The pterygopalatine fossa: morphometric CT study with clinical implications.

PURPOSE: The pterygopalatine fossa is a deep viscerocranial space containing the maxillary artery and nerve, the pterygopalatine ganglion, and the nerve of the pterygoid canal (vidian nerve). The endoscopic approach to this area relies on adequate preoperative imaging, such as computed tomography (CT). The aim was to determine the morphometric characteristics of the pterygopalatine fossa and its communications, including several previously unpublished measurements. METHODS: 100 CT scans (56 male and 44 female patients) were analyzed. The axial, coronal, and sagittal slices, together with the three-dimensional reconstructions, were used in the study. RESULTS: The central diameter and the length of the foramen rotundum, the vertical diameter and the length of the pterygoid (vidian) canal, and the diameter of the sphenopalatine foramen were significantly larger in men. The central diameters of the foramen rotundum and the vidian canal were significantly smaller than their anterior and posterior transverse diameters. The vidian canal length of 12.1 mm indicates the presence of the type 3 VC with a sensitivity of 83% and a specificity of 85%. CONCLUSION: Several new descriptions of the pterygopalatine fossa are presented here (such as the angle between the sphenopalatine foramen and the vidian canal, a new aspect in the understanding of the FR, and the distance between the posterior wall of the maxillary sinus to the vidian canal and the foramen rotundum), which might prove useful in the comprehension of the anatomy of the pterygopalatine fossa.

Superficial palmar branch of the radial artery: A study of occurrence and diameter.

The superficial palmar branch (SPB) of the radial artery (RA) is an important blood vessel in plastic surgery procedures of the hand. It is used as the axial artery in a free flap used for finger reconstruction. The occurrence of this arterial branch is variable, as well as its diameter and course. The aim of this study was to determine the occurrence and measure the external diameter of the SPB, as well as the external circumference of the RA. All results were analyzed with the intent to determine a possible correlation between RA and SPB size, as well as between SPB occurrence and the cadavers' sex and height. The study was conducted on both upper extremities of 60 cadavers (31 male and 29 female), of 35-55 years of age (average age was 46.5 years). A radial artery sample was taken at the level of the wrist, together with its superficial palmar branch. The samples were preserved in 4% formaldehyde for four weeks. After the fixation, the external circumference of the radial artery and the external diameter of the superficial palmar branch were measured with a Vernier caliper and an operating microscope. Bilateral SPB absence was the most common variant of SPB occurrence in our material. There was no linear correlation between the size of the RA and the SPB, nor was there any relationship between SPB occurrence and the cadavers' age and height. Also, the correlation between the cadavers' height and the size of both blood vessels was not linear. We conclude that the SPB diameter and occurrence are independent of the other factors described in this study.

The assessment of airbag deployment and seatbelt use in preventing facial injuries.

This study aimed to determine the effectiveness of airbags and seatbelts in the prevention of facial fractures and slight facial injuries in relation to the speed and kinetic energy experienced in frontal collisions. All cases of vehicle occupants who had been in frontal collisions and had subsequently been examined in the Institute for Emergency Medical Assistance and the Clinical Center of Montenegro in 2017 were analyzed. There were 29 cases of facial fractures (Group 1), 35 cases of slight facial injuries (including nondisplaced nasal fractures) (Group 2), and 26 cases of occupants who had suffered no facial injuries (control Group 3). In all assessed cases all of the subjects had been wearing a seatbelt and the airbag had deployed at the time of impact. A frontal collision is defined as a collision in which the principal force acts within a range of 90° from the longitudinal axis of the vehicle. Using the mass and the speed of the vehicles, the total kinetic energy (KE) of all frontal collisions being analyzed was calculated. The cut-off value of total KE in frontal collisions that were associated with either facial fractures or slight facial injury was estimated using a receiver operating characteristic (ROC) curve. The cut-off amounts of KE were then used to calculate the barrier equivalent velocity (BEV). The BEV for a vehicle of average mass was estimated to be 55.7 km/h (34.6 mph) in Group 1, and 49.2 km/h (30.6 mph) in Group 2. Airbags and seatbelts are effective in preventing facial injuries in vehicles of average mass that are traveling at speeds under 49.2 km/h (30.6 mph) at the point of impact, but they do not protect from facial fractures when the vehicle speed exceeds 55.7 km/h (34.6 mph).