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Background: The objective of this study is to investigate the position and frequency of dehiscences in the medial orbital wall and to reveal that dehiscences and orbital adipose tissue hernias are distinct entities. Materials and methods: Two hundred-thirty medial orbital walls of 115 patients with a preliminary diagnosis of headache and sinusitis but without active ethmoidal sinusitis were examined by computer tomography in the axial plane. Two separate radiologists assessed continuity of the medial orbital wall and orbital fat tissue herniation in ethmoid cells. The medial orbital wall was divided into four quadrants and the dehiscence distribution was evaluated. Results: Bone defects were detected in 71 patients (30.9%) in 230 orbital medial wall reviews of 115 patients (59 males, 56 females). Eight of these cases (4 male, 4 female) (3.5%) had herniation of the orbital adipose tissue into the ethmoid sinus. Of the 108 dehiscences, 47 were localized in the posterior upper quadrant. A statistically significant difference was found in the dehiscence distribution according to the quadrants. No significant relationship was found among age, gender, side of dehiscence and frequency of dehiscence. Conclusions: Dehiscences in the posterior upper quadrant are more common in the medial orbital wall. Although bone dehiscences in the medial orbital wall and the herniation of the orbital fat tissue are two different entities, they are used interchangeably in most of the literature and in radiological reporting.

Background/aim The aim of this study was to measure the volume of interscalene space in thoracic outlet region on cadavers and radiological images and to analyze the potential value of these measurements in diagnosis and treatment of thoracic outlet syndrome (TOS). Materials and methods The dimensions of the anterior interscalene space in 8 formalin-fixed human cadavers were studied by direct measurement and additionally evaluation of the volume of this space were done by using mold and volume calculation formula of square pyramid, due to resembling a pyramid. In the second phase of this study, interscalene space volume was calculated by formula and compared to calculations from computed tomography (CT) sections in 18 TOS and 16 control patients. Results There was a strong correlation between the volume calculated by formula (4.79 ± 2.18 cm3) and by mold (4.84 ± 1.58 cm3), (R = 0.934, p = 0.001) in cadavers. The average volume measured in TOS patients (2.05 ± 0.32 cm3) was significantly smaller than control patients (4.30 ± 1.85 cm3, p < 0.0001). There were excellent or good results in 14 patients whereas in 4 patients who had neurogenic TOS achieved fair results after surgery. In these 4 patients the average volumes of abnormal sides were close to the healthy sides. Conclusion In our study, volume of interscalene space in TOS patients was statistically smaller than control group. Also, the volume was even smaller in patients with excellent or good results after surgery. In this respect, volumetric measurements from CT sections could be used in diagnosis and treatment selection in TOS patients.

Aim The aim of this study was to evaluate the arterial collateral vasculature between the superior mesenteric artery and the inferior mesenteric artery (IMA) from a surgical perspective. Method A total of 107 fresh adult cadavers (94 male) were studied with emphasis on the vascular anatomy of the left colon. Dissections were carried out mimicking the anterior resection technique. The vasculature of the left mesocolon and the collaterals between the superior mesenteric artery and the IMA with respect to their relationship to the inferior mesenteric vein (IMV) were assessed and classified. Collaterals were classified into three different groups: marginal anastomoses (via the marginal = pericolic artery), intermediate mesocolic anastomoses (parallel to the marginal artery but neither adjacent to the IMV nor close to the duodenum) and central mesocolic anastomoses (next to the IMV at the level of the duodenojejunal junction and the lower border of the pancreas). Results All patients had a marginal anastomosis. However, the marginal anastomosis, as the only anastomosis between the superior and inferior mesenteric arteries at the splenic flexure, was observed in 41 cases (38%). In addition to the marginal artery, intermediate mesocolic anastomoses were found in 49 (46%) and a central mesocolic anastomosis was observed in 17 (16%) of the 107 cases in the splenic flexure mesocolon. It is in this latter variant that collateral vessels can be compromised during ligation/transection of the IMV. Conclusion This new classification can contribute to a precise mesocolic dissection technique and splenic flexure mobilization and help prevent ischaemic damage to the descending colon.

Orbita medial duvarını oluşturan kemik yapılar lakrimal kemiğin lateral ya da orbital yüzü, maksiller kemiğin frontal prosesi, ethmoid kemiğin lamina papyracea’sı ve sfenoid kemiğin korpusudur. Paranazal sinüsler (PNS) çok fazla varyasyonun görüldüğü bir bölgedir. Kemik yapılar çok ince olup dehisanslar sık görülür [ONODİ 1909]. Bu çalışmamızda standart PNS BT incelemesi yapılan hastalarda kemik devamlılığın bozulduğu vakaların sıklığını, yaş ve cinsiyet ilişkisini araştırmayı, orbita medial duvarındaki kemik defektlerin saptanması konusunda Bilgisayarlı Tomografi etkinliğinin ortaya konulmasını, ayrıca geniş bir literatür taraması ile bu malformasyon konusunda yapılan paylaşımlardaki terminolojik farklılıkların vurgulanmasını amaçladık. Paranazal sinüslere yönelik olarak uygun şartlarda çekilen Bilgisayarlı Tomografi (BT) sinonazal anatomi ve varyasyonları hakkında detaylı bilgiler verir. Çekimler GE marka IQ model 32 dedektörlü spiral cihaz ile, 130 kV voltaj ve 80-120 mAs değerleri kullanılarak kemik protokolüne uygun olarak yapılmıştır. 115 hastaya (59 erkek, 56 kadın) ait 230 orbita medial duvar incelemesinde 71 adet (%30.9) kemik defekt saptandı (34 erkek, 37 kadın). Bu vakaların 8’inde (4 erkek, 4 kadın) (% 3.5) orbital yağ dokusunun etmoid sinüs içerisine herniasyonu mevcuttur. Çalışmamızda herniasyon bulunmayan kemik devamlılık kaybı literatürde bahsedilenden fazla bulunmuştur. BT incelemelerinde belli kalınlığın altındaki düşük dansiteli kemik yapının dansite farklılığının ayırt edilememesinin bu sayıdaki büyüklüğün sebebi olabileceği ve bulguların BT çekilen kadavra spesimenlerinde dehisans saptanan örneklere mikrodiseksiyon yapılarak teyit edilebileceği düşünülmüştür. Sonuç olarak radyolojistlerin PNS CT değerlendirmesinde herniasyon olsa da olmasa da mutlaka bu dehisansların varlığını araştırmaları gerektiği, yapılan yorum ve çalışmalarda herniasyon ve dehisans / Gap kelimelerinin doğru kullanılmasına daha fazla özen gösterilmesi gerektiği kanaatindeyiz.

Background/aim: The aims of this study are to determine the incidence and more frequent localizations of orbital fat tissue herniation accompanying dehiscences in the medial orbital wall and to investigate the relationship between orbital fat tissue herniations and the anterior and posterior ethmoidal foramina. Material and methods: One thousand two hundred patients who had undergone computed tomography with a preliminary diagnosis of sinusitis and who had no previous facial, orbital, paranasal sinus surgeries or history of trauma were retrospectively analyzed. The localization of the ethmoidal foramina and orbital fat tissue herniations were marked. In patients with orbital fat tissue herniation, the relationship between the localization of orbital fat tissue herniation and the anterior and posterior ethmoidal foramina was investigated. Results: The incidence of orbital adipose tissue herniation in our study was 7.9%. Of the 98 herniations on the bilateral medial orbital wall, 60 were in zone 3, and the most common herniation site was zone 3. A statistically significant difference was noted between the localization zone of the anterior ethmoidal foramen and the localization zones of orbital fat tissue herniations (Fisher's exact test, p < 0.001). Conclusion: Zone 3 is the weakest area of the medial orbital wall, and zone 3 is the most prone to herniation of fat tissue. The association of orbital fat tissue herniations with the anterior ethmoidal foramen is extremely common. Being cognizant of this finding may help a surgeon better estimate the anatomical view to be met before functional endoscopic sinus surgery as well as to minimize the risk of possible orbital complications, especially anterior ethmoidal artery injury.

