Contribution Of Axillary Nerve In The Innervation Of Long Head Of Triceps Brachii: A Cadaveric Study

Background: Traditionally the axillary nerve innervates the Deltoid and the Teres minor(TM) muscle. Axillarynerve injuries are common in shoulder dislocation, fracture surgical neck of humerus, brachial plexus injuriesand neuropathies. Traumatic injuries of axillary nerve have also shown weakness of Long head of triceps and insurgical practice, the nerve to long head of triceps is utilized for nerve transfer to neurotise the deltoid muscle inpatients with axillary nerve injuries. Hence the aim of the study was to find out the prevalence of contribution ofaxillary nerve to the innervation of Long head of triceps brachii (LHT).Materials and Methods: Nine embalmed adult human cadavers (bilaterally) and twelve disarticulated upperextremities were dissected. Total of thirty upper extremities were dissected. The axillary nerve was observedemerging from the quadrangular space. Anterior and posterior branches of axillary nerve were noted. Themuscular branches to deltoid, TM and LHT were traced to their point of innervation. The focus was on the branchof axillary nerve supplying the LHT. The branching configuration was classified into three types. Type I- posteriorbranch of axillary nerve supplying the LHT, Type II- Branch to TM supplying the LHT and Type III- A branch from thebifurcation of anterior & posterior branch of axillary nerve supplying LHT.Results: The present study showed that axillary nerve innervated the LHT in 8 out of 30 limbs (26.66%). Amongstthese, in 4 limbs(50%) posterior branch of axillary nerve supplied the LHT(type I ), in 3 limbs(37.5%) branch to TMsupplied the LHT(type II) and in 1 limb(12.5%) a branch from the bifurcation of axillary nerve into anterior andposterior branch supplied the LHT( type III). It was also observed that in 2 (6.66%) specimens, axillary nerve wasthe only supply to LHT and in 6 (20%) specimens both axillary nerve & radial nerve supplied the LHT and in theremaining 22 (73.3%) specimens, only the radial nerve supplied the LHT.Conclusion: Awareness of the variation of axillary nerve supplying the LHT is important for surgeons,orthopaedicians and anaesthetists for surgical treatment of traumatic nerve injuries.

Morphometric analysis of cruciate ligaments

Introduction: Anterior cruciate ligaments (ACL) and posterior cruciate ligaments (PCL) are tough band of fibrousstructures extending between tibia and femur. Cruciate ligaments are at risk of injury in sports personnel.Injured ligaments are treated by reconstruction surgeries which require the morphometric understanding.Therefore, this study intended to find the length and width of ACL and PCL in cadavers and by MRI in healthyindividuals.Material and methods: Thirty embalmed cadaver knees were dissected to expose the ligaments. Length and widthof the ligaments was measured by the Vernier’s calipers. Thirty MRIs of knee joint with no previous detected kneepathology were obtained and reviewed. The data was tabulated for statistical analysis. Student‘t’ test was usedfor comparison. P value <0.05 was considered as statistically significant.Results: In the cadavers, ACL was significantly longer than PCL in length (p <0.014). PCL width was larger than ACLwidth (p <0.001).Conclusion: The present study contributes to the relative morphometric data on ACL and PCL and stresses that PCLis shorter and wider than ACL making it a more stable structure.

Learning embryology: fun or fear? students’ perspective

Background: Embryology forms an important part of Anatomy in medical curriculum. As a subject it is difficultfor the first year students. The aim of the study was to make the subject simple, to inculcate interest and to reachto different types of learners as possible and to assess the effect of various teaching methods on learning.Methods: First year medical students were taught Embryology using different methods over one academic yearby one faculty member. In addition to black board and power point as the main methods of teaching, supplementarymethods like videos, props, models, handouts & quiz were also used. These were compared on different parametersof teaching-learning process like conceptual understanding, recollection & long term memory, reproducibility &writing in exam, structure and sequence of events, drawing of diagrams, clinical application, overall effectivenessand fun in the process of learning. A comparison of different methods of teaching was done in the form a writtenfeedback questionnaire.Results: It was observed that 73.9% students preferred Black board, 21.73% preferred Power point and 4.34%opted for videos as the choice of method. The study also revealed that 76.08% of students preferred a combinationof different methods for the embryology lectures, where as 15.21% preferred only Black Board, 6.52% preferredonly Power Point and 2.17% of students preferred only Videos as the method for learning Embryology.Most of the parameters of teaching Embryology were better fulfilled by black board method specially drawing ofdiagrams (82.60% students). However for clinical application of the subject, power point (50.43% students) waspreferred. The students’ response revealed that Quiz was a fun loving method of learning (40%students), whereas(31.3%students) enjoyed videos on Embryology. The overall effectiveness of Black board was found to be (60.86%),Power point (18.2%), Videos (8.69%), Props (4.34%), Quiz (3.47%), Handouts (2.6%) and Models (1.73%).Conclusions: A multi-modal approach was made to facilitate and enhance the learning process of the subject. Thestudy revealed that blackboard was the most valued method for teaching-learning Embryology.

