The anatomic landmarks of ethmoidal arteries for the surgical approaches

WOS: 000236747300014PubMed ID: 16633176Knowledge of variations in the possible patterns of origins, courses, and distributions of the ethmoidal arteries are necessary for the diagnosis and important for the treatment of orbital disorders. Ethmoidal arteries are damaged in endonasal surgical interventions and in operations performed on the inner wall of the orbita. A description of the anatomic landmarks of the ethmoidal arteries and ethmoidal canals is presented, based on data from microdissection in 19 adult cadavers studied after injection of red-dyed latex into the arterial bed. In all subjects, each of ethmoidal arteries originated from ophthalmic artery. The anterior ethmoidal artery was observed in all specimens except for one case. The diameter of the artery thicker than the posterior ethmoidal artery was 0.92 +/- 0.2 min on the right and 0.88 +/- 0.15 min on the left. The branching of the anterior ethmoidal artery from the ophthalmic artery was determined in four different types. The diameter of the posterior ethmoidal artery was measured as 0.66 +/- 0.21 min on the right and 0.63 +/- 0.19 mm on the left. The anterior ethmoidal canal was located between the second and third lamella in 29 of 38 cases. The mean distance between the limen nasi and anterior ethmoidal canal was 48.1 +/- 3.2 mm. The article confirms the well-known variability of the ethmoidal arteries and their topographic relation to the ethmoidal canals. Advances in surgical techniques, instrumentation, and regional arterial anatomy have resulted in functional operations of endoscopic sinus and orbital surgery with fewer complications

Distal variations of the neurovascular pedicle of the serratus anterior muscle as a flap

WOS: 000228847200004PubMed ID: 15645159The serratus anterior muscle has recently been suggested as a versatile and reliable flap for reconstruction of complex craniofacial and neck lesions, extremity and sacroiliac region injuries, as well as intrathoracic and extrathoracic reconstruction procedures. The muscle has been used as a microvascular flap or a pedicled transfer and has been transferred in combination with other muscles, bones, and skin. We performed 15 dissections of adult axilla regions that were examined under x3.5 loupe magnification to collect anatomic data regarding the neurovascular pedicle of the serratus anterior muscle. The serratus muscle and fascia were found to have a dual blood supply, with the upper part supplied by the lateral thoracic artery and the lower part by terminal branches of the thoracodorsal artery. The lateral thoracic artery was noted to supply the upper four slips but it extended into the lower serratus anterior muscle in two cases. Seven branching patterns were found in the lower serratus anterior muscle. In type I, the only branch of serrati proceeded over the long thoracic nerve. Type II had the only branch of serrati proceeding under the long thoracic nerve. In type III, double branches of serrati proceeded over the long thoracic nerve; while in type IV branches of serrati ran with a double branch under the long thoracic nerve. In type V, three serrati branches proceeded over the long thoracic nerve. Type VI serrati branches were branches of thoracodorsalis, which was hypoplastic, and the supply was maintained from the lateral thoracic artery. In type VII, one serrati branch ran over the long thoracic nerve. There was no connection between the branches of serrati and the branches of the lateral thoracic artery. The length of the long thoracic nerve, the number of motor axons and the vascular network in anatomic proximity to this nerve make it an expendable but powerful source of reconstructions of head, neck, chest wall and extremity defects. Results of this study provide an anatomic framework to improve current reconstructive or aesthetic procedures on the serratus anterior neurovascular structures

Mapping the course of long thoracic nerve

Long thoracic nerve (LTN) injury has been reported after radiotherapy, trauma, patient's position, transaxillary breast augmentation, implantation of transvenous leads, anaesthetic nerve block and transaxillary incision. Denervation of the serratus anterior muscle at LTN injury results in loss of scapular stabilization or winged scapula. LTN injury results in prolonged disability and impact on quality of life for patient and potential medicolegal concerns for the physician. The purposes of this study is to map the course of LTN relative to the scapula and sternum, thereby developing guidelines to aid in the prevention of LTN injuries. The course of the long thoracic nerve were investigated in 15 adult Turkish cadavers. Each cadaver was placed in the transaxillary thoracotomy positions. The LTN was exposed bilaterally in its course from axilla to its penetration into serratus anterior muscle. The nerve courses vertically, gets progressively closer to the anterior border of the scapula. The length of the LTN was measured as 201.4±20.7 mm on the right and 208.6±17 mm on the left. The distance from main trunk to clavicle was 28.8±6.3 mm on the right and 29.8±3.6 mm on the left side. The distance from sternal angle to LTN was measured as 212.4±21 mm on the right and 220.5±27.5 mm on the left. The distance between xiphoid process was 246.5±21.8 mm on the right and 242.8±27.9 mm on the left. The distance from scapul ar rim to LTN was 61.9±10.7 mm on the right and 57.6±13 mm on the left. The length of thickest branch of LTN was 22.6±10.4 mm on the right and 31.4±28.1 mm on the left. The diameter of the thickest branch was 1.6±0.59 mm on the right and 1.63±0.85 mm on the left. The number of side branches was 6.44±2.06 ones on the right and 6.45±2.77 ones on the left side. Bifurcation number of terminal branch of LTN was 2.55±0.72 ones on the right and 2.54±0.68 ones on the left. By using these anatomical guidelines, we believe that the incidence of iatrogenic long thoracic nerve injury can be minimized. © neuroanatomy.org

