Morphometric analysis of the infraorbital foramen and its localization relative to surgical landmarks.

AIM: The infraorbital foramen (IOF) is an important anatomic landmark for maxillofacial surgery; therefore, its location should be well documented. In morphometric analyses of the IOF, various methods have been applied and differences have been found among the results of the measurements. The aim of this study was to facilitate localization of the IOF during clinical practice. METHODS: In the current study, in order to perform anatomic and morphometric analyses of the IOF, 112 skulls were used. The shortest distance from each IOF to certain determined points was identified and measured by digital calipers. RESULTS: The longest and the shortest diameters of the IOF were measured as 4.21±0.91 mm and 3.11±0.62 mm, respectively. The shortest distances between the IOF and the landmarks were measured as follows: the maxillary mid-line (ML) as 28.47±2.49 mm; the supraorbital foramen/supraorbital notch (SOF/SON) as 43.43±3.39 mm; the lower end of the nasomaxillary suture (LENS) as 26.47±3.05 mm; the lower end of the alveolar juga of the canines (LAJC) as 31.62±3.09 mm; the infra-orbital margin (IOM) as 6.98±1.72 mm; and the opposite IOF as 56.85±3.89 mm. CONCLUSION: Among the landmarks, the most useful ones in clinical practice might be the distances between the IOF and the IOM, IOF and LAJC, and even IOF and ML. SOF/SON and LENS provide more accurate localization when they are used together with the other parameters. Moreover, their importance increases when other parameters are not available for use (because of fractures or damage).

Surgical anatomic evaluation of cervical uncinate process for ventral and ventrolateral subaxial decompression.

An anatomical study was designed to investigate the cervical uncinate processes morphology and their variations. Linear and angular measurements were performed on 145 vertebrae (29 spines) from C3 to C7. The dimensions and variations of the uncinate processes were measured to obtain some morphologic data for an effective neurovacular decompression via the ventral and ventrolateral approaches. Four researchers performed the linear and angular measurements including uncinate process height, width, length, sagittal angle with the superior margin of the vertebral body, inter-uncinate process distance, vertebral body anteroposterior dimeter and width measurements. The data were presented as mean value, standard deviation and range values. These data provide a three-dimensional orientation and anatomical knowledge, and contribute to perform more effective neurovascular decompression with minimizing the surgical complications.

Surgical anatomy and morphometric analysis of the optico-chiasmatic apparatus, optic canal and sphenoid ridge.

An anatomical study was performed in order to obtain help for orientation regarding the cranial base approaches to the anterior cranial base. Cranial base approaches were studied in 8 adult cadaver heads, and morphometric measurements critical in these approaches were achieved in 76 dry skulls. Importance of the surgical anatomy of the opticochiasmatic apparatus, optic canal, sphenoid ridge, and anterior clinoid was emphasised in this study. Observations from the dissections and operative approaches, and measurements between various points were recorded in a specifically designed software, and these data helped both to understand the local anatomy and the relationship to the intimate structures better and to decide the head position, the degree and direction of safe bony removal, and the direction of the operative approach during the surgery. Considerations important in the selection of these structures, anatomical landmarks and distances were discussed.

Importance of the mitral subvalvular apparatus for left ventricular functional anatomy.

The mitral subvalvular apparatus is so important to attain the integrity of the left ventricular geometric model and systolic pump function of the heart. We conducted a detailed dissection of the anatomic structure of mitral valve complex and left ventricle of 10 adult hearts from fixed human cadavers (eight male and two female) at Department of Anatomy. Faculty of Medicine of Istanbul University and Department of Cardiovascular Surgery, Kosuyolu Heart and Research Hospital. The distribution of chordae tendinea and classification of musculus papillaris were recorded. The distribution of chordae tendinea varied slightly both anterior and posterior groups. Musculus papillaris was not simetrical in all subjects. Four type of musculus papillaris were distinguished. The insertio angulus of musculus papillaris varied between 20 degrees and 55 degrees. The left ventricular distances (inflow-outflow) and axes (short-long) were determined as the criteria, together with the mitral subvalvular apparatus, to gain the architecture of the left ventricle. We believe that the goal a more precise data collection and developed model will influence our understanding of functional anatomy of left ventricular subvalvular apparatus, and concept of changes in left ventricular configuration after mitral valve surgery.

Surgical anatomy and morphometric analysis of the occipital condyles and foramen magnum.

