Morphometric analysis of the palatine triangle in adult human skulls: a potential aid for anthropologists and intraoral bone grafts.

Morphometrics of the hard palate is an important aspect of forensic anthropology and odontology. Palatine triangle is a triangular area in the hard palate formed by the palatine processes of the maxillae, which can aid intraoral bone grafts. We present the osteological measurements of the palatine triangle (maxillary palate) based on sex, compare it with other hard palate parameters, and establish the correlation between them. Seventy-seven male skulls and 36 female skulls were examined. Various morphometric measurements of the hard palate and palatine triangle were performed meticulously. Mean and standard deviation of each parameter were computed for groups using SPSS 16.0. Relationships between all parameters were analyzed using Pearson's rank correlation test. The mean palatine length was 38.84 ± 3.75 mm in males and 37.22 ± 4.12 mm in females; the mean palatine breadth was 31.36 ± 2.61 mm in males and 29.78 ± 3.07 mm in females. The mean area of the palatine triangle was 600.88 ± 80.16 mm2 in male skulls and 547.96 ± 94.28 mm2 in the female skulls. Statistically significant difference in various measurements of the palatine triangle and hard palate between the male and female skulls was noted. Leptostaphyline (narrow palate) was the most prominent type of palate. The area of the palatine triangle showed a strong positive correlation between the total length and breadth of the palate for both male and female skulls. A strong positive correlation was also observed between the palate length and the palatine triangle length. Palatine index and palate breadth had a statistically significant moderate linear relationship. The maxillary palate length, breadth, and area of the palatine triangle were higher in males when compared to females in South Indian origin skulls. Most of the skulls had a narrow palate. The results of this metric analysis of the palatine triangle may lead to a new concept of anatomical research into studying the hard palate, which can be used for sexual dimorphism.

Effect of Photobiomodulation Therapy on Oxidative Stress Markers in Healing Dynamics of Diabetic Neuropathic Wounds in Wistar Rats.

BACKGROUND: Prolonged and overlapping phases of wound healing in diabetes are mainly due to the redox imbalance resulting in the chronicity of the wound. Photobiomodulation therapy works on the principle of absorption of photon energy and its transduction into a biological response in the living tissue. It alleviates the cellular responses, thereby improving the mechanism of wound healing in diabetes. OBJECTIVE: To find out the effect of photobiomodulation therapy of dosage 4 J/cm2 in the healing dynamics of diabetic neuropathic wounds in Wistar rats and its relation with oxidative stress markers. METHODOLOGY: Diabetes was induced using Streptozotocin of 60 mg/kg of body weight to eighteen female Wistar rats. Neuropathy was induced by the sciatic nerve crush injury followed by an excisional wound of 2 cm2 on the back of the animal. Experimental group animals were treated with dosage 4 J/cm2 of wavelength 655 and 808 nm, and control group animals were kept unirradiated. The biomechanical, histopathological, and biochemical changes were analysed in both groups. RESULTS: There was a reduction in mean wound healing time and an increased rate of wound contraction in the experimental group animals compared to its control group. The experimental group showed improved redox status, and histopathological findings revealed better proliferative cells, keratinisation, and epithelialization than un-irradiated controls. CONCLUSIONS: Photobiomodulation therapy of dosage 4 J/cm2 enhanced the overall wound healing dynamics of the diabetes-induced neuropathic wound and optimised the oxidative status of the wound, thereby facilitating a faster healing process.

Hippocampal neural cell degeneration and memory deficit in high-fat diet-induced postnatal obese rats- exploring the comparable benefits of choline and DHA or environmental enrichment.

