Özlem Elvan

Accessory head of flexor pollicis longus muscle in fetuses and adult cadavers and its relation to anterior interosseous nerve.

This study was conducted to examine the accessory head of flexor pollicis longus muscle (ahFPL) and its relation with the anterior interosseous nerve (AIN) in human fetuses and adult cadavers. Ninety fetus forearms and 52 adult cadaver forearms were dissected to evaluate the incidence, morphology, and innervation of the ahFPL. The ahFPL was observed in 29/90 (32%) of the fetus forearms and 20/52 (39%) of the adult cadaver forearms. The overall side incidence was 34.5% (49/142) among total forearms examined. On the other hand, the population incidence of ahFPL was 42% (19/45) in fetuses while it was 50% (12/24) in adult cadavers. So, the overall incidence in humans was 44.9% (31/69) in the population studied. Compression of the AIN in the forearm by the ahFPL is known as one of the causes of the anterior interosseous nerve syndrome (AINS). So, the relation of ahFPL with the AIN was evaluated, and in light of previous classifications a modified new classification is proposed. The most common relation detected in this study was Type IVa (71.4%) (AIN and its branches coursed posterior to the ahFPL). While Type I was not observed in this study, the incidences of Type II, Type III, and Type IVb (all AIN branches ‘without AIN itself’ coursed posterior to the ahFPL) were 2%, 14.3%, and 12.3%, respectively. The Types I, IVa, and IVb are thought to be associated with complete or incomplete types of AINS and Type III with incomplete type of AINS only. Clin. Anat. 25:601–608, 2012.

Anatomy of Master Knot of Henry: A morphometric study on cadavers

Objective The objective of this study was to evaluate the features of flexor hallucis longus (FHL), flexor digitorum longus (FDL) and flexor digitorum accessorius (FDA) muscles with relevance to the tendon grafts and to reveal the location of Master Knot of Henry (MKH). Methods Twenty feet from ten formalin fixed cadavers were dissected, which were in the inventory of Anatomy Department of Medicine Faculty, Mersin University. The location of MKH was identified. Interconnections of FHL and FDL were categorized. According to incision techniques, lengths of FHL and FDL tendon grafts were measured. Attachment sites of FDA were assessed. Results MKH was 12.61 ± 1.11 cm proximal to first interphalangeal joint, 1.75 ± 0.39 cm below to navicular tuberosity and 5.93 ± 0.74 cm distal to medial malleolus. The connections of FHL and FDL were classified in 7 types. Tendon graft lengths of FDL according to medial and plantar approaches were 6.14 ± 0.60 cm and 9.37 ± 0.77 cm, respectively. Tendon graft lengths of FHL according to single, double and minimal invasive incision techniques were 5.75 ± 0.63 cm, 7.03 ± 0.86 cm and 20.22 ± 1.32 cm, respectively. FDA was found to be inserting to FHL slips in all cases and it inserted to various surfaces of FDL. Conclusion The exact location of MKH and slips was determined. Two new connections not recorded in literature were found. It was observed that the main attachment site of FDA was the FHL slips. The surgical awareness of connections between the FHL, FDL and FDA, which participated in the formation of long flexor tendons of toes, could be important for reducing possible loss of function after tendon transfers postoperatively.

Topographic methods to expose the exiting points of supratrochlear, supraorbital, and zygomaticotemporal nerves

Background/aim: We evaluated the relations of the exiting points of supratrochlear (STN), supraorbital (SON), and zygomaticotemporal (ZTN) nerves with certain landmarks to provide improved anatomic knowledge. Materials and methods: The twenty-eight hemifaces of 5 fresh frozen and 11 embalmed heads (5 female and 11 male cadavers) were dissected. Distance and angular measurements were made between the exiting points of the nerves to the midline, lateral, and medial canthi. Comparisons of side, sex, and cadaver groups were evaluated.Results: Mean values were determined for all parameters. There was no difference between side measurements. There were significant differences between sexes and cadaver groups regarding STN and lateral canthus in both sides. The angle of the ZTN to the lateral canthus was found to be higher in embalmed cadavers than in fresh frozen ones.Conclusion: This study is the first to supply both distance and angular measurements to reach the exact locations of the nerves. Quantitative and topographic information about the localizations of the STN, SON, and ZTN is crucial for forehead lifting and migraine treatment, as well as for injection and local surgical interventions.

