Epidemiology of trigeminal neuralgia: an electronic population health data study in Korea

Background@#Trigeminal neuralgia (TN) is one of the most painful disorder in the orofacial region, and many patients have suffered from this disease. For the effective management of TN, fundamental epidemiologic data related to the target population group are essential. Thus, this study was performed to clarify the epidemiological characteristics of TN in the Korean population. This is the first national study to investigate the prevalence of TN in Korean patients. @*Methods@#From 2014 to 2018, population-based medical data for 51,276,314 subscribers to the National Health Insurance Service of Korea were used for this study. @*Results@#The incidence of TN was 100.21 per 100,000 person-years in the year of 2018 in Korea, and the male to female ratio was 1:2.14. The age group of 51-59 years had the highest prevalence of TN. Constant increases in medical cost, regional imbalance, and differences in prescription patterns by the medical specialties were showed in the management of TN. @*Conclusions@#The results in this study will not only help to study the characteristics of TN, but also serve as an important basis for the effective management of TN in Korea.

Epidemiology of trigeminal neuralgia: an electronic population health data study in Korea

Background@#Trigeminal neuralgia (TN) is one of the most painful disorder in the orofacial region, and many patients have suffered from this disease. For the effective management of TN, fundamental epidemiologic data related to the target population group are essential. Thus, this study was performed to clarify the epidemiological characteristics of TN in the Korean population. This is the first national study to investigate the prevalence of TN in Korean patients. @*Methods@#From 2014 to 2018, population-based medical data for 51,276,314 subscribers to the National Health Insurance Service of Korea were used for this study. @*Results@#The incidence of TN was 100.21 per 100,000 person-years in the year of 2018 in Korea, and the male to female ratio was 1:2.14. The age group of 51-59 years had the highest prevalence of TN. Constant increases in medical cost, regional imbalance, and differences in prescription patterns by the medical specialties were showed in the management of TN. @*Conclusions@#The results in this study will not only help to study the characteristics of TN, but also serve as an important basis for the effective management of TN in Korea.

New insights into pathways of the accessory nerve and transverse cervical artery for distal selective accessory nerve blockade

Background@#The aim of this study was to clarify the topographical relationship between the accessory nerve (AN) and transverse cervical artery (TCA) to provide safe and convenient injection points for AN blockade. @*Methods@#This study included 21 and 30 shoulders of 14 embalmed Korean adult cadavers and 15 patients, respectively, for dissection and ultrasound (US) examination. @*Results@#The courses of the TCA and AN in the scapular region were classified into four types based on their positional relationships. Type A indicated the nerve that was medial to the artery and ran parallel without changing its location (38%). In type B (38%), the nerve was lateral to the artery and ran parallel without changing its location. In type C (19%), the nerve or artery traversed each other only once during the whole course. In type D (5%), the nerve or artery traversed each other more than twice forming a twist. At the levels of lines I-IV, the nerve was relatively close to the artery (approximately 10 mm). TCAs were observed in all specimens around the superior angle of the scapula at the level of line II, whereas they were not found below line VI. In US images of the patients, the TCA was commonly observed at the level of line II (93.3%) where all ANs and TCAs were observed in cadaveric dissection. @*Conclusions@#The results expand the current knowledge of the relation between the AN and TCA, and provide helpful information for selective diagnostic nerve blocks in the scapular region.

Facet joint injections for management of low back pain: a clinically focused review

Lumbar facet joints have been implicated in chronic low back pain in up to 45% of patients with low back pain (LBP). Facet joint pain diagnosis and management are always challenging for pain physicians. Facet joint pain is not diagnosed by specific demographic features, pain characteristics, or physical findings, even though electrodiagnostic studies and imaging modalities are available. Although comparative local anesthetics or placebo saline injections can be used, diagnostic blocks are the only reliable diagnostic measures according to the current literature. Treatment of chronic LBP arising due to facet joint includes intraarticular injections, medial branch blocks, and radiofrequency neurotomy. However, the evidence of their clinical efficacy is continuously under scrutiny. Pain physicians must have a detailed understanding of the spinal anatomy in order to perform safe and effective interventional procedures. This review outlines the important aspects of spinal anatomy as they relate to interventional pain management related to facet joint injections. Additionally, we provide a comprehensive review of the procedure and clinical evidence.

