Fatih Yazar

Double superior gemellus together with double piriformis and high division of the sciatic nerve

We report a case with double superior gemellus and double piriformis mm. associated with the sciatic n. dividing high and passing between the two piriformis mm. in the same lower extremity. This abnormality has not previously been described in the literature. As many musculoskeletal structures may be involved in sciatica, the supernumerary superior gemelli and piriformis mm. may exert pressure on the sciatic n. and this should be taken into account by clinicians.

An unusual variation of the superficial ulnar artery

Anomalous superficial ulnar arteries were found bilaterally during routine dissection of the upper limbs of a 60-year-old male cadaver. In the left arm, the superficial ulnar artery originated from the axillary artery. It crossed the median nerve anteriorly and ran anteromedial to this nerve and the brachial artery. The superficial ulnar artery was also rudimentary and gave rise to only a narrow muscular branch to the biceps brachii. In the hand, it anastomosed with the radial artery, completing the superficial palmar arch. The radial artery was larger than usual and the deep palmar arch was formed only by the radial artery. In the right arm, the superficial ulnar artery originated from the brachial artery at the level of the inter-epicondylar line. Additionally there were “inverse palmaris longus muscles” bilaterally. This was a rare case in which the superficially ulnar artery originated from a different source on each side accompanied by anomalies of the palmar arches on one side.

Unusual origin and course of the testicular arteries

BackgroundThe testicular arteries usually arise from the anterolateral aspect of the abdominal aorta just inferior to the renal arteries at the level of the second lumbar vertebra. However, they may also originate from the renal artery, middle suprarenal artery, one of the lumbar arteries, common or internal iliac artery, or the superior epigastric artery.MethodsAn unusual origin of the right testicular artery and an unusual course of the left one were observed during routine dissection of the retroperitoneal space of a 43-year-old male cadaver.ResultsThe right testicular artery originated from the inferior segmental branch of the right renal artery. After the left testicular artery originated from the anterolateral surface of the abdominal aorta just inferior to the left renal artery it was located between the left renal vein and the left renal artery and descended anterior to the renal vein. Thereafter it coursed on its normal route distally with the testicular vein.ConclusionsAwareness of variations of the testicular arteries, such as that shown in this case, is important during surgical and radiological procedures pertaining to kidney.

Drainage patterns of middle lobe vein of right lung: an anatomical study

OBJECTIVE The purpose of the present study was to determine the variations in the drainage patterns of middle lobe vein of the right lung. METHODS Right lungs of 30 formalin fixed cadavers, were dissected carefully to expose the variations in the venous drainage of their middle lobes. After identifying the pulmonary veins for each lobe, middle lobe vein (MLV) drainage patterns were followed to their openings. The diameters of the MLV and its lateral and medial parts were measured with a caliper. The length of the MLV trunk was also evaluated. RESULTS Five different types of venous drainage patterns were observed. Type-I: Union of medial and lateral parts to form MLV as a trunk and opening of this vein to the right superior pulmonary vein (RSPV) (53.3%). Type-II: Opening of medial and lateral parts to the RSPV separately (16.6%). Type-III: Union of medial and lateral parts to form the MLV trunk and opening of this vein into the left atrium (16.6%). Type-IV: Opening of medial and lateral parts into the left atrium separately (10%). Type-V: Union of medial and lateral parts to form MLV trunk and opening of this vein to the right inferior pulmonary vein (3.3%). CONCLUSION The venous drainage patterns of right middle lobe reveals great number of variations. Knowing the frequency of different types of drainage patterns classified in this study is extremely important for the surgeons performing pulmonary surgery, atrial fibrillation and imaging techniques.

The neurovascular and muscular anomalies of the gluteal region: an atypical pudendal nerve.

In two cases, one male and one female, muscular anomalies together with neurovascular variations were encountered in the gluteal regions, in each cadaver on the same side. In the male cadaver, there was a double piriformis muscle and high division of the sciatic nerve. In the female cadaver, in addition to these anomalies, the superior and inferior gemelli and obturator internus muscles, and the internal pudendal vessels and pudendal nerve passed behind the sacrotuberous ligament. Although duplication of the piriformis and high division of the sciatic nerve have been reported previously, to the best of our knowledge the other anomalies have not yet been reported. The abnormal relationship of the internal pudendal vessels and the pudendal nerve with the sacrotuberal ligament, as in our case, may cause venous congestion, arterial obstruction, dysfunction of penile erection and perineal neuralgia. These anomalies of the gluteal region are not only of academic interest, but may be of practical importance for surgical intervention in the area.

Accessory extensor carpi radialis muscle and interconnecting muscular bundle.

An accessory muscle and a muscular bundle were found and prepared in both forearms of a 55-year-old male cadaver. On the left side, the accessory muscle-originated from the medial aspect of the extensor carpi radialis brevis (ECRB) muscle, coursed downwards, crossed posterior to the tendon of ECRB, passed through the second chamber of the extensor retinaculum and inserted into the base of second metacarpal bone. Additionally, a muscular bundle was observed between the extensor carpi radialis longus (ECRL) and ECRB muscles. On the right side, both ECRL and ECRB had bifid tendons. The long and thin additional tendon of ECRL coursed downwards and joined the accessory tendon of the ECRB before entering the second chamber of the extensor retinaculum and the common tendon inserted into the base of the second metacarpal bone.

