon during full digital and wrist motion, which warrant reappraisal of the tendon zone concept. Because of the tendon excursions many lacerations should be regarded as multiple zone injuries. Furthermore, the length-spans of glide of the distal tendon stump and of the tendon junction (i.e. the glide zones of tendon injury and repair, respectively) are mostly not of the same length because, due to pulley release and bulkiness of the tenorrhaphy, the glide zone of tendon repair is shorter than that of tendon injury. Therefore, it would be practical to notate the glide zones of the lacerated tendon by indicating the anatomic position of the distal tendon stump and tendon junction in full extension and flexion. This data can be provided separately or along with the conventional tendon zones, e.g. II (A4–C2) or II–III (A2–PA), where A, C, and PA stand for the annular, cruciform, and palmar aponeurosis pulleys, respectively. The conventional tendon zone classification could be improved with a tendon glide zone concept. Documentation of the actual excursions of the distal tendon stump and of the tenorrhaphy interface would prevent misinterpretation of the actual level of tendon injury and repair.

Introduction The nasolabial fold (NLF) causes particular concern during aging in the middle face region. However, arterial complications of filler injections at this site have been continually reported during recent years. The aim of this study was to investigate the arterial locations and their anastomotic pathways related to filler injection sites in the NLF. Materials and methods Thirty hemi-faces of 15 embalmed Thai cadavers were dissected. Three anatomical landmarks of NLFs were assigned: the inferior margin level (NLF1), the mid-philtral horizontal line level (NLF2), and the inferior alar level (NLF3). Ten hemi-faces of five soft embalmed Thai cadavers underwent a modified Sihler's staining procedure to investigate the arterial anastomoses. Results The artery closest to all of the landmarks was the facial artery. It was located inferomedial to NLF1 in 28%, and the mean distances along the X- and Y-axes were 3.53 ± 2.11 mm and 3.53 ± 1.75 mm, respectively. It was also located medial to NLF2 in 52.1% with an X-axis distance of 4.93 ± 1.53 mm. Several arteries were located close to NLF3, including the facial (33.3%), lateral nasal (33.3%), and infraorbital (30.0%) arteries. Anastomoses of the nasolabial arteries served to connect both the external-external and internal-external carotid systems. Conclusions Several arteries are located close to NLF1-NLF3. To prevent arterial injury, the locations and anastomotic pathways, as possible sources of severe complications, should be recognized prior to NLF filler injection.

A standard lumbar puncture may be impossible for many anatomic or technical reasons. Previous accounts of caudal epidural anesthesia and other procedures via the sacral hiatus prompted us to test if image-guided percutaneous trans-sacral hiatus access to the lumbosacral subarachnoid cistern would be anatomically feasible. To study vertebral canal morphometry and curvature, we analyzed midsagittal computed tomography-myelogram images of 40 normal subjects and digitally measured sacral curvatures between S1 to S5 and S2 to S4 using two methods whereby a lower angle signifies a straighter sacrum. We measured midsagittal vertebral canal area, hiatus width, dural sac termination levels, and distance from sacral hiatus to the dural sac tip (needle distance). Subjects were F:M = 25:15, with a mean age of 44.9 years. The two S1-S5 full sacral curvature mean angles were 57.3° and 60.4°. Almost all sacral hiatuses were at S4, and dural sac terminations were at S1-S2. The mean S2-S4 sacral curvature was 25.1°, and the mean needle distance was 57.7 mm. Using two-way analysis of variance, there were significant sex differences for needle distances (p = .001), and full and limited sacral curvatures (p = .02, and p = .046, respectively). There were no significant linear regression correlations between age and sacral curvature, needle distance, canal area, or hiatus width. Therefore, despite a frequently prominent full sacral curvature, the combination of S1-S2 dural sac termination plus a relatively straight trajectory of the lower vertebral canal between S2 and S4 support the theoretical feasibility of percutaneous trans-sacral hiatus and vertebral canal access to the lumbosacral cistern using a standard spinal needle.

The first metatarsophalangeal joint (MTPJ) is vital to the biomechanics of the foot and supports a weight up to eight times heavier than the body during athletic activities. The first MTPJ comprises osseous and cartilaginous surfaces along with a complex of supporting structures, including the dorsal extensor tendons, collateral ligaments, and a plantar plate complex. In contradistinction to the lesser MTPJ plantar plates, a single dominant fibrocartilaginous capsular thickening does not exist at the first MTPJ. Instead, the plantar plate complex comprises a fibrocartilaginous pad that invests the hallux sesamoids and is inseparable from the plantar capsule, the intersesamoid ligament, paired metatarsosesamoid and sesamoid phalangeal ligaments (SPLs), and the musculotendinous structures. Acute injury at the first MTPJ is typically secondary to forced hyperextension—turf toe—and can involve multiple structures. During hyperextension, the resulting forces primarily load the distal SPLs, making these structures more susceptible to injury. SPL injuries are best seen in the sagittal plane at MRI. Radiography can also aid in diagnosis of full-thickness SPL tears, demonstrating reduced sesamoid excursion at lateral dorsiflexed (stress) views. Hallux valgus is another common condition, resulting in progressive disabling deformity at the first MTPJ. Without appropriate treatment, first MTPJ injuries may progress to degenerative hallux rigidus. The authors detail the anatomy of the first MTPJ in cadaveric forefeet by using high-resolution 3-T and 11.7-T MRI and anatomic-pathologic correlation. Injuries to the plantar plate complex, collateral ligaments, and extensor mechanism are discussed using clinical case examples. Online supplemental material is available for this article. (©)RSNA, 2020

The aim of this work was to determine reliable anatomical landmarks for locating and preserving the abducens nerves (6th cranial nerves) during trans-facial or trans-nasal endoscopic approaches of skull base tumors involving the clivus and the petrous apex. In order to describe this specific anatomy, we carefully dissected 10 cadaveric heads under optic magnification. Several measurements were taken between the two petro-sphénoidal foramina, from the bottom of the sella and the dorsum sellae. The close relationship between the nerves and the internal carotid artery were taken into account. We defined a trapezoid area that allowed drilling the clivus safely, preserving the 6th cranial nerve while being attentive to the internal carotid artery. The caudal part of this trapezium is, on average, 20 mm long at mi-distance between the two petro-sphenoidal foramina. The cranial part is at the sella level, a line between both paraclival internal carotid arteries. Oblique lateral edges between the cranial and caudal parts completed the trapezium.

Ultrasound guidance in the operative treatment of carpal tunnel syndrome is gaining in popularity as it noninvasively provides the surgeon with a real-time high-resolution overview of anatomic structures. A new incision-less approach to achieve a division of the transverse carpal ligament has been developed that combines ultrasound guidance with cannulated needles and a thread. Conceptually, an abrasive thread is looped percutaneously around the ligament while avoiding injury to neurovascular structures, the palmar aponeurosis, and skin. The thread is positioned using 2 puncture sites and a contoured Tuohy needle under ultrasound visualization. With a minimal injury to surrounding structures, this approach is designed to minimize recovery time and decrease pillar pain. This article will provide a step-by-step overview of the technique and includes a review of clinical outcomes published so far.

