Mete Edizer

Anatomic study of the vasculature of the submental artery flap.

The submental artery island flap is a versatile option in head and neck reconstruction. This flap may be used for the coverage of perioral, intraoral, and other facial defects, leaving a relatively acceptable donor-site scar. In this study, the submental region of 13 formalin-fixed cadavers was dissected bilaterally. Comprehensive anatomical information regarding the pedicle of the flap and its relationship with the important adjacent structures is provided. The mean values of the measurements of the facial and submental arteries were as follows: the facial artery was 2.7 mm in diameter at the origin, and it crossed the mandibular border 26.6 mm from the mandibular angle. The origin of the submental artery was 27.5 mm from the origin of the facial artery, 5.0 mm from the mandibular border, and 23.8 mm from the mandibular angle. The diameter of the submental artery was 1.7 mm at the origin. The artery was found mostly to course superficial to the submandibular gland. In one case, the artery passed through the gland. The total length of the submental artery was 58.9 mm. The artery anastomosed with the contralateral artery in 92 percent of the cadavers. The submental artery was deep to the anterior belly of the digastric muscle in 81 percent of the cases. This study presents detailed anatomical data about the location, dimension, and relationship of the facial artery, the submental artery, and the submental vein that may be useful during dissection of the submental artery island flap.

Cadaveric study of the arterial anatomy of the upper lip.

Arterial distribution of the upper lip was investigated in this study. The location, course, length, and diameter of the superior labial artery and its alar and septal branches were determined on 14 preserved cadaver heads. Another cadaver head was used to show the arterial tree by the colored silicone injection technique. The superior labial artery was the main artery of the upper lip and always originated from the facial artery. The superior labial artery was 45.4 mm in length, with a range from 29 to 85 mm. The mean distance of the origin of the superior labial artery from the labial commissura was 12.1 mm. The superior labial artery was 1.3 mm in external diameter at its origin. The mean distance of origin of the superior labial artery from the lower border of the mandible was 46.4 mm. The alar division of the superior labial artery was mostly found as a single branch (82 percent). Its mean length was 14.8 mm and the mean diameter at the origin was 0.5 mm. The distance between the origins of the superior labial artery and the septal branch was 33.3 mm. The septal branch was single in most of the cases (90 percent). The mean length of the septal branch was 18.0 mm and the diameter at its origin was 0.9 mm. After all dissections, it was concluded that the arterial distribution of the upper lip was not constant. The superior labial artery can occur in different locations unilaterally and bilaterally, with the branches showing variability.

Arterial anatomy of the lower lip: A cadaveric study

The aim of the study was to investigate the arterial anatomy of the lower lip. The location, course, length, and diameter of the inferior labial artery and the sublabial artery were revealed by bilateral meticulous anatomic dissections in 14 adult male preserved cadaver heads. Another cadaver head was used for silicone rubber injection to fill the regional arterial tree. The inferior labial artery was the main artery of the lower lip and in all cases branched off the facial artery. The mean length of the inferior labial artery was found to be 52.3 mm (range, 16 to 98 mm). The mean distance of the origin of the inferior labial artery from the labial commissura was 23.9 mm. The mean external diameter of the inferior labial artery at the origin was 1.2 mm. The sublabial artery was present in 10 (71 percent) of the cadavers. Mean measurements of this artery were 1 mm for diameter, 23.4 mm for length, and 27.6 mm for distance from the labial commissura. The sublabial artery may originate from the facial artery or the inferior labial artery. This study found that this region does not have a constant arterial distribution, the inferior labial artery and the sublabial artery (if it exists) can be in different locations unilaterally or bilaterally, and the diameter and the length may vary.

Anatomic Bases of Superficial Temporal Artery and Temporal Branch of Facial Nerve

Abstract The superficial temporal artery (STA)-based flaps have been used for different reconstructive purposes. These operations may cause facial nerve injury. The variations of the STA and its relation to temporal branch of the facial nerve (TBFN) were evaluated in this study. Thirteen cadavers with 26 STA and TBFN have been dissected. The bifurcation of STA was found to be 60% above the superior border of the zygomatic arc and 40% below this level. The mean lengths of frontal and temporal branches (FB and TB) of STA were 11.5 and 11.4 cm, respectively. The mean numbers of perforators of FB and TB to deep plane were 1.30 and 1.34, respectively. The mean diameter of STA at the superior border of zygomatic arc was 2.5 mm. The mean diameters of TB and FB at the level of bifurcation were 1.8 mm and 2.0 mm, respectively. The mean number of TBFN at the level of zygomatic arc was 3.70. The mean distance of the first and last branching of TBFN to tragus was found to be 24 mm. The mean number of TBFN at the level of the middle orbita was found to be 2.7. The mean distance of first and last branches of TBFN to the lateral orbital rim was 12 and 24 mm, respectively. The results found in this study may increase the accuracy of flaps based on STA and decrease the risk of facial nerve paralysis during these operations.

