Hemifacial microsomia: a scoping review on progressive facial asymmetry due to mandibular deformity.

PURPOSE: This scoping review explores various parameters of the mandible in progressive facial asymmetry (FA) in hemifacial microsomia (HFM) patients, highlighting its relationship with sex, population, and age group. METHODS: The review was based on a comprehensive search of PubMed, EBSCOhost, and Web of Science. Eligible studies that met the inclusion criteria form part of the selection study. The included studies were appraised using screening and quantitative criteria of mixed-method appraisal tools. The authors utilised a pre-set data extraction form to obtain information from the included studies. RESULTS: Eleven studies met the inclusion criteria. The mandible parameters used were angular measurements, chin point, ramal height, body length, and total length. There was no relationship between FA and sex in HFM patients in the included studies. Most of the studies were comprised of European participants (55%), followed by Americans (36%) and Chinese (9%). The age groups included in the selected studies were categorised as dentition age (18%), early-to-middle childhood (18%), and varied ages (64%). The data presented in this review only pertains to the anomalous characteristics recorded on the affected side in HFM patients. No concomitant control data was recorded in this review. CONCLUSION: An assessment of the included studies revealed that FA does not increase with age in HFM. Hence, FA is non-progressive in HFM patients. This information is relevant to diagnosing and managing HFM patients. More reports are needed on the progression of FA in HFM patients.

Exploring the anatomical configurations of the cerebral arteries in a cohort of South African patients.

The cerebral arteries, specifically the anterior cerebral artery (ACA) and posterior cerebral artery (PCA), work together with the smaller calibre arteries to provide effective communication between the anterior and posterior circuits of the brain via the circle of Willis (CoW). Morphologic variations of the cerebral arteries and the CoW may alter blood flow to the brain, resulting in intracranial vascular disorders associated with stroke, and aneurysms. This study aimed to document the morphology of the cerebral arteries and the CoW in the South African population. Two hundred and thirty-nine computed tomography angiography scans were assessed. Cerebral arteries and CoW normal morphology and variations were classified as complete, absent, or hypoplastic. The ACA A1 was absent in 4.91%, hypoplastic in 30.40%, fenestrated in 1.06%, and typical in 63.6%. The ACA A2 was absent in 0.42%, hypoplastic in 26.28%, and typical in 69.44%. We found triple ACA A2 in 2.98%, azygos in 1.28% and fenestrated in 1.28%. The middle cerebral artery (MCA) was hypoplastic in 7.35% and typical in 92.64%. The PCA was hypoplastic in 28.74% and typical in 71.25%. Knowledge of the configuration of the CoW plays a significant role in guiding therapeutic decision-making in treating various neurovascular pathologies.

Prevalence of anatomical variations at the suboccipital (V3) segment of the vertebral artery: a systematic review.

BACKGROUND AND OBJECTIVE: A recent meta-analysis on the incidence of iatrogenic injury to the VA has revealed that patients with variant anatomy are more prone to iatrogenic injury. Therefore, this review is designed to investigate the incidence of variations in the suboccipital component of the vertebral artery in different population groups according to the available literature. METHODS: This systematic review was conducted according to PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The review is based on a comprehensive and extensive search of PubMed, Google Scholar, and ResearchGate. The following search terms were used: "vertebral artery" AND "suboccipital segment" AND "anomalies/anatomical variations of the V3 segment." Reference lists of all extracted articles were also extensively searched for references to any further relevant publications. RESULTS: A total of 17 papers met the inclusion criteria. The 17 studies corresponded to a total of 10,820 patients. A persistent first intersegmental artery was registered in 1.8% (197 out of 10,820) of the patients. Extradural PICA origin was observed in 1.6% (175 out of 10,820) of the patients. Fenestration was detected in 0.7% (72 out of 10,820) of the patients. CONCLUSION: The authors summarize the incidence of vascular variation at the suboccipital segment of the VA in different population groups across the Asian, European, American, and African continents. Awareness of the extent of possible anatomical variation will help interpret radiographs, which will enhance the identification of vascular pathologies and reduce the risk of iatrogenic injury.

