Variant insertion of the teres major muscle / 대한해부학회지

The teres major (TerMa) muscle has a clinical significance for tendon transfer procedures in patients with massive rotator cuff tears. Individually, it originates from the dorsum of the inferior angle of scapula and inserts into the medial lip of bicepital groove of the humerus. Functionally, TerMa in cooperation with latissimus dorsi (LD) adducts arm, medially rotates arm, and assists in arm extension. The variation of TerMa insertion is very rare. In the shoulder and axillary regions of a 33-year-old Thai male cadaver, the variant insertion of the right TerMa was found. The muscle fibers of TerMa are directly attached at the supero-medial border of LD tendon. Notably, there was no terminal tendon of TerMa. To explain an unusual movement of the arm, this rare variation of the TerMa insertion is necessary to be recognized. This case report is very important for surgeons to preoperatively consider using the terminal tendon of TerMa for tendon transfer in treating patients with irreparable cuff tears.

Position Variation of Vermiform Appendix in Northeast Thai Cadavers

Background and objective: The acute appendicitis is a common and serious cause of acute abdominal pain. Oftentimes, the surgeons could not find the vermiform appendix in its usual position. A detailed study of variation positions of the vermiform appendix is necessary for an appropriate treatment.  The data could also contribute to the collection of the world such as the World Health Organization from a population of the Northeast Thailand. This study aims to study and accumulate the gross anatomical data on position variation of the vermiform appendix in the Northeast Thailand cadavers.  The incidence and morphometry of the structure were established.Design: A detailed dissection is the descriptive study.Materials and Methods: A total number of 102 cadavers donated by the Northeast Thailand population were carefully dissected. The identification of the urinform appendix site was done by following the three teniae coli caudally to its base where the three muscular lands meet to form a complete longitudinal, smooth muscular tube. The length was measured using the venire caliper and the percentage was calculated.Results: Among 102 specimens, the most common type of vermiform appendix is the post-ileal at 37.25% while the least common (called the pre-ileal and paracecal types) is at 3%.  The approrimate length of 6 cm is the most frequent group. The average length + SD of both genders is 6.127 + 2.028 cm.Conclusion: This study  discovered that the most common type of position variation of vermiform appendix is the post-ileal type at 37.25%. The average length in male and female cadavers are 6.329 + 2.012 cm. and 5.688 + 2.023 cm., respectively.Keywords: cecum, gut rotation, rotation axis, vermiform appendix, position variation, morphometry,  mesoappendix, teniae coli, situs inversus

A revisit to the cubital fossa : Brachiopronatus muscle

 Surgery of the elbow joints is not uncommon to which several approaches could be made, lateral approach, posterior approach, postero-lateral approach, and medial approach (Anson and McVay, 1971).  The detail anatomy of the region is as ever important as the awareness of any of deformity or variation therein.  Our experience in Khon Kaen University Medical School dissecting room for 18 years with 288 cadavers supplied us one case of variation in the antecubital fossa.  The presence of this superfluous muscle is assessed to interfere with the medial approach of the elbow joint surgery.  It was the separate muscle covered with its own fascia and originated from the medial intermuscular septum of the brachium; ran vertically and superficial to the brachial artery and median nerve but deep to the bicipital aponeurosis; and finally joined the pronator teres tendon of insertion.  The muscle received branches from the median nerve.  We proposed the name “Brachio-pronatus” for this muscle.  The name, “Brachial head” of the pronator teres muscle was also suggested by the Society of Anatomy of Thailand member in the 15th Annual Meeting on 22-24 April 1992.  Its gross anatomy will be described and we proposed four possibities of its developmental anomaly.  Its kinesiological advantage is also discussed.

