Optico-carotid recess and anterior clinoid process pneumatization â€" proposal for a novel classiï¬cation and uniï¬ed terminology: an anatomic and radiologic study.

BACKGROUND: The aims of this study were to propose a novel and uniï¬ed classiï¬cation system of the optico-carotid recess (OCR) and anterior clinoid process (ACP) pneumatization, determine their frequency in a Caucasian population and measure the size of the OCR. METHODOLOGY: A total of 200 specimen (400 sphenoid sinuses) were evaluated in a separate anatomic cadaveric study (n=100) and radiologic study (n=100) by using sphenoidal sinus cast and computed tomography (CT) scan. OCR was divided according to its location to the optic nerve into sub-optical and latero-optical OCR grade I-III. RESULTS: An OCR was found in 39% of the samples (78/200) and in 19% (38/200) it occurred bilaterally. Both, sub-optical and latero-optical OCR were identiï¬ed in 14% of the sides (58/400), with a mean length and depth of 6.9 mm; 7.7 mm and 2.3 mm, 7.1 mm, respectively. We determined the pneumatized ACP frequency with 23% (46/200) and deï¬ned 3 uniï¬ed different types of pneumatization. CONCLUSIONS: The OCR is a reliable landmark to identify the optico-carotid region in endoscopic sphenoid sinus surgery, and can even be visualized by CT. Hence, preoperative investigation of the sphenoid region is mandatory. In our opinion, the classiï¬cation presented in this study can be useful in order to avoid surgical complications.

Anatomical variations of the posterior intercostal arteries and the thoracic vertebral artery.

This study evaluated the occurrence and frequency of the anatomical variations of the origin and course of the posterior intercostal arteries (PIA) in 44 human cadavers. During a classical anatomical dissection of each cadaver an anomalous course of the PIA, defined as a thoracic vertebral artery, was found in six (14%) individuals. Every dorsally coursing PIA was taken into account, regardless of its origin, and their different origins and course were described. A specific dorsal course for the PIA was found in nine cases, which was bilateral in two cases. The variations that were found and that have been schematically presented will provide new information about the anatomical variations of the PIA. Consideration of the potential for anatomical variation of the PIA is important in vascular and thoracic surgery and in diagnostic and interventional radiology such as spinal angiography.

Anatomical variations of coronary ostia, aortocoronary angles and angles of division of the left coronary artery of the human heart.

Classic anatomical dissection of 150 heart specimens from adults aged 18 - 80 years was performed. Anatomical variations were studied in: (i) the position of the ostium of the left coronary artery; (ii) the angle between the proximal segment of the left coronary artery and the longitudinal axis of the aorta and between the circumflex and the anterior descending branches; (iii) the angle between the anterior descending artery and the diagonal branches, and between the diagonal and circumflex branches in trifurcation of the left coronary artery; (iv) the position of the ostium of the right coronary artery in the right coronary sinus of Valsalva; (v) the angle between the initial part of the right coronary artery and the longitudinal axis of the aorta; and (vi) the position of the initial part of the left coronary artery relative to the coronary groove. Knowledge of and the ability to recognize and identify the variety of sites of origin of coronary arteries, aortocoronary angles and angles of division of the left coronary artery of the human heart may help to overcome potential difficulties in cardiosurgical procedures, such as aortic valve replacement and reinsertion of coronary arteries.

Anatomical aspects of the arterial blood supply to the sinoatrial and atrioventricular nodes of the human heart.

Classic anatomical dissection of 150 hearts from adults aged 18 - 80 years was performed. The sinoatrial (SA) node artery was most frequently a large atrial branch of the right coronary artery (63%), arising at a mean distance of 1.2 cm (range 0.2 - 2.2 cm) from its beginning, with a mean external diameter of 1.7 mm (range 1 - 3 mm). In 37% of cases the SA node artery was a branch of the left coronary artery or one of its branches, with an initial mean external diameter of 2.2 mm (range 2 - 3 mm). The origin of the SA node artery was not related to coronary arterial dominance. The atrioventricular (AV) node artery was the first and longest inferior septal perforating branch of the right (90%) or left (10%) coronary artery, arising from the U- or V-shaped segment of the corresponding artery at the level of the crux cordis. Mean external diameter was 2 mm (range 1 - 3.5 mm). The origin of the AV node artery was dependent on coronary arterial dominance. Identification of the anatomical variants of the arterial blood supply to the SA and AV nodes may help in overcoming potential difficulties in treating arrhythmias and in mitral valve surgery.