Evaluation of Lumbar Vertebral Body and Disc: A Stereological Morphometric Study

El acceso anterior a las vertebras L1-L5 y espacios entre los discos puede ser tecnicamente dificil, con frecuencia requiere la participacion de un cirujano para una exposicion adecuada. La tecnica se utiliza para la extirpacion de la lesion, corpectomia, la reconstruccion del cuerpo vertebral con jaulas, realineamiento y / o placas o tornillos. Para un enfoque exitoso anterior y un diseno adecuado instrumental a traves de tornillo, un acabado conocimiento sobre la morfometria del cuerpo de las vertebras lumbares y de los espacios entre los discos y la evaluacion volumetrica son necesarias para el neurocirujano. El objetivo fue la evaluacion morfometrica y volumetrica de los cuerpos lumbares y los discos, para contribuir al abordaje seguro durante la cirugia. Se evaluo en 25 sujetos adultos, diestros, sin antecedentes de fracturas vertebrales y de enfermedad degenerativa espinal, el cuerpo vertebral y la morfometria del disco mediante estereologia con RM. La forma de las vertebras, el indice de concavidad y la definicion de las medidas volumetricas de los cuerpos L1-L5. Ademas, se midieron los parametros morfometricos como longitud, altura, ancho del cuerpo vertebral. Se efectuo un analisis morfometrico y volumetrico de loss cortes axiales y sagitales de los discos entre L1 y L5. Como era de esperar, las dimensiones promedio de las vertebras en los hombres fueron mayores que en las mujeres, pero la mayoria de ellos no son estadisticamente significativas. Solo tres dimensiones, la diferencia promedio entre la altura anterior y central de las vertebras L3, L4 y L5 mostraron diferencias estadisticamente significativas, indicando menor altura central tanto en los hombres como en las mujeres. Los diametros transversal y anteroposterior del cuerpo vertebral, la altura del disco intervertebral y el volumen no mostraron dimorfismo sexual (p>0,05). Sin embargo, aumentaron la altura del disco intervertebral y el volumen de L1 a L5 (p<0,01). Los indices de concavidad, de todas las vertebras lumbares, para ambos sexos, no diferian estadisticamente. El metodo es importante para el neurocirujano, para estimar el tamano y cantidad del implante y su aplicacion en las cirugias de descompresion.

Lumbar vertebra morphometry and stereological assesment of intervertebral space volumetry: a methodological study.

The use of technology in the treatment of degenerative spinal diseases has undergone rapid clinical and scientific development. It has been extensively studied in combination with various techniques for spinal stabilization from both the anterior and posterior approach. Minimally invasive and instrumental approach via posterior fixation is increasingly being used for the treatment of adult degenerative disc disease, stenosis, and deformity of the lumbar vertebrae. Posterior access to the lumbar disc spaces for posterolateral fusion scan has been technically challenging, frequently requiring the use of an approach surgery for adequate exposure. For successful surgery and suitable instrumental design, adequate anatomical knowledge of the lumbar vertebra is also needed. Anatomic features of lumbar vertebrae are of importance for posterior screw fixation technique. The morphometry of L1-L5 has been studied to facilitate the safe application of pedicle screws. Thus, we aimed to evaluate the morphometric landmarks of lumbar vertebrae such as pedicle, vertebral body, vertebral foramen, intervertebral space height and volume for safe surgical intervention using a posterior fixation approach to offer anatomical supports for lumbar discectomy, stenosis and cases of deformity. The features of the L1-L5 vertebral body, the detailed morphometric parameters of lumbar vertebrae and the intervertebral space were analyzed using computerized tomography scan, magnetic resonance imaging and also dry lumbar vertebrae. Additionally, intervertebral space volumes were measured using stereological methods to ensure safe surgical intervention.

