A Rare Case of Biliary Atresia with Biliary Ascites on a (Hepatobiliary Iminodiacetic Acid) HIDA Scan.

Biliary atresia is one of the most challenging conditions in pediatric surgery even when it is the only finding. Here we present a rare case of biliary atresia complicated with biliary ascites due to ductal perforation identified on a hepatobiliary iminodiacetic acid (HIDA) scan.

The surgical relevance of the anatomic position of the extraosseous mental nerve in a Kenyan population.

INTRODUCTION: Precise location of the mental nerve is important in implant surgery, administration of mental nerve block anaesthesia, and for osteotomy procedures. The position is known to show inter-population differences but data from sub-saharan region is scarce. METHODS: The point of emergence of 64 nerves was studied and data analyzed with Microsoft Excel 2010 and differences in side means compared using the paired one tailed student's t test. RESULTS: The location of left mental nerve was 2.85 (±0.38) cm, 1.42 (±0.33) cm, 1.77 (±0.46) cm while the right was 2.91(±0.47) cm, 1.38 (±0.3.1) cm, 1.71 (±0.46) cm from the mental symphysis, inferior border of mandible and cemento-enamel junction respectively. The differences in position between the right and left sides were not statistically significant (p<0.05 CI: 95%). It emerged inferior to but in line with the 2nd premolar in 57.8% of the cases, 2nd premolar-1st molar (25%) and inter-premolar junction (9.4%). Unique to this study, was the location of the MN at the canine (3.1%), and 1st molar (4.7%) positions. CONCLUSION: The aberrant position of the mental nerve seen in 42%, is an important consideration for tooth implants and placement of mandibular reconstruction plates.

Branching pattern of the extraosseous mental nerve in a kenyan population.

Knowledge of the branching pattern of the mental nerve is an important consideration during placement of tooth implants and reconstructive plates. It is known to display population variations and data for the same is scarce form the sub-Saharan region. With the recent increase in surgical interventions in the mandibular region in Kenya, a detailed description of mental nerve is warranted. A total of 64 mental nerves were dissected and branching pattern was noted. Single mental nerve was present in 60 (93.7%) cadavers while double mental nerves occurred in 3 (4.7%) and accessory in 1(1.6%). Most common pattern was bifurcation (39%) followed by trifurcation (34%), single (19%), and quadrification (8%). The double and triple branches were seen to further divide into two to three subbranches with diverse patterns. Side symmetry in branching was seen in four (6.25%). These are important anatomical considerations during placement of reconstructive plates for mandibular trauma and administration of mental nerve blocks.