The aim of this study is to re-define the anatomical structures which are important for blocking the sciatic nerve and the nerves within the adductor canal which innervate the knee joint through the same injection site. We also aimed to investigate the spread of the anesthetic toward the areas in which the mentioned nerves lie on cadavers. This study was performed on 16 lower extremities of formaldehyde-embalmed eight adult cadavers. The anatomy of adductor canal, courses of the nerves within the canal and the relationships of the saphenous, medial femoral cutaneous, medial retinacular, posterior branch of the obturator and sciatic nerves with each other and with the fascial compartments were investigated. Transverse sections that crossed the superior border of vastoadductor membrane were taken to reach the sciatic nerve in the shortest way. Colored latex was injected to demonstrate the anesthetic blockage of the targeted nerves. The structures along the needle’s way were investigated. The saphenous, medial femoral cutaneous and at its distal part posterior branch of the obturator nerve were colored with latex within the adductor canal. The nerve to vastus medialis (in other words, the medial retinacular nerve) lay beneath the fascia of vastus medialis and did not enter the adductor canal. There was a fascial plane which did not allow the passage of colored latex toward the sciatic nerve. To traverse this fascial structure, it was found out to be necessary to insert the needle perpendicular to both the vertical and transverse axes of the thigh and then advance it along 2/3 of diameter of the thigh. Thus, the colored latex was observed to fill the compartment where the sciatic nerve lay within. Blocking the sciatic nerve and the nerves within the adductor canal which innervate the knee joint through the same injection site seems anatomically possible without injuring any neurovascular structures.

The purposes of this study were to identify possible compression points along the transit route of the subclavian artery and to provide a detailed anatomical analysis of areas that are involved in the surgical management of the thoracic outlet syndrome (TOS). The results of the current study are based on measurements from cadavers, computed tomography (CT) scans and dry adult first ribs.The width and length of the interscalene space and the width of the costoclavicular passage were measured on 18 cervical dissections in 9 cadavers, on 50 dry first ribs and on CT angiography sections from 15 patients whose conditions were not related to TOS.The average width and length of the interscalene space in cadavers were 15.28 ± 1.94 mm and 15.98 ± 2.13 mm, respectively. The widths of the costoclavicular passage (12.42 ± 1.43 mm) were significantly narrower than the widths and lengths of the interscalene space in cadavers (P 0.05). The average width and length of the interscalene space (groove for the subclavian artery) in 50 dry ribs were 15.53 ± 2.12 mm and 16.12 ± 1.95 mm, respectively. In CT images, the widths of the costoclavicular passage were also significantly narrower than those of the interscalene space (P 0.05). The measurements from cadavers, dry first ribs and CT images were not significantly different (P 0.05).Our results showed that the costoclavicular width was the narrowest space along the passage route of the subclavian artery. When considering the surgical decompression of the subclavian artery for TOS, this narrowest area should always be kept in mind. Since measurements from CT images and cadavers were significantly similar, CT measurements may be used to evaluate the thoracic outlet region in patients with TOS.

Amaç: Bu çalışmanın amacı beyin arterlerinin üç boyutlu yapısını koruyarak korozyon tekniği kullanarak ortaya çıkarmak. Korozyon yöntemi daha önce koroner ve testiküler arterleri göstermede kullanılmış olmasına rağmen beyin arterlerini göstermede ilk defa kullanılmıştır. Metod: Taze insan beyni her iki internal karotid ve baziller arterlerinden kanülize edilerek irrige edildi. Ardından renklendirilmiş polyester ile dolduruldu. Korozyon işlemi için dilüe sülfirik asit ile dolu kabın içinde bekledikten sonra su ile geride kalan küçük atıklar dikkatlice temizlendi. Bu şekilde beynin üç boyutlu yapısı ortaya çıkarıldı. Sonuçlar: Enjeksiyon-korozyon yöntemi en derin yerleşimdeki vasküler yapıları dahi üç boyutlu yapısı ile ortaya çıkarabilen yeni bir ekspozisyon yöntemidir. Tartışma: Vasküler yapılar normalde kadaverik diseksiyon yöntemi ile ortaya çıkarılmaktadır. Bu şekilde yapılan diseksiyonlarda vasküler yapıların orjinleri hakkında bilgi edinilebilirken anatomic pozisyonları ve projeksiyonları hakkında bilgi edinebilmek mümkün olmamaktadır. Enjeksiyon-korozyon yöntemi vasküler yapıları kraniumdaki normal duruş pozisyonlarında, en ufak bir dal dahi zarar görmeden, en ince ayrıntısına kadar üç boyutlu olarak ortaya çıkarabilmemizi sağlamıştır. Serebral arteryel yapıların projeksiyonları da korunarak bu şekilde ortaya çıkarılabilmesinin nöroşirürji eğitimine ve bundan sonraki vasküler çalışmalara çok önemli katkıları olacağına inanmaktayız.

The shoulder joint, commonly known as the glenohumeral joint, is very important as it is the joint with the body highest mobile capability. The ability of movement restriction of the passive structures of the joint (joint surfaces and ligaments) is very low. The articular surfaces of the bones which take part in the joint allow a wide range of movement; on one side is the shallow glenoid cavity and on the other side, the wide humeral head. The thin and loose joint capsule, again allows a wide range of movement.

We analyze the relationships of the 3 segments of the facial nerve with respect to constant anatomic structures that can be identified during revision surgery via translabyrinthine approach. This study was conducted on 15 formalin-fixed cadavers whose facial nerves were dissected bilaterally under operative microscope via translabyrinthine approach. The distances between the round window niche and the midpoint of the tympanic segment and the beginning of the mastoid segment were 6.64 ± 1.79 mm and 3.99 ± 0.79 mm, respectively. The distances between the tympanic ostium of the eustachian tube and the first and the second genu were 7.02 ± 0.62 mm and 12.25 ± 1.24 mm, respectively. We used the superior semicircular canal, the tympanic ostium of the eustachian tube, and the round window niche as landmarks to identify the facial nerve during revision surgery. Our study also showed that the auricular branch may also be originated from the posterior surface of the facial nerve.

The purpose of this study was to clarify the morphologic features, location and variations of the dorsal root ganglion (DRG).Fifteen formalin fixed cadavers for the current study were included. Total of 150 DRGs were examined from L1 to L5. The relationships of the nerve root DRGs to the intervertebral foramen were noted. Position of the DRG was classified by the location of the ganglia in relation to the pedicle. The relationship of the DRG to the intervertebral foramen was evaluated.The distance between the midpoint of the DRG to the cross section of the root with the medial border of the pedicle gradually increased from L1 to L5. The medial border of the foramen distances along the nerve root were L1, 1.77 mm; L2, 2.79 mm; L3, 3.23 mm; L4, 7.28 mm and L5, 8.31 mm. The mean width of the lumbar DRGs were L1, 4.36 mm; L2, 4.56 mm; L3, 4.99 mm; L4, 5.22 mm and L5, 5.82 mm. The mean length of DRGs were as follows: L1, 5.39 mm; L2, 5.83 mm; L3, 7.24 mm; L4, 7.97 mm and L5, 10.83 mm. The mean width and length of DRGs gradually increased from L1 to L5.The DRG in the lumbar region play a key role in the occurence of low-back pain and sciatica; therefore, it is important to understand the anatomy of DRG. The accurate anatomic information about the position of DRGs would be useful to perform a safe surgical intervention in the lumbar foraminal region.

ESMER, TULIN SEN/0000-0002-1879-1790 WOS: 000376992200014 PubMed: 26999695 Background and Objective: Different accesses have been used to perform lateral osteotomies in rhinoplasty. All of them have some disadvantages. The aim of this paper was to report a new access to overcome drawbacks of the other techniques in lateral osteotomy during open rhinoplasty. Methods: An anatomical study was designed to search possibility of intranasal extramucosal access (open sky access) for the lateral osteotomy in open rhinoplasty. It was performed directly on the lateral wall of piriform aperture, and then possible advantages of this technique were investigated. Five fixed cadavers were used for this purpose. No drawbacks were observed during procedure in cadavers. Then the same procedure was performed in 23 consecutive rhinoplasty patients. Nineteen operations were primary and 4 operations were secondary. Median oblique osteotomies were added to the procedure in all patients. The mean follow-up was 17 months. Results: Intranasal extramucosal access during lateral osteotomy was easily performed in all patients. Hemorrhage due to angular vessel injury was not occurred during intraoperative period. Edema and ecchymosis was minimal. Intranasal examination did not show any sign for nasal mucosal tearing in all patients. Residual bone spurs or bone irregularities were not observed in any patients. Conclusion: Intranasal extramucosal access that produces precise, predictable, and reproducible aesthetic and functional results could also provide better exposure during lateral osteotomy. Additionally, open sky access minimizes scars because it does not need additional incisions on the skin and mucosa. Protection of the internal periosteum of the nasal bones may be the main advantages of this technique.

