Finite element analysis of cervical intervertebral discs after removing different ranges of uncinate processes / 解剖学报

Objective To study the stress change characteristics of the cervical disc after removing different ranges of the uncinate process by establishing a three⁃dimensional finite element model of the C

A Case Report on Hepatopancreatic Anomaly with its histomorphological study in Adult Cadaver

The pancreas is a soft, lobulated and mixed gland. As the liver and pancreas develop together from the hepatopancreatic bud it is common that congenital anomalies of liver and pancreas exist together. This study was done during routine practical dissection where a band of tissue was found extending from the head of the pancreas to the root of the Mesentry. On histological examination the tissue was confirmed to be pancreas. It is seen that the hepatic bud grows at the expense of the ventral pancreas. In the present study, we found an atrophied left lobe of liver and an abnormally rare and large uncinate process of pancreas.

Anatomy of lacrimal sac fossa affecting success rate in DCR surgery / Шинэ санаа Шинэ нээлт

Background@#Primary acquired nasolacrimal duct obstruction (PANDO) is a common cause of epiphora in adults, standard surgery for blockage of the lacrimal outflow tract is the dacryocystorhinostomy (DCR). The majority of studies have analyzed the lacrimal system of whites anatomically and presented guidelines for endonasal DCR. It has been our experience that DCR procedures for Asians are more difficult than for whites and we reasoned that the difficulty might be attributable to the anatomic differences in the intranasal structures between the races. Before we started doing endoscopic endonasal DCR in Mongolia, there was no hospital doing this surgery and there was lack of study done on anatomy of lacrimal fossa and DCR surgery result among Mongolians are our rationale of study.@*Goal@#To study the effect of anatomical variance of lacrimal sac fossa on dacryocystorhinostomies performed by the endoscopic endonasal approach.@*Methods@#METHODS: A total of 292 consecutive cases of DCR were performed age between 16-75 years old who have primary nasolacrimal obstruction (ICD-H04.559). This study was approved by the Ethics Committee of Mongolian National University of Medical Sciences. A total of 146 EX-DCR and 146 EN-DCR patients were identified. Full success was defined as no symptoms of tearing after surgery and anatomical patency with lacrimal irrigation. Standard Lac-Q questionnaire was used to compare satisfaction of the surgery in both groups. All statistical tests were two-sided, and a p-value of <0.05 was considered to be statistically significant. Statistical analysis was performed using STATA for Windows version 11.2.@*Results@#There was no significant difference in age or gender distribution between the two groups. Frontal process of the maxillary bone is 4.41± 1.96 mm in successful group and 4.97± 1.04 in failed group (p<0.05). The uncinate process was attached to the lacrimal sac fossa in 80.1% of the all cases and 100% in surgery failed group (p<0.05). The variation that agger nasi cell adjacent to the lacrimal sac fossa was in 93.9%. The operculum of the middle turbinate was attached to the lacrimal sac fossa in 94.5% of the cases (p=0.76). Postoperative assessment was performed for 6 months. Patients who underwent endonasal group reported a 11.0-point improvement (IQR, 9.0–16.5). @*Conclusions@#A thick frontal process of the maxilla and uncinate process, operculum of the middle turbinate, and ethmoid cells adjusting to lacrimal fossa are dominant in Mongolians. Patients who have these features are prone to have recurrence of nasolacrimal duct obstruction after DCR surgery. The EN-DCR have a high surgical success rate and good result on reduce of symptoms and improvement in quality of life by using the Lac-Q standard questionnaire.

Anatomy of lacrimal sac fossa affecting success rate in endoscopic and external dacryocystorhinostomy surgery / Монголын Анагаах Ухаан

