Variations In Pulmonary Fissures: An Anatomical Study

Background: Pulmonary fissures are invaginations of the visceral pleura that extend from the outer surface of thelung into its substance. The fissures are grouped into normal and accessory fissures . The oblique fissure andhorizontal fissures are the normal pulmonary fissures which may be complete, incomplete or absent. Incompletepulmonary fissures are considered to be markers of collateral ventilation. They play a significant role indetermining clinical response following valve replacement surgery in emphysematous patients. The Accessoryfissures occurring within an individual lobe may be confused with other lesions such as linear atelectasis,pleural scar. Knowledge of the variations in the pulmonary fissures is useful for clinical interpretation. It is inthis regards that this study was undertaken to assess the morphology of pulmonary fissures.Materials and methods: The study was conducted on 60 formalin preserved adult human lungs (32 right, 28 left)of unknown age and sex obtained during dissection of embalmed cadavers for undergraduate teaching inDepartment of Anatomy, Rajarajeswari medical college and hospital. The anatomical classification proposed byCraig and Walker is followed to determine the completeness of pulmonary fissures . Four grades of fissures havebeen described. Grade 1- complete fissure with entirely separate lobes. Grade 2- complete visceral cleft butparenchymal fusion at the base of the fissure. Grade 3 - visceral cleft evident for a part of the fissure. Grade 4 -complete fusion of lobes with no evident fissure line. The data was tabulated and analysed using descriptivestatistics. The study was undertaken after obtaining approval from the institutional ethics committee.Results: Oblique fissure was incomplete in 13.33% of the right lungs while horizontal fissure was found to beincomplete in 30% of the right lungs. Horizontal fissure was found to be absent in 2 (3.33%) of the right lungs. Asuperior accessory fissure in the lower lobe separating the upper part of the lobe from the rest of the basalsegments was found in one right lung .Conclusions: The present study shows that the horizontal fissure is more frequently incomplete or absent whencompared to the oblique fissure in the right lung. Superior accessory fissure in the lower lobe of a right lung wasobserved in 1 (1.66%) specimen. Knowledge of the varying degrees of completeness of pulmonary fissures andaccessory fissures is essential to avoid misinterpretation of radiological signs

A case of anomalous horizontal fissure and hypoplastic middle lobe of the right lung / Un caso de fisura horizontal anómala y lóbulo medio hipoplásico del pulmón derecho

During dissection practice for medical students at Nagasaki University, a horizontal fissure and hypoplastic middle lobe were encountered in the right lung of an 81-year-old Japanese female. In a normal right lung, the horizontal fissure is situated anterior to the oblique fissure. On the contrary, in the present case, the horizontal fissure was situated posterior to the oblique fissure. We identified a small, additional lobe on the medial surface of this lung. It was situated in the medial part of the oblique fissure, and was determined to be a small hypoplastic middle lobe. As a result of the hypoplasia of the middle lobe, the original horizontal fissure may have disappeared from the anterior surface. The horizontal fissure, in this case, may be a compensatory additional fissure that developed within the inferior lobe. This horizontal fissure was incomplete, both in length and depth. The left lung was normal. This case might be very rare; however, it may aid in the understanding of normal lung development. Therefore, we report this case, including its bronchial branching and vascular distribution.

Durante la práctica de disección para estudiantes de medicina en la Universidad de Nagasaki, se encontró una fisura horizontal y un lóbulo medio hipoplásico en el pulmón derecho de una mujer japonesa de 81 años de edad. En un pulmón derecho normal, la fisura horizontal está situada anterior a la fisura oblicua. Por el contrario, en el presente caso, la fisura horizontal estaba situada posterior a la fisura oblicua. Se identificó un pequeño lóbulo adicional en la superficie medial de este pulmón. Estaba situado en la parte medial de la fisura oblicua, y se determinó que era un pequeño lóbulo medio hipoplásico. Como resultado de la hipoplasia del lóbulo medio, la fisura horizontal original puede haber desaparecido de la superficie anterior. La fisura horizontal, en este caso, puede ser una fisura adicional compensatoria que se desarrolla dentro del lóbulo inferior. Esta fisura horizontal era incompleta, tanto en longitud como en profundidad. El pulmón izquierdo era normal. Este caso podría ser muy raro; Sin embargo, puede ayudar en la comprensión del desarrollo pulmonar normal. Por lo tanto, informamos este variación, incluyendo su ramificación bronquial y la distribución vascular.

