Medial circumflex femoral artery with different origin and course: a case report and review of the literature.

The femoral artery (FA) and its branches play important roles in the arterial supply of the lower extremity. If the femoral artery is occluded, the circulation of the extremity is maintained by certain anastomoses. Therefore, identification of variations of these arteries is critical from a clinical and surgical point of view. During routine anatomical dissections for student education at the Department of Anatomy of the School of Medicine at Ondokuz Mayls University, a variation of the medial circumflex femoral artery (MCFA) was observed and photographed in a male, formalin-fixed cadaver aged 55 years. In this case, MCFA branched off from the posterolateral aspect of the FA, 32 mm distal to the inguinal ligament. A frequency rate of 17-26% has been reported regarding this variation. However, MCFA emerging from the postero-lateral aspect of the FA and its course, as in this case, is not that frequent. Knowledge of anomalies in the emergence and course of the arteries that join the cruciate anastomosis and are important in the arterial supply of the head and neck of the femur appear to be a critical component that requires caution during surgical interventions towards this region.

The double outlet right ventricle with additional cardiac malformations: an anatomic and echocardiographic study.

Double outlet right ventricle (DORV) is a complex group of abnormal ventriculoarterial connections where both the aorta and pulmonary artery rise from the right ventricle morphologically. It is a rare condition affecting 1-1.5% of patients with congenital heart disease. The patient's cardiac measurements were taken by two-dimensional echocardiography. The pathological findings of the defined case are illustrated in the figures. A 20-year-old male patient with palpitations, tachypnea, and tiredness with weak exercise capacity and back pain was diagnosed with heart murmur in different degrees; slight cyanosis, cachexia, and developmental retardation were found clinically. Echocardiography showed: DORV, perimembranous ventricular septal defect, pulmonary stenosis, dilatated right ventricle, and dilatated left atrium. However, the left ventricle was normal. In addition, the septum interatriale filled the left atrium like an aneurysm. DORV is an important and rare congenital cardiac malformation. This complex condition may result in different clinical findings and require different therapeutic approaches.

Absence of the musculocutaneous nerve together with unusual innervation of the median nerve.

During routine anatomical dissections, absence of the musculocutaneous nerve was determined in a 58-year-old male cadaver. Moreover, the biceps brachii and brachialis muscles were innervated by two separate branches which divided from the median nerve instead of the musculocutaneous nerve. From a branch that divides from the main trunk of the median nerve at nearly the middle of the arm a motor branch again divided that innervated the brachialis muscle and a sensory branch that conveyed the sense of the lateral part of the forearm. Furthermore, it was found that the brachial artery divided into its terminal branches, the radial and ulnar arteries. We believe that this rare variation of the median nerve will shed light upon surgical procedures involving the median nerve.

A rare accessory coracobrachialis muscle: a review of the literature.

During previous dissections to investigate the incidence of the third head of the biceps brachii in neonate cadavers an accessory coracobrachialis muscle was unilaterally found in a neonate male cadaver. This muscle originated from the coracoid process and the capsule of the shoulder joint. It was inserted into the antebrachial fascia and the medial epicondyle of the humerus. The coracobrachialis muscle is used as a transposition flap in deformities of infraclavicular and axillary areas and in postmastectomy reconstruction. It is also a guide to the axillary artery during surgery and anesthesia. This additional muscle may cause musculocutaneous or high median nerve paralysis. We were unable to find any similar case in the published literature. The anatomic variations of the coracobrachialis muscle may cause confusion during surgery or evaluation of CT and MRI scans.

Report of a rare human variation: the superficial ulnar artery arising from the axillary artery.

A rare variation of the ulnar artery is presented on routine anatomical dissection in one male cadaver. The superficial ulnar artery was found to originate from the axillary artery. The free forearm flap is increasingly popular among plastic surgeons. As a result of this case, and a review of the literature to gain further knowledge of anatomical variations, it is advised that more attention should be paid clinically to this artery to prevent its injury.

