Anatomy Research International The latest articles from Hindawi © 2017 , Hindawi Limited . All rights reserved. Comment on “Variability in the Branching Pattern of the Internal Iliac Artery in Indian Population and Its Clinical Importance” Mon, 26 Dec 2016 14:56:33 +0000 Vinodhini Bhaskaran Copyright © 2016 Vinodhini Bhaskaran. All rights reserved. Morphometric Analysis of the Infraorbital Foramen: The Clinical Relevance Sun, 25 Dec 2016 13:39:21 +0000 The present study was conducted to ascertain the shape, size, presence of accessory foramina, direction, and the precise position of the infraorbital foramen (IOF) in relation to the inferior orbital margin (IOM), anterior nasal spine (ANS), nasion (Na), maxillary teeth, and supraorbital foramen/notch (SOF/N) in adult skulls in a Sri Lankan population. Fifty-four skulls (42 males and 12 females) were analyzed. The IOF was oval in shape (38.6% and 36.3% on the right and left side, resp.) in a majority of skulls. The direction of the IOF was mostly medially downward (48.6%). Accessory foramina were found in 7.4% of the skulls. The infraorbital foramina were located at a mean distance of 6.52 ± 2.03 mm and 7.30 ± 1.57 mm, vertically below the IOM on the right and left side, respectively; 33.81 ± 2.68 mm and 34.23 ± 2.56 mm from the ANS on the right and left side, respectively; and 42.37 ± 3.52 mm and 42.52 ± 3.28 mm from the Na on the right and left side, respectively. In relation to the upper teeth the majority of IOF (37.5% and 55.9% on the right and left side, resp.) were located in the same vertical axis as the tip of the buccal cusp of the maxillary second premolar tooth. Deepthi Nanayakkara, Roshan Peiris, Navini Mannapperuma, and Amal Vadysinghe Copyright © 2016 Deepthi Nanayakkara et al. All rights reserved. Surface Projection of Interosseous Foramen of the Leg: Cadaver Study Sun, 13 Nov 2016 06:48:57 +0000 Purpose. This study was conducted to identify the surface projection of the interosseous foramen and associated structures of the proximal leg using the average clinician’s thumb width as a quick measurement to assist in differential diagnosis and treatment. Methods. Twelve cadavers (5 males and 7 females, age range = 51–91 years, and mean age = 76.9) were dissected for analysis. Location and size of interosseous foramen, location of anterior tibial artery, location of deep fibular nerve, and corresponding arterial branches were measured and converted into thumb widths. Results. Mean thumb width measured among the cadavers was  mm. The interosseous foramen measured was approximately 1 thumb width vertically ( mm) and 1/2 thumb width horizontally ( mm) and was located approximately 1 thumb width distally to the tibial tuberosity ( mm) and 2 thumb widths ( mm) lateral to the tibial ridge. The anterior tibial artery and deep fibular nerve converged approximately 4 thumb widths ( mm) inferior to the tibial tuberosity and 2 thumb widths ( mm) lateral to the tibial ridge. Conclusion. Clinicians may identify anatomical structures of the proximal leg with palpation using the thumb width for measurement. Eric Arguello, Carissa Stoddard, Hao (Howe) Liu, Mike Richardson, and Andrea Hartis Copyright © 2016 Eric Arguello et al. All rights reserved. Cystic Artery: Morphological Study and Surgical Significance Sun, 16 Oct 2016 13:36:32 +0000 The cystic artery is the key structure sought to be clipped or ligated during laparoscopic or conventional cholecystectomy. The possible complications like hemorrhage or hepatobiliary injury are always centered on the search, dissection, and clipping or ligation of the cystic artery, many a time because of possibility of variations in its course and relations to the biliary ducts. This descriptive study was carried out to document the normal anatomy and different variations of the cystic artery to contribute to improve surgical safety. This study conducted on 82 cadavers revealed cystic artery with mean length of 16.9 mm (ranged between 2 mm and 55 mm) and mean diameter of 1.6 mm (range between 1 mm and 5 mm). The origin of cystic artery from celiac right hepatic artery was found in 79.3% and in the remaining 20.7% it was replaced. Single cystic artery was present in 72% and double cystic artery in 28%. Considering the site of origin of the cystic artery with reference to Calot’s triangle, it was observed within the triangle in 62.2% and outside it in 37.8%. All the cystic arteries passed through Calot’s triangle except for 3.6%. The cystic artery crossed the common hepatic duct anteriorly in 26.8% and posteriorly in 6.1%. It crossed common bile duct anteriorly in 1.2% and posteriorly in 3.7%. The knowledge of such variations and its awareness will decrease morbidity and help to keep away from a number of surgical complications during cholecystectomy. Usha Dandekar and Kundankumar Dandekar Copyright © 2016 Usha Dandekar and Kundankumar Dandekar. All rights reserved. New Possible Surgical Approaches for the Submammary Adipofascial Flap Based on Its Arterial Supply Thu, 29 Sep 2016 12:35:25 +0000 Introduction. Submammary adipofascial flap (SMAF) is a valuable option for replacement of the inferior portion of the breast. It is particularly useful for reconstruction of partial mastectomy defects. It is also used to cover breast implants. Most surgeons base this flap cranially on the submammary skin crease, reflecting it back onto the breast. The blood vessels supplying this flap are not well defined, and the harvest of the flap may be compromised due to its uncertain vascularity. The aim of the work was to identify perforator vessels supplying SMAF and define their origin, site, diameter, and length. Materials and Methods. The flap was designed and dissected on both sides