Introduction@#Primary acquired nasolacrimal duct obstruction (PANDO) is a common cause of epiphora in adults, standard surgery for blockage of the lacrimal outflow tract is the dacryocystorhinostomy (DCR). The majority of studies have analyzed the lacrimal system of whites anatomically and presented guidelines for endonasal DCR. It has been our experience that DCR procedures for Asians are more difficult than for whites and we reasoned that the difficulty might be attributable to the anatomic differences in the intranasal structures between the races. Before we started doing endoscopic endonasal DCR in Mongolia, there was no hospital doing this surgery and there was lack of study done on anatomy of lacrimal fossa and DCR surgery result among Mongolians are our rationale of study.@*Goal@#To study the effect of anatomical variance of lacrimal sac fossa on dacryocystorhinostomies performed by the endoscopic endonasal approach.@*Material and Methods@#A total of 292 consecutive cases of DCR were performed age between 16-75 years old who have primary nasolacrimal obstruction (ICD-H04.559). This study was approved by the Ethics Committee of Mongolian National University of Medical Sciences. A total of 146 EX-DCR and 146 EN-DCR patients were identified. Full success was defined as no symptoms of tearing after surgery and anatomical patency with lacrimal irrigation. Standard Lac-Q questionnaire was used to compare satisfaction of the surgery in both groups. All statistical tests were two-sided, and a p-value of <0.05 was considered to be statistically significant. Statistical analysis was performed using STATA for Windows version 11.2.@*Results@#There was no significant difference in age or gender distribution between the two groups. Frontal process of the maxillary bone is 4.41± 1.96 mm in successful group and 4.97± 1.04 in failed group (p<0.05). The uncinate process was attached to the lacrimal sac fossa in 80.1% of the all cases and 100% in surgery failed group (p<0.05). The variation that agger nasi cell adjacent to the lacrimal sac fossa was in 93.9%. The operculum of the middle turbinate was attached to the lacrimal sac fossa in 94.5% of the cases (p=0.76). Postoperative assessment was performed for 6 months. Patients who underwent endonasal group reported a 11.0-point improvement (IQR, 9.0–16.5). @*Conclusions@#A thick frontal process of the maxilla and uncinate process, operculum of the middle turbinate, and ethmoid cells adjusting to lacrimal fossa are dominant in Mongolians. Patients who have these features are prone to have recurrence of nasolacrimal duct obstruction after DCR surgery. The EN-DCR have a high surgical success rate and good result on reduce of symptoms and improvement in quality of life by using the Lac-Q standard questionnaire.

Clinical study of "total laparoscopic pancreaticoduodenectomy" in low-flow hospitals / 国际生物医学工程杂志

Objective:To explore the safety, feasibility and clinical value of the "posterior colon approach, uncinate process first" of total laparoscopic pancreaticoduodenectomy in low volume hospitals.Methods:The clinical data of 3 patients who underwent complete laparoscopic pancreaticoduodenectomy were analyzed from January 2020 to August 2020.Results:All the 3 patients successfully underwent total laparoscopic pancreaticoduodenectomy. For the 3 patients, the operative time was 430, 385 and 425 min, and the blood loss was 550, 420 and 400 ml. After the operation, no pancreatic fistula, bile leakage, intestinal fistula and astric emptying disorder were found in the patients. The exhaust time of the 3 patients was 4, 5 and 5 days after the operation, respectively. On the 6th day after the operation, the gastric tube was removed. The extraction time of the abdominal drainage tube of the 3 patients was the 7th, 7th and the 9th day, and the postoperative hospital stay was 18, 15 and 16 days, respectively. Postoperative pathological diagnosis results showed that the 3 patients included 1 case of pancreatic head high-moderately differentiated ductal adenocarcinoma, 1 case of duodenal ampullary high-moderately differentiated adenocarcinoma, and 1 case of duodenal papillary well-differentiated adenocarcinoma.Conclusions:"Posterior approach of uncinate process" is safe and feasible in laparoscopic pancreaticoduodenectomy. It can be popularized in low volume hospitals.

Anatomical Variations in Nose and Paranasal Sinuses in Patients Presenting with Chronic Rhinosinusitis

Introduction: The anatomy of organs of ENT is a herculeantask to understand and evaluate in the whole human anatomy.Knowledge about the possible variabilities is never complete,since there is always a scope to understand better and knowmore. Many studies have been undertaken in the past tounderstand better the already existing knowledge about thevarious anatomical details in the nose and paranasal sinusescausing chronic rhinosinusitis. The present study was carriedto know the details of variations in anatomy of nose andparanasal sinuses causing chronic sinusitis.Material and Methods: A Cross sectional study conductedover a period of two years, in patients presenting to ENTOPD with symptoms and signs and chronic rhinosinusitis, ina setting of tertiary hospital, with the requisite investigativeprotocols. Patients meeting the inclusion criteria were includedin the study and subjected to the prescribed interventions.Results: Observations gathered from this study are- of the65patients included, 86.1% had septal deformities, 58.4% hadConcha bullosa, 52.3% had Agger Nasi, 15.3% had HallerCell, 13% had Paradoxical Middle Turbinate, 4.6% hadEverted Uncinate Process, 3% had Enlarged Bulla.Conclusion: Sinonasal anatomy is different in each individual,with various combined variations also.

