Jyothsna Patil

Safety and Effectiveness of Total Thyroidectomy and Its Comparison with Subtotal Thyroidectomy and Other Thyroid Surgeries: A Systematic Review

Diseases associated with the thyroid gland are one of the most frequently seen endocrine disorders across the globe. Total thyroidectomy is currently the preferred treatment for many thyroid diseases. Controversies exist among surgeons regarding safety of total thyroidectomy due to the risk associated with it like postoperative hypoparathyroidism or recurrent laryngeal nerve damage. Since, in the recent years, the incidence of thyroidectomy is in increasing trend in south Indian population, this review aims to study the available data regarding the appropriateness and safety of total thyroidectomy and compares it with subtotal thyroidectomy and other thyroid surgeries. This is a retrospective comprehensive review of various articles and publications regarding total and partial thyroidectomy performed across the world. Many retrospective studies and few prospective studies suggest that the incidence of transient hypocalcemia is higher after total thyroidectomy than after subtotal thyroidectomy, but the incidence of other complications including recurrent laryngeal nerve palsy and postoperative hematoma is not significantly different between the two procedures. Hence in our review we found that total thyroidectomy is safe and cost effective with low complication rates and provides little significant advantage of being safer procedure compared to subtotal thyroidectomy.

Additional circular intercostal space created by bifurcation of the left 3rd rib and its costal cartilage: a case report

IntroductionIn the thorax there are normally 11 pairs of intercostal spaces: the spaces between adjacent ribs. The intercostal spaces contain intercostal muscles, intercostal nerves and vessels.Case presentationDuring a routine dissection for undergraduate medical students, we observed a variation involving the left 3rd rib and 3rd costal cartilage in the cadaver of a man of Indian ethnicity aged about 65 years. The left 3rd rib and its costal cartilage were bifurcated at their costochondral junction enclosing a small circular additional intercostal space. Muscle tissue covered by deep fascia was present in this circular intercostal space. The muscle in the circular intercostal space received its nerve supply from a branch of the 2nd intercostal nerve.ConclusionsKnowledge of such variations is helpful to surgeons operating on the anterior thoracic wall involving ribs and intercostal spaces. Knowing the possibility of the presence of an additional space between normal intercostal spaces can guide a surgeon through to a successful surgery.

Absence of retromandibular vein associated with atypical formation of external jugular vein in the parotid region.

Veins of the head and neck exhibiting anatomical variations or malformations are clinically significant. Anatomical variation in the external jugular vein is very common. However, anatomical variation in the retromandibular vein is rare. In this paper, we report a rare case of complete absence of the retromandibular vein. In the absence of the retromandibular vein, the maxillary vein divided into anterior and posterior divisions. The posterior division joined the superficial temporal vein to form an atypical external jugular vein, and the anterior division joined the facial vein to form an anonymous vein. In clinical practice, radiologists and surgeons use the retromandibular vein as a guide to expose the branches of the facial nerve during superficial parotidectomy. Therefore, absence of the retromandibular vein is a hurdle during this procedure and may affect the venous drainage pattern from the head and neck.

The foramen ovale morphometry of sphenoid bone in South Indian population.

BACKGROUND The foramen ovale is an oval opening in the greater wing of sphenoid bone transmitting the mandibular nerve as its major content. It serves as an important landmark for neurosurgeons in certain procedures as to gain access to trigeminal nerve. Therefore, its topographic position in relation to adjacent bony landmarks provides useful tool during these procedures. AIM To analyse the morphometric measurements of the foramen ovale among South Indian population. MATERIAL AND METHODS Morphometric analysis was carried out on 104 foramina ovalia of 52 dry human skulls from South India. Following dimensions of foramen ovale were measured: antero-posterior length, transverse width, distance (d(1)) from tubercle of root of zygoma to the centre of the foramen (CF) and distance (d(2)) from the midline of the base of the skull to CF. RESULTS The mean antero-posterior length was 7.0±2.17mm on right side and 6.8±1.40mm on left side, mean transverse width was 5.0±0.42mm and 4.70±0.91mm on right and left side respectively. Mean d(1) was 32.58±1.72mm on right side and 32.75±1.76mm on left side. Mean d(2) was 25.83±1.26mm on right side and 25.08±1.31mm on left side. CONCLUSION Regional variations in the morphometric measures may be useful in neurosurgical procedures like administration of anaesthesia involving the mandibular nerve.

