Surgical and Radiologic Anatomy最新文献

Purpose: This study aimed to clarify the origin, insertion, and subdivision of the orbicularis oculi in detail with in situ specimens, as well as with isolated muscle specimens from the superficial and deep aspects.

Methods: The periorbital muscles in fifteen cadavers fixed with formalin were examined in situ and/or in isolated muscle specimens, and evaluate their actions.

Results: The orbicularis oculi arose via the nasoglabellar aponeurosis, which was observable in the deep aspect of isolated specimens as a rigid sheet of connective tissue in the middle of both orbits and adhered to the dorsum nasi in situ (100%). The two subdivisions of the orbicularis oculi were demarcated at the lateral angle of the eye and exhibited different insertions. The fascicles of the upper and lower halves of the inner part met each other at the lateral canthus and formed a shallow groove between them as observed in situ, and terminated via the lateral palpebral raphe on the deep aspect of the muscle to the temporal fascia. The fascicles of the upper and lower halves of the outer part extended over the orbital margin and intermingled with each other to disperse in the temporal subcutaneous tissue.

Conclusions: The nasoglabellar aponeurosis was structurally characterized as the common origin of the periorbital muscles. The present study confirmed that the inner and outer parts of the orbicularis oculi are distinguished by the difference of lateral termination and interpreted as having different function on the palpebral movement in each.

Purpose: To report a rare anatomical variant of the maxillary sinuses, with radiological and clinical emphasis.

Methods: A 40-year-old male with recurrent acute rhinosinusitis presented to our center for clinical management. A computed tomography scan revealed the presence of an incidental anatomical variant of bilateral maxillary sinuses for which we coin the term "kissing antra".

Results: Kissing antra appearances on computed tomography consisted of enlarged bilateral palatine recesses of the maxillary antra that met in the midline across a narrow bony septum below the floor of the nasal cavity. The right palatonasal recess angle was markedly acute at 61° instead of the normal 90°.

Conclusion: Kissing antra of the maxillary sinuses are important for anatomists, radiologists and surgeons to be aware of, both as rare anatomical variants, as well as for their multiple clinical diagnostic and therapeutic implications that we discuss in this report.

Purpose: An entire fascial configuration at the esophageal hiatus might not be demonstrated histologically. According to observations of human fetus histology, the aim of this study was to consider which factor is likely to make the individual variation in adults.

Methods: We observed frontal histological sections containing the esophageal hiatus from 12 midterm fetuses at 12-16 weeks (crown-rump length: CRL, 85-137 mm) and 10 near-term fetuses at 26-30 weeks (CRL, 214-250 mm).

Results: At midterm, the transversalis fascia covering the diaphragm turned upward to join the adventitia of the left aspect of the esophagus: thus, the upper leaflet of the phreno-esophageal membrane was established first. A connection between the adventitia and endothoracic fascia (i.e., the upper leaflet of the PEM) was deleyed in the right. At near-term, both the transversalis and endothoracic fasciae often joined the adventitia in the left side but not in the right side. Therefore, fascial development advanced in the left side as well as the inferior side of the hiatus. The foregut-midgut junction, suggested with cytokeratin 5/6 immunostaining, was located in the hiatus.

Conclusion: Development and growth of the phreno-esophageal membrane showed left/right and superior/inferior differences. The transiently-appeared pleural recess, the upward protruding right crus of diaphragm and, the right liver and adrenal extending upward seemed to disturb the fascial connection to the adventitia in the right and/or superior side. Individual variations in the fascial configuration at the hiatus might occur due to the site-dependent delay of the establishment of structures.

Purpose: To evaluate the precise origin of sensory nerves through gross anatomical study of the TFCC, synthesized alongside imaging and histological techniques.

Method: Six cadaveric forearm specimens were obtained to map the course and branches of the ulnar nerve through macrodissection. Immunohistochemical staining targeting PGP 9.5 and type IV collagen was performed on frozen TFCC sections to visualize nerve fibers microscopically. Computed tomography, magnetic resonance imaging, and arthrography findings were also reviewed.

