Drowning with Bound Wrists: Report of Two Autopsy Cases / 대한법의학회지

Drowned bodies with bound wrists are occasionally observed in forensic practice. Suicidal victims may bind their hands or feet with a rope to ensure success of the suicide attempt, but the possibility of homicidal drowning cannot be excluded. We report on two autopsy cases of drowning with bound wrists. A 51-year-old man (case 1) was found in the bathroom beside the bathtub, with his head under the water in the bathtub. His wrists were tied with a green bath towel. An 83-year-old man (case 2) was found dead in a reservoir. His wrists were loosely bound with blue nylon traps on the back, and both ankles were loosely tied with socks, with a simple knot on the left ankle. At autopsy, the lungs were hyperinflated, and foamy fluid was exuded from the bronchi in both cases.

Anterolateral thigh flap for head and neck reconstruction : anatomic study

Location of the Modiolous and the Morphologic Variations of the Risorius and Zygomaticus Major Muscle Related to the Facial Expression in Koreans / 체질인류학회지

Location of the modiolous and morphological variations of the risorius and zygomaticus major muscles are related to the facial expression. The zygomaticus major, levator labii superioris, depressor labii inferioris, depressor anguli oris, risorius, orbicularis oris, buccinator and levator anguli oris muscles insert on the lateral border of the lip, forming the modiolus and mutually associating each other for functioning. The knowledge of the location of the modiolus and surrounding structures are essential to anatomy, prosthodontics, linguistic, physiology and computer simulation based on facial expressions. The authors examined the location of the modiolus, the morphological variations and anatomical relationship of risorius and zygomaticus major muscle to understand the features of the smile of Korean by dissecting 39 cadavers. The location of the modiolus can be showed as three types, according to their height related to the intercheilion horizontal line. Type A that modiolus locate at the intercheilion line was shown in 20 sides (26.0%), type B that modiolus locate above the intercheilion line was shown in 12 sides (15.6%), then type C that modiolus locate under the intercheilion line was shown in 45 sides (58.4%). Most modioli located at 10 ~20 mm lateral to the mouth corner and 0 ~10 mm below the intercheilion line. The risorius muscle was classified into five types by directions of muscle fibers. The depressor anguli oris -risorius type (type I) was observed in 31 sides (40.2%), the platisma -risorius type (type II) was observed in 30 sides (39.0%). Previously, it has been known that zygomaticus major muscle attaches to the modiolus mainly as one bundle. However, the results were clearly shown that two bundles of the zygomaticus major muscle attaches to the modiolus and the position of the mouth edge in 18 sides (23.4%). To sum it up, facial expression is of fundamental importance concerning the morphological variations and these results also can be considered for the facial reconstruction surgery and computer animation department.

An Anatomic Variation of the Trapezius Muscle in a Korean: The Cleido-occipitalis Cervicalis

A variation of the trapezius muscle was observed in a Korean female adult cadaver during routine student dissection. The lateral, upper three-fourths of the descending portion of the trapezius muscle were separated from the remainder of the muscle. This single, isolated bundle fused above the insertion of the midpoint of the clavicle, and attached to the clavicle as a separate tendon. The remaining descending portion inserted into the clavicle and scapula as usual. This abnormal muscle bundle is considered as a variant of the cleido-occipitalis cervicalis, and formation of this variation is discussed based on the embryological development of the relative muscular structures.

Topography of the Branching Patterns of the Facial Nerve in Korean / 체질인류학회지

This study demonstrates the anatomical relationships and variability of the facial nerve trunk and branches with emphasis on intraparotid connections between divisions. Microsurgical dissections were performed on 30 Korean halfheads. The facial nerve trunk was exposed, depth from the skin surface to the stylomastoid foramen (21.0+/-3.1 mm) and distance between the stylomastoid foramen and the bifurcation point of temporofacial (upper) and cervicofacial (lower) divisions (13.0+/-2.8 mm) were measured. In 26 out of 30 dissections, the facial nerve terminated in a bifurcation into two main divisions, and in four cases, the nerve ended in a trifurcation pattern. According to the origin of the buccal division, branching patterns of the facial nerve were classified into 6 categories. A buccal division was originated from the upper and lower divisions (type I, 13.8%), from the two main and zygomatic divisions (type II, 44.8%), from the two main and marginal mandibular divisions (type III, 17.3%), from the two main, zygomatic and mandibular divisions (type IV, 17.3%), from the lower, zygomatic and mandibular divisions (type V, 3.7%), and from the upper, zygomatic and mandibular divisions (type VI, 3.7%). These details of facial nerve anatomy suggest surgical procedures such as tumor resection, facial nerve reconstruction, and facelift.