Placental Morphology and Morphometry: Is It a Prerequisite for Future Pathological Investigations?

Successful pregnancy is dependent on implantation, nutrient and gas exchange, as well as fetal protection from the immunologic attack. Placental pathologies and preterm delivery closely correlate with the size and shape of the placenta. Additionally, normal vaginal microbiota is disturbed during viral insults such as SARS-CoV-2 and HIV, with consequent placental anomalies. This chapter focuses on placental development, morphology, and pathology while also investigating placental bed structure and function. Placental anomalies with regard to HIV-1 and SARS-CoV-2 infection and placental morphometric image analysis and its relevance for verification of placental pathology are explored. Since image analysis remains optional for routine diagnostic purposes, authentication of placental appraisal warrants the use of measurable predefined definitions. Immunohistochemical analyses of placental morphology and angiogenic, epithelial, and apoptotic mechanisms facilitate research into etiopathogenetic pathways involved in placental anomalies with a focus on discovering novel diagnostic foci. Thus, image analyses as an adjunct to complement pathological investigations are recommended.

Anterior Synostotic Plagiocephaly: A Quantitative Analysis of Craniofacial Features Using Computed Tomography.

The premature fusion of one coronal suture causes anterior synostotic plagiocephaly (ASP), which results in overt craniofacial dysmorphology that could be challenging to correct. This study aimed to document and compare the morphometry of the anterior cranial fossa (ACF), orbit, and ear on the ipsilateral (synostotic) and contralateral (nonsynostotic) sides in a select cohort of South African patients with ASP, using computed tomography (CT) scans. The dimensions of the ACF, orbit and the position of the ear on the ipsilateral and contralateral sides were measured using a set of anatomical landmarks on 2-dimensional CT scans of 18 consecutive patients diagnosed with nonsyndromic ASP. The differences between the ipsilateral and contralateral sides were calculated and expressed as a percentage of the contralateral side. All ACF parameters decreased significantly on the ipsilateral side when compared to the contralateral side, resulting in the volume of the ACF being the most affected (-27.7%). In terms of the orbit, on the ipsilateral side, the length-infraorbital rim, height, and surface area parameters increased significantly, with the height being the most affected (24.6%). The remaining orbital parameters (length-supraorbital rim, breadth and volume) decreased significantly, with the length-supraorbital rim parameter being the most affected (-10.8%). The ipsilateral ear was found to be displaced anteriorly (9.33 mm) and caudally (5.87 mm) from the contralateral ear. These measures may be useful to surgeons during corrective surgery by indicating the degree of the asymmetry on each side, making it easier to plan the technique and extent of surgical correction of the affected structures.

Morphometric Analysis of the Cranial Fossae in Scaphocephalic Patients: An Anatomical Basis.

ABSTRACT: Scaphocephaly is the morphological consequence of premature sagittal suture fusion. Morphologic and morphometric studies on the cranial vault in scaphocephaly flourish in the literature. However, few studies are available on the cranial base in a scaphocephalic population, let alone the morphometry of its fossae. Therefore, this study aimed to analyze and compare the morphometry of the anterior, middle, and posterior cranial fossae (ACF, MCF, and PCF) in patients with scaphocephaly.The length and width of the ACF, MCF, and PCF were measured using fixed anatomical landmarks on the two-dimensional computed tomography scans of 24 consecutive patients diagnosed with isolated sagittal synostosis between 2014 and 2020, and 14 controls.A comparison of the results between patients with scaphocephaly and the controls showed that the ACF and PCF lengths increased significantly ( P = 0.041 and P = 0.018) in patients with scaphocephaly. No differences in the MCF lengths were observed ( P = 0.278; 0.774). When compared by the degree of severity, the ACF and PCF lengths were significantly increased ( analysis of variance [ANOVAI, P = 0.033; post-hoc, P = 0.013 and ANOVA, P = 0.015; post-hoc, P = 0.036) in scaphocephalic patients within the severe group as opposed to the control group.The morphometric data obtained indicate a preponderance of deformity in the ACF and PCF with elongation along the anteroposterior plane (lengths) in scaphocephalic patients. Minimal changes were observed in the transverse plane (widths) in scaphocephaly versus controls. This data could aid craniofacial surgeons in understanding the affectation of the cranial fossae and influencing the decision on the most suitable method of corrective modality.