Surgical anatomy that provides the basis for dealing with lesions arising in the lower clivus and ventral foramen magnum was reviewed in 8 adult cadaver heads and 76 dry skulls. The extreme lateral transcondylar approach was performed in cadavers; the morphometric analysis was studied in both the cadavers and the skulls. The landmarks, distances and structures were selected in order to guide the surgical operations in this area. In the paper, surgical approaches to this region are reviewed, and the results are discussed from the standpoint of surgical importance.

Surgical anatomy of the temporal bone and measurements of the skull base for transpetrosal approaches.

Transtemporal approaches exposing the petroclival region require extensive drilling of the petrous bone. This is only possible with an understanding of the three dimensional anatomy of the temporal bone and the cranial base. The purpose of this study is to review the topographic anatomy of the petrous bone and peripetrous region, with emphasis on the relationships critical to the lateral approaches for posterior and lateral skull base. To understand the surgical anatomy and the cranial base approaches to this area, 8 cadaveric heads and 76 dry skulls were studied. Cadaveric dissections were performed, and morphometric data from measurements of the relationships of the surface landmarks in the petroclival region were provided. The results and the observations could be useful to understand the anatomy better, and to estimate the degree and direction of a safe bony removal for the most radical transpetrosal surgery.

Surgical landmarks during mastoidal and petrosal operations.

This study was made on twenty-one formalin fixed, adult skull left-half specimens. Each of the measurements was made using callipers accurate to 0.1 mm. The dissection of the temporal bone was begun with simple mastoidectomy and completed when the endosteum of the semicircular canals were opened. During the temporal bone dissection step by step, eleven different measurements have been made with small size callipers, and mean, median, range and standard deviations have been determined. The following set of correlations was found to be significant; I--The correlation between the orbitomeatal length and the distance from the most lateral point of the tympanomastoid suture to the facial canal (r = 0.69, p < 0.001). II--The correlation between the orbitomeatal length and the distance from the tympanic ring to the facial canal (r = 0.49, p = 0.011). III--The correlation between the distance from the most lateral point of the tympanomastoid suture to the facial canal and the distance from the tympanic ring to the facial canal (r = 0.71, p < 0.001).

A case report; trilobular spleen?

During dissection course a spleen with a pyramidal extremity was noted. Literature reviewed and this rare case has been presented.

Human persistent left superior vena cava with doubled coronary sinus.

A heart with a persistent left superior vena cava was found in a 72 year old man during routine dissection. The right superior vena cava was absent. The right brachiocephalic vein crossed over the aortic arch and its branches to the left side of the heart. This variation reportedly occurs in about 0.16% of humans. The azygos vein was, as a result, also left sided with a hemiazygos vein on the right side. The left superior vena cava drained into a channel contained with the posterior wall of the left atrium of the heart above, and parallel with the coronary sinus. The channel of the left superior vena cava opened into the right atrium above the opening of the coronary sinus. The coronary sinus may have been doubled during embryonic development. The two vessels were joined by a small connecting vessel.

Musculus comitans nervi mediani (M. palmaris profundus).

Palmaris profundus muscles were found in two cadavers during routine dissection of the upper limb. This rare muscle was found in two forms. In the first case, the muscle resembled a diminutive palmaris longus with the belly arising from the common flexor tendon. In the second case however, a reversed muscle with the belly emerging from beneath the transverse carpal ligament and its long thin tendon extended to and inserted in the common flexor tendon. The similarity therefore of these muscles to variable forms of palmaris longus is remarkable but they differed in one very important aspect from palmaris longus. The muscles are of special interest because, in both cases, the muscles were found enclosed in a common fascial sheath with the median nerve. These unusual muscles, in spite of mimicking palmaris longus, may perhaps, be better named "musculus comitans nervi mediani" to denote their very important relationship to the median nerve, that of being the intimate traveling companion of the median nerve through the forearm and into the hand by way of the carpal canal beneath the transverse carpal ligament. In one case, a well developed median artery was also found which also entered the carpal canal along with the median nerve and its muscular companion.

Human doubled renal and testicular arteries.

Doubled renal and testicular arteries were found in a well-developed 69-year-old caucasian male. The right kidney had two renal arteries, one at its usual midorgan (hilar) position and one inferior polar. One testicular artery arose from the mid-point of the usual renal artery, passed under the renal vein at its junction with the inferior vena cava, and then crossed over the inferior polar renal artery. The second testicular artery arose from the inferior polar renal artery near its origin from the abdominal aorta. The two testicular arteries remained doubled throughout their course and both entered the right testis at separate sites on the organ. The inferior vena cava passed under the inferior polar and over the superior testicular artery and the superior renal artery.