Topographic Anatomy of the Mandibular Nerve Branches Distributed on the Lateral Pterygoid Muscle / 체질인류학회지

According to the electromyographic study, the superior and inferior heads of lateral pterygoid, one of the masticatory muscles, are known to perform the reciprocal actions in mandibular movements; the superior head is active in closing movement, whereas the inferior head is active in opening of the jaw. Through these two reciprocal actions of these two heads, the articular disk of TMJ is seated in its resting position. Many reports regarded the superior and inferior heads of the lateral pterygoid as functionally independent muscles, but from a morphological point of view, the origin of the independent nerve innervation and intramuscular branching patterns of the mandibular nerve are unclear. Twenty -four adult hemi -sectioned heads were dissected to clarify the topography of the nerve distribution on two heads of lateral pterygoid and also to determine the anatomico -clinical relevance related with temporomandibular disorder. Most buccal nerves were found to run between the superior and inferior heads of the lateral pterygoid (21 cases, 87.5 %). In 3 cases, buccal nerves passed through the inferior head of the lateral pterygoid (12.5%). In front of the ascending ramus region, most buccal nerves ran in front of the temporalis without being entrapped within the temporalis (16 cases, 66.7%). However, in 8 cases buccal nerve passed in front of the temporalis being entrapped within the anterior fiber of the temporalis (33.3%). In this study, the mandibular nerve trunk was located intimately to the lateral pterygoid. Both heads of the lateral pterygoid muscles were innervated from the mandibular nerve branches, but the patterns of nerve distribution were various. Nerves innervated to the superior head of the lateral pterygoid had different origin. Only in 45.8% (11 cases), they originated from the buccal nerve. In 16.7% (4 cases) the nerve branches originated from the anterior deep temporal nerve only, and in 12.5% (3 cases) from the buccal and anterior deep temporal nerve. In contrast, nerves innervated to inferior head of the lateral pterygoid showed different pattern of distribution. In 58.3 %, nerves distributed on the inferior head originated from both the buccal and mandibular nerve trunk. In 20.8%, they originated from the buccal nerve only, in 12.5% from the mandibular nerve trunk only. In seven categories of the distribution of mandibular nerve branches, in only 20.8% (5 cases), both the superior and inferior heads of the lateral pterygoid had the common source of nerve innervation, the buccal nerve. In contrast, in 45.9% (11 cases) additional nerve twigs from the mandibular nerve trunk were distributed on the inferior head of the lateral pterygoid muscle. Author observed the pterygoid loop (ansa pterygoidea) located between the mandibular nerve trunk and the nerve innervating to the lateral pterygoid in 4 cases. In addition, the intramuscular nerve loop within the inferior head of lateral pterygoid was observed in 5 cases. Summarizing these results, besides the buccal nerve mentioned in an anatomical textbook, nerve twigs originating directly from the mandibular nerve trunk innervated to the lateral pterygoid and the ones originating from the anterior and middle deep temporal nerves distributed on the lateral pterygoid muscle in various manners. Considering the various patterns of nerve distribution on the lateral pterygoid, author concluded that the two heads of the lateral pterygoid are controlled by independent innervation. Furthermore, we found out that nerve entrapments and nerve communications are related with symptoms of temporomandibular disorder and with possible collateral route of motor innervation to the facial expression muscles, respectively.

Morphometries of the Maxillary Sinus in Koreans / 체질인류학회지

The anatomical description and the relationship between the root apex and the inferior wall of sinus are critical in diagnoses and surgeries of the sinus pathoses, and in dental implantation. So, identification of the proximity between the root apex and the inferior wall of sinus and the clarification of cortical thickness of inferior wall of sinus are indicated the topography of spreading dental infection into the maxillary sinus. Therefore, anatomical knowledge of the topography between the root apex and the inferior wall maxillary sinus are important in the diagnosis and treatment planning of the dental implantation, endodontic procedures, and orthodontic treatment. The purposes of this study were 1) to clarify the morphological and clinical characteristics of the maxillary sinus, especially the inferior wall of sinus in Korean, 2) to identify the relationship between the inferior wall of maxillary sinus and the roots of maxillary teeth, and 3) to evaluate the degree of accuracy of DentaScan reformatted images of the maxillary sinus. 33 sides of maxillae of the hemi -sectioned Korean heads were used in this study. All specimens were taken periapical radiographs, computed tomography and DentaScan reformatted cross -sectional images were taken for the radiographic evaluation of the maxillary teeth and inferior wall of maxillary sinus. From the CT images, 3 -dimentional reconstructive images of maxillary sinuses were made using the V -works TM 3.0 program. All specimens were decalcificated and then were sectioned coronally. On the sectioned specimen, 21 metric items were measured using the image analyzing system. The results were as follows: 1. In 6 categories of maxillary sinus according to their lateral aspects and shapes of the inferior walls, flat (54.5%) and round (21.2%) inferior wall of maxillary sinus were prominent. In 58.4%, the anterior limit of maxillary sinus was located in the 1st premolar area and the posterior limit was in the 3rd molar and maxillary tuberosity area (93.9%). The lowest level of the maxillary sinus was in the 1st molar and 2nd molar area. 2. From the 3 -dimentional reconstructive images of maxillary sinus, the maximum anteroposterior length of sinus was 39.3 +/-4.2 mm, the maximum height was 37.1 +/-5.6 mm, and the maximum width was 32.6 +/-6.5 mm. And the average volume of sinus was 15.1 +/-6.2 ml. All measurements were larger in male than female. Taken all together, this study demonstrated various anatomical characteristics and relationships between the maxillary sinus and their surrounding structures. Recognition of these findings may have an impact on the clinical management of patients.

