Tuncay Peker

Variations in the anatomy of the inferior alveolar nerve

Variations in the anatomy of the inferior alveolar nerve were seen in 2 of the 20 dissections of the infratemporal fossa in 10 cadavers. A connecting nerve branch that originated from the auriculotemporal nerve joined the inferior alveolar nerve on both sides. The second part of the maxillary artery passed between the mandibular nerve, the root of the inferior alveolar nerve, and the connecting nerve branch which formed a loop. The maxillary artery seemed to be entrapped. Neurovascular entrapment can cause pain and numbness. Anatomical variations in this region should be kept in mind, particularly in cases of failed treatment of trigeminal neuralgia.

Bilateral anomaly of anterior bellies of digastric muscles

During dissection of the submental region, the anterior bellies of the right and left digastric muscles were found to have two separate portions, inserting into different locations in the submental region. The lateral portions of the anterior bellies of the digastric muscles originated from the digastric fossa and inserted into the hyoid bone. The medial parts of the anterior bellies of the right and left digastric muscles ran medially and inserted into the mylohyoid raphe on both sides, forming accessory digastric muscles. This anatomic abnormality of the muscle could be significant in surgical procedures involving the submental region.

Insertion abnormality of bilateral pectoralis minimus

Bilateral insertion abnormality of pectoralis minimus (sterno-costo- coracoidian muscle) muscle was examined. The variant muscle was lying under the pectoralis major muscle and was medial to the pectoralis minor muscle. This muscle started from the first costal cartilage to the manubrium sterni and ended in the upper surface of the shoulder joint on the right side. On the opposite side, it took origin from the second costal cartilage to the manubrium sterni and the second costochondral joint, afterwards became a tendinous structure and divided into two on the coracoid process. The thicker part ended on the upper surface of the articular capsule of the shoulder joint, the thinner part inserted on the lateral third of inferior part of clavicle and fascia of subclavius muscle.

Improving fat graft survival through preconditioning of the recipient site with microneedling

Although fat grafts are considered the ideal soft-tissue fillers, the main concern dealing with this technique is not being able to predict long-term graft survival due to high absorption rates. The purpose of this study was to investigate the angiogenic effects of preconditioning the recipient area with micro-needling and to determine its overall impact on fat graft survival. The study consisted of a sham, control and study group. The source of fat was the Wistar albino rat inguinal fat pad while the recipient area was a dorsal subcutaneous pouch. The dorsal area was preconditioned with standard technique micro-needling 1-week prior to fat graft transfer in the study group while the control group did not undergo micro-needling. At the end of 15 weeks, morphological, biochemical, histological and immunohistochemical evaluation was carried out. Fat grafts in the study group had better integrity and a higher level of vascularity compared to the control group. Volume analysis demonstrated higher graft survival in the study group in comparison to the control group. Histomorphometric and immunohistochemical evaluation showed better graft integrity and uniform adipocytes, less fibrosis, less vacuolisation and inflammation and better vascularisation in the study group. Although higher triglyceride concentrations were measured for the study group, the difference between the two groups was statistically insignificant. In conclusion, fat grafting performed in an area preconditioned with micro-needling results in higher graft volume, better integrity and vascularisation and an overall higher graft survival rate.

Observation of the relationship between the shape of skeletal muscles and their nerve distribution patterns: a transparent and microanatomic study.

Background: There are many gaps in the understanding of the neuroanatomy of skeletal muscles with regards to the nerve distribution pattern and shape of the muscles. This study was designed to examine the entire intramuscular nerve-distribution patterns of various human skeletal muscles. Methods: The relationships among nine skeletal muscles with various architecture (rhomboid major, biceps brachii, flexor pollicis longus, rectus femoris, sternohyoid, trapezius, masseter, digastric muscles) and their nerve-distribution patterns were investigated in four fetal cadavers using the Sihler staining method. The diameter and number of extramuscular (main) and major nerve branches, the number of minor nerve branches, and anastomoses were examined and evaluated statistically. Results: With regards to the number of extramuscular (main) nerve branches, the rhomboid major muscle resembled the flexor pollicis longus, trapezius, masseter, and sternohyoid muscles, and the anterior belly of the digastricus muscle (p > 0.05), whereas it was significantly different from the rectus femoris, the posterior belly of digastricus, and the long and short heads of the biceps brachii (p < 0.05). Trapezius and masseter muscles were different from all of the skeletal muscles that were studied with regards to the diameter of main branches (p < 0.05). The masseter muscle had the largest diameter (p < 0.05). With regards to the number of minor nerve branches, the sternohyoid muscle was significantly different from all the skeletal muscles that were studied (p < 0.05) except the short head of the biceps brachii, rectus femoris, and the posterior belly of digastricus (p > 0.05). As for the number of neural anastomoses, the sternohyoid muscle was statistically different from all skeletal muscles that were studied (p < 0.05) except the masseter and trapezius muscles (p > 0.005). Conclusions: A surgeons thorough knowledge of the relationship between the shape and nerve distribution pattern of skeletal muscles is important in successful reinnervation and regeneration of these muscles. It might also be useful in the field of muscle transplantation.

