Anatomical study on sciatic nerve variations in Andhra Pradesh, India

Background: The sciatic nerve is the largest and widest nerve in the body and is derived from ventral rami of spinal nerves L2 to S3. Sciatic nerve appears in the Gluteal region below Piriformis from Pelvic cavity by passing through Greater Sciatic foramen. In between the Ischial tuberosity and greater trochanter of Femur, it reaches the back of the thigh. At the superior angle of Popliteal fossa, it divides into Tibial and common Peroneal (fibular) nerves. The division varies, and it may occur within the pelvis, Gluteal, upper, mid and lower part of thigh. The anatomical variations of the level at which the Sciatic nerve divides is considered important by Neurosurgeons, Anaesthetists, Orthopaedicians and Surgeons.Methods: This study was conducted on 52 lower limbs to determine the level of sciatic nerve bifurcation and its variations on 26 embalmed human cadavers. The data was analyzed manually using numbers, frequencies and percentages.Results: The findings of this study states that in 2 limbs (3.84%) the nerve divided in the gluteal region; in 4 limbs (7.69%) in the pelvic region; in 10 limbs (19.23%) at the junction between upper and middle thigh. The highest incidence of division occurs in 36 limbs (69.23%) at the superior angle of the popliteal fossa.Conclusions: The findings of this study revealed that the majority of sciatic nerve divisions occur   at the superior angle of popliteal fossa while some divided into other regions such as Pelvis, Gluteal and thigh regions.

Scimitar syndrome: a rare congenital venolobar anamoly.

Scimitar syndrome is a rare congenital anomaly presenting with partial anomalous pulmonary venous drainage from right lung to inferior vena cava. This is the rarest anomaly seen in 1 to 3 in 100000 births. Embryologically it is thought to be a primary developmental anomaly of lung with secondary anomalous venous drainage. This is seen commonly in right lung and is common in females. Most of the cases are asymptomatic or minimally symptomatised. If symptoms are present patient usually presents with pulmonary hypertension and symptoms of left to right shunt. Clinically this syndrome is diagnosed by chest x- ray by the presence of “Scimitar sign”. Surgical treatment effective in this syndrome.

Giant intermuscular lipoma of neck and chest: a case report with review of literature.

Intermuscular lipoma is an uncommon benign tumor. In this case report we described a case of a patient with intermuscular lipoma located between sternocleidomastoid, pectoralis and scalene muscles on left side. These typ es of tumors are exceedingly rare in head and neck regions. Intermuscular lipomas are thought to arise from the Intermuscular septa and enlarge between muscle bundles. Clinical data, investigations, Magnetic Resonance Imaging scan confirm the diagnosis. These tumours are more common in males than females. Complete surgical excision of tumor is the treatment of choice. It is crucial for the surgeon to consider deep lipomas when dealing with soft tissue tumors.

Anatomical variation in the formation and course of median nerve: a cadaveric study.

Background: Median nerve is one of the terminal branches of brachial plexus. Its formed by the union of medial root and lateral root coming respectively from medial and lateral cords of brachial plexus. Knowledge of anatomical variations of median nerve at origin and course is important in repair of traumatic injuries and surgical correction of brachial plexus injuries. These conditions need dissection of median nerve and knowledge of its variations. Methods: Present study included 53 cadavers and 106 upper limbs from our department of Anatomy. In this study, anatomically embalmed cadavers which were kept for routine dissection for under graduates were included. The present study we studied the anatomical variations in origin and course of median nerve in arm. We also studied the relation of median nerve with axillary and brachial arteries. Results: In this study we found origin of median nerve from 3 roots in 26.41%, 4 roots from 1.88%. Regarding the relation of median nerve with axillary artery we observed in 8.49% cadavers median nerve lies medial to axillary artery and in 0.94% Median nerve is passing along the lateral side of brachial artery without crossing the artery. Conclusions: This study shows high percentage of deviations from normal anatomy in origin of median nerve. Anatomical variation in brachial plexus and adjacent arteries knowledge is important for anatomist, plastic surgeon and vascular surgeons.

study of cephalic index and facial index in Visakhapatnam, Andhra Pradesh, India.

Background: The description of the human body has been a major concern since ancient times. The use of medical terminology enhances reliability of comparison made between studies from different areas thereby contributing higher level of scientific evidence. Cephalic index is an important parameter in forensic medicine, anthropology and genetics to know the sex and racial differences between individuals. Facial index is useful index for forensic scientists, plastic surgeons and anatomist. The parameters are useful for plastic surgeons during treatment of congenital and traumatic deformities, identification of individuals in medicolegal cases by forensic scientists and identifying craniofacial deformities of genetic syndromes by geneticist. Methods: 170 males and 110 female adults from Visakhapatnam, Andhra Pradesh, India region are included in this study. Anthropometric points for cephalic index were measured by using spreading calipers. Facial index measurements were taken by measuring tape. All measurements were taken in subjects sitting in relaxed condition and subjects head is in anatomical position. Cranial index and facial index were calculated as per the formula. Results: Maximum number of males with mean cephalic index values of 80.21 were observed as mesocephalic and female with mean value of 79.25 observed as brachycephalic. Regarding facial index males were leptoprosopic and females were mesoprosopic. Conclusion: Cephalic index and facial index were terms used by anthropologists, anatomists, plastic surgeons and forensic scientists to identify individual’s race and sex for treatment of craniofacial deformities.

Schwannoma arising from hypoglossal nerve in the submandibular triangle: a case report.

Hypoglossal schwannomas usually develop in the intracranial portion of the brain. The incidence of hypoglossal schwannomas of the submandibular region is extremely rare. Here we report a case of schwannoma arising from the extracranial hypoglossal nerve in the left submandibular region.

Idiopathic gynaecomastia in twins: a case report.

Gynaecomastia is a common pathological condition of breast seen in men. This is defined as benign enlargement of breast tissue in males. It was first described by Palus Aegineta (AD 635-690). Herewith we are presenting cases of 14 year old twins attending the surgical O.P.D with bilateral enlarged breasts and pain. A diagnosis of pubertal gynaecomastia was made with no evidence of malignancy by histopathological examinations and mammography. One boy with 5 x 6 cm of right breast and 2 x3 cm of left breast was treated by subcutaneous mastectomy. Other boy had only enlargement of nipple and areola. He was reassured and sent home without surgical intervention. A rare case of idiopathic gynaecomastia in pubertal twins is described here.