Simel Kendir

Temporal Branch of the Facial Nerve and Its Relationship to Fascial Layers

OBJECTIVES To eliminate the inconsistency in the nomenclature, to anatomically and definitively describe the topographic relationship of the temporal branch of the facial nerve to the fascial layers and the fat pads, and to create an effective algorithm to define the safest approaches and planes for surgical procedures in this area. METHODS The study was performed using 18 hemifacial cadaveric specimens. In 12 hemifacial specimens, the facial halves were coronally sectioned and dissected. In 6 hemifacial specimens, planar dissection was performed layer by layer. RESULTS The temporal branch of the facial nerve that traversed inside the deep layers of the temporoparietal fascia and the superficial musculoaponeurotic system coursed along the zygomatic arch as 1 (14.3%), 2 (57.1%), 3 (14.3%), and 4 (14.3%) twigs in the specimens. The temporoparietal fascia had no attachment to the zygomatic arch and continued caudally as the superficial musculoaponeurotic system. Adhesions were between the temporoparietal fascia and the superficial layer of the deep temporal fascia around the zygomatic arch. In most specimens, the superficial layer of the deep temporal fascia continued as the parotideomasseterica fascia, and a deep layer abutted the posterosuperior edge of the zygomatic arch. CONCLUSION An easy and safe surgical approach in this area is to elevate the superficial layer deep to the intermediate fat pad directly on the deep layer of the deep temporal fascia descending to the periosteum along the zygomatic arch.

The precise localization of distal motor branches of the tibial nerve in the deep posterior compartment of the leg

The tibial nerve has been reported to be often iatrogenically injured during fibular graft harvest, high tibial osteotomy and fascial release procedures. Despite this complication, there are limited data available in the literature concerning the surgical anatomy of tibial nerve branches in the deep posterior compartment of the leg. The aim of the present study was to quantitative and localize the motor nerve points for the flexor hallucis longus (FHL), tibialis posterior (TP) and flexor digitorum longus muscles (FDL) in relation to a regional bony landmark. The range for the number of branches of the tibial nerve and the terminal motor points of each muscle were identified and measurements were made with a digital caliper from these points to the apex of the head of fibula. Three particular types in the branching of tibial nerve were determined. In 55.6% of the cases there were separate branches to each of the muscles in the deep posterior compartment of the leg (Type I). In 30.6% of the cases there were two main branches of the tibial nerve that provided motor branches (Type II). Finally, the tibial nerve had one main branch, which gave rise to separate motor branches to each of the muscles in 13.8% (Type III). In 61.1% of the cases the FHL was innervated by proximal and distal branches of the tibial nerve. In 38.9% of the cases, it was innervated only by one proximal branch. In all of our cases, the TP was innervated by both proximal and distal branches and the FDL innervated only distally. This provided a detailed anatomical description of the tibial nerve in the deep posterior compartment of the leg. Knowledge of the variable peripheral course of the tibial nerve, as well as the detailed anatomy of its motor branches may decrease iatrogenic injuries and motor loss of the foot during surgical procedures.

Surgical anatomy of the superior gluteal nerve and landmarks for its localization during minimally invasive approaches to the hip.

The superior gluteal nerve (SGN) is vulnerable to damage during total hip arthroplasty and various pelvic surgeries. Recently introduced minimally invasive approaches to the hip show promise for less muscle trauma compared to conventional approaches. However, the risk of damaging the SGN has not been well documented for such alternative approaches. Therefore, we aimed to investigate the anatomic course of the SGN and to define anatomical landmarks that may be used by surgeons during minimally invasive approaches to the hip. Twenty‐eight gluteal regions from 14 formalin‐fixed cadavers were dissected and the course and the distances of the SGN and its branches to the tip of the greater trochanter (GT) were measured. The landmarks for standardizing the course of the SGN included the posterior inferior iliac spine (PIIS), GT, and a line (PIIS‐GT) connecting these two points. The exit of the SGN was found to be at the medial one third of the PIIS‐GT line and 5.4 cm from the GT. Two branching patterns were noted. The branches of the SGN were distributed lateral to the PIIS‐GT line. On the basis of our study, the safe zone for the SGN was smaller than previously reported. Posterior, lateral, or anterolateral minimally invasive approaches to the hip should take into account the point of exit of the SGN and the area of distribution of its branches. A minimally invasive anterolateral approach may particularly compromise branches to the tensor fasciae latae muscle. Localization of the SGN and its branches using the anatomic landmarks defined in this study may decrease surgical morbidity. Clin. Anat. 26:614–620, 2013.

Window anatomy for neurosurgical approaches. Laboratory investigation.

