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Introduction: Anatomical knowledge is very important for accurate diagnosis and proper treatment of the patient.The popliteal region presents a wide range of vascular anomalies. The correct diagnosis of these anatomicalvariations plays a key role in success of diverse procedures performed by orthopaedicians, vascular surgeonsand radiologists. In this context, the aim of our study was to gain knowledge on the origin, level and mode oftermination, course and relations of popliteal artery with surrounding structures, mainly the muscles, in poplitealfossa. The results obtained were compared with previous studies.Materials and methods: The study was carried out in 50 lower limbs of 25 well-embalmed cadavers. There wasno evidence of previous knee surgeries in any of the limbs. The specimens were collected from the department ofAnatomy, KVG Medical College, Sullia.Results: The femoral artery continued as popliteal artery, which terminated at the lower border of popliteusmuscle. Trifurcation pattern was observed in one specimen. 10% of specimens had hypoplastic/aplasticposteriortibial artery, distally replaced by peroneal artery. Another 4% of specimens had smaller posterior tibialand larger peroneal artery. Length of tibio peroneal trunk from the lower border of popliteus muscle was shorterthan normal (2.5 cm) in one specimen and longer in another specimen. The observation on course and relationsshowed that the popliteal artery passed beneath a bony tunnel of fibula before terminating in one specimen andin another specimen, popliteal artery was superficial to popliteal vein in the middle of popliteal fossa. In othertwo specimens, it coursed more medially towards medial head of gastrocnemius and another specimen presentedwith popliteal artery crossed by muscle belly of plantaris.Conclusion: This study adds up to the knowledge on vascular variations in the popliteal region, the awareness ofwhich is important to vascular surgeons while performing arterial reconstructions in femoro distal bypass graftprocedures and also to orthopaedicians during surgical clubfoot release.
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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.
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Background: The anatomical variations of left coronary artery [LCA] determine the course in the pathogenesis ofatherosclerosis, mechanical stress and hemodynamic change.Aim: To study the gross anatomy of left coronary artery [LCA] in terms of its origin, termination, branchingpattern, dominance pattern, external diameter at origin, length of main trunk of left coronary artery, variationsand/ anomalies if present.Materials and Methods: After an ethical approval, 150 adult human cadaveric hearts were collected fromDepartment of Anatomy, B.V.D.U. Medical College and Hospital, Sangli and Pune. The careful dissection wascarried out to note details about left coronary artery and data was analyzed using SPSS software.Results: The origin of left coronary artery was observed in the left posterior aortic sinus 100%. The incidence ofbifurcation, trifurcation and quadrifurcation was 69.33, 28% and 2.67% respectively. SA nodal artery was directlyarising from main trunk of left coronary artery in 2 hearts (1.33%). Circumflex branch of left coronary artery gaveSA nodal artery, AV nodal artery and posterior interventricular artery in 18.66%, 16% and 16% hearts respectively.In one case (0.66%), we found a hyperdominant left anterior descending artery which continued as posteriorinterventricular artery [PDA] occupying entire posterior interventricular sulcus and terminated at crux of theheart by giving AV nodal artery. Hence left dominance was observed in total 16.66% cases. The mean externaldiameter of left coronary artery at its origin was 5.02 ±1.0328. Length of main trunk of left coronary artery wasranging from 4 mm to 22 mm with mean length of 11.66±3.529 mm.Conclusion: Short or long main trunk of left coronary artery, small diameter of main trunk, additional terminalbranches of left coronary artery, left coronary artery dominance, Mouchet’s posterior recurrent interventricularartery, hyperdominanant left anterior descending artery are the significant anatomical factors which decide theextent of coronary insufficiency, its functional impact and may create challenges during the interventionalcoronary care.
