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BACKGROUND The aim of this study was to investigate the axillary nerve's location along superficial anatomical landmarks, and to define a convenient risk zone. METHODS A total of 123 upper extremities were evaluated. After dissection of the axillary nerve, the vertical distance between the upper border of the anterolateral edge of the acromion and the proximal border of the nerve was measured. Furthermore, the interval between the proximal border and the distal border of the axillary nerve's branches was evaluated. The interval between the distal border of the branches and the most distal part of the lateral humeral epicondyle was measured. The distance between the anterolateral edge of the acromion and the lateral humeral epicondyle was evaluated. Measurements were expressed as proportions with respect to the distance between the acromion and the lateral humeral epicondyle. RESULTS The distance between the acromion and the proximal border of the axillary nerve's branches was at a height of 10 percent of the distance between the acromion and the lateral humeral epicondyle, starting from the acromion (90 percent when starting from the lateral humeral epicondyle). The interval between the proximal and distal margins of the axillary nerve's branches was between 10 percent and 30 to 35 percent of this interval, starting from the acromion (65 to 70 percent when starting from the lateral humeral epicondyle). CONCLUSIONS The authors were able to locate the branches of the axillary nerve at an interval between 10 and 35 percent of the distance between the acromion and the lateral humeral epicondyle, starting from the acromion. This makes the proximal third of this distance an easily applicable risk zone during shoulder surgery.

IntroductionAnatomic cruciate ligament reconstruction is known to be correlated with better clinical results. The aim of the study was to provide a simple method to enable anatomic results in the setting of PCL reconstruction. We, therefore, assessed the tibial and femoral insertion site of the posterior cruciate ligament (PCL) by the use of an objective coordinate system in an anatomical study. We also sought to show reproducibility of these measurements using intra- and inter-observer coefficients.Materials and methodsWe studied 64 knees, previously preserved according to Thiel’s technique. After proper preparation of the articular surfaces of both the tibiae and femora, photographs were taken according to a standardized protocol. PCL footprints were measured by the use of a coordinate system twice by two examiners. We evaluated these measurements by use of the Cohen’s kappa inter- and intra-observer coefficient for two observers.ResultsTibial and femoral measurements of PCL footprints were generated with highly comparable inter- (k = 0.970) and intra-observer (k = 0.992) coefficients and may, therefore, be considered as highly reproducible.ConclusionOur findings confirmed the reproducibility of defining PCL footprints using a coordinate system and may contribute to planning intraoperative graft-placement to ensure optimal conditions in the upcoming techniques for PCL reconstruction.

Objective Helical plating is a known concept in humeral fracture treatment. Attention should be paid to the axillary nerve when inserting a plate underneath the deltoid muscle. The purpose of this cadaveric study was to estimate axillary nerve stretching when introducing the plate. Methods: On 42 fresh frozen human humeri, an 8-, 10- and 12-hole Philos plate in a straight and a helical shape were compared measuring the maximum plate-bone-distance. Results: For all three plate lengths, the helical plates had a significantly lower plate-bone-distance. Conclusion: Indirectly, this suggests a lower axillary nerve elongation and hence less chance of nerve damage.

BACKGROUND: Posterior interosseous nerve (PIN) entrapment syndrome is a rare condition and is predisposed by anatomical factors such as narrow passages through fibrous arcades; whereas, the Arcade of Frohse (AF) is the most common entrapment point. The aim of this study was to evaluate the entrance and exit points of the PIN into the supinator in detail. MATERIALS AND METHODS: One hundred unpaired upper extremities underwent dissection. The PIN’s entrance and exit points from the supinator were depicted. The distances between the tip of the radial head (RH) and the AF and the exit point of the PIN from the supinator were measured. Further, it was checked if the borders of the AF and the exit point were muscular, tendinous or a combination of these. RESULTS: The interval between the PIN’s entry into the supinator and the tip of the RH was at a mean of 28.9 mm. Concerning the border of the AF, in 54 cases a muscular and in 46 specimens a tendinous version could be observed. The interval between the exit point of the PIN and the tip of the RH proved to be at a mean of 64.2 mm. Further, the exit’s border was muscular in 65 specimens and tendinous in 35 cases. CONCLUSION: During surgical treatment of the PIN syndrome, it needs to be kept in mind that approximately one-third of all patients might also suffer from entrapment at the exit point of the PIN.

Introduction The sigmoidea ima artery is defined as the lowest sigmoid artery, which forms the distal end of the marginal artery by linking with the superior rectal artery. It supplies the rectosigmoid junction, which is a critical area for ischemia. The aim of the present study was to delineate the area supplied by the inferior mesenteric artery with special consideration of the sigmoidea ima artery. Materials and Methods The inferior mesenteric artery was dissected from its origin to the bifurcation of the superior rectal artery in 30 cadavers (15 male, 15 female). Vessel length and distance to the promontory were measured for each branch. Results There were two manifestations of the sigmoidea ima artery, irrespective of the branching pattern of the inferior mesenteric artery. It originated below the promontory in 25 cases (83.3%) and above it in three (10%). It did not derive from the superior rectal artery in two cases (6.7%). In these 16.7%, the marginal artery was absent near the rectosigmoid junction. Conclusions We suggest the terms “arteria sigmoidea ima pelvina” and “arteria sigmoidea ima abdominalis” for the two variants. The terms “arteria marginalis pelvina” and “arteria marginalis abdominalis” could be applied in clinical practice. An abdominal marginal artery could be considered a risk factor for colonic ischemia in colorectal resections and abdominal aortic aneurysm repair. Both variants should be considered when pre‐ and intra‐operative perfusion measurements are interpreted.

