Bilateral cadaveric variations of musculocutaneous nerve and median nerve in the anterior brachium: a case report

Formation of the brachial plexus is by the union of ventral rami of C5-T1 spinal nerves. The musculocutaneous nerve is a continuation of the lateral cord, pierces the coracobrachialis and supplies the flexor compartment of the arm. Our case report presents a unique bilateral cadaveric variation in the musculocutaneous nerve and median nerve branching patterns, in the flexor compartment of the arm. A case report of bilateral variations of musculocutaneous nerve and median nerve (R-Right, L-Left) was found during the routine dissection in the Department of Anatomy, Shridevi Institute of Medical Sciences and Research Hospital, Tumakuru. From the right lateral cord, separation of few nerve fibres forming the lateral root of the median nerve was appreciated. The lateral root joins the medial root of the medial cord, after emerging out of the ulnar nerve and forms the initial segment of median nerve. Before the union of lateral and medial roots of initial segment of median nerve, ulnar nerve, medial cutaneous nerve of arm and medial cutaneous nerve of forearm descends along the medial aspect of the right arm. From the left lateral cord musculocutaneous nerve pierces the coracobrachialis. Before piercing the muscle, it gives one vascular branch and a motor branch. After piercing, the musculocutaneous nerve runs downwards and gives a motor branch to left biceps brachii. Variations of brachial plexus are frequently subjected to compression neuropathy. During surgical approaches to the brachium region, awareness about the anatomical variations of lateral and medial cords is mandatory for diagnosing the peripheral nerve entrapment syndrome. An integrated understanding of these branches prevent iatrogenic injuries during surgical procedures

Anatomical variation in the sphenoidal sinuses in patients with chronic rhinosinusitis: A CT scan study

المخلص: أهداف البحث: يعد فهم تشريح الجيوب الأنفية أمرا بالغ الأهمية لتخطيط الجراحة قبل العملية. تهدف هذه الدراسة إلى تقييم العلاقة بين التغيرات التشريحية للجيوب الجبهية والتهاب الجيوب الأنفية المزمن باستخدام الأشعة المقطعية. طرق البحث: أجريت دراسة وصفية على المرضى الذين يعانون من التهاب الجيوب الأنفية المزمن، والذين أحيلوا لإجراء الأشعة المقطعية إلى قسم التشخيص بالأشعة والتصوير، وتمت مقارنة المعلمات بين مجموعات الدراسة والسيطرة. النتائج: من بين التغيرات التشريحية، كانت وجود أجزاء مساعدة مكررة داخل الجيب الجبهي، وانحسار وبروز الشريان السباتي الداخلي والعصب البصري مرتفعة في الذكور والإناث من الحالات مقارنة بالمجموعة المرجعية. بين التغيرات التشريحية في منطقة الجيوب الأنفية للمشاركين الذكور في مجموعات الدراسة، كان هناك ارتباط كبير مع بروز العصب البصري وانحساره. أظهر بروز العصب البصري في الذكور خطرا أعلى للإصابة بالتهاب الجيوب الأنفية المزمن بين مجموعة الدراسة. الاستنتاجات: توفر المعرفة حول التغيرات التشريحية في الجيوب الجبهية فهما أفضل لحدود الاستئصال الجراحي خلال علاج جراحات الجيوب الجبهية. Abstract: Computerized tomography (CT) of the skull base region has become an indispensable tool for endoscopic sinonasal surgery. Objectives: Fundamental knowledge of the sinus anatomy is crucial for preoperative surgical planning. The aim of this research was to evaluate associations between the anatomical variations sphenoidal sinuses and chronic rhinosinusitis (CRS) by using CT. Methods: A descriptive study was performed on patients with CRS, who were referred to the department of radiodiagnosis and imaging for CT scanning. Parameters were compared between the study and control groups. Results: Among the anatomical variations, the presence of bilateral accessory septa within the sphenoidal sinus, and dehiscence and protrusion of the internal carotid artery and optic nerve (ON), were high in men and women in the case group compared with the control group. Among the anatomical variations in the sinonasal region of the male participants, a significant association (p < 0.05) was observed with ON protrusion and ON dehiscence. ON protrusion (OR = 2.168) in men was associated with elevated risk of CRS in the study population. Conclusion: Knowledge of the anatomical variations in the sphenoid sinuses enables better understanding of the limits of surgical dissection during the treatment of sphenoid sinus surgeries