Necdet Kocabiyik

Anatomical assessment of bile ducts of Luschka in human fetuses

Bile ducts of Luschka (also called subvesical or supravesicular ducts) can cause bile leakage during laparoscopic cholecystectomy, especially if surgery is carried out in ignorance of such variations. The aim of this study was to clarify the clinical anatomy of these ducts in human fetuses and frequency of the ducts locating near gallbladder fossa. Thirty-two fetal cadaver livers were dissected and the gallbladders were separated from the livers and ducts were investigated under a surgical microscope. All observed ducts were examined microscopically and connective tissue cords were excluded. Bile ducts of Luschka locating near cystic fossa were found in 7 of 32 fetuses (21.9%). Three of the seven ducts ran towards to liver segment 5 (S5); three ducts were found in the gallbladder fossa; and one duct ran towards to liver segment 4 (S4). Also it was found that three of the seven ducts drained into the subsegmental duct of S5, two ducts drained into the right hepatic duct, one duct drained into the right anterior branch bile duct, and one duct drained into the subsegmental duct of S4. Subvesical ducts running along the gallbladder fossa between the gallbladder and the liver parenchyma were found in a relatively high incidence in fetuses than adults. Awareness and knowledge about incidence of such ducts alerts the surgeon during laparoscopic cholecystectomy. Therefore morbidity due to bile leaks can be reduced.

Clinical and anatomical aspects of possible mylohyoid nerve injury during genioplasties

Damage to the cutaneous branch of the mylohyoid nerve (CBMN) during genioplasties is possible but rare. The aim of this cadaveric study was to demonstrate possible mechanisms of injuring the CBMN during genioplasties. Mandibulotomy access was used to carry out sublingual and lateral cervical dissections on 10 formalinized cadavers with a mean age of 65 years. The length of the mylohyoid nerve was measured at three sections on the mandible. The posterior section of the mylohyoid nerve was 8.7+/-0.5 mm; the middle section was 14.5+/-0.9 mm and the anterior section was 15.6+/-1.2 mm in length. The submental skin island of 7 specimens had unilateral innervation by the CBMN. The bilateral innervation pattern was detected in 3 of the specimens. Damage to the sensory and the motor branches of the mylohyoid nerve can occur during genioplasties by transaction of the soft tissue pedicle attached to the mental spine and inferior border of the symphis. Surgeons should pay attention during dissection and osteotomy of the chin to avoid complications of the mylohyoid nerve and its branches.

The Efficacy of Mylohyoid Nerve Anesthesia in Dental Implant Placement at the Edentulous Posterior Mandibular Ridge

The aim of this study is to evaluate the anesthetic efficacy of mylohyoid and buccal nerve anesthesia at the posterior edentulous mandible versus regional anesthetic block to the inferior alveolar nerve in dental implant surgery. The study was composed of 2 groups. In the first group (group A), 14 voluntary adults (7 female and 7 male) received local infiltrations of 1 mL articaine HCl 4% with epinephrine 1/200,000 to the ipsilateral mylohyoid and buccal nerves. In the second group (group B, control; 9 female and 5 male adults), the inferior alveolar and the buccal nerve blocks were performed. Visual analog scales were obtained from patients to determine the level of pain during incision, drilling, implant placement, and suturing stages of implant surgery. A combination of buccal and mylohyoid nerve block offered an acceptable level of anesthesia. Two patients from group A stopped the ongoing surgery and had extraregional anesthesia by inferior alveolar nerve block. In group B, patients were operated on successfully. Local anesthetic infiltrations of the mylohyoid and the buccal nerve may be considered alternative methods of providing a convenient anesthetic state of the posterior mandibular ridge.

The morphometric analysis of the central retinal artery

In this study, we aimed to investigate some features of the central retinal artery (CRA), which supplies the internal aspect of the retina. The CRA is the main vessel supplying blood to the retina. The origin, course and penetration point of the optic nerve by the CRA were studied in 30 human orbits. We compared the right sides to the left sides on the basis of gender in order to statistically analyse the relation between them. The CRA arose directly from the ophthalmic artery in 28 specimens. In two specimens, however, it arose in common with the medial posterior ciliary artery. When we observed the penetration point (site) of the CRA into the optic nerve, in 28 of 30 (93.3%) cases, the artery entered the nerve from the lower medial aspect and in two (6.7%) cases from the upper lateral aspect. The CRA penetrated the optic nerve between 6.4 and 15.2 mm behind the eyeball and reached the eyeball through the centre of the optic nerve. Because of the small diameter of the artery, it has a high risk of getting damaged during a surgical approach to the orbit. Therefore the anatomical relationships of this artery must be well known.

