S.S. Joshi

Morphometric study of cricoid cartilages in Western India

BACKGROUND It is important to determine the size and proportion of the larynx as such information is useful in procedures such as intubation, endoscopy and surgical manipulations. Recent interest in the cases of subglottic stenosis and postintubational stenosis of the lower respiratory tract has led to renewed interest in ascertaining the measurements of the various laryngeal cartilages. The aim of the present study was to collect morphometric data of cricoid cartilage from a regional population. METHOD Fifty laryngeal preparations from adult cadavers of Western India were assessed. Sections were prepared via dissection and the removed cricoid cartilages then measured and weighed. RESULTS The mean antero-posterior diameter (19.29±2.47) of the cricoid cartilage was greater than the average transverse diameter (18.33±2.26). The height of arch of cricoid cartilage was 6.54±1.23mm and height of lamina was 21.45±1.97mm. Mean weight of cricoid cartilage was 4.53±1.27grams. The shape of the cricoid cartilage was ovoid in 46% of cases, oval in 38%, pear shaped in 12% and narrow-oblong in 4% of cases. CONCLUSION Inter-subject variability in the dimensions of cricoid cartilages was observed. The large difference in almost all sizes and shapes of the cricoid cartilage makes it difficult to standardise the rigid stents used in these organs. Endotracheal tubes of the appropriate size should therefore be based on the measurements of individual patients. Clinicians should therefore be aware of morphological variations as they are of fundamental clinical importance.

Origins of the coronary arteries and their significance

OBJECTIVE: To describe the normal and variant anatomy of the coronary artery ostia in Indian subjects. INTRODUCTION: Anomalous coronary origins may cause potentially dangerous symptoms, and even sudden death during strenuous activity. A cadaveric study in an unsuspected population provides a basis for understanding the normal variants, which may facilitate determination of the prevalence of anomalies and evaluation of the value of screening for such anomalies. METHODS: One hundred and five heart specimens were dissected. The number of ostia and their positions within the respective sinuses were observed. Vertical and circumferential deviations of the ostia were observed. The heights of the cusps and the ostia from the bottom of the sinus were measured. RESULTS: No openings were present in the pulmonary artery or the non-coronary sinus. The number of openings in the aortic sinuses varied from 2–5 in the present series; multiple ostia were mostly seen in the anterior sinus. The majority of the ostia lay below the sinutubular ridge (89%) and at or above the level of the upper margin of the cusps (84%). Left ostial openings were mainly centrally located (80%), whereas the right coronary ostia were often shifted towards the right posterior aortic sinus (59%). DISCUSSION: The preferential location of the ostia was within the sinus and above the cusps, but below the sinutubular ridge. On occasion, normal variants like multiple ostia, vertical or circumferential shift in the position, and slit-like ostia may create confusion in interpreting the images and pose a difficulty during procedures like angiography, angioplasty, and coronary artery bypass grafting.

Internal architecture of calcaneus: correlations with mechanics and pathoanatomy of calcaneal fractures

BackgroundAvailable studies on internal architecture of the calcaneus are cursory and contradictory. Present study focused on elaborate descriptions of the different trabecular groups and their correlation with the fractures of this bone.MethodTo study the internal architecture, 50 dry adult human calcanei were sectioned in various planes and grossly dissected.ResultsSix different groups (A–F) of lamellae were identified. Based on the observations of trabecular architecture, potential weak areas in this bone were identified. The predicted weak zones correlate well with the fracture lines described in the calcaneus and provide anatomical basis for their occurrence.ConclusionsThis study underscores the major influence of the internal architecture of the calcaneus in predicting the fracture lines. The findings can be utilized to classify fractures of calcaneus, which has been a topic of ongoing debate. Knowledge of weak zones will aid clinicians to improve the techniques of internal fixation.

Internal architecture of the talus.

Background: Ideally, bone has the external shape and internal architecture best adapted to its function. The internal architecture of the talus should reflect its functional adaptations. The purpose of this study was to evaluate the orientation of lamellae to account for its role in transmission of various forces. Method: Twenty-five pairs of dry adult human tali were sectioned in various planes and dissected grossly to study the internal architecture of the talus. Results: Two sets of lamellae were observed in the body of the talus. One set was descending from the posterior two-thirds of the lateral part of trochlear surface onto the posterior calcaneal facet of the talus. These lamellae were in the form of vertical perforated interconnected plates. The second set of trabeculae originated from medial part of trochlear surface and anterior third of the lateral part. The neck of the talus showed the continuity of sagittal plates extending from the body to the head, which was occupied by stacked curved plates extending from infero-medial to the supero-lateral part of the head. Conclusion: We identified two sets of lamellae which we believe reflect the lines of forces of weightbearing through the talus. Clinical Relevance: These findings may help in better understanding of fracture lines in the talus, which could improve internal fixation techniques, and the design of talar prostheses.