Anatomy of the maxillary sinus ostium: a cadaveric study

Background: Recognition of the maxillary sinus position is tedious as it is small and not easily seen. A detailedknowledge of the anatomical variations of maxillary sinus opening is required for endoscopic surgeons toperform safe surgeries. The aim of the present study is to determine the anatomical location of the maxillaryostium in a cadaveric specimen. The position of the accessory maxillary sinus, if present is also noted to furtherbenefit the surgeons.Materials and Methods: Thirty bisected halves of the formalin fixed adult head and neck specimens were obtainedfrom the Department of Anatomy. The anterior part of the skull was divided in the midline and then the nasalseptum was removed taking care not to damage the osteomeatal components. Probes were used in identifyingthe location of maxillary sinus ostium. Various other parameters like vertical diameter, transverse diameter,distance between ostium and anatomical landmarks such as inferior concha and hard palate were measured.Results: In accordance to the parameters considered in the current study, the following results were observed.The maxillary sinus ostium was present in the posterior 1/3rd of the Hiatus semilunaris in 53% of the cadavers.The most common shape of maxillary sinus ostium was oval. The mean vertical and transverse diameters ofostium were 2mm and 2.6mm respectively. The perpendicular distance of the ostium from the lower border ofinferior concha was 14.6 mm and from the upper border of the hard palate was 17.5 mm.Conclusion: The knowledge about the variations in location of the maxillary sinus Ostium and the distances ofthe ostium from the major anatomical landmarks will help the maxillofacial surgeons and otolaryngeologists toperform the surgical procedures safely.

Measurements Of Maxillary Sinus In Correlation To Age And Gender By Computed Tomography

Introduction: The sinonasal region is often imaged because of infectious and allergic diseases of the nasal cavityand paranasal sinuses. Improved knowledge of normal pneumatization and development of paranasal sinusesis important to allow sinus diseases to be evaluated and an adequate treatment to be proposed.Materials and methods: 100 patients (72 males and 28 females) undergoing coronal and axial sections of computedtomography scan of maxillary sinus of head and neck aged between 1year to 90 years at the Radiology Department,Vydehi Institute of Medical Science & Research Centre Bangalore for reasons other than due to craniofacialabnormalities or sinus problem were taken for the study. Volume and dimensions of the maxillary sinuses withits anatomical variations were obtained. Mean, SD, significant difference between age & gender was calculated.Results: Maxillary sinuses in Males on both sides have higher values in mean height, depth and volume thanfemales except right side width which was lesser in value than females. All the mean parameters were more onleft sinus both in male and females, except mean height of right sinus in males, on side comparison all the meanparameters were more on right side in females. There is a significant difference in mean height of right and leftmaxillary sinus in between male and female. There is a significant difference on right and left side widthbetween male and female in the age group 51-60 yrs and 61-70 yrs. The maximum age growth in males was during11-20 yrs and 41-50 yrs in height, width and volume, in 21-30 yrs and 31-40 yrs in depth, later dimensions weredecreasing in growth by 61-70 yrs in height and 81-90 yrs both in depth, width and volume. In females maximumgrowth was in 21-30 yrs and 51-70 yrs for height, depth, volume, 11-20 yrs and 51-60 yrs for width dimensions, laterdecreases by 61-70 yrs onwards in height, width and 11-20 yrs in depth and volume.Conclusion: These results will be helpful in understanding normal and pathological conditions of the maxillarysinuses and useful in clinical planning of medical or surgical interventions of the maxillary sinuses

