Humeral Head And Glenoid Dimensions In The Indian Population: A Cadaveric Study

Background: Shoulder prosthesis should accurately mimic the proximal shoulder and glenoid anatomy to recreatethe shoulder biomechanics. There may be a mismatch in the sizes of the Indian native bone and the currentlyavailable western shoulder prosthesis, since the bony morphology of Indians may be different from that of thewestern counterpart.Purpose: To measure the average humeral head diameter and glenoid length and width, so that a proper implantselection may be done based on the knowledge of average Indian bony morphology.Methods: Twenty shoulders in ten fresh cadavers were dissected to expose the humeral head and glenoidarticular surface. The humeral head diameter was measured with the help of a digital vernier caliper in twoplanes: Supero-inferior diameter (D1) and antero-posterior diameter (D2). The glenoid length (l) and width (w)were measured with the help of a vernier caliper.Results: The average humeral head diameter (D1) ± S.D. in the Supero-inferior plane was 45±3.4 mm (range 40-50.6mm) and antero-posterior (D2) plane was 42.7±2.2 mm (range 40-46mm) with a mean difference of 2.2 mm.The average length of the glenoid (l) was 35.4±1.3 mm (range 32-37mm) and width of the glenoid (w) was 25.3±2.1mm (range 21-28mm). The shape of the humeral head was more ellipsoidal at diameters above 45 mm.Conclusion. We can conclude that the humeral head diameters and glenoid length and width in Indian populationare smaller than the western counterparts. The ellipsoidal shape of the humeral heads becomes more marked atdiameters above 45mm.

Feasibility of Ultrasound Guided Atlanto-occipital Joint Injection

OBJECTIVE: To evaluate the feasibility of ultrasound guided atlanto-occipital joint injection. METHOD: Six atlanto-occipital joints of three cadavers were examined. Cadavers were placed in prone position with their head slightly rotated towards the contra-lateral side. The atlanto-occipital joint was initially identified with a longitudinal ultrasound scan at the midline between occipital protuberance and mastoid process. Contrast media 0.5cc was injected into the atlanto-occipital joint using an in-plane needle approach under ultrasound guide. The location of the needle tip and spreading pattern of the contrast was confirmed by fluoroscopic evaluation. RESULTS: After ultrasound guided atlanto-occipital joint injection, spreading of the contrast media into the joint was seen in all the injected joints in the anterior-posterior fluoroscopic view. CONCLUSION: The ultrasound guided atlanto-occipital injection is feasible. The ultrasound guided injection by Doppler examination can provide a safer approach to the atlanto-occipital joint.

A New Facial Composite Flap Model(Panorama Facial Flap) with Sensory and Motor Nerve from Cadaver Study for Facial Transplantation

PURPOSE: The purpose of this study was to investigate the possibility that a dynamic facial composite flap with sensory and motor nerves could be made available from donor facial composite tissue. METHODS: The faces of 3 human cadavers were dissected. The authors studied the donor faces to assess which facial composite model would be most practicable. A "panorama facial flap" was excised from each facial skeleton with circumferential incision of the oral mucosa, lower conjunctiva and endonasal mucosa. In addition, the authors measured the available length of the arterial and venous pedicles, and the sensory nerves. In the recipient, the authors evaluated the time required to anastomose the vessels and nerve coaptations, anchor stitches for donor flaps, and skin stitches for closure. RESULTS: In the panorama facial flap, the available anastomosing vessels were the facial artery and vein. The sensory nerves that required anastomoses were the infraorbital nerve and inferior alveolar nerve. The motor nerve requiring anstomoses was the facial nerve. The vascular pedicle of the panorama facial flap is the facial artery and vein. The longest length was 78mm and 48mm respectively. Sensation of the donor facial composite is supplied by the infraorbital nerve and inferior alveolar nerve. Motion of the facial composite is supplied by the facial nerve. Some branches of the facial nerve can be anastomosed, if necessary. CONCLUSION: The most practical facial composite flap would be a mid and lower face flap, and we proposed a panorama facial flap that is designed to incorporate the mid and lower facial skin with and the unique tissue of the lip. The panorama facial composite flap could be considered as one of the practicable basic models for facial allotransplantation.

