Muzaffer Sindel

Incidence of accessory ossicles and sesamoid bones in the feet: a radiographic study of the Turkish subjects

Most accessory ossicles and sesamoid bones of the ankle and the foot remain asymptomatic; however, they have increasingly been examined in the radiology literature, because they can cause painful syndromes or degenerative changes in response to overuse and trauma. Our aim was to document a detailed investigation on the accessory ossicles and sesamoid bones of Turkish subjects in both the feet according to the sex, frequency and division of the bones, coexistence and bilaterality by radiography. A double-centered study was performed retrospectively to determine the incidence of the accessory ossicles and sesamoid bones in the ankle and foot. Accessory ossicles (21.2%) and sesamoid bones (9.6%) were detected by Radiographs of 984 subjects. The most common accessory ossicles were accessory navicular (11.7%), os peroneum (4.7%), os trigonum (2.3%), os supranaviculare (1.6%), os vesalianum (0.4%), os supratalare (0.2%), os intermetatarseum (0.2%). We observed bipartite hallux sesamoid in 2.7% of radiographs. Interphalangeal sesamoid bone of the hallux was seen in 2% of radiographs. Incidences of metatarsophalangeal sesamoid bones were found as 0.4% in the second digit, 0.2% third digit, 0.1% fourth digit and 4.3% fifth digit. We also identified the coexistencies of two different accessory ossicles as 6%, accessory ossicles and sesamoid bones as 7%, and bipartite sesamoid bones and sesamoid bones as 1.9%. Distribution of the most common accessory ossicles in male and female subjects was similar. We reported the incidence of accessory ossicles and sesamoid bones of the feet in Turkish adult population.

Anatomical evaluation of the groove for the vertebral artery in the axis vertebrae for atlanto-axial transarticular screw fixation technique

Anatomical measurements were studied on 40 dry axis vertebrae to determine the suitability of the groove for the vertebral artery for atlanto‐axial transarticular screw fixation technique. We measured 13 parameters including three angular and 10 linear dimensions related to the groove of the vertebral artery, pedicle, and pars interarticularis and evaluated 80 measurements for each parameter. All measurements were done after placing a Kischner guide wire through the pedicle. We found that differences between measurements on the left and right sides of each vertebra were nonsignificant. In spite of the variability in measurements such as height, width, and median angle of the pedicle, the decline angle for instrumentation, the depth of the groove for the vertebral artery, and the internal height of the pars interarticularis, all of these had good symmetry. However, there were statistically significant differences between the sides in measurements for both the width (P=0.05) and the angle (P<0.02) of the pedicle allowing instrumentation and they did not show good symmetry. The risk of vertebral artery injury was found to be 22.5% per specimen, or 16.25% per screw inserted because the internal height of the pars interarticularis at point of fixation was ≤ 2.1 mm. In addition, we found that the pedicle width allowing instrumentation was not suitable in 12.5% of screws inserted because their values were ≤ 6 mm. When the width of the pedicle for instrumentation and the internal height of the pars interarticularis were both evaluated together, we also found that this technique would be extremely dangerous in 7.5% of specimens. In conclusion, the internal height of the pars interarticularis and the width of the pedicle for instrumentation should be evaluated together in thin CT sections preoperatively, because of the risk of vertebral artery injury in patients upon which atlanto‐axial transarticular screw fixation is to be performed. Clin. Anat. 13:237–243, 2000.

Anteroposterior diameter of the vertebral canal in cervical region: Comparison of anatomical, computed tomographic, and plain film measurements

The purpose was to compare the computed tomographic and plain film measurements with those of anatomical specimens to determine the antero‐posterior diameter of the spinal canal in cervical region. Antero‐posterior diameters of 75 cervical vertebral canals (15 sets of C3–C7) were measured anatomically at two different levels. Computed tomographic and plain film measurements were also obtained at the corresponding levels. Considering anatomical measurements as the gold standard, plain film and computed tomographic measurements were statistically compared. Interobserver and intraobserver differences were also evaluated. At the uppermost pedicle levels, there was no statistically significant difference between plain films and anatomical measurements, a good correlation. However, at lowermost pedicle level there was a statistically significant difference between plain films and anatomical measurements but not between tomographic and anatomical measurements. Our results suggest that plain films can accurately estimate cervical spinal canal mid‐sagittal diameter at the uppermost pedicle level and be used as a first step examination for the evaluation of cervical spinal stenoses. Clin. Anat. 14:15–18, 2001.

Definition of a safe-zone in open carpal tunnel surgery: a cadaver study

Carpal tunnel decompression is one of the most common surgical procedures in hand surgery. Cutaneous innervation of the palm by median and ulnar nerves was evaluated to find a suitable incision preserving cutaneous nerves. A morphometric study was designed to define the safe-zone for mini-open carpal tunnel release. Sixteen fresh-frozen (8 right, 8 left) and 14 formalin-fixed (8 right, 6 left) cadaveric hands were dissected. Anatomy of the palmar cutaneous branch of the median and the ulnar nerve, motor branch of the median nerve, superficial palmar arch were evaluated relative to the surgical incision. We also identified the motor branch of the median nerve. Detailed measurements of the whole palmar region are reported in this study. The motor branch of the median nerve was extraligamentous as 60%, subligamentous as 34%, transligamentous as 6%. The palmar cutaneous branches of the median and the ulnar nerves in the palmar region were classified as Type A (34%), Type B (13%), Type C (13%), Type D (none), Type E (40%) according to forms of palmar cutaneous innervation originating from the ulnar and median nerves. Injury to the palmar cutaneous branch of the median nerve (PCBMN) is the most common complication of the carpal tunnel surgery. Various techniques were described to decrease post-operative morbidity. Based on these anatomic findings mini incision between the superficial palmar arch and the most distal part of the PCBMN in the palmar region is the safe-zone for carpal tunnel surgery.