New insights into pathways of the dorsal scapular nerve and artery for selective dorsal scapular nerve blockade / 대한통증학회지

BACKGROUND: The aim of this study was to clarify the topographical relationships between the dorsal scapular nerve (DSN) and the dorsal scapular artery (DSA) in the interscapular region to identify safe and convenient injection points related to DSN blockade. METHODS: Thirty shoulders of embalmed Korean cadavers and 50 live subjects were used for dissection and ultrasound (US) analysis. RESULTS: The running patterns of the DSA and DSN in the interscapular region were classified into 3 types. Type I was defined as nerves that were medial to the artery and parallel without changing location (80.0% of specimens). In type II (13.3%), the nerve and artery traversed one another only one time over their entire length. In type III (6.7%), the nerve and artery traversed one another, resembling a twist. Above the level of the scapular spine, the nerve was always medial to the artery. Below the scapular spine, the number of arteries was obviously decreased. Most of the arteries were lateral to the medial border of the scapula, except at the level of the superior angle of the scapula artery (SA). The positional tendency of the DSN toward the medial or lateral sides from the medial border of the scapula was similar. In US imaging of live subjects, the DSA was most observed at the level of the SA (94.0%). CONCLUSIONS: Results of this study enhance the current knowledge regarding the pathway of the DSN and DSA and provide helpful information for selective diagnostic nerve blocks in the interscapular region.

The inferior epigastric artery arising from the internal iliac artery via a common trunk with the obturator artery / 대한해부학회지

We report a rare case of a left inferior epigastric artery arising from the internal iliac artery via a common trunk with the obturator artery in an 84-year-old female cadaver. A common trunk for the inferior epigastric and obturator arteries firstly originated from the left internal iliac artery, at 3.0 mm below the bifurcation of the left common iliac artery. This trunk ran straight between the left external iliac artery and left external iliac vein, and was finally divided into the left inferior epigastric and left obturator arteries just superior to the inguinal ligament.

Anatomic Variations of Ligaments and Muscles Related with the Ulnar Nerve Entrapment Syndrome in the Upper Arm / 대한해부학회지

Compressive neuropathy of the ulnar nerve occurs commonly at the cubital tunnel, but it can also be occurred by the anatomic variations of the structures on the ulnar nerve passage. This study was thus performed to clarify the variations of the ligaments and muscles, which can cause the ulnar nerve entrapment syndrome in the upper arm. One hundred arms of 50 Korean adult cadavers were used. The arcade of Struthers, a musculo-tendinous band from the medial head of the triceps brachii to the medial intermuscular septum, was observed in 34% of the cases. This arcade was mostly in a narrow-band shape, but a broad-band shaped arcade was sometimes observed. The internal brachial ligament was observed in 17% of cases. The epitrochleoanconeus muscle between the medial epicondyle and the olecranon was observed in 3% of cases. The ulnar nerve was wrapped or covered by the medial head of triceps brachii in 5% of cases. This study is expected to further the current understanding of the anatomic variations of ligaments and muscles on the ulnar nerve passage, and to be helpful data for the diagnosis and treatment of the ulnar nerve entrapment syndrome in the upper arm.

Morphologic Variations of the Umbilical Ring, Umbilical Ligaments and Ligamentum Teres Hepatis

PURPOSE: The varied morphology of the umbilical ring and its surrounding structures, such as the ligamentum teres hepatis, and the median and medial umbilical ligaments, has not been thoroughly investigated. Hence, this study was undertaken to clarify the morphologic variations of these structures. MATERIALS AND METHODS: The anterior abdominal walls were removed en bloc from 57 adult cadavers and dissected under a surgical microscope. RESULTS: One case of umbilical hernia was observed, and the remaining 56 umbilical rings were classified into 3 types: oval or round in 33 cases (Type A, 59.0%), obliterated or slitted in 12 cases (Type B, 21.4%), and completely covered by a connecting band between the ligamentum teres hepatis and umbilical ligaments in 11 cases (Type C, 19.6%). The median and medial umbilical ligaments were classified into four types based on their interrelationships. The most common type was the median umbilical ligament terminated by joining one or both medial umbilical ligaments (Type II, 41.1%). The ligamentum teres hepatis frequently ended by dividing into several branches in the area cranial to the umbilical ring, some of which crossed the umbilical ring. The umbilical fascia covered the umbilical ring in 50.0% of cases, and the rest either not covering the ring or not existing. CONCLUSION: These results are expected to improve our understanding of the anatomy of the umbilical area, and further improve treatments of the umbilical hernia.

