Suri Rk

Ossification of caroticoclinoid ligament and its clinical importance in skull-based surgery.

CONTEXT The medial end of the posterior border of the sphenoid bone presents the anterior clinoid process (ACP), which is usually accessed for operations involving the clinoid space and the cavernous sinus. The ACP is often connected to the middle clinoid process (MCP) by a ligament known as the caroticoclinoid ligament (CCL), which may be ossified, forming the caroticoclinoid foramen (CCF). Variations in the ACP other than ossification are rare. The ossified CCL may have compressive effects on the internal carotid artery. Thus, anatomical and radiological knowledge of the ACP and the clinoid space is also important when operating on the internal carotid artery. Excision of the ACP may be required for many skull-based surgical procedures, and the presence of any anomalies such as ossified CCL may pose a problem for neurosurgeons. CASE REPORT We observed the presence of ossified CCL in a skull bone. A detailed radiological study of the CCL and the CCF was conducted. Morphometric measurements were recorded and photographs were taken. The ACP was connected to the MCP and was converted into a CCF. Considering the fact that standard anatomy textbooks do not provide morphological descriptions and radiological evaluations of the CCL, the present study may be important for neurosurgeons operating in the region of the ACP.

Unusual Organization of Auriculotemporal Nerve and Its Clinical Implications

S J he auriculotemporal nerve is a highly significant tructure of infratemporal fossa. It may be comressed due to hypertrophy of the lateral pterygoid uscle leading to paresthesia over its area of distribuion and it may even be injured during temporomanibular joint surgery. Thus the precise anatomy of uriculotemporal nerve and its variations may prove eneficial to clinicians, especially to oral and maxilloacial surgeons. This study documents a rare variation f auriculotemporal nerve and its clinical implicaions.

Anomalous pectoral musculature

Anomalous disposition of pectoral muscles was encountered in an adult female cadaver on the left side. A prominent cleft separating the sternocostal and clavicular portions of the pectoralis major was noticed. The fibers of pectoralis major were partially fused with the deltoid, resulting in obliteration of the deltopectoral groove. Interestingly, cephalic vein was seen traversing superficial to the clavicular portion of the pectoralis major and pierced it to drain into the axillary vein. The pectoralis minor was inserted mainly on the coracoid process and few fibers were found blending with the coracobrachialis and short head of biceps brachii. Further, pectoralis minimus, a rare anatomic variant, was also observed lying superior to pectoralis minor. It was innervated by a twig from the lateral pectoral nerve at its superficial surface. Awareness of possibility of such anomalous muscles is important for surgeons operating on the chest wall.

Unilateral intercordal neural communication coexistent with variant branching pattern of posterior cord of brachial plexus.

Variant branching pattern of the cords of brachial plexus coupled with erroneous communications has been an area of concern for surgeons opting to explore this region. Anaesthetic blocks and surgical approaches are the highlights of these interventions, where a keen familiarization of the anatomy of this region is mandatory. The present case description reports a unilateral variant branching pattern of the posterior cord coexistent with a neural communication between lateral and medial cords in an adult male cadaver. This intercordal neural communication between lateral and medial cords was oriented obliquely and measured 2.2 cm in length. Furthermore, the posterior cord revealed a variant branching pattern. It branched into three upper subscapular nerves and a common trunk for the thoracodorsal and lower subscapular nerves. The lowest of the three upper subscapular nerves gave a communicating twig to the thoracodorsal nerve. Inspite of uncountable reports on variations ofbrachial plexus, descriptions regarding anomalous branching patterns hold enormous clinical significance for the radiologists, anesthetists and surgeons, besides being of academic interest for the anatomists.

Human tibial torsion - Morphometric assessment and clinical relevance

Background: Tibial torsion is an important anatomical parameter in clinical practice and displays variability among individuals. These variations are extremely significant in view of alignment guides such as those related to rotational landmarks of tibia in total knee arthroplasty. Further, precise knowledge and information pertaining to angle of tibial torsion also helps in correction of traumatic malunion or congenital maltorsion of tibia. Methods: The present study was carried out to determine the angle of tibial torsion in 100 adult dry tibia bones in the Department of Anatomy, Government Medical College, Amritsar. The study group comprised 50 males and 50 females with equal number of right- and left-sided bones. The measurements were meticulously recorded and the data were subjected to statistical analysis. The results were analyzed and discussed in the light of existing literature. Results: On the right side, it was found to be 29.84° ± 4.86°° (range = 22.00° -38.00°) in males and 28.92° ± 5.10°° (range = 15.00°-38.00°) in females. On the left side, it was found to be 28.00° ± 4.94°° (range = 20.00°-40.00°°) in males and 28.12° ± 4.28°° (range = 20.00°-37.00°°) in females. Conclusion: The present study is an endeavor to provide baseline data with reference to the angle of tibial torsion in the Indian population. The results of the study assume special importance in view of the technical advancements in reconstructive surgical procedures in orthopedic practice.