Morphometric study of dried cervical vertebrae / Estudio morfométrico de vértebras cervicales secas

The aim of this study was to emphasize the clinical importance of morphometry and the surgical parameters of the cervical vertebrae. The present study was carried out on ninety six adult dry cervical vertebrae (C3-C7, 96) of unknown gender of Turkish population. The various dimensions of the cervical vertebrae (from C3 to C7) were measured with using a digital caliper accurate to 0.01 mm. Linear parameters including vertebral body anteroposterior width (14.03 mm), vertebral body transverse width (24.45 mm); vertebral body height (10.64 mm); pedicle length (R:5.65±1.91 mm, L:5.65±1.76 mm); pedicle width (R:3.72 mm, L:3.61 mm); lamina height (R:9.87 mm, L:9.86 mm); lamina transverse length (R:13.41 mm, L:13.49 mm); superior articular process anteroposterior width (R:7.26 mm, L:7.46 mm); superior articular process transverse diameter (R: 9.87 mm, L:9.58 mm); superior articular process height (R:16.41 mm, L:16.08 mm); inferior articular process anteroposterior width (R: 7.67 mm, L:7.44 mm); inferior articular process transverse diameter (R: 10.32 mm, L:10.09 mm); inferior articular process height (R:12.72 mm, L:12.67 mm); spinous process length (17.91 mm); uncinate process width (R:4.37 mm, L:3.78 mm); uncinate process height (R:4.58 mm, L:3.93 mm); uncinate process length (R:9.28 mm, L:9.12 mm); vertebral foramen anteroposterior width (13.85 mm); vertebral foramen transverse diameter (20.88 mm); foramen transversarium anteroposterior width (R:4.23 mm, L:4.28 mm); foramen transversarium transverse diameter (R:4.78 mm, L:4.95 mm) were measured. Additionally, the distance of the apex of the uncinate process to foramen transversarium (R:2.91 mm, L:2.70 mm), and the distance of the apex of the uncinate process to intervertebral foramen (R: 5.77 mm, L:5.66 mm) were also calculated. There were found significant differences between two sides in the uncinate process width and height, and distance between uncinate process and foramen transversarium. Present measurements suggest that parameters relevant cervical vertebrae can be used as reference and anatomical landmark for evaluating pathologic changes and minimizing complications in the cervical spine.

El objetivo de este estudio fue enfatizar la importancia clínica de la morfometría y los parámetros quirúrgicos de las vértebras cervicales. El presente estudio se realizó en noventa y seis vértebras cervicales secas adultas (C3-C7) de sexo desconocido de la población turca. Las diversas dimensiones de las vértebras cervicales (C3 a C7) se midieron utilizando un calibrador digital con una precisión de 0,01 mm. Se determinaron parámetros lineales incluyendo ancho anteroposterior del cuerpo vertebral (14,03 mm), ancho transversal del cuerpo vertebral (24,45 mm); altura del cuerpo vertebral (10,64 mm); longitud del pedículo (R: 5.65 ± 1,91 mm, L: 5.65 ± 1,76 mm); ancho del pedículo (R: 3,72 mm, L: 3,61 mm); altura de la lámina (R: 9,87 mm, L: 9,86 mm); longitud transversal de la lámina (R: 13,41 mm, L: 13,49 mm); Diámetro anteroposterior del proceso articular superior (R: 7,26 mm, L: 7,46 mm); Diámetro transversal del proceso articular superior (R: 9,87 mm, L: 9,58 mm); Altura articular superior del proceso (R: 16,41 mm, L: 16,08 mm); Diámetro anteroposterior del proceso articular inferior (R: 7,67 mm, L: 7,44 mm); Diámetro transversal del proceso articular inferior (R: 10,32 mm, L: 10,09 mm); Altura del proceso articular inferior (R: 12,72 mm, L: 12,67 mm); longitud del proceso espinoso (17,91 mm); ancho del proceso uncinado (R: 4,37 mm, L: 3,78 mm); altura de proceso uncinado (R: 4,58 mm, L: 3,93 mm); longitud del proceso uncinado (R: 9,28 mm, L: 9,12 mm); Ancho anteroposterior del foramen vertebral (13,85 mm); Diámetro transverso del foramen vertebral (20,88 mm); Ancho anteroposterior del foramen transverso (R: 4,23 mm, L: 4,28 mm); Diámetro transverso del foramen transverso (R: 4,78 mm, L: 4,95 mm). Además, la distancia del vértice del proceso uncinado al foramen transverso (R: 2,91 mm, L: 2,70 mm) y la distancia del vértice del proceso uncinado al foramen intervertebral (R: 5,77 mm, L: 5,66 mm) Se encontraron diferencias significativas entre los dos lados, en el ancho y la altura del proceso uncinado, y la distancia entre el proceso uncinado y el foramen transverso. Las mediciones actuales sugieren que los parámetros relevantes de las vértebras cervicales se pueden usar como referencia y punto de referencia anatómicos para evaluar los cambios patológicos y minimizar las complicaciones en la columna cervical.

