Morphology of cranial sutures and radiologic evaluation of the variations of intersutural bones.

BACKGROUND: As far as our literature searches showed us, morphological characteristics of cranium such as sutures, sutural bones and fontanelles had been examined in the skulls in the museums and dry specimens until now. As a modern method, three-dimensional virtual reconstruction of cranial bones by using multidetector computed tomography-computed tomography angiography (MDCT-CTA) can display in vivo morphological characteristics. In our study, we aimed to determine the presence and incidence of these morphological characteristics that can be clinically significant in our population, by using radiologic methods. MATERIALS AND METHODS: We examined head and neck regions of 185 patients via MDCT-CTA. We evaluated radiologically detectable variations of the metopic sutures, lambda, bregma, asterion and pterion, which can be very easily confused with fractures. Additionally, the differences between the genders and incidence of coexistence of these variations were evaluated. RESULTS: According to our study, the incidence of persistent metopic suture was 8.1% and the incidence of lambda variations was 5.9%. Variations were most commonly encountered on the left asterion, and least commonly on the bregma and left pterion. In the evaluation of the coexistence of the parameters and combinations, the Wormian bones located at the right and left asterions were detected. There were no statistically significant differences between genders. CONCLUSIONS: Variations of the sutures and sutural bones can be easily misdiagnosed with the fractures of related bony regions in unconscious patients with multiple traumas. During surgical interventions in these patients, surgeons must take this fact into consideration in order to make differential diagnosis of fractures and intersutural bone variations.

Multiple variations of the deep artery of arm: double deep artery of arm and deep artery of arm with the superior ulnar collateral artery. A case report.

Multiple variations of the deep artery of arm were observed during routine gross anatomic dissection of the right upper extremity of a 54-year-old male cadaver. In this case study, a double deep artery of arm and the deep artery of arm with the superior ulnar collateral artery were reported. The anatomic origin of the deep artery of arm is variable. In the literature, a double deep brachialis since its origin is reported in 0.7% and the deep brachial with the superior ulnar collateral artery in 22.3%. Such variations are considered to be occurring during embryologic development. These type of variations are important both in surgical and clinical situations.

Variations in anatomy at the suprascapular notch possibly causing suprascapular nerve entrapment: an anatomical study.

The purpose of the study was to determine anatomical variations at the suprascapular notch for better understanding of possible predisposing factors for suprascapular nerve entrapment. We dissected 32 shoulders of 16 cadavers between the ages of 39 and 74 years. We observed abnormally oriented superior fibers of the subscapularis muscle in five shoulders of the 16 cadavers, which were covering the entire anterior surface of the suprascapular notch and significantly reducing the available space for the suprascapular nerve. We also detected anterior coracoscapular ligament in six of the 32 shoulders, and calcified superior transverse scapular ligament in four of the shoulders. In this study, we classified the variations for the superior transverse scapular ligament. In conclusion, knowing the anatomical variations in detail along the course of the suprascapular nerve might be important for better understanding of location and source of the entrapment syndrome, especially for individuals who are involved in violent overhead sports activities such as volleyball and baseball. To our knowledge, close relationship of subscapularis muscle with the suprascapular nerve as a possible risk factor for suprascapular nerve entrapment has not been mentioned previously.

Studies on the location of the mental foramen in Turkish mandibles.

The position of the mental foramen was studied in 58 adult Turkish skulls which were divided into two groups according to age. A previously published method was used to determine the position of the mental foramen. The most common position of the mental foramen lies in line with the longitudinal axis passing between the first and second premolars. This result was in accordance with classical textbooks. Another measurement was also performed on the mental foramen in both groups. The distance between the mental foramen and the mandibular symphysis (A) and the distance between the mental foramen and the inferior border of the mandible (B) were measured. There was a significant difference between the two groups in B, but not in A.

Multiple variations in the azygos venous system: a preaortic interazygos vein and the absence of hemiazygos vein.

Multiple variations of the azygos venous system were detected during routine dissection. The hemiazygos vein was underdeveloped. On the left side of the thorax, posterior intercostal veins between the 8th and 11th intercostal spaces and the subcostal vein drained into the azygos vein independently. In addition, the posterior 4th, 5th, 6th and 7th intercostal veins united and formed two superior and inferior trunks. The superior common trunk, at the level of the T4 vertebra, crossed the vertebral column obliquely, lying anterior to the aorta and posterior to the esophagus, opening into the azygos vein at the level of the T4 vertebra. The other structures in this part were normal. There were different courses of the azygos vein system. This variation is important in mediastinal surgery and also in the interpretation of radiographs.

Abnormal digastric muscle with unilateral quadrification of the anterior belly.