The peroneus brevis tendon at its insertion site on fifth metatarsal bone

BACKGROUND The differences at the attachment site of peroneus brevis (PB) to the fifth metatarsal bone is important in terms of the forces exerted on the bone and hence the mechanism of fractures involving this structure. In this study, we investigated the anatomical properties of PB at the insertion site to the base of fifth metatarsal bone, its possible intertendinous connections with peroneus tertius (PT) and their possible effects on the fracture occurrence at the bony attachment site. METHODS The length and the width of PB tendons at their mid- and end-points were measured and classified according to the insertion types. Besides, the length and the width of the base of fifth metatarsal bone were assessed. The slips extending from the PB tendons and their relationship with PT were also evaluated. The data was compared statistically with each other and between the right and left sides. RESULTS The length of PB tendon was measured 79.57±15.40mm on the right side; 81.48±14.31mm on the left. The width of PB tendon at the mid-point was 4.46±0.80mm on the right side; 4.42±0.94mm on the left. The width of the tendon at its insertion point was measured 14.85±3.40mm and 15.16±3.42mm on the right and left sides respectively. PB was divided into three types according to its attachment to base of fifth metatarsal bone (5thMB). Type I, Type II and Type III were observed at the rates of 59.5%, 28.6% and 11.5% respectively. It was observed that the slips to the bone were extending more commonly from PB than from PT and that the large majority of them were single having their insertions on the base of the proximal phalanx of the fifth toe. CONCLUSIONS Knowing the width and insertional types of PB aids in understanding the mechanism of fractures at the site of bony attachment. The existence of slips may help the surgeon in the procedures involving PB or the lateral side of the forefoot.

DOUBLE SUPERIOR VENA CAVA Two cases

Duplication of superior vena cava (SVC) is a rare anomaly. The incidence of double SVC in general population is 0.3% whereas in patients with congenital heart disease it varies between 10-11%. Double SVC cases have clinical importance if especially the one on the left side drains into the left atrium. Moreover, double SVC is surgically important in the presence of congenital heart disease. In this article, we presented adult patients who incidentally diagnosed with double SVC, one drained into the right atrium while the other into the left atrium and discussed the embryologic basis of these patent vessels.

Insertional Characteristics of the Peroneus Tertius Tendon: Revisiting the Anatomy of an Underestimated Muscle

The present study was performed to describe the morphologic characteristics of the peroneus tertius (PT) tendon, evaluate the variations in its insertion point, investigate the interconnections with the tendons of the extensor digitorum longus, and discuss whether these insertion differences of the muscle tension might have an effect on fracture formation. The length and width of the PT tendon and the width at its midpoint were measured in 44 lower extremities. The data obtained were compared statistically. The PT was found to occur in 2 types according to the number of tendons: type 1, a single tendon without a slip; and type 2, 2 tendons with a slip. It has been suggested that the PT tendon could contribute to avulsion fractures of the tuberosity of the fifth metatarsal bone. Therefore, to understand the mechanism of Jones fracture, knowledge of the PT tendon would be beneficial to determine the insertion points.

Anthropometry of the Medial Canthal Ligament Related to Naso-Orbitoethmoidal Fractures