The location of the radial nerve (RN) is described with various bony landmarks, but such may be disturbed in the setting of fracture and dislocation of bone. Alternative soft tissue landmarks would be helpful to locate the nerve in such setting. To recognize certain anatomic landmarks to identify, locate and protect RN from any iatrogenic injury during surgical intervention such as open reduction and internal fixation. Forty arms belonging to 20 adult cadavers were used for this study. We measured the distance of RN from the point of confluence of triceps aponeurosis (TA), tip of the acromion and tip of the lateral epicondyle along the long axis of the humerus. These distances were correlated with the upper arm length (UAL). The average UAL was 32.64±0.64 cm. The distance of the RN from the point of confluence of TA (tricepso-radial distance, TRD), tip of acromion (acromion-radial distance) and tip of lateral epicondyle of humerus (condylo-radial distance, CRD) was 3.59±0.16 cm, 14.27±0.59 cm, and 17.14±1.29 cm respectively. No correlation was found with UAL. Statistically, TRD showed the least variability and CRD showed maximum variability. The minimum TRD was found to be 3.00 cm. So this should be considered as the maximum permissible length of the triceps split. The point of confluence of the TA appears to be the most stable and reliable anatomic landmark for localization of the RN during the posterior approach to the humerus.

Objectives Obstetric demands have long been considered in the evolution of the pelvis, yet consideration of the interaction of pregnancy, the pelvis, and the gastrointestinal tract (gut) is lacking. Here, we explore sex differences in the relationship of gut volume with body size and pelvic dimensions. Materials and methods Computed tomography (CT) scans of living adult Homo sapiens (46 females and 42 males) were obtained to measure in vivo gut volume (GV) and to extract 3D models of the pelvis. We collected 19 3D landmarks from each pelvis model to acquire pelvic measurements. We used ordinary least squares regression to explore relationships between GV and body weight, stature, and linear pelvic dimensions. Results The gut-pelvis relationship differs between males and females. Females do not exhibit significant statistical correlations between GV and any variable tested. GV correlates with body size and pelvic outlet size in males. GV scales with negative allometry relative to body weight, stature, maximum bi-iliac breadth, inferior transverse outlet breadth, and bispinous distance in males. Discussion The lack of association between GV and body size in females may be due to limits imposed by the anticipation of accommodating a gravid uterus and/or the increased plasticity of the pelvis. The pattern of relationship between GV and the pelvic outlet suggests the role of the bony pelvis in supporting the adominal viscera in females may be small relative to its role in childbirth. We conclude that gut size inference in fossil hominins from skeletal proxies is limited and confounded by sexual dimorphism.

Alignment of cranial CT scans (cCTs) to a common reference plane simplifies anatomical-landmark-based orientation and eases follow-up assessment of intracranial findings. We developed and open sourced a fully automated system, which aligns cCTs to the Anterior Commissure/Posterior Commissure (ACPC) line and exports the results to the PACS. FMRIB's Linear Image Registration Tool (FLIRT) with an ACPC-aligned atlas is used in the alignment step. Five mm mean slabs are generated with the top non-air slice as the starting point. For evaluation, 301 trauma cCTs from the CQ500 dataset were processed. In visual comparison with the respective ACPC-aligned atlas, all were successfully aligned. Image quality (IQ) and ease of identification of the central sulcus (CS) were rated on a Likert scale (5 = excellent IQ/immediate CS identification). The median IQ was 4 (range: 2-4) in the original series and 5 (range: 4-5) in the ACPC-aligned series (p 0.0001). The CS was more easily identified after fatbACPC (original scans: 4 (range: 2-5); ACPC-aligned: 5 (range: 4-5); p 0.0001). The mean rotation to achieve alignment was |X| = 6.4 ± 5.2° ([-X,+X] = -26.8°-24.2°), |Y| = 2.1 ± 1.7° ([-Y,+Y] = -8.7°-9.8°), and |Z| = 3.1 ± 2.4° ([-Z,+Z] = -14.3°-12.5°). The developed system can robustly and automatically align cCTs to the ACPC line. Degrees of deviation from the ideal alignment could be used for quality assurance. KEY POINTS:: · fatbACPC automatically aligns cranial CT scans to the Anterior Commissure/Posterior Commissure plane.. · ACPC-aligned images simplify anatomical-landmark-based orientation.. · fatbACPC does not impact image quality.. · fatbACPC is robust, fully PACS-integrated, and Open Source: https://github.com/BrainImAccs. CITATION FORMAT: · Rubbert C, Turowski B, Caspers J. Automatic Alignment of Cranial CT Examinations to the Anterior Commissure/Posterior Commissure (ACPC) Reference Plane for Reliable Interpretation and Quality Assurance. Fortschr Röntgenstr 2021; 193: 61 - 67.Die Ausrichtung kranialer CTs (cCTs) an einer etablierten Referenzebene unterstützt die Orientierung anhand anatomischer Landmarken und vereinfacht die Verlaufsbeurteilung von Pathologien. Wir haben ein vollautomatisches System als Open Source entwickelt, welches cCTs an der Commissura anterior/Commissura posterior (ACPC) ausrichtet und in das PACS exportiert. Im Ausrichtungsschritt wird das FMRIB Linear Image Registration Tool (FLIRT) mit einem ACPC-orientierten Atlas genutzt. 5mm-Mittelwert-Scheiben mit der obersten soliden Schicht als Ausgangspunkt werden generiert. Zur Evaluation wurden 301 Trauma-cCTs des CQ500-Datensatzes genutzt. Im visuellen Vergleich mit dem ACPC-orientierten Atlas wurde alle cCTs erfolgreich ausgerichtet. Bildqualität (BQ) und der Aufwand, den Sulcus centralis (SC) zu identifizieren, wurden auf einer Likert Skala eingestuft (5 = optimale Bildqualität/auf Anhieb zu identifizierender SC). Die mediane BQ betrug 4 (Spannbreite: 2–4) in den originalen Serien und 5 (4–5) in den ACPC-ausgerichteten Serien (p 0,0001). Der SC war nach fatbACPC einfacher zu identifizieren (Original: 4 (2–5); ACPC: 5 (4–5); p 0,0001). Die mittlere Rotation betrug |X| = 6,4 ± 5,2° ([–X,+X] = –26,8°–24,2°), |Y| = 2,1 ± 1,7° ([–Y,+Y] = –8,7°–9,8°) und |Z| = 3,1 ± 2,4° ([–Z,+Z] = –14,3°–12,5°). Das entwickelte System kann cCTs verlässlich und automatisch an die ACPC-Linie anpassen. Abweichungen von der idealen Ausrichtung könnten zur Qualitätssicherung genutzt werden. KERNAUSSAGEN:: · fatbACPC richtet kraniale CT Untersuchungen automatisch an der Anterior Commissure/Posterior Commissure Referenzebene aus.. · ACPC-ausgerichtete Bilder erleichtern die Orientierung an anatomischen Landmarken.. · fatbACPC setzt die Bildqualität nicht herab.. · fatbACPC ist robust, vollständig PACS-integrierbar und Open Source: https://github.com/BrainImAccs.