in 10 female cadavers. SMAF outline was 10 cm in length and 7 cm in width. The flap was raised carefully from below upwards to identify the perforator vessels supplying it from all directions. These vessels were counted and the following measurements were taken using Vernier caliper: diameter, total length, length inside the flap, and distance below the submammary skin crease. Conclusions. The perforators at the lateral part of the flap took origin from the lateral thoracic, thoracodorsal, and intercostal vessels. They were significantly larger, longer, and of multiple origins than those on the medial part of the flap and this suggests that laterally based flaps will have better blood supply, better viability, and more promising prognosis. Both approaches, medially based and laterally based SMAF, carry a better prognosis and lesser chance for future fat necrosis than the classical cranially based flap. Ehab M. Elzawawy, Melad N. Kelada, and Ahmed F. Al Karmouty Copyright © 2016 Ehab M. Elzawawy et al. All rights reserved. Incidence of Clavicular Rhomboid Fossa in Northeastern Thais: An Anthropological Study Sun, 28 Aug 2016 14:48:50 +0000 The rhomboid fossa of clavicle is used to determine the age and sex in anthropology and forensic sciences. The variant types of rhomboid fossa on inferior surface have been reported in many races except in Thais. This study therefore was aimed at classifying the types of the rhomboid fossa in Northeastern Thais. The identified 476 Northeastern Thais dried clavicles (270 males and 206 females) were observed and recorded for the types of rhomboid fossa. The results showed that Thai-rhomboid fossa could be classified into 4 types: Type 1: smooth; Type 2: flat; Type 3: elevated; and Type 4: depressed, respectively. The incidences of rhomboid fossa were as follows: Type 1: 0.21%; Type 2: 19.75%; Type 3: 76.26%; and Type 4: 3.78%, respectively. Additionally, it was found that the percentage of Type 4 (11.84%) was much greater than that of female (1.94%) compared to other types. This incidence of rhomboid fossa types especially Type 4 may be a basic knowledge to be used in sex identification. The high incidence of rhomboid fossa in both sexes of Northeastern Thai clavicles was Type 3 (elevated type). Ailadda Kaewma, Apichakan Sampannang, Panya Tuamsuk, Jaturat Kanpittaya, and Sitthichai Iamsaard Copyright © 2016 Ailadda Kaewma et al. All rights reserved. A Cadaveric Investigation of the Dorsal Scapular Nerve Mon, 15 Aug 2016 12:20:17 +0000 Compression of the dorsal scapular nerve (DSN) is associated with pain in the upper extremity and back. Even though entrapment of the DSN within the middle scalene muscle is typically the primary cause of pain, it is still easily missed during diagnosis. The purpose of this study was to document the DSN’s anatomy and measure the oblique course it takes with regard to the middle scalene muscle. From 20 embalmed adult cadavers, 23 DSNs were documented regarding the nerve’s spinal root origin, anatomical route, and muscular innervations. A transverse plane through the laryngeal prominence was established to measure the distance of the DSN from this plane as it enters, crosses, and exits the middle scalene muscle. Approximately 70% of the DSNs originated from C5, with 74% piercing the middle scalene muscle. About 48% of the DSNs supplied the levator scapulae muscle only and 52% innervated both the levator scapulae and rhomboid muscles. The average distances from a transverse plane at the laryngeal prominence where the DSN entered, crossed, and exited the middle scalene muscle were 1.50 cm, 1.79 cm, and 2.08 cm, respectively. Our goal is to help improve clinicians’ ability to locate the site of DSN entrapment so that appropriate management can be implemented. Vuvi H. Nguyen, Hao (Howe) Liu, Armando Rosales, and Rustin Reeves Copyright © 2016 Vuvi H. Nguyen et al. All rights reserved. Anatomy of Teaching Anatomy: Do Prosected Cross Sections Improve Students Understanding of Spatial and Radiological Anatomy? Mon, 08 Aug 2016 12:02:53 +0000 Introduction. Cadaveric dissections and prosections have traditionally been part of undergraduate medical teaching. Materials and Methods. Hundred and fifty-nine first-year students in the Faculty of Medicine, University of Colombo, were invited to participate in the above study. Students were randomly allocated to two age and gender matched groups. Both groups were exposed to identical series of lectures regarding anatomy of the abdomen and conventional cadaveric prosections of the abdomen. The test group (, 48.4%) was also exposed to cadaveric cross-sectional slices of the abdomen to which the control group (, 51.6%) was blinded. At the end of the teaching session both groups were assessed by using their performance in a timed multiple choice question paper as well as ability to identify structures in abdominal CT films. Results. Scores for spatial and radiological anatomy were significantly higher among the test group when compared with the control group (, CI 95%). Majority of the students in both control and test groups agreed that cadaveric cross section may be useful for them to understand spatial and radiological anatomy. Conclusion. Introduction of cadaveric cross-sectional prosections may help students to understand spatial and radiological anatomy better. L. B. Samarakoon, S. Vithoosan, S. Kokulan, M. M. Dissanayake, D. J. Anthony, Vajira Dissanayake, and Rohan Jayasekara Copyright © 2016 L. B. Samarakoon et al. All rights reserved. Morphology and Functional Anatomy of the Recurrent Laryngeal Nerve with Extralaryngeal Terminal Bifurcation Thu, 14 Jul 2016 16:59:16 +0000 Anatomical variations of the recurrent laryngeal nerve (RLN), such as