Bare area on the trochanter and its correlations to gluteal tendon insertion dimensions.

Gluteus medius and minimus tears have recently been reported to be very common and the main etiology of lateral sided hip pain. The purpose of this study was to determine whether there is any correlation between the dimensions of the tendon insertions and bare areas (BA) and various bony landmarks. Twenty-seven hemipelvises from adult male hips were included. The bony landmarks [anterior tip (Ta), posterior tip of trochanter, vastus tubercle (VT) and center of BA] were marked. The longitudinal lengths and widths (maximum) of posterosuperior (PS), lateral facets (LF), minimus insertion (Min) and BA and the distance between posterior (Tp) and Ta and between anterior/posterior tips and the VT or center of BA were measured using a digital caliper. A correlation analysis was performed between variables. There was a correlation between LFlength and Minlength (r = 0.4, P = 0.01) and between Ta-BA and PS + LF (r = 0.5, P = 0.003) or Minlength (r = 0.4, P = 0.016). LFwidth was negatively correlated with BAwidth (r = -0.4, P = 0.002). Tp-BA was negatively correlated with BAwidth (r = -0.4, P = 0.01). LFwidth was correlated with Tp-BA, and this nearly reached statistical significance (r = 0.3, P = 0.05). BA can be used intraoperatively as landmarks to estimate the width of the LF and also to determine the length of the longitudinal insertion of the gluteus medius and minimus tendons.

Anatomic implications of lesser trochanterplasty.

OBJECTIVE: The aim of this study was to measure the area of iliopsoas tendon attachment and the distance of sciatic nerve, medial circumflex femoral artery (MCFA) and quadratus muscle to lesser trochanter tip, before and after 5, 10, 15 mm depth excision of lesser trochanter. METHODS: A total 15 hips of 8 adult male cadavers were evaluated. Distances between lesser trochanter tip, sciatic nerve, the lower edge of quadratus muscle and MCFA; length and width of quadratus muscle insertion; area of iliopsoas muscle and quadratus muscle insertion was measured before and after sequential 5,10 and 15 mm depth trochanterplasties using 5 mm wide burr parallel to the posterior cortex. RESULTS: Each incremental 5 mm depth bone removal led to significant decrease of tendon area (p=0.001) at each stage. Mean decreases of iliopsoas tendon attachment area with incremental 5 mm burring were 22%±10 with 5 mm, 50%±13 with 10 mm, and 76% ±13 with 15 mm of burring. CONCLUSION: Up to 15 mm lesser trochanter removal did not result in complete detachment of the iliopsoas tendon. Lesser trochanter tip was detected at least 20 mm away from important anatomic structures including quadratus tendon, sciatic nerve, and the medial circumflex femoral artery.

The Morphological Grading and Comparison of Sutural Patency Among Cranial Sutures in Dry Human Skulls.

OBJECTIVE: To investigate the degree of fusion (patency) among cranial sutures in human dry skulls in the Anatolia. METHODS: One-hundred fifty-eight human dry skulls that were accepted as adults according to the teeth eruption were macroscopically examined and photographed with Canon 400B (55 mm objective). The grades of fusion of coronal, sagittal, and lambdoid were quantitatively analyzed by using the modified grading scale. According to the extent of patency, the sutures were graded as grade-0 (open), grade-1 (fused but not obliterated), grade-2 (50%< obliterated), grade-3 (50% > obliterated), and grade-4 (100% obliterated). The authors determined and compared the rate for each grade of sutural patency on coronal, sagittal, and lambdoid sutures. RESULTS: The cranial sutures of 4 cranii (4/158; 2.53%) had grade-4 fusion, whereas there were no any cranii with sutures of grade-0 fusion. The number of each grade of fusion among cranial sutures of 158 skulls, in descending order, was as follows: 171 (grade-3), 145 (grade-1), 133 (grade-2), and 25 (grade-4). The grade-4 fusion was significantly less observed than the others. The grade-1 and grade-4 fusion of lambdoid sutures were established as the most (66/41.8%) and least (5/3.2%) common fusions among cranial sutures, respectively. The frequencies of each grade of fusion for each cranial suture were determined in a descending order: coronal (grade-3 > 2 > 1 > 4), sagittal (grade-3 > 2 > 1 > 4), and lambdoid sutures (grade-1 > 3 > 2 > 4). The frequency of grade-1 fusion of lambdoid suture (66/41.8%) was significantly different when compared with coronal (39/24.7%) and sagittal sutures (40/25.3%), respectively. CONCLUSION: The grades of fusion (or sutural patency) vary among cranial sutures.