Frequency of successful intra-articular puncture of finger joints: influence of puncture position and physician experience.

OBJECTIVE: Physicians and specialists routinely perform IA punctures and injections on patients with joint injuries, chronic arthritis and arthrosis to release joint effusion or to inject drugs. The purpose of this study was to investigate the frequencies of intra- and peri-articular cannula positioning during this procedure. METHODS: A total of 300 cadaveric finger joints were injected with a methyl blue-containing solution and subsequently dissected to distinguish intra- from peri-articular injections. To assess the influence of puncture position on successful injection, half of the joints were injected dorsally and the other half dorso-radially. To assess the importance of practical experience for a positive outcome, half of the injections were performed by an inexperienced resident and half by a skilled specialist. RESULTS: The overall frequency of occurrence of peri-articular injections was much higher than expected (overall: 23%, specialist: 15%, resident: 32%) The failure rate was significantly higher than the average with the joints of the little finger and the DIP joints of each phalanx. CONCLUSIONS: Even skilled specialists cannot guarantee to insert the cannula into the joint in every case. Unintended peri-articular drug injection moreover may affect the surrounding ligaments or tendons, leading to serious complications. Correct positioning of the needle in the joint may be facilitated by fluoroscopy in doubtful cases.

Anatomical variations of the coronary sinus ostium area of the human heart.

Classic anatomical dissection of 150 heart specimens from adults aged 18 - 80 years was performed. The Thebesian valve was absent in 20% of cases and, in these, 4% had a large ostial valve of the middle cardiac vein in front of the coronary sinus ostium. Fibres of Chiari were found in 10% of cases. Ostia of the middle cardiac vein, posterior veins of the left ventricle, small cardiac vein and deep cardiac veins were present in the distal 10 mm of the coronary sinus. Some samples had ostial and/or parietal valves or antivalves that sometimes contained muscular fibres. Distal accessory parietal valves (2%) and antivalves (1%) of the coronary sinus wall were found at a distance of 4 - 7 mm from its ostium. The frequency and variability of anatomical structures in the area of the coronary sinus ostium probably influence the haemodynamics of this area. Knowledge of and being able to identify these anatomical variations may help in identifying and overcoming potential difficulties in treating arrythmias and in cardiosurgery.

Promontory of radius: a new anatomical description on the distal radius.

Surgical treatment of distal radius fractures with palmar plates has gained popularity as the preferred approach to achieve anatomical fracture reposition. One hundred and thirty four radii of human cadavers were examined to elucidate the anatomy of the distal radius, especially the transition of the anterior into the lateral surface and a new term was given: promontory of radius. The promontory was located on the lateral surface between the changing of the convex to the concave curvature and the base of the styloid process. The anterior surface increased gradually from the ulnar notch to the lateral surface and formed the "base" of the promontory. The length of the promontory on the lateral surface measured 14-28 mm (mean 20.766 mm, SD 2.69 mm). The width of the promontory was found in between 10 and 27 mm (mean 13.857 mm, SD 2.14 mm). The width of the distal radius was 16-38 mm (mean 31.015 mm, SD 3.26 mm) and did not show any statistical correlation to the promontory. On the anterior surface the minimal width of promontory measured 4.9 mm, the maximal one 17.9 mm (mean 8.95 mm, SD 3.60). The height of the promontory on the anterior surface ranged in between 1.2 and 4.3 mm (mean 2.90 mm, SD 1.05 mm). The promontory of radius must be kept in mind to avoid any dorsal dislocation of the radial fragment often described as complication of intraarticular fractures. Based on this anatomical survey the data can be used for a new palmar radius plate designs.

[Training methods for regional anaesthesia. Evaluation and comparison]. / Trainingsmethode für Regionalanästhesisten. Evaluierung und Vergleich.

INTRODUCTION: Optimized training facilities are the key to efficient teaching of regional anesthesia. MATERIAL AND METHODS: A combination of Thiel's embalming method, flap dissection and pulse simulation was offered to participants in several workshops on regional anesthesia. Tutors, experienced anesthetists and anatomists, evaluated the workshop and compared Thiel's method to classic formaldehyde conservation. Additionally both embalming methods were assessed with regard to the mechanical properties according to the requirements of regional anesthesia. RESULTS: The evaluation showed high acceptance of the method offered in the workshop. In a comparison of fixation methods Thiel's method was generally preferred as it presented more similar conditions to living patients and almost ideal conditions for regional anesthesia. CONCLUSION: The presented method is an optimized, strongly accepted teaching and training tool for teaching regional anesthesia.