Clinical value of uncinate process resection combined with portal-superior mesenteric vein resection and end-to-end anastomosis in distal pancreatectomy / 中华消化外科杂志

Objective To explore the clinical value of uncinate process resection combined with portalsuperior mesenteric vein resection and end-to-end anastomosis in distal pancreatectomy.Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 11 patients who underwent distal pancreatectomy combined with portal-superior mesenteric vein resection and end-to-end anastomosis in the Peking University Cancer Hospital (8 patients) and Jilin Guowen Hospital (3 patients) between January 2014 to April 2018 were collected.During the vascular reconstruction,uncinate process of the pancreas was first resected for reducing anastomotic tension,and then end-to-end anastomosis was done after portal-superior mesenteric vein resection.Observation indicators:(1) intraoperative situations;(2) postoperative recovery situations;(3) postoperative pathological examination situations;(4) follow-up and survival situations.Follow-up using outpatient examination and imaging examination was performed to detect patients' postoperative survival,tumor recurrence and metastasis and postoperative venous anastomotic patency up to May 2018.Measurement data with normal distribution were represented as x±s.Measurement data with skewed distribution were described as M (range).The non-recurrence and non-metastasis survival curve,overall survival curve and survival rate were respectively drawn and calculated by the Kaplan-Meier method.Results (1) Intraoperative situations:11 patients received uncinate process resection of the pancreas,and successfully underwent distal pancreatectomy combined with portal-superior mesenteric vein resection and end-to-end anastomosis.Eight patients underwent distal pancreatectomy + Appleby combined with celiac axis resection due to pancreatic tumor involving common hepatic artery,including 2 undergoing combined total gastrectomy due to gastric ischemia;2 patients underwent distal pancreatectomy;1 patient underwent distal pancreatectomy + distal gastrectomy due to blood supply obstacle of distal stomach.Operation time and volume of intraoperative blood loss of 11 patients were (5.8± 1.1) hours and 800 mL (range,200-2 500 mL).(2) Postoperative recovery situations:there was no grade C of pancreatic fistula of 11 patients.Four patients had grade B of pancreatic fistula,including 2 were cured by drainage-tube indwelling of pancreatic wound ＞ 3 weeks,1 was cured by continous washing due to pancreatic fistula combined with infection,and 1 was cured by the second abdominal puncture drainage due to pancreatic fistula with fever;1 of 4 patients was combined with grade C of delayed gastric emptying and cured by conservative treatment,and other 3 patients didn't occur postoperative complications.Of 5 patients diagnosed as biochemical fistula,1 had esophagus-jejunum anastomotic leakage,and 1 had changes of hepatic ischemia in S2,S3 and S4b segments by CT examination and recovered normal liver function at 2 weeks postoperatively,with long-term hepatatrophia in S2 and S3 segments.There was no postoperative death and reoperation in 11 patients.Duration of postoperative hospital stay of 11 patients was (22± 5) days.(3) Postoperative pathological examination results:tumors of 11 patients were located in neck and body of the pancreas,with a maximum diameter of (4.8± 1.7)cm.Among 11 patients,10 were confirmed with moderate-or low-differentiated ductal adenocarcinoma and 1 with anaplastic carcinoma.The length of portal-superior mesenteric vein resection of 11 patients was (2.6± 0.8) cm.Seven of 11 patients occurred different degrees of tumor infiltration in the portal-superior mesenteric vein,and other 4 patients occurred inflammatory adhesion,without tumor infiltration.(4) Follow-up and survival situations:11 patients were followed up for 3.0-37.6 months,with a median time of 15.7 months.During the follow-up,8 patients died of tumor recurrence and /or metastasis,and 3 survived;the non-recurrence and non-metastais survival time and overall survival time were respectively 9.0 months (range,3.0-37.6 months) and 24.6 months (range,3.0-37.6 months).One patient was complicated with anastomotic stenosis and surrounding varices of portal-superior mesenteric vein by postoperative half-year reexamination,anastomotic vein anomalies and venous thrombosis were not found in other patients before local tumor recurrence and / or death.Conclusion The combined uncinate process resection of the pancreas cannot increase the risk of postoperative pancreatic fistula,and it could effectively reduce the anastomotic tension in the distal pancreatectomy combined with portal-superior mesenteric vein resection and reconstruction,meanwhile,it can also achieve end-to-end anastomosis after longer vein resection.