Background Precise reduction of a syndesmosis after disruption is critical to improve patient physical function. Intraoperative lateral radiographs of the unaffected ankle are often used in clinical practice as a template for anatomic syndesmotic reduction because sagittal plane malreduction is common. However, there is little data to suggest fibular station, or the position of the fibula in the AP plane on the lateral radiograph, is symmetric side-to-side in patients. Questions/purposes (1) Is the position of the fibula in the AP plane (fibular station) on lateral ankle radiographs symmetric in an individual? (2) Do the measurements used to judge the position of the fibula on lateral radiographs have good inter- and intraobserver reliability? Methods Over the period from August 2016 to October 2018, we identified 478 patients who presented to an orthopaedic clinic with forefoot and midfoot complaints. Skeletally mature patients with acceptable bilateral lateral ankle radiographs, which are common radiographs obtained for new patients to clinic for any complaint, were included. Based on that, 52% (247 of 478 patients) were included with most (22%, 107 patients) excluded for poor lateral radiographs. The most common diagnosis in the patient cohort was midfoot OA (14%, 35 patients). The median (range) age of the included patients was 54 years (15 to 88), and 65% (159 of 247) of the patients were female. Fibular station, defined as the position of the fibula in the AP plane, and fibular length were measured using a digital ruler and goniometer on lateral radiographs. A paired t-test was used to determine if no difference in fibular station existed between the left and right ankles. With 247 paired-samples, with 80% power and an alpha level of 0.05, we could detect a difference between sides of 0.008 for the posterior ratio, 0.010 for the anterior ratio, and 0.012 for fibular length. Two readers, one fellowship-trained orthopaedic traumatologist and one PGY-4, measured 40 patients to determine the inter- and intraobserver reliability by intraclass correlation coefficient (ICC). Results The posterior fibular station (mean right 0.147 [σ = 0.056], left 0.145 [σ = 0.054], difference = 0.03 [95% CI 0 to 0.06]; p = 0.59), anterior fibular station (right 0.294 [σ = 0.062], left 0.299 [σ = 0.061], difference = 0.04 [95% CI 0 to 0.08]; p = 0.20), and fibular length (right 0.521 [σ = 0.080], left 0.522 [σ = 0.078], difference = 0.05 [95% CI 0.01 to 0.09]; p = 0.87) ratios did not differ with the numbers available between ankles. Inter- and intraobserver reliability were excellent for the posterior ratio (ICC = 0.928 and ICC = 0.985, respectively) and the anterior ratio (ICC = 0.922 and ICC = 0.929, respectively) and moderate-to-good for the fibular length ratio (ICC = 0.732 and ICC = 0.887, respectively). Conclusion The use of lateral radiographs of the contralateral uninjured ankle appears to be a valid template for determining the position of the fibula in the sagittal plane. However, further prospective studies are required to determine the efficacy of this method in reducing the syndesmosis over other methods that exists. Level of evidence Level III, diagnostic study.

Rouvière's sulcus (RS) is increasingly being recognized as an important extra-biliary landmark during laparoscopic cholecystectomy (LC). The aim of this study was to conduct a systematic analysis of the prevalence and morphological types of RS. A systematic search was conducted through the major databases PubMed, ScienceDirect, Google Scholar, China National Knowledge Infrastructure (CNKI), SciELO, and the Cochrane Library to identify studies eligible for inclusion. The data were extracted and pooled into a random-effects meta-analysis using STATA software. The primary and secondary outcomes of the study were the pooled prevalence of RS and its morphological types, respectively. A total of 23 studies (n = 4,495 patients) were included. The overall pooled prevalence of RS was 83% (95% confidence interval [CI] [78, 87]). There were no significant differences in prevalence between cadaveric studies (82%, 95% CI [76, 87]) and laparoscopic studies (83%, 95% CI [77, 88]). The open RS constituted 66% (95% CI [61, 71]) of all cases, while the closed type was present in 34% (95% CI [29, 39]). RS is a relatively constant anatomical structure that can be reliably identified in most patients undergoing cholecystectomy. It can therefore be used as a fixed extra-biliary landmark for the appropriate site at which to start dissecting during LC to help prevent iatrogenic bile duct injury.

BACKGROUND The venous access for the insertion of permanent leads of cardiac implantable electronic devices is often achieved by venous cutdown of the cephalic vein, or by "blind" puncture of the subclavian vein using anatomical landmarks, or by fluoroscopy-assisted methods. METHODS We have retrospectively analyzed our clinical experience to verify the feasibility, the safety, and efficacy of the adoption of ultrasound-guided puncture/cannulation of the axillary vein for this purpose. RESULTS Nine hundred eighty-seven leads were placed during 548 consecutive procedures, accessing the axillary vein in the infraclavicular area using real-time ultrasound guidance. Venipuncture was successful in 99.8% of cases. The access time was 11 seconds (range 4-580). We recorded three cases of pneumothorax (0.5%), but no hemothorax and no hemo-mediastinum. The incidence of local hematoma was 2.1% (12 cases). No injury to the brachial plexus or to the phrenic nerve was recorded. In a follow-up of 33 months (range 16-39), we observed no cases of "subclavian crush syndrome" (damage of the leads at the level of the thoracic inlet), and the rate of pocket infection/infective endocarditis was 0.7%. CONCLUSION In our experience, ultrasound-guided puncture/cannulation of the axillary vein for implantation of permanent leads is feasible, effective, and safe. It might be considered as a first option for this procedure.

Background: We identified the vidian canal (VC) in a Turkish subpopulation on cone-beam computed tomography (CBCT) images and explored its anatomic relationships; the canal serves as an anatomic pathway during endonasal surgical approaches. Materials and methods: Coronal and axial CBCT images of 100 patients (50 males and 50 females) were evaluated (slice thickness and interval, 0.5 mm). We measured the length of the VC length, extent of VC pneumatisation into the sphenoid sinus, position of the VC relative to the medial pterygopalatine plate (MPP), pterygopalatine fossa (PPF) depth, and VC-VC, VC-MPP, and VC-foramen rotundum (FR) distances, the angle between the posterior end of the middle turbinate and the lateral part of the VC anterior opening, and the angle between the VC and the palatovaginal canal. Results: The mean VC length was 13.09 ± 2.07 and 13.01 ± 2.12 mm on the right and left sides, respectively. Relative to the MPP, the VC was located medially in 54.5% of patients, on the same level in 36%, and laterally in 9.5%. Pneumatisation was of grade I in 24% of patients, grade II in 33%, grade III in 23.5%, and grade IV in 19.5%. The VC-FR and VC-MPP distances were significantly greater on the left side. The angle between the posterior end of the middle turbinate and the lateral part of the anterior VC opening was significantly greater on the right side. The VC-VC distance was significantly greater when the VC lay lateral to the MPP. Conclusions: Anatomic characteristics of the VC on CBCT images unique to Turkish populations should be kept in mind during surgery.

espanolObjetivo: Evaluar la frecuencia de foramen mentoniano accesorio (AMF) y variantes anatomicas del asa anterior del nervio mentoniano mediante tomografia computarizada de haz conico (CBCT) en una poblacion peruana. Material y Metodos: Este estudio transversal retrospectivo evaluo 80 hemi-mandibulas de 40 sujetos utilizando CBCT. La muestra incluyo 38 mujeres y 42 hombres, con una edad promedio de 25±4,45 anos. Se realizo una reconstruccion en 3D multiplanar para identificar la ubicacion y presencia del foramen mentoniano accesorio, sus caracteristicas morfologicas (ovaladas o circulares), su posicion con respecto al foramen mentoniano (MF), trayectoria del asa anterior (AL) y otros hitos anatomicos incluyendo longitudes y angulos. Los analisis estadisticos incluyeron pruebas de chi cuadrado y t de Student. El nivel de significancia fue de p EnglishTo evaluate the frequency of accessory mental foramen (AMF) and anatomical variants of the mental nerve anterior loop using cone-beam computed tomography (CBCT) in a Peruvian population. Material and methods: This retrospective cross-sectional study evaluated 80 hemi-mandibles from 40 subjects using CBCT. The sample included 38 females and 42 males, with an average age of 25±4.45 years. A 3D multi-planar reconstruction was performed to identify the location and presence of accessory mental foramina, their morphological characteristics (oval or circular), their position with respect to the mental foramen (MF), anterior loop (AL) path and other anatomical landmarks including lengths and angles. Statistical analyses included chi square and t-tests. The significance level was p