an extralaryngeal terminal bifurcation (ETB), threaten the safety of thyroid surgery. Besides the morphology of the nerve branches, intraoperative evaluation of their functional anatomy may be useful to preserve motor activity. We exposed 67 RLNs in 36 patients. The main trunk, bifurcation point, and terminal branches of bifid nerves were macroscopically determined and exposed during thyroid surgery. The functional anatomy of the nerve branches was evaluated by intraoperative nerve monitoring (IONM). Forty-six RLNs with an ETB were intraoperatively exposed. The bifurcation point was located along the prearterial, arterial, and postarterial segments in 11%, 39%, and 50% of bifid RLNs, respectively. Motor activity was determined in all anterior branches. The functional anatomy of terminal branches detected motor activity in 4 (8.7%) posterior branches of 46 bifid RLNs. The motor activity in posterior branches created a wave amplitude at 25–69% of that in the corresponding anterior branches. The functional anatomy of bifid RLNs demonstrated that anterior branches always contained motor fibres while posterior branches seldom contained motor fibres. The motor activity of the posterior branch was weaker than that of the anterior branch. IONM may help to differentiate between motor and sensory functions of nerve branches. The morphology and functional anatomy of all nerve branches must be preserved to ensure a safer surgery. Fuat Cetin, Emin Gürleyik, and Sami Dogan Copyright © 2016 Fuat Cetin et al. All rights reserved. Bilateral Chondroepitrochlearis Muscle: Case Report, Phylogenetic Analysis, and Clinical Significance Sun, 08 May 2016 11:09:21 +0000 Anomalous muscular variants of pectoralis major have been reported on several occasions in the medical literature. Among them, chondroepitrochlearis is one of the rarest. Therefore, this study aims to provide a comprehensive description of its anatomy and subsequent clinical significance, along with its phylogenetic importance in pectoral muscle evolution with regard to primate posture. The authors suggest a more appropriate name to better reflect its proximal attachment to the costochondral junction and distal attachment to the epicondyle of humerus, as “chondroepicondylaris”; in addition, we suggest a new theory of phylogenetic significance to explain the twisting of pectoralis major tendon in primates that may have occurred with their adoption to bipedalism and arboreal lifestyle. Finally, the clinical significance of this aberrant muscle is elaborated as a cause of potential neurovascular entrapment and as a possible hurdle during axillary surgeries (i.e., mastectomy). Sujeewa P. W. Palagama, Raymond A. Tedman, Matthew J. Barton, and Mark R. Forwood Copyright © 2016 Sujeewa P. W. Palagama et al. All rights reserved. Repeated Exposure to Dissection Does Not Influence Students’ Attitudes towards Human Body Donation for Anatomy Teaching Wed, 13 Apr 2016 07:16:34 +0000 The use of unclaimed bodies for anatomical dissection has been the main method of instruction at our institution. There is however a shortage of cadavers for dissection given the increase in the number of medical schools as well as in the number of students enrolling in these schools. This shortage could be mitigated by having voluntary human body donation programs. This study aimed at assessing the attitudes of medical students and surgical residents towards body donation for anatomy learning. We conducted an online survey involving 72 first-year medical students and 41 surgical residents at University of Nairobi who had completed one year of anatomy dissection. For the medical students, this was their first dissection experience while it was the second exposure for the surgery trainees. Most of the surgical trainees (70.7%) and medical students (68.1%) were opposed to self-body donation. This was mainly due to cultural (37%) and religious (20%) barriers. Surprisingly, of those not willing to donate themselves, 67.9% (82.8% surgical trainees, 59.2% medical students) would recommend the practice to other people. Exposure to repeated dissection does not change the perceptions towards body donation. It is noteworthy that culture and religion rank high as clear barriers amongst this “highly informed” group of potential donors. Philip Maseghe Mwachaka, Pamela Mandela, and Hassan Saidi Copyright © 2016 Philip Maseghe Mwachaka et al. All rights reserved. Limited Trabecular Bone Density Heterogeneity in the Human Skeleton Mon, 11 Apr 2016 08:54:15 +0000 There is evidence for variation in trabecular bone density and volume within an individual skeleton, albeit in a few anatomical sites, which is partly dependent on mechanical loading. However, little is known regarding the basic variation in trabecular bone density throughout the skeleton in healthy human adults. This is because research on bone density has been confined to a few skeletal elements, which can be readily measured using available imaging technology particularly in clinical settings. This study comprehensively investigates the distribution of trabecular bone density within the human skeleton in nine skeletal sites (femur, proximal and distal tibia, third metatarsal, humerus, ulna, radius, third metacarpal, and axis) in a sample of individuals (11 males and 9 females). pQCT results showed that the proximal ulna (mean = 231.3 mg/cm3) and axis vertebra (mean = 234.3 mg/cm3) displayed significantly greater () trabecular bone density than other elements, whereas there was no significant variation among the rest of the elements (). The homogeneity of the majority of elements suggests that these sites are potentially responsive to site-specific genetic factors. Secondly, the lack of correlation