Laparoscopic pancreaticoduodenectomy with a novel artery first and uncinate process first approach through Treitz ligament / 中华外科杂志

Objective@#To explore the clinical effect of a novel artery first and uncinate process first approach for laparoscopic pancreaticoduodenectomy(LPD), emphasizing the left lateral and posterior dissection of uncinate process (UP) via Treitz ligament approach.@*Methods@#From April to November 2016, 18 patients received LPD with a novel approach in Pancreas Center of the First Affiliated Hospital with Nanjing Medical University. All patients were diagnosed as pancreatic head or peri-ampulla tumor, without major vessel invasion nor distant metastasis. For resection, routine caudal view was used in the first step, to dissect the anterior medial border between uncinate process and superior mesenteric vein(SMV). Lymphatic tissues were completely dissected form anterior surface of hepatoduodenal ligament. In the second step, left lateral view with camera from left para-umbilical trocar was used, Treitz ligament was incised, SMA root was exposed. After anticlockwise rotation and retraction of mesentery, the anatomic relationship between SMA trunk, inferior pancreaticoduodenal artery(IPDA), jejunal branch of SMV, and distal part of UP, could be perfectly exposed from left lateral view. SMA was dissected from its root until the position above the uncinate process and duodenum, IPDA was transected, distal part of UP was freed from SMA. In the third step, right lateral view and caudal view were alternatively used; proximal UP mesentery was completely dissected out from SMA root, CA root and posterior surface of hepatoduodenal ligament. Pancreaticoduodenectomy was completed in the forth step after transection of pancreatic neck and common hepatic duct.@*Results@#The SMA root and distal UP were successfully dissected out via Treitz ligament approach in all 18 patients, among them, distal UP was completely excised in 8 patients from left view. Postoperative pathology showed R0 resection rate in 69%. Postoperative complication included intra-abdominal hemorrhage in 1 patient, pancreatic fistula in 7 patients(6 cases with grade A and 1 case with grade B), delayed gastric emptying in 4 patients (2 cases with grade A, 2 cases with grade B). Average postoperative hospital stay was (15.5±6.8)days.@*Conclusion@#The novel artery first and uncinate process first approach through Treitz ligament could help surgeons to completely dissect the full length of meso-pancreas along celiac axis-SMA axis in LPD.

Management of Nasolacrimal-Cutaneous Fistula – A Maxillofacial Review and Sharing Experience.

Nasolacrimal cutaneous fistula can be presented with a complaint of discharge from an opening found below the eye and beside the nose. The patient’s history can be remarkable with repair of severe maxillofacial injuries. Examination reveals a nasolacrimal-cutaneous fistula extending from lacrimal sac to the overlying skin with co-existing nasolacrimal duct obstruction. To correct a lacrimal-cutaneous fistula, an endoscopic dacryocystorhinostomy should be performed to create a new opening to the lacrimal apparatus medially. Simultaneous irrigation and probing of the common canaliculus and fistula tract under direct visualization allows identification of the origin of the lacrimal fistula in relation to the internal ostium on the lateral lacrimal sac wall. Post-traumatic nasolacrimal disturbances are not uncommon findings in trauma patients and management of these chronic fistulas may be helpful for complete rehabilitation of the patient.

Morphometric evaluation of the uncinate process and its importance in surgical approaches to the cervical spine: a cadaveric study

<p><b>INTRODUCTION</b>The uncinate process (UP) has an important role because of its relationship with the vertebral artery and spinal roots. Degenerative diseases cause osteophyte formation on the UP, leading to radiculopathy, myelopathy and vertebral vascular insufficiency, which may require surgical management. This study aimed to evaluate the morphometry of this region to shed light on the anatomy of the UP.</p><p><b>METHODS</b>Morphometric data was obtained from 13 male formaldehyde-fixed cadavers. Direct measurements were obtained using a metal caliper. Computed tomography (CT) morphometry was performed with the cadavers in the supine position.</p><p><b>RESULTS</b>Direct cadaveric measurements showed that the height of the UP increased from C3 (5.8 ± 1.0 mm) to C7 (6.6 ± 0.5 mm). On CT, the corresponding measurements were 5.9 ± 1.2 mm at C3 and 6.9 ± 0.6 mm at C7. The distance between the left and right apex of the UP from C3 to C7 also increased on both direct cadaveric and CT measurements (C3: 20.8 ± 1.0 mm and C7: 28.1 ± 2.4 mm vs. C3: 23.7 ± 3.4 mm and C7: 29.0 ± 3.0 mm, respectively). On CT, the distance between the UP and superior articular process at the C3 to C7 levels were 9.8 ± 1.7 mm, 7.9 ± 1.8 mm, 7.9 ± 1.6 mm, 7.8 ± 1.3 mm and 8.2 ± 1.7 mm, respectively.</p><p><b>CONCLUSION</b>Direct cadaveric and CT measurements of the UP are useful for preoperative evaluation of the cervical spine and may lead to better surgical outcomes.</p>

Correlation research and clinical significance between youth cervical hook and transverse foramen / 局解手术学杂志

Objective The correlation analysis was proceeded between youth cervical hook and transverse foramen by using imaging scanning and three-dimensional reconstruction method,which can provide theoretical basis for early diagnosis,treatment and prevention of ju-venile cervical spondylosis.Methods A total of 66 teenagers who had no trauma,neurological symptoms or signs were selected with aged from 6 to 20 years old,who were scanned by multi slice spiral CT,ranged from C1 to T1 .The original data in DICOMformat to import 3D re-construction software was related index measurement and subsequent statistical analysis.Results There was a correlation between hook height,base width,base length of luschca joint and transverse diameter,longitudinal diameter.Conclusion Hook vertebral meridian of lus-chca joint and transverse foramen has a close contact.Factors such as fracture and hyperplasia of luschca joint,vertebral artery of transverseforamen can be oppressed that cause corresponding vertebral artery type of cervical spondylosis.