BACKGROUND: The aim of our study was to project the A1-pulley of the thumb onto the total thumb length to enable its complete division with and without direct sight. MATERIALS AND METHODS: The study involved 50 hands from adult human cadavers. The proximal and distal borders of the A1-pulley were measured with reference to the first metacarpophalangeal joint (MCPJ). The length of the thumb was defined as the interval between the first carpometacarpal joint (CMCJ) and the apex of the thumb. The length of the pulley is calculated proportionally with reference to the line between the first CMCJ and apex of the thumb. RESULTS: Approximated by computing 95% confidence intervals, the pulley can be expected to lie in an area between 34.0% (proximal border) and 57.8% (distal border) alongside this line. CONCLUSION: Percutaneous and minimally-invasive division of the A1-pulley needs to be performed between 34.0 and 57.8% of the length between the first CMCJ and apex of the thumb.

The aim of the study was to evaluate the anatomical details of the articular branch of the peroneal nerve to the proximal tibiofibular joint and to project the height of its descent in relation to the fibular length. Twenty-five lower extremities were included in the study. Following identification of the common peroneal nerve, its course was traced to its division into the deep and superficial peroneal nerve. The articular branch was identified. The postero-lateral tip of the fibular head was marked and the interval from this landmark to the diversion of the articular branch was measured. The length of the fibula, as the interval between the postero-lateral tip of the fibular head and the tip of the lateral malleolus, was evaluated. The quotient of descending point of the articular branch in relation to the individual fibular length was calculated. The articular branch descended either from the common peroneal nerve or the deep peroneal nerve. The descending point was located at a mean height of 18.1 mm distal to the postero-lateral tip of the fibular head. Concerning the relation to the fibular length, this was at a mean of 5.1%, starting from the same reference point. The articular branch of the common peroneal nerve was located at a mean height of 18.1 mm distal to the the postero-lateral tip of the fibular head, respectively, at a mean of 5.1% of the whole fibular length starting from the same reference point. These details represent a convenient orientation during surgical treatment of intraneural ganglia of the common peroneal nerve, which may result directly from knee trauma and indirectly from ankle sprain.

The purpose of the study was to evaluate the relationship of implant-related injuries to the adjacent anatomical structures in a newer generation straight proximal humeral nail (PHN) regarding different entry points. The proximity of the proximal lateral locking-screws of the MultiLoc proximal humeral nail (ML PHN) may cause iatrogenic tendon injuries to the lateral edge of the bicipital humeral groove (BG) as reference point for the tendon of the long head of biceps brachii (LBT) as well as the lateral insertion of the infraspinatus tendon (IST).The study comprised n = 40 upper extremities. Nail application was performed through a deltoid approach and supraspinatus tendon (SSP) split with a ML PHN. All tests were performed in three different entry points. First nail (N1) - standard position in line with the humeral shaft axis; second nail (N2) - a more lateral entry point; third alternative (N3) - medial position, centre of the humeral head. After nail placement, each specimen was screened for potential implant-related injuries or worded differently hit rates (HR) to the BG and the IST. The distances to the anatomical structures were measured and statistically interpreted.The observed iatrogenic IST injury rate was 17.5% (n = 7/40) for N1, 5% (n = 2/40) for N2 and 62.5% (n = 25/40) for N3, which was statistically significantly higher (p 0.001). Regarding the BG, the evaluated HR was 7.5% (n = 3/40) for both N1 and N2. Only the nail placed in the head centre (N3) showed an iatrogenic injury rate of 20% (n = 8/40) (p 0.062). No statistically significant association between humeral head size and the HR could be observed (head diameter: IST: p = 0.323, BG: p = 0.621; head circumference: IST: p = 0.167; BG: p = 0.940). For the IST and BG, all distances in nail positions N1 and N2 as well as N2 and N3 differ statistically significant (p 0.001).An entry point for nail placement in line or slightly laterally to the humeral shaft axis - but still at the cartilage - should be advocated.

Osteotomies of the Le Fort I segment are routine operations with low complication rates. Ischemic complications are rare, but can have severe consequences that may lead to avascular bone necrosis of the Le Fort I segment. Therefore the aim of this study was to investigate the blood supply and special arterial variants of the Le Fort I segment responsible for arterial hypoperfusion or ischemic avascular necrosis after surgery.The arterial anatomy of the Le Fort I segment's blood supply using 30 halved human cadaver head specimens was analyzed after complete dissection until the submicroscopic level. In all specimens the arterial variants of the Le Fort I segment and also the arterial diameters measured at two points were evaluated.The typical known vascularization pattern was apparent in 90% of all specimens, in which the ascending palatine (D1: 1,2 mm ± 0,34 mm; D2: 0,8 mm ± 0,34 mm) and ascending pharyngeal artery (D1: 1,3 mm ± 0,58 mm; D2:0,4 mm) were both supplying the Le Fort I segment. However in 10% of all specimens, the Le Fort I segment was dependent on the ascending pharyngeal artery alone and the missing ascending palatine artery was replaced with the anterior branch of the ascending pharyngeal artery (D1: 1,9 mm ± 0,32; D2: 1,0 mm ± 0,3 mm).This study is the first description of a special type of arterial variation of the Le Fort I segment. The type of this arterial variation, its clinical relevance and potential consequences are explained. Individuals with this special arterial anatomy may clinically be at a high risk for hypoperfusion and avascular segment necrosis after surgery. An individualized operation plan may prevent ischemic complications in at-risk patients.

