Jelena Krmpotić-Nemanić

Mandibular neuralgia due to anatomical variations

Abstract In our large collection of macerated human adult skulls and disarticulated skulls of young individuals we found cases with an extremely large lateral lamina of the pterygoid process. The medial wall of the infratemporal fossa was defined as its formation by the lateral lamina of the pterygoid process and the medial pterygoid muscle. The muscular part formed two-thirds and the lateral lamina one-third of this wall. In cases of a very large lateral lamina in our specimens nearly the whole medial wall was osseous. The third portion of the trigeminal nerve gives off the lingual nerve and alveolar mandibular nerve in the region of the infratemporal fossa. These two nerves generally passed between the lateral and medial pterygoid muscles to their terminal sites. In cases of extremely large lateral laminae the nerves had to make a curve in their course, following the shape of the enlarged lamina. During contraction of the pterygoid muscles both nerves can be compressed. Since the lingual nerve runs between muscular elements, tension and compression is probably avoided. In contrast, the mandibular nerve fixed between the oval and mandibular foramina cannot avoid tension and compression. The result is possible pain, especially during chewing, and may finally create a trigeminal neuralgia. Similar symptoms could be provoked by a foramen pterygospinale or ovalis canal replacing the foramen ovale.

Morphological and Histological Changes Responsible for the Droop of the Nasal Tip in Advanced Age

The droop of the nasal tip in advanced age is due to the changes of the shape and of the structure of the lobular cartilage. In young people this cartilage is convex and rather resistant. In advanced age it is straightened and segmented so that it becomes larger in cranio-caudal direction and it thus shifts caudally.

Surgical anatomy of head and neck

1 The Neck and Thorax.- 2 The Larynx and the Thyroid Gland.- 3 The Oral Cavity and the Oropharynx.- 4 The Paranasal Sinuses and the Retromaxillary Space.- 5 The Eye and its Orbital Adnexa.- 6 The Ear.- 7 The Middle and Posterior Cranial Fossae.- 8 The Skull and the Gross Anatomy of the Central Nervous System.- 9 Frontalization of the Eyes.- 10 Early Development of the External Ear.- 11 The Topography and Variations of the Extra- and Intracranial Vessels.- 12 The Paraganglia.- References.- Index of Operations and Surgically Important Anatomic Relationships.

Anatomie, Variationen und Mi\bildungen der GefÄ\e im Kopf- und Halsbereich

After a short review of developmental data concerning the head and neck arteries, the normal conditions, variations and malformations of single arteries are described. Special attention is paied to the skeletotopic and topographic relations of the arteries. In every bigger vessel its length, position, origin and branches are described, and in most cases are also demonstrated by diagrams and tables. As the aortic arch may also reach the neck region, its variation and malformations as well as the variations of its branches are mentioned. The variations and the malformations of the inominate artery, of the common carotid artery, as well as of the external and internal carotid arteries are described. The practical importance of these variations is stressed. Upon description of variations and malformations anatomical, surgical und roentgenological findings described in literature, as well as personal experiences are considered. Special attention has been paied to the variations of the circulus arteriosus Willisi, to the persistence of the presegmental arteries and to the possibility of formation of a by-pass in occlusion or aplasia of cerebral arteries. The position of the subclavian artery, its variations and the variations of its branches are described. After a short embryological introduction, the variations of the venous system and its anastomoses are described. At the end, the main variations of the big lymphatic vessels in the neck are mentioned.SummaryAfter a short review of developmental data concerning the head and neck arteries, the normal conditions, variations and malformations of single arteries are described. Special attention is paied to the skeletotopic and topographic relations of the arteries. In every bigger vessel its lenght, position, origin and branches are described, and in most cases are also demonstrated by diagrams and tables. As the aortic arch may also reach the neck region, its variation and malformations as well as the variations of its branches are mentioned. The variations and the malformations of the inominate artery, of the common carotid artery, as well as of the external and internal carotid arteries are described. The practical importance of these variations is stressed. Upon description of variations and malformations anatomical, surgical und roentgenological findings described in literature, as well as personal experiences are considered. Special attention has been paied to the variations of the circulus arteriosus Willisi, to the persistence of the presegmental arteries and to the possibility of formation of a by-pass in occlusion or aplasia of cerebral arteries. The position of the subclavian artery, its variations and the variations of its branches are described. After a short embryological introduction, the variations of the venous system and its anastomoses are described. At the end, the main variations of the big lymphatic vessels in the neck are mentioned.ZusammenfassungNach einer kurzen übersicht der Arterienentwicklung im Kopf- und Halsgebiet werden die normalen VerhÄltnisse, die Variationen und Mi\bildungen der einzelnen GefÄ\e geschildert. Es werden dabei die skeletotopischen und die topographischen Beziehungen der GefÄ\e berücksichtigt. Bei einem jeden grö\eren GefÄ\ werden die LÄnge, die Lage, der Ursprung und die Äste beschrieben und bei den meisten von ihnen auch schematisch oder tabellarisch dargestellt. Da der Aortenbogen ebenfalls in die Halsgegend reichen kann, werden sowohl die Variationen und Mi\bildungen desselben als auch die Variationen seiner HauptÄste berücksichtigt. Anschlie\end werden die Variationen und Mi\bildungen der A. anonyma, der A. carotis communis, der A. carotis externa und interna geschildert. Es wird immer auf die praktische Bedeutung einzelner Variationen hingewiesen. Bei der Schilderung der Variationen und Mi\bildungen werden sowohl die anatomischen und operativen, als auch die röntgenologischen Befunde aus der Literatur und eigener Erfahrungen beschrieben. Spezielle Aufmerksamkeit wurde den Variationen des Circulus arteriosus Willisi, der Persistenz der presegmentalen Arterien und der Möglichkeit der Bildung eines kollateralen Kreislaufes gewidmet. Bei der A. subclavia werden besonders die Lagevariation derselben und die Variationen ihrer Äste berücksichtigt. Anschlie\end werden, nach einer kurzen embryologischen Einleitung, die Variationen des Venensystems des Kopfes und des Halses und die Anastomosen der venösen Stromgebiete beschrieben. Am Ende werden die Variationen der HauptlymphgefÄ\e des Halses geschildert.

