Foramina on the zygomatic bone: its clinical significance.

AIM: To study the anatomy of zygomatico-orbital, zygomatico-facial and zygomatico temporal foramina in south Indian population. MATERIALS AND METHODS: 50 dry adult skulls of south Indian origin were studied. The number of ZO, ZF and ZT were recorded on each side. The distances of these foramina to the nearest palpable bony points, infero-lateral angle of the orbit and infra-orbital foramen were measured using Vernier's calipers. RESULTS: Variable number of ZO and ZF foramina, ranging from 0 to 4 was seen. Single ZO foramen in 56% and 44%, double in 6% and 12%, absent in 38% and 44% on right and left sides were seen. Distance of ZO foramen from inferolateral angle of orbit was 9+2.51 mm and 7.8+1.74 mm on right and left side respectively. The mean distance from infraorbital foramen was 29.93+2.76 mm and 30.19+ 3.52 mm on right and left side respectively. Single ZF foramen in 40% and 42%, double in 10% and 8%, 3 in 4% on right side and 4 in 2% on left sides were seen. In the remaining 46% and 48% of bones, the ZF foramen was absent. Mean distance from inferolateral angle of orbit was 8.05+2.68 and 9.15+2.11 mm respectively on the right and left side. Mean distance from infraorbital foramen was 25.45+4.35 mm and 25.42+4 mm respectively on right and left side. CONCLUSION: The location of ZO and ZF foramen can be population specific and knowledge of its location is important during stabilization of zygomatic fractures, in endoscopic subperiosteal facelift.

Aortic aneurysm: a case report with emphasize on microscopic and surgical anatomy.

We report a case of fusiform type of abdominal aortic aneurysm which was found during the routine dissection of a cadaver, done for teaching the undergraduate medical students. The aneurysm was seen unruptured and positioned below the renal arteries, just above the aortic bifurcation. This study illustrates the microscopic and surgical anatomy of the aneurysm with added literature review and clinical implications. We believe that the knowledge of this vascular pathology will be enlightening for broad specialties of medicine and medical science researchers alike.

Bilateral anomaly of rectus capitis posterior muscles in the suboccipital triangle and its clinical implication.

Rectus capitis posterior muscles are located in the suboccipital triangle and function in extension and lateral rotation of the head and neck. There are two of these muscles on each side: the rectus capitis posterior major and the rectus capitis posterior minor. In the present case we observed bilateral double rectus capitis posterior major muscle and bilateral absence of rectus capitis posterior minor muscle. The additional rectus capitis posterior major may put more strain to the spine of the axis and mean time the bilateral absence of rectus capitis posterior minor muscles will result in muscular in coordination in the suboccipital region while balancing the head. The present variation should be considered in the aetiology of cervicogenic headache.

Is elective induction safe? A prospective analysis.

OBJECTIVES: To identify whether electively induced labor places the mother or her fetus at an increased risk as compared to her spontaneous labor cohort. To quantify the risk of cesarean section in the induced group. METHODS: A prospective analysis comparing 200 electively induced parturients with 200 matched controls who labored spontaneously, in 1 year from April 2007 to April 2008. The parturients were between 37 and 41 weeks of gestation and had no complications necessitating induction. RESULTS: Induction per se was not associated with a statistically significant increase in cesarean section rates. Only when associated with nulliparity, low bishop score, and birth weight >3.5 kg, the risk of cesarean increases. CONCLUSION: Elective induction does not appear to pose an increased risk to the mother or her fetus in a carefully selected patient population. However, when associated with risk factors the cesarean rate increases. Hence informed consent should be taken before induction.

An anatomical and clinical insight on brachialis with emphasis on portal's muscle.

There have been conflicting descriptions regarding the anatomy of portal's muscle in the literature. The purpose of the present study seeks to clarify the presence, morphology, and potential function of this muscle in order to refine surgical techniques around the elbow. Forty-eight formalin fixed upper extremities were dissected and observed for attachments of brachialis meticulously and particularly over the anterior elbow joint capsule with special emphasis to the anatomical relation of the deeper fibers to the joint. It was found that there were varying patterns of muscular attachments over the anterior joint capsule with majority of the fibers of brachialis simply passing superficial to the joint capsule. The highest concentration of fibers was noted on the inferior part of the joint capsule, which was attached via connective tissue. These fibers were the deepest fibers of brachialis muscle that had no affect on the joint capsule following tension. Knowledge of this muscle may help the surgeons who operate in the elbow region to be tension free in preserving such fibers of clinically less importance.

Morphometry of A1 segment of the anterior cerebral artery and its clinical importance.