Students Perception On Internal Assessment In Anatomy

Background: Assessment is one of the most important aspect of teaching and learning process. Various assessmentmethods are available to assess the knowledge & skills of students. The objective of the study was to know viewsof the students regarding the best assessment method in anatomy.Materials and methods: Inputs from 200 MBBS students were collected who completed first year MBBS. Aquestionnaire which included questions relating to various assessment techniques for theory & practical internalexams in anatomy was used to get the feedback from the students.Results: Majority students felt that internal assessment should be conducted thrice in a year. The assessmentmethods preferred by them was written test for theory in the form of SAQ & SEQ and MCQ also should be includedin it. Many students felt that internal assessment should be the criteria for allowing students to appear inuniversity examinations but disagreed to include the internal assessment marks in university examination.Conclusion: It is important to obtain more frequent feedback from the students which will help teachers to modifythe assessment methods and improve the standards of medical education

Non-genetic Factors Contribute To The Incidence Of Non Syndromic Clefts In The Craniofacial Region

Background: The multifactorial etiology of clefts includes both genetic and environmental factors. Many studieswere conducted to identify the genetic basis of the etiology of clefts and effect of maternal folic acid intake inreducing the risk of clefts.. Not many studies conducted about other environmental factors causing clefts. Thepresent study is to find out the non-genetic factors associated with the nonsyndromic clefts. The maternalpericonceptional intake of folic acid, family history, parental age, socioeconomic status, parental alcoholismand smoking, and parental occupational exposure are the factors included in the study.Materials and methods: The study group comprised 400 subjects with 200 Nonsyndromic cleft cases and 200healthy controls from the South Indian population. The data was collected in a detailed questionnaire by directinterview and analyzed the data using SPSS version 21. Logistic regression model was used to measure the oddsratio(OR) for the independent variables and Chi- square analysis was performed to find out the significance.Results: The family history of clefts was found in 10.6% cleft cases (p value= 0.001). The risk of cleft wasincreased in cases with no maternal folic acid intake in their first trimester of pregnancy (p value= 0.001).Parental age more than 35 years (p value= 0.004) and low maternal education (p value= 0.001) were also foundas the risk factors to cleft. Low socioeconomic background was another risk factor (p value= 0.001). Parentaloccupational exposure in terms of pestcidal exposure was found significant but not the parental medicationand smoking.Conclusion: Maternal consumption of folic acid and multivitamins during the periconceptional period to beassured to prevent the occurrence of oral clefts. Family history of cleft increases the risk of cleft and the risk isfurther increased when cleft is present in parents or siblings. And maternal age more than 35 years is foundmore significant than the paternal age . Consanguinity showed 4 fold increase in clefts. Maternal diet is a primefactor as it is directly related to folic acid and vitamin supplementation apart from the socioeconomic status offamily

An Anatomical Study Of Gracilis Muscle & Its Role In Clinical Reconstruction Surgeries

Introduction: It is the most superficial of the adductor group of muscles. Gracilis muscle is used oftenly inreconstructive plastic surgery,because ofits reliable vascular and neurological pedicles and the minimal donorsite morbidity.Materials and Methods: The present study was conducted on 40 cadaveric lower limbs (22 males and 18 females)in the Deptartment of Anatomy of VIMS&RC.Metrical and non-metrical characteristics of gracilis muscle andvascular pedicles were analyzed.Results: All the parameter were more in males compared to females. distal tendon length was more than proximaltendon length. P value was significant in all the measurements. The ratios between various components ofmuscle remain fairly constant. Main vascular primary pedicle was arising from profund femoral artery in 60 %& 40% from Medial circumflex femoral artery .Presence of proximal secondary pedicle was only in 30% of thespecimens arising from profunda femoral artery or Medial circumflex femoral artery. Distal secondary pediclesarising from 5% of femoral artery.Conclusion: These parameters will help the reconstructive surgeon in assessing the length of muscle belly ortendon available for reparative procedures before undertaking surgery like Anterior Cruciate Ligament graft,Restoration of sphincteric function in anogenital area, Repair of ano-vaginal or recto-vaginal fistulas, Facialrehabilitation, Upper limb and lower limb defects, Groin wounds and autologous breast reconstruction.