Topographic and morphometric anatomy of the proximal part of the dorsal scapular nerve.

The dorsal scapular nerve (DSN) entrapment neuropathy has recently been recognized as a common cause of circumscapular pain and cases of winged scapula. Course of the nerve is important because the middle scalene muscle is frequently accessed for surgical treatments. Studies in the literature have not focused on the morphometric relationship of the DSN with the scalene muscles and its relationship with the long thoracic nerve (LTN). The neck regions of 13 adult cadavers were dissected bilaterally. The relationship of DSN with scalene muscles and LTN was evaluated. Cervical spinal nerves involved in the formation of the DSN were identified. Three types of DSN were observed based on the cervical spinal nerves from which it originates, five types of DSN from its relationship with the scalene muscles, and two types of DSN from its relationship with the LTN. The distance from where the nerve pierces the scalene muscle to the mastoid process was found to be greater in DSNs originating from C4 and C5 (93.85 ± 4.11 mm, p = 0.033). In DSNs not connected with LTN, the distance from where the nerve pierces the scalene muscle to the superior trunk/C5 (12.74 ± 7.73 mm, p = 0.008) and the length of the nerve within the scalene muscle (14.94 ± 5.5 mm, p = 0.029) were found to be statistically significantly greater. The topographic and morphometric anatomy of the proximal part of the DSN is important, especially for scalene muscles-focused surgical treatments and interscalene nerve blocks. We believe our results may guide clinical approaches and surgery.

A new anatomic trait for identifying the mendosal suture in young children: the mendosal-lambdoidal angle.

PURPOSE: Radiologic diagnosis of skull fractures in young children is difficult due to numerous accessory sutures. This is especially true around the occipital bone because it has more than one ossification center. Normal anatomic variants, such as the mendosal suture, may be misinterpreted as a skull fracture. We investigated the anatomic traits of the mendosal suture in young children. METHODS: We retrospectively evaluated 52 children, aged between 1 month and 4 years, who had undergone head computed tomography with three-dimensional reconstructions. We evaluated the presence or absence of the mendosal suture. If present, then we measured the length of the suture and the angle between the lambdoidal and mendosal suture lines. RESULTS: The presence of the mendosal suture was bilateral in 12 children and unilateral in 5 children. The mendosal suture had a mean length of 13.9 ± 3.4 mm on the right side and 11.2 ± 4 mm on the left side. The angle between the mendosal and lambdoidal sutures had a mean value of 54.2° ± 11° for the right side and 53.6° ± 13.9° for the left side. The 95 % confidence interval for the mean value of the angle had a lower and upper bounds of 48° and 60° on the right side and 46° and 61° on the left side, respectively. CONCLUSIONS: The angle between mendosal and lambdoidal suture lines may help radiologists to identify the mendosal suture.

Efficacy of immediate postoperative intramasseteric dexamethasone injection on postoperative swelling after mandibular impacted third molar surgery: A preliminary split-mouth study.

OBJECTIVE: To evaluate the efficacy of immediate intramasseteric injection of dexamethasone on postoperative oedema. METHODS: The prospective study was conducted at the Department of Oral and Maxillofacial Surgery, Ankara University, Ankara, Turkey, in July 2012, and comprised patients aged 15-32 years who presented for the removal of bilateral vertical impacted mandibular third molar teeth.The right and left impacted third molars of each patient were randomly allocated into study and control groups. The impacted teeth in the study group were extracted with surgical bone removal, and 2ml of 8mg/2ml dexamethasone was injected into the ipsilateral masseter muscle immediately after suturing.In the control group, dexamethasone was replaced with 2ml of sterile saline solution. Postoperative facial oedema was measured with a tape scale by calculating the distance between several facial landmarks on postoperative day 2. SPSS 15 was used for data analysis. RESULTS: The mean age of 20 patients was 21.35±4.18 years, and there were 9(45%) patients between 15-20 years of age, while 11(55%) were 21-32 years. IN terms of gender, 9(45%) patients were male and 11(55%) were female. Postoperative oedema was significantly reduced in the study group compared to the control group (p<0.05). CONCLUSIONS: Immediate intramasseteric injection of dexamethasone was effective in reducing postoperative oedema after mandibular impacted third molar surgery.