Prevalence and Mophometry of Os Peroneum amongst Central Indians

INTRODUCTION Os Peroneum is round or oval shaped sesamoid within the substance of the Peroneus longus tendon as it plays on the Cuboid bone. MATERIALS AND METHODS Thirty six embalmed cadavers were dissected bilaterally. Lateral part of foot and sole was dissected to expose Peroneus longus tendon and Os Peroneum. Measurements of Os Peroneum and articular surfaces of cuboid (calcaneum) were taken by the Digital Vernier Caliper. Histological and Radiological Examinations of Os Peroneum were also done. OBSERVATION A flattened oval enlargement i.e. Os Peroneum was found in all the tendons examined. The deep surface of Os Peroneum (i.e. articular surface) was concave, smooth and shiny; sometimes divided into two parts. There was a well defined convex articular facet on the Cuboid at the proximal end of the peroneal sulcus, which sometimes extended proximally on to the Calcaneum forming a synovial joint. RESULTS Average length of Os Peroneum was found to be 13.35 mm (Right - 13.35 mm, Left - 13.35 mm). Average breadth of Os Peroneum was 8.96 mm (Right - 8.87 mm, Left - 9.05 mm). Average thickness of Os Peroneum was 4.11 mm (Right - 4.13 mm, Left - 4.10 mm). Incidence of double articular facets on cuboid and Calcaneum was more on the right side (25.80%) than the left (16.20%). CONCLUSION Findings suggest that Os Peroneum is present at the site of angulations of Peroneus Longus tendon with attendant change in direction and the exposure to various stresses and strains leading to its thickening and formation of Os Peroneum.

Lumbar plexus and its variations

Introduction: Looking to the applied significance of lumbar plexus in the form of its involvement in various injuries, direct or iatrogenic and entrapment, it is imperative to have a thorough knowledge about its formation, branching pattern, and variations. Tubbs et al referred to the lumbar plexus as a ‘no mans land’ because of relative inaccessibility of this region and there is infrequency in operating on retroperitoneal structures by neurosurgeons. However, a recent increase in retroperitoneal laparoscopic surgeries inspired us to revisit the anatomy of lumbar plexus. Material and methods: The study was conducted on 30 formalin embalmed cadavers available in the Department of Anatomy, RMC, PIMS, Loni, Maharashtra. Thorough dissection was performed to observe the formation of branches of lumbar plexus and measurements were taken from the adjacent bony landmarks. Result: Bilateral prefixation of the lumbar plexus was found in one cadaver bilaterally. Ilioinguinal and iliohypogastric nerves were arising by a common stem in 11.66% of cases; in the remaining ones, they were having separate origins. In majority, 81.6% of the genitofemoral nerve pierced the medial third of the anterior surface of the psoas major muscle. Accessory obturator nerve was observed in 3 cases (5%) of 60 plexuses. The site of formation of femoral nerve was 5 cm inferior to the iliac crest in 71.6% of instances. The formation of obturator nerve was found to vary from the level of supracristal plane to 3.5 cm inferior to the plane; in 58.3%, it was 3 cm below the plane. Conclusion: The measurements given in this study will help the surgeon to avoid iatrogenic nerve injury as well as to assess them during lumbar plexus block.

The morphological study of adult human larynx in a Western Indian population

Background: Knowledge of the size and proportions of the human larynx is essential for the diagnosis and treatment of laryngeal disorders. Objective of the present cadaveric study was to study dimensions of larynx, various laryngeal folds and laryngeal cavity of adult human larynx in the western Indian population. Materials and Methods: Sagittal section of the head and neck region was taken from the cadaver. Larynx was separated from tongue from the level of hyoid bone to 3 rd tracheal ring. The measurements of intact and split larynx were taken with the help of digital vernier caliper, thread, and scale. Data was analyzed using software StatistiXL. For each of the parameters, the mean, standard deviation (S.D.), and range was calculated. Z test was used to test the significance of difference between the two mean. Results: Height of larynx from floor of thyroid notch to lower margin of cricoid cartilage was 32.42 ± 3.41 mm. Height of larynx from upper border of hyoid to lower border of cricoid. (L2) was 54.39 ± 6.04 mm. Height of larynx from tip of epiglottis to lower margin of cricoid cartilage was 57.13 ± 7.32 mm. Total height of laryngeal cavity was 61.51 ± 6.84 mm. Bilateral symmetry was noted in the size of vocal and vestibular folds length. Conclusion: There was wide individual variation in the dimensions of the most of the parameters in the selected population. Bilateral asymmetry, though present in majority of specimens, was insignificant. Morphometrical data of the larynx may be very useful in otorhinolaryngology, laryngeal microsurgery, and evaluation of results of diagnostic techniques. These parameters can be helpful in evaluation of the damage and proper repair of the larynx.

A Review of Presentations in the National Conferences of the Anatomical Society of India in the Last Twenty Five Years from 1984 to 2008

Abstract The present study is an attempt to analyze the presentations in the National Conferences of the Anatomical Society of India over a period of twenty five years. These paper presentations in the conferences were obtained from the proceedings of the conferences published in Journal of Anatomical Society of India for a period of 25 years from 1983 to 2008. The presentations were categorized using various criteria. Nearly four thousand papers have been presented in various national conferences during the study duration. A remarkable increase was observed in average number of presentations per year. The number of interdepartmental and inter-institutional projects have also steadily increased. The average number of case reports presented has escalated from 17/year in the first decade of study period to 96/year in the last five years. This has occurred at the expense of the original studies of all subject categories. This fact along with predominance of certain states/institutes into the research arena and reduction in proportion of animal and experimental studies needs urgent attention of our scientific community. The present attempt is expected to bring forth the strengths and deficiencies of our scientific endeavor and provide directions for the future.

Absence of superior cornua: a rare variant of thyroid cartilage anatomy

During ongoing morphological study of adult human larynx, we found a rare variant of thyroid cartilage anatomy. Absence of superior cornua of thyroid cartilage was seen on left side in a specimen of larynx. In the same specimen was present a large spindle shaped triticeous cartilage. Very few studies describe this type of variation. We recommend that surgeons, radiologists and autopsy surgeons performing any procedures in the region of the neck, to make a mental note of this anatomical variation. This variation and its clinical significance are reported in the paper.