Tessier Number 3 and 4 Clefts: Clinical Presentation and Associated Clefts in a South African Population.

INTRODUCTION: The defects found in Tessier clefts number 3 and number 4 come in various forms in different patients. These variations have to a great extent affected not only documentation of these craniofacial defects but invariably their treatment and communication amongst craniofacial researchers. This study has not only documented the clinical presentation of these clefts in a South African population but has also incorporated the clinical presentation of Tessier clefts number 3 and 4 from different regions of the world. METHODS: The records of 8 patients, who had been treated for either Tessier clefts number 3 or 4, were reviewed and compared with 16 studies pulled from the literature systematically. The defects recorded as well as associated clefts and other congenital malformations were documented, and findings were compared. RESULTS: The anatomical and clinical presentation of the patients was compared to the reviewed literature and the different parameters were documented. In addition, associated clefts were also recorded in the study-it was noted that the association pattern recorded in Tessier cleft number 4 in this study did not conform to its traditional counterpart. CONCLUSION: This study concluded that the clinical presentations of these clefts, however variable, seem to have a similar presentation worldwide. Additionally, associated clefts do not conform to the original Tessier classification system and therefore it is imperative for these patterns to be clearly mapped out.

Developmental changes of the facial skeleton from birth to 18 years within a South African cohort (A computed tomography study).

Skeletal remains are often found on a crime scene in which a forensic anthropologist is then consulted to create a biological profile, which includes the estimation of age, sex, ancestry and stature. The viscerocranium plays an important role in the formation of a biological profile. However, to utilise the viscerocranium for age estimation, population specific normative data and knowledge of the development of the viscerocranium is required. Therefore, this study aimed to investigate the developmental changes from birth to 18 years of age of the facial skeleton of individuals from a South African cohort. This study comprised of 239 computed tomography (CT) scans (128 males; 111 females). The viscerocranium was subdivided into five regions viz.: orbital, nasal, midfacial, maxillary and mandibular. The linear parameters in each region were correlated to age to identify the developmental growth patterns of the viscerocranial regions according to male and female. The measurements which displayed the highest correlations with age were used to develop formulas which could be used for age estimation. The results of this study showed that the measurements in the orbital, midfacial, maxillary and mandibular regions experienced rapid growth between 0 and 5 years of age, with the nasal region increasing steadily over time. It was noted that males displayed overall larger measurements than females except for the anterior interorbital distance and both right and left zygomatic arch lengths (ZAL). Although only the left orbital height, nasal aperture height and mandible width displayed statistically significant size differences according to sex (p ≤ 0.05). The measurements which showed the highest correlations to age were the zygomatic arch distance (r = 0.8842, p < 0.001), ZAL (right: r = 0.8929, p < 0.001; left: r = 0.8656, p < 0.001) and the mandible width (r = 0.8444, p < 0.001). Formulas were derived for the measurements that could be used to forensically estimate age within a subadult cohort.

Anatomical Classification of Tessier Craniofacial Clefts Numbers 3 and 4.

BACKGROUND: Craniofacial clefts are rare occurrences with an incidence of about 1.43 to 4.85 per 100,000 live births. Understanding the skeletal deformity in these clefts is basic to any reconstructive surgery of the face. This study documented the skeletal defects present in Tessier numbers 3 and 4 using anthropometric measurements to generate a subclassification which will aim to improve the means of communication between surgeons managing this anomaly. METHODS: Seven computed tomography scans of patients who had been treated for Tessier 3 and 4 clefts between 2003 and 2017 were analyzed. Measurements of the expected defects in each cleft was taken and compared with unaffected side as the reference. Emerging patterns of their analysis was then used to generate a subclassification for these clefts. The reliability and validity of the measurements were ensured by allowing the data to be examined by both an intra- and interobserver. RESULTS: The presence or absence of an alveolar cleft, the emerging patterns of comparison of the measurements of the maxilla and the orbits of the cleft side and the noncleft side as well as absence of the bone were used to arrive at a subclassification system using (a), (b), (c), (M+ O+), (M- O-), and (0). CONCLUSION: The study recommends a subclassification for Tessier clefts numbers 3 and 4 that will allow physicians anticipate the extent and the form of skeletal defects present before even seeing the patient. This can improve the communication among surgeons and team members regarding Tessier craniofacial clefts.