[Meaning of stylopharyngeal fascia in intraoral block techniques]. / Die Bedeutung der Fascia stylopharyngea bei intraoralen Blockadetechniken.

BACKGROUND: The almost unknown stylopharyngeal fascia may be one of the reasons for unsuccessful therapy of the trigeminal neuralgia by a transoral block of the superior ganglion of the sympathetic trunk. We investigated the anatomy of the fascia to show the efficiency of the block for this therapy. MATERIALS AND METHODS: 103 halves of human heads were investigated. The stylopharyngeal fascia was dissected by a lateral approach. We classified three groups. Group A was formed by fascias without perforation, group B by perforated fascias and group C by all halves without a developed fascia. RESULTS: We found a fully developed fascia in 86 cases. 13 halves had perforated fascias; in 4 cases the fascia was not developed. CONCLUSION: The stylopharyngeal fascia may inhibit the distribution of opoids into the infratemporal fossa associated with a consecutive block of the mandibular nerve and lower the rate of pain relief.

Additional muscle in idiopathic club foot.

During the dissection of seven club feet of foetuses, aborted between the 25th and 37th week of gestation, an additional muscle bundle was found in a right foot. This muscle arose from both heads of the gastrocnemius muscle, continued downwards onto the posterior surface of the soleus, crossed the calcaneal tendon and assumed a position on the lateral side of the calcaneal tendon. The muscle's tendon was fixed just laterally to the calcaneal tendon in the calcaneal tuberosity with some tiny fibres branching off into the superior fibular retinaculum.

Anatomic basis of vascularized nerve graft using the long thoracic nerve.

Vascularized nerve transplants can lead to satisfactory functional reconstruction for nerve defects. These include defects following traumatic nerve severance, iatrogenic severance during tumour resection and extensive defects in poorly vascularized transplant sites. No previous description of the long thoracic nerve as a vascularized nerve graft is available. The aim of this study was to demonstrate the anatomic and initial clinical application of such a graft. The long thoracic nerve was dissected in 84 cases to examine its length, diameter, ramification and type of perfusion. On removal of the nerve, adequate perfusion through the thoracodorsal artery and a constant anatomic course with minimal loss of function were found. The long thoracic nerve is accessible anatomically, easily dissected and removed. This may be carried out together with the thoracodorsal vein and artery and even with a pedicled myocutaneous latissimus dorsi transplant, an osseo-myocutaneous scapulo-latissimus dorsi transplant or an osseous scapular transplant. The long thoracic nerve transplant can be employed for extensive facial defects together with simultaneous osseous and myocutaneous transplants of the shoulder region.

Variations in the branching of the internal pudendal artery in the ischioanal fossa.

The branches of the ischiorectal part of the internal pudendal artery include the inferior rectal artery and small branches to the obturator internus muscle. For our research we had 164 embalmed half pelves, the arteries of which has been injected by the Thiel method. After the dissection of the ischioanal fossa the arteries were documented. Four types of branching of the inferior rectal artery were found. I. (43%) One artery on each side. II. (31%) Two arteries on one side. III. (4%) Three arteries on one side. IV. (22%) Two arteries or more on each side. In the specimens examined we found one branch to the obturator internus muscle in 31%, two branches in 43% and three branches in 11%. In 15% of cases this branch was absent. In seven cases two branches formed an anastomosis parallel to the internal pudendal artery.

[Blood supply to the cervical spinal cord and possible therapeutic consequences in cervical spinal cord injuries]. / Die Blutversorgung des zervikalen Rückenmarks und mögliche therapeutische Konsequenzen bei zervikalen Rückenmarkverletzungen.

The study was designed to demonstrate the blood supply to the cervical cord through radicular branches and was carried out in 23 human cadavers into which preparations were injected by the intra-articular route. One corrosion cast of the head and neck showed extravertebral anastomotic pathways. After removal of the vertebral bodies and discs from C1 to D3, the anterior spinal artery and radicular branches were identified and dissected back to their origins from the vertebral, deep or ascending cervical arteries. Twelve preparations had only one or two radicular branches reaching the cervical spinal cord. If there is traumatic compression of an ascending branch a high risk of ischaemic damage to cranial areas of the spinal cord arises. The blood supply to the cervical enlargement of the spinal cord was provided by branches of the deep cervical artery in eight preparations, but only in one by branches of the vertebral artery. We therefore plead for decompression of the anterior spinal artery and the spinal cord and for sufficient arterial blood pressure, and give our reason for these demands.