PURPOSE: Childhood obesity increases risk for neural dysfunctions causing learning and memory deficits. The objective of the study is to identify the effects of high fat diet-induced obesity in postnatal period on serum lipids, memory and neural cell survival in hippocampus and compare the role of choline and DHA or environmental enrichment in attenuating the alterations. MATERIALS AND METHODS: 21 day postnatal male Sprague Dawley rats were assigned as Normal control [NC] fed normal chow diet, Obesity-induced [OB] fed high fat diet, Obesity-induced fed choline & DHA [OB + CHO + DHA], Obesity-induced environmental enrichment [OB + EE] [n = 8/group]. Memory was assessed using radial arm maze. Subsequently blood was collected for serum lipid analysis and rats were euthanized. 5 µm hippocampal sections were processed for cresyl-violet stain. Surviving neural cells were counted using 100 µm scale. RESULTS: Memory errors were significantly higher [p < 0.001, 0.01] in OB compared to same in NC rats. Mean number of surviving neural cells in hippocampus of OB was significantly lesser [p < 0.01] compared to same in NC. Interventions in OB + CHO + DHA and OB + EE significantly attenuated [p < 0.01] memory errors and number of surviving neural cells in hippocampus [CA1, CA3 and DG] compared to same in OB. Moreover, hippocampal neural cell survival was found to be inversely related to serum lipid profile in OB group and was attenuated in OB + CHO + DHA and OB + EE rats. CONCLUSIONS: High fat diet-induced postnatal obesity in rats causes CA1/CA3 hippocampal neuro-degeneration and memory deficits. Supplementation of choline and DHA in obese rats attenuates these deficits.

Human bone marrow-derived mesenchymal stromal cells in combination with silymarin regulate hepatocyte growth factor expression and genotoxicity in carbon tetrachloride induced hepatotoxicity in Wistar rats.

BACKGROUND: To evaluate the antimutagenic potential of combination treatment of human bone marrow-derived mesenchymal stromal cells (BM-MSCs) and silymarin and its effect on hepatocyte growth factor levels in CCl4 induced hepatotoxicity in Wistar rats. METHODS: Hepatotoxicity was induced in adult female Wistar rats using carbon tetrachloride (CCl4 ). Thirty-six rats were randomly divided into six groups with six rats in each group: Group 1 (normal control group), Group 2 (received only CCl 4 ), Group 3 (CCl 4 +low dose BM-MSCs), Group 4 (CCl 4 +high dose BM-MSCs), Group 5 (CCl 4 + silymarin), Group 6 (CCl 4 +silymarin+high dose BM-MSCs). Thirty days after the treatment, blood samples were collected for hepatocyte growth factor estimation. The rats were then killed, bone marrow was extracted for chromosomal aberration assay. Liver tissue was processed for evaluating the DNA fragmentation assay, histopathology, and scanning electron microscopy study. RESULTS: Combination treatment of silymarin and high dose BM-MSCs significantly (P < 0.05) restored the plasma hepatocyte growth factor levels which were comparable with normal levels and exhibited significant antimutagenic and antiapoptotic activity by decreasing the frequency of structural chromosomal aberrations and suppressing the DNA fragmentation in liver tissue samples. The combination treatment produced significant hepatoprotective effect which was supported by histopathology and scanning electron microscopy study. CONCLUSION: Results indicate that the treatment of BM-MSCs in combination with silymarin had a better hepatoprotective and antimutagenic effect and represents a novel strategy for the treatment of hepatotoxicity.

Anatomical and clinical significance of pterygospinous and pterygoalar ligaments and bony bars in dentistry / Significado anatómico y clínico de los ligamentos pterigoespinoso y pterigoalar y los puentes óseos en odontología

The Pterygospinous Ligament (PSL) extends from the Pterygospinous process of the lateral Pterygoid plate to the spine of the sphenoid bone. Sometimes, it may be ossified forming a bar of bone bounding the pterygospinous foramen to which mandibular nerve and its branches are variably related. Mandibular and chorda tympani nerves may get compressed depicting various clinical symptoms, which in turn depend upon dimensions of the foramen and grades of compression. Therefore, knowledge of the position and extent of ossification of PSL and its relation to the important structures in the deep infratemporal fossa is important for radiologists, neurologists, maxillofacial surgeons, dental surgeons and anesthesiologists during various anesthetic and surgical procedures.

El ligamento Pterigoespinoso (LP) se extiende desde el proceso Pterigoespinoso de la placa Pterigoideo lateral a la espina etmoidal del hueso esfenoides. A veces, se puede osificar formando un puente de hueso que une el foramen espinoso con el cual el nervio mandibular y sus ramas están relacionados de manera variable. Los nervios mandibulares y el cordón timpánico se pueden comprimir resultando en diversos síntomas clínicos, que a su vez dependen de las dimensiones del foramen y los grados de compresión. Por lo tanto, el conocimiento de la posición y el grado de osificación del ligamento pterigoespinoso y su relación con las estructuras importantes en la fosa infratemporal profunda es importante para radiólogos, neurólogos, cirujanos maxilofaciales, cirujanos dentales y anestesistas durante diversos procedimientos anestésicos y quirúrgicos.