BackgroundThe localization of lumbar fourth spinous process (L4-SP) is an important anatomical landmark, and identifying its accurate position is essential for the diagnosis and treatment of waist diseases.MethodsFive hundred participants were scanned with positive and lateral computed tomography (CT), which aimed to clarify anatomic characteristics of L4-SP. Anatomical parameters of the surface localization of L4-SP were measured and recorded through a three-dimensional (3D) reconstruction.ResultsFive hundred participants were classified into three types according to the position of BC with the iliac spine. There are just 266 that the line between the highest point of the iliac spine on both sides located on L4-SP (type I, 53.20%), 16 above L4-SP (type II, 3.20%), and 218 below L4-SP (type III, 43.60%). BC in type I (15.92 ± 1.30 mm) is longer than type III (15.56 ± 1.32 mm). While the angle combined with AB and BC is different in the three groups, the angle in type I (173.00 ± 4.83°) is larger than that in type II (164.69 ± 5.50°) and type III (159.45 ± 8.39°). Other measurements were not found any significant differences between above.ConclusionThe traditional palpation for L4-SP is not absolutely exact. The accuracy rate is only 53.20%, and the errors may cause serious consequences.

In standard lateral wrist radiographs, the radiocarpal joint is often obscured because of the angulation of the radial styloid process. A modified lateral projection at a 20° angle has been shown to demonstrate the distal radius in profile in postoperative patients without superimposing of the orthopedic hardware used in open reduction and internal fixation procedures over the wrist joint. We assessed whether this 20° axial-lateral view is advantageous in a wider patient group.Consenting adults receiving wrist radiographs in a tertiary hospital radiology department for any indication underwent posteroanterior, posteroanterior-oblique, 0° lateral, and 20° lateral views. A musculoskeletal radiologist and a radiology technologist, blinded to clinical data and to which view was 0°/20°, both evaluated 0°/20° images in random order for whether the radiocarpal joint was obscured by radial styloid, radiocarpal articular margins, or ulnar styloid process, and which view was preferred.In 124 cases, the radiocarpal joint was shown clearly on more 20° than 0° views (75/124 vs. 23/124, P.001). Orthopedic hardware obscured joint lines in fewer 20° than 0° views (12/124 vs. 28/124, P.001). There was a trend to the ulnar styloid process obscuring part of the radiocarpal joint less in 0° view (28/124 vs. 78/124 in 20°; P = .088), primarily in 20° laterals of wrists with positive ulnar variance. The 20° view was preferred by the radiologist in 76% (95/124) and preferred by the technologist in 83% (104/124).The 20° lateral view was superior to the current 0° lateral view in a wide range of patients, with the radiocarpal joint obscured significantly less by hardware or adjacent anatomy, and preferred by both the blinded radiologist and technologist.

Objective To introduce a three‐point method combining the midpoint of the posterior cruciate ligament (PCL), the midsulcus of the tibial spines, and the midpoint of the anterior cruciate ligament (ACL) to determine appropriate tibial resection and component placing during TKA and to compare this method with Insall's 1/3 method. Methods A consecutive series of 128 knees that underwent TKA from January 2015 to August 2018 were analyzed. In one group (64 knees), the medial 1/3 of tibial tubercle (the Insall's traditional method) was used for tibial component alignment. In the other group (64 knees), the three‐point line connecting the midpoint of the PCL, the midpoint of the tibial spines, and the midpoint of the ACL was used for tibial component alignment. Both groups used the anterior tibial tendon as the distal reference for tibial resection. The coronal alignment error of the tibial component was determined by the angle between the line parallel to the tibial component platform and the tibial mechanical axis measured on postoperative radiograph. The axial rotation error of the femoral or tibial component was the intersection angle between the transepicondylar axis (TEA) and a line tangent to the posterior edge of the femoral or tibial component measured on CT. The coronal and axial alignment errors were compared between the two groups. Results The average coronal alignment error of the tibial component in the three‐point method group was 0.2° ± 1.4° versus − 0.9° ± 1.8°in the Insall's 1/3 method group (P

Objective Localization of the temporal horn of the lateral ventricle (TH) may be required during temporal lobe and ambient cistern surgery. Most available anatomic landmarks for TH localization are based on adjacent cortical landmarks that are inherently variable or subtle. This study aimed to localize the anterior tip of the TH relative to adjacent bony landmarks. Methods The TH was exposed on 21 sides of 11 cadaveric heads via removal of the middle temporal gyrus. Two lines were defined: (1) a perpendicular line to the zygomatic arch projected from the anterior concavity of the posterior zygomatic root (line A), and (2) a parallel line passing through the anterosuperior corner of the external auditory canal (line B). Sagittal distances from lines A and B to a parallel line passing through the anterior recess of the TH (line H) were measured. Results Mean (standard deviation) distances from lines A and B to line H were 13.3 (2.5) mm and 11.9 (2.2) mm, respectively. Line H was at 53% (8%) of the line A–line B interval measured from line A. The best way to search for the TH was to start approximately 15 mm posterior to line A and progress posteriorly such that a more posteriorly located TH tip would not be missed. Conclusions The zygomatic-meatal landmark is a reliable tool to localize TH during various approaches. It is independent from the approach trajectory. This landmark may be used as an ancillary tool in conjunction with other cortical landmarks and image guidance.

Summary Objective Understanding craniofacial growth and development is important for accurate diagnosis, treatment planning and post-treatment evaluation of orthodontic cases. Paramount to this is knowledge of the cranial base growth and development, since it is the foundation upon which the remaining facial structures develop. The purpose of this study was to analyse different anatomical structures in the posterior cranial base and determine its changes during the adolescent years (13–15 year of age) using CBCT. Materials and methods Sixty CBCT images of the adolescent population that received orthodontic treatment at two time-points (mean age T1: 13.1 years/T2: 14.6 years) were used to assess growth related dimensional changes using 33 selected landmarks. Inter-rater, intra-rater and accuracy of 33 selected landmarks in the posterior cranial base and surrounding area were then evaluated via three-dimensional (3D) cone-beam computed tomography (CBCT). Linear differences were then calculated among the different landmarks to determine the changes present in the sample. Results The selected landmarks in the posterior cranial base and surrounding area were found to be reliably and accurately located in 3D. Over the growth period studied (17.5 months), minor statistically significant changes occurred, but they were deemed clinically irrelevant. Conclusions The studied landmarks in the posterior cranial base and surrounding area showed minor clinically insignificant changes over the study period. The observed changes could be attributed to measurement error. The posterior cranial base is deemed to be stable in all three dimensions of study during the adolescent growth period studied.