BACKGROUND AND AIM: Anterior cerebral artery, one of the terminal branches of the internal carotid artery is an important vessel taking part in the formation of circle of Willis. It supplies a large part of the medial surface of the cerebral hemisphere containing the areas of motor and somatosensory cortices of the lower limb. Aim of this study was the morphometry of A1 segment of the anterior cerebral artery. MATERIALS AND METHODS: 93 formalin fixed brain specimen of either sex and of Indian origin were studied. The mean length, mean external diameter and the anomalies present in A1 segment of the vessel were studied in detail and photographed. RESULTS: The mean length of A1 segment of the vessel was 14.49+/-0.28 mm and 14.22+/-0.22 mm on right and left side respectively. The mean external diameter of the vessel on right and left side was 2.12+/-0.07 mm and 2.32+/-0.06 mm respectively. Narrowing, aneurysm formation, buttonhole formation and median anterior cerebral artery were the anomalies seen with an occurrence of 15.05%, 5.37%, 3.22% and 12.9%, respectively. The above anomalies did not have any sex or side predilection. CONCLUSION: Knowledge of morphometry of the vessel will be of use to neurosurgeons while performing the shunt operation, in assessing the feasibility of such operations and in the choice of patients. From this study we infer that the morphometry of anterior cerebral artery varies in different population and that the neurosurgeons operating should have a thorough knowledge of the possible variations.

Anatomy of plantaris muscle: a study in adult Indians.

AIM: The plantaris muscle (PM) and its tendon is subject to considerable variation in both the points of origin and of insertion. The present study was carried out to fi nd the different types of origin, insertion and possible variations of the PM in the population of southern costal region of India. MATERIALS AND METHODS: 52 embalmed (Formalin fixed) cadaver lower limbs of 26 males (age ranged 48-79 years, mean age 68 years) were dissected, to study the origin and insertion of PM. Various dimensions (length and width) of plantaris muscle belly and its tendon were also measured. RESULTS: Three types of origin and equal number of insertion were noticed in the present study. The PM took origin from type I: Lateral Supracondylar ridge, Capsule of Knee joint and Lateral head of gastrocnemius in 73.07% cases; type II: Capsule of Knee joint and Lateral head of gastronemius in 5.76% cases; type III: Lateral Supracondylar ridge , Capsule of Knee joint , Lateral head of gastrocnemius and fibular collateral ligament in 13.46% cases. The plantaris tendon was inserted into type I: to the flexor retinaculum of foot in 28.84% cases; type II: independently to the os calcaneum in 36.53% cases; type III: to the tendocalcaneus at various levels in 26.92% cases. In four lower limbs (7.69%) the plantaris muscle was completely absent. Additionally the length and width of the plantaris muscle and its tendon were measured to know any side difference. There were no statistically significant differences between the measurements of left and right side (p>0.05). CONCLUSION: Present study will help the surgeons while attempting various surgical procedures in and around the posterior aspect of knee involving plantaris.

Dual innervations of mylohyoid muscle: a case report.

Mylohyoid and anterior belly of the digastric muscles are supplied by a branch from the inferior alveolar nerve called the mylohyoid branch. Here we present an unusual finding in a 60-year-old male cadaver in which the mylohyoid muscle is supplied by a branch from hypoglossal nerve in addition to its usual nerve supply. Hypoglossal nerve after giving superior root of the ansa cervicalis and muscular branches to thyrohyoid and geniohyoid muscles gave another branch to supply the mylohyoid muscle. Any variation in the formation and/or branching pattern of ansa cervicalis or hypoglossal nerve can cause confusion and may complicate the procedures involving this nerve such as skull base surgery, neck dissection, and anterior cervical spinal approach. Developmentally mylohyoid muscle is from the mesoderm of the first arch, therefore, must be innervated by the mandibular nerve. Hence, we report this uncommon variation based on embryology and the clinical implications.

An anomalous belly of sternothyroid muscle and its significance.

The sternothyroid muscle and other infrahyoid muscles play a vital role in the process of vocalization, swallowing and mastication by mobilizing the hyoid bone and thyroid cartilage. During routine dissection of a 70-year-old male cadaver, we observed an anomalous sternothyroid muscle. It was arising from the posterior surface of the manubrium sterni and partly from the cartilage of the first rib. After a distance of 3.3 cm, the belly of sternothyroid muscle was divided into lateral and medial fibers. The lateral belly was inserted above the oblique line on the lamina of the thyroid cartilage, but the medial additional belly turned into a tendon, which was crossing over the thyroid artery and inserted to the hyoid bone and intermediate tendon of digastric muscles. The superior thyroid artery was below the above tendon on its way to the thyroid gland. The muscle was innervated by a branch from the ansa cervicalis.