between elements () suggests that density measurements of one anatomical region are not necessarily accurate measures of other anatomical regions. Habiba Chirchir Copyright © 2016 Habiba Chirchir. All rights reserved. Anatomical Considerations on Surgical Anatomy of the Carotid Bifurcation Mon, 07 Mar 2016 12:40:17 +0000 Surgical anatomy of carotid bifurcation is of unique importance for numerous medical specialties. Despite extensive research, many aspects such as precise height of carotid bifurcation, micrometric values of carotid arteries and their branches as their diameter, length, and degree of tortuosity, and variations of proximal external carotid artery branches are undetermined. Furthermore carotid bifurcation is involved in many pathologic processes, atheromatous disease being the commonest. Carotid atheromatous disease is a major predisposing factor for disabling and possibly fatal strokes with geometry of carotid bifurcation playing an important role in its natural history. Consequently detailed knowledge of various anatomic parameters is of paramount importance not only for understanding of the disease but also for design of surgical treatment, especially selection between carotid endarterectomy and carotid stenting. Carotid bifurcation paragangliomas constitute unique tumors with diagnostic accuracy, treatment design, and success of operative intervention dependent on precise knowledge of anatomy. Considering those, it becomes clear that selection and application of proper surgical therapy should consider anatomical details. Further research might ameliorate available treatment options or even lead to innovative ones. Adamantios Michalinos, Markos Chatzimarkos, Nikolaos Arkadopoulos, Michail Safioleas, and Theodore Troupis Copyright © 2016 Adamantios Michalinos et al. All rights reserved. Right Hepatic Artery: A Cadaver Investigation and Its Clinical Significance Wed, 16 Dec 2015 13:39:58 +0000 The right hepatic artery is an end artery and contributes sole arterial supply to right lobe of the liver. Misinterpretation of normal anatomy and anatomical variations of the right hepatic artery contribute to the major intraoperative mishaps and complications in hepatobiliary surgery. The frequency of inadvertent or iatrogenic hepatobiliary vascular injury rises with the event of an aberrant anatomy. This descriptive study was carried out to document the normal anatomy and different variations of right hepatic artery to contribute to existing knowledge of right hepatic artery to improve surgical safety. This study conducted on 60 cadavers revealed aberrant replaced right hepatic artery in 18.3% and aberrant accessory right hepatic artery in 3.4%. Considering the course, the right hepatic artery ran outside Calot’s triangle in 5% of cases and caterpillar hump right hepatic artery was seen in 13.3% of cases. The right hepatic artery (normal and aberrant) crossed anteriorly to the common hepatic duct in 8.3% and posteriorly to it in 71.6%. It has posterior relations with the common bile duct in 16.7% while in 3.4% it did not cross the common hepatic duct or common bile duct. The knowledge of such anomalies is important since their awareness will decrease morbidity and help to keep away from a number of surgical complications. Usha Dandekar, Kundankumar Dandekar, and Sushama Chavan Copyright © 2015 Usha Dandekar et al. All rights reserved. Distal Insertional Footprint of the Brachialis Muscle: 3D Morphometric Study Tue, 10 Nov 2015 14:15:31 +0000 Objective. The purpose of this study is to describe the three-dimensional morphometry of the brachialis muscle at its distal attachment to the ulna. Methods. Fifty cadaveric elbows were dissected and the brachialis distal insertion was isolated on the ulna bone and probed with a three-dimensional digitizer, to create a three-dimensional model of the footprint. Measurements and analysis of each footprint shape were recorded and compared based on gender and size. Results. There was significant gender difference in the surface length () and projected length () of the brachialis footprint. The shapes of the footprint also differed among the specimens. Conclusion. The shape of the brachialis muscle insertion differed among all the specimens without significant variation in gender or sides. There was also a significant difference in muscle length between males and females with little difference in the width and surface area. Significance. The information obtained from this study is important for kinematic understanding and surgical procedures around the elbow joint as well as the understanding of the natural age related anatomy of the brachialis footprint morphology. Srinath Kamineni, Abdo Bachoura, William Behrens, Ellora Kamineni, and Andrew Deane Copyright © 2015 Srinath Kamineni et al. All rights reserved. Anatomy of the Ophthalmic Artery: A Review concerning Its Modern Surgical and Clinical Applications Mon, 09 Nov 2015 11:16:02 +0000 Anatomy of ophthalmic artery has been thoroughly studied and reviewed in many anatomical and surgical textbooks and papers. Issues of interest are its intracranial and extracranial course, its branches, its importance for vision, and its interaction with various intracranial pathologies. Improvement of our understanding about pathophysiology of certain diseases like aneurysm formation, central retinal artery occlusion, and retinoblastoma and also invention of new therapeutic modalities like superselective catheterization, intra-arterial fibrinolysis, and intra-arterial chemotherapy necessitate a reappraisal of its anatomy from a clinical point of view. The aim of this review is to examine clinical anatomy of ophthalmic artery and correlate it with new diagnostic and