Surgical Anatomy of the Longus Colli Muscle and Uncinate Process in the Cervical Spine

PURPOSE: There have been a few previous reports regarding the distances between the medial borders of the longus colli to expose the disc space. However, to our knowledge, there are no reports concerning longus colli dissection to expose the uncinate processes. This study was undertaken to assess the surgical relationship between the longus colli muscle and the uncinate process in the cervical spine. MATERIALS AND METHODS: This study included 120 Korean patients randomly selected from 333 who had cervical spine MRIs and CTs from January 2003 to October 2013. They consisted of 60 males and 60 females. Each group was subdivided into six groups by age from 20 to 70 years or more. We measured three parameters on MRIs from C3 to T1: left and right longus colli distance and inter-longus colli distance. We also measured three parameters on CT: left and right uncinate distance and inter-uncinate distance. RESULTS: The longus colli distances, uncinate distances, and inter-uncinate distances increased from C3 to T1. The inter-longus colli distances increased from C3 to C7. There was no difference in longus colli distances and uncinate distances between males and females. There was no difference in the six parameters for the different age groups. CONCLUSION: Although approximate guidelines, we recommend the longus colli be dissected approximately 5 mm at C3-5, 6 mm at C5-6, 7 mm at C6-7, and 8 mm at C7-T1 to expose the uncinate process to its lateral edge.

A Computerized Tomographic Study of Uncinate Process of Ethmoid Bone.

Background: The uncinate process is an important landmark in the anatomy of osteo-meatal complex of frontal recess which also plays a vital role in the ventilation of middle meatus and sinuses. Its superior attachment shows great anatomic variability. The aim of this study was to observe and classify superior attachment and presence of pneumatisation in uncinate process. Materials and methods: Computed tomographic images of paranasal region from 100 patients were studied retrospectively. In 100 patients, 54 belonged tomale and 46 female and were in the age group of 11 to 75 years with an average of 32.7 years. The superior attachment of uncinate process was observed and tabulated according to Landsberg and Friedman classification and pneumatisation of uncinate process was also noted. The results were analysed statistically. Results: The superior attachment of uncinate process was observed in 200 sides out of 100 patients and its attachment to the agger nasi cells (type - 2) was found in 36% while its attachment to lamina papyracea (type – 1) and to middle turbinate (type – 6) were found in 19% and 20% respectively. Uncinate process ending at the junction of middle turbinate with cribriform plate (type – 4), at the ethmoid skull base (type – 5), bifurcating towards lamina papyracea and junction of middle turbinate with cribriform plate (type – 3) were seen in 2%, 8% and 5% respectively. In 11%, the superior end showed no attachment to surrounding structures. The uncinate process was pneumatised in 34 of 200 sides (17%), among which 45.5% was unilateral and 54.5% bilateral. Conclusion: Preoperatively evaluating variations of uncinate process and its pneumatisation helps to avoid intraoperative damage to surrounding structures. The detailed knowledge of extent of uncinate process may also help to deduce the reason for refractory chronic sinusitis.

Unduly extensive uncinate process of pancreas in conjunction with pancreatico-duodenal fold / 대한해부학회지

Anatomical variations of pancreatic head and uncinate process are rarely encountered in clinical practice. These variations are primarily attributed to the complex development of the pancreas. An unduly enlarged uncinate process of the pancreas overlapping the third part of duodenum was discovered during dissection. This malformation of the pancreatic uncinate process was considered to be due to excessive fusion between the ventral and dorsal buds during embryonic development. On further dissection, an avascular pancreatico-duodenal fold guarding the pancreatico-duodenal recess was observed. The enlarged uncinate process can cause compression of neurovascular structures and also cause compression of adjoining viscera. The pancreatico-duodenal recess becomes a potential site for internal herniation. This case is of particular interest to the gastroenterologists and surgeons performing surgical resections. Precise knowledge of embryogenesis of such pancreatic anomalies is necessary for understanding and thus treating many diseases of the pancreas.