On the incidence of third head of biceps brachii in Turkish neonates and adults.

The occurrence of a third head of the biceps brachii has been reported in several articles. The aim of this study is to determine on the incidence of the third head of biceps brachii in Turkish neonates and adults, and to compare it with other studies. Also the functional and phylogenetic importance of the third head was described here. The third head was studied in 160 arms of 60 (45 males, 15 females) neonatal and 20 (13 males, 7 females) adult cadavers and was found in 24 (15%) specimens. It had the three different origins and frequently arose from the anterior surface of the humerus and distal to the insertion of the coracobrachialis muscle. In all cases, the third head inserted into the conjoined tendon of biceps brachii and received its nerve supply from the musculocutaneous nerve. In our study the rate of the third head was different than those for most other published series and that the difference are possibly caused by evolutionary and/or racial trends in different studied populations. We believe that the third head of biceps brachii muscle is not a relatively rare variant. The knowledge of such variations may become significant in preoperative diagnosis and during surgery.

A rare anomaly of the abductor digiti minimi muscle of the foot.

One case with anomalous fascicles in the abductor digiti minimi muscle (ADM), noted in the course of dissecting the left lower extremity of a 62-year-old male cadaver, is described. The ADM had proximally three bellies and distally one. One of the proximal bellies presented the normal belly and others were the supernumerary fascicles. Both fascicles arose from the calcaneus, one was inserted into the base of the fifth metatarsal (FMB) and the other into the tuberosity of the fifth metatarsal (FMT). One belly coursing distally arose from the FMB and was inserted into the proximal phalanx of the fifth digit. The normal belly ended in the FMB and also both in the distal belly and in the flexor digiti minimi muscle. One of the supernumerary fascicles (medial fascicle) crossed the lateral plantar artery. To our knowledge, this is an anatomic variation which has never been described before. The morphology of this anomaly is discussed in relation to previously described anomalies of the plantar muscles.

The femoral sulcus angle in neonatal cadavers: a macroscopical and ultrasonographical study.

The shape of the femoral sulcus is an important factor in patellofemoral congruence. The aim of the present study was to investigate the femoral sulcus angle using neonatal cadavers through ultrasonographic and macroscopic observations, in order to evaluate the differences between those two methods and also in order to compare them with adult data published previously. Both knees of 20 neonatal cadavers were examined to measure the femoral sulcus angle. The mean cartilaginous femoral sulcus angle was 145.77 degrees on the macroscopic measurements, and 146 degrees in the ultrasonographic examinations. There was no significant difference between neonatal and adult values and between ultrasonographic and macroscopic measurements (P > 0.05). In the most of the knees two condyles were symmetrical (92.5%). In conclusion the cartilaginous femoral sulcus angle is completely formed in the neonatal age group. Internal and external factors during childhood may be responsible for condylar dysplasia.

The shape of the lumbar vertebral canal in newborns.

STUDY DESIGN: This study used geometric measurement criteria to assess the incidence of a trefoil spinal canal configuration in neonates. OBJECTIVES: To examine the shape of the neonatal lumbar vertebral canal with regard to its shape and the incidence of trefoilness. SUMMARY OF BACKGROUND DATA: Many studies consider the trefoil canal to be a developmental feature. Because of a lack of neonatal samples it is still unknown whether some individuals are prone to develop a trefoil spinal canal because of genetically determined factors. METHODS: The last two lumbar vertebrae of 31 term neonatal cadavers from the collection of the Anatomy Department of Ondokuz Mayis University were examined. After removal, the vertebrae were processed and embedded in paraffin blocks to enable accurate sectioning at the pedicle level. Subsequently, unmagnified images were obtained through a color photocopy machine. These two-dimensional images were digitalized, and accurate measurements were made to determine the circularity and the trefoilness. RESULTS: Trefoilness assessment indicated that the trefoil-shaped spinal canal does not exist in newborns. The spinal canal at this age is mostly dome-shaped. CONCLUSIONS: In accordance with the previous hypotheses made by other authors, the authors of this study found that the trefoil shape of the lumbar vertebra does not occur at the end of the intrauterine period.