An anomalous digastric muscle with three accessory bellies and one fibrous band

During our routine dissection studies we encountered an anomalous digastric muscle with three accessory bellies and one fibrous band in one embedded cadaver. All of these structures were attached to the mylohyoid raphe. This anomaly should be considered during surgical procedures involving this region.

Tibial tubercle position and patellar height as indicators of malalignment in women with anterior knee pain

In this study, we evaluated 70 limbs in 42 women with anterior knee pain. We investigated tibial tubercle position and patellar height indices as indicators of malalignment. Tibial tubercle rotation angles were determined by computed tomography, and patellar height indicators, Insall‐Salvati, modified Insall‐Salvati, Caton, and Blackburne indices were calculated on lateral knee roentgenograms. The results were compared to values obtained from 80 limbs in 40 healthy female volunteers. Tibial tubercle rotation angle was 68.1° (±3.6) in the study group and 70.3° (±3.8) in the control group. The difference was statistically significant (P< 0.01). Patellar height indicators were not statistically different between the two groups. These results suggested that patellar height is not a malalignment indicator in female patients with anterior knee pain. These patients should be investigated by computed tomography to determine tibial tubercle position. Clin. Anat. 13:199–203, 2000.

Percutaneous Anterior Odontoid Screw Fixation Technique

Summary We describe a new instrument and a percutaneous technique for closed anterior fixation of odontoid fracture. The instrument which we developed consists of a telescopic tube system. This new instrument and closed fixation technique was used in six cadavers with type II odontoid fractures and to two cadavers with an intact odontoid process. Each cadaver underwent satisfactory placement of the screw to the odontoid with this technique under biplanar scopy control. After this procedure, no serious injury was found in the parapharyngeal and neurovascular areas of the necks of the cadavers, in which anatomical dissection along the track of this instrument was performed. The instrumentation and the technique as a whole is seen as reliably applicable for odontoid fracture fixation. Also, we expect to reduce operating time and hospital costs because this system is simple, easily applicable and minimally invasive.

Co-existence of the pectoralis quartus and pectoralis intermedius muscles

During the routine dissection studies on the right side of a 56-year-old female cadaver we encountered co-existence of the pectoralis quartus and pectoralis intermedius muscles. The pectoralis quartus originated from the costochondral junction of the fifth and sixth ribs, and then extended laterally under the border of pectoralis major muscle, but it was entirely separate from it. The pectoralis quartus formed a long flat band with an average width of 1.5 cm. It then inserted as an aponeurosis to the both of lateral lip of the intertubercular groove of the humerus and tendon of the short head of the biceps brachii muscle. Furthermore, the pectoralis intermedius muscle was a fleshy slip between the pectoralis minor and pectoralis quartus muscles and arose from the third and fourth ribs. It then united to the tendon of the short head of the biceps brachii muscle two cm below the coracoid process.

Pierre Mollaret (1898-1987) and his legacy to science.

Pierre Mollaret was a French physician who made various significant contributions to neurology and infectious diseases. He was born in Auxerre, France in 1898. In 1916, he began to study medicine and science but his education was interrupted by World War I. During 1917 and 1918, he served as an assistant physician and was decorated with the Croix de Guerre when the war ended. He resumed his medical studies in 1920 and received his degree in science in 1926. During his education, one of his teachers was Professor Georges Charles Guillian (1876–1961; Guillian of the Guillian–Barre syndrome), with whom Mollaret worked …

The canal of the posterior ampullar nerve: an important anatomic landmark in the posterior fossa transmeatal approach.

Abstract The canal of the posterior ampullar nerve is located between the inferior part of the internal acoustic meatus and ampulla of the posterior semicircular canal. It permits a more accurate localisation of the underlying labyrinth in inner-ear surgery. An anatomical and radiological study was undertaken to determine the importance the relationship between the canal and the labyrinth. Ten dry and 10 cadaveric temporal bone dissections, together with 20 high resolution CT scans of the same temporal bones were studied in an attempt to describe the anatomy of the canal of the posterior ampullar nerve. The length of the canal of the posterior ampullar nerve, the length of internal acoustic meatus, and distances from porus acusticus to the singular foramen and the transverse crest, and from the singular foramen to the vestibule and transverse crest, and from operculum to the sigmoid sinus and to the porus acusticus were measured. During the transmeatal posterior cranial fossa approach using the canal of the posterior ampullar nerve as a landmark enables more bone to be safely removed from the internal acoustic meatus thus preserving hearing.