Duplication of falx cerebelli, occipital sinus, and internal occipital crest.

The incidence of variations of falx cerebelli was studied in 52 adult cadavers of south Indian origin, at Kasturba Medical College Mangalore, after removal of calvaria. In eight (15.4%) cases, we observed duplicated falx cerebelli along with duplicated occipital sinus and internal occipital crest. The length and the distance between each of the falces were measured. The mean length of the right falces cerebelli was 38 mm and the left was 41 mm. The mean distance between these two falces was 20 mm. No marginal sinus was detected. Each of the falces cerebelli had distinct base and apex and possessed a distinct occipital venous sinus on each attached border. These sinuses were noted to drain into the left and right transverse sinus respectively. After detaching the dura mater from inner bony surface of the occipital bone, it was noted that there were two distinct internal occipital crests arising and diverging inferiorly near the posterolateral borders of foramen magnum. The brain from these cadavers appeared grossly normal with no defect of the vermis. Neurosurgeons and neuroradiologists should be aware of such variations, as these could be potential sources of hemorrhage during suboccipital approaches or may lead to erroneous interpretations of imaging of the posterior cranial fossa.

Unusual communication between the lingual nerve and mylohyoid nerves in a South Indian male cadaver: its clinical significance.

It is well known that variations in the branching pattern of the mandibular nerve frequently account for the failure to obtain adequate local anesthesia in routine oral and dental procedures, and also for the unexpected injury to branches of the nerves during surgery. During our routine dissection, we found the presence of a communicating branch between the mylohyoid and lingual nerves in a middle aged male cadaver. We also discussed its clinical and surgical implications in this report.

Accessory lateral pectoral nerves supplying the pectoralis major.

Certain surgical treatment failures of the brachial plexus lesions are due to the presence of anatomical variations. Anatomical knowledge of the pectoral nerves is of clinical importance during mastectomy, neurotization or other surgical procedures in the axilla. The present case describes three nerves arising from the lateral cord of brachial plexus supplying the pectoralis major muscle one below the other which was observed during routine dissection for undergraduate students. Knowledge of certain variations as in the present case may be advantageous for cosmetic augmentations during radical mastectomy where pectoralis major can be preserved because of its additional nerve supply in the lower part.

A case report on accessory brachialis muscle.

Supernumerary heads or slips of brachialis (anticus) muscle is one among the most striking variations, described and encountered in the dissection routine. Very few studies are quoted in the list of its anomalies. We present a unique occurrence of an accessory brachialis muscle (acBr) that formed a fibro-muscular tunnel after blending with the medial intermuscular septum in the lower part of the arm. This tunnel contained the median nerve, the brachial artery and few additional twigs that innervated the neighboring muscles. Because of its intimate topographical relation with the neurovascular bundle, there is no doubt about its role, in the etiogenesis of various compression syndromes. Also, the brachial flexors received innervation from the median nerve, due to the absence of the musculo-cutaneous nerve. We discuss in this report the possible embryogenesis and the clinical application of this variation that can aid the physicians in their approach and required treatment.

Anatomical variations of the thyroid gland: possible surgical implications.

INTRODUCTION: The organogenesis of the thyroid gland in humans is often disturbed, leading to a variety of morphological variations of the gland, such as hypoplasia, ectopy, hemiagenesis and agenesis. As the morphological variations are usually diagnosed incidentally during examination for other thyroid gland diseases, the true incidence is therefore uncertain. METHODS: This study was structured to investigate the gross anatomical features of the thyroid gland in 105 (88 male and 17 female) cadavers from the coastal belt of southern India, an endemic goitre region. RESULTS: The pyramidal lobe was present in 61 (58 percent) male cadavers, and 52 (49.5 percent) cadavers showed the presence of the levator glandulae thyroideae. 33 percent of the specimens studied showed agenesis of the isthmus. However, the accessory thyroid tissue was found in only one cadaver. CONCLUSION: This study highlights the various developmental anomalies of the thyroid gland, which forms a cornerstone to safe and effective surgery.

An accessory iliacus muscle: a case report.

We present a case of an anomalous accessory iliacus muscle in the iliac fossa which gets originated from the iliac crest and inserting along with iliopsoas, and appear to compress the L4 root of femoral nerve. During the routine dissection of a male cadaver aged 58 years, we found an accessory iliacus muscle. The L2 and L3 nerve roots joined the L4 root distal to the accessory iliacus muscle. The L4 root of the femoral nerve supplied accessory iliacus muscle. Accessory iliacus muscle might cause tension on the femoral nerve resulting in referred pain to the hip and knee joints and to the lumbar dermatome L4. The clinical significance of this variant muscle and its importance in the femoral nerve entrapment has been discussed.

