Concurrent Variations of Celiac and Superior Mesenteric Arteries.

Celiac trunk is the first ventral branch of the abdominal aorta. It usually terminates by giving three branches; the common hepatic artery, the left gastric artery and the splenic artery. We report a rare variation of the branching pattern of the celiac trunk. The Celiac trunk divided into two branches; left gastric artery and splenicogastroduodenal trunk. The splenico-gastroduodenal trunk divided into splenic and gastroduodenal arteries. The superior mesenteric artery and hepatic artery took origin from a common hepato-mesenteric trunk. The hepatic artery had a winding course around the portal vein and hepatic duct. The knowledge of these variations is important while doing radiological investigations and liver transplant and pancreatic surgeries.

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.

Bifurcated Bicipital Aponeurosis Giving Origin to Flexor and Extensor Muscles of the Forearm - A Case Report.

Bicipital aponeurosis is usually attached to the antebrachial fascia on the medial side of forearm and to posterior border of ulna assisting in the supination of the forearm along with biceps brachii muscle. Variations in the bicipital aponeurosis may lead to neurovascular compression as reported earlier. In the present case, the bicipital aponeurosis had two slips i.e. medial and lateral. Medial slip gave origin to some fibers of pronator teres and flexor carpi radialis and the lateral slip gave origin to some fibers of brachioradialis. Such unusual slips of bicipital aponeurosis may distribute the stress concentration and may work in different directions affecting the supination of forearm by biceps brachii muscle and bicipital aponeurosis.

Unilateral Double Great Saphenous Vein: A Clinically Significant Case Report.

Great saphenous vein (GSV) is the longest vein in the body originating from the dorsum of the foot at medial malleolus to the level of groin skin crease. It is one among the clinically significant superficial veins of the lower limb. Double or duplication of GSV is considered to be one of its rarest variant forms, which might be often mistaken with the accessory saphenous vein. The overall incidence of duplicated GSV is reported to be 1%. We report herein, a unilateral duplication of GSV with its morphological and clinical perspectives. The major clinical complication that is often encountered from its duplication is recurrent incompetence of the GSV, which predisposes varicosity. Therefore, a thorough knowledge of venous anatomy is important for clinicians and sonographers.

Atypical arterial supply to the spleen by polar branches of splenic artery and accessory splenic artery - a case report.

Vascular anomalies of the spleen are usually asymptomatic. However, variant anatomy of splenic artery becomes clinically important, when the patients undergo diagnostic angiography for gastrointestinal bleeding or during transcatheter therapy. We report here a concurrent variant arterial pattern of the spleen. The splenic artery was unusually elongated and excessively tortuous. Prior to its normal termination into segmental arteries, it gave superior and inferior polar arteries which entered the spleen distal to corresponding ends of the splenic hilum. In addition to this, the spleen also received an additional blood supply from an accessory splenic artery arising from left gastro-epiploic artery. The accessory splenic artery entered the substance of the spleen through its lateral end. Presence of such kind of concurrent variant arterial pattern of spleen makes the surgeons obligatory to have prior knowledge to prevent bleeding during any surgical or radiological interventional procedures targeting the spleen, pancreas etc.

Absence of retromandibular vein associated with atypical formation of external jugular vein in the parotid region.

Veins of the head and neck exhibiting anatomical variations or malformations are clinically significant. Anatomical variation in the external jugular vein is very common. However, anatomical variation in the retromandibular vein is rare. In this paper, we report a rare case of complete absence of the retromandibular vein. In the absence of the retromandibular vein, the maxillary vein divided into anterior and posterior divisions. The posterior division joined the superficial temporal vein to form an atypical external jugular vein, and the anterior division joined the facial vein to form an anonymous vein. In clinical practice, radiologists and surgeons use the retromandibular vein as a guide to expose the branches of the facial nerve during superficial parotidectomy. Therefore, absence of the retromandibular vein is a hurdle during this procedure and may affect the venous drainage pattern from the head and neck.

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.

Variant origin of an arterial trunk from axillary artery continuing as profunda brachii artery--a unique arterial variation in the axilla and its clinical implications.

BACKGROUND: Axillary artery is known to show different variations mostly in its branching pattern. Similarly, the origin of profunda brachii is often encountered with abnormality. Therefore, when the vascular variations in the upper limb persist, mostly it is confined to its branching pattern followed by its variant origin. But, among all the reported variations of profunda brachii, its variant origin from the 3rd part of the axillary artery with common trunk for the branches of axillary artery is unique. CASE DETAILS: We report here an anomalous origin of profunda brachii as continuation of an arterial trunk arising from 3rd part of the axillary artery. This common trunk at its commencement passed between 2 roots of median nerve and gave branches of 3rd part of axillary artery before it continued as profunda brachii artery. The further course and branching pattern of profunda brachii were normal. CONCLUSION: Since the axillary artery is next choice of artery for arterial cannulation in cardiopulmonary bypass procedures, prior knowledge of existence of such variation in its branching pattern helps in avoiding possible diagnostic or interventional therapeutic errors.

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.

Abnormal Intraparotid Termination of Facial Vein and Its Clinical Importance

Facial vein is the main vein of the face. Though its origin is constant, it frequently shows variations in its termination. We report a rare type of variation of facial vein. The right facial vein coursed transversely across the masseter, superficial to the parotid duct and entered into the substance of the parotid gland, at its anterior border. Deep dissection of the gland revealed the abnormal termination of facial vein into the superficial temporal vein. The transverse facial vein drained into the facial vein. The superficial temporal vein after receiving the facial vein continued as retromandibular vein. Knowledge of this anomalous course and termination of facial vein may be important for the surgeons doing parotid, maxillofacial and plastic surgeries.