Foramen arcuale: a rare morphological variation located in atlas vertebrae.

OBJECTIVE: To investigate the incidence of foramen arcuale in dry atlas vertebrae which may cause clinical problems. MATERIALS AND METHODS: Eighty-one dry human cervical vertebrae were examined. The evaluated parameters of two atlas vertebrae including foramen arcuale were as follows: maximum antero-posterior, transverse diameters and areas of the right and left superior articular facets and transverse foramina; maximum antero-posterior diameters, heights, areas and central sagittal thickness of bony arch forming roof of foramen arcuale, respectively. All parameters were measured with caliper in milimeters. RESULTS: Thirteen of eighty-one cervical vertebrae specimens (13/81, 16.05%) were atlas and the two of thirteen atlas vertebrae (2/13, 15.38%) had macroscopically complete foramen arcuale. Each of the two atlas vertebrae was including one foramen arcuale (one on the left and one on the right side). There was a statistically significant difference (p = 0.04) between the mean antero-posterior diameter of superior articular facet located on each side of atlas vertebrae, whereas not (p = 0.51) between mean antero-posterior diameter of transverse foramina. There was not any significant difference between the mean transverse diameters and areas of superior articular facets and transverse foramina located on each side of atlas vertebrae, respectively. Each of the areas of transverse foramina located on the same sides with foramen arcuale in two atlas vertebrae was less than the mean areas of transverse foramina located ipsilateral side with each foramen arcuale in thirteen atlas vertebrae. CONCLUSION: The present study provides additional information about the incidence and topography of the atlas vertebrae including foramen arcuale.

Morphometrical aspect on angular branch of facial artery.

Anatomic variability and anastomosis of the angular artery of the facial artery with the other arteries are important for both anatomists and surgeons. In particular, the angular artery is a significant landmark in dacryocystorhinostomy. Because of variations on anatomy of the angular artery, there are limited numbers of anatomic studies on the flaps of facial region. Hence, the aim of the cadaveric study was to evaluate the anatomic features of the angular artery in detail to help surgical procedures.The artery was represented under ×4 loop magnification in 32 sides of 16 formalin-fixed adult cadavers. The angular artery's position, diameter, and branch patterns relevant to the nose arterial supply were evaluated. The facial artery ended symmetrically in 10 (62.5%) of the cadavers. The facial artery was terminated as angular artery in all of the cases. The types of the angular artery were as follows: classical angular type in 8 cases (25.0%), nasal type in 15 cases (46.9%), alar type in 4 cases (12.5%), and labial type in 5 cases (15.6%) on the facial halves. We studied the topographic anatomic features of the angular artery for increasing reliability of the flaps on the region. The angular arterial anatomic details are critical and essential for surgical cosmetic and functional results.

The volume of experimental design cerebellum: stereological microanatomic study.

Cerebellum is responsible to higher cognitive functions and delicate motor activity. Because of its significance, cerebellum may play a major role in cognitive, behavioral, and psychiatric diseases. Therefore, the investigations on cerebellum may be contributed to the future researches so as to solve reasons of the diseases. The rabbit brain relatively larger than the rat and mouse brain and the individual evaluation of its subdivisions are rather easy. There are no data on cerebellar volume of rabbits in literature. Thus, the study presents microscopic volume calculation of rabbits' cerebellum using the stereological method. The mean (SD) calculated volume of the cerebellum in the rabbit brain was found to be 0.69 (0.03) cm3. The individual microscopic volume estimation of an animal subject can be achieved by Cavalier method. Researchers believed that the findings and the applied method in this study may be useful for the scientists.