Dimensional analysis of the bicipital groove and its associated pathology in a South African population.

The bicipital groove (BG) forms an indentation between the greater and lesser humeral tubercles and lodges the long head of biceps brachii tendon (LHBBT) along with the ascending branch of the circumflex humeral artery. This study aimed to determine the dimensions (length, width, depth) of the BG in a select South African population. The dimensions of the BG in one hundred and sixty (n = 160; Right: 80; Left: 80, Male: 100; Female: 60) unpaired dry bone humerii were measured with a digital caliper (Linear Tools 2012, 0-150 mm, LIN 86500963) and was analyzed using SPSS (V25). Results: Bicipital groove dimensions: (a) Length (mm): Right 66.64 ± 9.06, Left 68.31 ± 11.52; Male 67.44 ± 9.12, Female 67.53 ± 12.25; (b) Width (mm): Right 8.98 ± 1.49, Left 9.27 ± 1.30; Male 9.18 ± 1.45, Female 9.05 ± 1.31; (c) Depth (mm): Right 7.73 ± 1.31, Left 7.20 ± 1.18; Male 7.43 ± 1.29, Female 7.53 ± 1.24. The mean BG length observed in this study disagreed with previous studies where smaller lengths were reported. In addition, the comparison of the mean BG depth in this study also revealed a statistically significant difference which may suggest that increased depth in the BG is a common finding in right side of BG specimens. This finding was unique as BG depth is associated with biceps tendon pathology and augments South African shoulder-related literature. Since biceps tendon pathology is associated with decreased biceps activity and pain, investigation of the BG may provide useful data to evaluate individuals with potential abnormality of the bicep tendon. It may also be used as a landmark for humeral head replacement in the treatment of proximal humerus fractures.

Scoping review of the morphology and anthropometry of Tessier craniofacial clefts numbers 3 and 4.

BACKGROUND: In 2016, WHO reported a death rate of 303,000 newborns before 4 weeks of age due to congenital anomalies. Those that survive congenital anomalies may have long-term disabilities which may have significant impacts on the individual, their families, the healthcare system, and societies. Tessier craniofacial clefts numbers 3 and 4 are congenital anomalies that result in a partial or total defect of craniofacial tissues thereby seriously influencing the patient's appearance and impair normal functioning. Therefore, understanding these defects is paramount to relieving the burden caused by this disability. The objective of this review was to examine the literature on the understanding of the knowledge of morphology and anthropometry of Tessier craniofacial clefts numbers 3 and 4 so that areas yet to be fully understood by research can be mapped out for future research. METHODS AND ANALYSIS: A scoping review for literature on patients who have Tessier craniofacial clefts numbers 3 and 4 was conducted. Relevant studies from 1976 to the present were identified. The following databases were searched for peer-reviewed literature viz., PubMed, MEDLINE, EBSCOhost, Google Scholar, and the Cochrane library. The study selection was guided by the eligibility criteria. A data table was designed to extract information from the literature. The result of this study was reported using the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA). The quality of the included studies was assessed using the Mixed Method Appraisal Tool (MMAT). RESULT: Thirty-three studies met the inclusion criteria. The majority of the studies included were conducted in middle-income countries (54.5%) and some in high-income countries (45.5%); none was recorded from low-income countries. The total available sample size from the studies was 120 with a dominant male population of 67 (55.8%) and female 53 (44.2%). The majority (97%) of the studies reported on the knowledge of morphology while 12.1% of the included studies reported on anthropometry. Of the 33 included studies, 32 scored the highest quality (76-100%) from the quality assessment. DISCUSSION: The findings from this review show evidence of the knowledge of morphology and the knowledge of anthropometry of Tessier craniofacial clefts numbers 3 and 4. However, these knowledges have not translated to universally recognized ways of repairing and documenting these clefts due to the sparse amount of studies on Tessier craniofacial clefts numbers 3 and 4.