Assessment for learning: a needs analysis study using formative assessment to evaluate the need for curriculum reform in basic sciences.

A needs analysis study for curriculum reform in basic sciences was conducted at Melaka Manipal Medical College, India, by means of a formative assessment method, namely Basic Science Retention Examination (BSRE). Students participated in a BSRE, which comprised recall and clinical multiple-choice questions in six discipline areas. They also rated the clinical relevance of each question and provided responses to three open-text questions about the exam. Pass rates were determined; clinical relevance ratings and performance scores were compared between recall type and clinical questions to test students' level of clinical application of basic science knowledge. Text comments were thematically analyzed to identify recurring themes. Only one-third of students passed the BSRE (32.2%). Students performed better in recall questions compared with clinical questions in anatomy (51.0 vs. 40.2%), pathology (45.1 vs. 38.1%), pharmacology (41.8 vs. 31.7%), and biochemistry (43.5 vs. 26.9%). In physiology, students performed better in clinical questions compared with the recall type (56.2 vs. 45.8%). Students' response to BSRE was positive. The findings imply that transfer of basic science knowledge was poor, and that assessment methods should emphasize clinical application of basic science knowledge.

Bifurcated Great Saphenous Vein: A Report on Its Therapeutic and Diagnostic Perspectives.

The great saphenous vein (GSV) is the longest superficial vein in the body extending from the medial malleolus to groin skin crease level. The clinical usage of GSV has made its anatomical variations noteworthy. Since many tributaries accompany it, GSV is often mistaken with the variant vein. Duplication and persistence of accessory GSV are the two major clinically significant anatomical variations of the GSV which is frequently misinterpreted as a synonym. In the present case, we report a unique variation of GSV wherein it bifurcated into anterior and posterior divisions of two uneven calibers at knee region, which then reunited at thigh region to form a single vein before its termination into the femoral vein. Locating such variations of bifurcated GSV is a challenging task for both diagnostic and therapeutic tactics, particularly in venography procedures as it might lead to iatrogenic traumatic injury of the vessel.

Preinguinal Splitting and Reunion of Femoral Nerve Entrapping the Fleshy Fibres of Iliacus Muscle - A Case Report.

Division of nerves close to their origin and muscular entrapments by nerves in the limbs is not very common. Femoral nerve is the largest branch of the lumbar plexus and arises from dorsal divisions of ventral rami of L2 to L4 spinal nerves. During routine cadaveric dissection for first year medical students at Melaka Manipal Medical College (Manipal Campus), Karnataka, India, we observed a variation in the division and course of left femoral nerve in about 65-year-old male cadaver. The femoral nerve was split into two divisions above the inguinal ligament after its origin from the lumbar plexus. The lower division of the nerve passed deep to the iliopsoas muscle fibres and the upper division ran superficial to iliacus muscle deep to fascia iliaca. Both the divisions joined just above the inguinal ligament to form the trunk of the femoral nerve. Further course and distribution of the nerve was normal. The reports have shown that compression neuropathies of femoral nerve in the limbs are caused by neoplastic masses, vascular abnormalities and also by different anomalous muscles. Such neuropathies may also result from indirect compression of femoral nerve between the fibres of psoas major muscle and lateral pelvic wall. The potential clinical importance of above mentioned variations in the division of femoral nerve would emphasize the surgeons to diagnose the neuromuscular entrapments and consequent alterations of sensation in the anterior and medial aspects of the thigh.

Unilateral Existence of Chondro-epitrochlearis: Its Embryological Perspectives and Clinical Implications.

Chondroepitrochlearis (CET) is an anomalous muscular slip that originates from the pectoralis major muscle and inserts into epicondyle of the humerus. The morphology of this variant form of pectoralis major can vary from slender to strong musculo-tendinous. In its course, it usually crosses the neurovascular structures of arm; their compression is a major complication that could be manifested by its persistence. In the present case, potentially anomalous CET muscle with the slender slip of origin, but strong tendinous insertion to the medial epicondyle of the humerus was found unilaterally. This musculo-tendinous structure was found to be compressing the brachial artery and median nerve in the arm. Detailed embryological and clinical perspective of such variant muscular slip helps the physiotherapists, orthopaedicians in their treatment strategy in complain of restricted shoulder movement. It may also help the neurologists, radiologists in their diagnostic approach of ulnar neuropathy.

