Horseshoe kidney with surplus renal vessels: A case report in Thai cadaver.

A horseshoe kidney (HK) was discovered in an 84-year-old Thai male cadaver during routine dissection. Inferior poles of the kidneys fused to form a parenchymatous isthmus and constituted a HK. The HK located anterior to the abdominal aorta and the inferior vena cava at a level lower than the normal kidney. Both renal hila directed anteriorly and ureters which drained from each pelvis descended anterior to the isthmus to enter the urinary bladder. Eight renal arteries and five renal veins were observed. In this case the bulky isthmus, anatomical abnormalities, and a variable blood supply were found in association with the HK. It is important to be aware of this anomalous existence in clinical practice, especially during kidney surgeries, kidney transplants, or surgical and endovascular procedures on the aorta.

Anatomical consideration of length and angulation of the styloid process and their significances for eagle's syndrome in Thais.

Objectives: Elongated styloid process was reported concerning dento-maxillofacial and ear-nose-throat patients. Several studies described that its length as well as the anterior and medial angulations occasionally involved in the symptom of Eagle’s syndrome and the surgical shortening of the process could alleviate neck and cervicofacial pain in patients. This study aimed to investigate the length and the angulation of the styloid process, and to study the occurrence of the elongated styloid process in Thais. Methods: The investigation was done in both sides of 176 Thai dry and 150 cadaveric skulls with intact styloid processes. The length and the angulation (anterior and medial angles) of the styloid process were measured and expressed as Mean±SD. A styloid process longer than 30 mm was identified as an elongated styloid process. Results: The means of length, and anterior and medial angles of styloid process were 24.12 ± 7.28 mm, and 28.03 ± 9.85 and 23.53 ± 10.19 degrees, respectively. Out of all styloid processes, 18.40% (11.70% in males, 6.70% in females) were the elongated styloid process. There was no statistical difference of angles between groups with normal and elongated styloid processes (P>0.05). Conclusions: The elongated styloid processes were found up to 18.40% of Thais. The presence of the elongated styloid process and its angulation, though rare, does highlight the importance of routine examination of the styloid process as it may cause pain in craniocervical region.

Anatomic and morphometric consideration for external landmarks of foramen spinosum in Thai dry skulls.

Background and Objectives: The foramen spinosum (FS) is an important opening on the greater wing of the sphenoid bone and transmits the middle meningeal artery to the middle cranial fossa. Because the presence of FS is important in microsurgery of this area, the anatomic and morphometric consideration for localizing the FS using external landmarks were studied. Methods: One hundred and three dry skulls were examined for the FS in the middle cranial fossa and at the extracranial view of the skull base. The type of FS was classified according to its shape. Its diameter and the distances to the zygomatic arch (ZA) and the external acoustic meatus (EAM) were also measured. Results: The FS in both views of the skull base was mostly round in shape (43.2% intracranially and 49.5% extracranially) and was present bilaterally 30.1% extracranially. The maximum and minimum diameters of the FS and the FS-ZA distance were greater in males than females and the ZA-EAM distance was greater on the right than the left sides significantly. (P<0.05) Conclusion: Although a great variation was found in the shapes of the FS, prior estimation of the location of FS was suggested using external landmarks as the point on the ZA 16.42 mm anterior to the EAM and 34.19 mm from that point medial and perpendicular to the ZA. These findings may help neurosurgeon to approach the middle cranial fossa more precisely and gain better preservation of surrounding neurovascular structures.

Dimensional guide to harvesting the radius for orofacial reconstruction.