The incidence and types of sella and sphenopetrous bridges

The incidence and types of sella and sphenopetrous bridges were investigated in 37 adult male and 43 adult female (a total of 80) dry skulls with removed calvarias. In addition to this, the sellar and parasellar region of ten fixed cadavers (two female and eight male) were carefully dissected, and the individuals were examined for the evidence of sella and sphenopetrous bridges. Sella bridges were seen in 34.17% of the subjects overall. The trace, incomplete and complete types were 11.9%, 3.7% and 17.5%, respectively. On the other hand, sphenopetrous bridges were observed in 15.8% of the male and 4.9% of the female subjects overall. The cadaveric investigation revealed one trace, three incomplete, and one complete sella bridge in three cadavers. In addition to this, a complete sphenopetrous bridge was detected in one of the cadavers. Variations in the cranial base are of importance for surgical approaches in that location.

Demonstration of the Nerve Distribution of the Masticatory Muscles in Rabbits (Oryctolagus cuniculus)

Two methods can be used in order to demonstrate the nerve distribution of an organ. One is the three‐dimensional reconstruction of the innervation pattern of the organ by tracing images of that organ from serial histological sections. The other is the in toto staining of the organ with subsequent clearing of the muscles. In the present study, in order to visualize the nerve distribution of the organ, that organ was completely cleared and the nerve fibres were stained. Detailed morphological structure of the intramuscular nerve distribution of a certain region and its functions are of importance not only for anatomists and physiologists but also for clinicians. In this study eight New Zealand rabbits were used to visualize the intramuscular nerve distribution of the muscles involved in mastication (temporalis m., pterygoideus medialis m., digastricus m., retractor mandibulae m. and masseter m.). The main nerve bundle was observed entering into the muscle as a single trunk and dividing into three branches in the muscle. These branches were also observed dividing into several subbranches while going to the periphery. When the samples were examined under a stereomicroscope, ‘Y’‐, ‘I’‐ and ‘O’‐shaped communications between those branches were observed.

Phrenic Nerve Distribution in the Rabbit Diaphragm and Morphometric Analysis of Nerve Branches

The best method to evaluate the pathogenesis of diaphragmatic disorders is to demonstrate the distribution pattern of the phrenic nerve in the diaphragm. For this purpose the branching pattern and the microanatomic features of the phrenic nerve were observed in six rabbits. All diaphragms were stained by using Sihlers stain method. The phrenic nerve divided into three to four branches when entering the diaphragm. These branches were classified as sternal, anterolateral, posterolateral and crural. The crural branches were the thickest whereas the anterolateral branches were the thinnest. Knowledge about the distribution pattern of the phrenic nerve may be important in surgical approach to the diaphragm.

Three‐dimensional assessment of the morphology of the umbilical artery in normal and pre‐eclamptic placentas

Aim:  Pre‐eclampsia is one of the main causes of intrauterine growth retardation. Although there are many studies performed in this setting showing the course of the umbilical vessels within the umbilical cord along with its structural changes, studies are lacking with regard to intraplacental vasculature and its structural changes.

Clearing and embedding in polyester resin for demonstrating the nerve distribution pattern of skeletal muscles

The preservation of many stained gross specimens in solution creates some difficulties. It is convenient and effective to preserve material in polyester resin instead of glycerol. The aim of this study was to determine the usefulness of clearing and embedding using polyester resin. The samples consisted of the nerve distribution patterns of skeletal muscles stained using Sihlers method. The muscles were cleared more successfully and the intramuscular nerve distributions were demonstrated better in polyester than in glycerol. The method presented here eliminates not only the storage and handling problems of specimens, but also problems such as pale stains and the molding of preparations. Furthermore, it is more convenient to examine and to photograph specimens cleared and embedded in polyester than those stored in glycerol.