The importance of costoclavicular space on possible compression of the subclavian artery in the thoracic outlet region: a radio-anatomical study

OBJECTIVES: 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. METHODS: 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. RESULTS: The average width and length of the interscalene space in cadavers were 15.28 ± 1.94mm and 15.98 ± 2.13 mm, respectively. The widths of the costoclavicular passage (12.42 ± 1.43mm) 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 ± 2.12mm and 16.12 ± 1.95mm, respectively. In CT images, the widths of the costoclavicular passage were also significantly narrower than those of the interscalene space (P 0.05). CONCLUSIONS: 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

Localization of Mental and Mandibular Foramens on the Conventional and Digital Panoramic Images

The purpose of this study was to compare the efficiency of conventional and digital panoramic images for localization of mental and mandibular foramens. Six dry edentulous human mandibles were used in the study. Conventional and digital panoramic images were obtained and the vertical and horizontal measurements were performed for localization of mental and mandibular foramens on the images. The correlations between radiographic (conventional and digital) and direct measurements were compared. A measurement error between the radiographic and direct measurements was determined at the level of 1 mm. The measurement errors were generally less in conventional panoramic radiography than digital one. There was statistically strong positive correlation between direct and radiographic measurements. Statistically significant difference was found between radiographic and direct measurements for bone height of mandible in ramus region. According to the results of this study, diagnostic performance of conventional and digital panoramic images seems to be equal for the localization of mental and mandibular foramens. The vertical radiographic measurements are generally reliable and correlated with direct measurements in mandible for conventional and digital panoramic radiography, but the evaluation of bone height in ramus region may not be sufficiently reliable

Details of fibroligamentous structures in the cervical unco-vertebral region: An obscure corner

Vertebral bone, joints and ligaments on the cervical spine are structures that maintain the stability of the spine and protect the neurovascular structures. Determining the detailed anatomical location of the intervertebral foramen and unco-vertebral (UV) region with respect to the vertebral bone, joint and ligaments is critical when choosing the safest surgical approach to the cervical spine. We studied the microscopic detailed anatomy of the dural covering and posterior longitudinal ligament (PLL) in eight cadaver specimens and the relevance of these structures in the UV region from C4 to C7. The uncinate process (UP) and its covering ligaments are mechanical barriers that prevent the nerve root and the vertebral artery against unintentional surgical damage. Dissection at the posterolateral surface of the UP revealed a separate perivascular fibroligamentous tissue (PVFLT) that originates from the PLL. The recognition of the PVFLT may provide for safe surgery by protecting the neural and vascular structures during decompression in the UV region

Clinical importance of ligamentous and osseous structures in the cervical uncovertebral foraminal region

The vertebral artery, cervical spinal nerves, spinal nerve roots, and the bony and ligamentous tissue related to the cervical vertebrae are structures whose anatomy determines the path of a surgical approach. Defining the anatomy and, in particular, determining the precise location of vulnerable structures at the intervertebral foramen and the uncovertebral foraminal region (UVFR), a region defined by the uncinate process anteriorly, the facet joint posteriorly and the foramen transversarium laterally, has critical significance when selecting the safest surgical approach. We studied the anatomy of the vertebral artery, cervical spinal nerves, and spinal nerve roots within the UVFR in six cadaver specimens. We also obtained measurements of bony structures in 35 dry cervical vertebral columns, from C3-C7. The uncinate process (UP) projects superiorly from the posterolateral aspect of each cervical vertebral body, except for the first and second vertebrae. Because the posterior part of the UP lies adjacent to the vertebral artery, spinal nerve, and spinal nerve roots, its resection creates sufficient space to decompress these structures directly. The posterolateral surface of the UP is covered by ligamentous tissue that originates from the posterior longitudinal ligament and protects the neural and vascular structures during their decompression in the UVFR

Temporomandibularis ağrısına neden olan Eagle sendromunun farklı teşhisi

Çalışmamızda Eagle sendromuna bağlı olarak gelişen art.temporomandularis ağrısının tanısının konulmasında farklı teşhis yöntemlerinin dışında intraoral muayenenin önemi ortaya konulmuş ve literatür bulgularıyla karşılaştırılmıştır.We presented the case of a patient with Eagle's Syndrome, which had beter was referred for temporomandibular joint (TMJ) pain dysfunction syndrome in a review of the literature , we discovered the importance of a intra-oral examination for making a differential diagnosis for the TMJ pain dysfunction syndrome