Multiple unilateral variations in medial and lateral cords of brachial plexus and their branches.

During routine dissection of the upper extremity of an adult male cadaver, multiple variations in branches of medial and lateral cords of brachial plexus were encountered. Three unique findings were observed. First, intercordal neural communications between the lateral and medial cords were observed. Second, two lateral pectoral nerves and one medial pectoral nerve were seen to arise from the lateral and medial cord respectively. The musculocutaneous nerve did not pierce the coracobrachialis. Finally, the ulnar nerve arose by two roots from the medial cord. Knowledge of such variations is of interest to anatomists, radiologists, neurologists, anesthesiologists, and surgeons. The aim of our study is to provide additional information about abnormal brachial plexus and its clinical implications.

A rare bimuscular conglomeration gluteopiriformis case report.

The present paper reports a rare anomalous muscle in the gluteal region, which appears to be a conglomeration of gluteus maximus and piriformis muscles. The muscle was proximally attached to the gluteus maximus and distally merged with the piriformis muscle. The innervation of the anomalous muscle was derived from the inferior gluteal nerve. Recognition of such a muscle variant may facilitate early clinical diagnosis and treatment of patients with symptoms of piriformis syndrome or sciatica of unexplained etiology. Contraction of such an anomalous muscle could lead to altered biomechanics of the piriformis and the gluteus maximus. Such a rare muscle, which morphologically resembles the piriformis and developmentally appears to be a part of gluteus maximus could be a challenging puzzle for the present day surgeon and radiologist.

Unusual Topography of Posterior Antebrachial Musculature in the First Osseofibrous Compartment of Wrist: Clinicomorphological Appraisal

Las variaciones anatomicas de los musculos abductor largo del pulgar y extensor corto del pulgar son importantes en la evaluacion clinica de la mano enferma y traumatizada. El presente caso informa una inusual fusion de los vientres musculares de los Mm. abductor largo del pulgar y extensor corto del pulgar con dos tendones de insercion separados, el tendon medial se inserto en la base del primer metacarpiano y el tendon lateral en el musculo abductor corto del pulgar. El conocimiento de estas variaciones anatomicas es de importancia en el manejo de la enfermedad de De Quervain y cirugia reconstructiva de la mano.

Enigma of scapular foramen and tunnels: an untold story

PurposeThe study was undertaken to make a qualitative and quantitative assessment of unnamed foramen and tunnels in adult human scapulae with aid of plain and contrast radiographs.Materials and methodsA total of 120 dry bones, 60 each of the right and the left side were included in the study. Distribution of these foramina and tunnels was noted for their number, side, location, course and communication. Their morphometry was done using Vernier’s caliper.ResultsIncidence of scapular foramina was 7.5% (R > L), whereas scapular tunnels were seen in 15.8% cases. Incidence of the sinuous, curved, and straight tunnels was found to be 50, 39, and 10.7% respectively. Left-sided tunnels were longer than the right ones. Plain and contrast radiographs were taken to confirm the findings.ConclusionAnatomy literature describes only two scapular foramina, namely, nutrient foramen and suprascapular foramen/notch in a great zeal; occurrence of such anonymous foramina is hardly discussed. Through this study, there is an endeavor towards unfolding the mystery of scapular foramina in terms of their morphometry and distribution, the knowledge of which will aid clinicians, forensic experts, and surgeons in better diagnosis and management of clinical cases.

Unusual Branching Pattern of the Lateral Cord of the Brachial Plexus Associated with Neurovascular Compression: Case report

The brachial plexus consists of a network of nerves that innervates the upper limbs and its musculature. We report a rare formation of the lateral cord of the brachial plexus observed during the dissection of a 47-year-old male cadaver at the Department of Anatomy, Vardhman Mahavir Medical College, New Delhi, India, in 2016. The lateral cord was exceptionally long with twin lateral pectoral nerves and twin lateral roots of the median nerve. The proximal lateral root of the median nerve was thin in comparison to the medial root of the median nerve. The distal lateral root of the median nerve was thicker and followed an unusual course through the coracobrachialis muscle. In the lower third of the arm, the median nerve and the brachial artery-along with its vena comitans-spanned through the brachialis muscle. Surgeons, anaesthesiologists, radiologists and anatomists should be aware of such anatomical variations as they may result in neurovascular compression.