Variaciones anatómicas del proceso uncinado en tomografía computada multidetector en pacientes con rinosinusitis crónica

Objetivo: Describir la anatomía del proceso uncinado y sus variaciones observadas a través de cortes coronales por tomografía computada multidetector (TCMD) en una población con rinosinusitis crónica. Introducción: Según la literatura científica revisada, no se encontraron estudios sobre las variaciones anatómicas del complejo osteomeatal (COM) en la población adulta colombiana. Los reportes coinciden en que las variaciones anatómicas de este complejo son parte de las causas de la sinusitis crónica refractaria a tratamiento médico, por lo que el presente trabajo se propone estudiar la anatomía de este complejo e identificar sus posibles variaciones anatómicas en pacientes adultos colombianos diagnosticados con sinusitis crónica. Materiales y métodos: Se realizó un estudio descriptivo de corte transversal, observacional y retrospectivo. Para las variables continuas se estimaron medidas de tendencia central y de dispersión, con un intervalo de confianza del 95%, mientras que para las variables categóricas se determinaron las frecuencias y los porcentajes con que se presentaron en la muestra. Resultados: Se contó con 143 casos. De este total, el 53,8% fueron hombres y el 46,2% mujeres. Tanto en el lado derecho como en el izquierdo, el proceso uncinado del hueso etmoides se insertó en la lámina papirácea (el 49,7% y el 53,1% de los hombres y mujeres, respectivamente). La inserción del proceso uncinado en la lámina cribosa del hueso etmoides en el lado derecho fue el segundo en frecuencia (25,2%) y en el lado izquierdo este lugar lo ocupó la inserción en la concha nasal media (23,8%). También se encontró que, en la mayoría de los casos, el proceso uncinado tuvo una orientación lateral (el 51% en el lado derecho y el 56,6% en el lado izquierdo). Conclusión: El proceso uncinado es una estructura anatómica muy variable que se encuentra a cada lado de la cavidad nasal. Presenta diferentes puntos de inserción y tiene cambios en su angulación y distintas longitudes. Es importante tener en cuenta estas variaciones para el manejo quirúrgico de la rinosinusitis crónica.

Objective: To describe the uncinate process anatomy and its variations observed through coronal, multislice computed tomography (MSCT) in patients with chronic rhinosinusitis. Introduction: As reviewed in the literature, no studies of anatomical variations ostiomeatal complex in Colombian adults were found. The reports agree that the anatomical variations of this complex are part of the causes of chronic sinusitis refractory to medical treatment, which motivated the present work to study the anatomy of this complex and identify possible anatomic variations in adult patients from Colombia, diagnosed with chronic sinusitis. Materials and methods: A descriptive, cross-sectional, observational and retrospective study. Continuous variables were estimated with measures of central tendency and dispersion, with a confidence interval of 95%. Categorical variables were determined with frequencies and percentages. Results: The total sample was 143 cases. In the sample, 53.8% were men and 46.2% were women. Both of the right and left, the uncinate process of the ethmoid was inserted into the lamina papyracea in 49.7% and 53.1% of cases, respectively. The insertion of the uncinate process in the cribriform plate of the ethmoid (T6) had a frequency to the right side of 25.2%, but for the left side was the insertion into the middle nasal concha (T1) (23.8%). In most cases, the uncinate process had a lateral orientation and 51% on the right side and 56.6% on the left side. Conclusion: The uncinate process is a highly variable anatomical structure at each side of the nasal cavity, arranged indifferent insertion sites, changes in angle and different lengths which is important from the point of view of surgical management of chronic rinosinusitis.

Total Uncinatectomy Revisited: Revision Surgery for Persistent Radiculopathy Following Anterior Cervical Discectomy and Fusion (ACDF) / 대한정형외과학회잡지

We report on a case involving total en bloc uncinatectomy of C7 without removal of the previously inserted cage, performed on a patient with a history of previous anterior cervical discectomy and fusion without uncoforaminotomy at C5-6-7 who had persistent pain radiating to the upper extremity along with progressive weakness. Satisfactory results were achieved. This procedure should be regarded as an effective option for surgical treatment of persistent or recurrent radiculopathy caused by remaining foraminal stenosis following anterior cervical fusion, and we suggest it as a new indication for this procedure.

The CT morphological difference of luscka joint between Hirayama disease patients and non-Hirayama disease patients / 中国脊柱脊髓杂志