Electromagnetic navigation-guided acupuncture of foramen ovale: A cadaver study / 实用口腔医学杂志

Objective: To evaluate the surgView-RFT electromagnetic navigation system in radiofrequency thermocoagulation(RFT). Methods: 6 foramen ovales of 3 cadavers were punctured by 3 beginners. Every one tried 5 times by free-hand and 5 times by SurgView-RFT electromagnetic navigation-guidance. After each puncture, CT scans were used as golden standard to measure the distance between the tip of needle and the anterior margin of the foramen ovale. T test and variance of SAS 6.12 statistical software was used to do the statistic analysis. Results: The punctures by free-hand failed, and the distances between the tip of needle and the anterior margin of the foramen ovale were 8-10.6 mm. The punctures by navigation guidance were successful, and the distances between the tip of needle and the anterior margin of the foramen ovale were 2.68-3.54 mm. The error of navigation system was 0.59 mm which was verified by CT scan. There was significant difference between free-hand puncture and navigation-guided puncture. Conclusion: The surgView-RFT electromagnetic navigation system is characteristic with high performance, high accuracy and minimal invasion, while it is applied in training or clinical using.

The Anatomical Study of Internal Mammary Perforators

PURPOSE: As a recipient vessel, internal mammary vessels have many advantages for microvascular reconstruction of the breast. But the approach is time consuming and results in large morbidities. However, the perforating branches of the internal mammary vessels can be used to minimize such demerits. The purpose of this cadaver study is to clarify the location and diameter of the perforating branches of internal mammary vessels and to prove that they are safe and reliable recipient vessels. METHODS: We studied 11 formalin-fixed cadavers and dissected their anterior chests bilaterally. The chests were exposed using midline presternal incisions. We dissected and found all perforators at subfascial planes under loupe magnification. The number, external diameter, and the distance from the midline were measured. Result: The mean external diameter of the arterial perforators was 1.32mm and the mean external diameter of the venous perforators was 1.48mm. The largest arterial and venous perforators were most frequently found in the second intercostal space. The mean distance from the midline to the perforator was evaluated; the artery averaged 1.95cm and the vein averaged 2.08cm. CONCLUSION: This study will be helpful when using the internal mammary perforating vessels as a recipient vessel during breast reconstruction.

Suggestion of Safer and Easier Technique of Suprascapular Nerve Block based on Cadaver Study

OBJECTIVE: To suggest a safer and easier technique of suprascapular nerve block by assessing anatomical relationship of the suprascapular notch from a view point of surface anatomy. METHOD: Fourteen shoulders of seven cadavers were dissected in prone position. The scapular notch was exposed and the articular branch of suprascapular nerve was observed. The length and depth of spine, height and relative position of scapular notch were measured for all of the specimen. RESULTS: The length of the spine was 11.45+/-0.72 cm. The injection point was measured as relative position of scapular notch on the spine. The ratio between distance from medial border of the spine to injection point and from the injection point to posterior angle of acromion was 1.89+/-0.2: 1. The depth of the spine, which was defined as the shortest vertical distance from the injection point to the scapula was 2.69+/-0.43 cm, and the vertical distance from this contact point to the base of the scapular notch, e.g. the height of the scapular notch, was 1.18+/-0.1 cm. CONCLUSION: We expect we could perform suprascapular nerve block easily and safely with suggested surface landmarks and measured data in this study.

A Cadaver Study of Iliolumbar Ligament from a Viewpoint of Surface Anatomy

OBJECTIVE: To assess the anatomical relationship between spinous process of the lumbar vertebrae and iliolumbar ligament from a viewpoint of surface anatomy. METHOD: Fourteen iliolumbar ligaments of seven human cadavers were dissected and measured distance from the lumbar spinous process to the iliolumbar ligament and vertical depth of iliolumbar ligament from the skin surface. RESULTS: All 14 iliolumbar ligaments were originated at the L5 transverse process and inserted in anterior surface of the iliac crest. Direct distance from lumbar spinous process to the origin siteof the iliolumbar ligament was 7.67+/-0.39 cm(distance from the spinous process to presumed skin point of the termination site of the ligament, 6.71+/-0.4 cm). Vertical depth from skin surface was 3.94+/-0.57 cm to the origin site of the iliolumbar ligament, and 3.67+/-0.54 cm to the termination site of the iliolumbar ligament. CONCLUSION: The iliolumbar ligament was deep seated anatomical structure in the lumbosacral region. Superficial landmark of the lumbar spinous process may be useful in approach to iliolumbar ligament.