The long thoracic nerve: Its origin, branches, and relationship to the middle scalene muscle

Anatomical knowledge regarding the long thoracic nerve (LTN) is important during surgical procedures considering that dysfunction of this nerve results in clinical problems. The purpose of this study was to explore the anatomy of the LTN, its origin, configuration, branching pattern, and relationship to the middle scalene muscle (MSM). The course of the LTN was investigated in 12 embalmed cadavers (21 sides). We defined four different types for this nerve according to the origins of its roots. The most common formation of the LTN was the contribution of three branches that originated from the fifth, sixth, and seventh cervical ventral roots. C5 and C6 components or upper portion of the LTN roots lay primarily between the middle and posterior scalene muscles, sometimes passed through the MSM, and less frequently coursed over the MSM. C7 contributions to the LTN were always located anterior to the MSM. Contributions from C8 were also found over the MSM. The median number of branches arising directly from the cervical roots and branches arising from the main trunk of the nerve were 3 and 7, respectively. Along its course, the median number of branches to the serratus anterior was 10. Clin. Anat. 22:476–480, 2009.

Transcanal anterior approach for cystic lesions of the petrous apex.

Objective: To investigate the utility of a newly described approach, the transcanal anterior approach that is a modification of the subcochlear approach for the drainage of cystic lesions of the petrous apex. Study design: Prospective temporal bone study. Setting: Tertiary referral center. Materials: A total of six cadaveric temporal bone specimens (four males) were included. Right ear in four specimens and left ear in two specimens were used. Interventions: The approach commenced with postauricular skin incision. After the transsection of the meatal skin, antero-inferior tympanotomy was performed. Anteroinferior canaloplasty localized the carotid canal. As much as 0.5 cm of the vertical segment of the internal carotid artery was skeletonized. After the identification of the artery, petrous apex cells were reached by drilling the cortical bone between the cochlea and the internal carotid artery. An air cell tract was established. Position and length of the tract in two specimens were demonstrated on the 1 mm-cut computerized tomography scans. Main outcome measures: Utility of the approach was investigated based on the established criteria: anteroposterior diameter and height of the fenestra of the tract, length of the tract from the cochlea to the deepest point of the tract (depth of the tract), and the injury risk of the internal carotid artery and the cochlea. Results: The mean anteroposterior diameter, the height, and the length were 4.7 ± 1.05 mm, 3.2 ± 0.68 mm, and 14.7 ± 1.1 mm, respectively. Injury did not occur in the cochlea or internal carotid artery in any of the specimens. Conclusion: With the subcochlear approach, there is always potential risk of injury to the cochlea, the internal carotid artery, and the jugular bulb. Although this new approach includes a technically challenging stage (exposing the vertical portion of the internal carotid artery), partly exposing the vertical portion of the artery provides a safer approach, which decreases the injury risk for the round window and the jugular bulb. Additionally, measurements show that it is possible to reach a considerable part of the petrous apex cells.

The demonstration of the number, course, and the location of nutrient artery canals of the femur by multidetector computed tomography

PurposeThe aim of this study was to evaluate the number, course, width and location of nutrient artery canals of the femur by using multidetector computed tomography (MDCT).MethodsSixty-six adult (35 right and 31 left) dry femurs were included in this study and scanned by MDCT. Nutrient artery canals were evaluated on the multi-planar reformatted and volume rendered images which were reproduced on the basis of axial images.ResultsThe median value of nutrient artery canals was two (minimum 1 and maximum 6). We determined that there was a negative correlation between the number of nutrient canals and the canal diameters. The outer ostia of the nutrient artery canals were most frequently located at the middle third segment of femoral diaphysis (65%). While the vast majority of the canals were showing upward courses (95%), only a few canals were having transverse (3%) or downward (2%) courses. Most encountered location of outer ostia of the canals according to linea aspera was the medial lip of the linea aspera (44%). Various variations were demonstrated in the number, course, and location of nutrient artery canals using MDCT.ConclusionsIn conclusion, the knowledge of the topographic features of the nutrient artery canals may be useful in various clinical implications such as bone grafting or radiologic evaluation for the fracture lines.

The peroneus brevis tendon at its insertion site on fifth metatarsal bone

BACKGROUND The differences at the attachment site of peroneus brevis (PB) to the fifth metatarsal bone is important in terms of the forces exerted on the bone and hence the mechanism of fractures involving this structure. In this study, we investigated the anatomical properties of PB at the insertion site to the base of fifth metatarsal bone, its possible intertendinous connections with peroneus tertius (PT) and their possible effects on the fracture occurrence at the bony attachment site. METHODS The length and the width of PB tendons at their mid- and end-points were measured and classified according to the insertion types. Besides, the length and the width of the base of fifth metatarsal bone were assessed. The slips extending from the PB tendons and their relationship with PT were also evaluated. The data was compared statistically with each other and between the right and left sides. RESULTS The length of PB tendon was measured 79.57±15.40mm on the right side; 81.48±14.31mm on the left. The width of PB tendon at the mid-point was 4.46±0.80mm on the right side; 4.42±0.94mm on the left. The width of the tendon at its insertion point was measured 14.85±3.40mm and 15.16±3.42mm on the right and left sides respectively. PB was divided into three types according to its attachment to base of fifth metatarsal bone (5thMB). Type I, Type II and Type III were observed at the rates of 59.5%, 28.6% and 11.5% respectively. It was observed that the slips to the bone were extending more commonly from PB than from PT and that the large majority of them were single having their insertions on the base of the proximal phalanx of the fifth toe. CONCLUSIONS Knowing the width and insertional types of PB aids in understanding the mechanism of fractures at the site of bony attachment. The existence of slips may help the surgeon in the procedures involving PB or the lateral side of the forefoot.