A study was undertaken to examine the presence of the distal oblique bundle of the forearm in a large sample in order to describe its true prevalence. The study sample consisted of 200 cadaveric forearms. Fifteen were excluded due to defects in the distal interosseous membrane. In the remaining 185 specimens, the distal interosseous membrane was examined following removal of soft tissue, to determine whether a distal oblique bundle was present and whether there were connecting fibres to the distal radio–ulnar joint. The distal oblique bundle was observed in 53 specimens (29%). In 45 of these forearms (85%), one or more connecting fibres to the distal radio–ulnar joint were identified. The presence of a distal oblique bundle in 29% is less frequent than that reported in previous literature. The presence of the distal oblique bundle should be noted and may be of importance in the management of disorders of the distal radio–ulnar joint.

Background Although needle decompression of tension pneumothorax through the second intercostal space in the midclavicular line (Monaldi’s approach) is a life-saving procedure, severe complications have been reported after its implementation. We evaluated the procedure by comparing how it was performed on cadavers by study participants with different training levels. Methods Six participants including one thoracic surgeon performed bilateral thoracic drainage after Monaldi on 82 torsos. After the thoraces were opened, the distances from the internal thoracic artery (A), the site of the puncture (B) and the midclavicular line (C) were measured bilaterally with reference to the median of the sternum. Further, it was determined whether the participants had correctly identified the second intercostal space. The differences between B-A and C-B were analysed. Results The needle was placed in the second intercostal space in 136 hemithoraces (83%). The thoracic surgeon showed a hit rate of 0% laceration of adjacent vessels. All the other participants had hit rates between 10% and 15%. The interval B-A ranged from 2.88 to 5.06 cm in right and from 3.00 to 5.00 cm in left hemithoraces. The distance C-B lay between 1.03 cm and 1.87 cm (right side), and 0.84 cm and 2.02 cm (left side). Conclusion In our collective, the main problem was failure to assess correctly the lateral extension of the clavicle. If this fact is emphasized during training, Monaldi’s approach is a safe method for needle decompression of pneumothorax.

The aim of our study was to project the borders of the flexor retinaculum (FR) onto superficial landmarks since its insufficient splitting is the most common reason for persistence of symptoms after carpal tunnel release. In 60 hands the radial and ulnar styloid processes were linked by a horizontal line and a longitudinal line was laid through the ring finger's radial side. These were intersected resulting in the reference point "A" on the forearm. As the second basing point "B", the radial margin of the ring finger at the palmar digital crease was chosen. Measurement of the FR was carried out with regard to the reference points. The proximal margin of the FR was located at 4% of the reference line A-B starting from point A and extended up to 52% of this total length. Results indicate that splitting alongside the proximal half of line A-B divides the FR completely. Clin. Anat. 30:512-516, 2017. © 2017 Wiley Periodicals, Inc.

The aim of this study was to investigate the intersection point of the radial artery (RA) with Henry's approach. Ninety forearms from adult human cadavers which had been embalmed using Thiel's method underwent dissection. Henry's approach was performed alongside the whole length of the forearm, and the RAs course was investigated. Its crossing point with the approach was identified, and the distance from this point to the radial styloid process was determined. In addition, the total radial length (RL) was measured from the radial styloid process to the proximal margin of the radial head. The former measurements were analyzed as proportions with regard to the total RLs. Concerning right radii, the intersection point was, on average, at a proportion of 56.2% of the radius, starting from the tip of the radial styloid process. In left radii, this was located at a mean proportion of 61.2%. In cases of multiply fractured radii, care must be taken at the interval between 40% and 80% to avoid RA lesions during dissection from distal to proximal. Clin. Anat., 33:983-987, 2020. © 2019 Wiley Periodicals, Inc.

Puncture of the temporomandibular joint (TMJ) is a minimally invasive treatment for various jaw disorders. This study used a cadaveric model to evaluate the procedure from two entrance points with respect to hit ratio and possible complications, such as extraarticular extrusion of injection fluid. Ten heads, embalmed with Thiel's method, were investigated. A straight line drawn with a colored pen connected the center of the tragus and the lateral canthus. The first portal "A" was located at a distance of 1 cm anterior and 2 mm caudal from the center of the tragus. Portal "B" was located 2 cm anterior and 1 cm caudal starting from the same reference point. Punctures "A" and "B" were performed alternately on the right and left sides. Specimens were dissected and the local distribution of the injected latex was recorded. With Approach A, four punctures (40%; 4/10) reached the TMJ, whereas with Approach B, six injections (60%; 6/10) entered the TMJ. There were no statistically significant differences between the tested puncture methods (P = 0.0317) and body sides (P = 1). With each method, for example, 35% (7/20) each, the injected latex was either periarticular or retromandibular. In a further 20% (4/20), it was located subperiosteally alongside the ramus of mandible. The latex was injected into the infratemporal fossa and the external acoustic meatus in one case each (each 5%). There was no statistically significant difference between the techniques. The adjacent anatomy has to be kept in mind during TMJ puncture as the complication rate was remarkably high, suggesting that ultrasound guided intraarticular injection could improve the hit rate. Clin. Anat., 33:683-688, 2020. © 2019 Wiley Periodicals, Inc.