therapeutic applications. Adamantios Michalinos, Sofia Zogana, Evangelos Kotsiomitis, Antonios Mazarakis, and Theodore Troupis Copyright © 2015 Adamantios Michalinos et al. All rights reserved. Angle at the Medial Border: The Spinovertebra Angle and Its Significance Wed, 07 Oct 2015 14:00:56 +0000 Background. The evolution from quadrupedalism to bipedalism has adjusted the balance of the upper limb to extensive movement at the shoulder. The scapular angles provide the point of attachment and control to various muscles and have been associated with the different movements of the shoulder girdle and joint. This has made the morphometric and anthropometric study of scapula a subject of extensive investigation. Aim. In the present study, the angle at the medial border was measured in the South-Southern Nigerian population and an anatomical name was ascribed to the angle. Method. The study was conducted on 173 scapulae (75 right and 98 left) obtained from various Anatomy Department of South-Sothern Nigerian Universities. The angle at medial border was obtained by pinning the edge of the superior and inferior angles, the lined traced out, and the angle measured using a protractor. SPSS version 20 was used to analyse the data. t-test was used to determine mean angular difference in the sides. Result. The mean ± SD of the medial angle was observed to be 136.88 ± 7.70° (R = 138.13 ± 7.06° : L = 135.92 ± 8.05°). Statistical analysis using the Z-test for mean difference showed the medial angle was found to be higher in the right side of the scapula (mean difference of 2.214 ± 1.152°), but the observed difference was not statistically significant (P > 0.05). The above findings have adjusted the scapula from three to four angles (lateral, superior, inferior, and medial) formed from four borders (lateral, superior, inferior, and superomedial and inferomedial). The medial angle because of its anatomical location was named “spinovertebral” angle, owing to its position at the scapulae spine, and located in medial proximity to the vertebra column. Conclusion. The medial angle (now referred to as the spinovertebral angle) of the right side of the scapula is wider than the left. The representation of the spinovertebral angle is very important, as the directional attachment of the levator scapulae may be altered if it increases or decreases greatly hence resulting in stiffness of the neck. At this point, it could be postulated that the scapular is quadrangular rather than triangular. G. S. Oladipo, E. O. Aigbogun Jr., and G. L. Akani Copyright © 2015 G. S. Oladipo et al. All rights reserved. A Morphometric Study of the Foramen of Diaphragma Sellae and Delineation of Its Relation to Optic Neural Pathways through Computer Aided Superimposition Sun, 13 Sep 2015 13:03:35 +0000 The diaphragma sellae (DS) is a fold of dura that forms a partial roof over the pituitary gland. The foramen of the diaphragma sellae (FDS) is thereby a pathway for suprasellar extension of pituitary tumors. The purpose of this study was to describe the anatomical dimensions of the DS and FDS and to understand the relationship of FDS with the overlying optic chiasma. The study was conducted in 100 autopsy cases. Measurements were taken using vernier calipers. Photographs, taken before and after removal of optic pathway, were superimposed using image processing software. The results showed that the mean A-P dimension of DS was 1.17 ± 0.48 cm; the lateral dimension of DS was 1.58 ± 0.60 cm. The mean A-P dimension of FDS was 0.66 ± 0.42 cm; the lateral dimension of FDS was 0.82 cm ± 0.54 cm. The shapes of FDS were irregular (40%), transversely oval (29%), circular (13%), sagittally oval (11%), or trapezoid with posterior dimension more than the anterior one (6%) or anterior dimension more than the posterior one (1%). The margins of FDS were either well defined (31%) or ill defined (69%). The positional relation of FDS to optic chiasma was also found out. Doris George Yohannan, Renuka Krishnapillai, Romi Suresh, and Shobha Ramnarayan Copyright © 2015 Doris George Yohannan et al. All rights reserved. Dimensions and Anatomical Variants of the Foramen Transversarium of Typical Cervical Vertebrae Thu, 10 Sep 2015 11:59:52 +0000 The study was conducted on random sample of seventy-one dried, typical cervical vertebrae (C3–C6). The data on the age, sex, and built was not available. Using vernier calipers with 0.01 mm accuracy, the anteroposterior and transverse diameters of transverse foramina and their distance from the medial margin of the uncinate process were measured bilaterally. The mean diameter of the right/left transverse foramen varied from 2.54 mm to 7.79 mm (mean = 5.55 ± 0.87 mm) and from 2.65 mm to 7.35 mm (mean = 5.48 ± 0.77 mm), respectively. The transverse foramen was less than 3.5 mm in three vertebrae on the right and two on the left. The osteocytes observed in 21.3% of specimens and the narrow transverse foramen may place patients at risk for vertebrobasilar insufficiency or thrombus formation. The mean distance of the transverse foramen from the medial margin of uncinate process is an important landmark to avoid vertebral artery laceration and was 5.0 ± 0.87 mm (range: 3.5–7.9 mm) on the right and 5.0 ± 1.0 mm (range: 3.2–7.7 mm) on the left side. No statistically significant difference was observed between the right and left sides. The accessory transverse foramina seen in 24% of vertebrae suggest duplications or fenestrations in the vertebral artery. Santosh Kaur Sangari, Paul-Michel Dossous, Thomas Heineman, and Estomih Phillip Mtui Copyright © 2015 Santosh Kaur Sangari et al. All rights reserved. Anatomical Study of Chiari Network and the Remnant of Left Venous Valve in the Interior