BACKGROUND Accurate quantitative data of the adult bony orbital volume and dimension are needed for treatment optimization. In the present study, the authors aim to evaluate adult orbital volume and corresponding linear dimensions according to age, volume, and individual symmetry. METHODS Seventy computerized tomography facial scans of adults were randomly chosen from an institutional database and 3-dimensionally reconstructed. Studies were excluded for orbital pathology or incomplete radiographic data. Anatomic landmarks were marked. Interval linear distances and orbital volumes were calculated. Data were analyzed using paired T-tests, independent T-tests, linear regression analysis, and 1-way analysis of variance. RESULTS A total of 140 orbits from 70 patients were analyzed (female = 35, male = 35), ranging from 20 to 88 years of age. Orbital volume was similar between an individual's left and right side; however, a difference was observed in vertical orbital height, orbital width, inferior orbital rim position, orbital roof length, orbital width, and medial orbital wall length (0.45, 0.64, 0.4, 0.77, 0.97, and 5.1 mm, respectively; P

To perform an anatomical study to analyze the size, weight, and the relationships of the parotid levels proposed by the European Salivary Gland Society (ESGS). Anatomical dissections of the parotid region in 19 human specimens were performed. All dissections were systematically carried out to study the dimensions and weight of each level. We also studied the facial nerve distribution between the different levels and the relative position of the facial nerve main trunk and parotid duct in regard to the Frankfort line plane. The facial nerve trunk and the parotid duct were identified in all the 19 specimens, which made it feasible to define the 4 principal levels of the parotid gland body (levels I–IV). Level V was identified in 9 out of 19 dissections (47.5%). For the whole gland, the mean for the height and width dimensions were 66.37 mm and 46.84 mm, respectively, and it weighted 18.13 g. In terms of relative weight regarding the whole gland, level II was always the heaviest, representing from 41 to 47% of the gland's weight, depending on the presence of level V. Levels I and III represent almost the same amount of relative weight as they range from 20 to 22% for each one. Level IV was the lightest body level representing 8–10% of the whole, and when present, level V represented less than 5% of the whole parotid weight. The temporal and zygomatic terminal branches were always found between the cranial levels, whereas the cervical and marginal nerves lie in all cases between the caudal levels. The buccal branches had multiple ramifications that lie between both cranial and caudal levels in 47% of the cases, being found exclusively between cranial levels in 21% and between the caudal levels in the remaining 32%. As traditionally reported, the caudal superficial portion of the gland represents the most voluminous portion of the gland, being labeled in our classification as level II. Levels I and III represent similar amounts of gland, though presenting a significantly different morphological disposition. Level IV is the smallest portion of the body gland and level V, when present represents a scarce 5% of the whole body gland weight. The ESGS levels have a clear anatomical basis and the basic references needed to define them are always present.

BACKGROUND: The acetabular index and center-edge angle are widely used radiographic parameters. However, the exact landmarks for measuring these parameters are not clearly defined. Although their measurement is straightforward when the lateral osseous margin of the acetabular roof coincides with the lateral end of the acetabular sourcil, where these two landmarks disagree, recommendations have differed about which landmark should be used. Using a radiographic parameter with high reliability for predicting residual hip dysplasia helps avoid unnecessary treatment. QUESTIONS/PURPOSES: We aimed to (1) compare two landmarks (the lateral osseous margin of the acetabular roof and the lateral end of the acetabular sourcil) for measuring the acetabular index and center-edge angle with respect to intraobserver and interobserver reliability and the predictability of residual hip dysplasia in patients with developmental dysplasia of the hip (DDH) and (2) evaluate longitudinal change in the acetabular edge’s shape after closed reduction with the patient under general anesthesia. METHODS: Between February 1985 and July 2006, we performed closed reduction with the patient under general anesthesia as well as cast immobilization in 116 patients with DDH. To be included in this study, a patient had to have dislocated-type DDH. We excluded patients with a hip dislocation associated with neuromuscular disease, arthrogryposis, or congenital anomalies of other organs or systems (n = 9); hips that underwent osteotomy within 1 year since closed reduction (n = 8); hips that underwent open reduction because of re-dislocation after closed reduction (n = 4); and hips with Type III or IV osteonecrosis according to Bucholz-Ogden’s classification (n = 4). Ninety-one patients were eligible. We excluded 19% (17 of 91) of the patients, who were lost to follow-up before they were 8 years old, leaving 81% (74 of 91 patients) with full preoperative and most-recent data. Ninety-seven percent (72 patients) were girls and 3% (two patients) were boys. The mean ± standard deviation age was 14.0 months ± 6.4 months (range 3-40 months) at the time of closed reduction and 12.1 years ± 2.3 years (range 8.0-16.0 years) at the time of the latest follow-up examination, the duration of which averaged 11 years ± 2.2 years (range 6.5-15.4 years). To investigate whether longitudinal change in the acetabular edge’s shape differed among hips with DDH, contralateral hips, and control hips, we identified control participants after searching our hospital’s database for patients with a diagnosis of congenital idiopathic hemihypertrophy from October 2000 to November 2006 who had AP hip radiographs taken at 3 years old and then at older than 8 years. From 29 patients who met these criteria, we randomly excluded two male patients to match for sex because girls were predominant in the DDH group. We excluded another female patient from the control group because of a hip radiograph that revealed unacceptable rotation. Eventually, 26 patients were assigned to the control group. Control patients consisted of 24 girls (92%) and two boys (8%). The demographic characteristics of control patients was not different from those of 67 patients with unilateral DDH, except for laterality (left-side involvement: 64% [43 of 67] in the DDH group versus 38% [10 of 26] in the control group; odds ratio 1.7 [95% confidence interval, 1.0-2.8]; p = 0.035). The acetabular index and center-edge angle at 3 years old were measured using the lateral osseous margin of the acetabular roof (AI(B) and CEA(B)) and the lateral end of the acetabular sourcil (AI(S) and CEA(S)). The treatment outcome was classified as satisfactory (Severin Grade I or II) or unsatisfactory (Grade III or IV). The intraclass correlation coefficient (ICC) was used to compare the intraobserver and interobserver reliability of each method. We compared the predictability of residual hip dysplasia of each method at 3 years old as a proxy using the area under the receiver operating characteristic (AUC) curve. To evaluate longitudinal change in the acetabular edge’s shape, we compared the proportion of hips showing coincidence of the two landmarks between 3 years old and the latest follow-up examination. To investigate whether the longitudinal change in the acetabular edge’s shape differs among hips with DDH, contralateral hips, and control hips, we compared the proportion of coincidence among the three groups at both timepoints. RESULTS: Intraobserver and interobserver reliabilities were higher for the CEA(B) (ICC 0.96; 95% CI, 0.94-0.98 and ICC 0.88; 95% CI, 0.81-0.92, respectively) than for the CEA(S) (ICC 0.81; 95% CI, 0.70-0.88 and ICC 0.69; 95% CI, 0.55-0.79, respectively). The AI(B) (AUC 0.88; 95% CI, 0.80-0.96) and CEA(B) (AUC 0.841; 95% CI, 0.748-0.933) predicted residual hip dysplasia better than the AI(S) (AUC 0.776; 95% CI, 0.67-0.88) and CEA(S) (AUC 0.72; 95% CI, 0.59-0.84) (p = 0.03 and p = 0.01, respectively). The proportion of hips showing coincidence of the two landmarks increased from 3 years old to the latest follow-up examination in hips with DDH (37% [25 of 67] to 81% [54 of 67]; OR = 8.8 [95% CI, 3.1-33.9]; p < 0.001), contralateral hips (42% [28 of 67] to 85% [57 of 67]; OR = 16.5 [95% CI, 4.2-141.9]; p < 0.001), and control hips (38% [10 of 26] to 88% [23 of 26]; OR = 14 [95% CI, 2.1-592.0]; p = 0.001). The proportion of coincidence in hips with DDH was not different from that in the contralateral hips and control hips at both timepoints. CONCLUSIONS: Measuring the acetabular index and center-edge angle at 3 years old using the lateral osseous margin of the acetabular roof has higher reliability for predicting residual hip dysplasia than that using the lateral end of the acetabular sourcil in patients with DDH treated with closed reduction. Measuring the acetabular index and center-edge angle at an early age using the lateral end of the sourcil may lead to overdiagnosis of residual hip dysplasia and unnecessary treatment. LEVEL OF EVIDENCE: Level III, diagnostic study.

