An Anatomical Evaluation of Normal and Aberrant Foramen Ovale in Skull Base with Its Clinical Significance.

Introduction: Foramen ovale is one of the most significant foramina of skull base and transmits mandibular nerve. Its detailed knowledge is crucial in treatment of trigeminal neuralgia and various diagnostic practices. Aim: Aim of the study was to provide anatomical data of foramen ovale regarding number, shape, diameters and its relation to nearby bony landmarks. Material and method: The present study was ethically approved and 100 dry adult human skulls were included in the study to evaluate 200 foramina ovale. Non-metric parameters were observed and metric parameters were measured with Vernier calliper and goniometer. Results:Different kinds of shapes were found in foramen ovale. Variant features in the form of bony spine, ridge, foramen or bar were identified. The means of anteroposterior and transverse diameter of foramen ovale were found to be 8.16 and 4.97 mm on the right side, and 7.68 and 4.74 mm on the left side. The mean distance of its anterior and posterior ends from the midsagittal plane were 22.69 and 28.92 mm on the right side, and 22.18 and 22.66 mm on the left side. Distance from the lateral border of foramen ovale to the posterior end of zygoma and midpoint of infratemporal crest was found to be 30.65 and 21.05 mm on the right, and 30.30 and 20.87 mm on the left side. The mean of angle of foramen ovale with midsagittal was 45.44º on the right side and 45.78º on the left side. Conclusion:Variations found in foramen ovale are key points to keep in mind while operating in this region. Measured metric parameters were found to a higher extent on the right side than the left one. The present study will be helpful for both further research and neurosurgeons operating in this region.

Retroaortic left renal vein associated with unilateral superior renal polar artery: a clinico-embryological perspective.

The aim of the current study is to report an unusual occurrence of a retroaortic left renal vein in an adult male cadaver of Caucasian origin. This unusual variant was discovered during the course of preclinical educational training programme for undergraduate medical students. The vascular anomaly was dissected and the surrounding adnexa carefully studied for associated variations. Subsequently, morphometry was performed on the specimen to measure certain important parameters. The left renal vein was found to emerge from lower part of renal hilum and traversed posterior to abdominal aorta and finally terminated into Inferior vena cava. Additionally, the left renal artery was higher in position and originated from the abdominal aorta at the level of upper border of body of Ist lumbar vertebra. This type of anomaly is very important as it may be associated with varicocoele. Furthermore, in preoperative planning for nephrectomy, partial nephrectomy and living donor nephrectomy, the surgeons should keep in mind the possibility of this vascular anomaly. It is also stated that left renal vein appears to be at the centre of a huge venous network which makes the nephrectomy hazardous and permits the spread of infectious material and neoplasms.

Superficial brachial artery with its high division.

The upper extremity arterial system shows a large number of variations attributed to the complex and multiple sites of their embryonic development. It is important to be aware of arterial variations in this region because upper extremity is a frequent site of injury. Moreover, brachial artery is of significance in cardiac catheterization for angioplasty, pedicle flaps, or arterial grafting. Accurate knowledge and relationships of major arterial conduits and their variational patterns is important in reparative surgery in the arm, forearm and hand. One such variation is superficial brachial artery with prevalence rate of 0.2-25%. In this report, the brachial artery emanated normally but coursed superficial to the median nerve and about five cm above the intercondylar line, bifurcated into its terminal branches i.e. radial and ulnar artery.

Bilateral eventration of sciatic nerve.

During routine dissection of a 60 years male cadaver, it was observed that the two divisions of sciatic nerve were separate in the gluteal region on both the sides with the tibial nerve passing below the piriformis and the common peroneal nerve piercing the piriformis muscle. The abnormal passage of the sciatic nerve (SN), the common peroneal nerve (CPN), and the tibial nerve (TN), either through the piriformis or below the superior gemellus may facilitate compression of these nerves. Knowledge of such patterns is also important for surgeons dealing with piriformis syndrome which affects 5-6% of patients referred for the treatment of back and leg pain. A high division may also account for frequent failures reported with the popliteal block.

Bilateral superficial brachial artery.

Variations of the upper limb arterial system are well documented. Accurate knowledge of the normal and variant arterial anatomy of the axillary artery is important for clinical procedures and vascular radiology. In this article, a rare bilateral variation of superficial brachial artery is being reported. The axillary artery on both sides divided in its third part into a superficial brachial artery passing superficial to the lateral root of median nerve and brachial artery proper. The former terminated in the cubital fossa by dividing into ulnar and radial arteries while the later descended deep to the medial root of median nerve and gave anterior and posterior circumflex humeral branches of axillary artery and profunda brachii of brachial artery. Then it terminated by giving twigs to muscles of arm. Earlier superficial brachial artery is reported with a prevalence rate varying from 0.2-25 % but a bilateral variation is extremely rare. Further its ontogeny and clinical implications are discussed in detail.

Axillary arch muscle.

Langer's arch is one of the rare muscular variation in the axillary region. In the present article, a case of 50 year old male cadaver with axillary arch in the right axillary region is being reported. It originated from anterior border of latissimus dorsi and merged with short head of biceps brachii. The embryological derivation, genetic basis and clinical implication of this muscular variant are also discussed.