Introduction: Differences of anatomical characteristics regarding side and gender have been the topic of interest in various recent studies. Studies have reported either significant or insignificant differences of the bony pelvis. The aim of this study was to evaluate possible gender and side differences of the pelvis in a cadaveric model. Material and Methods: Fifty human cadaver pelves, preserved by the use of Thiel's method, underwent measurement during this study. Diverse parameters were measured on both hemipelves by three surgeons. Analysis of the morphology of the acetabular cavity was performed by measuring its longitudinal, horizontal, and maximal diameters. Results: The distance between the anterior superior iliac spine and the posterior superior iliac spine (females: mean of 15.9 cm; males: mean of 16.9 cm) and the horizontal diameter of the acetabular cavity (females: mean of 4.5 cm; males: mean of 4.9 cm) were statistically significantly shorter in females than in males. The subpubic angle was significantly (P

The aim of this study was to evaluate the anatomical characteristics of the anterolateral ligament of the knee (ALL) with the focus on potential gender differences. The ALL length and the length of the lateral collateral ligament (LCL) were taken in extension. The length of the anterior cruciate ligament (ACL) was measured at 120° flexion. We correlated the length of the ALL with the LCL and ACL with respect to potential gender differences. The ALL was significantly (p = 0.044) shorter in females (mean length: 32.8 mm) compared to males (mean length: 35.7 mm). The length of the ALL correlated significantly positively with the lengths of the ACL (p

Purpose To describe a minimally invasive approach to find the radial nerve (RN) simply and safely by tracing the posterior antebrachial cutaneous nerve (PACN) without damaging muscles, using only the surgeon's hand to define a window for the skin incision. Background Although it is absolutely necessary to locate the radial nerve during osteosynthesis of the humerus, the literature lacks guidelines on how to do so. Methods We have dissected the upper extremities of 54 adult human cadavers, embalmed using Thiel's method. After the PACN was identified in a defined space, its course was traced proximally by incising the lateral intermuscular septum (LIS) of the upper arm and thereby reaching the radial nerve (RN). Subsequently, using the lateral epicondyle (LE) of the humerus as a reference point, the distances to the points where the PACN perforated the LIS, and where the RN was identified, were measured. These individual data were related to the total length of the humerus. Results The results indicate that with this approach and without harming musculature, the RN can be reached by tracing the PACN at a height of 11.1–13.0 cm (females) and 11.9–14.0 cm (males) starting from the LE. Conclusion Our examination shows the PACN to be a convenient guide to the RN.

The posterior interosseous nerve (PIN) is at risk during the posterior and lateral approaches to the proximal radius. We aimed to define a safe zone for these approaches to avoid injury of the PIN and to evaluate their close and changing relationship to the nerve during forearm rotation. The study collective consisted of 50 upper limbs. After performance of the lateral approach, the distance between the tip of the radial head and the PIN’s exit point from the supinator (= distance 1) and the shortest interval between the nerve’s exit to the radial margin of the ulna (= distance 2) were measured in maximum pronation and supination. Then, the dorsal approach was conducted and again distance 1 and the interval between the distal margin of the anconeus and the nerve’s exit point (distance 2) were evaluated (pronation and supination). There were significantly shorter distances during supination in comparison to pronation. Regarding the lateral approach, distance 1 changed from a mean of 60.3 mm (supination) to 62.7 mm in pronation (p

Background Opinions vary concerning the position of forearm rotation during detachment of the supinator in radial nerve palsy Henry’s and Thompson’s approaches. Purpose To define the optimal forearm position for a safe detachment of the supinator during these approaches and to clarify their close relationship to the posterior interosseous nerve (PIN). Methods The study sample comprised 90 upper extremities of 45 human adult cadavers, embalmed using Thiel’s method. After detection of the radial nerve in the interval between the brachialis and brachioradialis, its pathway was traced to the Arcade of Frohse (AF). Measurements involved the distance between the AFand the radial border of the distal biceps tendon (DBT) in pronation and supination, the interval between the AF and the radiocapitellar joint space (RCJS) in supination and the radial length (RL). Results Distances between the DBT and the AF were significantly shorter during pronation (right side: 14.1 ± 3.4 mm; left side: 13.5 ± 3.2 mm) compared with supination (right side: 20.5 ± 3.6 mm; left side: 19.8 ± 3.5 mm) for both right and left extremities. The mean interval between the AF and the centre of the RCJS was 25.2 ± 5.9 mm for the right side and 24.7 ± 5.6 mm for the left side, which correlated positively with the RL. Conclusion These results indicate a safe detachment of the supinator from the radius with the forearm placed in supination during both Henry’s and Thompson’s approaches.

Xenobiotics and drugs may lead to cholangiopathies and biliary fibrosis, but the underlying mechanisms are largely unknown. Therefore, we aimed to characterize the cause and consequences of hepatobiliary injury and biliary fibrosis in 3,5-diethoxycarbonyl-1,4-dihydrocollidine (DDC)-fed mice as a novel model of xenobiotic-induced cholangiopathy. Liver morphology, markers of inflammation, cell proliferation, fibrosis, bile formation, biliary porphyrin secretion, and hepatobiliary transporter expression were studied longitudinally in DDC- and control diet-fed Swiss albino mice. DDC feeding led to increased biliary porphyrin secretion and induction of vascular cell adhesion molecule, osteopontin, and tumor necrosis factor-alpha expression in bile duct epithelial cells. This was associated with a pronounced pericholangitis with a significantly increased number of CD11b-positive cells, ductular reaction, and activation of periductal myofibroblasts, leading to large duct disease and a biliary type of liver fibrosis. After 4 weeks, we constantly observed intraductal porphyrin pigment plugs. Glutathione and phospholipid excretion significantly decreased over time. Expression of Ntcp, Oatp4, and Mrp2 was significantly reduced, whereas Bsep expression remained unchanged and adaptive Mrp3 and Mrp4 expression was significantly induced. We demonstrate that DDC feeding in mice leads to i) a reactive phenotype of cholangiocytes and bile duct injury, ii) pericholangitis, periductal fibrosis, ductular reaction, and consequently portal-portal bridging, iii) down-regulation of Mrp2 and impaired glutathione excretion, and iv) segmental bile duct obstruction. This model may be valuable to investigate the mechanisms of xenobiotic-induced chronic cholangiopathies and its sequels including biliary fibrosis.