Morphological Variations in Fissures and Lobar Pattern in Human Lungs.

Background: Our study aims to study the variations in lobar pattern and fissures of both right and left human lungs. Methods: 41 formalin fixed cadaveric lungs were obtained from the Department of Anatomy, SRMS IMS. The lungs were studied to observe the variations of fissures and lobes. Abnormal or accessory lobes were also noted. Results: 18 right lung and 23 left lung specimens were obtained and studied. Among the right lungs studied one showed an incomplete oblique fissure, six showed incomplete horizontal fissures. The horizontal fissure was absent in three right lungs. In the left lung only one lung showed the presence of an incomplete oblique fissure. Conclusion: The lung is a vital organ for life. Hence, considering the clinical importance of such anomalies, we as anatomists suggest that awareness and knowledge of the variations in the lobes and fissures of the lungs may be important for surgeons planning lobectomies and surgical resections involving individual segments and for radiologists to accurately interpret radiological images. This knowledge has further become more significant with the increasing incidence of lung carcinomas.

Fissures and Lobes of Lungs: A Morphological and Anatomical Study.

Background and Aims: The fissures of the lungs serve as boundaries for the lobes of the lungs. They also acts as barriers to avoid the spread of pathologies .The proposed aim of the study was to study the fissures and lobes of the lungs and their variations and to compare them with previous studies and to find their clinical implications. Methods: Thirty pairs of lungs were used for the study, obtained from formalin-fixed cadavers of south-indian origin. The lung specimens were observed for the patterns of lobes and fissures, variations were noted and specimenswere photographed. Results: Five right lungs showed absence of horizontal fissure. Out of thirty, twelve right sided lungs showed incomplete fissures.On the left side, seven specimens showed incomplete oblique fissure. In addition, two right-sided specimens and four left sided specimens showed presence accessory fissure. Conclusion: The results and their comparison with the previous works show that there is a wide range of difference in occurrence of major, minor and accessory fissures between and among different populations. Knowledge of such variations is mandatory for surgeons in pre-operative planning for performing pulmonary lobectomies and for radiologists for interpreting X-rays and CT scans.

Accessory Fissure Of Right Lung: A Report Of Two Cases.

Right lung is divided into upper (superior), middle and lower (Inferior) lobes by an oblique and a horizontal fissure.Oblique fissure passes spirally from posterior border to inferior border deep into the lung separating the lower lobe from upper and middle lobes. A short horizontal fissure passes horizontally forwards from the oblique fissure at midaxillary line to meet the anterior border at 4th costochondral junction. This separates the upper lobe from the middle lobe. During routine dissection in 2010-11 undergraduate batch, we came across two cases of right lungs where an accessory fissure was extending horizontally backwards from the oblique fissure at mid axillary line towards the vertebral part of medial surface. In the 1st case, this accessory fissure was not meeting the normal horizontal fissure where as in the 2nd case it was meeting. This accessory fissure separates the lower lobe into a superior and an inferior segment. Knowledge of different types of accessory fissures is important because it may mislead the radiological findings, may act as a barrier to spread of infection creating a sharply marginated pneumonia which can wrongly be interpretated as atelectasis or consolidation. Identification of completeness of fissure is important prior to lobectomy, because individuals with incomplete fissures are more prone to develop postoperative air leak. Considering the clinical importance of such anomalies, anatomical knowledge and prior awareness of accessory fissures in the lungs may be important for clinicians and radiologists.

Variations in the inter-lobar fissures of lungs obtained from cadavers of south Indian origin / Variaciones en las fisuras pulmonares interlobulares de cadáveres del sur de la India

The proposed aim of the study was to elucidate the variations of the lung fissures and to correlate their importance in clinics. The study was conducted on 48 lung specimens, 30 right and 18 left, obtained from the cadavers of South Indian origin. Among the right-sided lungs, 2 specimens showed absence of horizontal fissure, and the remaining 25 showed incomplete horizontal fissure. Oblique fissure was incomplete in 15 lungs and one lung showed absence of oblique fissure. An accessory fissure was observed in 4 lungs. Among the left sided lungs, the oblique fissure was incomplete in 7 lungs. The presence of an accessory fissure was found in 5 lungs. With the development of radiological and endoscopic techniques and the advancement of pulmonary surgery, the knowledge of morphological variations of lung fissures is of utmost importance to clinicians to correctly locate the bronchopulmonary segment during pulmonary lobectomy, and for radiologists to correctly interpret X-rays and CT scans.