Multiple muscular anomalies of upper extremity: a cadaveric study.

During routine cadaveric dissection, we encountered multiple muscular anomalies in a 58-year-old embalmed male cadaver. All the variations were encountered on the flexor compartment of right upper limb. The anomalies include an axillary arch (Aa) in the axilla, a third head of biceps brachii (Thb) in the arm, a reverse palmaris longus (Rpl) and a Gantzer's muscle (Gm) in the forearm and an unusually large palmaris brevis muscle (Pbm) in the palm. Anatomical description is achieved by measuring the length, width and attachments of the above-mentioned variants. The morphological and clinical significance of the anomalous muscles are discussed.

A cadaveric study of the testicular artery in the South Indian population.

INTRODUCTION: The male gonadal arteries, namely the testicular arteries, may vary at their origin and arise from the renal artery, suprarenal artery or lumbar artery. They may also be doubled, tripled or even quadrupled and may arise as a common trunk. With the advent of new intra-abdominal operative and laparoscopic techniques, the anatomy of the gonadal vessels has assumed much more importance. Therefore, a study was designed to assess the percentage of normal and aberrant origin and course of the testicular artery in the Indian population. METHODS: The posterior abdominal walls of 34 male cadavers (68 sides) were dissected and studied for the variations in the origin and course of the testicular arteries. RESULTS: In 85.3 percent of the cases, the male gonadal artery was normal in origin, number and course. However, in the remaining 14.7 percent, various anomalies in the testicular artery were noted. CONCLUSION: The variations in the testicular arteries are attributed to their embryological origin. A deep knowledge of these variations and their relations to the adjacent structures is very important in avoiding the complications in operative surgery.

The palmaris longus muscle: its anatomic variations and functional morphology.

The functional morphology and evolution of the superficial forearm flexor, the palmaris longus, have long fascinated kinesiologists, physical anthropologists and anatomists alike. The anomalies, agenesis, variations and polymorphic presentation of the muscle, coupled with its biomechanical role in the performance of flexion and supination through distal articulations in the upper limb, have formed the base for many studies found in medical literature. We present data from published sources, along with our observations on the kinetics of palmaris longus, drawn from a series of dissections done on 30 cadavers. Complete agenesis was seen in four limbs. Reversal in the muscle-tendon orientation was seen in two limbs and duplication in one limb. The functional dynamics of the muscle and the clinical implication of its modifications in humans are discussed. We believe that every surgeon must be aware of the variations, since this, otherwise unimportant muscle, provides a very useful graft in tendon surgery.

Additional branches of celiac trunk and its clinical significance.

The anatomical variations of the abdominal arteries are important due to its clinical significance. Various types of vascular anomalies are frequently found in human abdominal viscera, during cadaveric dissection and diagnostic radiological imaging. The present report describes a variation in the celiac trunk as found during routine dissection in a 59-year-old male cadaver. The celiac trunk (CT) was unusually lengthy and took origin from the left antero-lateral surface of the abdominal aorta. Altogether, there were five branches, including three classic branches of CT. The left phrenic artery (LPA) was the first branch of the CT. The remaining four branches were left gastric artery (LGA), splenic artery (SA), common hepatic artery (CHA) and gastroduodenal artery (GDA). There was an arterial loop between the posterior branches of the superior pancreatico-duodenal artery (SPDA), arising from the GDA, and the posterior branch of the inferior pancreatico-duodenal artery (IPDA), arising from the superior mesenteric artery (SMA). The arterial loop formed by the above arteries, supplied the head of the pancreas and duodeno-jejunal flexure. The embryological and clinical significance of above variations has been described.

Accessory brachialis muscle: a case report.

Variations of arm flexors are not uncommon with the exception of brachialis muscle. The role of brachialis is critical as it is the primary flexor of the elbow joint. Variations of brachialis are rare in literature. We present a case of an accessory-brachialis muscle (AcBr), found during routine cadaveric dissection. The AcBr originated from the lateral aspect of the brachialis muscle and lateral intermuscular septum. During its course towards the elbow, it crossed over the radial nerve and the distal tendon splits into two. The medial slip ran over the ulnar artery and merged with the deep fascia covering the pronator teres muscle, whereas lateral slip was inserted to the fascia covering the supinator. In the ipsilateral arm, an additional lateral cutaneous nerve of forearm (LCNF) was found coursing over the brachialis muscle medial to the LCNF. Clinical consideration of the present variations has been discussed. The present variation should be considered in the etiology of radial-tunnel syndrome (RTS).