Multiple Heads of Gastrocnemius with Bipennate Fiber Arrangement- A Clinically Significant Variation.

It is common to have additional muscles or muscle slips in the extremities. Some of them may compress the nerves and vessels or restrict the movements, while others may enhance the muscular activity. However, a small number of them may go unnoticed. Knowledge of such variant muscles becomes important for plastic surgeons while performing various reconstructive surgeries and for clinicians while managing the pain. A case of multiple heads of gastrocnemius muscle was observed during routine dissection of the right lower limb of about 70-year-old male cadaver. It was observed that the medial head of gastrocnemius was attached to the femur with 3 thick heads and lateral head was arising from the lateral condyle of femur by 3 thick heads. All the heads of the muscles remained separate till they formed tendocalcaneus. Some of these heads showed bipinnate fiber arrangement. All the heads were innervated by the branches of tibial nerve. As the muscle heads passed down from their origin, they entrapped the sural nerve and sural nerve was seen emerging at the beginning of tendocalcaneus. Further, detailed literature and the clinical and surgical importance of the case are discussed.

Looped and Tortuous Ulnar Artery - An Erratic Unilateral Vascular Presentation in the Proximal Forearm.

Precise and detailed knowledge of possible anatomical variations of the arterial pattern in the upper extremity is vital during reparative surgery in this region. Scientific literatures witnessed several reports on variant origin and branching pattern of ulnar artery. But report on looped and tortuous ulnar artery is lacking in the literature. We report here a unique case of ulnar artery having double loop at its commencement giving it an appearance of sigmoid shape and its undue tortuous course in the forearm. Such an unusual and unpredictable variation of ulnar artery is vulnerable for life threatening hemorrhage during clinical approaches. It could also lead to misinterpretation of CT scans as presence of tumours. Awareness on such exceptional anatomical discrepancy of ulnar artery is important to clinicians, neuroradiologists and radiologists in general.

Impact of Seasonal Variant Temperatures and Laboratory Room Ambient Temperature on Mortality of Rats with Ischemic Brain Injury.

INTRODUCTION: A popular rat model for hypoperfusion ischemic brain injury is bilateral common carotid artery occlusion (BCCAO). BCCAO surgery when performed in varying geographical locations and during different seasons of the year is reported to have variable mortality rates. Studies have also documented the diminishing influence of Ketamine-Xylazine (KT-XY) on thermoregulatory functions in rodents. AIM: To explore the impact of seasonal variant temperatures and laboratory room ambient temperatures on mortality of rats following BCCAO surgery. MATERIALS AND METHODS: The study has two parts: 1 The first part is an analysis of a three year retrospective data to explore the association between the geographical season (hot summer and cold winter) induced laboratory room ambient temperature variations and the mortality rate in KT-XY anaesthetized BCCAO rats. 2. The second part investigated the effect of conditioned laboratory room ambient temperature (CAT) (23-25(0)C) in KT-XY anaesthetized BCCAO group of rats. Rats were divided into 4 groups(n =8/group) as-Normal control, BCCAO and Sham BCCAO where they were all exposed to unconditioned ambient temperature (UCAT) during their surgery and postoperative care. And finally fourth group rats exposed to CAT during the BCCAO surgery and postoperative care. RESULTS: Pearson's chi-square test indicates a significantly high association (p<0.006) between post-BCCAO mortality and hot season of the year. CAT during the hot season reduced the mortality rate (24% less) in post- BCCAO rats compared to the rats of UCAT. CONCLUSION: Despite seasonal variations in temperature, conditioning the laboratory room ambient temperatures to 23-25(0)C, induces hypothermia in KT-XY anaesthetized ischemic brain injured rodents and improves their survival rate.

Comparative Effect of Lisinopril and Fosinopril in Mitigating Learning and Memory Deficit in Scopolamine-Induced Amnesic Rats.