Intraorbital fat tissue: An anatomic cadaver study

Göz kapaklarında yaşlılıkla artan yağ torbacıklarının çıkartılması klasik bleferoplasti operasyonlarının önemli bir evresidir.Bu çalışmada toplaın 10 kadavradaki 20 adet intra orbital yağ dokusu incelenmiş ve yağ dokusunun anatornik lokalizasyonu araştırılmıştır. Elde edilen a natomik bulgular bu alandaki diğer çalışmalar incelenerek tartışılmıştır.Removal of the fat bags whose size increases with age is the imporant part of the conventional bleforasty operation. Localisation of the intraorbital fat tissue and evidence of the fat compartments were investigated in total 20 orbits from 10 cadavers. Anatomic findings were dissused as compared with review of literature

The coexistence of temporomandibular disorders and styloid process fracture: A clinical report

WOS: 000238395200005PubMed: 16765153This 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

Nazolabial flep operasyonlarından sonra dudağın innervasyon paterni

Özellikle iki taraflı nazolabial flep operasyonlarından sonra dudağın denervasyon problemleri olabileceği düşünülmüştür. Biz sukuamoz karsinoma sonrası beş olguda ortaya çıkan defektleri nazolabial "gate" flap ile onardık. Dudak innervasyonunu postoperative dönemde EMG ile araştırdık.Erken postoperative dönemde bile dudağın innervasyonu olduğunu gözledik. Bu klinik bulgu sonrası beş kadavra üzerinde bir anatomik çalışma yaptık ve 10 nazolabial flebi dudağın innevasyonunu araştırmak için kaldırdık. Bu çalışma sırasında üst dudağa sinir iletimine izin veren nazolabial flebin en üst kenarı ile piriforum aperturanın lateral kenarı arasında bir alan lokalize edildi. Ardından bu alandan nekropsiler alındı ve çok fazla sinir dokusu histolojik incelemede gözlendi. Sonuç olarak nazolabial "gate" flap bilateral olgularda bile dudak rekonstrüksiyonunun innerve dokularla yapıl-masına olanak sağlayan iyi bir flep seçeneğidir.Dernervation problems of the lip both the upper lip and reconstructed lower lip have been considered possible after nasolabial flap procedures particularly in bilateral cases. We performed gate flap operations in five patients for lip defects due to squamous carcinoma excision. Lip innervation was investigated with EMG studies in the postoperative period. We observed that innervation of the lip was present in early postoperative period. After this clinical finding an anatomic study was performed on five cadavers. Ten nasolabial flaps were elevated to examine lip innervation. An area which can permit neural pathways for upper lip was localized between the most cephalic borders of the nasolabial flap and the lateral wall of the pyriform apertura then .Then necropsies were identified with histologic examination. In conclusion, nasolabial "gate " flap provides ideal lower lip reconstruction with innervated tissue and upper lip innervation is protected with bileteral gate flap operatio

A case of variation in the terminal Branches of the ulnar nerve

52 yaşında bir erkek kadavranın sağ elinin diseksiyonu sırasında n. ulnaris'in elin palmar yüzünde verdiği uç dallara ait bir varyasyon tesbit edildi. Küçük parmağın ulnar tarafında seyreden n. digitalis palmaris proprius, n. ulnaris'in r. superficialis ve r. profundus'undan çıkan dalların birleşmesiyle oluşmaktaydı. R. profundus'tan çıkarak m. abductor digiti minimi'yi innerve eden sinirden ayrılan bir dal bu kasın içinden geçip yüzeyelleşmekte ve daha sonra r. superficialis'ten gelen dallarla birleşmekteydi.During the dissection of a 52 year old male cadaver's right hand a variation in the terminal branches of the ulnar nerve was observed in the palm of the hand. The medial proper palmar digital nerve to the little finger was formed by the branches separated from the superficial and the deep branches of the ulnar nerve. The branch given off by the nerve that arose from the deep branch of the ulnar nerve and innervating the abductor digiti minimi muscle pierced this muscle and passed through. Then, it connected with the branches from the superficial branch of the ulnar nerve