Servet Celik

A study of the course of the internal carotid artery in the parapharyngeal space and its clinical importance

The differences in the course and shape of the internal carotid artery (ICA) in the parapharyngeal space were investigated to determine the possible risks for serious hemorrhage during tonsillectomy, drainage of peritonsillar abscess, soft palate injuries, adenoidectomy and velopharyngeoplasty. The course of the ICA was studied in the parapharyngeal spaces of 50 adult cadavers. From each specimen, circumferential sections were obtained and they stained with hematoxylin–eosin and Verhoeff’s elastic staining. The cervical course of the ICA showed no curvature in 70 cases; but in 25 cases it had a medial curve, and five cases showed kinking out of a total 100 dissected carotid sheaths. In two cases, kinking of the ICA was related to the pharyngeal wall. The histological examination of all kinking specimens demonstrated depletion and decreasing muscle tissue in tunica media and an increase was observed in vasa vasorum numbers in the tunica adventitia of ICA. The dissections and integrity losses were seen in tunica media and tunica adventitia. The vessel wall of histological structure change were detected in kinking specimens and lays the groundwork for the vessel wall to get easily harmed or torn either directly or indirectly by decreasing the elasticity and soundness of the wall. The transposition of the ICA artery in submucous position becomes important for otorhinolaryngologists when its aberrant course causes a widening in the retropharyngeal or parapharyngeal tissues and an impression on the pharyngeal wall. Curving and kinking of the ICA can constitue a risk factor for acute hemorrhage in routine surgical procedures, which are performed by inexperienced surgeons.

The anatomical variations of the extensor tendons to the dorsum of the hand.

To lead a quality life, tendon repair must be performed in a trauma causing damage to the extensor tendon of the hand. The aim of this study is to study the structures that can be used as donor tendons. Fifty‐four dissected adult hands were examined to study the pattern of the extensor tendons on the dorsum of the hand. The most common distribution patterns of the extensor tendons of the fingers were as follows: a single extensor indicis proprius (EIP) tendon which inserted ulnar to the extensor digitorum (ED)‐index; a single ED‐index; a single ED‐middle; a single ED‐ring; an absent ED‐little; a double extensor digiti minimi (EDM), and a single ED‐ring to the little finger. The frequency of the number of tendons is as follows: a single (87.03%) EIP, a single ED‐index (100%), a single (92.6%) ED‐middle, a single (75.9%) ED‐ring, and an absent (68.5%) or a single (24.1%) ED‐little. A double (88.9%) EDM tendons were seen. The thickest type of juncturae tendinum (JT) is found primarily between the ring and little fingers (90%). Suitable excessive tendon and the thickest JT as donor tendon were found in the fourth intermetacarpal space. The present findings, especially the fourth intermetacarpal space, may explain why incisions on the dorsum of the hand should be large and performed with particular care. It is necessary to have a thorough understanding of the arrangements of the multiple extensor muscles and their junctural connections of the hand when tenoplasty or tendon transfer is required. Clin. Anat. 21:652–659, 2008.

Anatomical and surgical aspects of the lobes of the thyroid glands.

Variation in the descent of the thyroid gland and during fetal life and regression of the thyroglossal duct is associated with many variations in form of the mature gland. The shape and morphometric details of gland, its extension as the pyramidal lobe (PYR-L) and attachments of the levator glandulae thyroidea were studied in 40 cadavers. We categorized the shape of the thyroid into 12 types. The most frequent type was PYR-L with 22.5% which started from the left lobe and moved across by intercrossing the larynx. Horseshoe-shaped gland and the gland with separate lobes were the most frequently observed glandular shapes, with 17.5 and 20%, respectively. The incidences of the PYR-L and the levator glandulae thyroideae were 60 and 17.5%, respectively. The pyramidal lobe branched off more frequently from the left part of the isthmus (14 specimens) than from the right (5 specimens) or the midline (2 cases). Knowledge about the glandular landmarks and anatomic measurements around the thyroid will be helpful for the surgeon to constitute a simplification of the topographic anatomy, plan and decide on a safe approach to the thyroid gland, and to avoid postoperative complications.

Anatomic position of the lingual nerve in the mandibular third molar region as potential risk factors for nerve palsy.

