A newly discovered muscle: The tensor of the vastus intermedius

The quadriceps femoris is traditionally described as a muscle group composed of the rectus femoris and the three vasti. However, clinical experience and investigations of anatomical specimens are not consistent with the textbook description. We have found a second tensor-like muscle between the vastus lateralis (VL) and the vastus intermedius (VI), hereafter named the tensor VI (TVI). The aim of this study was to clarify whether this intervening muscle was a variation of the VL or the VI, or a separate head of the extensor apparatus. Twenty-six cadaveric lower limbs were investigated. The architecture of the quadriceps femoris was examined with special attention to innervation and vascularization patterns. All muscle components were traced from origin to insertion and their affiliations were determined. A TVI was found in all dissections. It was supplied by independent muscular and vascular branches of the femoral nerve and lateral circumflex femoral artery. Further distally, the TVI combined with an aponeurosis merging separately into the quadriceps tendon and inserting on the medial aspect of the patella. Four morphological types of TVI were distinguished: Independent-type (11/26), VI-type (6/26), VL-type (5/26), and Common-type (4/26). This study demonstrated that the quadriceps femoris is architecturally different from previous descriptions: there is an additional muscle belly between the VI and VL, which cannot be clearly assigned to the former or the latter. Distal exposure shows that this muscle belly becomes its own aponeurosis, which continues distally as part of the quadriceps tendon

Full Thickness Cartilage Palisade Tympanoplasty with Malleus Interposition; A Study of the Long Term Results

The aim of this retrospective study is to review long term results of full-thickness cartilage palisade tympanoplasty (FTCPT) with malleus head interposition performed on 51 patients (56 ears); 36 women and 15 men (7-73 years, 44 years average). The pathology of ears which encourages this technique of tympanoplasty is presented. On average 12 years after surgery we have elaborated anatomic and functional results. Anatomic results were categorized based on empiric evaluation of the new tympanic membrane status: 40 (71%) tympanic membranes without anatomic irregularities, 14(25%) with irregularities and 2(4%) with secondary perforation. Functional results (tonal audiogram) are based on pure tone average air-bone gap (PTA-ABG) at 4 frequencies. Main functional results of 51 ears (51 audiograms performed): pre- and post-operative average PTA-ABGs were 27.07±9.98 and 10.77±7.85 dB (t=10.36; p<0.001). In the group of ears with a tympanic membrane with no anatomic irregularities, pre- and post-operative average PTA-ABGs were 27.30±10.56 and 10.82±8.33 dB (t=8.09; p<0.001). In the group of ears with cartilage resorption, pre- and post-operative PTA-ABGs were 24.92±8.19 and 9.33±6.58 dB (t=6.21; p<0.001). The differences between the two groups are irrelevant. Postoperative PTA-ABG values of ears after first surgery (n=34) and revision surgery (n=17) was significantly different (8.75±5.75 and 15.16±9.62 dB) (t=2.60; p=0.016). In spite of the thickness of the new tympanal membrane, FTCPT is a successful technique for solving advanced ear pathology

The number of intercostal artery perforators over the distal latissimus dorsi muscle

With the increasing popularity of perforator flaps as "musculocutaneous flaps without muscle," a new interest in the intercostal vessels as source vessels for perforator flaps has arisen. In a recent study, the branches of the three lowermost intercostal vessels to the latissimus dorsi were studied in detail. Now that these muscular branches are well understood, the present study examines how many of these branches reach the overlying skin as musculocutaneous perforators. We identified the intercostal artery perforators in the ninth, tenth, and eleventh interspaces, in 42 hemithoraces. Only branches that measured 0.5 mm or more in external diameter were included. The course of the perforators was followed from their exit from the latissimus dorsi muscle up to the entrance at the undersurface of the skin. This entrance point was punctured by a pin and thus marked on the skin. This study showed that at least three musculocutaneous perforators were present over the intercostal spaces IX-XI in every dorsal hemithorax (average 8 +/- 3, range 3-16). Potentially, each of these vessels can be used as a pedicle for a separate perforator flap, leaving the more proximal parts of the latissimus dorsi intact for a second flap based on the dominant thoracodorsal vessels

