Position Variation of Vermiform Appendix in Northeast Thai Cadavers

Background and objective: The acute appendicitis is a common and serious cause of acute abdominal pain. Oftentimes, the surgeons could not find the vermiform appendix in its usual position. A detailed study of variation positions of the vermiform appendix is necessary for an appropriate treatment.  The data could also contribute to the collection of the world such as the World Health Organization from a population of the Northeast Thailand. This study aims to study and accumulate the gross anatomical data on position variation of the vermiform appendix in the Northeast Thailand cadavers.  The incidence and morphometry of the structure were established.Design: A detailed dissection is the descriptive study.Materials and Methods: A total number of 102 cadavers donated by the Northeast Thailand population were carefully dissected. The identification of the urinform appendix site was done by following the three teniae coli caudally to its base where the three muscular lands meet to form a complete longitudinal, smooth muscular tube. The length was measured using the venire caliper and the percentage was calculated.Results: Among 102 specimens, the most common type of vermiform appendix is the post-ileal at 37.25% while the least common (called the pre-ileal and paracecal types) is at 3%.  The approrimate length of 6 cm is the most frequent group. The average length + SD of both genders is 6.127 + 2.028 cm.Conclusion: This study  discovered that the most common type of position variation of vermiform appendix is the post-ileal type at 37.25%. The average length in male and female cadavers are 6.329 + 2.012 cm. and 5.688 + 2.023 cm., respectively.Keywords: cecum, gut rotation, rotation axis, vermiform appendix, position variation, morphometry,  mesoappendix, teniae coli, situs inversus

Six lumbar vertebrae in Thai : A case report

Background: The vertebral column in general is made up of 33 vertebrae of different shape and size, although all of which share typical features. There are 7 cervical,        12 thoracic, 5 lumbar, 5 sacral  vertebrae that fuse into one at the age of about 20 years, and 4 coccygeal vertebrae that become one piece at middle age. The study of human skeletons in the Gross Anatomy Laboratory, Faculty of Medicine, Khon Kaen University from 1975 to 2004 totalled 480 skeletons which we found a case with 6 lumbar vertebrae. The first and the sixth presented anatomical variations from the typical and normal lumbar vertebrae. We are interested in reporting the case that has never been reported in Thai.Objectives:   1.To study anatomy of the six lumbar vertebrae in Thai skeletons.                    2.To study the articulation between the sixth lumbar vertebra and sacrum.Results:  The skeleton of a 57 year old male presents anatomical variations of  lumbar vertebrae. He has six, in contrast to normal five lumbar vertebrae whereas the other levels are normally, 7 cervical, 12 thoracic, 1 sacral and 1 coccygeal vertebrae. The first lumbar vertebra is obviously differently from others in that its transverse processes are short and articulated with the malformed ribs. The pair of this malformed ribs is the 13th, an extra pair additional to the normal 12 pairs. The right one is 4 centimeters long while the left is 3.5 centimeters. Additional malformed of pair of ribs in this case made 3 pairs of floating ribs. Anatomy of the second to fifth lumbar vertebrae are similar to the typical lumbar vertebrae. The sixth lumbar vertebra situated below the fifth and articulated to the first sacral vertebra. Although in general the body of the sixth lumbar vertebra configuration is similar to the other lumbar vertebrae but its spinous process projected posterior, is short with a shape of plump ridge. The left transverse process is slender and longer than the right transverse process. The upper border of the body that is articulated to the intervertebral disc below the fifth lumbar vertebra is rough and extended around its rim. The lower border that articulated to the sacrum has a smoother surface than the upper. The inferior surface of the both transverse processes are the extended tubercles that projected downward anteriorly and articulate to the upper surface of ala of sacrum completely. The inferior articular process on inferior surface of both transverse processes were seen but the processes looked very small and short with tubercles that articulated to the small and short superior articular processes of the sacrum.Conclusion:  The sixth lumbar vertebra is the anomaly of the skeletal system that found in our study. This abnormality can be ascribed to the over-splitting of the embryonic somite and the subsequently complicated development process starting from the cellular level up to the naked eye observation. This is the first report on sixth lumbar vertebra in 480 skeletons. The incidence of this anomaly in Thai should be further researched.

