Surgical anatomy of the deep lateral orbital wall.

PURPOSE: To determine the exact anatomic location and volume of the thickest section of the greater wing of the sphenoid bone (trigone), which is removed during deep lateral orbital wall decompression. METHODS: Eighteen dried skulls were used to determine the exact anatomic location and computed tomography (CT) images of 20 patients (10 male, 10 female) were used for volumetric calculations. RESULTS: Mean values were 14.5 mm for the orbital rim to inferior orbital fissure distance, 23.3 mm for rim to trigone distance, 13.0 mm for width of the trigone base, 5.8 mm for trigone to orbital apex distance, and 12.3 mm for trigone height. The width of the narrowest section of the trigone was 5.2 mm. The trigone was found to have a lower segment (0.92 cc) neighboring the inferior orbital fissure, and an upper segment (0.32 cc) adjoining the thick substance of frontal bone. The narrowest part between these two segments was located just at the superior border of the lateral rectus muscle. CONCLUSIONS: The authors recommend avoiding the thin rectangular portion located in the inter-fissural area adjacent to the superior orbital fissure. A high intersubject variability underscores the need for individualized preoperative analysis by imaging studies.

A rare accessory coracobrachialis muscle: a review of the literature.

During previous dissections to investigate the incidence of the third head of the biceps brachii in neonate cadavers an accessory coracobrachialis muscle was unilaterally found in a neonate male cadaver. This muscle originated from the coracoid process and the capsule of the shoulder joint. It was inserted into the antebrachial fascia and the medial epicondyle of the humerus. The coracobrachialis muscle is used as a transposition flap in deformities of infraclavicular and axillary areas and in postmastectomy reconstruction. It is also a guide to the axillary artery during surgery and anesthesia. This additional muscle may cause musculocutaneous or high median nerve paralysis. We were unable to find any similar case in the published literature. The anatomic variations of the coracobrachialis muscle may cause confusion during surgery or evaluation of CT and MRI scans.

The membranous portion of the interventricular septum in neonates. An anatomic study in neonatal cadavers.

The membranous portion of the interventricular septum (MPIS) has been described as a small, oval portion of the cardiac septum that lies immediately below the aortic valve. Its location and relationship with the aortic valve are very important in surgical interventions. Several studies have been reported in adults but few in neonates. For this reason, studies of the MPIS were made in the hearts of 26 (12 male, 14 female) fulterm neonates. The left side of the MPIS was photographed with transillumination from the right ventricle. The shapes of the septum were assessed from the photographic images. In addition, in accordance with the ruler in the photographs a millimetric scale was prepared on the tracing paper and the surface area of the MPIS and its distance from the superior border of the aortic valve were measured. In these 26 cases, the following shapes of MPIS were found: semilunar, 7 (26.92%); triangular, 6 (23.07%); quadrangular, 5 (19.23%); oval, 4 (15.38%); circular, 2 (7.69%); irregular, 2 (7.69%). Its surface area varied from 2-21 mm2 (mean 5.84 mm2). The superior border of MPIS was in close relationship with the aortic valve. In 10 cases (38.46%) the MPIS was in direct continuity with the attachments of both the right and posterior aortic cusps, in 8 (30.76%) only with the posterior aortic cusp, in 5 (19.23%) only with the right aortic cusp, while in 3 (11.53%) the superior border of MPIS was below the attached portion of both cusps. The distance between the superior border of the MPIS and the attachment of the right or posterior aortic cusps did not exceed 3.5 mm. There were no statistically significant sex-related differences in shape, surface area and relationship with the aortic valve.

Variant high-origin radial artery: a bilateral case.

During a dissection of both upper extremities, an abnormally high origin of the radial a. was found on each side. However, the arterial patterns were not the same. On the right side, the radial a. arose 2 cm above the junction of the two roots of the median n. On the left side, the radial a. arose from the brachial a. 3 cm distal to the origin of the profunda brachii a. The course of these arteries in the forearm were normal. However, in the hand, on the right side, the contributions of the radial and ulnar aa. to the superficial and deep palmar arches were, unusually, equal. On the left side, the superficial palmar arch was formed as usual mainly by the ulnar a. and the deep palmar arch was formed mainly by the radial a. The high origin of the radial aa. in this case is explained on the basis of the embryologic development and is distinguished from the other common arterial variations in the upper limb.

Vertebral level of the ending of the spinal cord and its relationship to the length of the vertebral column in northern Turkish neonates.

Racial and sex differences in the level of ending of the spinal cord of the adult have been reported. It is lower in Africans and in females. Since such differences may affect even fetuses and newborns we aimed to study in Northern Turkish neonates. The study was made on 40 full-term newborn still-births (23 male, 17 female). In all cases, the length of the vertebral column, the length of the spinal cord and the body weight were measured and the vertebral level of ending of the spinal cord was noted. It was found that the termination of the spinal cord varied from the first lumbar to the second sacral vertebra, with a mean level between L2 and L3. In female neonates, it was observed that the spinal cord ended at a slightly lower level (0.2 vertebra) than in males. Our findings approximately agreed with those of Barson [2] who studied neonates in England and of Jit and Charnalia [5] in North India. However, we found that the spinal cord ended one and half vertebrae lower in Northern Turkish neonates than in South African and South Indian subjects. The correlations between body-weight and length of the spinal cord, weight and length of the vertebral column, length of the spinal cord and length of vertebral column, length of the vertebral column and level of ending of the cord were statistically highly significant for males, females and both sexes together (p < 0.001). The longer the vertebral column, the higher the termination of the spinal cord.