Lisinopril and fosinopril were compared on scopolamine-induced learning and memory deficits in rats. A total of eighty-four male Wistar rats were divided into seven groups. Group I received 2% gum acacia orally for 4 weeks, group II received normal saline, and group III received scopolamine (2 mg/kg/ip) as single dose. Groups IV and V received lisinopril ( 0.225 mg/kg and 0.45 mg/kg), while Groups VI and VII received fosinopril (0.90 mg/kg and 1.80 mg/kg), respectively, orally for four weeks, followed by scopolamine (2 mg/kg/ip) given 45 minutes prior to experimental procedure. Evaluation of learning and memory was assessed by using passive avoidance, Morris water maze, and elevated plus maze tests followed by analysis of hippocampal morphology and quantification of the number of surviving neurons. Scopolamine induced marked impairment of memory in behavioral tests which correlated with morphological changes in hippocampus. Pretreatment with fosinopril 1.80 mg/kg was found to significantly ameliorate the memory deficits and hippocampal degeneration induced by scopolamine. Fosinopril exhibits antiamnesic activity, indicating its possible role in preventing memory deficits seen in dementia though the precise mechanism underlying this effect needs to be further evaluated.

Presence of multiple tendinous insertions of palmaris longus: a unique variation of a retrogressive muscle.

BACKGROUND: Palmaris longus, being the most variable muscle of the upper extremity is generally considered important morphologically rather than functionally. The palmar aponeurosis represents the distal part of the tendon of Palmaris longus. CASE DETAILS: We report here a unique case of palmaris longus presenting variation distally as its tendon divides to gain multiple attachments with the fascia covering the abductor pollicis brevis, flexor retinaculum and the tendon of flexor carpi ulnaris. In addition, it also continues as palmar aponeurosis as its normal course. CONCLUSION: Presence of this kind of variation might result in compression of the median and ulnar nerves and may aggravate the complications in case of inflammation of palmar aponeurosis thus mimicking the manifestations of Dupuytren's contracture.

Unique formation of sciatic nerve below the piriformis muscle - a case report.

Dorsal and ventral divisions of ventral rami of lower lumbar and sacral spinal nerve were found to pass ventral and dorsal to the piriformis muscle respectively. These divisions joined each other below the piriformis muscle to form sciatic nerve. This low formation of sciatic nerve was observed in distal part of left gluteal region of a 50-year-old male cadaver. The sciatic nerve thus formed passed caudally into back of thigh and divided into tibial and common peroneal nerves in the upper part of popliteal fossa. In addition, a communicating nerve from the sciatic nerve was found to join the common peroneal nerve in the popliteal fossa. Such variations may lead to piriformis syndrome or non-discogenic sciatica.

Analysis of the morphometry and variations in the extensor digitorum brevis muscle: an anatomic guide for muscle flap and tendon transfer surgical dissection.

The extensor digitorum brevis muscle (EDB) is a practical option for use as an island flap or free flap when reconstructing soft tissue defects in the ankle as well as in the entire lower limb. It is frequently used to correct crossover toe deformity and other painful toe disorders. We evaluated the morphometry of the EDB in 44 formalin-fixed limbs. Length and width of the muscles were measured. Surface area was calculated as the product of length and width of the muscle. The length of each tendon was also measured from its origin to the point of distal attachment. Presence of any additional tendons was noted. Mean length, width, and surface area of the muscle were 7.39±0.71 cm, 4.1±0.37 cm, and 30.5±4.78 cm(2) on the right side and 7.2±0.84 cm, 3.9±0.37 cm, and 28.4±5.35 cm(2) on the left side, respectively. Morphometry of the tendons revealed that the tendon of the great toe had the highest mean length (9.5 cm) and the tendon of the fourth toe had the lowest mean length (6.3 cm). Four of the limbs studied (9.09%) had only three tendons. Three of the limbs studied (6.81%) had five tendons, and in one exceptional case (2.27%), six tendons were detected. These observations have significant value and are applicable to plastic and orthopedic surgery.

Anthropometric analysis of palpebral fissure dimensions and its position in South Indian ethnic adults.