Results: At the macroscopic level, the articular branches supplying the TFCC originated predominantly from the dorsal branch of the ulnar nerve. Microscopic analysis revealed positive PGP 9.5 expression and discernible neural marker expression, signifying fine nerve fiber ingrowth within the TFCC. Imaging modalities aided the diagnosis of TFCC lesions. The dorsal cutaneous branch of the ulnar nerve, medial cutaneous nerve of the forearm, and volar sensory branch of the ulnar nerve emerged as the principal nerves innervating the TFCC.

Conclusions: This study provides anatomical evidence that the TFCC receives innervation from branches of the ulnar nerve and contains sensory nerve fibers. These findings enhance understanding of potential neuropathic pain mechanisms in TFCC injuries and offer insights to guide surgical interventions. Further investigations are warranted to elucidate the clinical implications.

Purpose: Traditional dissection methods are primarily limited by challenges in identifying minute structures, which can lead to irreversible tissue damage. Anatomical observation of the larynx is particularly challenging in educational and clinical settings owing to its microscopic structures and complex three-dimensional (3D) nature, making it difficult to dissect. Therefore, this study aimed to demonstrate that micro-computed tomography (micro-CT) imaging of the larynx can serve as an effective alternative for educational and clinical purposes, overcoming these limitations.

Methods: Three laryngeal specimens were obtained from cadavers, stained with a phosphotungstic acid-based contrast agent, and imaged using enhanced micro-CT. The resulting images were reconstructed in three dimensions, allowing for a detailed 3D observation of the specimens.

Results: Phosphotungstic contrast-enhanced micro-CT provided comprehensive anatomical information on laryngeal structures, including muscles, nerves, arteries, and vocal folds.

Conclusion: This study demonstrates the high effectiveness of micro-CT in producing detailed structural images of the larynx, enabling 3D observation of even the smallest anatomical structures. These images can be applied in both educational and clinical settings to analyze the human larynx, effectively overcoming the limitations of traditional dissection methods. This approach facilitates the analysis of laryngeal structures that are otherwise difficult to observe with the naked eye.

Purpose: The anatomy of the abdominal aorta (AA) varies with age and sex; however, limited studies exist from South Africa. Given the increased incidence of endovascular treatment of the AA, reference values are relevant for interventionalists for improving the safety of endovascular procedures. Therefore, the study aimed to determine the lengths, diameters and tortuosity of the AA and their association with age and sex in a South African sample.

Methods: After ethical approval, 97 computed tomography angiography (CTA) scans from an adult sample (54 male and 43 female), mean age 48.5 ± 17.2 years were analysed. The aortic length was measured from the origin of the coeliac trunk to the bifurcation point of the AA. The lumen diameters of the aorta were measured at three landmarks. Tortuosity of the AA was quantified with the tortuosity index and its prevalence was determined.

Results: The AA was longer in males and showed a significant weak positive correlation with age. The mean diameters of the AA were larger in males and had a significant strong positive correlation with age in both sexes (p < .001). There was a strong positive correlation between age and tortuosity in both sexes (p < .001). The prevalence of a tortuous c-shaped-curve phenotype was 8.2%, with a 7:1 male-to-female ratio.

Conclusion: The dimensions and tortuosity differed between sexes and varied significantly with age. These findings may contribute towards reference values in the South African setting, inform patient selection and complement decision-making of endovascular treatment strategies.

Background: Lumbar ribs (LR) are a rare and relatively unknown anatomical abnormality of the lumbar spine. The literature provides better understanding regarding other spinal congenital variations like cervical ribs or lumbosacral transitional vertebrae, which are rather commonly recognised conditions. Thus, this meta-analysis aimed to provide data on prevalence and key characteristics of LR.

Methods: Relevant databases were systematically searched for studies reporting the prevalence, laterality and geographic distribution of LR. No exclusion criteria based on language and date of original articles were employed. The pooled prevalence estimates (PPE) were calculated using a random-effects model. To assess the between-study heterogeneity, the I² statistic and Chi-square test were utilized. Throughout the investigation, the PRISMA guidelines were adhered to scrupulously. Evaluation of the included studies' reliability was made with the AQUA tool.