During dissection of the submental region we observed that the anterior belly of the left digastric muscle had four separate insertions. These muscle bands united in a common tendon as they continued with the posterior belly. This is an anatomical variation in the mylohyoid digastric muscle group in the floor of the mouth. When an asymmetry in the floor of the mouth is detected during diagnostic procedures, such as radiologic studies, anomalies of the anterior belly of the digastric muscle should be considered besides other reasons of asymmetry. Additionally, possible occurrence of such anomalies should be remembered during surgical procedures involving the submental region. This unique variation has not been reported in the literature.

Three-dimensional (3-D) reconstruction of the human coccygeal body.

The three-dimensional reconstructions of the human coccygeal bodies were undertaken using semi-thin serial sections which were cut from the tissue specimens taken from the ventral parts of the tip of the coccyges of four patients. The coccygeal bodies were observed in the form of convoluted, irregular helical tubes. The diameters of the coccygeal bodies in serial sections were measured and a statistical analysis performed. The lumens of the coccygeal bodies were not observed in the twisted parts of the tissue specimens. Depending upon to the irregular courses of the lumens and their lack of appearances in the twisted areas, we are unable to show the three-dimensional reconstructions of the lumens of the coccygeal bodies. In conclusion, this is the first study reporting the three-dimensional reconstruction of the contours of the coccygeal body. These type of studies, which were done by using serial sections will be very helpful for the understanding of the little known organs of the human body.

Origin of the radial and ulnar arteries: variations in 81 arteriograms.

In a retrospective review of 81 upper extremity arteriograms, 8 (9.8%) origin anomalies of the major arteries were detected. High origin of the radial artery from the brachial artery was the most frequent variation, found in 7 (8.6%) cases representing 87.5% of all variations in this series. In one case, the left ulnar artery originated from the axillary artery, accounting for 12.5% of the variations. These anomalous origins of the upper extremity arteries can be explained on the basis of the embryologic development. It is important for the surgeons and radiologists to be aware of the possible arterial variations in order to prevent complications during surgical and diagnostic procedures.

A case with dextrocardia, ventricular septal defect, persistent left superior vena cava and drainage of the great cardiac vein into the left internal thoracic vein.

A 17-month-old female patient was operated on for ventricular septal defect and pulmonary stenosis. During the operation several cardiac anomalies were observed; these were dextrocardia, ventricular septal defect, persistent left superior vena cava, drainage of the great cardiac vein into the left internal thoracic vein and a pericardial pouch. These anomalies have not previously been reported together.

Frequency of cavum veli interpositi in non-psychotic population: a magnetic resonance imaging study.

This prospective MRI investigation was performed to determine the incidences of the cavum veli interpositi (CVI) in 505 (242 Male, 263 Female) non-psychotic persons. The mean age of the population was 39,179 +/- 0,904 (40,461 +/- 1,395 Male, 38 +/- 1,166 Female). There was no significant difference between the means of age in male and female groups (t-test, DF=479, p>0,05). The incidences of the CVI were 5.77%, 1.89%, 5.66%, 8.24%, 5%, 4.55%, 7.94%, 3.03% for age group of 0-9, 10-19, 20-29, 30-39, 40-49, 50-59, 60-69, 70-79 respectively. There was no significant difference between the incidences of the CVI in age-groups (chi(2)=3.804, DF=7, p>0.05). The incidences of the CVI were 5.54%, 6.61%, 4.56% for whole, male, and female populations respectively. There was no significant difference between the incidences of the CVI in both sexes (chi(2)=1.01, DF=1, p>0.05).

A bilateral location anomaly of the parotid gland (case report).

During an anatomic dissection of the parotid region inferiorly located parotid glands were noted on both sides. Because within the glands lies the external carotid artery, retromandibular vein and the facial nerve, surgeons should have detailed knowledge of the anatomy of this region and possible variations to avoid risk of damaging, especially the facial nerve. Also the unusual location of the gland may be confused with pseudomass during CT or MRI.

A connecting branch between the musculocutaneous nerve and the median nerve.

We report here a connecting branch between the musculocutaneous and the median nerves in a 42 years old male cadaver. The connecting branch was 8 cm in length and 3 mm in width. One of the brachial veins and the brachial artery were located between the roots of the median nerve and the second brachial vein was present between the connecting branch and the median nerve. These kinds of variations may effect the venous return and may cause edema in the upper extremities. Additionally, variations of these nerves have an importance during operations of this region.

Frequency of septum pellucidum anomalies in non-psychotic population: a magnetic resonance imaging study.