Lumbar vertebra morphometry and stereological assesment of intervertebral space volumetry: a methodological study.

The use of technology in the treatment of degenerative spinal diseases has undergone rapid clinical and scientific development. It has been extensively studied in combination with various techniques for spinal stabilization from both the anterior and posterior approach. Minimally invasive and instrumental approach via posterior fixation is increasingly being used for the treatment of adult degenerative disc disease, stenosis, and deformity of the lumbar vertebrae. Posterior access to the lumbar disc spaces for posterolateral fusion scan has been technically challenging, frequently requiring the use of an approach surgery for adequate exposure. For successful surgery and suitable instrumental design, adequate anatomical knowledge of the lumbar vertebra is also needed. Anatomic features of lumbar vertebrae are of importance for posterior screw fixation technique. The morphometry of L1-L5 has been studied to facilitate the safe application of pedicle screws. Thus, we aimed to evaluate the morphometric landmarks of lumbar vertebrae such as pedicle, vertebral body, vertebral foramen, intervertebral space height and volume for safe surgical intervention using a posterior fixation approach to offer anatomical supports for lumbar discectomy, stenosis and cases of deformity. The features of the L1-L5 vertebral body, the detailed morphometric parameters of lumbar vertebrae and the intervertebral space were analyzed using computerized tomography scan, magnetic resonance imaging and also dry lumbar vertebrae. Additionally, intervertebral space volumes were measured using stereological methods to ensure safe surgical intervention.

Supraclavicular artery flap.

Supraclavicular artery-based flaps provide aesthetic and functional coverage for the head and neck region. Fourteen formalin-fixed cadavers were dissected bilaterally, and 28 supraclavicular arteries were evaluated. The origin of the supraclavicular artery was transverse cervical artery in 62.9% and suprascapular artery in 37.1% of the cases. The origin of the artery was at the level of the medial third of the clavicle in 3.7%; 3.7% of the cases were at the junction of medial and middle third of the clavicle, 33.3% at the level of middle third of the clavicle, 11.1% at the junction of middle and lateral thirds, 44.4% at the level of lateral third, and 3.7% at the level of acromioclavicular joint. The mean values of the results were as follows: The diameter of the artery was 1.0 mm at the origin. The distance of the origin of the artery from sternoclavicular joint and from the upper border of the clavicle was 76.4 and 22.2 mm, respectively. The average length of the artery was 70.8 mm. In all dissections, the artery was deep to the platysma muscle. Forty-one percent of supraclavicular arteries accompanied the middle supraclavicular nerve, whereas 59% of the arteries run with lateral supraclavicular nerve. The supraclavicular artery had a parallel course to the 2 horizontal imaginary lines passing from the coracoid process and acromion in 63% of the cases; 18.5% of the arteries were oblique, and 18.5% were vertical to the imaginary lines. The venae comitantes were double in all dissections.

Anatomic bases of superficial temporal artery and temporal branch of facial nerve.

The superficial temporal artery (STA)-based flaps have been used for different reconstructive purposes. These operations may cause facial nerve injury. The variations of the STA and its relation to temporal branch of the facial nerve (TBFN) were evaluated in this study. Thirteen cadavers with 26 STA and TBFN have been dissected. The bifurcation of STA was found to be 60% above the superior border of the zygomatic arc and 40% below this level. The mean lengths of frontal and temporal branches (FB and TB) of STA were 11.5 and 11.4 cm, respectively. The mean numbers of perforators of FB and TB to deep plane were 1.30 and 1.34, respectively. The mean diameter of STA at the superior border of zygomatic arc was 2.5 mm. The mean diameters of TB and FB at the level of bifurcation were 1.8 mm and 2.0 mm, respectively. The mean number of TBFN at the level of zygomatic arc was 3.70. The mean distance of the first and last branching of TBFN to tragus was found to be 24 mm. The mean number of TBFN at the level of the middle orbita was found to be 2.7. The mean distance of first and last branches of TBFN to the lateral orbital rim was 12 and 24 mm, respectively. The results found in this study may increase the accuracy of flaps based on STA and decrease the risk of facial nerve paralysis during these operations.