Results: In total, 9 studies were included in this meta-analysis. The pooled prevalence estimate (PPE) of LR was 2.1% (95%CI: 1.0-4.6). In studies based on CT imaging, LR were found in 1.6% (95%CI: 0.6-4.3) of patients and in Xray based studies in 2.1% (95%CI: 0.4-11.1) of patients. Lumbar ribs were bilateral in majority of individuals (65.4%, 95%CI: 39.4-84.6) and could be most frequently encountered in Europe with PPE of 2.8% (95%CI: 3.0-20.0), then in East Asia with PPE of 1.5% (95%CI: 1.0-19.2) and Middle East with PPE of 1.1% (95%CI: 0.6-20.0).

Conclusions: The findings of our study indicate that LR are a common anatomical variation of lumbar spine, contrary to previous beliefs. In a clinical practice, when a patient presents with a non-specific low back pain, a possible occurrence of LR should be taken into consideration. The presence of LR may be misleading for surgeons and result in wrong-level spine surgeries.

Introduction: The lungs are essential respiratory organs divided into lobes by the horizontal and oblique fissures. The hilum, located on the mediastinal surface of each lung, is where the bronchus, pulmonary veins, and pulmonary arteries enter and exit. This study aims to investigate and record the variations in the morphology of lung fissures, lobes, and hilar patterns observed in a South African sample.

Methods and materials: This cross-sectional observational study employed descriptive analysis. A total of 48 formalin-fixed bodies, comprising 24 females and 24 males from the Department of Human Biology at the University of Cape Town were studied were examined. Fissures were classified according to the Craig and Walker criteria.

Results and discussion: Incomplete oblique fissures were found in 25 right lungs and 30 left lungs. Incomplete horizontal fissures were observed in 39 right lungs, and one right lung exhibited the absence of both horizontal and oblique fissures. Accessory fissures were present in five right and seven left lungs. Variations in the hilar pattern were noted, including differences in the number and arrangement of structures in both right and left lungs.

Conclusion: Variations were observed in the lobes, fissures and the hilar patterns of several lungs. Awareness of these morphological variations is crucial for surgeons and radiologist to avoid misdiagnosis and complications during surgical procedures.

Background: The common femoral artery is a chief source of blood supply to the lower limb. Variations in its anatomy, like its absence, high level commencement of the deep femoral artery (DFA) with a superficial course, are unusual. The knowledge of such variations may have substantial clinical applications, specifically in vascular surgical procedures, catheterizations, and diagnostic or interventional radiology.

Case report: During femoral triangle dissection of a 78-years female cadaver, absence of common femoral artery, commencement of DFA at the inguinal ligament level, following a superficial path contrary to its name was observed bilaterally. The exterior diameter of superficial and DFA were 5 mm, 4 mm and 6 mm, 4 mm respectively on the right and left side.

Conclusions: Awareness of such variations is essential for interventional radiologists, vascular, orthopaedic, plastic & reconstructive surgeons to plan and execute interventional and surgical procedures effectively and for Anatomist for successful embalming.

Purpose: This study aimed to evaluate subtympanic sinus (STS) and its vicinity in high-resolution computed tomography (HRCT) scans of children under five years old with non-diseased temporal bones.

Material and method: We divided the whole group into children under 24 months of age (first stage of pneumatisation development) and between 25 and 60 (second stage). We have determined the width of the entrance to STS, depth of the STS, type in relation to facial nerve according to Anschuetz classification, the pneumatisation of posterior and medial air cell tracts, and jugular bulb position. All the HRCTs (280 temporal bones) were analyzed according to the multiplanar reconstruction protocol with symmetrization.

Results: STS's mean width and depth were 2.71 ± 0.60 mm and 3.26 ± 1.11 mm, respectively. The most common STS type was type A (59.3%), followed by type B (30.7%) and type C (10%). The posterior air cell tract (retrofacial cells) was present in 39.3%. The medial air cell tract (hypotympanic cells) was present in 30.7% The jugular bulb position affected the final shape of STS in 17.5%.

Conclusion: The results support the necessity of the classification for the STS. Our study may help with surgical planning regarding endoscopic ear procedures and gives a broader understanding of how pneumatization or jugular bulb might correlate with the final shape of the retrotympanum. The historical remarks track the term's origin for clarity in research and respect for earlier investigators.