Topography of the Inferior Wall of the Maxillary Sinus in Koreans / 체질인류학회지

The anatomical description and the relationship between the root apex and the inferior wall of sinus are critical in diagnoses and surgeries of the sinus pathoses, and in dental implantation. So, identification of the proximity between the root apex and the inferior wall of sinus and the clarification of cortical thickness of inferior wall of sinus are indicated the topography of spreading dental infection into the maxillary sinus. Therefore, anatomical knowledge of the topography between the root apex and the inferior wall maxillary sinus are important in the diagnosis and treatment planning of the dental implantation, endodontic procedures, and orthodontic treatment. The purposes of this study were to clarify the morphological and clinical characteristics of the maxillary sinus, especially the inferior wall of sinus in Korean, and to identify the relationship between the inferior wall of maxillary sinus and the roots of maxillary teeth. 24 sides of maxillae of the hemi -sectioned Korean heads were used in this study. All specimens were taken DentaScan reformatted cross -sectional images were taken for the radiographic evaluation of the maxillary teeth and inferior wall of maxillary sinus. All specimens were decalcificated and thenp were sectioned coronally. On the sectioned specimen, 21 metric items were measured using the image analyzing system. The results were as follows: 1. The distance between the each root apex and the inferior wall of maxillary sinus were measured. In the 2nd molar area the distance from the root apex to the inferior wall of sinus was the shortest and the longest in the 1st premolar area. 2. The thickness of the cortical plate of the inferior wall of maxillary sinus was thinnest in the 1st premolar area, whereas, the thickest in the 2nd premolar area. 3. The vertical relationship between the inferior wall and the roots of the maxillary molars was classified into 5 types. Type I (the inferior wall of sinus was located above the level connecting the buccal and lingual root apices) was predominant (54.5% in the 1st molar area, 52.4% in the 2nd molar area). 4. The horizontal relationship between the inferior wall of sinus and root apex were classified into 3 types. Type 2 (the alveolar recess of the inferior wall of sinus was located between the buccal and lingual roots) was predominant (80% in the 1st and 2nd molar area). Taken all together, this study demonstrated various anatomical characteristics and relationships between the maxillary sinus and their surrounding structures. Recognition of these findings may have an impact on the clinical management of patients.

Quality and Morphology on cortico-cancellous bone in Korean mandibular symphysis area / 대한치주과학회지

In performing implant procedures in the anterior portion of the maxilla, many difficulties exist because of anatomical reasons, such as the proximity of the nasal floor, lateral extension of the incisive canal, and labial concavity. On the other hand, in the posterior region of the maxilla, there is often insufficient recipient bone between the maxillary sinus and alveolar ridge due to alveolar ridge resorption and pneumatization of the maxillary sinus. In order to perform implants in such regions, ridge augmentation procedures such as onlay bone graft, guided bone regeneration, and maxillary sinus grafting are performed. In studies of Caucasians, use of autograft from mandibular symphysis has been reported to be highly successful in maxillary sinus grafting. However, in a clinical study of Koreans, autograft of mandibular symphysis has been reported to have significantly low success rate. It has been hypothesized that this is because of insufficient cancellous bone due to thick cortical bone. In order to test this hypothesis, bone quality and morphology of Koreans can be compared with those of Caucasians. In this study, the bone density and morphology of the cortical bone and cancellous bone in the mandibular symphysis of 35 Korean cadavers were evaluated. The following results were obtained: 1. In terms of bone density, type I, type II, and type III consisted of 1.4%(3/213), 72.3%(154/213), and 26.3%(56/213) of the cross-sectioned specimens, respectively. In general, the bone density tended to change from type II to type III, as cross-sectioned specimens were evaluated from the midline to the canine. Type IV wasn't observed in this study. 2. The distance between the root apex and the lower border of the cancellous bone was 18.34mm-20.59mm. Considering that the bone has to be cut 5mm below the root apex during the procedure, autografts with about 15mm of vertical thickness can be obtained. 3. The thickness of cortical bone on the labial side increased from the root apex to the lower border of the mandible. The average values ranged from 1.43mm to 2.36mm. 4. The labio-lingual thickness of cancellous bone ranged from 3.43mm to 6.51mm. The thickness tended to increase from the apex to the lower border of the mandible and decrease around the lower border of cancellous bone. From the above results, the anatomic factors of the mandibular symphysis (bone density, thickness, quantity and length of the cortical bone and cancellous bone) didn't show any difference from Caucasians, and it cannot be viewed as the cause of failure in autografts in the maxillary sinus for implants.

