Hasan Ozan

The position of the mandibular canal and histologic feature of the inferior alveolar nerve

The inferior alveolar nerve is the one of the large branches of the mandibular division of the trigeminal nerve. It is vulnerable during surgical procedures of the mandible. Despite its importance, no anatomical and histological examination has been conducted to provide a detailed cross‐sectional morphology of the mandibular canal according to dental status. Therefore, the present study aimed to identify the position of the mandibular canal through direct measurement and to determine the branches of the inferior alveolar nerve through histologic examination. The area between the anterior margin of the third molar and the anterior margin of the second premolar of dentulous, partially dentulous, and edentulous hemimandible specimens (n = 49) from 26 human cadavers was serially sectioned into seven segments, and specific distances were measured using digital calipers. Following this, 5‐μm cross‐sections were prepared along the mandibular canal and mental foramen, and examined by fluorescence microscopy. The mandibular canal was located at a mean distance of 10.52 mm above the inferior margin of the mandible. The mean maximum diameters of the mandibular canal, inferior alveolar nerve, inferior alveolar artery, and inferior alveolar vein were 2.52, 1.84, 0.42, and 0.58 mm, respectively. This study found that the inferior alveolar nerve often gives rise to several branches at each level (range 0–3). To minimize the risk of injury, knowledge of the small branches of the nerve and of the detailed findings regarding the position of the mandibular canal reported here should be considered when planning mandibular surgery, especially during implant placement. Clin. Anat. 23:34–42, 2010.

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.

High origin of gonadal arteries associated with other variations

In two cases, one male and one female, the gonadal arteries, together with accessory renal arteries, originated from the abdominal aorta at a higher level than normal. The variation was bilateral in the male and unilateral in the female. Associated unusual findings in one of these cases (male cadaver) were: a. external lobation of the kidneys, b. slight lateral rotation of the kidneys, more pronounced on the right side, c. a right middle suprarenal artery and a parenchymal branch to the kidney arising from the right testicular artery by a common trunk. Additionally, the right kidneys were at a higher position than the left kidneys in both of the cases. Embryological as well as surgical aspects are discussed.

Anomalous insertional slip of latissimus dorsi muscle: arcus axillaris

An anomalous muscular slip arising from the latissimus dorsi m. was encountered on the right side of a male cadaver during a dissection in our laboratory. The slip left the muscular part of the latissimus dorsi 8 cm distal to its insertion, coursed superolaterally anterior to the neurovascular structures and was inserted into the coracobrachialis fascia. The morphology of the additional slip and its possible clinical implications are discussed.

Relationship Between Zuckerkandl's Tubercle and the Inferior Laryngeal Nerve Including the Laryngeal Branches

PurposeZuckerkandls tubercle (ZT) is the most posterior extension of the lateral lobes of the thyroid gland in the area of the ligament of Berry. We investigated the relationship between ZT and the inferior laryngeal nerve (ILN), including the laryngeal branches.MethodsWe examined 40 specimens (80 sides) from 24 male and 16 female cadavers aged between 40 and 89 years at the time of death. The ZTs were graded according to Pelizzo as grade 0, unrecognizable; grade 1, only a thickening of the lateral lobe; grade 2, smaller than 1 cm; or grade 3, larger than 1 cm.ResultsFirst, we classified ZT into three groups according to its location, and then we investigated the relationship between ZT and the ILN, including the laryngeal branches. Zuckerkandls tubercle was located in the middle third of the thyroid gland in 46 of 52 sides defined as grade 2 or 3. We observed that some of the tubercles passed over the ILN, some passed over the laryngeal branches, and some passed over only the anterior laryngeal branch. ZT also indicated the ILN or only the anterior laryngeal branch.ConclusionsZuckerkandls tubercle indicated or passed over the ILN and the laryngeal branches. These findings suggest that an identifiable ZT could be used as a landmark to expose the ILN and the laryngeal branches.

Double gluteus maximus muscle with associated variations in the gluteal region.

Summary We report bilateral muscular and neurovascular anomalies of the gluteal region in a cadaver. On the right side, the gluteus maximus muscle had two parts, one of which was fibrous and the other muscular. In addition, there were duplicated piriformis muscles and high division of the sciatic nerve. The common peroneal nerve passed between the two parts of the piriformis muscle, and the tibial nerve emerged from under the lower piriformis muscle (infrapiriform foramen). At the same time the internal pudendal vessels and pudendal nerve passed over the sacrotuberous ligament on the left side. The double piriformis muscles and high division of the nerve are known as an anomaly which is believed to cause a nerve compression syndrome called the syndrome of the piriformis muscle. To the best of our knowledge anomalies of the gluteus maximus muscle and pudendal structures have not yet been reported. This complex anomaly should be kept in mind in connection with intramuscular injections of the gluteal region, the piriformis syndrome, and the surgery of this region.

Location of the ostia of the renal arteries in the aorta

A total of 30 adult abdominal aorta specimens dissected from cadavers was used in our study. The location of the ostium of the superior mesenteric a. relative to the ostium of the celiac trunk was identified on the aortic wall. Following this, the locations of the ostia of the renal aa. on the internal wall of the abdominal aorta were examined relative to the ostia of the arteries mentioned earlier. The ostium of the superior mesenteric a. was usually localized on the inferior-right side of the ostium of the celiac trunk. The mean value of the distance between the ostia was 17.9 mm. The ostium of the right renal a. was more cranial than the ostium of the left renal a. (53.3%). However, the ostia of both right and left renal aa. were at the same level in three cases (10%). Locations of the ostia of the renal aa. were usually on the lateral and anterolateral regions of the aortic wall. This study was carried out in order to contribute to selective angiography and surgical interventions for the removal and transplantation of organs, particularly of the kidney. Our results are compared with previous similar studies in man.

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.

Left gastric artery originating directly from the aorta

During the dissection of a 48-year-old male cadaver, the left gastric artery was observed directly originating from the abdominal aorta. An unusual embryologic development of the ventral splanchnic arteries may lead to considerable variations. The rare occurrence of this variation is stated to be 0.5% - 15%. This case of the left gastric artery is described in detail, especially its point of emergence which may be important in operative procedures on the supracolic organs, in stomach resection, and during dissection of lymph nodes along this artery in gastric cancer.