Biomechanical and Morphometric Properties of Long Flexor Tendons of the Toes: A Cadaver Study

BACKGROUND METHODS: RESULTS: CONCLUSIONS.

Relations of Facial Nerve With Retromandibular Vein in Human Fetuses

Abstract The relationship of facial nerve (FN) and its branches with the retromandibular vein (RMV) has been described in adults, whereas there is no data in the literature regarding this relationship in fetuses. The study was conducted to evaluate the anatomic relationships of these structures on 61 hemi-faces of fetuses with a mean age of 26.5 ± 4.9 weeks with no visible facial abnormalities. The FN trunk was identified at its emergence at the stylomastoid foramen. It was traced till its ramification within the parotid gland. In 46 sides, FN trunk ramified before crossing RMV and ran lateral to it, while in 8 sides FN trunk ramified on the lateral aspect of the RMV. In 3 sides, FN trunk ramified after crossing the RMV at its medial aspect. In only 1 side, FN trunk trifurcated as superior, middle, and inferior divisions and RMV lied anterior to FN trunk, lateral to superior division, medial to middle and inferior divisions. In 2 sides, FN trunk bifurcated as superior and inferior divisions. Retromandibular vein was located anterior to FN trunk, medial to superior division, lateral to inferior division in both of them. In 1 side, RMV ran medial to almost all branches, except the cervical branch of FN. Variability in the relationship of FN and RMV in fetuses as presented in this study is thought to be crucial in surgical procedures particularly in early childhood.

The Relationship of the Temporal Branch of the Facial Nerve to the Fascial Planes of Temporal Region in Human Fetuses

Abstract The aim of this study was to obtain information by assessing the relationship between temporal region fascial structures, fat pads, and temporal branches of facial nerve in human fetuses to use the knowledge on treatment of early childhood period surgeries. This anatomic dissection study was conducted on 40 hemifaces with no visible external abnormalities on their faces. Fascial layers and related fat pads of temporal region were dissected layer by layer beginning from superficial to deep. The relations of temporal branches of facial nerve and temporoparietal fascia and the structures of these fascial layers were evaluated. Temporoparietal fascia showed continuity below zygomatic arc with superficial musculoaponeurotic system. Temporal branches of facial nerve showed a multiple branching. Parotid-masseteric fascia became very thin on the superficial of zygomatic arch and ran with superficial layer of temporal fascia above without attaching to periosteum. Temporal branches of facial nerve entered between multilayered layers of temporoparietal fascia. Temporoparietal fascia became thicker on anterior and middle parts because of the localization of superficial temporal fat pad. Temporal fascia was a 2-layered thick and fibrous tissue enveloping intermediate fat pad. Deep layer connected to periosteum of zygomatic arch and superficial layer continued passing superficial of zygomatic arch and connected to the parotid-masseteric fascia. Deep temporal fat pad was found on the deep to deep layer of temporal fascia and surface of temporal muscle. The findings of this study may contribute to the knowledge of the topographical localization of temporal branches of facial nerve with temporal region fascial structures and fat pads in fetuses.