Six lumbar vertebrae in Thai : A case report

Background: The vertebral column in general is made up of 33 vertebrae of different shape and size, although all of which share typical features. There are 7 cervical,        12 thoracic, 5 lumbar, 5 sacral  vertebrae that fuse into one at the age of about 20 years, and 4 coccygeal vertebrae that become one piece at middle age. The study of human skeletons in the Gross Anatomy Laboratory, Faculty of Medicine, Khon Kaen University from 1975 to 2004 totalled 480 skeletons which we found a case with 6 lumbar vertebrae. The first and the sixth presented anatomical variations from the typical and normal lumbar vertebrae. We are interested in reporting the case that has never been reported in Thai.Objectives:   1.To study anatomy of the six lumbar vertebrae in Thai skeletons.                    2.To study the articulation between the sixth lumbar vertebra and sacrum.Results:  The skeleton of a 57 year old male presents anatomical variations of  lumbar vertebrae. He has six, in contrast to normal five lumbar vertebrae whereas the other levels are normally, 7 cervical, 12 thoracic, 1 sacral and 1 coccygeal vertebrae. The first lumbar vertebra is obviously differently from others in that its transverse processes are short and articulated with the malformed ribs. The pair of this malformed ribs is the 13th, an extra pair additional to the normal 12 pairs. The right one is 4 centimeters long while the left is 3.5 centimeters. Additional malformed of pair of ribs in this case made 3 pairs of floating ribs. Anatomy of the second to fifth lumbar vertebrae are similar to the typical lumbar vertebrae. The sixth lumbar vertebra situated below the fifth and articulated to the first sacral vertebra. Although in general the body of the sixth lumbar vertebra configuration is similar to the other lumbar vertebrae but its spinous process projected posterior, is short with a shape of plump ridge. The left transverse process is slender and longer than the right transverse process. The upper border of the body that is articulated to the intervertebral disc below the fifth lumbar vertebra is rough and extended around its rim. The lower border that articulated to the sacrum has a smoother surface than the upper. The inferior surface of the both transverse processes are the extended tubercles that projected downward anteriorly and articulate to the upper surface of ala of sacrum completely. The inferior articular process on inferior surface of both transverse processes were seen but the processes looked very small and short with tubercles that articulated to the small and short superior articular processes of the sacrum.Conclusion:  The sixth lumbar vertebra is the anomaly of the skeletal system that found in our study. This abnormality can be ascribed to the over-splitting of the embryonic somite and the subsequently complicated development process starting from the cellular level up to the naked eye observation. This is the first report on sixth lumbar vertebra in 480 skeletons. The incidence of this anomaly in Thai should be further researched.

The Prevalence of Kinking of the External iliac Artery

Background and Objective: The aim of this study is to find the prevalence of kinking of the external iliac artery (EIA) in cadavers and related symptoms of lower limbs and illness before death.Methods: The 128 halves of pelvis  from 64 cadavers (  age = 72.5 years) were dissected and identified the kinking of the EIA. A retrospective study of symptom of lower limbs and illness before death were inspected by interviewing their relatives of 6 cases.  The inguinal ligament and femoral ring edge were also observed for possible causes of abnormality of the artery.Results:  Kinking of the external iliac artery was found  in 10 cases (  age = 77.1 years, men = 9, woman = 1). The kinking was classified  into 2 types : type I (3 right and 1 left sides)  and type II (5 bilateral and 2 right sides)   respectively.  A retrospective history revealed that the symptoms of lower limb and illness before death were related to the kinking of the external iliac artery.Conclusion: Aging persons who showed symptoms of fatigue, edema, pain, weakness or claudication in lower limbs could be  caused by  kinking or coiling of blood vessels in the pelvis.  The high degree of kinking or coiling may lead to ischemia of lower limbs or vascular complication during surgery. Therefore meticulous investigation should be performed to rule out external iliac artery kinking along with any treatment of pelvis and hip regions.Keywords: Kinking, Prevalence, External iliac artery

Accessory abductor digiti minimi muscle

Background: Accessory belly of the hypothenar muscles in hand have been involved in vascular and nerve compression.  The most common variable muscle is abductor digiti minimi (AbDM).  The purpose of this study is to investigate the anomaly of  AbDM that is called AAbDM.Objective: To study quantity and describe the AAbDM in Thai people.Study design: A descriptive studySetting: The study was carried out at the Department of Anatomy, Faculty of Medicine, Khon Kaen University, Thailand.Subject: The study included six hundred hands from 300 formalin-embalmed cadavers,  25-82 years of age.Methods:   1. Study the number of hands which was found AAbDM.      2. Describe the origin, insertion and nerve supply of each muscle.Results: Only one hand from 600 hands was seen AAbDM.  It was found in the right hand of Thai male cadaver aged 55 years.  The origin of this muscle arises from pisiform bone, splitting from AbDM  then forms aponeurosis and inserts into the base of the proximal phalanx of the fifth finger.  The  innervation is by the deep branch of ulnar nerve.Conclusion: Only one right hand from 600 hands was found AAbDM.  The origin, insertion and nerve supply of this muscle were  described.Key Words: Abductor digiti minimi muscle, Accessory abductor digiti minimi muscle,                       Variation, Anomaly.