Purpose This study aimed to (1) quantitatively analyze the fibular footprints of the lateral collateral ligament (LCL) and popliteofibular ligament (PFL) and (2) evaluate whether a fibular tunnel can restore the LCL and PFL fibular footprints simultaneously without modification in anatomic posterolateral corner reconstruction of the knee. Methods In 20 cadaveric knees, anatomic characteristics, such as diameter, location and relationship with anatomic landmarks, of the LCL and PFL footprints were analyzed. Subsequently, a fibular tunnel that connected the LCL and PFL footprint centers was created with 1.5 mm drill bit, and tunnel depth, which is defined as the distance between the tunnel and the nearest cortex, was evaluated. An additional tunnel from the anteroinferior border of the LCL footprint to the posteroinferior border of the PFL footprint was created, and its tunnel depth was evaluated as well and compared with that of the original tunnel. Results The LCL footprint was longitudinally ovoid (8.4 ± 1.0 × 13 ± 1.0 mm), and its inferior margin corresponded well with the lateral apex of the fibula (distance, 1.0 ± 0.7 mm). The PFL footprint was round (9.7 ± 1.3 × 9.0 ± 1.1 mm), and its center was very close to the tip of the fibular styloid process (1.2 ± 0.8 mm). The tunnel depth of the original fibular tunnel was 1.8 ± 0.7 mm, and it was very shallow for tunnel reaming. On the contrary, the tunnel depth of the modified fibular tunnel (6.4 ± 1.1 mm) was significantly higher than that of the original tunnel (P Conclusions A single fibular tunnel cannot reproduce the LCL and PFL footprint centers simultaneously because the trajectory is too close to the cortex. A modified fibular tunnel, using the margins of the footprints, is recommended to avoid cortical blowout. Clinical Relevance A modified fibular tunnel that covers only portions of the LCL and PFL footprints, from the anteroinferior LCL footprint to the posteroinferior PFL footprint, is less likely to blow out the lateral fibula than is a similar tunnel using the anatomic footprint centers.

Surgery for tethered spinal cord caused by thickened filum terminale (FT) is frequently performed through S1 laminectomy based on the assumption that the internal FT (FTi) fuses with dura mater at S2 vertebral level. Literature on specific study for the site of its fusion and dural sac (DS) termination was rather limited. Moreover, there is no large anatomical study in Asian population. To determine the anatomy, examination of the FTi fusion site, as well as the region at which DS ended, was undertaken. From 80 embalmed cadavers, the majority of FTi fusion occurred at, or below, S1/S2 disk space (62.5%) which was less frequent than previous reports (70%-90%). In addition, there was 11.3% of the fila that fused above S1. Regarding the DS termination, it was found at, or below, S1/S2 disk space in 76.3% with one subject (1.3%) at L5/S1 disk space. With modest differences compared with non-Asian cadaveric data, our results offer pertinent information to surgeons performing tethered cord release. One ought to keep in mind that small, but not negligible, percentage of FTi can fuse with dura mater above S1 level; hence, more rostral laminectomy at L5 may be required. Clin. Anat. 33:558-561, 2020. © 2019 Wiley Periodicals, Inc.

Much research has been conducted on the morphological growth and development of Chinese children. However, very few facial measurements have been documented, especially of the sagittal plane of the face. Morphometric variations and growth of the sagittal plane of the face in children were analyzed using geometric morphometric method in this study. The studied sample consisted of 108 boys (4-15 years) from Huzhu County in Qinghai Province of China, which were divided into three groups: 4-6 years old, 7-11 years old and 12-15 years old. It was revealed that the landmark-groups of nose area were relatively long, indicating large variation in the direction of the nasal protuberance, which possibly reflected the vigorous growth of the children's nose. There were larger landmark-groups' variability ranges in children aged 7-11 years, which may be related to the rapid growth in this period. The average morphology of the sagittal plane of the face changed a lot with age, which was showed in the comparison of the averaged graph of three groups: (1) the proportion of the forehead to entire face became smaller; (2) the 7th landmark extruded more noticeably; (3) the nose became protruding; (4) the position of the mouth was relatively getting more upward, and the angle formed between the upper lip and the lower lip increased, and the lower lip moved forward; (5) the chin protuberated. Principal Component Analysis (PCA) revealed significant differences in the main distribution areas between age group 4-6 years and 12-15 years, even though there was a lot of overlap in the three age groups. Allometric analysis showed that the sagittal plane of the face aged 4-6 years and 7-11 years changed in the following way as the size increased: the forehead became vertical and the upper lip turned to be smaller. Additionally, as the size increased in age group 12-15 years, the most prominent landmark of the forehead became more conspicuous, and the bridge of the nose got more upturned. These may reflect the common morphological features and growing development of the facial sagittal plane of Chinese children.

The variability of the recurrent branch (RB) of the median nerve lends itself to an increased risk of injury when performing the minimally invasive approach for carpal tunnel release without its direct visualization. This risk is less so when it is released via the more invasive open approach as the RB can be easily identified, but the drawback is that of longer postoperative patient recovery time. Therefore, performing these releases via the less invasive approach should be more favorable for patients providing it could be done safely. Hence with there being a positive link between the hypertrophy of the thenar musculature and the course of RB according to previous studies. We dissected 28 hands of 14 donated bodies fixed using Thiel’s method to try to demonstrate these findings of the associations among the RB, palmar creases and other superficial anatomical landmarks. Fisher’s exact test was conducted to verify the relationship between those structures statistically. Statistically significant links were found between the type of the RB and the type of the palmar creases (p value = 0.0094) and between the RB type and the palmaris longus muscle presence (p value = 0.028). It was inferred that palmar creases and other superficial anatomical landmarks listed in the text could not be used to predict the variability of the RB and the choice of mini-invasive approach should not be based on their course.

Estimating the appropriate tendon length and associated skin incision needed to achieve a plantigrade foot without compromising function are essential steps in open Achilles tendon lengthening. Here we describe a technique using basic surgical instruments referencing anatomic landmarks without the need for radiographs. The center of ankle rotation in the sagittal plane is found referencing the tip of the medial malleolus. This point is translated to the plantar surface of the foot, and a straight instrument in line with the foot is used to make a mark at the posterior calcaneal fat pad. The straight instrument is then rotated (representing the plantar surface of the foot) as if dorsiflexing the ankle along the axis of the transposed tibiotalar joint from a plantar-flexed position to the desired final position and a second mark is made at the posterior heel. The distance between the marks is measured, representing the amount of Achilles lengthening required. The skin incision and tendon limb lengths area a sum of the operative correction and the amount of desired tendon overlap, typically 2 cm of tendon overlap is optimal to allow for suture fixation, ensure tendon healing, and maintain the integrity of the repair. A Z-type lengthening is then performed using this tendon limb length. This technique allows an accurate and simple approach to lengthening the Achilles tendon. In this way the ideal tendon limb length is selected to optimize function while minimizing incision length, associated wound complications, inadequate lengthening, and overlengthening. Level of evidence: Technical note, Level V.