Anatomy of gracilis muscle flap.

Gracilis muscle flap is commonly used in reconstructive surgery. The gracilis muscles of 15 formalin-fixed adult cadavers (30 cases) were dissected with 4× loupe magnification. The most proximal pedicle of gracilis muscle was the deep branch of the medial circumflex femoral artery. It was located 60 mm from the pubic tubercle and had a diameter of 0.9 m on the average. The second pedicle was the medial circumflex femoral artery. It was the dominant pedicle in 13% of the cases. The mean diameter of the artery was 1.2 mm, and it entered the muscle 98 mm from the pubic tubercle. The third artery that nourished the muscle was deep femoral artery. It was the dominant pedicle in 87% of the cases. It had a mean diameter of 1.6 mm with a length of 54 mm. The most distant pedicles originated from the superficial femoral artery. They were present in all cases and were double in 77% of the cases. Mean diameter and length of the artery were 1.4 and 52 mm, respectively. They entered the muscle 266 mm from the pubic tubercle. These distal pedicles seem to be large enough to elevate the middle part of the muscle as a free flap.

Anatomy of vastus lateralis muscle flap.

A vastus lateralis muscle flap is used as a pedicled and free flap. In this study, the vastus lateralis muscles of 15 adult formalin-fixed cadavers (30 cases) were dissected. The dominant pedicle was found to be descending branch of the lateral circumflex femoral artery. The mean diameter of the artery was found to be 2.1 mm. This pedicle was located 119.4 mm distal to the pubic symphysis. The mean length of the major pedicle was found to be 56.8 mm when the dominant pedicle was chosen to nourish the flap. The dominant pedicle entered the muscle 155.8 and 213.7 mm from the greater trochanter and the anterior superior iliac spine, respectively. The muscle had proximal minor pedicles from the ascending and transverse branches of lateral circumflex femoral artery. These arteries had mean diameters of 1.8 and 2.0 mm, respectively. The distal minor branches were present in all of the dissections. The distal branch had a mean diameter of 1.8 mm. The origin of this distal branch was located 83.7 mm proximal to the intercondylar line. The motor nerve of the vastus lateralis was found to be originating from femoral nerve. The nerve entered the muscle 194.6 mm from the anterior superior iliac spine.

Evaluation of lumbar vertebral body and disc: a stereological morphometric study / Evaluación del cuerpo y disco vertebral lumbar: estudio morfométrico estereológico

Anterior access to the L1-L5 vertebrae and disc spaces can be technically challenging, frequently requiring the use of an approach to a surgeon for an adequate exposure. The technique is used for lesion excision, corpectomy, vertebral body reconstruction with cages, realignment, and/or plating or screwing. For a successful anterior approach and a suitable instrumental design via screw, adequate morphometric knowledge about body of lumbar vertebrae and disc spaces and standardized volumetric data are also required for neurosurgeons. We aimed morphometric and volumetric evaluation of lumbar bodies and discs to contribute to a safe anterior approach during surgery. We evaluated vertebral body and disc morphometry using stereology in right-handed 25 adult subjects on MRI in the same population with no history of vertebral fractures and degenerative spinal disease. The shape, defining concavity index and volumetric measurements of the body L1-L5 vertebrae, morphometric parameters such as length, height, width of the vertebral body were measured. Also morphometric and volumetric analysis of discs between L1 and L5 were evaluated selected axial and sagittal slices. As expected, the average dimensions of male vertebrae are greater than those of females, but most of them do not differ statistically. Only three dimensions, the mean difference between anterior and central heights of L3, L4 and L5 showed statistically significant difference, indicating smaller central height in both males and females.The transverse and anterior-posterior diameters of the vertebral body, intervertebral disc height and volume displayed no sexual dimorphism (p>0.05). But, the intervertebral disc height and volume increased from L1 to L5 (p <0.01). Concavity indexes for all lumbar vertebrae for both sexes did not differ statistically. The method is important to estimate applying implant size and amount in decompression operations for neurosurgeons.