Five Heads of the Biceps Brachii Muscle in Thai : A Case Report

Background : Anatomical variations are possible to in all aspects of human body and should be recognized. Variations of form and origin of the biceps brachii muscle have been reported.  The origin of the biceps brachii muscle are classicall described as being a long head from the supraglenoid tubercle and a short head from the coracoid process of the scapula.  These two heads unite and insert into the radial tuberosity and the bicipital aponeurosis.  Occasionally, the presence of a third head of the biceps brachii muscle have been well documented in the avilable literatures.  There have been no previous report of five heads in the literature.Objective : To study the anatomy of the biceps brachii muscle with five heads.Results  : Five distinct origins of the biceps brachii muscle were dissected carefully in the right arm of a 67 year old female cadaver.  The long head arises from supraglenoid tubercle of the scapula, the short head and the third hdad arise from coracoid process of the scapula.  The origin of the fourth head and the fifth heath are the humeral shaft between the insertion of the coracobrachialis and the origin of the brachialis muscles.  Distally all bellies of this muscle unite and insert through a biceps tendon into radial tuberosity together with bicipital aponeurosis, except the fourth head which inserts into the fifth head.  All five heads of this muscle receive their innervation from the musculocutaneous nerve and the arterial supply from the brachial artery.Conclusions : This report has emphasized that the biceps brachii muscle with five heads was found in Thai female cadaver in Gross Anatomy Laboratory, Faculty of Medicine, Khon Kaen University.  This variation may occur during embryological development.  The five heads of the biceps brachii muscle may enhance the strength of elbow flexion and forearm supination and stability of elbow joint.

The Prevalence of Infraorbital Canal Dehiscence in Thai Cadaveric Skull : A Preliminary Report