Objective Medial canthal ligament (MCL) and lacrimal system are often associated with naso-orbitoethmoidal fractures. The MCL anchors tarsal plate to medial orbit and has an important role in lacrimal pump system. The purpose of this study was to describe the anatomy of the MCL and present the anthropometric measurements on cadaveric specimens. Methods Dissections were performed on 14 formalin-fixed cadavers. The length, thickness, width of the MCL, width of the nasal dorsum, and intercanthal distance were measured with a digital caliper. A surgical microscope and an digital photo camera were used in all dissections. Means, SDs, and paired-samples t test were computed. Results The mean lengths of the right and left MCLs were measured as 8.01 (SD, 2.27) and 7.93 (SD, 2.43) mm. The mean thicknesses of the right and left MCLs were 1.63 (SD, 2.41) and 1.75 (SD, 2.44) mm. The mean widths of the right and left MCLs were 4.20 (SD, 0.75) and 4.17 (SD, 0.61) mm. The intercanthal distance was 31.7 (SD, 1.7) mm. The width of the nasal dorsum was measured as 14.37 (SD, 1.9) mm. Length and thickness differed on both sides. Asymmetric insertion of medial canthi was observed in 5 specimens. Conclusions Reconstruction of traumatic telecanthus requires reaproximation of medial canthi and the displaced nasoethmoid bony fragment with transnasal wiring or microplates. Identification and reconstruction of detached medial canthi could be accomplished sucesfully with anatomic familiarity of the region. The most developed and firmly adherent was the anterior limb of the MCL. Reattachment of that part seems to be adequate for repair of a detached canthus.

Reply to: The furcal nerve revisited

Dear Sirs, We read Dr. Harshavardhana et al.’s article The furcal nerve revisited and found it interesting. Nevertheless we have confusions about same points this study.1 They reported It is formed by ventral and dorsal rami of L1-L4 nerve roots with contribution from 12th thoracic nerve (i.e. subcostal nerve). After the anterior rami of the upper four lumbar nerves have supplied psoas and quadratus lumborum segmentally, they form the pleksus in the substance of psoas major.2,3 Juliana Farny et al. reported The lumbar plexus originated from the first four lumbar ventral rami that joined within the substance of the psoas major.4 As a result, the sentence will be eligible to be corrected as stated above Lumbar plexus is formed by ventral rami of L1-L4 nerve roots.1-4 Imre Nurcan, Kocabiyik Necdet

Koroner Kalp Hastalığının Anatomik Risk Faktörleri

Objectives: The aim of this study was to explore the possible anatomical risk factors of coronary heart disease (CHD) such as vascular geometry of the left coronary artery and its branches using coronary angiography. Patients and Methods: The trunk length (T) of the left coronary artery, the curve angle of the left anterior descending artery (LAD) and the bifurcation angle between the LAD and the circumflex artery (Cx) were measured in 77 patients (age range 20-83, mean 58.9aplusmn;11.68). Results: The atherosclerotic plaque existence was investigated in LAD and Cx. The mean values of the T length, LAD curve angle and the LAD-Cx bifurcation angle were respectively 12.86 mm, 140.99adeg; and 94.07adeg;. In patients who have atherosclerotic plaques in LAD, the mean value of the T lengths was found 2.5 mm shorter than those of the patients whose LADs are intact (p=0.020). On the other hand a significant negative correlation between the LAD curve angle and the bifurcation angle was found (palt;0.001). Conclusion: In view of our results it can be suggested that geometrical pattern of LAD and its branches may be a congenital risk factor in development of CHD in patients who have no other risk factors. Amac: Calismanin amaci koroner anjiografi kullanarak sol koroner arterin vaskuler geometrik ozellikleri gibi konjenital kalp hastaliklarinin muhtemel anatomik risk faktorlerini aciklamakti. Hastalar ve Yontemler: Sol koroner arterin trunk uzunlugu (T), arteria interventricularis anterior (LAD)a#39;un donus acisi, LAD ve arteria circumflexa (Cx) arasindaki bifurkasyon acisi 77 hastada (yas araligi 20-83, ort. 58.9aplusmn;11.68) olculdu. Bulgular: Arteria interventricularis anterior (LAD) ve Cxa#39;de aterosklerotik plak varligi arastirildi. Sol koroner arterin trunk uzunlugu, LAD donus acisi ve LAD-Cx bifurkasyon acilari degerleri sirasiyla ortalama 12.86 mm, 140.99adeg; ve 94.07adeg; idi. Arteria interventricularis anteriora#39;de aterosklerotik plagi olan hastalarda ortalama T degerleri LADa#39;leri intakt olan hastalarinkinden 2.5 mm daha kisa bulundu (p=0.020). Diger taraftan LAD donus acisi ile bifurkasyon acisi arasinda negatif korelasyon bulundu (palt;0.001). Sonuc: Sonuclarimiza gore LAD ve dallarinin geometrik ozellikleri, baska risk faktoru olmayan CHDa#39;li hastalarin gelisiminde bir risk faktoru olabilir.