Five Heads of the Biceps Brachii Muscle in Thai : A Case Report

Background : Anatomical variations are possible to in all aspects of human body and should be recognized. Variations of form and origin of the biceps brachii muscle have been reported.  The origin of the biceps brachii muscle are classicall described as being a long head from the supraglenoid tubercle and a short head from the coracoid process of the scapula.  These two heads unite and insert into the radial tuberosity and the bicipital aponeurosis.  Occasionally, the presence of a third head of the biceps brachii muscle have been well documented in the avilable literatures.  There have been no previous report of five heads in the literature.Objective : To study the anatomy of the biceps brachii muscle with five heads.Results  : Five distinct origins of the biceps brachii muscle were dissected carefully in the right arm of a 67 year old female cadaver.  The long head arises from supraglenoid tubercle of the scapula, the short head and the third hdad arise from coracoid process of the scapula.  The origin of the fourth head and the fifth heath are the humeral shaft between the insertion of the coracobrachialis and the origin of the brachialis muscles.  Distally all bellies of this muscle unite and insert through a biceps tendon into radial tuberosity together with bicipital aponeurosis, except the fourth head which inserts into the fifth head.  All five heads of this muscle receive their innervation from the musculocutaneous nerve and the arterial supply from the brachial artery.Conclusions : This report has emphasized that the biceps brachii muscle with five heads was found in Thai female cadaver in Gross Anatomy Laboratory, Faculty of Medicine, Khon Kaen University.  This variation may occur during embryological development.  The five heads of the biceps brachii muscle may enhance the strength of elbow flexion and forearm supination and stability of elbow joint.

The Superior Thyroid Artery Arising from the Common Carotid Artery in Thai : A case Report

Background : The superior thyroid artery supplies the thyroid gland.  It usually arises from the proximal part of the external carotid artery.  However, the rare incidence of the superior thyroid arising from the common carotid artery have have reported.  There was no reported in Thai.Objective : To study the anatomy of the superior thyroid artery that aries from the common carotid artery in Thai.Results : Dissection of a 57 year old Thai male cadaver from 64 cadavers was revealed that the  left superior thyroid artery arose from medial side of the left common carotid artery.  It was 26.95 millimeters below to the bifurcation of the common carotid artery.  Results from dissection of this artery showed that this artery ran downward and forward without any branches.  At 5 millimeters distal to the origin this artery divided into 2 branches as anterior and posterior branches which each branch descended to anterior and posterior surface of the upper part of the thyroid gland, respectively.Conclusions : This report has emphasized that the superior thyroid artery arose from the common carotid artery.  The surgeon should be aware of this during surgery of the thyroid gland.

Retroesophageal right subclavian artery in Thai: A case report

Background :  The variable structures and pattern of the organs in the body are normally found during dissection of formalin-embalmed cadavers in the practical class of Gross Anatomy. The variation of the right subclavian artery is one of the variable structures. Normally, this artery is a branch from brachiocephalic trunk, which is the first branch of the arch of aorta. The observation on   mediastinum dissection of the male cadaver, 89 years of age in the Gross Anatomy  Laboratory, Department of Anatomy, Faculty of Medicine, Khon Kaen University,  it has been found that the right subclavian artery is a branch arising from posterior aspect of the distal part of the arch of  aorta, it runs behind esophagus and directly to the right upper extremity, called retroesophageal right subclavian artery (RRSA). This finding is the first case in our laboratory since the year 1997 to 2004  totalled 480 cadavers. The variable of the RRSA is highly investigated in case of abnormal development of the arch of aorta thus, the surgeon and  related physician should be always aware. Objectives1. Describe the anatomical characteristics of  the RRSA in these aspects: the position of the origin, the diameter, the length and the course of this artery.2.    Describes the surrounded structures related to this              artery.               Result :  The observation while carefully dissecting the mediastinum of the male cadaver, 89 years old of age.   It had been found that the brachiocephalic trunk is absent. The first branch of the arch of aorta is the right common carotid artery, the second is the left common carotid artery, the third is the left subclavian artery and the fourth branch is the RRSA.  The RRSA arises from the posterior of the distal part of the arch of aorta, next to the left subclavian artery. The course of this artery is behind the esophagus traversing the mediastinum to supply the right upper extremity. However, there is no variable of the branches from RRSA.  Measurement with the digital vernier caliper was done and revealed the length of the RRSA is 8.86 centimeters, the diameter at the proximal and distal part of RRSA are 0.99 and 0.83 centimeters respectively. Furthermore, from this study, the right recurrent laryngeal nerve does not hook around the RRSA as normal.Conclusion :        The RRSA is a defective development of the right fourth aortic arch and/or part of the right dorsal aorta, a segment between the right fourth aortic arch and the right seventh intersegmental artery which may be degenerated during embryological development. This is the first report on  the RRSA in Thai. The incidence of this anomaly in Thai should be further researched and accumulated. 