of Right Atrium Wed, 09 Sep 2015 13:40:44 +0000 Chiari network occurs due to incomplete resorption of right valve of sinus venosus. It is often noticed as fenestrated membranous structure or reticular network like structure in the valve of inferior vena cava and coronary sinus. The remnant of left venous valve is observed as trabeculae over the fossa ovalis. The incidence of Chiari network and the remnant of left venous valve were studied in 80 cadaveric hearts utilized for teaching the undergraduates. The right atrium was opened anterior to sulcus terminalis and the interior was examined for the presence of these embryological remnants. The incidence of Chiari network and left venous valve in the present study is 3.75% and 7.5%, respectively. Chiari network was observed as a fenestrated membranous structure in 2 specimens and a reticular network in 1 specimen, with variable extension to coronary sinus opening and right atrial wall. The remnant of left venous valve was observed as multiple fine strands in 3 specimens and trabecular structure in 3 specimens. These structures may create diagnostic confusion, difficulty in interventional procedures, and complications like thromboembolic events. Hence, the knowledge about the incidence, morphology, and clinical manifestations of these rare embryological remnants is mandatory. D. Devi Jansirani, S. Shiva Deep, and S. Anandaraja Copyright © 2015 D. Devi Jansirani et al. All rights reserved. Inner Synovial Membrane Footprint of the Anterior Elbow Capsule: An Arthroscopic Boundary Tue, 25 Aug 2015 10:27:51 +0000 Introduction. The purpose of this study is to describe the inner synovial membrane (SM) of the anterior elbow capsule, both qualitatively and quantitatively. Materials and Methods. Twenty-two cadaveric human elbows were dissected and the distal humerus and SM attachments were digitized using a digitizer. The transepicondylar line (TEL) was used as the primary descriptor of various landmarks. The distance between the medial epicondyle and medial SM edge, SM apex overlying the coronoid fossa, the central SM nadir, and the apex of the SM insertion overlying the radial fossa and distance from the lateral epicondyle to lateral SM edge along the TEL were measured and further analyzed. Gender and side-to-side statistical comparisons were calculated. Results. The mean age of the subjects was 80.4 years, with six male and five female cadavers. The SM had a distinctive double arched attachment overlying the radial and coronoid fossae. No gender-based or side-to-side quantitative differences were noted. In 18 out of 22 specimens (81.8%), an infolding extension of the SM was observed overlying the medial aspect of the trochlea. The SM did not coincide with the outer fibrous attachment in any specimen. Conclusion. The humeral footprint of the synovial membrane of the anterior elbow capsule is more complex and not as capacious as commonly understood from the current literature. The synovial membrane nadir between the two anterior fossae may help to explain and hence preempt technical difficulties, a reduction in working arthroscopic volume in inflammatory and posttraumatic pathologies. This knowledge should allow the surgeon to approach this aspect of the anterior elbow compartment space with the confidence that detachment of this synovial attachment, to create working space, does not equate to breaching the capsule. Alternatively, stripping the synovial attachment from the anterior humerus does not constitute an anterior capsular release. Srinath Kamineni, Abdo Bachoura, Koichi Sasaki, Danielle Reilly, Kate N. Harris, Anthony Sinai, and Andrew Deane Copyright © 2015 Srinath Kamineni et al. All rights reserved. Study of Posterior Cerebral Artery in Human Cadaveric Brain Mon, 24 Aug 2015 11:27:06 +0000 Objective. Basilar artery (BA) terminates in right and left posterior cerebral arteries (PCAs). Each PCA supplies respective occipital lobe of the cerebrum. The present study is designed to know the morphology, morphometry, branching pattern, and symmetry of PCA. Methods. The study included 340 PCAs dissected from 170 human cadaveric brains. Results. Morphological variations of P1 segment included, aplasia (2.35%), hypoplasia (5.29%), duplication (2.35%), fenestration (1.17%), and common trunk shared with SCA (1.76%). Morphological variations of origin of P2 segment included direct origin of it from BA (1.17%) and ICA (2.35%). Unusually, two P2 segments, each arising separately from BA and ICA, were observed in 1.17%. Unilateral two P2 segments from CW were found in 0.58%. Morphological variations of course of P2 were duplication (0.58%), fenestration (0.58%), and aneurysm (1.76%). Unilateral P2 either adult or fetal was seen in 4.71%. The group II branching pattern was found to be most common. Asymmetry of P2 was 40%. Morphometry of P2 revealed mean length of 52 mm and mean diameter of 2.7 mm. Conclusion. The present study provides the complete anatomical description of PCA regarding morphology, morphometry, symmetry, and its branching pattern. Awareness of these variations is likely to be useful in cerebrovascular procedures. S. A. Gunnal, M. S. Farooqui, and R. N. Wabale Copyright © 2015 S. A. Gunnal et al. All rights reserved. Retromolar Canal Associated with Age, Side, Sex, Bifid Mandibular Canal, and Accessory Mental Foramen in Panoramic Radiographs of Brazilians Thu, 20 Aug 2015 16:13:57 +0000 Background. The retromolar canal (RMC) is an anatomical variation that can cause complications in dental procedures. Method. The RMC was evaluated according to age, sex, and presence of accessory mandibular canal and accessory mental foramen, on both sides in 500 panoramic radiographs, belonging to individuals at