Medical education development is a continuous process. Anatomy is the basis of medicine and needs to conform to the requirements of the era by applying new teaching methods and contributing to the development of scientists who can meet global standards. New visual materials and three-dimensional anatomy models are increasingly being used in anatomy training. The contribution of these methods to anatomy training will be substantial. However, it is obvious that the new educational methods will be more effective when used with cadavers, a classic and fundamental part of anatomy training. In this review, presenting the results of the various studies conducted on anatomy education, we aim to contribute to further studies on anatomy education and its curriculum in Turkey. Keywords: anatomy education; cadaver; medical education; three-dimensional anatomy models

Object The branching structure of the middle cerebral artery (MCA) remains a debated issue. In this study the authors aimed to describe this branching structure in detail. Methods Twenty-seven fresh, human brains (54 hemispheres) obtained from routine autopsies were used. The cerebral arteries were first filled with colored latex and contrast agent, followed by fixation with formaldehyde. All dissections were done under a microscope. During examination, the trunk structures of the MCA and their relations with cortical branches were demonstrated. Lateral radiographs of the same hemispheres were then obtained and comparisons were made. Angles between the MCA trunks were measured on 3D CT cerebral angiography images in 25 patients (50 hemispheres), and their correlations with the angles obtained in the cadaver brains were evaluated. Results A new classification was made in relation to the terminology of the intermediate trunk, which is still a subject of debate. The intermediate trunk was present in 61% of cadavers and originated from a superior trunk in 55% and from an inferior trunk in 45%. Cortical branches supplying the motor cortex (precentral, central, and postcentral arteries) significantly originated from the intermediate trunk, and the diameter of the intermediate trunk significantly increased when it originated from the superior trunk. In measurements of the angles between the superior and intermediate trunks, it was found that the intermediate trunk had significant dominance in supplying the motor cortex as the angle increased. The intermediate trunk was classified into 3 types based on the angle values and the distance to the bifurcation point as Group A (pseudotrifurcation type), Group B (proximal type), and Group C (distal type). Group A trunks were seemingly closer to the trifurcation structure that has been reported on in the literature and was seen in 15%. Group B trunks were the most common type (55%), and Group C trunks were characterized as the farthest from the bifurcation point. Group C trunks also had the smallest diameter and fewest cortical branches. Similarities were found between the angles in cadaver specimens and on 3D CT cerebral angiography images. Beyond the separation point of the MCA, trunk structures always included the superior trunk and inferior trunk, and sometimes the intermediate trunk. Conclusions Interrelations of these vascular structures and their influences on the cortical branches originating from them are clinically important. The information presented in this study will ensure reliable diagnostic approaches and safer surgical interventions, particularly with MCA selective angiography.

The objective of this study was to analyze relationship of the intervertebral disc to the nerve root in the intervertebral foramen. Fourteen formalin-fixed cadavers were studied and measurements were performed. At the medial line of the neural foramen, the disc-root distance gradually increased from L1-L2 to L5-S1. The shortest distance between the disc to nerve root was L1-L2 (mean, 8.2 mm) and the greatest distance was found at L3-L4 (mean, 10.5 mm). In the mid-foramen, the disc-root distance decreased from L1-2 to L5-S1. The shortest distance from the disc to nerve root was found at L5-S1 (mean, 0.4 mm); and the greatest distance, at L1-L2 (mean, 3.8 mm). For the lateral line, the distance between an intersection point between the medial edge of the nerve root and the superior edge of the disc and lateral line of the foramen consistently increased from L1-L2 to L5-S1. The shortest distance from nerve root to the lateral border of the foramen, at the point where the nerve root crosses disc was at level L1-L2 (mean, 2.6 mm), the greatest distance, L5-S1 (mean, 8.8 mm). The width of the foramina progressively increased in a craniocaudal direction (mean, 8.3-17.8 mm from L1-2 to L5-S1, respectively). The mean height of the foramina was more or less the same for disc levels (range, 19.3-21.5). The results showed that nerve roots at lower levels traveled closer to the midline of the foramen. This morphometric information may be helpful in minimizing the incidence of injury to the lumbar nerve root during foraminal and extraforaminal approaches.

OBJECTIVE: To determine the differences between manual and cephalometric measurements on different sections of the human skull, which were obtained using computer-assisted three-dimensional (3D) analysis and conventional two-dimensional (2D) techniques. MATERIALS AND METHODS: Measurements were carried out on 13 dry human skulls, then 2D cephalograms and 3D computed tomographic (CT) images were obtained. Anatomic landmarks were determined and marked with clay before CT images were taken, and the same landmarks were marked with the help of metallic balls and pins for lateral and frontal cephalograms. Manual, lateral/frontal cephalometric, and computer-assisted 3D cephalometric measurements were compared statistically. One-way analysis of variance and Tukey Honestly Significant Difference tests were used to compare the results among the groups. RESULTS: All measurements were statistically insignificant between the computer-assisted 3D and manual measurements. On the other hand, the differences between the conventional 2D and the manual measurements were statistically significant. The greatest amount of magnification was found at the Nasion-Menton distance (14.6%), which was located at the farthest distance from the central x-ray beam in the lateral cephalogram (P < .01). For the same reason, the greatest enlargement (16.2%) was observed in the distance between the zygomaticomaxillary sutures on the conventional frontal cephalogram (P < .01). CONCLUSIONS: The computer-aided 3D cephalometric measurements were found to be more accurate than the conventional cephalometric measurements. The results revealed that 3D cephalometric measurements were consistent with the manual measurements. In addition, the magnification and distortion might limit the results of conventional cephalometric measurements.

Object Although infrequent, injury to adjacent neurovascular structures during posterior approaches to lumbar intervertebral discs can occur. A detailed anatomical knowledge of relationships may decrease surgical complications. Methods Ten formalin-fixed male cadavers were used for this study. Posterior exposure of the lumbar thecal sac, nerve roots, pedicles, and intervertebral discs was performed. To identify retroperitoneal structures at risk during posterior lumbar discectomy, a transabdominal retroperitoneal approach was performed, and observations were made. The distances between the posterior and anterior edges of the lumbar intervertebral discs were measured, and the relationships between the disc space, pedicle, and nerve root were evaluated. Results For right and left sides, the mean distance from the inferior pedicle to the disc gradually increased from L1–2 to L4–5 (range 2.7–3.8 mm and 2.9–4.5 mm for right and left side, respectively) and slightly decreased at L5–S1. For right and left sides, the mean distance from the superior pedicle to the disc was more or less the same for all disc spaces (range 9.3–11.6 mm and 8.2–10.5 mm for right and left, respectively). The right and left mean disc-to-root distance for the L3–4 to L5–S1 levels ranged from 8.3 to 22.1 mm and 7.2 to 20.6 mm, respectively. The root origin gradually increased from L-1 to L-5. The right and left nerve root–to-disc angle gradually decreased from L-3 to S-1 (range 105°–110.6° and 99°–108°). Disc heights gradually increased from L1–2 to L5–S1 (range 11.3–17.4 mm). The mean distance between the anterior and posterior borders of the intervertebral discs ranged from 39 to 46 mm for all levels. Conclusions To avoid neighboring neurovascular structures, instrumentation should not be inserted into the lumbar disc spaces more than 3 cm from their posterior edge. Accurate anatomical knowledge of the relationships of intervertebral discs to nerve roots is needed for spine surgeons.