Topographic Anatomy of the Discomalleolar and Anterior Malleolar Ligaments in Human Adults and Fetuses / 체질인류학회지

During temporomandibular joint (TMJ) formation, discomalleolar ligament (DML) and anterior malleolar ligament (AML) are formed within the dorsal end of the 1st branchial arch. But, DML is known as a remnant or the degenerated tissue through the TMJ development. There is few reports said that damage of AML and DML cause the damage of middle ear during surgical procedures. Especially, in case of anterior disk displacement of TMJ, aural symptom can be made via DML due to hyperextension anteriorly. A few studies have been reported about DML and AML in embryological and histological points of view, morphology and clinical aspects of DML and AML are still unclear. Four fetuses and sixteen adult hemi -sectioned heads were dissected to clarify the topographical relationship of AML and DML and to find out the anatomico -clinical relevance related with temporomandibular disorder. In fetal specimens, DML was firmly attached from the disk of the TMJ to the malleus. Also, AML in which distinguished into the superior and inferior lamellae was running anteriorly and continuous with the sphenomandibular ligament (SML) through the future petrotympanic fissure (PTF). DML attached to the malleus was observed in all adult specimens and was expanded broadly to the disk and capsule of the TMJ as shown the V -shaped ligament structures. The average distance between the anterior aspects of the malleolar head to the anterior wall of the tympanic cavity was 1.13 mm(0.75 ~1.59), and the length of the DML from the anterior aspect of the malleolar head to the attached site to the TMJ capsule at the PTF was 5.37 mm (4.53 ~6.07). The average width of the DML at the PTF was 6.06 mm (4.72 ~7.46). Most of the posterior attachments of the DML were the cases in which DML was directly attached to the malleus (68.7%). In all specimens, DML was attached to the disk and capsule of TMJ and attached to the anteromedial border of the PTF concurrently. In this study, two morphological patterns of AML were observed according to the presence of the bony ridge on the Huguiers canal in the PTF. The bony ridge of the Huguiers canal showed DML and AML separately in 56.3%, and the fused pattern of DML and AML was observed in 43.7%. AML was not distinguished with two lamellae in most specimens, superior ligament fibers were attached to the anteromedial border of the PTF and most of the inferior lamella was entering the gap in PTF and continuous with the SML. Average length from the anterior aspect of the malleolar head to the exit point of the AML on the PTF was 8.40 mm(6.62 ~11.42), and the shortest distance between the AML and chorda tympani was 2.01 mm(1.25 ~3.02). Taken all together, DML and AML were not the rudimentary, but the distinguishable structures in adults. Through the various morphological findings, DML and AML were separated ligamentous structures in which might be given rise from the divergent origin. And the anterior hyperextension of the disk of TMJ did not lead the movement of the malleus in the tympanic cavity, whereas, the movement of the malleus followed by the traction of the AML and SML was observed in a few cases. So, this results can be explained the possibility of the clinical symptom on the middle ear in case of the over -traction of the AML and SML.

Changes in soft tissue profile after surgical correction of prognathic mandible / 대한치과교정학회지

The treatment plan for orthognathic surgery must be based on accurate predictions, and this can be produced the most esthetic results. Treatment of prognathic mandible in adult is usually orthognathic surgery using mandible set back, but mandible with retruded chin point os needed additional chin augmentation. In this case, the directions between mandible and chin point are different therefore, the prediction of soft tissue reactions must be modified. In this study, we materialize the patients who was taken orthognathic surgery due to prognathic mandible, 11each(Group A) was taken only Bilateral Sagittal Sprit Ramus Osteotomy (BSSRO), 9each(Group B) was taken additional advancement genioplasty. The lateral cephalometric radiography taken 8 months later after orthognathic surgery by this patients were used. The results of this study were as follows 1. The profile of lips was favorable after surgery due to upper lip to E-line became prominent and lower lip to E-line was retruded. 2. In both group, upper lip moved posteriorly and national angle was increased. 3. The ratio of the soft tissue profile change in POGs point to skeletal B point movement was 84% in group A and 66% in group B, and there was statistical significance between group A and group B. 4. Vertical movement of hard tissue points is decreased in group A.