the age of 7 to 20 years. The associations of interest were studied through Fisher’s Exact Test and Pearson’s Chi-Square Test, and the correlation was studied through Pearson’s Correlation Coefficient (r). The significance level used was 5%. Results. The RMC was observed in 44 radiographs (8.8%), and out of those 24 were females. There was no statistically significant association between the RMC and age (; Fisher’s Exact Test), sex (; Pearson’s Chi-Square Test), amount of mandibular canals and mental foramina, on both sides (; Pearson’s Chi-Square Test). There was a significant association between RMC and side, the higher frequency of the canal being on the right side (; Fisher’s Exact Test). Conclusions. Despite the low occurrence of the RMC, its identification and the verification of its dimensions and path are relevant, mainly in cases when anesthetic and surgical procedures can present failures or difficulties. Ticiana Sidorenko de O. Capote, Marcela de Almeida Gonçalves, and Juliana Álvares Duarte Bonini Campos Copyright © 2015 Ticiana Sidorenko de O. Capote et al. All rights reserved. Variations in the Root Form and Root Canal Morphology of Permanent Mandibular First Molars in a Sri Lankan Population Thu, 13 Aug 2015 09:46:49 +0000 The present study was conducted to determine the number of roots and morphology of the root canal system of permanent mandibular first molars (M1) in a Sri Lankan population. Sample of 529 M1 teeth was used. The number of roots was examined and the lengths of the mesial and distal roots were measured to the nearest 0.01 mm. Vacuum injection protocol was used to inject China ink into the root canal system, making it transparent. Root canal morphology was recorded using Vertucci’s classification. Presence of furcation canals, position of lateral canals, intercanal communications, level of bifurcation, and convergence of the root canal system were recorded. M1 showed three roots in 4.1% of the sample. Commonest root canal morphology of the mesial root was type IV and the distal root was type I. The level of bifurcation of the root canals was commonly observed in the cervical one-third of the root while convergence was observed in the apical one-third in both roots. Prevalence of three rooted mandibular first molars is less than 5%. Mesial root showed the most variable canal morphology. Prevalence of furcation canals was 1.5% while that of middle mesial canals was 0.2%. Roshan Peiris, Uthpala Malwatte, Janak Abayakoon, and Anuradha Wettasinghe Copyright © 2015 Roshan Peiris et al. All rights reserved. The Prevalence and Classification of the Cystoduodenal Ligament Wed, 12 Aug 2015 06:49:26 +0000 Variant patterns of peritoneal folds could be formed due to the complex nature of the embryology of the peritoneum and the gastrointestinal tract. When uncommon peritoneal folds are formed, they could influence aberrant formation of surrounding gastrointestinal structures and create spaces that may harbour peritoneal fluids in cases of infection or malignant tumor. One of such variant peritoneal folds is the cystoduodenal ligament which is a doubled peritoneal membrane attaching the gallbladder to the duodenum. Yet no study was found that had reported the frequency of occurrence of the cystoduodenal ligament. The current study determined the prevalence of the cystoduodenal ligament in forty adult cadavers. The ligament was reported in 35% of cases. The ligament was further classified as types I and II. Type I cystoduodenal ligament was attached partially to the gallbladder (neck and proximal part of body) while type II was attached to the entire extent of the gallbladder. Type I occurrence was found in 44% and type II was found in 56% of the occasions of cystoduodenal ligament formation. It is concluded that the cystoduodenal ligament could be commonly found, it possesses important vascular structures, and it could affect the shape of the gallbladder. Surgeons, radiologists, and anatomists should be kept abreast of these findings. J. O. Ashaolu, J. Olayinka, and V. O. Ukwenya Copyright © 2015 J. O. Ashaolu et al. All rights reserved. Binary Logistic Regression Analysis of Foramen Magnum Dimensions for Sex Determination Wed, 05 Aug 2015 08:47:09 +0000 Purpose. The structural integrity of foramen magnum is usually preserved in fire accidents and explosions due to its resistant nature and secluded anatomical position and this study attempts to determine its sexing potential. Methods. The sagittal and transverse diameters and area of foramen magnum of seventy-two skulls (41 male and 31 female) from south Indian population were measured. The analysis was done using Student’s t-test, linear correlation, histogram, Q-Q plot, and Binary Logistic Regression (BLR) to obtain a model for sex determination. The predicted probabilities of BLR were analysed using Receiver Operating Characteristic (ROC) curve. Result. BLR analysis and ROC curve revealed that the predictability of the dimensions in sexing the crania was 69.6% for sagittal diameter, 66.4% for transverse diameter, and 70.3% for area of foramen. Conclusion. The sexual dimorphism of foramen magnum dimensions is established. However, due to considerable overlapping of male and female values, it is unwise to singularly rely on the foramen measurements. However, considering the high sex predictability percentage of its dimensions in the present study and the studies preceding it, the foramen measurements can be used to supplement other sexing evidence available so as to precisely ascertain the sex of the skeleton. Venkatesh Gokuldas Kamath, Muhammed Asif, Radhakrishna Shetty, and Ramakrishna Avadhani Copyright © 2015 Venkatesh Gokuldas Kamath et al. All rights reserved. Use of Digital Panoramic Radiographs in the Study of Styloid Process Elongation Tue, 28 Jul 2015 12:20:10 +0000 This work aimed to evaluate the occurrence of suggestive images of styloid process elongation in panoramic radiographs, noting their frequency according to sex, age, and location, as well as measure and classify the types and patterns of calcification of elongated styloid processes. 