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SUMMARY: A detailed understanding of the coronary arteries is of paramount importance in the management of coronary arterial diseases. The arterial supply to the heart originates from right (RCA) and left (LCA) coronary arteries which form an oblique inverted crown within the atrioventricular groove. This study aimed to document the embryologic relationship between the RCA and the LCA including their lengths, diameters, branching patterns and arterial dominance in fetuses. Forty-one human fetal heart specimens with an age range of 13.13 to 26.95 weeks were dissected at the Department of Clinical Anatomy, University of Kwazulu-Natal, Durban, South Africa. The RCA arose from the right aortic sinus and was dominant in all the specimens. The LCA was classified into types according to their branching pattern. The bifurcation, trifurcation and quadrifurcation of the LCA occurred in 68.3 %, 29.3 % and 2.4 % of hearts, respectively. The mean lengths of the RCA and LCA were 0.98±0.54 mm and 1.83±0.77 mm, respectively. The mean external diameters of the RCA and LCA were 0.38±0.12 mm and 0.49±0.17 mm, respectively. There was a significant correlation between the RCA and LCA length and the fetal age which is indicative of significant changes in the coronary vasculature with fetal growth.
RESUMEN: Una comprensión detallada de las arterias coronarias es de suma importancia en el manejo de las enfermedades en estas arterias. El suministro arterial al corazón se origina de las arterias coronarias derecha (ACD) e izquierda (ACI) que forman una "corona oblicua invertida" dentro del surco atrioventricular. Este estudio tuvo por objetivo documentar la relación embriológica entre la ACD y la ACI, incluyendo sus longitudes, diámetros, patrones de ramificación y dominio arterial en fetos. Se disecaron 41 corazones de fetos humanos con un rango de edad de 13,13 a 26,95 semanas, en el Departamento de Anatomía Clínica, Universidad de Kwazulu-Natal, Durban, Sudáfrica. La ACD surgió del seno aórtico derecho y fue dominante en todos los especímenes. La ACI se clasificó en distintos tipos según su patrón de ramificación. La bifurcación, trifurcación y cuadrifurcación de la ACI ocurrieron en 68,3 %, 29,3 % y 2,4 % de los corazones, respectivamente. Las longitudes medias de la ACD y ACI fueron 0,98 ± 0,54 mm y 1,83 ± 0,77 mm, respectivamente. Los diámetros externos medios de la ACD y ACI fueron 0,38 ± 0,12 mm y 0,49 ± 0,17 mm, respectivamente. Hubo una correlación significativa entre la longitud de la ACD y la ACI y la edad fetal, que es indicativa de cambios significativos en la vasculatura coronaria con crecimiento fetal.
Subject(s)
Humans , Coronary Vessels/anatomy & histology , Fetus/anatomy & histology , Body Weights and Measures , Dissection , South AfricaABSTRACT
Patients with Klippel-Feil syndrome (KFS) have an increased incidence of vascular anomalies as well as vertebral artery (VA) anomalies. In this article, we presented imaging findings of a 15-year-old female patient with KFS with a rare association of extraforaminal cranially ascending right VA that originated from the ipsilateral carotid bulb. Trifurcation of the carotid bulb with VA is a very unusual variation and to the best of our knowledge, right-sided one has not been reported in the literature.
Subject(s)
Adolescent , Female , Humans , Incidence , Klippel-Feil Syndrome , Vertebral ArteryABSTRACT
Introduction: Nerves supplying the hand are notoriously variable in their divisions and their course; do not follow any standard pattern. The palmar aspect of hand is supplied by median and ulnar nerve. The clinical importance of Guyon’s canal is emphasized due to the various branching patterns of the ulnar nerve in this canal. The palmar aspect of hand is usually supplied by ulnar nerve and median nerve. Medial one and a half fingers are supplied by ulnar nerve and lateral three and a half fingers are supplied by the median nerve. The branches of ulnar nerve are notoriously variable morphologically and no standard pattern can be given regarding the course of these branches. Presence of trifurcation of ulnar nerve or communications of superficial branches to median nerve do not cause symptoms usually but becomes important during surgical and orthopaedic interventions. Material and Methods: The study was conducted on 40 hands (20 left and 20 right ) of preserved adult human cadavers.The roof of the Guyon’s canal was opened with care not to disturb the stuctures. The ulnar nerve observed for its terminal branches, the course of its superficial branches was observed. The point of division of superficial branch into digital branches was measured from bistyloid line. The point of origin of superficial communicating branch from superficial branch or digital branch of ulnar nerve to median nerve was observed from bistyloid line. Observations: In 29 hands the ulnar nerve showed bifurcation, in 10 hands it trifurcated in the Guyon’s canal and in 1 right hand of a male cadaver there was higher division of the ulnar nerve and trifurcation.The superficial branch was observed for its course and division from bistyloid line. The superficial branch gave rise to 2 digital branches in 27 hands and it gave 3 branches i.e. 2 digital branches and 1 communicating branch to medialmost digital branch of median nerve in 13 hands. The typical ramus communicans from digital branch of ulnar nerve to the medial most digital branch of median nerve was observed in 27 hands.(67.5%). Conclusion: This study attempted at exploring the superficial anatomy of ulnar nerve in hand.The branching pattern of the ulnar nerve in Guyon’s canal is variable as there is no exact level at which the nerve terminates.The superficial communicating branch to median nerve though present in all the hands but the typical ramus communicans was observed in 67.5% of specimens. Thus surgical procedures in hand should be planned carefully keeping in mind in advance such variations which can be encountered.