Variations of the ethmoid labyrinth and sphenoid sinus and CT imaging

SummaryThree hundred macerated and partly isolated postmortem mid-facial bones were studied for the development, variations and dimensions of the structures of the nasal cavity. On 184 axial CT scans of bones (102 male, 82 female) from patients ranging in age from 1 to 90 years old, the dimensions of the ethmoid labyrinth and sphenoid sinus were studied in detail in order to determine which anatomic situation might be unsafe during clinical endoscopic interventions. Six anatomic variations were identified. Most unsafe for surgery seemed to be the following types: type 111, in which the anterior diameter of the ethmoid labyrinth was large and the posterior ethmoid and sphenoid diameters were relatively narrow; type V, in which both ethmoid dimensions were large and the sphenoid diameter was narrow: type VI, in which the ethmoid labyrinth had an “hour-glass” shape. Present findings indicate that CT orientation before any endoscopic intervention might help to avoid serious complications.

Postnatal changes in osseous and mucosal morphology of the hard palate.

We investigated the postnatal changes in the dimensions, configuration, and surface pattern of the hard palate in 68 skulls, ranging in age from birth to 90 years of age. The number of palatine rugae of the palatine mucosa was assessed in 168 living subjects aged 11–98 years. Before the first dentition appeared, the osseous palate was concave, smooth, and lacked alveolar processes. In maxillar specimens from the end of the first year to the end of the fourth year of life, balloon‐like osseous formations, containing the elements of permanent teeth, appeared bilaterally behind the deciduous incisors. With age, the concavity of the palate diminished and became flat with the loss of the teeth. The presence of teeth was associated with the height of the alveolar ridge, which decreased from 7.3 ± 4.4 mm in specimens with intact teeth to 4.7 ± 4.1 mm in specimens without teeth (P = 0.020). Palatine rugae were a common finding in living subjects, but were more often absent in older age (2.2% in 11–50 age group vs. 12.8% in 51–98 age group, P = 0.0183). Our results suggest that the morphology of the hard palate rapidly changes during deciduous and permanent teeth eruption and is related to the presence of alveolar ridges and teeth in adults. Palate osseous morphology may be morphologically and functionally independent from its mucosal morphology. Changes in the morphology of the osseous palate are clinically relevant for dental prosthetics and tooth implantation. Clin. Anat. 21:158–164, 2008.

Trace metal enrichment on the surface of the nasal septum bone

Abstract The content and migration of trace elements in bones is an important topic in the study of human life in the environment. In this work metal concentration levels and distributions in nasal cavity bones were studied because of a possible air pollution relationship. Proton microprobe analysis showed iron, zinc and arsenic enrichment on the surface of the transversal osseous nasal septum section.

Distribution of trace elements within bones in nasal cavity and labyrinth in humans

Measurements of trace element concentrations within bones in nasal cavity and labyrinth have shown large variations, both with a single bone and between different bones of a same individual. Factors that influence trace element levels include: metabolic activity, environmental effects, sex, and age. Detection of characteristic X-rays has been shown to be a convenient method for the measurement of concentration profiles, micropixe for micrometer variations, and X-ray centration profiles, micropixe for micrometer variations, and X-ray fluorescence for millimeter variations.

Macroscopical and microscopical changes in the bottom of the internal auditory meatus.

Our macroscopical findings in the region of the deeper part of the internal auditory meatus in presbyacusis have been proved also on microscopical sections. The apposition of bone substance with advancing age, causing the compression and atrophy of the acoustic nerve fibres and the reduction of the ganglionic cells has been found also microscopically in cases of clinical presbyacusis.

The neglected maxillary process of the palatine bone

In most recent anatomy textbooks as well as in the latest anatomical nomenclature, the maxillary process of the palatine bone is not mentioned at all. The maxillary process is, however with rare exceptions, always present as an important part of the closure of the hiatus sinus maxillaris. In our material consisting of 200 disarticulated, macerated skull bones and 25 specimens of maxillary sinus, the maxillary process was missing in only 5 cases (2.2%). This process develops in the second year of life and displays different shapes. It can be long and slender or wide and round shaped. Its upper margin is more or less concave, corresponding to the margin of the hiatus over which it is bent. Its inferior margin can be smooth or irregular. In instances in which maxillary sinus is double, the os palatinum has two maxillary processes, so that both sinuses are partly closed with the maxillary process of the palatine bone.