The septation of the sphenoidal air sinus: a cadaveric study / Septación del seno esfenoidal: investigación cadavérica

The purpose of this study was to investigate the sphenoidal sinus septation in a select South African population, and document the relation of the number and location of the septa to the structures intimately related to the sinus. The intersinus and intrasinus septa of the sinus, the number and attachments of the septa were recorded from forty five cadaveric head specimens. The sphenoidal sinus intersinus septa were recorded as follows: Type 0 (absent septum) in 7.5 %, Type 1 (single septum) in 65 % and Type 2 (double septa) in 22.5 % of cases. The incidence of intersinus septa deviating to the left was prevalent; hence, the right sphenoidal sinus was dominant. The occurrence of intrasinus septa was observed in 93.3 % of cases, with a higher prevalence in males. The intrasinus septa formed cave like chambers on the sinus walls in 65.6 % cases. Incidences of the intersinus septa attaching to sella turcica (ST) (46.25 %) were prevalent compared to cases where they attached to the internal carotid artery (ICA) (6.25 %), maxillary (MN) (1.25 %) and vidian (VN) (1.25 %) nerves. However, the intrasinus septa attached more to the ICA (52.63 %) compared to their attachment to the other neurovascular structures (ST - 26.32 %; MN - 5.36 % and VN - 2.63 %). Surgeons need to be aware of the complex anatomical variations of the sphenoidal sinus septation when performing endoscopic endonasal transsphenoidal surgeries.

El propósito de este estudio fue investigar la septación del seno esfenoidal en una población sudafricana y documentar la relación del número y la ubicación de los septos en relación a las estructuras íntimamente relacionadas con el seno. Los septos interseno e intraseno del seno, el número y las uniones de los septos se registraron a partir de cuarenta y cinco cadáveres. El septo interseno del seno esfenoidal se registró de la siguiente manera: Tipo 0 (tabique/septo ausente) en el 7,5 %, Tipo 1 (tabique/septo único) en el 65 % y Tipo 2 (tabiques/septos dobles) en el 22,5 % de los casos. La incidencia de septos intersenos desviados hacia la izquierda fue prevalente. Por lo tanto, el seno esfenoidal derecho fue dominante. La ocurrencia de septo intraseno se observó en el 93,3 % de los casos, con una mayor prevalencia en varones. Los septos intrasenos formaron cámaras, como cuevas, en las paredes del seno en un 65,6 % de los casos. La incidencia de septos intersenos que se adhieren a la silla turca (ST) (46,25 %) fueron prevalentes en comparación con los casos en que se unieron a la arteria carótida interna (ACI) (6,25 %), al nervio maxilar (NM) (1,25 %) y nervio vidiano (NV) (1.25%). Sin embargo, los septos intersenos se adhirieron más a la ACI (52,63 %) en comparación con su unión a otras estructuras neurovasculares (ST - 26,32 %; NM -5,36 % y NV - 2,63 %). Los cirujanos deben ser conscientes de las complejas variaciones anatómicas de la tabicación del seno esfenoidal cuando se realizan cirugías transesfenoideas endonasales endoscópicas.