Unusual bifurcation-level variation of the left common carotid artery: anatomic presentation of a surgical case.

We report an anatomical variation of the left common carotid artery in a 65 year old patient with larynx carcinoma, that was detected during a radical neck dissection. The bifurcation of the artery was at the level of sixth cervical vertebra that is significantly lower than the commonly accepted normal level. To the best of our knowledge, there is no other report of a similar variation in the medical literature.

A further morphological study of the persistent median artery in neonatal cadavers.

Persistent median artery was studied in 60 upper limbs of 30 neonatal cadavers. It was found in 12 (20%) specimens while partial atrophy in the distal part of the median artery was detected in 9 (15%) specimens. These findings correlated well with those of other series including the authors' previous study which covered both adults and neonates. There was no significant difference statistically between the authors' current and previous studies (p > 0.05). Therefore both studies were combined. The incidence of persistent median artery in this enlarged series (100 specimens) was 17%. This rate of persistent median artery was higher than those of most other published series. We believe this may be due to evolutionary and racial trends; the neonatal origin of our specimens would be another differing factor. Partial atrophy of the median artery, and the different incidences in neonates and adults raised the possibility that the median artery regresses at a later age, possibly during perinatal and early infancy period.

The importance of the angulation and termination of external jugular vein in central venous catheterization in newborn.

The purpose of this study is to evaluate the termination and angulation of the EJV (External jugular vein) and the number and the position of its valves so as to improve our understanding of the anatomy of the EJV and to make the manuplation easier in central venous catheterization in newborn. The present study was carried out on 50 newborn cadavers (31 male, 19 female). 100 Dissections were bilaterally made. The angle of the termination of the EJV was measured. Its termination angle was also radiologically measured. Its termination was classified into three types: In 72 cases (72%), EJV flowed into the jugulo-subclavian venous confluence; in 26 cases (26%), into the SCV (Subclavian vein) at a distance (1cm) from its junction with the IJV (Internal jugular vein); in 2 cases (%2) into the trunk of the IJV. Its termination types were asymmetrical in 12 cadavers (24%) and symmetrical in 38 (76%). Its termination angle was found both anatomically or radiologically to be within 25 degrees-60 degrees. The valves of the EJV were examined in 10 newborn cadavers. They were most often bi-valvular, in paraostial position and were of a membranous character. It is important to remind the physician about the surprises related to its terminations and angulations during the central venous catheterization.

Gigantic patent ductus arteriosus--report of a newborn cadaver dissection and review of the literature.

During the gross anatomical dissection of the thoracic region in a newborn, a gigantic patent ductus arteriosus was found. This vessel had a diameter as large as the pulmonary trunk and a longer length. The brachiocephalic a. and the left common carotid a. originated from the aortic arch in close proximity with each other. The descending aorta showed a dilatation at the junction of this large-bored patent ductus arteriosus. We were unable to find any similar case in the published literature. Knowing that the anatomical variations of the great vessels may cause confusion during surgery or evaluation of CT and MRI scans, this rare case with a huge patent ductus arteriosus is presented.

Persistent median artery: an anatomical study in neonatal and adult cadavers.

To examine the association of the median artery with the median nerve, 110 forearms from 20 neonatal and 35 adult cadavers of Turkish populations were dissected and compared with those of adult cadavers. In neonatal cadavers, the persistent median artery was found unilaterally in 5 (12.5%) forearms, in 4 of which the artery arose from the ulnar artery and in one from the common interosseous artery. In adult cadavers, however, no persistent median artery was observed. From these results, it could be suggested that this artery undergoes regression even after birth.