Topographic Anatomy of the Median Nerve and the Pronator Teres and the Flexor Digitorum Superficialis Muscles / 대한해부학회지

The pronator teres syndrome can occur when the median nerve is compressed by the adjacent structures in the proximal forearm. The pronator teres and the flexor digitorum superficialis muscles have been suggested to contribute to this syndrome. This study was performed to clarify the topographical relationship among the median nerve, the pronator teres muscle and the flexor digitorum superficialis muscle in 55 Korean adult cadavers (100 sides of arms). The two heads of the pronator teres muscle met at the point of 61.3 mm distal to the biepicondylar line and inserted to the radius at the point of 141.5 mm distal to the line. The ulnar side of its ulnar head was muscular in 8%, tendinous in 70%, and mixed in 20%. The radial side of its humeral head was muscular in 53%, tendinous in 14%, and mixed in 33%. The median nerve was completely covered by the pronator muscle within 26.5 mm from the biepicondylar line and entered between the two heads of the pronator muscle at 54.2 mm from the line and exited it after running 25.5 mm. The most distal part of the musculotendinous arch of the flexor digitorum superficialis muscle was located at the average 80.9 mm from the biepicondylar line. The distalmost radial head of the flexor digitorum superficialis muscle originated from the distal point of the pronator teres insertion in 28.6%, distal to that point in 54.3%, and proximal to that point in 14.3%.

Topographic Anatomy on the Supinator Muscle and the Deep Radial Nerve in Relation with its Entrapment Syndrome / 대한해부학회지

The deep radial nerve could be compressed by the medial border of the extensor carpi radialis brevis muscle, superior or inferior border of the superficial layer of the supinator muscle and pathologic structures between two layers of the supinator muscle. The aim of this study was to clarify the topographic relationships between the deep radial nerve and the supinator muscle in the place where the entrapment syndrome of the nerve could be occurred. Sixty-six Korean adult cadavers (124 arms) were used. The angles of the deep radial nerve with the radius were measured on the anteroposterior and lateral radiographs. The average distance between a line through the tips of both epicondyles of the humerus, and the division sites of the radial nerve into superficial and deep branches, was 16.8+/-12.8 mm in the cases where the division sites were proximal to the line, and 7.8+/-5.0 mm in the cases where the division sites were distal to the line. The arcade of Frohse was 32.2+/-6.6 mm apart from the line connecting both tips of humeral epicondyles. The average length of the deep radial nerve covered by the superficial layer of the supinator muscle was 35.1+/-8.0 mm. The arcade of Frohse was classified into two types; semi-circular type in 68.6% and dull curved line type in 31.4%. The lateral border of the arcade of Frohse was composed of muscle, tendon, and both muscle and tendon in 12.1%, 26.6%, and 61.3%, respectively. The muscle fibers of two layers of the supinator muscle were fused with each other, at the area where the deep radial nerve came out between two layers of the muscle. The average angles of the deep radial nerve with the radius, were 23.4+/-4.6 degrees and 13.7+/-5.3 degrees, on the anteroposterior and lateral radiographs, respectively. The inferior border of the superficial layer of the supinator muscle was composed of tendon, muscle, and both muscle and tendon in 61.5%, 12.5%, and 17.3%, respectively. We discussed about the morphologic variations which could cause the entrapment syndrome of the deep radial nerve in the proximal and distal portions of the supinator muscle, and between the superficial and deep layers of the muscle.

Morphologic Variations of the Thyroid Gland in Korean Adults / 체질인류학회지

The shape of the thyroid gland was similarly described in many anatomical text books, but we observed that the shape of the thyroid gland was very diverse in the dissecting room. This study was performed to clarify the morphologic characteristics of the thyroid gland in Koreans. One hundred sixty eight Korean adult cadavers were used for this study. It was 57.1% that the size and the location of both lobes were symmetric. The frequency of the existence of the Pyramidal lobe was 76.8%. The pyramidal lobe located in the left, right, and middle of the isthmus were 48.8%, 26.4%, and 21.7% respectively. And the pyramidal lobes located in the both sides of the isthmus were 3.1% of the cases. The thyroid gland was classified into six types. Type I in which the thyroid gland had the classical H shape and the relatively wide isthmus was observed in 31.5%. Type II in which the thyroid isthmus could be distinguished but the distance between two lobes was very short was found in 28.0%. In type III, the inferior margins of the isthmus and the lateral lobes made a straight line (29.2%). In type IV, two lateral lobes of the thyroid gland were directly fused and the isthmus was not distinguished (5.4%). In type V, the thyroid gland had no isthmus and the lateral lobes were separated (3.0%). Type VI was not belonged to five types because of its irregular shape (3.0%). The incidence of the classical thyroid gland described in the text books was 12.5% in Korean adults.