Background : The infraorbital nerve is one of the branches of the maxillary division of the trigeminal nerve.  It lies in the infraorbital canal forming the roof of maxillary sinus.  The infraorbital canal dehiscence may have a cance to disturb the infraorbital nerve more than the non-dehiscence and could be a cause of the facial pain.  Many investigators have been reported the prevalence of the infraorbital canal dehiscence in many countries but not in Thailand.  The purpose of this investigation is to study the prevalence of infraorbital canal dehiscence and decribe the morphology of the infraorbital canal in Thai cadavers.Objective : To study the prevalence of the infraorbital canal dehiscance in Thai cadaveric skull and described the morphology of the i infraorbital canal in Thai cadavers.Design : A descriptive study.Setting : The study was carried out at the Department of Anatomy and the Department of Otolaryngology, Faculty of Medicine, Khon Kaen University, Kkhon Kaen, Thailand.Subjects : The study included 80 specimens of half head and face from formalin-embalmed cadavers, 36-84 years of age (average 62 years(.  They could be indentified for genders by only 62 specimens; male 9 specimens and female 13 specimens.Setting :  1. To study the infraorbital canal dehiscence that convering the infraorbital nerve as the following aspects :1.1 The number of the sample that found dehiscence, comparing male to female as well as right to left sides1.2 The site of the wall of the infraorbital canal which occurred dehiscence.1.3 To measure the width and the length of dehiscence of the infraorbital canal.2. To observe the type of infraorbital canal which occupied infraorbital nerve and measure the depth of the canal on the roof of the maxillary sinus.3. To study the dehiscence of the bone that covers the superior alveolar nerve which gives the branch to supply the upper teeth as the following as pects :3.1 The number of the sample with dehiscence.3.2 The site of the wall of the canal that found dehiscence.3.3 To measure the width and the length of dehiscence.4. To measure the length between infraorbital foramen and infraorbital rim.5. To study the number of the sample that dehiscence bone occxured around both infraorbital and superior alveolar nerves.Results: 1. Infraorbital canal dehiscence1.1 The infraorbital canal dehiscence was found in 15 specimens from 79 specimens of samples (1 specimen was broken before study). The sex difference and dehiscence was 7 specimens out of 61 in male and 4 out of 61 specimens in female from 61 specimens that can identify the sex.  In aspect of the side, we found that dehiscence in the right side was 7 specimens and the left side was 8 specimens.1.2  The number of the side of the wall of infraorbital canal dehiscence at  the inferior, lateral, medial, infraorbital and infraorbital wall were 5,4,3,2 and 1 out of 15 specimens respectively.1.3 The width of dehiscence of infraorbital canal was 0.5-3.5 mm., means 1.45 mm.  The ratio on the width of infraorbital canal and the diameter of infraorbital nerve was 10-100%, means 48%.  The length of the infraorbital canal dehiscence was 2.0-11.0 mm., means 5.09 mm.2. The number of three types of infraorbital canal dehiscence were 1, 5 and 9 specimens of  the first, secon and third type respectively, whereas the non-dehiscence were 12, 26 and 26 sfpecimens respectively.  Moreover the depth of the canal on the roof of maxillary sinus was 0 mm., 2.0-8.0 mm. (mean 4.6), and 3.5-12 mm. (mean 6.9) of the first, second and third type respectively.3. Superior alveolar nerve dehiscence3.1 The superior alveolar nerve dehiscence was found 36 specimens out of 79 specimens.3.2 The number of the site of the wall of superior alveolar nerve dehiscence at the lateral, inferior, medial anterior, infraorbital and inferomedial wall were 13, 9, 4, 3, 1 and 1 specimes respectively.3.3 The width of dehiscence of superior alveolar nerve was 0.5-2.5 mm., mean 1.29 mm. The ratio on the width of the bone cover the superior alveolar nerve and the diameter of superior alveolar nerve was 40-100 %, means 96%.  The length of the dehiscence was 1.0-14.0 mm., mean 5.97 mm.4. The distance from infraorbital foramen to the infraorbital rim of the orbit was 5.5-11.0 mm., mean 8.27 mm. Indehiscence group of the infraorbital canal and 1.0-11.0 mm., mean 7.49 mm. In non-dehiscence group.5. Only one specimen of maxillary sinus that was found with dehiscence covering both infraorbital and superior alveolar nerve.Conclusions : The results of this observation is the basic knowledge of the prevalence of the infraorbital canal dehiscence in Thai cadavers.  The infraorbital canal dehiscence was found 15 out of 79 of cases.  The dehiscence was found in femal more than male but there was no significance difference between right and left sides.  Among the types of infraorbital canal, the most prevalence was type 3 (total prominence type)j.  The knowledge from this observation is useful in medical sciences such as help to explain in diagnosis of the cause of facial pain.  One must be careful in performing antrostomy of the maxillary sinus.Key words : Dehiscence, infraorbital canal, infraorbital foramen, infraorbital nerve

Retroesophageal right subclavian artery in Thai: A case report

Background :  The variable structures and pattern of the organs in the body are normally found during dissection of formalin-embalmed cadavers in the practical class of Gross Anatomy. The variation of the right subclavian artery is one of the variable structures. Normally, this artery is a branch from brachiocephalic trunk, which is the first branch of the arch of aorta. The observation on   mediastinum dissection of the male cadaver, 89 years of age in the Gross Anatomy  Laboratory, Department of Anatomy, Faculty of Medicine, Khon Kaen University,  it has been found that the right subclavian artery is a branch arising from posterior aspect of the distal part of the arch of  aorta, it runs behind esophagus and directly to the right upper extremity, called retroesophageal right subclavian artery (RRSA). This finding is the first case in our laboratory since the year 1997 to 2004  totalled 480 cadavers. The variable of the RRSA is highly investigated in case of abnormal development of the arch of aorta thus, the surgeon and  related physician should be always aware. Objectives1. Describe the anatomical characteristics of  the RRSA in these aspects: the position of the origin, the diameter, the length and the course of this artery.2.    Describes the surrounded structures related to this              artery.               Result :  The observation while carefully dissecting the mediastinum of the male cadaver, 89 years old of age.   It had been found that the brachiocephalic trunk is absent. The first branch of the arch of aorta is the right common carotid artery, the second is the left common carotid artery, the third is the left subclavian artery and the fourth branch is the RRSA.  The RRSA arises from the posterior of the distal part of the arch of aorta, next to the left subclavian artery. The course of this artery is behind the esophagus traversing the mediastinum to supply the right upper extremity. However, there is no variable of the branches from RRSA.  Measurement with the digital vernier caliper was done and revealed the length of the RRSA is 8.86 centimeters, the diameter at the proximal and distal part of RRSA are 0.99 and 0.83 centimeters respectively. Furthermore, from this study, the right recurrent laryngeal nerve does not hook around the RRSA as normal.Conclusion :        The RRSA is a defective development of the right fourth aortic arch and/or part of the right dorsal aorta, a segment between the right fourth aortic arch and the right seventh intersegmental artery which may be degenerated during embryological development. This is the first report on  the RRSA in Thai. The incidence of this anomaly in Thai should be further researched and accumulated. 