ABSTRACT
The external carotid artery normally divides into two terminal branches at the level of the neck of the mandible. The terminal branches are usually the superficial temporal and maxillary arteries. The maxillary artery is described to be in three parts in relation to the lateral pterygoid muscle as the mandibular (first), pterygoid (second) and the pterygopalatine (third) parts. The second part passes behind the muscle. The branches that arise from the first part of the maxillary artery are the deep auricular, anterior tympanic, the middle meningeal, accessory meningeal and inferior alveolar arteries. The middle meningeal artery normally arises at the lower border of lateral pterygoid muscle from the first part of maxillary artery. It then ascends upwards, passes between the two roots of the auriculotemporal nerve and enters the foramen spinosum in the base of skull. During routine dissection of a male cadaver in the department of anatomy while teaching medical students variations were observed in the termination of the external carotid artery on the right side. The artery gave three branches at the termination, superficial temporal, maxillary and between the two the middle meningeal artery was seen arising close to the end of the external carotid artery. The middle meningeal artery did not pass between the two roots of the auriculotemporal nerve. The branches of first part of maxillary artery were variable. The deep auricular branch was absent and its territory may have been supplied by the posterior auricular and anterior auricular arteries. The anterior tympanic and accessory meningeal arteries arose from the middle meningeal artery. There were two inferior alveolar arteries 1.5 cm apart arising from the first part of maxillary artery. The first artery went to the mandibular canal along with the inferior alveolar nerve. The second artery accompanied the lingual nerve to the last molar tooth. Probably this artery may have been an additional supply to the gingiva around the last molar tooth. The other variations that were noted were the absence of mylohyoid branch from the inferior alveolar artery. To the best of our knowledge these variations in the arteries have not been previously reported.
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During the performance of an angiotecnich in a human heart, to highlight the coronary circulation, weobserved the presence of myocardial bridges in the anterior and medial branches of the left coronary artery, inthis heart was also demonstrated the presence of an artery trifurcation left coronary branches that originatedthe anterior interventricular, circumflex and median. Myocardial bridges are intriguing entities that do notalways show signs and symptoms, the presence of the median artery in hearts with myocardial bridges, is oneof the factors that may explain the absence of signs and symptoms in some patients with this entity. Moreoverthe myocardial bridges can explain the signs and symptoms of ischemia on functional testing.
Subject(s)
Humans , Coronary Artery Bypass , Coronary Circulation , Coronary Vessel AnomaliesABSTRACT
Anomalous right upper lobe bronchus takeoff from the trachea has been reported to occur in 1 of 250 otherwise normal patients. Difficulty with double-lumen tube(DLT) placement has been described previously and there are problems with Univent tube with the intention of using the bronchial blocker to achieve right lung collapse in this patient. In two cases, the fiberoptic bronchoscopic examination through Univent tube revealed a trifurcation, rather than the usual bifurcation, at the carina and revealed that the most rightward lumen was the right upper lobe bronchus and the middle lumen was the right middle and lower lobe bronchus. The left lumen was the left main bronchus. So in one case, the Univent tube was withdrawn and DLT was reinserted. In the other case right lung collpase achieved with the inflation of cuff of bronchial blocker. One lung anesthesia was performed without any problem in these two cases.