OBJECTIVE: To provide an accurate harvesting guide to maintain the maximum possible safe dimensions of the radius for orofacial reconstruction using the osteocutaneous radial forearm free flap. MATERIAL AND METHOD: Two hundred radii of 100 adult formalin-embalmed cadavers (52 males, 48 females) were measured. RESULTS: The mean minimum circumference of the radius measured between the pronator teres and brachioradialis insertions was 41.0 +/- 4.3 mm. At this point, the mean medio-lateral diameter was 13.4 +/- 1.6 mm. The mean of the maximum harvested length of the radius between the pronator teres and brachioradialis insertions was 81.3 +/- 10.4 mm. On the average, the maximum harvested length of the radius was 34.9% of its total length. The minimum medio-lateral diameter of the radius was consistently 1-5 mm less than 40% of its minimum circumference. There was no significant dimensional difference between sides but gender difference existed in all measurements (p < 0.001), except the maximum harvested length of the radius. CONCLUSION: The present study may be helpful to guide reconstructive surgeons for safer harvesting of the radius using the osteocutaneous radial forearm free flap to repair orofacial defects.

Dimensions for midline and paramidline andibulotomy: a radiographic study in the dentate Thai population.

BACKGROUND: Mandibulotomy is an important surgical approach of the oral cavity, oropharynx, and parapharyngeal space. OBJECTIVE: To provide dimensions for placement of bone cuts for midline (between two central incisors) and paramidline (between lateral incisor and canine) mandibulotomy. MATERIAL AND METHOD: Two hundred and sixteen periapical radiographs with the mandibular anterior teeth of 72 healthy Thai dental patients (30 males, 42 females) were selected. The angles between the long axes of the two central incisors (M) and between the lateral incisor and canine (PM) were bilaterally measured using computerized imaging. The horizontal distances (at crestal, middle, and apical levels) between the roots and the alveolar bone heights of the aforementioned teeth were also measured. RESULTS: The angles between the PM (0.00-9.26 degrees) were less convergent than those between the M (0.00-11.66 degrees) (p < 0.05). The distances between the PM were 0.60-8.03 mm, whereas those between the M were 0.47-6.63 mm (p < 0.05). Mean alveolar bone height is 15.88 +/- 1.72 mm in the canine. CONCLUSION: The paramidline mandibulotomy is done in a wider space than the midline cut and could have a better chance to avoid the extraction of a central incisor and preserve the origin of the genioglossus, geniohyoid, and digastric muscles.

Anatomical study of the maxillary artery at the pterygomaxillary fissure in a Thai population: its relationship to maxillary osteotomy.

BACKGROUND: The maxillary artery (MA) and its terminal branches are commonly damaged in the maxillary osteotomy, especially during separation of the pterygomaxillary junction (PMJ). OBJECTIVE: To evaluate the positional relationship between the MA at the pterygomaxillary fissure (PMF) and the PMJ in Thais, as well as to measure the diameter of the MA as it enters the pterygopalatine fossa (PPF) and the heights of PMJ, maxillary tuberosity and posterior maxilla. SUBJECTS AND METHOD: Both sides of 100 Thai adult cadavers (50 males and 50 females) were examined The mean age of the subjects was 64.5 +/- 12.8 years. With the lateral infratemporal approach, the branches from the third part of the MA, PMJ and posterolateral maxilla were dissected. Measurements taken included the following: First, the distance from the most inferior point of the PMJ to the most inferior position of the MA as it entered the PPF; second, the external diameter of the MA as it entered the PPF; third, vertical heights of the PMJ, maxillary tuberosity and posterior maxilla. Means, standard deviations and ranges were determined and statistical differences were calculated between sides and genders at p < 0. 05. RESULTS: The MA entered the PPF at a mean distance of 23.5 +/- 2.5 mm above the most inferior point of the PMJ. The mean external diameter of the MA as it entered the PPF was 2.8 +/- 0.6 mm. The mean heights of the PMJ, maxillary tuberosity and posterior maxilla were 19.5 +/- 2.3 mm, 6.1 +/- 2.7 mm, and 25.6 +/- 3.3 mm, respectively. There were no differences with respect to side and gender, except that the distance from the most inferior point of the PMJ to the most inferior position of the MA as it entered the PPF was longer in males than in females (p < 0.05). CONCLUSION: The mean location of the MA was 23.5 mm apart from the most inferior point of the PMJ, therefore, dysjunction of the PMJ using an osteotome with a 15-mm cutting edge may be conducted without damaging to the MA. When properly placed, the margin of safety from the superior cutting edge of the osteotome to the MA is approximately 8 mm in adults.