Summary Introduction The success rate of surgical retrograde treatment of an infected root apex is limited by the existence of infected side canals which are not treatable by conventional retrograde preparation and filling techniques. This experimental study introduces a new technique of retrograde apex preparation followed by covering the apex with a titanium cap. Material and methods In 10 extracted canines, retrograde circular preparation of the root apex was performed using a new ultrasonic preparation tip and a high-power ultrasound machine. The prepared stump was covered by a titanium cap fixed with glass ionomer cement. The teeth were examined clinically and radiologically for unevenness, steps or clefts in the border between the titanium cap and root surface. Furthermore, a histological work-up was performed to register the existence and number of side canals, as well as their covering by the titanium cap and the width of the cement layer. Results The clinical and radiological examinations revealed only a small degree of unevenness in one case. In all other teeth the border was without any unevenness. There were 0 – 4 side canals as noted in the histological cross sections, all of which were covered by the titanium cap. The mean width of the cement layer was 27.2 μm. From a technical point of view there were no difficulties or complications. Clinical case report For demonstration of the clinical use, a case of a 32-old-patient with an apical cyst on an upper lateral incisor is reported. The patient was treated successfully by apical capping. Conclusions Apical capping is a new technique for retrograde treatment of an infected root apex which seals all side canals effectively. The technique is easy to perform and can be carried out quickly without complications. The technique is suitable for clinical testing.

To explore the many osseous irregularities that are found in the area between the basiocciput, the anterior arch of the atlas and the tip of the dens axis we studied 99 cadaver specimens using magnetic resonance tomography (MRT), computed tomography (CT), median saw-cut sections, and histological sections. Additionally, "dry" specimens of the skull (n = 110), atlas (n = 56), and axis (n = 33) were investigated. In the median plane, the dry and cadaver specimens exhibited osteoarthritis-related osseous outgrowths and osteophytes of the articular surfaces of the median atlanto-axial joint (n = 63), and the presence of congenitally developed free ossicles (n = 22) and of third occipital condyles (n = 3). The largest osteophytes (giant osteophytes) (n = 4) of the anterior arch of the atlas formed osseous contact zones with the basiocciput that were visible histologically as real joints and were designated accessory median atlanto-occipital joints. The third occipital condyles also formed osseous contact zones, visible histologically as real joints, with the anterior arch of the atlas or with the tip of the dens, and were designated accessory atlanto-occipital or occipito-odontoid joints. Frequent free ossicles, incorporated into the accessory joint, were found by histological examination to be covered with hyaline cartilage.

Due to frequent changes in the anatomical nomenclature of the arteries in the posterior cervical triangle (lateral cervical region), anatomical and surgical papers relating to these topics are sometimes difficult to understand and are hard to compare. These changes, coupled with improper knowledge of the gross anatomy and nomenclature of the arteries in the posterior cervical triangle, have presented difficulties in musculocutaneous flap planning, especially in plastic and reconstructive surgery. As an illustration of this concern, the term, transverse cervical artery (A. transversa colli [cervicis]), and its associated branches, have been used frequently over the past several decades with different meanings. In an effort to address this nomenclature challenge and to offer a rational basis for arguing specific name changes, a total of 498 neck-halves were investigated in Graz, Innsbruck, and Munich. Lateral neck dissections were carried out to expose the subclavian artery and those branches destined for the posterior cervical triangle, specifically, the superficial cervical artery, the dorsal scapular artery, and the suprascapular artery. The course of these arteries and details of their origins and branching patterns were documented. Several arose either as direct branches or from trunks. The convention used in labeling trunks was similar to that described for other trunk formations in the body (e.g., linguo-facial trunk). Four trunks were observed and named according to the branches that arose from each. A cervico-dorsal trunk gave origin to the superficial cervical and dorsal scapular arteries, and was found in 30% of cases. A cervico-scapular trunk gave rise to the superficial cervical and suprascapular arteries in 22% of cases, and a dorso-scapular trunk provided origins for the dorsal scapular and suprascapular arteries in 4% of cases. A cervico-dorso-scapular trunk gave origin to the superficial cervical artery, the dorsal scapular artery, and the suprascapular artery, and was found in 24% of cases. Each of these trunks, in turn, arose from either the subclavian artery or from the thyrocervical trunk. This labeling convention necessitated omitting the term, transverse cervical artery, because this term has become inherently imprecise and variously used over the years. This study describes a simple, uniform, and rational basis for standardizing the nomenclature of the arteries in the posterior cervical triangle. Clin. Anat. 18:553–557, 2005. © 2005 Wiley-Liss, Inc.