The bottlenose dolphin, genus Tursiops, is cosmopolitan occurring in tropical and temperate regions, with morphological variation between and within different oceans. Since the genus' taxonomy has been under discussion for a long time, this work aimed at analyzing the cranial variability of T. truncatus from different regions of the world. Geometric Morphometrics analyses were performed in 201 skulls of adult specimens, on dorsal, ventral, and lateral views, from the Eastern North Pacific, Eastern North Atlantic, Eastern South Atlantic, and Western South Atlantic oceans. The results indicate differences between individuals that inhabit the Atlantic and Pacific oceans. Within the Atlantic Ocean, there is an evident longitudinal differentiation of specimens from the eastern and western regions. A latitudinal separation was also observed, considering specimens from the North and South Atlantic Ocean. In the Western South Atlantic statistical differences were found between two morphological groups, identified as T. gephyreus (sensu Lahille, 1908) and T. truncatus, and the cross-validation presented 98% as minimum confidence for correct classification of these two groups. The present study provides strong morphological support to consider these two lineages as separate species.

Introduction The shape of the talus determines the positional and kinematic features of the subtalar, talonavicular, and talocrural joints during walking. Thus, detailed knowledge of the pattern of sexual dimorphism of the human talus may be useful for revealing the pathogenetic mechanism of foot and knee disorders, which are more prevalent in females. The aim of this study was to characterize and visualize the three-dimensional shape variations of the talus in relation to sex and age using geometric morphometrics. Materials and methods Computed tomography images of 56 feet without talar injuries or disorders were used in this study. Thirty-seven anatomical landmarks were identified on a bone model of the talus to calculate principal components (PCs) of shape variations among specimens. PC scores were compared between sexes, and their correlations with age were also investigated. Results The female talus had a longer neck and narrower head width than the male talus. The superior trochlea was tilted more laterally in the frontal plane in females. Furthermore, the female talar head was more twisted and was more elongated in the dorsoplantar direction. Conclusions Morphological features of the talus in females could alter the subtalar and talonavicular joint kinematics during walking and could be a structural factor in the pathogenetic mechanism underlying foot and knee disorders. This study contributes to the comprehensive understanding of shape variations in the human talus.

Objective To assess long‐term follow‐up evaluations for the treatment of femoral intertrochanteric fractures with the “three‐finger method” assisted by proximal femoral nail antirotation (PFNA). Methods From January 2010 to January 2017, 123 patients were selected and followed for the treatment of femoral intertrochanteric fractures with PFNA assisted by the “three‐finger method” (application of the index finger, middle finger, and ring finger in the process of surgery to assist PFNA). There were 56 male patients and 67 female patients aged 52–93 years with an average age of 75.6 years, and 88 cases were due to a fall and 35 due to a traffic accident injury. The femoral necks were fixed with PFNA assisted by the “three‐finger method” applying the following procedure: traction reduction, determining the incision, inserting the needle, and placing screw. The Harris hip score, postoperative complications, hip pain and function status were statistically analyzed to evaluate the surgical efficacy and to discuss the surgical technique of the “three‐finger method” assisted by PFNA. Results According to the Harris scoring criteria, patients were followed for 1, 2, 4, 6, and 8 years, and the good outcomes of patients were recorded. The excellent and good rate of 87% was the highest in the second year of follow‐up. Then, the rate decreased following the eighth year of follow‐up. The excellent and good rate of 82.7% was the lowest. The patients with incisions healed well, there were no instances of fat liquefaction or infection. There were three cases of effusion, the rate was 2.4%. The secretions were cultured, and no bacterial growth was found. After treatment of the wound, it healed, and the spiral blade used for the femoral head did not wear out. There was one case of femoral head necrosis. There was no significant correlation between hip pain and sex and age (P > 0.05), and the function of the hip joint was significantly correlated with the age of the patients (P

Statement of problem The anterior mandible has conventionally been deemed as a safe zone for dental implants. However, with the evolution of cone beam computed tomography (CBCT), several anatomic challenges have been identified that, if violated, can lead to surgical complications, including life-threatening hemorrhage. Purpose The purpose of this observational clinical study was to obtain standardized average values for the location of the sublingual artery (SLA), submental artery (SMA), and mandibular incisive canal (MIC) and to determine whether differences exist between dentate and edentulous individuals. In addition, the prevalence of these anatomic landmarks on CBCT images was determined. An additional objective was to study the cross-sectional morphology of the anterior mandible. Material and methods CBCT images of 125 edentulous and 100 dentate patients were studied at the anterior mandible for the prevalence of SLA, SMA, and MIC. Measurements of these 3 structures were then made from the inferior cortical border of the mandible to the superior border of each structure to obtain average anatomic measurements. The cross-sectional shapes of anterior mandibles were then categorized, and the prevalence of each shape in this sample was calculated. Results The prevalence of SLA across all 225 CBCT images was 100% for edentulous patients and 98% for dentate patients. The SLA was located approximately 15 mm above the inferior border of the mandible. The prevalence of SMA was 94% for edentulous patients and 88% for dentate patients. The SMA was located approximately 5 mm above the inferior border of the mandible. The prevalence of MIC was 61% for edentulous patients and 59% for dentate patients. The MIC was located approximately 11 mm above the inferior border of the mandible in edentulous patients and approximately 14 mm above the inferior border of the mandible in dentate patients. Five distinct shapes were observed for the cross-sectional morphology of the anterior mandible: hourglass (1%), pear (53%), sickle (4%), ovoid (26%), and triangular (17%). The distance from the crest of the residual ridge to a minimum 6-mm width in the anterior mandible was approximately 4 mm. Conclusions The SLA and SMA vascular structures were consistently identified in the anterior mandible on CBCT images, both in dentate and edentulous patients, whereas the mandibular incisive canal was not consistently visualized. Average values from the inferior border of the mandible to the SLA, SMA, and MIC were computable. The cross-sectional morphology of the anterior mandible is diverse in dentate and edentulous mandibles, with pear shaped being the most common in both. These findings should be taken into consideration when dental implants are planned in the anterior mandible.

Background Conventional reconstructive options for large full-thickness eyelid defects are limited to static local flaps without replacing the missing orbicularis. The authors' aim is to delineate the platysma neurovascular anatomy for innervated functional eyelid reconstruction. Methods Fourteen fresh latex-injected heminecks were dissected. The locations where neurovascular structures entered the platysma muscles were expressed as the percentage distance ± SD from the sternocleidomastoid muscle mastoid insertion to manubrium origin. Results The superior thyroid, facial, and lingual vessels were the major pedicles in eight of 14 (57.1 percent), four of 14 (28.6 percent), and one of 14 specimens (7.1 percent), respectively. In one specimen (7.1 percent), both the superior thyroid and facial vessels supplied a major pedicle. Venous drainage generally mirrored arterial inflow but was redundant, with 43 percent and 14 percent of flaps also with major contributions from the external jugular and anterior jugular veins, respectively. Neurovascular pedicles entered the platysma 28 to 57 percent caudal to the sternocleidomastoid muscle mastoid insertion, between 0.5 and 4.8 cm anterior to the medial sternocleidomastoid muscle border. Conclusion Although variability exists, platysma neurovascular pedicles enter at predictable locations between 28 and 57 percent of the distance from the mastoid insertion of the sternocleidomastoid muscle, therefore making free platysma transfer a feasible option for eyelid reconstruction.