Opinions about student centre learning activities for Heath Science instructor and student in Khon Kaen University

Background : The student centered learning method was used in learning activity in graduate academy of Thailand, and settled in many institute includes Khon Kaen University. Although the national educational law was established in the year 1999 and used for along 6 years, but it can’t evaluate the effectiveness of this method. So we are study to dissolves that knowledge and principle of the students and the instructors in student centered learning method  are relevant to objectives and to applies learning experience for the optimal goal of care of population’s health.Objectives : To study practically on role of SCL of undergraduate, graduate students and instructors of each faculty in health science discipline. To study thought and suggestion in SCL of the students and the instructors of each faculty in health science discipline.Study design : The study was designed as descriptive research. In this research, standard criteria of evaluation was setting. Example population: The 326 example population come from the student of faculty of Nursing, Medicine, Associated medical science, Public health, Dentistry, Pharmacology and Veterinary.  All student s was studying in the year 2003 and  classified as   undergraduate for 116 peoples, graduated for 89 people and instructor group for 121 peoples.Result : The study reveals most of instructors of the faculty of Public health and Dentistry are not understand and not certain to know SCL, while the instructors of the rest faculty reply as not certain to know SCL 35.54 % The graduate student react  themselves to know SCL 71.91%. Practically by role of SCL, in group of undergrad, the students of the faculty of Nursing are the best , but for the graduate student are the students of the faculty of dentistry.     The group of undergraduate’s instructor that most relevant practice on the role of SCL are the instructors of the faculty of Associated medical science and faculty of Public health and graduate’s instructor are also from faculty of Public health.     The result from test of understand SCL reveal that the group of instructor and group of graduate students gain better than the undergraduate students and the most document confuse with SCL are (1) to use level of grade more than reinforcement  (2)  separate contents not integrate (3) evaluate of only output not processesConclusion :  In the group of faculty of health science discipline have many diverse in knowledge and level of understanding in SCL. Although on overview the amount of the instructor, graduate and undergraduate students of group of faculty of health science have a course of training on SCL more than the others but they have a lot of diverse in knowledge and practice. This phenomenon  be a sign of  differentiation standard and unity of learning activity, and reflect to in the quality of the students. The problem must be solve with level of university

Phallo-Orchido-Atrophy from a Huge Recurrent Indirect Inguinal Hernia: A cadaveric Case Report

Background: A huge indirect inguinal hernia with tiny penis and a gigantic scrotum was observed in a cadaveric male of age 77 years. Clinical record from the hospital was retrospectively studied with the permission of his son and the hospital director.Objective: To observe the hernial contents and its effects on the surrounding organs.Methods: Dissection was carefully done in the inguinal regions, scrotal sac and hernial coverings.Results: Bilateral indirect inguinal hernias with the predominantly large left side were observed. The scrotum was enlarged by a huge left hernial sac containing a long loop of sigmoid colon (8 inches long). This hernial sac put a great pressure on both testes, spermatic cords and pushed them inferiorly to the hernial sac until they were stretchedly thin and atrophied. The penis was pushed to the right and retracted to be tiny (1 inch long). The right hernial sac was incomplete indirect inguinal hernia containing the mesentery. His medical record revealed the history of the left hernial repair 8 years before death but did not report the recurrent time or any clinical sign ofphallo-orchido-atrophy.Conclusion: A case of 77 year old male cadaver with a huge recurrent indirect inguinal hernia was studied. The left hernial sac was larger than the right one and extended down to fill up and enlarge the scrotum. The content was a long loop of sigmoid colon (8 inches long). The huge hernial content put a great pressure on both testes, spermatic cords and the penis for a long period of time and consequently causing a phallo-orchido-atrophy.Keywords: recurrent indirect inguinal hernia, phalloorchido-atrophy