2,500 panoramic radiographs were evaluated in a Radiology Clinic in Recife, PE, Brazil, performed between 2008 and 2010, with the age ranging from 25 to 80 years old. 560 of the radiographs analyzed fulfilled the inclusion criteria. Of this total, 216 (38.57%) presented suggestive images of the styloid process elongation, 45 (20.8%) belonging to male and 171 (79.2%) to female, and 84.7% were bilateral. After all measurements, mean values of 35.5 mm (left side) and 37.6 mm (right side) were obtained and these differences were statistically significant (). The most common type of stretching found was elongated (type I) with 73.1%, and the pattern of calcification was partially calcified (62.5%). It was found that the elongation of the styloid process is an anatomical variation, which must be taken into account by dentists, and because panoramic radiography is a technique of easy approach and low cost and routine, it can be used to aid in the diagnosis of elongated styloid process. Carla Cabral dos Santos Accioly Lins, Renan Macêdo Cutrim Tavares, and Camila Caroline da Silva Copyright © 2015 Carla Cabral dos Santos Accioly Lins et al. All rights reserved. Anatomical Study of the Ulnar Nerve Variations at High Humeral Level and Their Possible Clinical and Diagnostic Implications Sun, 12 Jul 2015 09:38:45 +0000 Background. Descriptive evaluation of nerve variations plays a pivotal role in the usefulness of clinical or surgical practice, as an anatomical variation often sets a risk of nerve palsy syndrome. Ulnar nerve (UN) is one amongst the major nerves involved in neuropathy. In the present anatomical study, variations related to ulnar nerve have been identified and its potential clinical implications discussed. Materials and Method. We examined 50 upper limb dissected specimens for possible ulnar nerve variations. Careful observation for any aberrant formation and/or communication in relation to UN has been carried out. Results. Four out of 50 limbs (8%) presented with variations related to ulnar nerve. Amongst them, in two cases abnormal communication with neighboring nerve was identified and variation in the formation of UN was noted in remaining two limbs. Conclusion. An unusual relation of UN with its neighboring nerves, thus muscles, and its aberrant formation might jeopardize the normal sensori-motor behavior. Knowledge about anatomical variations of the UN is therefore important for the clinicians in understanding the severity of ulnar nerve neuropathy related complications. Anitha Guru, Naveen Kumar, Swamy Ravindra Shanthakumar, Jyothsna Patil, Satheesha Nayak Badagabettu, Ashwini Aithal Padur, and Venu Madhav Nelluri Copyright © 2015 Anitha Guru et al. All rights reserved. Pes Anserinus Structural Framework and Constituting Tendons Are Grossly Aberrant in Nigerian Population Thu, 09 Jul 2015 12:12:19 +0000 We evaluated the morphological framework of the pes anserinus in both knees of ten Nigerian cadavers and we observed high degree of variability in its morphology and location. The pes anserinus inserted specifically on the superior half of the media border of the tibia, as far inferiorly as 124.44 mm to the tibial tuberosity (prolonged insertion). The insertion was also joined to the part of tibia close to the tibia tuberosity (90%) and to the fascia cruris (10%). The initial insertion point of the pes anserinus was always found at the level of the tibia tuberosity. We found out that accessory bands of sartorius, gracilis, or semitendinosus were part of the pes anserinus in 95% of all occasions studied whereas the combined occurrence of monotendinosus sartorius, gracilis, and semitendinosus tendons was found in only 5% of all occasions. The pes anserinus did not conform to the layered pattern and the tendons of sartorius, gracilis, or semitendinosus were short. The inferior prolongation of the pes anserinus connotes extended surface area of attachment to support the mechanical pull from the hamstring muscles. This information will be useful in precise location and grafting of the pes anserinus. J. O. Ashaolu, T. S. Osinuga, V. O. Ukwenya, E. O. Makinde, and A. J. Adekanmbi Copyright © 2015 J. O. Ashaolu et al. All rights reserved. Artery to Cystic Duct: A Consistent Branch of Cystic Artery Seen in Laparoscopic Cholecystectomy Thu, 09 Jul 2015 11:04:29 +0000 Uncontrolled arterial bleeding during laparoscopic cholecystectomy is a serious problem and may increase the risk of bile duct damage. Therefore, accurate identification of the anatomy of the cystic artery is very important. Cystic artery is notoriously known to have a highly variable branching pattern. We reviewed the anatomy of the cystic artery and its branch to cystic duct as seen through the video laparoscope. A single artery to cystic duct with the classical “H-configuration” was demonstrated in 161 (91.47%) patients. This branch may cause troublesome bleeding during laparoscopic dissection in the hepatobiliary triangle. Careful identification of artery to cystic duct is helpful in the proper dissection of Calot’s triangle as it reduces the chances of hemorrhage and thus may also be helpful in prevention of extrahepatic biliary radical injuries. Arshad Rashid, Majid Mushtaque, Rajandeep Singh Bali, Saima Nazir, Suhail Khuroo, and Sheikh Ishaq Copyright © 2015 Arshad Rashid et al. All rights reserved.