Facial anatomy.

Dermatologic problems of the face affect both function and aesthetics, which are based on complex anatomical features. Treating dermatologic problems while preserving the aesthetics and functions of the face requires knowledge of normal anatomy. When performing successfully invasive procedures of the face, it is essential to understand its underlying topographic anatomy. This chapter presents the anatomy of the facial musculature and neurovascular structures in a systematic way with some clinically important aspects. We describe the attachments of the mimetic and masticatory muscles and emphasize their functions and nerve supply. We highlight clinically relevant facial topographic anatomy by explaining the course and location of the sensory and motor nerves of the face and facial vasculature with their relations. Additionally, this chapter reviews the recent nomenclature of the branching pattern of the facial artery.

Innervation pattern of the pronator teres muscle.

OBJECTIVE: To determine the innervation patterns of the pronator teres muscle (PTM), which is used as a donor in muscle transfer. METHODS: This study was conducted from 2001-2006 at the Anatomy Department of the Medical Faculty of Cerrahpasa, University of Istanbul. There were 34 upper extremities of 17 fixed adult cadavers dissected. RESULTS: The classical pattern of innervation by the superior and inferior branches of the median nerve was observed in 19 of the cases (55.9%). In 4 forearms (11.8%) one branch in 10 (29.4%), 3 branches (2 humeral, 1 ulnar) and in one (2.9%), 4 branches (3 humeral, 1 ulnar) were found to be innervating the muscles. CONCLUSION: In all cases, the humeral and ulnar head of the PTM was innervated separately. These variations are of great importance during transfer of PTM.

The muscular branching patterns of the ulnar nerve to the flexor carpi ulnaris and flexor digitorum profundus muscles.

The branching pattern of the ulnar nerve in the forearm is of great importance in anterior transposition of the ulnar nerve for decompression after neuropathy of cubital tunnel syndrom and malformations resulting from distal end fractures of the humerus. In this study, 37 formalin-fixed forearms were used to demonstrate the muscular branching patterns from the main ulnar nerve to the flexor carpi ulnaris muscle (FCU) and ulnar part of the flexor digitorum profundus muscle (FDP). Eight branching patterns were found and classified into four groups according to the number of the muscular branches leaving the main ulnar nerve. Two (Group I) and three (Group II) branches left the main ulnar nerve in 18 and 17 forearms respectively. The remaining two specimens had four (Group III) and five (Group IV) branches each. Usually one or two branches were associated with the innervation of the FCU. However, in 2 cases, three and in one, four branches to FCU were observed. The FDP received a single branch in all cases, except in four, all of which had two branches. In six forearms, a common trunk was observed arising from the ulnar nerve to supply the FCU and FDP. The distribution of the muscular branches to the revealed muscles was outlined in figures and the distance of the origin of these branches from the interepicondylar line was measured in millimeters. The first muscular branch leaving the main ulnar nerve was the FCU-branch in all specimens. The terminal muscular branch of the ulnar nerve to the forearm muscles arose at the proximal 1/3 of the forearm in all specimens. In 7 forearms, Martin-Gruber anastomosis in form of median to ulnar was observed.

Ramification pattern of the thenar branch of the median nerve entering the thenar fascia and the distribution of the terminal branches in the thenar musculature: Anatomic cadaver study in 144 hands.

Knowledge of the anatomy of the median nerve is important in surgery of the palmar aspect of the hand. The purpose of our study was to investigate the ramification pattern of the thenar branch before entering the thenar fascia and the distribution of the terminal branches in the thenar musculature. The observations were carried out on 144 hands of 74 dissecting room cadavers. According to the number of the thenar branches entering the thenar fascia we classified our specimens into four types. In 121 hands (84%, Group I) the thenar branch piercing the thenar fascia was a single trunk. In 19 hands (13.2%, Group II) two branches; in three (2.1%; Group III), three branches; and in one hand (0.7%; Group IV), four branches were identified entering the thenar fascia. Accessory thenar nerve was found in 8.3% of hands. The further division of each branch to its terminal branches was investigated in detail. Our results show that the more the number of thenar branches entering the thenar fascia, the less the terminal branching. Because more than one branch was seen in 16% of the specimens, meticulous dissection is required for preventing injury of the thenar branches before entering the thenar fascia.

An infrarenal abdominal aortic coarctation.

We describe a case of infrarenal abdominal coarctation in a 44-year-old woman who presented with severe uncontrolled hypertension. She had no signs of lower limb ischemia with normal distal pulses. Electron beam tomography revealed abdominal aortic coarctation extending from the superior mesenteric artery to the inferior mesenteric artery with a diameter of 9 mm. Also, at the level of coarctation, the aortic branches including the renal arteries were in a serpentine shape.

[The reliability of percutaneous osteotomy with the Gigli saw technique in the proximal tibia. A cadaveric study]. / Tibia proksimalinde Gigli testeresi ile yapilan perkütan osteotominin güvenilirligi: Kadavra çalismasi.

OBJECTIVES: To evaluate the reliability of percutaneous osteotomy with the use of a Gigli saw in the proximal tibia. METHODS: Forty-two attendants comprising of residents or consultants without any prior experience were assigned to 14 cadaveric models to perform percutaneous osteotomy. The technique was first described by an experienced specialist and then illustrated on a cadaver specimen. Thereafter, the attendants performed osteotomy using a Gigli saw without any help by the instructors. Finally, exploration of the deep and superficial branches of the fibular nerve, posterior tibial nerve, posterior and anterior artery and vein was made with regard to any injury caused during osteotomy. RESULTS: There were ten incisional injuries in three specimens due to erroneous determination of the osteotomy level or incision. A mean of 3.5 cm (range 2.5 to 4.0 cm) incision length was observed in four specimens. No procedure-associated injuries to major nerves and vessels were documented except for those to the cutaneous branch of the superficial peroneal nerve in two specimens, and to the extensor hallucis longus muscle in one specimen. There was no incidence of incomplete osteotomy. CONCLUSION: Despite the lack of any prior experience with the osteotomy method with the Gigli saw on the part of the attendants, the full success in performing osteotomy confirms the reliability of the technique. Moreover, if this method is to be used by experienced surgeons, excellent results can be achieved without any injuries to cutaneous nerves and surrounding muscles.