A Case of Multiple Aneurysms in Northeast Thailand Embalmed Cadaver

Background: Aneurysms left in the cadaver has been difficult to find in our experiences, during 34 years from the establishment of Khon Kaen University Medical School. We witnessed the first case of multiple aneurysms in 2007 in the male cadaver out of 843 of both gender specimens. We always have diagnosed and treated the patients now and then in our teaching hospital, Srinagarind.Purpose: 1) To record the basic data for clinical management of aneurysm. 2) To stimulate the interests of the medical students to make them pay more attention to gross anatomy as it is the basis for tackling the aneurysm problem early in the medical career.Materials \& Methods: We redissected 843 cadavers after the standard procedure. They were 371 females aged between 21-92 years and 472 males between 38-88 years old at the time of death. The work was accomplished in the KKU Dept. Anat. dissecting room and from 1973-2007.Results: We found 3 aneurysms in one male cadaver aged 65 years, They were, 1) right popliteal aneurysm, 2) right internal iliac aneurysm, and 3) left common iliac aneurysmConclusion: The gross lesion of aneurysm seen in the dissecting room is very exciting for the medical students and the anatomists which lead to the stimulation of the students’ interests. This leads further to the thoughts for the application in the patients. This also enhances the teaching and learning process. The other morbid anatomy in the cadaver will surely serve the same objective. The etiology was discussed.Key words: aneurysm, Northeast Thailand, etiology

Anomalous Origin of the Right Subclavian Artery Associated with Right-sided Thoracic Duct: A Case Report

Background: Variations of the branches of the arch of aorta are mostly resulted from abnormal development of the branchial arches.Objective: To present the abnormal origin of the right subclavian artery associated with abnormal thoracic duct and the right recurrent laryngeal nerve Methods: Dissection of the mediastinum was carefully done to investigate the great vessels of the arch of aorta. The outer diameter and length of the anomalous rightsubclavian artery were measured. The other abnormally related structures were identified.Results: The anomalous right subclavian artery was incidentally found in a female cadaver of 80 year-old. It arose as the fourth branch of the distal part of the arch of aorta and traveled across the midline at T3 retroesophageally to reach the right upper extremity. This anomalous artery was the biggest branch of the great vessels of the arch of aorta. It was associated with the abnormal right-sided thoracic duct and the absence of the right recurrent laryngeal nerve.Conclusions: A case of 80 year-old female cadaver showed the abnormal origin of the right subclavian artery arising as the fourth branch of the distal part of the arch of aorta. It was associated with the abnormal right-sided thoracic duct and the absence of the right recurrent laryngeal nerve.Keywords: Anomalous subclavian artery, arch of aortic, abnormal development, anatomical variation

Cleidohyoid Muscle in Human: A Case Report

Background and Objective: The surgical approaches of the neck region are very frequent. The examples are thyroidectomy, tracheotomy, and removal masses including lymph nodes. Therefore, the surgeons have to be aware of anatomical variations in the neck including the unseen and unreported ones. The present study was to report the cleidohyoid muscle in Thai cadavers as a first case in the Northeast Thailand.Methods: Re-dissection surveys had been performed on the embalmed, legally donated cadavers to Department of Anatomy, Faculty of Medicine, Khon Kaen University from 1974 to 2008.Results: The cleidohyoid muscle was observed in one male out off 939 cadavers. This muscle is present in birds and disappears somewhere along the course of evolution. The muscle helps in the process of feeding. It connects the pectoral girdle, specifically the clavicle, to the tongue skeleton especially the hyoid bone, so that the swallowing of food is possible. The incidence of this variation is very rare. It is 0.01% in this study. The developmental history and the surgical aspect of the muscle were presented. Conclusion: The occurrence of the cleidohyoid muscle in the densely packed region as in the neck requires an extremely careful procedure of the surgeons.Keywords: Gross anatomy variation, cleidohyoid muscle, mechanism of feeding, developmental history, evolution