Background Strong agreement exists concerning the standards of pathologic reporting for total mesorectal excision and complete mesocolic excision. It represents a quality standard that correlates with survival. However, no agreed standards of reporting are available to define D3 lymphadenectomy for right colectomy. Objective The purpose of this study was to define anatomopathological standards of specimen quality obtained from the surgical specimen when an oncologic right hemicolectomy with D3 lymphadenectomy has been correctly performed. Design This study was conducted in 2 different phases. The first part consisted of a cadaver-based study of right colon anatomy, and the second part consisted of a prospective assessment of a series of surgical specimens obtained after right hemicolectomy for cancer. Settings The anatomic phase of the study was performed in collaboration with the University of Valencia Department of Anatomy and Embryology. The second part was performed at a colorectal unit of a tertiary hospital. Patients Seventeen cadavers were used for the first phase, and 65 surgical specimens were examined for the second part of the study. Main outcome measures In each specimen, the pathologists looked for anatomic structures defined as markers of quality standards of the D3 lymphadenectomy during the first phase. Specimens were classified as complete, partial, and incomplete D3 lymphadenectomy. Results Twenty percent of specimens were classified as incomplete D3 lymphadenectomy, 31% as partial, and 49% as complete. A median number of 14 (6-64), 22 (11-47), and 29 (14-55) lymph nodes were isolated (p = 0.01). Similarly, the median numbers of lymph nodes isolated in the area of D3 lymphadenectomy were 0 in incomplete, 1 (0-5) in Partial, and 3 (0-8) in Complete D3 lymphadenectomy specimens (p = 0.0001). Limitations A large multicenter study with adequate power is needed. Conclusions We propose the right mesocolic sail and trunk of superior right colic vein as new and reproducible anatomopathologic standards of D3 lymphadenectomy in oncologic right hemicolectomy. See Video Abstract at http://links.lww.com/DCR/B149. PROPUESTA PARA NUEVOS ESTANDARES HISTOPATOLOGICOS EN LA LINFADENECTOMIA D3 EN EL CANCER DE COLON DERECHO: LA VELA MESOCOLICA Y LA VENA COLICA DERECHA SUPERIOR: Existe un claro acuerdo sobre los estandares de calidad patologicos para la escision total del mesorrecto y la escision completa del mesocolon. Son considerados "estandar de calidad" que se correlaciona con la supervivencia. Sin embargo, no se dispone de estandares de calidad para definir la linfadenectomia D3, en la colectomia derecha.Definir los estandares anatomopatologicos de calidad obtenidos de una muestra quirurgica, cuando se ha realizado correctamente una hemicolectomia derecha oncologica, con linfadenectomia D3.Dos fases diferentes. La primera parte consistio en un estudio basado en la anatomia del colon derecho, realizado en cadaveres, y la segunda parte consistio en una evaluacion prospectiva de una serie de muestras quirurgicas obtenidas despues de la hemicolectomia derecha para cancer.La fase anatomica del estudio se realizo en colaboracion con el Departamento de Anatomia y Embriologia de la Universidad de Valencia. La segunda parte se realizo en la Unidad Colorrectal de un hospital terciario.Se utilizaron diecisiete cadaveres para la primera fase y se examinaron 65 muestras quirurgicas para la segunda parte del estudio.En cada muestra, los patologos buscaron estructuras anatomicas definidas, como marcadores de los estandares de calidad de la linfadenectomia D3, durante la primera fase. Las muestras se clasificaron como linfadenectomia D3 completa, parcial e incompleta.El veinte por ciento de las muestras se clasificaron como "Linfadenectomia D3 Incompleta", el 31% como "Parcial" y el 49% como "Completa." Se aislo una media de 14 (6-64), 22 (11-47) y 29 (14-55) ganglios linfaticos respectivamente (p = 0,01). Del mismo modo, el numero medio de ganglios linfaticos aislados en el area de la linfadenectomia D3 fue 0 en "Incompleta", 1 (0-5) en "Parcial" y 3 (0-8) en muestras de "Linfadenectomia D3 Completa" (p = 0,0001).Se necesita un estudio multicentrico con potencia adecuada.Proponemos la vela mesocolica derecha y el tronco de la vena colica derecha superior, como estandares anatomopatologicos nuevos y reproducibles de linfadenectomia D3, en hemicolectomia derecha oncologica. Consulte Video Resumen en http://links.lww.com/DCR/B149.

BackgroundTo investigate differences in the tibial tubercle-trochlear groove (TT-TG) and patellar tendon-posterior cruciate ligament (PT-PCL) distances in symptomatic patients with non-contact internal knee derangements (IKD) and symptomatic patients with internally intact knees (control).MethodsA retrospective review of MRI studies was completed by comparing 78 patients with meniscal and ligamentous derangements of the knee to 63 internally intact knees (age range, 13 to 50 years). MRI findings were reviewed independently by two board-certified radiologists to assess for agreement. TT-TG and PT-PCL distances were measured on proton density-weighted axial images by two independent observers blinded to the MRI and arthroscopic findings. Independentttests were used to determine differences in TT-TG distance between the internal derangement and control groups. Chi-square tests were used to compare categorical variables for distributional equality between study groups.ResultsThe mean TT-TG distance averaged across the two raters in the IKD group was 11.5 mm (95% confidence interval [CI], 10.6–12.4), compared to 8.3 mm (95% CI, 7.6–9.0) in the control group (p< 0.001). The mean PT-PCL distance similarly averaged across both raters was 20.6 mm (95% CI, 19.7–21.5) for the IKD group compared to 18.2 mm (95% CI, 17.2–19.2) for the control group (p< 0.001). Among the IKD group, there were 51 meniscal tears, 12 cruciate ligament tears, and 15 tears with a combination of meniscal and cruciate findings. IKD was significantly correlated with greater TT-TG distance (p< 0.001) and greater PT-PCL distance (p< 0.003) when compared with control.ConclusionsIncreased TT-TG distances and PT-PCL distances are associated with both cartilaginous and ligamentous internal knee injuries in the present study, with TT-TG distances greater than the 12 mm representing a new threshold for concern.

Objective To review the microsurgical anatomy of the donor arteries for extracranial-intracranial bypass, namely, the superficial temporal artery (STA), occipital artery (OA), and internal maxillary artery (IMA). Methods Seven cadaveric specimens were dissected to identify the relationships between each artery and its surrounding structures. Nineteen computed tomographic angiographic images of Japanese adult patients (38 sides) were analyzed to examine the course of each artery and to measure the diameters and distances from various anatomic landmarks to each artery. Results The courses of the STA, OA, and IMA, which must be exposed during revascularization procedures, were shown via cadaver dissection with special reference to the following relationships to surrounding structures: STA, soft tissue layers of the temporoparietal region and facial nerve; OA, suboccipital muscles; and IMA, mandibular nerve. In addition, we measured the diameter of the anastomotic site for each artery and its relationship with surrounding muscles. Conclusions A precise understanding of the anatomic characteristics of the donor arteries and their relationships with surrounding structures provides safe access to these arteries.