BACKGROUND: Although injury to the lumbar arteries during anterior spinal approaches is often encountered, there are few published articles regarding the relationship between the lumbar arteries and spinal cord ischemia. OBJECTIVE: To examine the morphology of the lumbar arteries and to emphasize their clinical importance. METHODS: With the aid of a surgical microscope, 80 lumbar arteries in 10 formalin-fixed male cadavers were studied. Measurements of these structures were made and relationships observed. RESULTS: The spinal artery was usually the first branch of the lumbar artery. The greatest lumbar artery diameter was at L4 and had a mean diameter of 3.25 mm; the smallest diameter was identified at L2 and had a mean diameter of 2.05 mm. The largest spinal artery diameter was at L3 (mean, 0.56 mm) and the smallest at L1 (mean, 0.42 mm). The largest anastomotic artery diameter was at L4 (mean, 0.42 mm) and the smallest at L1 (mean, 0.32 mm). For the right and left sides, the mean greatest distance between the origin of the lumbar artery and the tendinous arch was at L4 (mean, 40.9 and 31.8 mm, respectively) and the least at L1 (mean, 31.8 and 22.5 mm, respectively). The mean of the greatest distance between the anastomotic branch and the base of the transverse process of the lumbar vertebrae was at L4 (mean, 4.41 and 4.35 mm, respectively) and the smallest at L1 (mean, 4.04 and 4.08 mm, respectively). CONCLUSION: These anatomic findings of the lumbar segmental arteries would be useful for emphasizing their surgical importance.

Because the skin of anteromedial thigh region usually is thinner, pliable, hairless it can be preferred based on the requirements of the recipient site. In this way more information is necessary about the perforators of anteromedial thigh region. The aim of this cadaveric study was described to provide useful knowledge about localizations and number of anteromedial thigh perforators. Study was carried out on 16 lower extremities of 9 cadavers. The area in anteromedial aspect of the thigh searched for perforators was defined between the anterolateral border of sartorius and the posterior border of gracilis. The diameters of the dissected perforators were measured and the locations were documented. A total of 204 perforators were dissected in 16 lower extremities. The majority of musculocutaneous perforators were from gracilis (24 of 37) and there were at most 3 musculocutaneous perforators arising from gracilis muscle. 167 septocutaneous perforators were identified. Origin of all perforators was determined as 52 from deep femoral artery, 25 from proximal part of femoral artery and 127 from distal part of femoral artery and their branches. Perforators with the largest diameter were the ones arising from the intermuscular septa between the adductor (longus and magnus) and sartorius muscles. The mean diameter of the perforators was 0.75 ± 0.11 mm and ranged between 0.61 and 0.96 mm. The septocutaneous perforators of the anteromedial aspect of the thigh are as much important as the musculocutaneous perforators and all they are with adequate to perform anteromedial thigh flap. This study provides numerical overview, useful perception about the localization of the perforators of the anteromedial aspect of the thigh and detailed anatomical basis for anteromedial thigh flap to be an important alternative.

The primary stability of implants should be high on insertion into fresh extraction sockets. Torque-fitting and resonance frequency analyses (RFA) are used to assess primary implant anchorage and stability. The torque-fitting and RFA of implants placed in conventional surgical sockets and sockets with controlled coronal bone defects was compared. The possible relation between torque-fitting and RFA was explored. Ø 3.3 mm × 12 mm implants were placed in 16 sockets finalized with Ø 2.8 mm surgical pilot drills in the right iliac crests of two fresh cadavers (control). In the test group, implants were placed into sockets prepared by Ø 2.8 mm drill followed by Ø 4.2 mm twist drills to a depth of 6 mm to create circumferential controlled coronal bone defects (50% bone loss). Primary implant stability was assessed using insertion torque values (ITV) followed by RFA. Mean ITV and RFA measurements for test groups (7.83 ± 0.91 N cm and 40.88 ± 3.57) were significantly lower than controls (14.80 ± 1 N cm and 66.31 ± 0.9) (P < 0.05). Reductions of ITV and RFA measurements in relation to bone defect were 47% and 38%. The existence of controlled bone defects eliminating contact coronally leads to decrease in torque-fitting and primary stability of implants. No relationship was observed between torque-fitting and RFA. © 2009 International Association of Oral and Maxillofacial Surgeons.

Object Epidural fibrosis is the scar tissue formed over the dura mater after a laminectomy. Extensive epidural fibrosis may be an important underlying cause of failed back syndrome. Pimecrolimus, an ascomycin derivative, is one of the new classes of immunomodulating macrolactams and was specifically developed for the treatment of inflammatory diseases. This study examined the preventive effects of the local application of pimecrolimus in minimizing spinal epidural fibrosis in a rat laminectomy model. Methods Thirty Wistar rats were divided into 3 equal groups: control, mitomycin C (MMC), and pimecrolimus groups. Each rat underwent a laminectomy at the L-3 lumbar level. In the experimental groups, a cotton pad soaked with MMC (0.5 mg/ml) or 5 mg pimecrolimus was placed on the exposed dura mater. No treatment was performed in the control group rats. Thirty days after surgery, the rats were killed and the dura mater thickness, epidural fibrosis, and arachnoidal involvement were quantified. Results The mean dura thickness was measured at 9.28 ± 3.39 μm in the MMC group and at 8.69 ± 2.32 μm in the pimecrolimus group, compared with 14.70 ± 4.14 μm in the control group. In addition, the epidural fibrosis and arachnoidal involvement were reduced significantly in the treatment groups compared with the control group. Conclusions In this animal model, it was shown that locally applied pimecrolimus effectively reduces epidural fibrosis and dural adherence in rats that underwent lumbar laminectomy. Mitomycin C was equally effective as pimecrolimus in reducing epidural fibrosis and dural adherence in this study.

Background PRF treatment has recently been described as minimally neurodestructive alternative to radiofrequency heat lesions. Patients with some pain syndromes in whom the pain could not be controlled by alternative techniques may be treated using PRF. In the present study, our main goal was to evaluate and compare the ultrastructure of peripheral nerve tissue that was heated by PRF, CRF with 42°C, and CRF with 70°C. Methods Forty-five male rats were divided into 5 groups. In PRF group and CRF with 42°C group, the sciatic nerve was heated at a temperature of 42°C for 120 seconds. As a positive control, some rat sciatic nerves were treated with CRF lesions at 70°C. The rats were kept alive for 21 days and then killed. Tissue was evaluated with transmission electron microscope, and grading was done to the groups. Results The unmyelinated nerve fibers were ultrastructurally normal in all groups. The results of myelinated axons indicated that PRF group had better grades, and CRF with 70°C group had the worst grade. Especially, comparison of the group of PRF and CRF with 42°C revealed significant difference. In PRF group, none of the myelinated axons showed severe degeneration findings, and most of the damaged myelinated axons showed only separation in myelin configuration. Conclusions PRF treatment may cause separation in myelinated axons. However, it seems that all changes were reversible. The present study supports the hypothesis that pulsed RF treatment does not rely on thermal injury of neurologic tissue to achieve its effect.

To compare the primary stability of implants placed in conventional and osteotome sites and to evaluate the level of correlation between cutting torque measurements, resonance frequency analysis (RFA), and bone density.Eight human femoral heads were scanned with computed tomography for bone density measurements as Hounsfield units (HU), and individualized computed tomography-based surgical stents were prepared for placement of implants. Five implant sockets were prepared in each collum (CoF), caput (CaF), and trochanter (Tr-MM) section of the femoral heads using the conventional drilling technique or by a combination of drilling and use of an osteotome. Cutting-torque values (CTV) of the implants were measured by a manual torque wrench, followed by determination of implant stability quotients (ISQ) by RFA.The CTVs of implants were similar in the conventional group, but different in the osteotome group (P0.05). There was a general tendency toward achieving higher CTV and ISQ values in CoF than CaF and Tr-MM (P0.05), and measurements in CaF and Tr-MM were comparable (P0.05). The mean HU of sites were similar, although CoF had higher HU values (P0.05). CTV of implants in CaF and Tr-MM and ISQ values in CoF in the conventional groups were higher than those in the osteotome groups (P0.05). The correlation between CTV and HU in Tr-MM was significant in the osteotome group, although no other correlations between CTV, ISQ, and HU could be detected (P0.025).Conventional placement led to higher implant stability than the drilling and osteotome technique used in the study. No correlation could be found between CTV, RFA, and bone density.