Multiple variations of the branches of the brachial plexus with bilateral connections between ulnar and radial nerves / Múltiples variaciones de los ramos del plexo braquial con conexiones bilaterales entre los nervios ulnar y radial

During routine dissection of the upper limbs of a caucasian male cadaver, multiple variations of the branches of the brachial plexus were observed. On the left side, the musculocutaneous nerve was absent and the muscles of the anterior compartment of the arm were innervated by the median nerve. The median nerve was also formed from three roots viz; two from the lateral and one from the medial cord of the brachial plexus. On the right side, the musculocutaneous nerve contributed a long communicating branch to the median nerve in the distal half of the arm. There were also communicating branches between the ulnar and radial nerves in both limbs at the humeral level. The co-existence of these variations appears to be unique and has not been reported in the literature reviewed. The anatomic and clinical significance of these variations is discussed.

Fueron observadas durante una disección de rutina de los miembros superiores de un cadáver caucásico masculino, múltiples variaciones de los ramos del plexo braquial. En el lado izquierdo, el nervio musculocutáneo estaba ausente y los músculos del compartimento anterior del brazo estaban inervados por el nervio mediano. El nervio mediano se encontraba formado de tres raíces dos provenientes del fascículo lateral y uno del fascículo medial del plexo braquial. En el lado derecho, en la mitad distal del brazo, el nervio musculocutáneo generó un largo ramo comunicante con el nervio mediano. Además, en el brazo, en ambos miembros superiores existían ramos comunicantes entre los nervios ulnar y radial. La coexistencia de estas variaciones aparece ser única y no ha sido relatada en la literatura consultada. Son discutidas la significancia anatómica y clínica de estas variaciones.

The great auricular nerve in fetuses / El nervio auricular mayor en fetos

The great auricular nerve (GAN) is the largest branch of the superficial cervical plexus that winds around the posterior border of the sternocleidomastoid muscle, accompanied by the external jugular vein. Forty fetuses (right side: 40/80; left: 40/80) with gestational ages between 15 to 28 weeks were microdissected to document the anatomy of the GAN. The results obtained were classified as: i) Incidence and morphometry: GAN was present in 100 percent of the fetal specimens with average length on the right and left sides recorded as 12.65 +/- 2.14 mm and 12.55 +/- 2.82 mm respectively. ii) Course: GAN was located parallel to the transverse cervical nerve and the external jugular vein. Duplicate external jugular veins were observed in 5 percent (4/80) with GAN located anterior to one of the tributaries; iii) Branching Pattern: 16 percent (13/80) of specimens depicted a single branch. Duplicate branches in 67 percent (54/80) (referred to as Type I: anterior and posterior branches and 33 percent (26/80) referred to as Type II: anterior and posterior branches; iv) Variation: the transverse cervical nerve formed a communication with GAN, inferior to the parotid gland in 1 percent. The anatomical knowledge of the course, bifurcation pattern and variations of GAN may prevent complications during surgical procedures such as parotidectomies.

El nervio auricular mayor (NAM) es el ramo más grande del plexo cervical superficial que gira alrededor del margen posterior del músculo esternocleidomastoideo, acompañado de la vena yugular externa. Cuarenta fetos (lado derecho: 40/80; izquierdo: 40/80), con edades gestacionales de 15 a 28 semanas fueron microdisecados para describir la anatomía del NAM. Los resultados obtenidos se clasificaron en: i) Incidencia y morfometría: NAM estaba presente en el 100 por ciento de las muestras fetales con una longitud media de los lados derecho e izquierdo de 12,65+/-2,14mm y 12,55+/-2,82mm, respectivamente. ii) Curso: NAM se encuentra paralelo al nervio cervical transverso y la vena yugular externa. Duplicación de las venas yugulares externas se observaron en el 5 por ciento (4/80) con el NAM situado por delante de uno de los afluentes, iii) Patrón de ramificación: 16 por ciento (13/80) de las muestras presentaba una solo ramo. Ramos duplicados en el 67 por ciento (54/80) de Tipo I, ramos anterior y posterior y, el 33 por ciento (26/80) Tipo II, ramos anterior y posterior, y iv) Variación: el nervio cervical transverso formando una comunicación con NAM, inferior a la glándula parótida en el 1 por ciento. El conocimiento anatómico del curso, patrón de bifurcación y variaciones del NAM pueden prevenir las complicaciones durante los procedimientos quirúrgicos como la parotidectomía.