The anatomy of the fibrous and osseous components of the first extensor compartment of the wrist: a cadaveric study.

PURPOSE: De Quervain disease is the stenosing tenosynovitis of the first extensor compartment of the wrist. It is diagnosed with a history of pain at the radial aspect of the wrist and a positive Finkelstein test. Although anatomic variations, such as a septum within the compartment, are considered as risk factors, bony anatomy of distal radius and its correlation with the septa are studied scarcely in the literature. METHODS: We dissected 50 wrists of 26 cadavers. Presence and location of a septum within the compartment was evaluated. We also observed the grooves at distal radius and their relation to the first extensor compartment and its content. RESULTS: The septum was absent in 23 wrists (46%). A septum was present in 27 (54%) wrists (15 incomplete 30%, 12 complete 24%). At the distal radius, we classified three radial groove types as Type 1 on 28 (56%), Type 2 on 14 (28%), and as Type 3 on 8 (16%) wrists. There was a statistically significant relation between complete type of septa and Type 1 grooves (p = 0.002). CONCLUSION: We investigated the bony structures of the compartment along with its content and we believe our results might guide clinicians who diagnose and treat de Quervain tenosynovitis.

Giant right atrial thrombus in premature newborn.

Pediatric guidelines for treatment options of right atrial thrombosis in newborn are quite limited. Herein we present a case with giant atrial thrombosis resulting from umbilical venous catheter and intend to discuss the therapy in the area of current literature on right atrial thrombus in newborn and children.

The relationship of the superficial radial nerve and its branch to the thumb to the first extensor compartment.

PURPOSE: The superficial radial nerve and its branches are vulnerable during surgery for de Quervain tenovaginitis. We studied the proximity of the nerve branches to the first extensor compartment. METHODS: We dissected 20 forearms of 11 cadavers and measured the branching point of the superficial radial nerve relative to the radial styloid. We defined the midline of the first extensor compartment and measured distances of nerves adjacent to it. RESULTS: The superficial radial nerve gave the lateral dorsal digital branch to the thumb at 50 ± 13 mm (minimum, 26 mm; maximum, 72 mm) proximal to the radial styloid. Average distances of the lateral dorsal digital branch to the thumb to the midline of first extensor compartment from proximal to distal were 2, 2, and 2 mm, respectively. In 8 forearms, the lateral dorsal digital branch to the thumb passed directly over the first extensor compartment along its entire length. We found that as the superficial radial nerve diverged from the first extensor compartment, its lateral dorsal digital branch to the thumb coursed parallel and in close relation to it. CONCLUSIONS: Anatomic knowledge of the course of the superficial radial nerve and its branches is important during open release for avoiding nerve injury. CLINICAL RELEVANCE: The close relation of the superficial radial nerve and its lateral dorsal digital branch to the thumb with the first extensor compartment may guide surgeons during surgery for de Quervain tenovaginitis.

The variations of osseous structure of the internal acoustic canal: an anatomical study.

OBJECTIVES: The internal acoustic meatus is an osseous canal that connects the inner ear to the posterior cranial fossa. It is located in the petrous portion of the temporal bone. A thin cribriform osseous plate known as the fundus is situated at the lateral end of the canal. This study assesses the structural and numerical variations of the fundus formations. METHODS: Fifty-four temporal bones of unknown gender and age were examined with the surgical microscope. RESULTS: The temporal bones analyzed were 46.2% right-sided and 53.7% left-sided. Only one temporal bone had two parallel transverse crests, while three had a single anterior crest that split into two branches posteriorly. The number of foramina at the transverse crest varied, with 29.6% having none, 48.1% having a single foramen, and 22.2% having several foramina. An anterior crest structure was seen in 53.7% of the temporal bones, with 5% having a slightly constricted entry to the facial canal. In cases with a single nerve foramen, 48.1% had one, while 51.8% had more than one, including examples with three or four foramina. A crest was found between the foramina of the single nerve in 7% of patients. Furthermore, a crest between the saccular nerve foramen and the high fiber foramina was seen in 25.9% of cases, and 5% had two saccular nerve foramina. CONCLUSION: We think that revealing the anatomical, structural and numerical variations in the fundus will be useful in explaining the disease-symptom relationship. LEVEL OF EVIDENCE: Level 4.