Although various posterior insertion angles for screw insertion have been proposed for C1 lateral mass, substantial conclusions have not been reached regarding ideal angles and average length of the screw yet. We aimed to re-consider the morphometry and the ideal trajections of the C1 screw. Morphometric analysis was performed on 40 Turkish dried atlas vertebrae obtained from the Department of Anatomy at the Medical School of Ankara University. The quantitative anatomy of the screw entry zone, trajectories, and the ideal lengths of the screws were calculated to evaluate the feasibility of posterior screw fixation of the lateral mass of the atlas. The entry point into the lateral mass of the atlas is the intersection of the posterior arch and the C1 lateral mass. The optimum medial angle is 13.5 +/- 1.9 degrees and maximal angle of medialization is 29.4 +/- 3.0 degrees . The ideal cephalic angle is 15.2 +/- 2.6 degrees , and the maximum cephalic angle is 29.6 +/- 2.6 degrees . The optimum screw length was found to be 19.59 +/- 2.20 mm. With more than 30 degrees of medial trajections and cephalic trajections the screw penetrates into the spinal canal and atlantooccipital joint, respectively. Strikingly, in 52% of our specimens, the height of the inferior articular process was under 3.5 mm, and in 70% was under 4 mm, which increases the importance of the preparation of the screw entry site. For accommodation of screws of 3.5-mm in diameter, the starting point should be taken as the insertion of the posterior arch at the superior end of the inferior articular process with a cephalic trajection. This study may aid many surgeons in their attempts to place C1 lateral mass screws.

Background and Objectives: The longus colli (LC) muscle is an important structure of the anterior cervical spine and has a critical role in stellate ganglion block. This technique involves withdrawing the needle to locate its port for injection above the anterior surface of the LC muscle; however, its exact thickness at the C5, C6, and C7 levels has not been measured. The aim of this anatomic and magnetic resonance-supported study was to evaluate the thickness of the LC muscle at these levels from the anterior tubercle of each vertebra toward the vertebral body at 5-, 10-, and 15-mm distances to provide precise anatomic data for stellate ganglion block. Methods: Ten cadavers, 60 vertebral body specimens, and cervical magnetic resonance imaging (MRI) scans of 40 adult patients were used for measurements. Results: The main findings of this study are that the thickness of the LC muscle varies between 5.0 and 10.0 mm at C6 and C7 in cadavers and between 8.0 and 10.0 mm in MRI scans. Sex has an important role; MRI scans revealed that male patients have a considerably thicker LC muscle at each vertebral level. Conclusion: We found a highly variable thickness of the LC muscle in anatomic and imaging studies, which may lead to negative block results.

As formalin is an extremely reactive electrophilic chemical that reacts with tissues, the purpose of this study was to explore whether formalin fixation could potentially alter the mechanical properties of bone tissue and have an effect on the primary stability measurements of implants.Ø 3.3 x 8 mm, Ø 4.1 x 8 mm, and Ø 4.8 x 8 mm implants were placed on sockets prepared into the anterior surface of the radius of two fresh-frozen human cadavers. The insertion torque of each implant was quantified using a strain-gauged torque-wrench connected to a data acquisition system at a sample rate of 10 KHz, and resonance frequency analysis measurements were also undertaken for each implant. The cadavers were then subjected to embalment with 10% formalin for 3 months, and the same experiments were undertaken on the contra lateral radius of the cadavers.The insertion torques before and after chemical fixation were similar for Ø 3.3 mm (P0.05), and higher values were obtained for Ø 4.1 mm and Ø 4.8 mm implants after chemical fixation (P0.05). The resonance frequency analysis values before and after chemical fixation were similar for all implants (P0.05).Implants have higher insertion torque values in formalin-fixed bone than fresh-frozen human bone, but similar implant stability quotients in both cases. The insertion torque technique can detect the difference between formalin-fixed and fresh-frozen human bone, but resonance frequency analysis cannot.

Amac: Travma sonrasi koku disfonksiyonu olan hastalarin en sik hasar goren yerleri bulbus olfactorius ve gyrus frontalis inferior’a uzanan tractus olfactorius’lardir. Bu hastalarda bulbus ve tractus olfactorius’larin hacim ve boyutlari daha kucuktur. Ayrica frontal kitle rezeksiyonlari esnasinda olfaktor yapilara zarar verme riski yuksektir. Bu calisma bulbus olfactorius, tractus olfactorius, sulcus olfactorius ve trigonum olfactorium’un direk normal boyutlari hakkinda morfometrik olcumler elde etmeyi amaclamistir. Gerec ve Yontem: Kirk insan beyninin 80 adet lobus frontalis’in bazal yuzeyi incelendi ve degerlendirmeye alindi. Dijital kumpas araciligi ile bulbus olfactorius’un uzunluk ve genisligi, tractus olfactorius’un genislik ve kalinligi, bulbus olfactorius’un on siniri ile trigonum olfactorium’un arka siniri arasindaki mesafe, sulcus olfactorius’un derinligi ve tractus olfactorius’un uzunlugu olculdu. Bulgular: Bulbus olfactorius’un on siniri ile trigonum olfactorium’un arka siniri arasindaki mesafe ve tractus olfactorius’un uzunlugunun ortalamalari, sirasiyla 42,5±8,45 mm ve 25,53±7,11 mm olarak bulundu. Bulbus olfactorius’un uzunluk ve genisligi, tractus olfactorius’un genislik ve kalinliginin ortalamalari da sirasiyla 13,22±3,14 mm, 4,87±1,83 mm, 1,97±1,86 mm ve 2,87±2,64 mm olarak olculdu. Sulcus olfactorius’un derinligi de, ortalama 9,91±2,87 mm olarak bulundu. Sonuc: Bulbus olfactorius, tractus olfactorius, sulcus olfactorius ve trigonum olfactorium’un normal anatomik ozellikleri ve morfometrik iliskisi hakkindaki direk elde edilen bilgi frontotemporal lezyon tedavisinde ve pterional yaklasimlar esnasinda onemlidir. Ayrica bulbus olfactorius ile tractus olfactorius’un normal anatomik ozellikleri ve boyutlari bu yapilarin normal olup olmadiklarina karar verirken de yardimcidir.

Anterior odontoid screw fixation is a safe and effective method for treatment of odontoid fractures. The screw treads should fit into the odontoid medulla, should pass the fracture line, and should pull fractured odontoid tip against body of axis in order to achieve optimum screw placement and treatment. This study has demonstrated optimal anterior odontoid screw thickness, length, and optimal angle for safe and strong anterior odontoid screw placement. Dry bone axis vertebrae were evaluated by direct measurements, X-ray measurements, and computerized tomography (CT) measurements. The screw thickness (inner diameter of the odontoid) was measured as well as screw length (distance between anterior-inferior point body of axis and tip of odontoid), and screw angle (the angle between basis of axis and tip of odontoid). The inner diameter of odontoid bone was measured as 6.5 ± 1.9 mm, the screw length was 37.6 ± 3.3 mm, and the screw angle was 62.4 ± 4.7 on CT. There was no statistical difference between X-ray and CT in the measurements of screw thickness and angle. X-ray and CT measurements are both safe methods to determine the inner odontoid diameter and angle preoperatively. Screw length should be measured on CT only. To provide safe and strong anterior odontoid screw fixation, screw thickness, length, and angle should be known preoperatively, and these can be measured on X-ray and CT.