Palsy of the lingual nerve (LN) during third molar extractions, ramus osteotomies, anesthetic injections, procedures of orthognathic, preprosthetic, and periodontal surgery are important complications reported with varying frequency. The purpose of this study is to present quantitative data describing the position and shape of the LN in the third molar area. In the course of dissection, the LN was noted, as well as the furcation pattern, position, course, and anatomic relations under 2.5X loupe magnification in 21 adult male human cadavers. The distance of the junction of the LN and the chorda tympani from the foramen ovale was measured as average 15.1 ± 5.8mm. The 4 furcation patterns of the LN and the inferior alveolar nerve (IAN) were observed based on their relative positions. Bifurcation of them above the level of the mandibular notch (type I) was observed in 66.7% of the specimens. The horizontal distance of the LN from the lingual plate of the mandible was greater in this study than in previous studies. This study provided measurable objective criteria for the relationship of LN in the third molar region. The knowledge of the relationship between the LN and third molar region is useful for the surgeon in avoiding unexpected complications.

An unreported anatomical finding: unusual insertions of the stylohyoid and digastric muscles

The presence of a unusual appearance of the stylohyoid and digastric muscles may lead to a confusion in some pathological cases, during the radiological examination and aesthetic facial surgery. These differences may cause pharyngeal pain and foreign body sensation in the throat. During the dissection, unusual insertions, origin, insertion, shape and bilaterality were investigated in 28 cadavers’ heads. In a total of 56, the presence of unusual insertions which belong to the stylohyoid muscle were observed in 22 sides (39.3%), and atypical fibers which belong to the digastric muscle were observed in 39 sides (69.6%). Bilaterality of the presence of atypical appearance was observed for stylohyoid and digastric muscles, in 10 (35.7%) and 19 (67.8%) specimens, respectively. In 12 heads (42.9%), atypical fibers, the stylohyoid and the digastric coexisted. These fibers which were shaped like a circular spiral were realized to have the shape of an arch or circle in front of the hyoid bone. The posterior bellies of the digastric muscle, the mylohyoid and the remaining suprahyoid muscles of both sides were normal. The unusual insertion of the stylohyoid muscles which cover the hyoid bone as a collar was not described in the classification of the previous studies. These fibers may give an variant mobility to the hyoid and they occur depending on the differences in the stylohyoid chains. Although the styloid process was in normal size, unusual insertions of the stylohyoid muscle that cover the hyoid as a belt or collar may give symptoms similar to those of the stylohyoid syndrome.

Innervation features of the extraocular muscles.

Several transcranial surgical approaches such as frontoorbital, lateral, medial, central, inferolateral, and transmaxillary orbitotomy have been used for exposure of lesions within the orbit. During surgical approaches, detailed anatomic knowledge regarding neural, muscular, and neighboring structures for preservation of the neurovascular structures is important in avoiding traumatic retraction of the nerves of the extraocular muscles. For this study, a total of 22 formalin-fixed cadavers were dissected. Vascular structures were perfused with colored latex to facilitate their definition. In this study, the orbit was investigated in two divisions, superior and inferior. In the superior division, innervation features of the levator palpebrae superioris, the superior rectus, and superior oblique muscles were examined. In the inferior division, innervation features of the medial rectus, the lateral rectus, the inferior rectus, inferior oblique muscles, and ciliary ganglion were investigated. The diameter of the oculomotor nerve (CN3) within the superior orbital fissure was measured as 2.10 mm on the right and 2.09 mm on the left. The diameter of the superior division of the CN3 was on average 1.54 ± 0.30 mm on the right and 1.65 ± 0.30 on the left. The mean diameter of the inferior division was measured as 1.85 ± 0.22 mm on the right and 1.94 ± 0.20 on the left. In the lower wall of the orbit, different branching types of inferior division of CN3 were observed. The diameter of the trochlear nerve in the superior orbital fissure was on average 1.15 ± 0.19 mm on the right and 1.21 ± 0.21 mm on the left. The diameter of the abducens nerve in the superior orbital fissure was on average 1.54 ± 0.24 mm on the right and 1.54 ± 0.22 on the left. The number of small branches entering the muscle was on average three branches. Areas nervosa of the nerves were located in the middle one third of the muscles. In this study, detailed knowledge regarding the innervation features of extraocular muscles was attained. An understanding of the innervation features of extraocular muscles is important for the preservation of neural structures during intraorbital procedures.