OBJECTIVES: The morphology and anatomical relationship of periorbital features vary according to age, sex and ethnicity. Standard database regarding periorbital region is available for other ethnic groups. Since there is no data available in the literature, specifically for south Indian ethnic adults, the present study was carried out to determine the normal average values for South Indian ethnic population related to gender. METHODS: Anthropometric measurements of both eyes were done on standardized frontal view photograph of 200 South Indian ethnic adults aged 18 to 26 years. Parameters included were palpebral fissure width (PFW), palpebral fissure height (PFH), palpebral fissure inclination (PFI), outercanthal distance (OCD), interpupillary distance (IPD), intercanthal distance (ICD) and comparisons were made between the genders using the independent t test. RESULTS: Significant sexual dimorphism was noted in the given parameters. Palpebral fissure width (male: 31.08 mm; female: 29.90 mm), palpebral fissure inclination (male: 5.053°; female: 6.102°), outercanthal distance (male: 95.55 mm; female: 92.44 mm) and interpupillary distance (male: 66.72 mm; female: 62.59 mm). The palpebral fissure height (male: 11.30 mm; female: 11.58 mm) and intercanthal distance (male: 34.27 mm; female: 33.41 mm) showed no significant sexual differences. CONCLUSION: Statistically significant differences were found between South Indian ethnic males and female in certain key parameters. The present study suggests that ethnicity and gender should be considered in orbital surgery. To individualize the treatment planning and diagnosis, it is important for the surgeons to have knowledge of these local norms.

Identification of facial shape by applying golden ratio to the facial measurements: an interracial study in malaysian population.

BACKGROUND: The "golden ratio" is considered as a universal facial aesthetical standard. Researcher's opinion that deviation from golden ratio can result in development of facial abnormalities. AIMS: This study was designed to study the facial morphology and to identify individuals with normal, short, and long face. MATERIALS AND METHODS: We studied 300 Malaysian nationality subjects aged 18-28 years of Chinese, Indian, and Malay extraction. The parameters measured were physiognomical facial height and width of face, and physiognomical facial index was calculated. Face shape was classified based on golden ratio. Independent t test was done to test the difference between sexes and among the races. RESULTS: The mean values of the measurements and index showed significant sexual and interracial differences. Out of 300 subjects, the face shape was normal in 60 subjects, short in 224 subjects, and long in 16 subjects. CONCLUSION: As anticipated, the measurements showed variations according to gender and race. Only 60 subjects had a regular face shape, and remaining 240 subjects had irregular face shape (short and long). Since the short and long shape individuals may be at risk of developing various disorders, the knowledge of facial shapes in the given population is important for early diagnostic and treatment procedures.

Cortico-hippocampal salvage in chronic aluminium induced neurodegeneration by Celastrus paniculatus seed oil: Neurobehavioural, biochemical, histological study.

OBJECTIVE: To investigate the effects of Celastrus paniculatus seed oil in preventing the onset of chronic aluminum induced cortico-hippocampal neurodegeneration and oxidative stress. MATERIALS AND METHODS: An animal model of senile dementia of Alzheimer's type was produced by administering aluminum as aluminum chloride (4.2 mg/kg) intraperitoneally to male Wistar rats for 60 days and results compared to untreated control. Neurobehavioral investigations of Morris water maze tests, passive avoidance test, rotarod test and biochemical estimations of acetylcholineterase, malondialdehyde, glucose-6-phosphate dehydrogenase, superoxide dismutase, and hemoglobin in blood were performed fortnightly which gauged the extent of global oxidative stress and progressive neural damage. Findings were fortified by the above enzyme assays and histology of brain at necropsy. Prophylactic oral C. paniculatus in two doses 0.5 ml and 1 ml, were given to animals and the results were analyzed in comparison to a similar rodent model with standard drug donepezil (0.5 mg/kg) intraperitoneally. RESULTS: C. paniculatus showed a significant prevention in onset of aluminum induced neural insult and overall systemic oxidative stress which was corroborated by the enlisted neurobehavioral, biochemical, and histological evidence. CONCLUSION: C. paniculatus is a putative decelerator of Al-mediated Alzheimer's like pathobiology.

The venous chiasma between the basilic vein and the brachial vein: a case report.

Variations in the venous pattern of the arm are common. In this case report, we are presenting the variations of the brachial vein and the basilic vein.During the routine dissections which were done by medical undergraduate students, we observed some variations in the veins of the upper limb. In the current case, there was only one brachial vein which accompanied the brachial artery. The basilic vein originated from the medial side of the dorsal venous network, ascended along the medial side of the forearm and joined the brachial vein to form the axillary vein at the distal border of the teres major muscle. The basilic vein and the brachial vein joined with one another in the middle of the arm to form a unique venous chiasma.A large number of invasive procedures are carried out by using the veins of the upper limb, particularly in and distal to the axillary region. This type of a venous chiasma may lead to complications in these procedures.