Phrenic Nerves and Cardiac Structures. Background: Phrenic nerve injury is a recognized complication following cardiac intervention or surgery. With increasing use of transcatheter procedures to treat drug-refractory arrhythmias, clarification of the spatial relationships between the phrenic nerves and important cardiac structures is essential to reduce risks. Methods and Results: We examined by gross dissection the courses of the right and left phrenic nerves in 19 cadavers. Measurements were made of the minimal and maximal distances of the nerves to the superior caval vein, superior cavoatrial junction, right pulmonary veins, and coronary veins. Histologic studies were carried out on tissues from six cavaders. Tracing the course of the right phrenic nerve revealed its close proximity to the superior caval vein (minimum 0.3 ′ 0.5 mm) and the right superior pulmonary vein (minimum 2.1 ′ 0.4 mm). The anterior wall of the right superior pulmonary vein was

In 1993 Angrigiani raised the question as to whether the distal part of the posterior interosseous artery (AIP) is a recurrent branch of the anterior interosseous artery (AIA) and forms a "choke"--anastomosis with the AIP in the middle of the forearm. A dissection study was conducted on 66 upper extremities to evaluate the diameters of the dorsal branch of the anterior interosseous artery, the anastomotic branch, the diameter of the posterior interosseous artery at the point of origin of the septocutaneous perforators in the middle of the forearm and the diameter of the posterior interosseous artery at the point of emergence in the dorsal compartment. We further tried to identify different forms and types of the "distal" anastomosis and the connections to the dorsal carpal arch and the ulnar artery. A distal anastomosis between the AIA and AIP was found in 65 of the 66 upper extremities. Three different types of anastomosis could be identified. The smallest diameter was found at the middle of the forearm (mean diameter AIA 1.28 mm; anastomotic branch 0.6 mm; AIP at the middle of the forearm 0.39 mm; AIP prox. 1.35 mm). A branch through the fifth extensor compartment was present in all of our specimens (mean diameter 0.54 mm). A branch through the forth extensor compartment could be found in 16 specimens. Based on our findings and the embryological development, we conclude that the AIP is only present in the proximal half of the forearm. In the distal part, the dorsal branch of the anterior interosseous artery forms a vascular arcade, which gives off branches to the dorsal carpal arch, the ulnar head and the ulnar artery. This arcade anastomoses with the posterior interosseous artery in the middle of the forearm by means of a choke anastomosis. We also conclude that the term "recurrent branch of the anterior interosseous artery" for the distal part of posterior interosseous artery is correct.

Grundlagen: Die Praparation der Zugangswege zum distalen Radius ist durch die besondere Anatomie der Sehnen, Sehnenscheiden, Muskeln, Gefase und Nerven erschwert.

The aim of the study was to evaluate the occurrence of the anatomical variations of the musculotendinous junction of the flexor carpi ulnaris (FCU) muscle and the variations of its insertion onto the pisiform. One hundred cadaver specimens preserved according to Thiel's method were assessed. Following careful dissection, the distance between the musculotendinous junction and the pisiform and the width of the muscle belly were determined. Three typical anatomical variations were found: 1) a large muscle belly running distally almost to the insertion onto the pisiform; 2) the muscle belly ending more proximally, with some large fibres running parallel to the tendon and almost reaching the pisiform; 3) the musculotendinous junction ending more proximally, with only single fibres continuing distally. The length of the tendon was greater than 10 mm. A number of variations of the distal region of FCU were observed. The presence of muscle fibres almost reaching the insertion point onto the pisiform have to be considered when interpreting MRI or ultrasound findings of this region.

The thenar region was studied with ultrasonography in 10 healthy volunteers. All thenar muscles could be identified and their course followed entirely. In addition, their function could be assessed by scanning during unresisted or resisted active movements. Standard approach, normal appearance, and dynamic tests for each muscle are described.

Eight portals are used for wrist arthroscopy, five for the radiocarpal joint and three for the midcarpal space. These portals pass between important vessels and cutaneous nerves and the extensor tendons underlying the extensor retinaculum and permit access to the common pathologies of the wrist joints. The portals can be safely established making precise use of the external landmarks and are associated with little soft tissue damage and few complications when performed gently and through the dorsal side of the wrist. Clin. Anat. 12:179–185, 1999. © 1999 Wiley-Liss, Inc.

Up to now, there is no uniform anatomic description neither of the branches of the subclavian artery nor of the pedicle of the lower myocutaneous trapezius flap. A dissection study was carried out on 140 necks in 70 cadavers. Variations of the subclavian artery and its branches, vessel diameter at different levels, the course of the pedicle under the levator scapulae muscle, the arc of rotation of the island flap, and the variations of the segmental intercostal branches to the lower part of the trapezius muscle were examined. Results of this study enable us to suggest a new nomenclature for the branches of the subclavian artery, a proper pedicle definition, and a technique for safe flap elevation. The lower trapezius island flap is a thin and pliable myocutaneous flap with a constant pedicle which ensures safe flap elevation. This flap has the potential for a wider acceptance due to minor donor site morbidity, large arc of rotation, and an ample range of clinical applications in the head and neck area as an island flap as well as a free flap.

The attachment point of the transverse lig. of the atlas was investigated in a series of 234 human skeletons of different ages and 42 cadaver dissections. This attachment point was found to be a bony bump at the lateral mass of the atlas which we called thecolliculus atlantis. These findings were confirmed by a retrospective study of more than 20.000 radiographs of the cervical spine. Furthermore, the study showed that thecolliculus atlantis is developed by age 13 at the latest and that it is visible in the open-mouth view radiograph. The rare absence of thecolliculus atlantis in the adult was found to be associated with lack of tension in the transverse lig. and thus at its attachment points due to dysfunction of the craniocervical joints. This dysfunction may be congenital (e.g. Morquio's syndrome, Kniest's syndrome) or acquired before age ten (e.g. trauma). In conclusion, the attachment point of the transverse lig. was found to be a product of normal function of the craniocervial junction and changes in the morphology and site of thecolliculus atlantis in certain inflammatory processes (e.g. juvenile chronic polyarthritis, salmonellar spondylitis) or injuries (Jefferson's fracture) allow an early diagnosis followed by an early adequate therapeutic procedure

The aim of this study was to determine the position, shape, number and radiographic appearance of the mental foramen in a selected Kosovarian population. Five hundred panoramic radiographs of dental Kosovarian patients were selected and analyzed according to the mental foramen position, shape, radiographic appearance, number and symmetry. The mean distance in the horizontal plane of the mental foramen to the posterior border of the mandibular ramus was 67.5 mm and for distance from the mental foramen to symphysis menti 24.84 mm. In the vertical plane the mean distance of the mental foramen to alveolar crest was 20.38 mm and 14.68 mm for distance of the mental foramen to the lower border of mandible. The majority of mental foramen was oval in shape and the most frequent radiographic appearance was the separated type. Accessory mental foramina were detected in1% of the cases and the mental foramen was not bilaterally symmetrical but no statistical differences were found. This study showed that the most common position of the mental foramen investigated using panoramic radiographs from a selected group in Kosovarian population was between the first and second mandibular premolars with distinct tendency to be positioned near to the second mandibular premolar.