Morphometric evaluation of the left atrioventricular valve complex and its clinical relations.

BACKGROUND: In this study, it was aimed to evaluate morphometrically and morphologically the left fibrous ring, mitral leaflets, tendinous cords, and papillary muscles, which are the components of the left atrioventricular valve complex (LAVC), and to reveal their clinical relationships. MATERIALS AND METHODS: A total of 120 human hearts were examined at the Forensic Medicine Institute. Cases aged 30 years and older, less than 24 hours after their death, were included in the study. Heart length, width, height/width ratio, anteroposterior and mediolateral diameters of the annulus, annular area, length and width of leaflets, number and attachment sites of tendinous cords, number, shape, length, the width of papillary muscles, and distances to various points were recorded to determine their spatial configurations. As well as the measurement data of LAVC components in cases with and without cardiovascular disease (CVD), the relationships of these data with the demographic characteristics of the cases are also explained. RESULTS: In the diagnostic performance test (ROC analysis), it was determined that body mass index (> 26.7), heart weight (> 414 g), heart height/width ratio (≤ 1.24), mitral valve width (> 99.96 mm), left ventricular wall thickness (> 15.08 mm), annular area (> 619.37 mm²) and mediolateral diameter of the annulus (> 30.71 mm) are important diagnostic criteria in determining CVD if they are outside the specified reference values. CONCLUSIONS: This study provides anatomical information about LAVC, as well as recommendations for diagnosis and surgical treatment planning. We therefore believe that our findings will be useful to clinicians.

Periodontal ligament cell behavior on different titanium surfaces.

AIM: The purpose of this study was to investigate proliferation, morphology, mineralization and mRNA expressions of mineralized tissue associated proteins of PDL cells on smooth (S), sandblasted small-grit (SSG), sandblasted large-grit (SLG) and sodium titanate (NaTi) coated titanium alloys, in vitro. METHODS AND MATERIALS: PDL cells were cultured with DMEM media containing 10% FBS on the S, SSG, SLG and NaTi titanium surfaces. PDL cell proliferation, mineralization and immunohistochemistry experiments for Bone Sialoprotein (BSP) were performed. The morphology of the PDL cells was examined using confocal and scanning electron microscopy (SEM). Gene expression profiles of cells were evaluated using a quantitative-polymerase chain reaction (Q-PCR) for type I collagen (COL I), Osteocalcin (OCN), osteopontin (OPN) and Runt-related transcription factor-2 (Runx2) on days 7 and 14. RESULTS: Proliferation results on days 6 and 10 were similar in groups, while those of day 13 revealed a decrease in the NaTi group when compared to the S group. NaTi surface induced BSP mRNA expression which was correlated with mineralization tests and BSP immunostaining results. Increased Runx2 mRNA expression was also noted in the NaTi surface when compared to other surfaces. CONCLUSIONS: This study considers the NaTi surface as a potential alternative to SSG and SLG surfaces. This surface might provide a promising environment for PDL ligament-anchored implants.

Variations of the external branch of the superior laryngeal nerve during its course and its importance in surgical approaches: an experimental cadaveric study.

INTRODUCTION: Injury of the external branch of the superior laryngeal nerve can cause a hoarse or weak voice due to the functional loss (dysergia) of the cricothyroid muscle. Defining the anatomical variations of the external branch of the superior laryngeal nerve and estimating the frequency of it, it makes crucial for surgical interventions. AIM: To reveal the topography of the external branch in the Anatolian population, to prevent injury of it during the surgical intervention in the anterior neck region. MATERIALS AND METHODS: Twenty-six bilateral hemilarynges (4 females, 22 males) were dissected. The morphometric and morphological features of the external branch were examined. The obtained results were compared statistically left and right. RESULTS: Landmarks such as the thyroid gland and laryngeal prominence were determined for the detection of the external branch. The variations of the course of the external branch and the points of piercing the cricothyroid muscle or inferior constrictor pharyngeal muscle were evaluated. DISCUSSION: Although safe approaches have been described for nerve protection during neck surgeries, it can expose injuries during preliminary surgery approaches as the nerve is thinner and more superficial than other branches of the vagus nerve. However, it can be detected more easily and safely during the surgical approach by knowing the defined anatomical landmarks and morphological variations of the external branch. CONCLUSION: The anatomical variations described can be a safe and important guide in surgical approaches to be applied in the anterior neck region.