Profunda femoris artery arise from the medial aspect of femoral artery: A case report

Background :     The profunda femoris artery is frequently involved in vascular reconstructive procedures in the thigh.    During usually dissection in Gross Anatomy laboratory of medical students, it was founded that the profunda femoris arose from the medial side of the right femoral artery in the embalmed female cadaver with age 56 year old. This variation is a very rare case, thus we are interest to study pattern and course of this artery and report for the referable in anatomical evidence.Objectives To study the course and branches of the profunda femoris atery that arise from medial side of the right femoral artery1.     To study the right femoral artery and its branches in this cadaver.Result :     The profunda femoris artery in this cadaver is the the third branch and arise from the medial side of the right femoral artery  and  far from mid-inguinal ligament for 20.47 millimeter. Within femoral triangle this artery run  inferior medially, anterior to femoral vein and superior to saphenous opening, then downward and turn back to the lateral with enclosed the right femoral vein  and descend to the adductor canal. As running behind to the femoral vein and before piercing the adductor canal this profunda femoris gives off its branches, the deep external pudendal, medial circumflex femoral, first perforating branch and first perforating branch from superior to inferior respectively. The dissection go on adductor canal and reveal the third and the fourth perforating branches.

The lateral cord of the brachial plexus piercing the coracobrachialis muscle: A case report

Background :       The present of variation of brachial plexus is founded in all level of unite of anterior rami of C5-T1  spinal nerves. On reviewing literatures reveal that, there are a lot of papers that report in brachial plexus variation 1.  However the variation of brachial plexus in infraclavicular part with the lateral cord piercing into coracobrachialis muscle is a very rare case 2. This variation should be kept in consideration while performing surgical exploration of the axilla and arm regions to avoid damage to these nerves.Objectives :  1.    To study the position and course   of   the lateral cord of brachial plexus that piercing into coracobrachialis muscle. 2. To study the distribution of the lateral cord of brachial plexus after piercing into coracobrachialis muscle.Result :  Dissection of the left axilla region of the embalmed male cadaver with age 43 years old revealed that the lateral cord of the brachial plexus piercing into coracobrachialis muscle.  On the way within the coracobrachialis, the lateral cord gives off the branch to innervate this muscle and separates to the lateral root of the median nerve and the musculocutaneous nerve.  After passing through the coracobrachialis muscle the musculocutaneous nerve gives off  a branch to innervate this muscle and continuing downward in the interval between the biceps brachii and brachialis muscles and gives off  branches to innervate these muscles. Later the musculocutaneous pierces the brachial fascia above the elbow lateral to the tendon of  biceps brachii muscle and continues as the lateral cutaneous of forearm.Conclusion :  This report is an anatomical evidence of the variation of lateral cord of the brachial plexus  piercing the coracobrachialis muscle. This variation is suggested to derive since embryonic period, which abnormality of signaling system that control the relation of the differentiation between the muscular and the nervous systems.