OBJECT Knowledge of the cranium projections of the gyral structures is essential to reduce the surgical complications and to perform minimally invasive interventions in daily neurosurgical practice. Thus, in this study the authors aimed to provide detailed information on cranial projections of the eloquent cortical areas. METHODS Ten formalin-fixed adult human skulls were obtained. Using sutures and craniometrical points, the crania were divided into 8 windows: superior frontal, inferior frontal, superior parietal, inferior parietal, sphenoidal, temporal, superior occipital, and inferior occipital. The projections of the precentral gyrus, postcentral gyrus, inferior frontal gyrus, superior temporal gyrus, transverse temporal gyri, Heschl gyrus, genu and splenium of the corpus callosum, supramarginal gyrus, angular gyrus, calcarine sulcus, and sylvian fissure to cranial vault were evaluated. RESULTS Three-fourths of the precentral gyrus and postcentral gyrus were in the superior parietal window. The inferior frontal gyrus extended to the inferior parietal window in 80%. The 3 important parts of this gyrus were located below the superior temporal line in all hemispheres. The orbital and triangular parts were in the inferior frontal window, and the opercular part was in the inferior parietal window. The superior temporal gyrus was usually located in the inferior parietal and temporal windows, whereas the supramarginal gyrus and angular gyrus were usually located in the superior and inferior parietal windows. The farthest anterior point of the Heschl gyrus was usually located in the inferior parietal window. The mean positions of arachnoid granulations were measured as 3.9 +/- 0.39 cm anterior and 7.3 +/- 0.51 cm posterior to the bregma. CONCLUSIONS Given that recognition of the gyral patterns underlying the craniotomies is not always easy, awareness of the coordinates and projections of certain gyri according to the craniometric points may considerably contribute to surgical interventions.

Re-defining the anatomical structures for blocking the nerves in adductor canal and sciatic nerve through the same injection site: an anatomical study

PurposeThe aim of this study is to re-define the anatomical structures which are important for blocking the sciatic nerve and the nerves within the adductor canal which innervate the knee joint through the same injection site. We also aimed to investigate the spread of the anesthetic toward the areas in which the mentioned nerves lie on cadavers.MethodsThis study was performed on 16 lower extremities of formaldehyde-embalmed eight adult cadavers. The anatomy of adductor canal, courses of the nerves within the canal and the relationships of the saphenous, medial femoral cutaneous, medial retinacular, posterior branch of the obturator and sciatic nerves with each other and with the fascial compartments were investigated. Transverse sections that crossed the superior border of vastoadductor membrane were taken to reach the sciatic nerve in the shortest way. Colored latex was injected to demonstrate the anesthetic blockage of the targeted nerves. The structures along the needle’s way were investigated.ResultsThe saphenous, medial femoral cutaneous and at its distal part posterior branch of the obturator nerve were colored with latex within the adductor canal. The nerve to vastus medialis (in other words, the medial retinacular nerve) lay beneath the fascia of vastus medialis and did not enter the adductor canal. There was a fascial plane which did not allow the passage of colored latex toward the sciatic nerve. To traverse this fascial structure, it was found out to be necessary to insert the needle perpendicular to both the vertical and transverse axes of the thigh and then advance it along 2/3 of diameter of the thigh. Thus, the colored latex was observed to fill the compartment where the sciatic nerve lay within.ConclusionsBlocking the sciatic nerve and the nerves within the adductor canal which innervate the knee joint through the same injection site seems anatomically possible without injuring any neurovascular structures.

The Anatomical Relationships of the Ocular Motor Nerves with an Emphasis on Surgical Anatomy of the Orbit: THE ANATOMICAL RELATIONSHIPS OF THE OCULAR MOTOR NERVES

The surgical procedures directed to the orbit are invariably reported to be one of the most challenging procedures of the neurosurgery and it is very important to take measures to protect the ocular nerves. Many researchers have tried to identify safe approaches or safe regions in the orbit but the suggestions and results vary among published studies. The ocular motor nerves are under risk of injury during various approaches to the orbit. Simple but careful attention to potential variations in the origin and anatomical course of the ocular nerves and their relationships to the orbit may help to define “safe zones” during various approaches, thus, help to enhance clinical outcomes. The objective of this review, therefore, is to discuss the surgical anatomy of the orbit with special emphasis on oculomotor, trochlear, and abducens nerves and further emphasize their relationships with a surgical point of view during various approaches directed to the orbit. Anat Rec, 302:568–574, 2019.

361 DOES THE PRESENCE OF ACCESORY OBTURATOR NERVE EFFECT THE SUCCESS OF OBTURATOR NERVE BLOCKADE

L.B. Couto2,3, C.M.R. Ferreira1, D.H. Elias-Filho1, C.A. Parada1, I.R. Pelá2, N.C. Coimbra1 °. 1Laboratory of Neuroanatomy & Neuropsychobiology, Department of Pharmacology, School of Medicine of Ribeirão Preto of the University of São Paulo-USP, Ribeirão Preto (SP), Ribeirão Preto (SP), 2Laboratory of Pharmacology, School of Pharmaceutical Sciences of Ribeirão Preto; University of São Paulo, Ribeirão Preto (SP), 3Medicine and Odontology Course, University of Ribeirão Preto (UNAERP), Ribeirão Preto (SP), Brazil