Arthroscopic EndoButton fixation of anterior cruciate ligament (ACL) grafts over the femoral cortex has become popular in recent years. However, elongation of fixation materials has lead to tunnel enlargement, graft tunnel motion and instability. Synovial fluid passages along femoral tunnels following ACL reconstruction may result in destruction of tissues. The purpose of the present study was to identify the seating position of the EndoButton in regard to the boundaries of the knee capsule in single-incision arthroscopic ACL reconstruction. A total of 20 cadaveric knees were dissected and arthroscopic drill guides were used to create tibial and femoral tunnels. The distances between the exit points and boundaries of the suprapatellar bursa at three different degrees of knee flexion were measured. The average distances from the exit points to the superior boundaries of the suprapatellar bursa were 6.89 +/- 5.40 mm (range, 16.87-1.21). However, in knee flexion of greater than 90 degrees , tunnel exits were placed below the superior boundaries of the suprapatellar bursa (-7.08 +/- 3.69 mm, range, -3.24 to -12.87). In order to place the EndoButton extraarticularly, a safe degree of knee flexion during femoral tunnel drilling was defined as 80 degrees .

Nerve injury is a common complication during anterior shoulder surgery. The purpose of the study was to evaluate the musculocutaneous nerve (MN) anatomically and to clarify the relationship of the MN to the glenoid labrum and coracoid process in different arm positions. The study was carried out on 40 shoulders of 20 adult cadavers fixed in 10% formaldehyde. The minimum distance of the MN at the entrance point of the nerve into the coracobrachialis to the anteromedial aspect of the coracoid tip and the distance between the MN and the top, middle, and inferior points of the glenoid labrum were measured. All measurements were performed with a digital caliper while the arm was in a neutral position, 45 degrees and 90 degrees of abduction, 90 degrees of abduction-internal rotation and 90 degrees of abduction-external rotation to evaluate whether arm position effects the results statistically or not. The results demonstrated that the position of the arm significantly changes the distance between the coracoid process (CP) and the MN or its cord. The change in distance between the glenoid labrum and the MN or its cord was also statistically significant. The distance between the CP and MN was greatest when the arm was abducted to 45 degrees (mean 3.4 cm) and least when the arm was positioned to 90 degrees of abduction-internal rotation (mean 2.0 cm). While the distance between the MN and the coracoid process was least at 90 degrees of abduction and internal rotation, the distance between the MN and glenoid labrum was lest with 90 degrees of abduction and external rotation. The distance between the glenoid labrum and MN was greatest with 45 degrees of abduction. The results of this study might be of use in avoiding the MN especially during Bristlow operations and certain rotator cuff procedures. Transferring the coracoid process during Bristow operations or placing arthroscopic portals when the arm is abducted to 45 degrees appears to be the safest position in terms of MN injury. Based on our results, when the arm needs to be abducted to 90 degrees during operation, externally rotating it may decrease the tension on the brachial plexus thus increasing the distance between the MN and the portals or retractors.

We aim to evaluate the mechanisms responsible for complications during trigeminal rhizotomy via foramen ovale puncture. Ten dry skulls and 10 skull-base specimens were investigated in the present study. In cadaveric skull-base specimens, the anatomical relationships between the foramen ovale, mandibular nerve and Gasserian ganglion and the surrounding neurovascular structures were investigated intradurally. The distance between the foramen ovale and Gasserian ganglion was measured as 6 mm. The abducent nerve, adjacent to the anterior tail of the petrolingual ligament, was observed passing along the lateral wall of the cavernous sinus. Advancement of the catheter more than 10 mm from the foramen ovale is likely to damage the internal carotid artery and the abducent nerve at the medial side of the petrolingual ligament. Thermocoagulation of the lateral wall of the cavernous sinus may damage the cranial nerves by heat, giving rise to pareses.

The objective of this study was to compare the bone strains of apically free versus grafted implants in the posterior maxilla. The experiments were undertaken in four edentulous maxillary posterior regions of fresh human cadavers, having a minimum bone height of 8 mm. In each bone fragment, two Ø 4.1 mm x 12 mm Straumann implants were placed, and insertion torque values (ITV) and implant stability quotients (ISQ) of the implants were quantified to determine implant anchorage. Two splinted crowns were fabricated for each experimental model. Strain gauges were bonded on the buccal and sinus floor cortical bones around apically free and grafted implants. Microstrains were recorded by a data acquisition system and corresponding software at a sample rate of 10 KHz under central and buccally oriented lateral-axial static loads of 100 and 150 N in separate cases. The data were compared by independent T test at a significance level set at P0.05. Bone tissue strains on the buccal cortical areas adjacent to apically free implants were higher than those of apically grafted implants (P0.05). The differences ranged between 10 and 48 mu epsilon under central and lateral axial loads of 100 and 150 N. The shift in load application from central to buccally oriented lateral axial mode increased strains between 60 and 201 mu epsilon on buccal cortical bone around apically free and grafted implants (P0.05). Bone strains around anterior implants were higher than those of posterior implants. Microstrains in the sinus floor cortical bone in apically grafted models were slightly higher than apically free models. Bone tissue strains on the buccal cortical areas adjacent to apicallyfree implants are higher than those of apically grafted implants. Sinus lifting, resulting in an enhanced apical support, slightly increases strains at the sinus floor region, but leads to a decrease in bone strains around the collar of supporting implants.

The present study was undertaken to determine the morphometric relationships between specific aspects of the cranial anterior and middle fossae because of their importance as landmarks in surgical approaches to the skull base. Bilateral and midline measurements were made between specific anatomic landmarks. The mean midline anteroposterior width of the lesser wing of the sphenoid and distance from the crista galli to the tuberculum sellae were 20 and 35.6 mm, respectively. Significant differences (P

Palsy of the external branch of the superior laryngeal nerve (EBSLN) during thyroid surgery is an important complication reported with varying frequency. This study was carried out to investigate the relationship between the EBSLN, the upper part of the thyroid gland and the inferior constrictor muscle of the pharynx (IC), and also to define consistent landmarks for identifying and preserving the EBSLN. Forty neck halves of 20 cadavers were dissected. Measurements were obtained between the crossing point of the EBSLN with the superior thyroid artery (STA) and the upper pole of the thyroid gland, the point where EBSLN penetrates the IC and the inferior thyroid tubercle, and the middle point of the oblique line of the thyroid cartilage, and the EBSLN. In 22.5%, the EBSLN crossed the STA more than 1 cm above the upper pole of the thyroid gland (Type I of Cernea et al. [1992a] Head Neck 14:380-383). In 60%, the EBSLN crossed the STA less than 1 cm above the upper pole of the thyroid gland (Type IIa of Cernea et al. [1992a] Head Neck 14:380-383). In 17.5%, the EBSLN crossed the STA under the upper pole of the thyroid gland (Type IIb of Cernea et al. [1992a], Head Neck 14:380-383). In 22.5%, the full course of the nerve was superficial to the IC (Type 1 of Friedman et al. [2002] Arch Otolaryngol Head Neck Surg 128:296-303). In 67.5%, the nerve penetrated the IC (Type 2 of Friedman et al. [2002] Arch Otolaryngol Head Neck Surg 128:296-303). In 10%, the nerve could not be identified at the lateral side of the IC (Type 3 of Friedman et al. [2002] Arch Otolaryngol Head Neck Surg 128:296-303). In conclusion, it is possible to identify the nerve superficial to the IC in 90% of specimens on average. Knowledge of the relationship between the EBSLN, IC, inferior thyroid tubercle, oblique line of the thyroid cartilage and the sternothyroid muscle will be useful for the surgeon in avoiding unexpected complications.