Variations in the course of the externalbranch of the superior laryngeal nerveand their importance in surgicalprocedures: an experimental cadaveric study.

<br><b>Introduction:</b> Injury of the external branch of the superior laryngeal nerve can cause a hoarse or weak voice due to the functional loss (dysergia) of the cricothyroid muscle. Defining the anatomical variations of the external branch of the superior laryngeal nerve and estimating their frequency are crucial for surgical interventions.</br> <br><b>Aim:</b> To reveal the topography of the external branch in the Anatolian population, to prevent injury of it during the surgical intervention in the anterior neck region.</br> <br><b>Material and methods:</b> 26 bilateral hemilarynges (4 females, 22 males) were dissected. The morphometric and morphological features of the external branch were examined. The obtained results were compared statistically, left and right.</br> <br><b>Results:</b> Landmarks such as the thyroid gland and laryngeal prominence were determined for the detection of the external branch. The variations of the course of the external branch and the points of piercing the cricothyroid muscle or inferior pharyngeal constrictor muscle were evaluated.</br> <br><b>Discussion:</b> Although safe approaches have been described for nerve protection during neck surgeries, injuries may occur during preliminary surgery as the mentioned nerve is thinner and more superficial than other branches of the vagus nerve. However, it can be detected more easily and safely by knowing the defined anatomical landmarks and morphological variations of the external branch.</br> <br><b>Conclusion:</b> The anatomical variations described can be a safe and important guide in surgeries of the anterior neck region.</br>.

Multiple intraoral teratoma in a newborn infant: epignathus.

Teratomas originating from the oral cavity are named as epignathus. It is a rare type of teratoma. An 11-day old male newborn was diagnosed with cleft palate and intraoral masses. The mass on the right side was protruding from the mouth. Another one on the left side was extending from the nasopharynx to the oropharynx. The diagnosis of mature teratoma was made based on the histopathological study of surgically excised masses. We desired to report on this case since multiple localized epignatus in a newborn with cleft palate has not been described yet in the literature.

The efficacy of fine needle aspiration cytology in the preoperative evaluation of parakeratotic odontogenic keratocysts.

OBJECTIVE: To assess the performance of fine needle aspiration cytology (FNAC) in preoperative diagnosis of parakeratotic odontogenic keratocyst. STUDY DESIGN: Twenty-three cases of odontogenic keratocyst which were evaluated with FNAC prior to enucleation were included in the study. Aspiration smears were stained with Papanicolaou and hematoxylin-eosin stain. Results obtained from FNAC were compared with histopathologic data obtained from the excisional biopsies. RESULTS: Keratotic cell clusters with or without inflammation were identified in all the cytologic smears. No dysplastic changes were seen. The evaluation of the excisional biopsies revealed cystic epithelium which is characterized by palisaded basal cells, a corrugated surface with a lumen containing keratin debris. Two of the cases which revealed satellite cysts were not associated with Gorlin-Goltz syndrome due to the absence of other findings. CONCLUSION: Parakeratotic odontogenic keratocyst can be substantially diagnosed preoperatively utilizing FNAC with a careful evaluation.

The mendosal suture.

PURPOSE: The knowledge regarding the mendosal suture is still on debate in the literature. Though reports of the closure of this childhood suture are variable, a few reports show the presence of the suture in the adults. This study was conducted to determine the occurrence and a better topographic location of the mendosal suture. METHODS: We used 129 dry skulls for this study. In the specimens, which were determined to have a mendosal suture, the morphometric traits of the mendosal suture and the angle between the mendosal suture line and lambdoidal suture line (α angle) were measured. RESULTS: We found mendosal suture on 18 specimens, 11 of them were bilateral and 7 were unilateral. The length of these sutures ranged from 10.4 to 23.8 mm on the right side and 10.8 to 31.6 mm on the left side, respectively. The angle between two suture lines ranged from 36 to 68° on the right side and 32 to 75° on the left side. CONCLUSIONS: We believe that, these data will be of use to clinicians in order to avoid any misinterpretation of the mendosal suture with cranial fractures.