Relationship between nicotinamide adenine dinucleotide phosphate-diaphorase-reactive neurons and blood vessels in basal ganglia

WOS: 000082436000014PubMed ID: 10501457The relationship between nicotinamide adenine dinucleotide phosphate-diaphorase-positive neurons and blood vessels was investigated within the rat basal ganglia. Nicotinamide adenine dinucleotide phosphate-diaphorase-positive cell bodies, dendrites or axon-like processes surrounding many but not all blood vessels were observed in the caudate-putamen, ventral pallidum, medial part of the globus pallidus, substantia nigra and subthalamic nucleus. It is concluded that this close relationship contributes to the local vasodilator effect of nitric oxide in the regulation of blood flow in cerebral blood vessels. (C) 1999 IBRO. Published by Elsevier Science Ltd

Importance of the anatomic features of the lacrimal artery for orbital approaches

WOS: 000234441800004PubMed ID: 16327539Knowledge of variations in the possible patterns of origin, course, and distribution of the lacrimal artery are necessary for the diagnosis and important for the treatment of orbital disorders. The vascularization of 38 lacrimal glands was studied by orbital dissection subsequent to injection of the arterial bed with red-dyed latex. The origin, calibration, and branches of the lacrimal artery and its topographic relations were investigated. In all subjects, arteria lacrimalis originated from ophthalmic artery. On the right, the lacrimal artery sprang from the angle of the ophthalmic artery in 63.15% of the cases, from the curve of the ophthalmic artery in 26.31%, and from the first part the ophthalmic artery in 5.26%. The outer diameter of the lacrimal artery was measured as 1.02 +/- 0.17 mm on the right and 1.03 +/- 0.16 mm on the left. In 68.42 of the cases on the right and in 52.63 of the cases on the left, the lacrimal artery was present, and the lacrimal nerve was seen in a superolateral position with respect to the origin of the artery. Variability of the glandular branch in its course toward lacrimal gland was observed. Recurrent meningeal branch was seen in six cases on the right and in five on the left. On the right, of the six cases, two passed through meningoorbital foramen, and four passed through superior orbital fissure and entered middle cranial fossa. On the left, of the five cases, two passed through meningoorbital foramen, and three passed through superior orbital fissure and entered middle cranial fossa. In this case, the lacrimal gland is the site of an intraorbital anastomosis between internal and external carotid systems. This article confirms the well-known variability of the lacrimal arterial branches and their relation to the lacrimal gland. These variations have been discussed and described with respect to the embryonic development. A better understanding of the vascular anatomy of the lacrimal gland should allow modification of surgical techniques to reduce bleeding during biopsy or excision of the lacrimal gland

Morphologic features of the acetabulum

WOS: 000233034900004PubMed ID: 16096799Introduction: The embryology and development of the hip joint are complex. The acetabulum is not always of the same shape, width, or depth. Minor anatomical abnormalities in the acetabular shape, joint congruences are frequent. Controversies still exist on the importance of these variations and help to prevent problems following in surgical procedures such as acetabular reconstruction and femoracetabular impingement. Material and methods: The aim of this study is to provide the location of the unusual facets, the acetabular point, and the anterior ridge of the acetabulum based on a morphological study of human pelvic bones. Morphologic features of the acetabulum, particularly determination of unusual facets, were studied in 226 human coxal bones. Results: In adult coxal bones the acetabular fossa has an irregular clover-leaf shape, the superior lobe being smaller than the anterior and the posterior lobes. Measured lunate surface area varied between 14.5 and 30.5 cm(2). A smooth unusual facet was found anteroinferior to the lunate surface in 62 acetabulums. Measured along the long axis, its size varied between 11 and 17 mm. Three different shapes of the unusual facet were as follows: oval (32.26%), piriform (45.16%), and elongated (22.58%). The prevalence of the piriform facet shape was higher in males. In 59.68% of the bones it extended to the superior ramus of the pubis, and in the remaining 40.32% it was limited within the acetabular margin. It is postulated that this facet could be a consequence of a particular posture, which results in traction of the ligaments attached to this area. Four distinct configurations were identified relative to the anterior acetabular ridge. The majority 98 (43.36%) were curved: 64 (28.33%) were angular; 37 (16.37%) were irregular; and 27 (11.94%) were straight. Conclusion: There have been no reports on details such as unusual facets, acetabular point, and anterior ridge of the acetabulum in a single research. These findings will be of help in planning reorientation procedures, using spikes, screws, and press-fitting for fixation