A rare anatomical variation of the Berrettini anastomosis and third common palmar digital branch of the median nerve

Variations in the origin and distribution of Berrettini anastomosis between the digital branches of the ulnar and median nerves exist and are well described in the literature. During regular dissections by medical students, we encountered a rare variation in the left hand of an approximately 50-year-old male cadaver. Berrettini anastomosis connecting the third common palmar digital branch of the median nerve with the fourth common palmar and proper palmar digital branches of the ulnar nerve presented a plexiform nature. This communicating branch and the third common palmar digital branch of the median nerve were perforated by the superficial palmar arch. Further, the superficial palmar arch was incomplete, and it was solely formed by the superficial branch of the ulnar artery. The unusual relationship of Berrettini anastomosis with the superficial palmar arch is very rare, and knowledge about such a variation is important when performing carpal tunnel release, flexor tendon surgery, and Dupuytren’s fasciectomy and when dealing with arterial repairs and vascular graft applications in the hand.

Atypical Arterial Supply to the Spleen by Polar Branches of Splenic Artery and Accessory Splenic Artery – A Case Report

Vascular anomalies of the spleen are usually asymptomatic. However, variant anatomy of splenic artery becomes clinically important, when the patients undergo diagnostic angiography for gastrointestinal bleeding or during transcatheter therapy. We report here a concurrent variant arterial pattern of the spleen. The splenic artery was unusually elongated and excessively tortuous. Prior to its normal termination into segmental arteries, it gave superior and inferior polar arteries which entered the spleen distal to corresponding ends of the splenic hilum. In addition to this, the spleen also received an additional blood supply from an accessory splenic artery arising from left gastro-epiploic artery. The accessory splenic artery entered the substance of the spleen through its lateral end. Presence of such kind of concurrent variant arterial pattern of spleen makes the surgeons obligatory to have prior knowledge to prevent bleeding during any surgical or radiological interventional procedures targeting the spleen, pancreas etc.

An anatomical variation in the formation of the inferior root of ansa cervicalis

During regular dissections, we observed an unusual organization of the inferior root of Ansa Cervicalis (AC). The superior root of ansa arose normally from the hypoglossal nerve. The ventral ramus of the C2 spinal nerve divided into two branches. One of its branches joined the superior root independently to form a loop at a higher level. Another branch ran along the vagus nerve, joined with the ventral ramus of C3 spinal nerve, finally connected with the superior root and formed the second loop at a lower level. No variation was found in formation of superior root. Knowledge on the possible deviations in the formation of these roots is clinically important, to prevent iatrogenic injuries in surgical procedures such as thyroplasties, arytenoids adductions, and Teflon injections.

Anatomical Study of the Ulnar Nerve Variations at High Humeral Level and Their Possible Clinical and Diagnostic Implications

Background. Descriptive evaluation of nerve variations plays a pivotal role in the usefulness of clinical or surgical practice, as an anatomical variation often sets a risk of nerve palsy syndrome. Ulnar nerve (UN) is one amongst the major nerves involved in neuropathy. In the present anatomical study, variations related to ulnar nerve have been identified and its potential clinical implications discussed. Materials and Method. We examined 50 upper limb dissected specimens for possible ulnar nerve variations. Careful observation for any aberrant formation and/or communication in relation to UN has been carried out. Results. Four out of 50 limbs (8%) presented with variations related to ulnar nerve. Amongst them, in two cases abnormal communication with neighboring nerve was identified and variation in the formation of UN was noted in remaining two limbs. Conclusion. An unusual relation of UN with its neighboring nerves, thus muscles, and its aberrant formation might jeopardize the normal sensori-motor behavior. Knowledge about anatomical variations of the UN is therefore important for the clinicians in understanding the severity of ulnar nerve neuropathy related complications.

Long Coeliac Trunk and its Low Origin and Unusual Branches: A Case Report

Introduction:Coeliac trunk supplies the derivatives of the foregut. Knowledge of its variations is useful for surgeons, gastroenterologists and radiologists. We report a case of low origin, unusual length and branches of coeliac trunk. Case report The coeliac trunk had a low origin (at the level of L2 vertebra) and was 5 cm in length. It gave origin to the right and left inferior phrenic arteries and terminated by giving splenic, left gastric and common hepatic arteries.Conclusion Unusual length and branches of coeliac trunk might cause confusions in diagnostic and surgical procedures.

Tunnel for ligamentum teres: a rare variation of the liver

Introduction Ligamentum teres hepatis, an embryological remnant derived from the obliterated left umbilical vein is lodged on the fissure for the ligamentum teres on the inferior surface of the liver. We report here an anomalous case where the ligament passed through a tunnel instead of a fissure. Case report The fissure for ligamentum teres was obliterated by bridging of liver tissue across the quadrate and left lobes. This bridging converted the fissure into a tunnel through which ligamentum teres coursed to its destination. A small fissure extended from the left end of porta hepatis to this tunnel. Lack of separation of lobes, in the early embryonic period might have led to this variation. Conclusion Anomalies like this can often mislead the radiologists or surgeons either in diagnosis or interpretations of liver diseases.