Postoperative analgesia in impacted third molar surgery: the role of preoperative diclofenac sodium, paracetamol and lornoxicam.

OBJECTIVE: The aim of this study was to compare the postoperative analgesic effects of preoperative intravenous (i.v.) paracetamol, diclofenac sodium and lornoxicam (nonsteroidal anti-inflammatory drugs). SUBJECTS AND METHODS: Sixty patients with impacted third molar who underwent surgical removal were randomly allocated into three groups: group P (n = 20), group D (n = 20) and group L (n = 20). Group P received preoperatively 1 g paracetamol i.v., group D 75 mg diclofenac sodium i.m. and group L 8 mg lornoxicam i.v. Postoperative pain intensity, additional consumption of analgesics postoperatively and postoperative complications were compared among groups. RESULTS: The groups were comparable for pain scores (p > 0.05). Maximum pain scores were recorded in postoperative 4th h in all groups (group L 22, 14-44 mm; group P 24, 13-43 mm; group D 14, 10-24 mm, p = 0.117). Patients experienced high satisfaction scores which were comparable among groups (group L 85, 75-100 mm; group P 87, 70-95 mm; group D 84, 77-98 mm, p = 0.457). CONCLUSION: Preoperative intramuscular diclofenac, intravenous paracetamol and lornoxicam effectively decreased the pain scores. The patients were satisfied with the three postoperative pain management regimens.

Evaluation of the Mortality and Morbidity of Premature Infants During a Five-Year Period in the Neonatal Intensive Care Unit.

Background Premature birth is the most important cause of perinatal mortality and morbidity. This study aimed to evaluate mortality and morbidity in premature infants over a five-year period at a university hospital providing tertiary intensive care health services. Methodology All premature infants born alive at ≤37 gestational weeks and hospitalized in neonatal intensive care units were included in the study. Data such as maternal and perinatal characteristics, characteristics of the newborn, respiratory and related problems, neonatal morbidities, and causes of death were retrieved retrospectively from file records. Results A total of 1,780 patients (53.7% male and 46.3% female) were included in the study. High-risk pregnancy was present in 55% of women. Respiratory distress syndrome (RDS) developed in 50.4% of the patients, intracranial hemorrhage in 8.4%, and necrotizing enterocolitis in 5.6%. Mortality was observed in 20.9% of the patients. The most frequent cause of death was RDS and related complications (11.8%), and 66.4% of mortality occurred during the early neonatal period, that is, the first 24 hours of life. Conclusions High-risk pregnancies were significantly associated with neonatal morbidity and mortality. Therefore, the management of maternal health factors should be the priority for controlling neonatal mortality.

Surface anatomy of the transverse sinus for the midline infratentorial supracerebellar approach.

AIM: Knowing the location of the transverse sinus in the midline supracerebellar infratentorial approach is important to prevent its inadvertent injury. The external landmarks of the occipital bone have been studied in this anatomic study in order to reveal their relationship with the transverse sinus. MATERIAL AND METHODS: Fifty-two dried skulls were used to study the relationship of the transverse sinus with various surface bone structures. The key bone surface structures identified in each specimen were the superior nuchal line, the inferior nuchal line, the inion, internal occipital protuberance, and the transverse sulcus. RESULTS: The distance from the inion to the inferior nuchal line in specimens ranged from 12.7 mm to 37.7 mm. The distance from the inferior nuchal line to the midline foramen magnum in the specimens ranged from 19 mm to 34.75 mm. The width of the proximal transverse sulcus ranged from 2.6 mm to 10.16 mm with an average of 6.43 mm on the right side and 3.4 mm to 10.6 mm with an average of 6.15 mm on the left. CONCLUSION: The first and most superior burr hole for midline supracerebellar infratentorial approach can be safely placed approximately 1 cm below the inferior nuchal line. A burr hole in this localization will avoid the transverse sinus.