Objective: In the femoral "3-in-1 block", obturator nerve block is routinely unsuccessful. Anatomical studies are not available to explain why blockade of obturator nerve or lumbar plexus does not occur. The aim of this study was to examine the effectiveness of femoral "3-in-1 block" obturator nerve block on a cadaver model. Materials and methods: Totally, 12 mature adult human cadavers were selected. Methylene blue dye (30 ml) was in-jected under the fascia iliaca in eight cadavers and into the femoral nerve sheath in four cadavers. Careful bilateral dissections were performed following dye injections. Results: It was seen that the dye did not spread to the medial part of the psoas major muscle and the obturator nerve was not stained with the dye in eight cadavers in whom dye was injected laterally into the femoral sheat. In four ca-davers in whom dye was injected into the femoral nerve sheat, metylene blue spread through fascial layers in the plane under the psoas muscle and stained the obturator nerve just before emerging medially from the fascia psoas. At this point, the obturator nerve pierced the psoas fascia and extended extrafascially in the medial and deep borders of the psoas muscle. In this area, the upper section of the obturator nerve was found also to be stained with the dye. Conclusion: We concluded that the cause of an unsuccessful obturator nerve block might be the fascial anatomy of this region. The lateral cutaneous femoral nerve and the femoral nerve easily can be blocked in the fascia iliaca com-partment, but the obturator nerve block fails because of its being extrafascial in this region., Amaç: Femoral "3-1 blok" uygulamalarında obturator sinir bloğu genellikle başarısız olmaktadır. Obturator sinir veya lomber pleksus bloğunun niçin oluşmadığını açıklayıcı yeterli sayıda anatomi çalışması bulunmamaktadır. Bu çalışma-nın amacı, femoral 3-1 obturator sinir bloku etkinliğini bir kadavra modeli üzerinde incelemektir. Gereç ve yöntem: Toplam 12 erişkin insan kadavrası seçildi. Sekiz kadavraya 30 ml metilen mavisi iliak fasiya altına ve dört kadavraya da femoral sinir kılıfı içerisine enjekte edildi. Daha sonra dikkatli bilateral disseksiyon yapıldı. Bulgular: Femoral kılıfın lateraline metilen mavisi enjekte edilen sekiz kadavrada metilen mavisinin psoas major kasın medialine yayılmadığı ve obturator sinire ulaşmadığı görüldü. Femoral sinir kılıfı içine metilen mavisi enjekte edilen dört kadavrada ise metilen mavisinin psoas kasının altından fasialar arasında yayıldığı ve obturator siniri boyadığı görüldü. Bu noktada obturator sinir psoas fasiyasını delerek ekstrafasiyal olarak psoas kasının orta ve derin kenarında ilerlemek-tedir. Bu alanda obturator sinirin üst bölümü de boyandı. Sonuç: Sonuç olarak başarısız obturator sinir bloğunun buradaki fasiya anatomisine bağlı olarak gelişiyor olabilir. Fe-moral ve lateral femoral kutanöz sinir subfasiyaldir ve bu iki sinir fasiya iliaka alanında kolaylıkla bloke olmaktadır, an-cak obturator sinir bu bölgede ekstrafasiyal alanda bulunduğu için bloke olmamaktadır.

The aim of this study was to evaluate the relationship between the cisternal segment of the oculomotor nerve and the posterior cerebral artery and its branches. The oculomotor nerve and the posterior cerebral artery of 15 cadaver brains (30 hemispheres) were examined using a surgical microscope. The dorsal portion of the cisternal segment of the oculomotor nerve had a close relationship with the P(1) and P(2) segments of the posterior cerebral artery in 100% of cases, the thalamoperforating arteries in 97%, the collicular arteries in 97%, the short circumferential arteries in 33% and the posterior medial choroidal arteries in 20%. The proximal portion of the nerve had a close relationship with the P(1) segment of the posterior cerebral artery, the thalamoperforating arteries, the collicular arteries and the short circumferential arteries, whereas the distal portion had a close relationship with the P(2) segment of the posterior cerebral artery and the posterior medial choroidal arteries. The oculomotor nerve was perforated by various arteries in different portions. These arteries were the thalamoperforating arteries in 10% of the hemispheres, the collicular arteries in 16% and the short circumferential arteries in 11%. It can be concluded that the dorsal portion of the cisternal segment of the oculomotor nerve has a close relationship with the branches arising from the P(1) and P(2) segments of the posterior cerebral artery. These arteries supply the cisternal segment of the oculomotor nerve.

Comert, Ayhan/0000-0002-9309-838X WOS: 000241769800011 PubMed: 17079396 Background: Several authors have defined a variety of so-called safe zones for deltoid-splitting incisions. The first aim of the present study was to investigate the distance of the axillary nerve from the acromion and its relation to arm length. The second aim was to identify a safe area for the axillary nerve during surgical dissection of the deltoid muscle. Methods: Twenty-four shoulders of embalmed adult cadavers were included in the study. The distance from the anterior edge of the acromion to the course of the axillary nerve was measured and was recorded as the anterior distance. The same measurement from the posterior edge of the acromion to the course of the axillary nerve was made and was recorded as the posterior distance for each limb. Correlation analysis was performed between the arm length and the anterior distance and the posterior distance for each limb. The ratios between arm length and the anterior and posterior distances were calculated for each case and were recorded as an anterior index and a posterior index. Results: The average arm length was 30.40 cm. The average anterior distance was 6.08 cm, and the average posterior distance was 4.87 cm. There was a significant correlation between arm length and both anterior distance (r = 0.79, p < 0.001) and posterior distance (r = 0.61, p = 0.001). The axillary nerve was not found to lie at a constant distance from the acromion at every point along its course. The average anterior index was 0.20, and the average posterior index was 0.16. Conclusions: The present study describes a safe area above the axillary nerve that is quadrangular in shape, with the length of the lateral edges being dependent on the individual's arm length. Using this safe area should provide a safe exposure for the axillary nerve during shoulder operations.

WOS: 000238395200005 PubMed: 16765153 This clinical report describes the diagnosis and treatment of a patient with both temporomandibular disorders (TMD) and styloid process fracture. The presence of tender muscles of mastication, facial pain, especially upon awakening, frequent grinding sounds, and tooth attrition indicated a diagnosis of TMD with bruxism as a possible etiological factor. However, the preliminary diagnosis of styloid process fracture based on the patient's sensation of a foreign body in the throat and some discomfort when turning the head was confirmed using radiography. The styloid process fracture was treated using conservative nonsurgical therapy, and an occlusal splint was used to treat the TMD. The patient's symptoms were significantly reduced at the 12-month follow-up visit.

SUMMARY Anatomy edication as a part of medical education is being discussed worldwide associating with medical education and restructuring studies are being continued. In this study, we aimed to determine and discuss available education programme and the issues on teaching learning process of anatomy education in Medical School, University of Ankara. The findings are as follows: *97,60 % of the subjects state that they would like to take the anatomy course in the first or second year. *60,46 % of them daim that the histology-embry ology course should be taken before the anatomy course; in addition, 42 % of them express that the physiology and medical biology courses should be studied earlier than the anatomy course. *95,70 % of them think that they have crowded classrooms, 80,29 % of them believe that they are negatively affected by the lecturers who do not use different teaching techniques rather than lecturing, 77,99 % of them admit that they do not prepare the course in advance, 55,61 % daim that they could not meet the lecturer outside the classroom, 54,81 % express that the audio-visual materials are not used efficiently in the dasses. They daim that ali the factors mentioned above influence their learning process. *77,43 % of them emphasize that clinical anatomy, transectional anatomy and radiological anatomy which help the correlation between anatomy and clinical sciences should be available in the syllabus. *79 % of them say that the theoretical part of the anatomy course is sufficient, but practice of the course should be increased. *85,99 % of them point out that the number of midterm exams is enough, but 9,18 % of them state that the number of the exams should be decreased. *The subjects want to have different types of questions in the exam. The rate of their demand for the various questions is between 2,70 % and 28,83 %. The most demanded type is multiple-choise questions.

Background The precentral gyrus (PG) is the primary motor area and is one of the most eloquent brain regions of neurosurgical interest. Although the arterial supply to the PG is generally known, contributions from different arterial branches such as the anterior cerebral artery (ACA), posterior cerebral artery (PCA), and middle cerebral artery (MCA) have not been comprehensively studied. The aim of the present study was to provide detailed information about the arteries of the PG. Methods Twenty adult human brains (40 hemispheres) were obtained, and ACA, MCA, and PCA were separately cannulated and injected with latex. The PG was identified. Results The ACA supplied the medial one third and the MCA supplied the lateral two thirds of the PG. The PCA did not reach the PG in any of the hemispheres. In 16 hemispheres (40%), the callosomarginal artery and, in 13 hemispheres (32.5%), the pericallosal artery were dominant for the medial one third of the PG. In 11 hemispheres (27.5%), equal dominance was observed. MCA branches at the lateral tip of the PG were classified into precentral, central, and postcentral groups. In 29 hemispheres (72.5%), the central group, and in 4 hemispheres (10%), the precentral group were dominant for the lateral two thirds of the PG. In 7 hemispheres (17.5%), the precentral and central groups were equally dominant. No dominance was identified for the postcentral group. Conclusion In each hemisphere, the PG was supplied by different vascularization patterns of ACA and MCA. The present study is the first to describe and discuss these details. Therefore, awareness of this pattern will provide a great contribution to surgical interventions.