The causes of the nasolabial crease: A histomorphological study

There are two main conflicting theories on how the nasolabial crease is formed: a muscular theory and a fascial theory. The muscular theory states that the nasolabial crease is mainly formed by the musculodermal insertions of the lip elevator muscles. The fascial theory claims that the nasolabial crease is mainly formed by dense fibrous tissue and by the firm fascial attachments to the fascia of the lip elevator muscles. If the muscular theory was true, the musculodermal insertions of the facial muscles could be interrupted directly by intradermal injections of low doses of botulinum toxin. Eight cadavers who presented with bilateral nasolabial creases were enrolled in the study. The nasolabial creases were harvested from 14 facial halves in their entire lengths and breadths with 5-mm medial and lateral rims. The horizontally cut samples were stained with hematoxylin-eosin (H&E) and Elastica van Gieson (EVG). Immunohistochemistry for the smooth muscle marker actin and the skeletal muscle marker desmin was also performed. In each of the nasolabial creases, numerous skeletal muscle fibers were found in the dermis, which confirmed the muscular theory of the cause of the nasolabial crease. In addition, muscle fibers were present in the dermis 4 mm medial and 4 mm lateral to the nasolabial crease, but the amounts were significantly less than the amount located directly in the crease. Botulinum toxin injected intradermally into the nasolabial crease might constitute a new treatment option to minimize or even eradicate the crease and the fold. Clin. Anat.2012. © 2012 Wiley Periodicals, Inc

PALISADNA TIMPANOPLASTIKA PUNOM DEBLJINOM HRSKAVICE I INTERPOZICIJOM GLAVICE ČEKIĆA : STUDIJA DUGOROČNIH REZULTATA

The aim of this retrospective study is to review long term results of full-thickness cartilage palisade tympanoplasty (FTCPT) with malleus head interposition performed on 51 patients (56 ears); 36 women and 15 men (7–73 years, 44 years average). The pathology of ears which encourages this technique of tympanoplasty is presented. On average 12 years after surgery we have elaborated anatomic and functional results. Anatomic results were categorized based on empiric evaluation of the new tympanic membrane status: 40 (71%) tympanic membranes without anatomic irregularities, 14(25%) with irregularities and 2(4%) with secondary perforation. Functional results (tonal audiogram) are based on pure tone average air-bone gap (PTA-ABG) at 4 frequencies. Main functional results of 51 ears (51 audiograms performed): pre- and post-operative average PTA-ABGs were 27.07±9.98 and 10.77±7.85 dB (t=10.36; p<0.001). In the group of ears with a tympanic membrane with no anatomic irregularities, pre- and post-operative average PTA-ABGs were 27.30±10.56 and 10.82±8.33 dB (t=8.09; p<0.001). In the group of ears with cartilage resorption, pre- and post- -operative PTA-ABGs were 24.92±8.19 and 9.33±6.58 dB (t=6.21; p<0.001). The differences between the two groups are irrelevant. Postoperative PTA-ABG values of ears after first surgery (N=34) and revision surgery (N=17) was significantly different (8.75±5.75 and 15.16±9.62 dB) (t=2.60; p=0.016). In spite of the thickness of the new tympanal membrane, FTCPT is a successful technique for solving advanced ear pathology.Namjera ove retrospektivne studije je analiza dugoročnih rezultata timpanoplastike s rekonstrukcijom bubnjića punom debljinom hrskavice uške i interpozicijom glavice čekića učinjene kod 51 bolesnika (56 uha); 36 žena i 15 muš- karaca u dobi od 7 do 33 godine (prosjek 44 godine). Prikazuje se uznapredovala patologija uha na osnovu koje je indicirana ova tehnika timpanoplastike. Prosječno 12 godina nakon operacije elaboriraju se anatomski i funkcionalni rezultati. Anatomski rezultati se kategoriziraju na osnovi empirijske evaluacije stanja novostvorenog bubnjića: 40 (71%) bubnjića bez anatomskih iregularnosti, 14 (25%) s iregularnostima i 2 (4%) s sekundarnom perforacijom. Funkcionalni rezultati se temelje na ispitivanju konduktivne komponente u tonalnom audiogramu (pure tone average air bone gap; PTA-ABG) kod 4 frekvencije. Funkcionalni rezultati kod 51 ispitanog uha (51 u~injen audiogram) su slijedeći: prosječni pre i postoperativni PTA-ABG iznosi 27,07±9,98 i 10,77±7,85 decibela (dB) (t=10,36; p<0,001). U skupini uha bez anatomskih iregularnosti novostvorenog bubnji}a prosječni pre i postoperativni PTA-ABG je 27,30±10,56 i 10,82±8,33 dB (t=8,09; p<0,001). Kod skupine uha s resorpcijom hrskavice bubnjića prosječni pre i postoperativni PTA-ABG iznosi 24,92±8,19 i 9,33±6,58 dB (t=6,21; p<0,001). Između skupina nema statistički značajne razlike. Postoperativne vrijednosti PTA-ABG kod uha nakon primarne operacije (N=34), odnosno reoperacije (N=17) značajno su različite (8,75±5,75 i 15,16±9,62 dB) (t=2,60; p=0,016). Usprkos debljini novostvorenog bubnjića navedena tehnika timpanoplastike je uspješna u rješavanju uznapredovale patologije uha