A morphometric study of the inferior orbital fissure using three-dimensional anatomical landmarks: Application to orbital surgery

The inferior orbital fissure (IOF) is an important structure during orbital surgery, however, neither its anatomical features nor the procedures necessary to expose the IOF have been examined in detail. A morphometric analysis of the IOF was performed on 232 orbits using computer software. The longest and shortest borders of the IOF were 18.2 ± 4.9 and 1.9 ± 1.3 mm, respectively. The outer and the inner angles were 138.9 ± 32.7° and 38.4 ± 24.7°, respectively. The perimeter of the IOF was 50.6 ± 13.5 mm and its area was 61.3 ± 39.1 mm2. Eight types of IOF were observed. Type 1 IOF was observed in 42.2% and the Type 2 IOF was identified in 15.9%. A statistically significant relation was found between the longest edge and area and the widest edge and area of the IOF. The findings of our study suggest that the removal of the lateral wall should begin inferiorly, just lateral to the IOF and extended superolaterally. These data may be useful during surgical approaches to the orbit. Clin. Anat. 22:649–654, 2009.

Orbital restoration surgery in the zygomaticotemporal and zygomaticofacial nerves and important anatomic landmarks.

A variety of etiologies may result in functional and aesthetic deficiencies requiring orbital reconstruction. Fractures of the zygomaticomaxillary complex in the acute stage are frequently accompanied by sensory disturbances of the zygomatic nerve (ZN). The purpose of the current study was to describe the anatomic and topographic landmarks of the ZN in 18 adult human cadavers regarding the localization and dimensions in the orbit. The zygomaticotemporal (ZTN) and zygomaticofacial nerves (ZFN) along the lateral wall of the orbit passed through the zygomaticotemporal and zygomaticofacial foramens, respectively. The angle between the ZTN and the ZFN within the orbit was approximately 42.21 degrees. The mean (SD) distance between the orbital opening of the ZTN and the meeting point of the ZTN was measured as 9.21 (5.18) mm. The mean (SD) distance between the orbital opening of the ZFN and the meeting point of the ZTN was calculated as 11.22 (4.25) mm. The mean (SD) distance between the orbital opening of the ZFN and the infraorbital margin of the orbit was 13.04. (3.21) mm. A detailed knowledge of the ZNs passage in the orbit is necessary for a surgeon while performing maxillofacial surgery. If these measurements are taken into account, there will be little surgical risk, and this will be helpful in identifying the extent of the operative field.

The types of talar articular facets and morphometric measurements of the human calcaneus bone on Turkish race

IntroductionThere are three facets over upper side of talocalcaneal joint: anterior talar facet, middle and posterior. Three types of calcaneus that have distinct talar facets were defined as types A, B and C.Materials and methodsA total of 221 calcanei (98 right, 123 left), with unknown gender, were dried and evaluated.ResultsIn our study type B calcaneus (58%) was defined as the most common type, and type A calcaneus (39.3%) as the second most common type. By using facet joint differences and bone measurement, we tried to define calcaneus bone.DiscussionIn many diseases of foot, such as the talocalcaneal artritis and coalition, intraarticular fractures and congenital dysmorphology, flatfood, valgus deformities, the size and shape of the bones, the relationships of the talus and calcaneus with each other and other bones of the foot must be considered for the internal and external fixation and surgical procedures. Type B calcaneus was defined as the most comman type in Turkish race and these results correlate with the ones which were performed on bones of American, Indian and African people, and it was uncorrelated with the results of the researches performed in Europe.

Three-dimensional anatomic landmarks of the foramen magnum for the craniovertebral junction.

The foramen magnum (FM) has a vital importance to have a direct view of the vertebral artery, lower cranial nerves, and the brainstem. The morphologic analysis of the FM was studied in 352 occipital bones of adult human skulls by 3D-Doctor V 3.5.050402 Demo version. The perimeter and area of the FM were calculated as 115.6 (SD, 9.9) mm and 829 (SD, 137.7) mm2, respectively. The FM index was found as 84.02%, and the majority (38.4%) of holes were observed to have a narrow index. The FM was observed to 8 different types. The most frequently observed types were the tetragonal type in 25.66%, and the one formed by the combination of 2 semicircles in 23.28%. The large anterior margin of the FM type, such as types 1, 4, 5, and 6, can be easily performed partially. In the cases of types 2, 3, and 8, the anterior margin was determined as narrow, the resection procedure is completed with more difficulty. In Pearson correlation analysis, it is significant that a statistically strong relation was found between the area and perimeter, and the area and length of FM. This findings suggest that the resection should be started at the anterior margin, just lateral and then extended superolaterally.