Purpose: To evaluate ex vivo bone tissue strains around maxillary implants supporting immediately loaded bar-retained overdentures. Material and methods: Ninety degree two-element rosette strain gauges were bonded on the labial bone of four ITI® dental implants placed in the maxillary anterior region of four completely edentulous maxilla of fresh human cadavers. The installation torque value (ITV) of each implant was measured by a custom-made torque wrench and resonance frequency analyses (RFAs) were undertaken. A bar-retained overdenture was fabricated for each cadaver, and two miniature load cells were integrated in the first molar region of the overdentures for controlled loading experiments. Strain measurements were performed at a sample rate of 10 kHz and under a maximum load of 100 N, simultaneously monitored from a computer connected to a data acquisition system. Finally, removal torque values (RTVs) of the implants were measured. Results: RFA values did not mirror ITVs, while RTVs of implants were slightly lower than the ITVs. Any correlation could not be obtained between RFA values and ITVs or RTVs. Maximum strains around loaded implants ranged between −100 and −550 μɛ under 25–100 N. The axial and lateral strain values of posterior implants of both sides were higher than those of anterior implants under all loads (P

PubMed: 16158979 Analgesia of the pudendal nerve is used in patients undergoing gynecologic, obstetric and penile surgery. Stimulation techniques are used to determine the functions of the nerve. In these interventions, different landmarks are used to describe the localization of this nerve. Although some authors use perineal approaches, others prefer a transvaginal (rectal in males) approach. Knowledge regarding the anatomy of the pudendal nerve and its blockade allows an easy approach to the clinical problems like perineal neuralgia, neurogenic bladder dysfunction and penile implant operations. However, in the descriptions of these different approaches, there is no clear information regarding the depth of the nerve and the branches of the pudendal nerve that are blocked. The aim of the present study was to determine the depth and location of the pudendal nerve and, thus, describe certain and easily identified surface landmarks for clinical use. According to our examinations, the distance between the ischial tuberosity and the coccyx (the base of a triangle defined by the ischial tuberosity, coccyx and ischial spine) was 8.62 ± 0.92 cm (range 6.74-9.77 cm). The distance between the ischial tuberosity and the ischial spine was 5.23 ± 0.33 cm (range 4.76-5.81 cm) and the distance from the ischial spine to the coccyx was 5.42 ± 0.52 cm (range 4.02-6.32 cm). Because the pudendal nerve intersected the distance between the posterior superior iliac spine and the ischial tuberosity, the distance between these two landmarks was also measured and found to be 13.31 ± 0.91 cm (range 10.58-15.13 cm); the depth of the nerve was 4.14 ± 0.83 cm (range 3.13-5.25 cm).

Purpose: To compare ex vivo bone tissue strains around natural teeth with immediate implants supporting unsplinted and splinted fixed prostheses. Material and methods: Six linear strain gauges were bonded on the labial marginal bone of bilateral maxillary anterior teeth in two fresh-frozen human cadavers. The natural teeth were loaded in centric occlusion via an occlusal splint with integrated miniature load cells. Strain measurements were performed at a sample rate of 10 kHz and under a maximum load of 100 N, simultaneously monitored from a computer connected to data acquisition system. Upon extraction of the anterior teeth, O 4.1 mm and O 4.8 mm ITI® dental implants were placed into sockets of incisors and canines, respectively. Installation torque value (ITV) of each implant was measured by a custom-made torque wrench and resonance frequency analyses (RFA) were also undertaken. Strain measurements were performed for (1) single-tooth implant restorations, (2) unilateral splinted anterior implants, and (3) bilateral splinted anterior implants. Finally, an autopolymerizing acrylic resin was injected into the implant sockets for simulation of osseointegration and strain measurements were performed. Results: Microstrains of all groups were statistically comparable (P>0.05), although lower strains were elicited for implants in sockets of incisors in comparison with natural teeth. Microstrains around canine implants were comparable or higher than those induced around natural canines. For all groups, microstrains around canines were higher than those around lateral (P 0.05). The RFA values of implants were comparable. The ITVs of implants in sockets of lateral incisors and canines were similar and were higher than those of implants in central incisor regions. Conclusion: The labial marginal bone having no contact with immediate implants may experience strain gradients within physiologic levels due to deformation of bone under load. Although one prosthetic design does not seem to have clear advantages over another, splinting of implants may be considered as a safety measure for immediately loaded immediate implants, if possible.

Reconstruction of the defects with various flaps is the main issue in plastic and reconstructive surgery. Tissues used for the repair of the defects of the face should be convenient for this most important aesthetic unit. Color, elasticity, and volume of the transferred tissues have the utmost importance for successful results. Platysma muscle flap appears to be a good alternative method for the reconstruction of the facial defects. Anatomic dissections on five fresh cadavers for the evaluation of the vascular structures and 11 clinical cases of reconstruction of the defects of the face and the neck with platysma muscle and musculocutaneous flaps are performed in this study to evaluate the efficacy and reliability of platysma flaps. Cadaveric dissections were performed on the face and the neck regions on both sides. Eleven patients with various defects on the face and the upper neck regions were surgically treated: three transverse cervical artery-based transverse musculocutaneous platysma flaps, seven facial artery-based vertical musculocutaneous platysma flaps, and one superior thyroidal artery-based platysma muscle flap were used for the repairs. The patients ranged in age from 42 to 74 years. The defects measured 2x3 cm to 6x9 cm and the flaps 3x3 cm to 7x10 cm. The follow-up periods were 2 to 21 months. Postoperative venous congestion between the 5th and 9th days was observed in seven patients. One patient had infection of the donor site, and another had infection of the recipient site; both recovered with systemic and topical antibiotherapy. Partial flap loss occurred in one patient. Our study concluded that platysma flaps showed sufficient tissue match with successful results for the reconstructive procedures of facial defects.

The aim of this study was to assess the anatomical variations, especially the anomalous muscles passing through Guyon's canal and the fibrous arch forming the piso-hamate hiatus, which may play a role in ulnar tunnel syndrome. We have also focused on the relation of these structures with specific concern to the ulnar nerve. Nineteen embalmed cadavers (37 hands and forearms) were dissected. A fibrous arch extending between the pisiform and the hook of the hamate was observed in 21 hands. In majority of the cases flexor digiti minimi muscle was found to originate only from this arch. An anomalous muscle was disclosed in six hands with four of them passing through the piso-hamate hiatus with the deep branch of the ulnar nerve. In two of four cases, the superficial branch of the ulnar nerve was also accompanying the deep branch of the ulnar nerve beneath the anomalous muscle and through the piso-hamate hiatus. Because these anomalous muscles were generally found to course through the piso-hamate hiatus with the branches of the ulnar nerve, we conclude that the distal portion of the Guyon's canal has a relatively higher risk for ulnar nerve entrapment. We believe that surgeons operating on this region should take into account these various anatomic structures.

WOS: 000226817300007 PubMed: 15692344 There are few local nasal flap options for repair of proximal nasal defects. Absence of suitable donor sites and the large dimensions of the defects limit the use of local nasal flaps in this region. Regional paranasal flaps may not be suitable in these cases because of color, texture, and donor-site scars. The composite procerus muscle and nasal skin flap, which is vascularized by the dorsal nasal branch of the angular artery, can be a useful treatment modality for proximal nasal reconstruction. Seven patients were successfully treated using the composite nasal flaps. The maximal size of the defects was 2.4 cm. In one case, the composite nasal flap was readvanced to close a new defect resulting from reexcision. The composite nasal flap has several advantages in reconstruction of proximal nasal defects. Reconstruction is performed with the same tissue and the donor defect is closed primarily. The composite nasal flap can be moved in multiple directions and has great mobility to reach every point of the proximal part of the nose with axial blood supply. Furthermore, it can be easily readvanced without additional morbidity in case of reexcision.