Aim To describe vascular anatomy of the maxillary sinus in dentate specimens dissected from human cadavers. Methods Twenty dentate maxillary specimens were dissected, anatomically prepared, and injected with liquid latex for a better visualization of the maxillary sinus artery. Results We found an intraosseous anastomosis in 100% and an extraosseous anastomosis in 90% of the cases. The anterior lateral wall of the maxillary sinus was transversed by two anastomoses between the posterior superior alveolar artery (PSAA) and the infraorbital artery (IOA). The PSAA was divided into a gingival and dental branch. The gingival branch anastomosed with the terminal extraosseous branch of the extraosseous anastomosis (EOA) and the dental branch with the intraosseous branch of the intraosseous anastomosis (IOA). The mean distances from the alveolar ridge to the extraosseus anastomosis were 16 mm for the second maxillary molar, 12.3 mm for the first maxillary molar, and 13.1 mm for the second maxillary premolar. The mean distances from the intraosseous anastomosis to the alveolar ridge were 17.7 mm for the second maxillary molar, 14.5 mm for the first maxillary molar, and 14.66 mm for the second maxillary premolar. Conclusion These findings provide relevant data for clinical dentistry in order to avoid bleeding complications and minimize the risk of injury to the arterial network of the maxillary sinus during surgical procedures in the dentate maxilla region.

Differences in the description of the blood supply of the lower trapezius m. and the fact that all former findings are based on very few cases caused us to reinvestigate the arterial supply of the lower trapezius m. Based on the anatomic investigation of 70 human cadavers, the trapezial branch of the dorsal scapular a. was found to be the constant vessel to the lower trapezius m. The origin of the dorsal scapular a., however, was found to be very variable. In 45% it was a direct branch of either the subclavian a. or the costocervical trunk. In the remaining 55% the dorsal scapular a. formed different trunks with the superficial cervical a. and/or suprascapular a. branching off either the subclavian a., the thyrocervical trunk, or the internal thoracic a. Additional segmental musculocutaneous perforators also supply the lower part of the trapezius m. and the overlying skin. Consequently, the lower or ascending part of the trapezius m. has a vascular pattern type V. Thus, the lower trapezius musculocutaneous flap merits consideration in head and neck reconstruction.

The anatomy of the facial nerve canal in the adult and the prenatal development of this canal are well described in the literature. It is divided into three segments (the labyrinthine segment, the tympanic segment and the mastoid segment). However, little is known of the facial canal anatomy in the newborn and almost nothing in the child. Postnatal changes in the development of the facial canal are directly connected with the postnatal development of the temporal bone. Particularly the development of the mastoid process and the bony external ear canal contribute to the development of the third (mastoidal) portion of the facial canal. Therefore, most of the postnatal changes in the facial canal are observed in this segment. However, the second (tympanic) portion also shows some postnatal changes in its direction caused by the changes of the squamous bone. The most significant changes take place during the first four years after birth. Provided with the anatomical description of the entire facial canal in the child, it is also easy to identify the canal on computed tomography scans. In summary, the first and the second part of the facial canal in the child are almost similar to the adult in length and in width; the only change from the newborn to the adult is in the direction of the second part which is more horizontal in the adult than during early childhood. The most significant changes are the changes in the length of the mastoidal part, the change in the position of the stylomastoid foramen and the change of the divergence of the chorda tympani.

Modern surgical techniques depend in part on knowledge of both the "normal" and the anomalous arterial blood supply. For instance, in liver transplantation, during surgery of the gallbladder, gastrectomy, and gastric lymphadenectomy, or when selective arterial chemotherapy is used for treatment of liver cancer, aberrant hepatic arteries can be a significant problem. A series of 138 cadavers with arterial latex injection were dissected and 10 corrosion casts were made to obtain an exact knowledge of the topography of the normal and anomalous arteries of the lesser omentum in humans. The so-called normal anatomy was found in only 9% (15 of 148 individuals), the remaining five-sixths presenting some variations from this, many of direct surgical importance. In these cases one or two aberrant hepatic arteries (37%), an artery in the free border of the hepatoduodenal ligament (19%), a right hepatic artery crossing the portal vein posteriorly (4%), the right hepatic artery entering the triangle of Calot anteriorly (29%) or not (7%), or an accessory left gastric artery branching off the left hepatic artery (2%) were found.