Morphologic variants of acromion in neonatal cadavers.

In this study, the morphology of the acromion in neonatal cadavers was investigated. The hooked-type acromions (Bigliani and Morrison type III), which are said to be responsible for rotator cuff lesions in adults, were found to have a very low incidence in this age group (5%). This finding challenges the validity of the assumption that some individuals have a congenital tendency for rotator cuff lesions, depending on their acromion types.

Morphometry of the fibrous ring of the mitral valve.

In standard textbooks of anatomy it is generally accepted that the fibrous ring of the mitral valve lies in a single plane throughout its entire circumference. Some authors have stated otherwise, but there are no morphometric studies. 30 formalin-fixed hearts were sectioned to reveal the shape of the fibrous ring of the mitral valve and studied by morphometric, radiographic and histological methods. It was noted that the fibrous ring adopted a horizontal "S" shape around the two commissures and the average distance between the highest and lowest parts of the fibrous ring was found to be 7.1 mm (range 6.2-12.5 mm). Radiographic evaluation revealed that the fibrous ring lies approximately in two planes rather than in one. Histological study showed that the fibrous tissue of the mitral valve is continuous with the aortic fibrous ring, and that a slight but significant thickening marks the insertion of the mitral valve. The mitral valve thus lies in two planes, and it is hoped that this information will contribute to cardiac and valvuloplastic surgery.

An unusual coursing of the facial vein.

During the dissections of 50 adult cadavers for educational purposes, we found a 45-year-old male cadaver with an abnormally coursing facial vein which has joined the retromandibular vein at a higher level--in the parotid gland--on the right side of the face. This anomaly has also been detected radiologically.

Morphology of the retromandibular vein in relation to the facial nerve in the parotid gland.

In order to help avoid complications of parotid surgery, we investigated the relationship between the facial nerve and the retromandibular vein. Fifty dissections were performed on 30 cadavers. In 45 (90%) of the cases the retromandibular vein was located on the medial side of the upper and lower trunks of the facial nerve, and in 5 (10%), the course of the retromandibular vein was lateral to the lower trunks and medial to the upper trunks. These variations were divided into subgroups. The most commonly encountered variation was that the retromandibular vein crossed the facial nerve from the medial (34 cases) or lateral side (3 cases) at a point between the bifurcation and ramification points of the lower facial trunk. In one case, the retromandibular vein was detected on the lateral side of the facial nerve at the bifurcation. In 3 cases (15%), the course of the retromandibular vein was different on the right and left sides of the face in the same cadaver.

Distribution of facial nerve in parotid gland: analysis of 50 cases.

The purpose of the present study is to reduce the postoperative morbidity related to facial paralysis during parotid surgery and to layout the different characteristics related to intraparotideal distribution and anastomoses of the facial nerve in our community. We also report new variations in the facial nerve branchings that have not been previously published. In this paper, facial nerves from 48 cadavers and 2 patients of which 45(90%) were males and 5(10%) were females; 26(52%) being right and 24(48%) being left facial nerves were put forward. Their photographs were taken and the diagrams of intraparotideal distributions of each facial nerve were drawn. The intraparotideal configuration of the facial nerve was evaluated in 5 types. Twenty-four% of the facial nerves had no anastomoses (Type I); 12% had a ring-like shape anastomosis between the buccal and the zygomatic branches (Type II); 14% anastomoses were between the buccal and the other branches in a ring-like shape (Type III); 38% of the facial nerves had multiple complex anastomoses and were named as multiple loops (Type IV); 12% had two main trunks (Type V). Of the bilateral cadaver dissections, the facial nerve distribution in 9(47.3%) were bilaterally the same and in 10(52.7%) main trunks were different. A facial nerve trifurcation composed of two main trunks were also established. There were no statistical differences between branching of the facial nerves in the right and left side of the faces.(ABSTRACT TRUNCATED AT 250 WORDS)