Anatomy of Gracilis Muscle Flap

Abstract Gracilis muscle flap is commonly used in reconstructive surgery. The gracilis muscles of 15 formalin-fixed adult cadavers (30 cases) were dissected with 4× loupe magnification. The most proximal pedicle of gracilis muscle was the deep branch of the medial circumflex femoral artery. It was located 60 mm from the pubic tubercle and had a diameter of 0.9 m on the average. The second pedicle was the medial circumflex femoral artery. It was the dominant pedicle in 13% of the cases. The mean diameter of the artery was 1.2 mm, and it entered the muscle 98 mm from the pubic tubercle. The third artery that nourished the muscle was deep femoral artery. It was the dominant pedicle in 87% of the cases. It had a mean diameter of 1.6 mm with a length of 54 mm. The most distant pedicles originated from the superficial femoral artery. They were present in all cases and were double in 77% of the cases. Mean diameter and length of the artery were 1.4 and 52 mm, respectively. They entered the muscle 266 mm from the pubic tubercle. These distal pedicles seem to be large enough to elevate the middle part of the muscle as a free flap.

Morphological parameters of the periorbital arterial arcades and potential clinical significance based on anatomical identification.

The aim of the study was to investigate the locations, diameters, and connections of the periorbital arterial vessels. The peripheral and marginal arcades of the superior and inferior eyelids were revealed by bilateral meticulous anatomic dissections in 12 adult male and 5 female preserved cadavers. Silicone rubber injection was used to fill the regional arteries. The mean external diameter of the lacrimal (0.4 mm), supraorbital (1.0 mm), supratrochlear (0.9 mm), superior medial palpebral (0.9 mm), inferior medial palpebral (1.0 mm), dorsal nasal (0.8 mm), and infraorbital (2.0 mm) arteries were measured. Contribution of superficial temporal artery to palpebral arcades via frontal, zygomatico-orbital, and transverse facial branches was demonstrated. The purpose of this study was to demonstrate the periorbital arterial supply with contributing anastomosis from facial vasculature and impact on clinical practice.

Anatomy of vastus lateralis muscle flap.

Abstract A vastus lateralis muscle flap is used as a pedicled and free flap. In this study, the vastus lateralis muscles of 15 adult formalin-fixed cadavers (30 cases) were dissected. The dominant pedicle was found to be descending branch of the lateral circumflex femoral artery. The mean diameter of the artery was found to be 2.1 mm. This pedicle was located 119.4 mm distal to the pubic symphysis. The mean length of the major pedicle was found to be 56.8 mm when the dominant pedicle was chosen to nourish the flap. The dominant pedicle entered the muscle 155.8 and 213.7 mm from the greater trochanter and the anterior superior iliac spine, respectively. The muscle had proximal minor pedicles from the ascending and transverse branches of lateral circumflex femoral artery. These arteries had mean diameters of 1.8 and 2.0 mm, respectively. The distal minor branches were present in all of the dissections. The distal branch had a mean diameter of 1.8 mm. The origin of this distal branch was located 83.7 mm proximal to the intercondylar line. The motor nerve of the vastus lateralis was found to be originating from femoral nerve. The nerve entered the muscle 194.6 mm from the anterior superior iliac spine.

Foramen arcuale: a rare morphological variation located in atlas vertebrae

ObjectiveTo investigate the incidence of foramen arcuale in dry atlas vertebrae which may cause clinical problems.Materials and methodsEighty-one dry human cervical vertebrae were examined. The evaluated parameters of two atlas vertebrae including foramen arcuale were as follows: maximum antero-posterior, transverse diameters and areas of the right and left superior articular facets and transverse foramina; maximum antero-posterior diameters, heights, areas and central sagittal thickness of bony arch forming roof of foramen arcuale, respectively. All parameters were measured with caliper in milimeters.ResultsThirteen of eighty-one cervical vertebrae specimens (13/81, 16.05%) were atlas and the two of thirteen atlas vertebrae (2/13, 15.38%) had macroscopically complete foramen arcuale. Each of the two atlas vertebrae was including one foramen arcuale (one on the left and one on the right side). There was a statistically significant difference (p = 0.04) between the mean antero-posterior diameter of superior articular facet located on each side of atlas vertebrae, whereas not (p = 0.51) between mean antero-posterior diameter of transverse foramina. There was not any significant difference between the mean transverse diameters and areas of superior articular facets and transverse foramina located on each side of atlas vertebrae, respectively. Each of the areas of transverse foramina located on the same sides with foramen arcuale in two atlas vertebrae was less than the mean areas of transverse foramina located ipsilateral side with each foramen arcuale in thirteen atlas vertebrae.ConclusionThe present study provides additional information about the incidence and topography of the atlas vertebrae including foramen arcuale.