[The nomenclature of the blood vessels of the kidney]. / Zur Nomenklatur der Nierengefässe.

The differing interpretations of the course of the renal artery-branches possibly are caused by the Nomina Anatomica. The course of the branches of the renal artery is described and based upon this less misleading names for these branches are suggested.

[The pedicled transposition of the digastric and stylohyoid muscles in the treatment of velopharyngeal incompetence. Anatomic basis and clinical application]. / Die gestielte Transposition des Musculus digastricus und stylohyoideus zur Behandlung der Velopharynxinkompetenz. Anatomische Grundlagen und klinische Anwendung.

The anatomical basis for the application of neurovascular pedicled muscle transfers of the digastric and stylohyoid muscles in the treatment of velopharynx incompetence is described. The fact that the neurovascular pedicle is located in the cranial third of the muscle bellies provides the safety of the operative procedure. The muscles have to be dissected with respect to that. The direction in which the transferred muscles pull is described. The muscle transposition is combined with the classic Wardill-Kilner operation to lengthen the soft palate. The transferred muscles have to avoid scar contraction and shortening of the soft palate and to gain a muscular function of the soft palate. The clinical use is justified in rare cases as demonstrated in one case.

[Trifurcations of the middle cerebral arteries]. / Uber Trifurkationen der Arteria cerebri media.

The furcation types of 100 human middle cerebral arteries (MCA) were investigated. Considering the physiological flow characteristics in furcations, a distinct definition for a bifurcation and a trifurcation was found. The common ramification type of the human MCA is the bifurcation. Trifurcations are very rare and we found them only in the proximal parts of the MCA. In 7 of the 100 cases, a trifurcation was found at the main division of the MCA, in 3 cases a secondary trunk trifurcated. Quadro- and pentafurcations according to the hydrodynamic definitions were not observed at all. Only in 1 case did the internal carotid artery trifurcate into the anterior cerebral artery, a superior trunk and an inferior trunk of the MCA.

[Two atavistic characteristics of the laryngeal skeleton]. / Zwei atavistische Merkmale des Kehlkopfskelettes.

In the analysis of laryngeal anomalies in 30 selected phoniatric patients by CT examination, 2 atavisms of the laryngeal skeleton were found. The ventral enclosure of the thyroid cartilage by the hyoid bone presents an inhibition malformation of the laryngeal skeleton with essential reduced vocal ability. The posterior junction between the cornu majus ossis hyoidei and the cornu superius cartilaginis thyroideae is marked by the direct contact of these cornua lacking the ligamentum thyrohyoideum laterale. Both anomalies are characterized by the persistence of the close relation between the hyoid bone and the thyroid cartilage, which normally exists phylogenetically as well as ontogenetically. That could be shown by anatomical sections performed on 4 human newborns in the horizontal plane.

[Anatomy of the anterior serratus flap]. / Die Anatomie des Serratus-anterior-Lappens.

The vascular territory of the serratus anterior muscle was investigated by injection studies in cadavers. The overlying skin and the ribs were stained only partially. The skin gets its blood supply by so called rami cutanei laterales originating from the intercostal system. The serratus fascia and the muscle can be transplanted safely on its pedicle, the thorakodorsal vessels. The main indication are the muscle transplantation for reconstruction of facial paralysis and as gliding tissue.

[Computed tomography of the larynx in the diagnosis of dysphonia]. / Die Computertomographie des Larynx in der Stimmdiagnostik: Untersuchungen zur Methodik und Massgenauigkeit.

By comparing CT scans of the larynx with anatomical sections in the horizontal plane as well as by examining patients, a method of investigation especially aimed at phoniatric questions has been worked out: CT scans are performed every 4 mm parallel to the vocal cord plane using a center of 50 HE and a window of 350 HE. The examination is done during regular respiration and if required can also be performed during phonation when producing the vowel /u/. Using this technique the laryngeal structures of clinical relevance can be demonstrated with the help of at least 10 scans. It requires little time and the radiation exposure for the patient is minimal. The accuracy of CT measurements corresponds excellently to the anatomical features. Allowing an exact evaluation of anomalies of the larynx in shape and position, CT essentially improves phoniatric diagnostics.