Volumetric data can be used as complementary information to characterize grafting materials. The aim of this cadaveric study was to analyze a noncommercial measurement technique based on the novel concept of an "interactive rigid registration algorithm" (IRRA). Parameters analyzed included the reproducibility of IRRA measurements and their reliability in comparison with the established measurement technique of "region growing segmentation thresholding" (RGST).Three human skulls were used to simulate a total of 18 sinus grafts, using three incremental grafting procedures in each sinus (three skulls ×t wo sinuses × three grafting increments). Radiopaque impression material was used for the simulated grafts, whose volumes were recorded by computed tomography from three different tilt angles. The reproducibility of IRRA measurements and the reliability of volumetric results obtained with both the IRRA and RGST techniques were evaluated by appropriate intraclass correlation coefficient (ICC) and Bland-Altman analysis.ICC greater than 0.9 indicated close to perfect agreement of the results obtained with both methods and good reproducibility of the IRRA measurements. Bland-Altman analysis demonstrated good inter-method and intramethod agreement.The IRRA measurement technique can be recommended as a noninvasive tool to evaluate graft volumes in human maxillary sinuses.

Johannes M. Mayr1,*, Wolfgang Grechenig2, Ursula Seebacher3, Andreas Fette3, Andreas H. Weiglein4 and Sergio Sesia1 1Department of Pediatric Surgery, University Children’s Hospital Basel, Basel, 2Medical University of Graz, Graz, Department of Traumatology 3Medical University of Graz, Department of Pediatric Surgery 4Department of Anatomy, Medical University of Graz, Graz 1Switzerland 2,3,4Austria

The facial canal containing the intratemporal portion of the facial nerve is very important for the otologist and radiologist concerning fractures and other lesions of the temporal bone. Axial and/or coronal standards are sufficient for imaging of the labyrinthine and the mastoidal segment of the facial canal. The sensitivity of visualization (sensitivity = number of identified structures per number of examinations) of the tympanic segment, however, is low and particularly the pyramidal segment (elbow, posterior knee) is not visualized in these standards. Based on anatomical considerations a new plain for imaging both the tympanic and mastoidal segment in continuity was obtained. The pyramido-longitudinal plain is achieved by a twice angulated 2-D-reconstruction based on axial high-resolution CT-scans.

Grundlagen: Chirurgisch relevant ist praktisch jede der zahlreichen makroskopisch erkennbaren Variationen. Jene an den Extremitaten sind allerdings wohl in den seltensten Fallen lebensgefahrlich, jedoch konnen einige auf eine korrekte Diagnostik, auf den Erfolg eines chirurgischen Eingriffes und auf die Lebensqualitat danach entscheidende Auswirkungen haben.

Grundlagen: Die Carpalknochen erhalten ihren Zuflus von anastomosierenden Gefasen rund um den Carpus. Die wichtigsten Arterien sind die A. radialis, ulnaris und A. interossea ant., von denen auf der palmaren und dorsalen Seite Gefasbogen ausgehen.

An Augenhohlen von 70 menschlichen fetalen Schadel wurden Messungen der Breite und Hohe des Orbitaeinganges, sowie des Volumens der Augenhohle durchgefuhrt.

The development of the orbits in 70 human fetal skulls was investigated by measuring the width and height of the orbital entrance, as well as the volume and depth of the orbital cavity and the interorbital width. For determination of the orbital volume, we used the imprint method; the remaining parameters were estimated. Our measurements showed a linear growth rate for the orbital width, height, and depth. After transformation to the cubic root, the values of the orbital volume also demonstrated a linear increase. The orbital index (height/width x 100) expressed the change in the oval outline of the orbital entrance during fetal development from a flat, wide form to a nearly round form at birth. No statistically significant difference between the right and left orbit was found.

Knowledge of the position of the mental foramen is very important during all surgical procedures and it needs to be considered before all surgical procedures in the mandible region. The aim of this study was to determine the position of the mental foramen in the dissected human cadaver specimens. Four hundred hemimandible specimens from human cadavers were dissected and analyzed for the position of the mental foramen. The most common position of the mental foramen investigated – using anatomical dissection – was between the first and second mandibular premolars. These investigations provide relevant data for clinical anatomy, especially when planning oral operative treatment in the premolar area.

The aim of this study was to provide guidance on the safe zones for the exposure of the proximal radius by measuring the distance from the PIN to various anatomical landmarks in the proximal forearm in pronation and supination.Twenty cadaveric arms were used for this study. On the anterior aspect of the forearm, the distance between insertion of the biceps tendon and the arcade of Frohse as well as the shortest distance between the PIN and the ulnar aspect of the radial neck were measured. On the posterior aspect of the forearm, the shortest distance between the PIN and the ulnar border of the interosseous membrane was measured at 30 and 50 mm distal to the articular surface of the radial head.The distance between the PIN and ulnar aspect of the radial neck had a mean of 21.6 mm in supination and 13.3 mm in pronation. The distance between the radial tuberosity and the arcade of Frohse was 18.6 mm. The mean distance between the PIN and the radial border of ulna at 30 mm distal to the articular surface of the proximal radius was 12.3 mm in supination and 22.3 mm in pronation. At 50 mm distal to the articular surface of the proximal radius the mean distance was 8 mm in supination and 16.2 mm in pronation.The course of this nerve is variable as it winds around the radial neck within the belly of the supinator muscle. Safe distances for dissection have been presented in our study.

The morphology of the inferior alveolar nerve is a very important factor for all surgical procedures in the mandibular region. The aim of this anatomical and histological study was to describe the intramandibular course and the microscopic histology of the inferior alveolar nerve in the dissected human cadaver. Twenty partially dentulous hemimandible specimens from human cadavers were dissected and embalmed, and the findings were interpreted by standard and histological imaging. The result of this study showed that the inferior alveolar nerve comprises two larger nerves that are separately wrapped in perineural sheaths and spirally twisted around each other. The mental nerve exits through the mental foramen in the premolar region and the dental nerve continues from the premolar region as the incisive nerve in the incisive canal. These findings provide relevant data for clinical dentistry, especially when planning oral and dental operative treatment procedures in the mandibular region.