El acceso anterior a las vértebras L1-L5 y espacios entre los discos puede ser técnicamente difícil, con frecuencia requiere la participación de un cirujano para una exposición adecuada. La técnica se utiliza para la extirpación de la lesión, corpectomía, la reconstrucción del cuerpo vertebral con jaulas, realineamiento y / o placas o tornillos. Para un enfoque exitoso anterior y un diseño adecuado instrumental a través de tornillo, un acabado conocimiento sobre la morfometría del cuerpo de las vértebras lumbares y de los espacios entre los discos y la evaluación volumétrica son necesarias para el neurocirujano. El objetivo fue la evaluación morfométrica y volumétrica de los cuerpos lumbares y los discos, para contribuir al abordaje seguro durante la cirugía. Se evaluó en 25 sujetos adultos, diestros, sin antecedentes de fracturas vertebrales y de enfermedad degenerativa espinal, el cuerpo vertebral y la morfometría del disco mediante estereología con RM. La forma de las vértebras, el índice de concavidad y la definición de las medidas volumétricas de los cuerpos L1-L5. Además, se midieron los parámetros morfométricos como longitud, altura, ancho del cuerpo vertebral. Se efectuó un análisis morfométrico y volumétrico de loss cortes axiales y sagitales de los discos entre L1 y L5. Como era de esperar, las dimensiones promedio de las vértebras en los hombres fueron mayores que en las mujeres, pero la mayoría de ellos no son estadísticamente significativas. Sólo tres dimensiones, la diferencia promedio entre la altura anterior y central de las vertebras L3, L4 y L5 mostraron diferencias estadísticamente significativas, indicando menor altura central tanto en los hombres como en las mujeres. Los diámetros transversal y anteroposterior del cuerpo vertebral, la altura del disco intervertebral y el volumen no mostraron dimorfismo sexual (p> 0,05). Sin embargo, aumentaron la altura del disco intervertebral y el volumen de L1 a L5 (p< 0,01). Los índices de concavidad...

The premasseteric branch of facial artery: its importance for craniofacial surgery.

AIM: The masseter muscle is often exploited by craniofacial surgeons in transposition operations to correct facial palsy, benign masseteric hypertrophy; or neurectomy-induced atrophy of the muscle. A clear understanding of the course of the premasseteric branch of the facial artery and its relations with adjacent structures is essential in maneuvering the masseter muscle safely. In the present study the premasseteric branch was analyzed in details. MATERIAL AND METHODS: Neurovascular and anatomical features and relations of the premasseteric branch and its branches were evaluated according to location, origin, diameter, length and course by bilateral meticulous anatomic micro dissection under 4x loop magnification in formalin fixed 14 adult preserved cadavers. RESULTS: The premasseteric branch originated separately from the facial artery in all cases. The course of the branch was observed to the upper anterior border of the masseter muscle. The diameter of the premasseteric branch was 1.12 mm (mean) at the level of origin. The diameter of the premasseteric branch was larger than the facial artery in 3% of cases. The location of the branch was defined according to body of the mandible. Branches and anastomoses of the premasseteric branch were also represented. CONCLUSION: Anatomical data of the premasseteric branch will help craniofacial surgeons elevate flaps safely.

Morphological parameters of the periorbital arterial arcades and potential clinical significance based on anatomical identification.

The aim of the study was to investigate the locations, diameters, and connections of the periorbital arterial vessels. The peripheral and marginal arcades of the superior and inferior eyelids were revealed by bilateral meticulous anatomic dissections in 12 adult male and 5 female preserved cadavers. Silicone rubber injection was used to fill the regional arteries. The mean external diameter of the lacrimal (0.4 mm), supraorbital (1.0 mm), supratrochlear (0.9 mm), superior medial palpebral (0.9 mm), inferior medial palpebral (1.0 mm), dorsal nasal (0.8 mm), and infraorbital (2.0 mm) arteries were measured. Contribution of superficial temporal artery to palpebral arcades via frontal, zygomatico-orbital, and transverse facial branches was demonstrated. The purpose of this study was to demonstrate the periorbital arterial supply with contributing anastomosis from facial vasculature and impact on clinical practice.