Morphological Features of the Popliteus Tendon, Popliteofibular and Lateral (Fibular) Collateral Ligaments

To reveal the detailed morphological features of the fibular collateral (fibular) ligament, popliteus tendon, popliteofibular ligament and the synovial components regarding to achieve data for surgical and biomechanical utilization. Knee s f 10 formalin-fixed male cadavers were dissected bilaterally. Bursae around the lateral collateral ligament and the relation of popl iteus tendon with lateral collateral ligament at the femoral attachment site were noted. The positional relation between both ends of poplit eofibular ligament was evaluated statistically. The PT exceeded the anterior margin of lateral collateral ligament in 11 sides, the poste rior margin of lateral collateral ligament in 3 sides and exceeded both the anterior and posterior margins of lateral collateral ligament i n 5 sid s. The shape of lateral collateral ligament was narrower at the lower part than the upper in 14 sides. The width of lower part of late ral collateral ligament was found narrower in the cases with sheath-like bursa (vagina synovialis). The relation between both ends of popliteo fibular ligament was as followed: the more anteriorly the fibular head attachment was located, the more anteriorly popliteofibular liga ment was attached to the popliteus tendon. To resolve the posterolateral corner of the knee with regard to surgical anatomy and biomecha nics, individual and concerted morphometric characteristics of lateral collateral ligament, popliteus tendon and PF should be evaluat ed together with accompanied synovial structures.

Radiological Management of the Exiting Points of Supraorbital Region Neurovascular Bundles

A preoperative computed tomography scan is useful to determine neurovascular exit points from orbit to supraorbital region. Determining the structure of exiting points (absence or presence, if present, being in form of foramen or notch) is imp ortant to plan the surgical approach. The aim of the study was to provide the radiological data by multi-detector computed tomography for estimating exiting points of the neurovascular bundles of the supraorbital region whether through foramen or notch in living su bjects related to side (right/left), sex and age. Computed tomography examinations of 214 (102 male and 112 female) adult patients, ag ed average 44.2 ± 14 years, were evaluated, retrospectively. Presence or absence, number and nature (foramen/notch) of exiting points of neurovascular bundles were noted in each side regarding sex and age groups. The distance of foramen/notch to the midline of the face was recorded. Single notch was seen on the right in 123 and in 134 on the left, single foramen was seen in 62 on the right and in 5 6 on the left side and double foramen was seen in 13 on the right and in 6 on the left. The absence was seen in 16 on the right and 18 on the left side. No significant difference was seen on frequency compared between the sexes and age groups. Foramen was seen in 58 sides unilateral ly and i 39 sides bilaterally. Notch was unilateral in 75 sides and bilateral in 95 sides. It was shown that males had a wider distance betwee right side foramen and left side notch to midline. Age groups did not show a significant difference in terms of side. Absence and for ame presence made up about 30-40 % of cases. Notch was the most common form. Foramen/notch presence was statistically unaffected by the sex and age factors. In terms of surgery, preoperative assessment of orbital exit points with computed tomography is essential.

Communications of the median nerve in fetuses

BACKGROUND Communications between the median, ulnar and musculocutaneous nerves in the arm, forearm and hand were reported in adult cadaveric and electrophysiological studies. These communicant branches may lead conflicting clinical and electrodiagnostic outcomes. While there are many studies on adult patients or cadavers, there is poor regarding foetuses. The present study was conducted to examine the frequencies of these communications and their coexistences in human foetuses. MATERIALS AND METHODS Anterior aspect of the forearms of 50 foetuses (29 females, 20 males, and 1 unknown) were dissected bilaterally (totally 100 sides) for this purpose. RESULTS Communications between the median and the musculocutaneous nerves in the arm were found unilaterally in 4%. Communications from the median to the ulnar nerve in the forearm were encountered unilaterally in 22%, and bilaterally in 12%; from the ulnar to the median nerve in the hand unilaterally in 28%, and bilaterally in 12%. Coexistence of all these variations was not encountered in any foetus. But coexistence of two different types of communicant branch was encountered in 4%. CONCLUSIONS Precise knowledge of nerve communications, variations and rate of coexistences in foetuses may have significance for clinicians and researchers dealing with subjects in foetal period.