This prospective MRI investigation was performed to investigate septum pellucidum (SP) anomalies in 505 (242 male, 263 female) non-psychotic persons. The mean age of the population was 39.179 +/- 0.904 (40.461 +/- 1.395 male, 38 +/- 1.166 female). There was no significant difference between the means of age in the male and female groups (t-test, DF = 479, p > 0.05). The SP anomalies were classified as cavitation anomalies (Type I) and absence of the SP (Type II). Type I anomalies were subdivided into four groups as isolated cavum septi pellucidi (Ia), cavum septi pellucidi et cavum vergae (Ib), anterior small triangular cavities (Ic), and cysts of the SP (Id). The incidences of the anomalies (Type I + Type II) were 17.31%, 1.89%, 7.55%, 3.53%, 7%, 4.55%, 4.76% and 6.06% for the age groups of 0-9, 10-19, 20-29, 30-39, 40-49, 50-59, 60-69 and 70-79 years respectively. The anomalies were very significantly more frequent in the 0-9 years age group than in the other age groups (chi 2 = 9.7858, DF = 1, p < 0.05). The incidences of the anomalies (Type I + Type II) were 6.34%, 5.37%, 7.22% for the whole, male, and female populations, respectively. These values were 1.39%, 1.65% and 1.14% for Type Ia, 2.77%, 2.89% and 2.66% for Type Ib, and 1.78%, 0.83% and 2.66% for Type Ic. Both Type Id and II anomalies were determined in only one case for each group in females (0.2%). There was no significant difference between the incidences of the anomalies in both sexes (chi 2 = 0.45, DF = 1, p > 0.05).

An unusual variation of the superficial ulnar artery.

Anomalous superficial ulnar arteries were found bilaterally during routine dissection of the upper limbs of a 60-year-old male cadaver. In the left arm, the superficial ulnar artery originated from the axillary artery. It crossed the median nerve anteriorly and ran anteromedial to this nerve and the brachial artery. The superficial ulnar artery was also rudimentary and gave rise to only a narrow muscular branch to the biceps brachii. In the hand, it anastomosed with the radial artery, completing the superficial palmar arch. The radial artery was larger than usual and the deep palmar arch was formed only by the radial artery. In the right arm, the superficial ulnar artery originated from the brachial artery at the level of the inter-epicondylar line. Additionally there were "inverse palmaris longus muscles" bilaterally. This was a rare case in which the superficially ulnar artery originated from a different source on each side accompanied by anomalies of the palmar arches on one side.

An accessory fissure in the lower lobe of the right lung.

We report here an accessory fissure in the right lung. Accessory fissures are described as clefts of various depths lined by two layers of visceral pleura. Anomalies of location of the lungs may be produced by the accessory fissures. In our case, an unusual accessory fissure in the right lung was found in a 50 years old male cadaver. The accessory fissure was located between the superior and basal segments of the lower lobe of the right lung. Its depth was around 3 cm as an average value. Its length was found to be 12 cm on the surface of the lung. In conclusion, a surgeon must always remember the anatomical variations of the location of the lungs especially in lobectomies and in segmental resection. From the radiological aspect, an accessory fissure is important in that it can be mistaken for lung pathologies.

Unreported anatomical variation of septum pellucidum.

During gross anatomy dissections of the brain, a developmental abnormality of the septum pellucidum was found in a 31-year-old male cadaver. Other parts of the central nervous system in this cadaver were normal in every aspect. Histological samples were taken from the neighboring areas of this abnormality, and they were examined under light microscope and scanning electron microscope. In this abnormality of the septum pellucidum, the two laminae of the septum pellucidum were fused together and there was a hole located 1 cm anterior to its apex. The maximum diameter of the hole was 0.5 cm in the sagittal plane and 0.6 cm in the vertical plane. In the light microscopic and scanning electron microscopic examinations, the free margin of this foramen was regular, and the surrounding tissue was intact and histologically unique to the septum pellucidum. Ependymal cells were present at the free margin of the foramen. Cavum vergae, cavum septum pellucidum, and agenesis of the septum pellucidum are described in the literature. These three abnormalities are seen in cadavers usually with histories of schizophrenia and other psychiatric or neurologic disorders. In a retrospective study, the cadaver with this abnormality had a history of schizophrenia and no history or signs of any kind of brain or head operation. As far as we could ascertain, the abnormality described here has not been reported previously.

An anomalous course of the interazygos vein.

During an anatomic dissection of the posterior mediastinum, an unusual course of the interazygos v. was noted. The hemiazygos v. ascended to the 8th thoracic vertebra, in front of the vertebral column. It left the column, ascending obliquely, and passing in front of the aorta and behind the oesophagus. This transverse segment, crossing the midline, is called the interazygos v. It may be confused with different lesions situated at this level: aneurysm, tumour or lymph node hypertrophy, during CT or MRI studies. Secondly, the surgeon must be aware of this azygos variation as a possible cause of haemorrhage during a procedure in this region.