Anatomic study of the vasculature of the submental artery flap.

The submental artery island flap is a versatile option in head and neck reconstruction. This flap may be used for the coverage of perioral, intraoral, and other facial defects, leaving a relatively acceptable donor-site scar. In this study, the submental region of 13 formalin-fixed cadavers was dissected bilaterally. Comprehensive anatomical information regarding the pedicle of the flap and its relationship with the important adjacent structures is provided. The mean values of the measurements of the facial and submental arteries were as follows: the facial artery was 2.7 mm in diameter at the origin, and it crossed the mandibular border 26.6 mm from the mandibular angle. The origin of the submental artery was 27.5 mm from the origin of the facial artery, 5.0 mm from the mandibular border, and 23.8 mm from the mandibular angle. The diameter of the submental artery was 1.7 mm at the origin. The artery was found mostly to course superficial to the submandibular gland. In one case, the artery passed through the gland. The total length of the submental artery was 58.9 mm. The artery anastomosed with the contralateral artery in 92 percent of the cadavers. The submental artery was deep to the anterior belly of the digastric muscle in 81 percent of the cases. This study presents detailed anatomical data about the location, dimension, and relationship of the facial artery, the submental artery, and the submental vein that may be useful during dissection of the submental artery island flap.

Cadaveric study of the arterial anatomy of the upper lip.

Arterial distribution of the upper lip was investigated in this study. The location, course, length, and diameter of the superior labial artery and its alar and septal branches were determined on 14 preserved cadaver heads. Another cadaver head was used to show the arterial tree by the colored silicone injection technique. The superior labial artery was the main artery of the upper lip and always originated from the facial artery. The superior labial artery was 45.4 mm in length, with a range from 29 to 85 mm. The mean distance of the origin of the superior labial artery from the labial commissura was 12.1 mm. The superior labial artery was 1.3 mm in external diameter at its origin. The mean distance of origin of the superior labial artery from the lower border of the mandible was 46.4 mm. The alar division of the superior labial artery was mostly found as a single branch (82 percent). Its mean length was 14.8 mm and the mean diameter at the origin was 0.5 mm. The distance between the origins of the superior labial artery and the septal branch was 33.3 mm. The septal branch was single in most of the cases (90 percent). The mean length of the septal branch was 18.0 mm and the diameter at its origin was 0.9 mm. After all dissections, it was concluded that the arterial distribution of the upper lip was not constant. The superior labial artery can occur in different locations unilaterally and bilaterally, with the branches showing variability.

Arterial anatomy of the lower lip: a cadaveric study.

The aim of the study was to investigate the arterial anatomy of the lower lip. The location, course, length, and diameter of the inferior labial artery and the sublabial artery were revealed by bilateral meticulous anatomic dissections in 14 adult male preserved cadaver heads. Another cadaver head was used for silicone rubber injection to fill the regional arterial tree. The inferior labial artery was the main artery of the lower lip and in all cases branched off the facial artery. The mean length of the inferior labial artery was found to be 52.3 mm (range, 16 to 98 mm). The mean distance of the origin of the inferior labial artery from the labial commissura was 23.9 mm. The mean external diameter of the inferior labial artery at the origin was 1.2 mm. The sublabial artery was present in 10 (71 percent) of the cadavers. Mean measurements of this artery were 1 mm for diameter, 23.4 mm for length, and 27.6 mm for distance from the labial commissura. The sublabial artery may originate from the facial artery or the inferior labial artery. This study found that this region does not have a constant arterial distribution, the inferior labial artery and the sublabial artery (if it exists) can be in different locations unilaterally or bilaterally, and the diameter and the length may vary.