El objetivo fue determinar las variaciones de las fisuras del pulmón y correlacionarlas con su importancia clínica. Se utilizaron 48 muestras de pulmón, 30 del lado derecho y 18 del izquierdo, obtenidos de cadáveres de origen del Sur de la India. Entre los pulmones, en el lado derecho, dos mostraron ausencia de la fisura horizontal, y 25 mostraron una fisura horizontal incompleta. La fisura oblicua fue incompleta en 15 pulmones y en 1 pulmón estuvo ausente. Se observó una fisura accesoria en 4 pulmones. Entre los pulmones del lado izquierdo, la fisura oblicua estuvo incompleta en 7 casos. La presencia de una fisura accesoria se observó en 5 casos. Con el desarrollo de técnicas radiológicas, endoscópicas y el avance de la cirugía pulmonar, el conocimiento de las variaciones morfológicas de las fisuras de pulmón es de importancia para los médicos, permitiendo localizar correctamente el segmento broncopulmonar durante la lobectomía, y para los radiólogos para interpretar correctamente las radiografías y las Tomografías Computarizadas.

Nuevo reparo anatómico para la identificación del núcleo dentado en el abordaje suboccipital / New anatomical repair for the identification of the tooth nucleus in the suboccipital approach

Introducción: El abordaje suboccipital constituye una de las vías de acceso más frecuentes a la fosa posterior. Objetivo: La finalidad del presente estudio es definir un reparo anatómico reproducible en la superficie suboccipital del cerebelo que permita ayudar a localizar el núcleo dentado (ND) del mismo. Material y Métodos: Quince cerebelos de adulto fueron estudiados, previa fijación con formol y congelación. Se realizaron cortes axiales y sagitales, con medición de las relaciones entre la fisura horizontal (FH) y el ND. Resultados: La proyección en profundidad de la FH permitió identificar el núcleo dentado en casi todos ellos. Conclusión: La identificación del ND en la cirugía a partir de la FH puede ser considerada un método rápido y confiable. Su utilización pre y perioperatoria podría disminuir las complicaciones derivadas de la lesión de dicho núcleo cerebeloso.

Introduction: The suboccipital approach is one of the most common surgical routes to the posterior fossa.Purpose: The aim of this study was to define a reproductible anatomic landmark in the suboccipital surface of the cerebellum, allowing to localize the dentate nucleus (DN).Material and methods: Fifteen cadaveric specimens (adult brains) were studied, previously fixed with formaldehyde and frozen. Sagittal and axial cuts were performed in the specimens, measuring the relationships between the horizontal fissure (HF) of the cerebellum and the DN.Results: The projection in depth of the HF allowed to identify the DN in almost all of them.Conclusion: The identification during surgery of the DN using the HF maybe a safe and quick method and its usage pre and intraoperatively can lower complications related to lesions of the DN.

Analysis of Eyelid Crease Position in Children

The position of the upper lid crease is important factor in the reconstruction for lid anomaly and cosmetic defect. We were determined the proportions of the upper lid contour based on the following measurements in 115 children with bilateral lid crease and divided into 4 groups according to patient's eye(group I: below 4 years, group II: 5 ~ 7 years. group III: 8 ~ 10 years. group IV: 11 ~ 15 years); lashline-lid crease(LC), lashline-lower brow(LB), vertical fissure(VF), horizontal fissure(HF). All measured values(LC, LB, VF, HF) were increased with age(p<0.05). VF/HF and LC/LB ratio were not statistically significantly different between each age group. We concluded that when eye open, normal upper eyelid crease position was less than one fourth in I, II group. but approximately one fourth in III, IV group, and when eye closed, upper eyelid crease position is less than one third in I, II group but about one third in III, IV group.