Objectives: To study the morphological difference of luscka joints between Hirayama disease patients and non-Hirayama disease patients on CT scan and to provide a new possible mechanism of Hirayama disease. Methods: 32 patients(all males) with a mean age of 19.4±4.1(range 16-37 years) and with Hirayama disease were treated in our hospital from October 2006 to January 2012, the mean course of disease was 31.7±23.7 months(range, 1-120 months). 32 patients(all males) with a mean of age was 19.1±4.3 (range, 12-26 years) suffering from acute neck pain and having no Hirayama disease were reviewed as control. Both groups showed no age related difference. From the cervical CT coronal plane reconstruction images which passing through the transverse foramen center of C3-C7 in GE-PACS system, the following data were measured in both sides: ①The width of the uncinate process base: the distance between inner and outer margin of the uncinate process at the upper edge of the vertebral body. ②The height of the uncinate process:the vertical distance from the top of the uncinate process to the upper edge of the vertebral body. ③The distance between two uncinate processes: the distance between the tips of the bilateral uncinate processes. ④The inclination angle of the uncinate process: the angle between the uncinate process and the upper edge of the vertebral body. ⑤The inclination angle of the inferior endplate: the angle between the uncinate process:the vertical distance from the top of the uncinate process to the upper edge of the vertebral body. Results:There were no significant side-related differences on the width of the uncinate process base, the height of the uncinate process, the distance of the uncinate process, the inclination angle of the uncinate process and the inclination angle of the inferior endplate at the same segment from C3 to C7 in Hirayama disease patients(P>0.05). However, differences were found on the height of the uncinate process and the distance between two uncinate processes of C3-C7 (PC5>C7>C3>C4. The distance of the uncinate process gradually increased from C3 to C7. There were no significant differences on the width of the uncinate process base, the inclination angle of the uncinate pro-cess and the inclination angle of inferior endplate(except for C3) of C3-C7(P>0.05). Then, using the mean value of the left and right sides as the width of the base of uncinate process, the height of uncinate process, and calculating the sum of inclination angle of the uncinate process, the sum of inclination angle of inferior endplate of the upper vertebra and the difference between the sums (the sum of inclination angle of uncinate process - the sum of inclination angle of inferior endplate of the upper vertebra), then calculating the mean value and standard deviation. Compared with the non-Hirayama disease patients, there were no significant dif-ferences on the uncinate process base, the distance of the uncinate process and the sum of inclination angle of the uncinate process at the same segment of Hirayama disease patients (P>0.05), while the height of the uncinate process and the sum of inclination angle of uncinate process of Hirayama disease patients were sig-nificantly smaller than those of the control group, respectively(P<0.05), and the differences between the sums were larger than those of the control group (P<0.05). Conclusions: Hirayama disease patients may possess a dysplasia in the luscka joint, manifesting the nonuniform development of the uncinate indicators. Lower unci-nate process and smaller inclination angle of inferior endplate of the upper vertebra are common, The conse-quential cervical instability may play a significantly important role in the pathogenesis and progress of Hi-rayama disease.

Clinical significance and change with age of cervical vertebral uncinate process and transverse process of teenagers / 局解手术学杂志

Objective To explore the uncinate-transverse hole spacing developmental patterns and aging characteristics by means of studying the teenagers aging from 6~20 years old,and provide the basis for image analysis of the treatment and prevention of cervical spondy-losis. Method the 66 adolescents without trauma nor problems of nervous system were selected to do thin spiral CT scan(0. 625 ~1. 25 mm) ,the range was C1 ~T1 . The original data in the form of DICOM are analyzed according to gender and age. Results There was no sig-nificant difference in gender and different sides. Overall,the physical development of human increases gradually with age and has some signifi-cant differences. Conclusion There exists a close relationship between cervical hook-transverse process and the incidence of vertebral artery type and nerve root type cervical spondylosis.

Anatomical Morphometric Study of the Cervical Uncinate Process and Surrounding Structures

OBJECTIVE: The purpose of this study is to elucidate the anatomic relationships between the uncinate process and surrounding neurovascular structures to prevent possible complications in anterior cervical surgery. METHODS: Twenty-eight formalin-fixed cervical spines were removed from adult cadavers and were studied. The authors investigated the morphometric relationships between the uncinate process, vertebral artery and adjacent nerve roots. RESULTS: The height of the uncinate process was 5.6-7.5 mm and the width was 5.8-8.0 mm. The angle between the posterior tip of the uncinate process and vertebral artery was 32.2-42.4degrees. The distance from the upper tip of the uncinate process to the vertebral body immediately above was 2.1-3.3 mm, and this distance was narrowest at the fifth cervical vertebrae. The distance from the posterior tip of the uncinate process to the nerve root was 1.3-2.0 mm. The distance from the uncinate process to the vertebral artery was measured at three different points of the uncinate process : upper-posterior tip, lateral wall and the most antero-medial point of the uncinate process, and the distances were 3.6-6.1 mm, 1.7-2.8 mm, and 4.2-5.7 mm, respectively. The distance from the uncinate process tip to the vertebral artery and the angle between the uncinate process tip and vertebral artery were significantly different between the right and left side. CONCLUSION: These data provide guidelines for anterior cervical surgery, and will aid in reducing neurovascular injury during anterior cervical surgery, especially in anterior microforaminotomy.