Anatomical and histological study of the alar fascia.

INTRODUCTION: The alar fascia remains one of the most variably described fascial structure in the human body. Much disagreement persists in the literature and mainstream anatomical texts about its anatomy, function, and clinical significance. It is generally described as a coronally oriented fascial sheet separating the retropharyngeal space anteriorly from the danger space posteriorly. The current study aimed to confirm the presence of the alar fascia and delineate its anatomical characteristics, connections, and potential function through gross dissection and microscopic analysis. Possible clinical and surgical implications are considered. METHODS: Twelve (12) cadaveric necks were dissected and examined histologically. Smooth muscle (αSMA), nerve (S100 protein), and myosin proteins were identified immunohistologically to characterize the composition and possible functions of the alar fascia. RESULTS: The alar fascia was found in all specimens spanning between the carotid sheaths. Morphologically, it was not a delamination or derivative of the prevertebral fascia. It extended from the base of the skull to the upper thoracic level (T2) where it fused with the visceral fascia. No midsagittal connection was found between the alar and visceral fasciae. Immunohistochemically, the alar fascia was positive in focal areas for αSMA and S100 proteins but negative for fast and slow myosin. CONCLUSION: The alar fascia is an independent and constant coronal fascial layer between the carotid sheaths. It contains neurovasculature and may limit the spread of retropharyngeal infections into the thorax as well as facilitate normal physiological functions of the cervical viscera.

Sternalis muscle, what every anatomist and clinician should know.

The sternalis muscle is a well documented but rare muscular variation of the anterior thoracic wall. It lies between the superficial fascia and the pectoral fascia and is found in about 8% of the population. It presents in several morphological variants both unilaterally and bilaterally and has no apparent physiological function. There is still much disagreement about its nerve supply and embryological origin. With the advent of medical imaging and thoracic surgery the clinical importance of this muscle has been re-emphasized. It has been implicated in misdiagnosis of breast masses on routine mammograms owing to its parasternal location and relative unfamiliarity among radiologists. When undetected before any thoracic surgery, it has the potential to interfere with and prolong such procedures. When present and detected preoperatively it can be used as a muscular flap in reconstructive surgeries of the breast and neck. This article will present the sternalis muscle with special emphasis on its morphology, homology, and clinical significance.

One is the loneliest number: a review of the ganglion impar and its relation to pelvic pain syndromes.

The ganglion impar is often overlooked as a component of the sympathetic nervous system. Despite its obscurity, this ganglion provides a pathway for neurons by accommodating postganglionic sympathetics, visceral afferents, and somatic fibers traveling to and from the pelvis. Its classic anatomic location as described in the 1720's held up until recently, with the current literature now revealing a great deal of anatomical variability. This variation becomes important when the ganglion impar is used as a treatment target for patients with chronic pelvic pain - its primary clinical implication. The aim of this review was to provide a better understanding of the anatomy of ganglion impar, accounting for variation in size, shape, and location. In addition, the clinical importance and treatment modalities associated with the ganglion impar are outlined.