Drainage Pattern of Craniofacial Veins With Emphasis on its Influence on Facial Reconstruction Procedures.

As the facial transplantation procedures are becoming more popular and frequent in recent years, for repairing facial trauma, variations in the veins of head and neck needs to be reported time and again. This study was undertaken to examine the course and drainage pattern of the facial vein and external jugular vein on this context and emphasize its surgical implications. The authors studied the head and neck region of 50 embalmed cadavers of both sexes to document normal and variant anatomy of facial, retromandibular, and external jugular veins. In 30% of the head and neck regions, different draining pattern of the above-mentioned veins were observed. One of the rare variation discovered was the splitting of the retromandibular vein to embrace the external carotid artery within the parotid gland. The data about variations in the termination of facial vein, retromandibular vein, and external jugular vein, as observed in the present study might be useful in avoiding accidental injury to these vessels during any surgical intervention in the face as well as neck. Level of Evidence: IV.

Zebrafish as an experimental model for the simulation of neurological and craniofacial disorders.

Zebrafish have gained momentum as a leading experimental model in recent years. At present, the zebrafish vertebrate model is increasingly used due to its multifactorial similarities to humans that include genetic, organ, and cellular factors. With the emergence of novel research techniques that are very expensive, it is necessary to develop affordable and valid experimental models. This review aimed to highlight some of the most important similarities between zebrafish and humans by emphasizing the relevance of the first in simulating neurological disorders and craniofacial deformity.

Radiation mitigating activities of Psidium guajava L. against whole-body X-ray-induced damages in albino Wistar rat model.

In the present study, we investigated radiation mitigating activities of Psidium guajava L. (P. guajava) against whole-body X- ray induced damages in albino Wistar rat model. The animals were orally administered with 200 mg/kg bodyweight of hydroalcoholic leaf extract of P. guajava for five consecutive days and on the fifth day, after the last dose of extract administration, animals were exposed to 4 Gy of X-rays. Rats were sacrificed 24 h post X-ray irradiation. The radiomitigating activity of the herb extract was assessed by micronucleus assay, histopathology of the small intestine and hematological parameters. Hepatic cyclooxygenase-2 (COX-2), interleukin-6 (IL-6) and interleukin -10 (IL-10) levels were assayed to validate the anti-inflammatory property. Biochemical estimations were also performed in RBC lysates to corroborate antioxidant properties in the leaf extract. HPLC analysis of crude extract confirmed the presence of standard flavonoid quercetin. Our results indicated that radiation elevated COX-2, IL-6 and decreased IL-10 levels and also induced micronucleus formation in polychromatic erythrocytes, simultaneously impairing hematological parameters along with erythrocyte antioxidants. The animals pre-treated with P. guajava exhibited a significant decrease in the COX-2 (P ≤ 0.01), IL-6 levels (P ≤ 0.05) and also displayed significant increase in the hepatic IL-10 levels (P ≤ 0.01). Pre-treatment with plant extract improved antioxidant enzyme activities, hematological parameters and reduced the intestinal damage by recovering the architecture of the small intestine. Moreover, extract also rendered protection against radiation induced DNA damage, as evidenced by the significant (P ≤ 0.01) decrease in the percentage of radiation-induced micronucleus in polychromatic erythrocytes. Furthermore, the herb extract treatment increased radiation LD50/30 from 6.6 Gy to 9.0 Gy, offering a dose reduction factor (DRF) of 1.36. Our findings for the first time propose the beneficial use of P. guajava as a radioprotector against X-ray induced damage.

Variants of latissimus dorsi with a perspective on tendon transfer surgery: an anatomic study.

BACKGROUND: The latissimus dorsi (LD) is often used for tendon transfers to treat massive irreparable posterosuperior rotator cuff tears. The operation requires the LD tendon to be mobilized to reduce tension on the tendon. In that respect, any connection between the LD tendon and contiguous muscles may hamper tendon mobility and affect the surgical outcome. The goal of this study was to document the occurrence of connections between the LD and adjacent muscles and nerves. METHODS: We studied the scapular region on 48 embalmed cadavers. The skin and superficial fascia were removed according to Cunningham's manual of dissection, and the muscle was exposed. RESULTS: It was found that the LD and teres major (TM) muscles are connected by muscle fibers in 10% of the cadavers studied. Another vital discovery was that in some cadavers, the LD tendon was penetrated by a nerve. CONCLUSION: Fascial connections between the LD and TM are well known, but these muscle links are comparatively unusual. From the results of this study, one should pay particular attention to muscle links between the LD and TM during dissection of the LD for transfer. It can also be suggested that during transfer surgery, the LD tendon should be cautiously examined for the possibility of a nerve penetrating it.

Anticlastogenic, radiation antagonistic, and anti-inflammatory activities of Persea americana in albino Wistar rat model.

The present study was undertaken to evaluate the anti-inflammatory activity and antigenotoxic effect of hydroalcoholic leaf extract of Persea americana (P. americana) in albino Wistar rats against whole body X-ray irradiation. Rats were orally administered with (25, 50, 100, 200, and 400 mg/kg body weight) of P. americana leaf extract for five days. On the fifth day after last administration, animals were exposed to whole body X-rays of 8 Gy. Based on Kaplan Meier's survival analysis, 100 mg/kg body weight was selected as an optimum dose for radioprotection. The radioprotective potential was analysed by bone marrow micronucleus test and comet assay in peripheral blood lymphocytes. Biochemical estimations were performed in liver tissue homogenates. DNA damage indicators analysed through comet assay displayed significant reduction in olive tail movement (P < 0.01), percentage DNA in tail (P < 0.05) and tail length (P < 0.001) in pretreated group when compared to radiation group. P. americana leaf extract restored the levels of reduced glutathione, catalase, and reduced the levels of lipid peroxidation, protein carbonyls, and cyclooxygenase-2 levels in liver homogenates of pre-treated group. Decrease in micronucleated polychromatic erythrocytes (P < 0.05) was witnessed in P. americana pretreated group when compared to radiation control. Pretreatment also resulted in the increase of animal survival with dose reduction factor of 1.28. Our findings for the first time demonstrated that P. americana offers significant protection to rats from whole body exposure to X-rays and helps in antagonising the radiation effects, thereby combating acute radiation induced damage in living systems.

A Cephalometric Analysis on Magnitudes and Shape of Sella Turcica.

Familiarity with the shape and dimensions of sella turcica is important to recognize and manage pathological conditions of pituitary gland as well as for orthodontic treatment planning. The present study aims to describe the morphology and dimensions of sella turcica from Indian population, using lateral cephalograms to set a reference data for comparison among different races. The study used 36 lateral skull radiographs of both sexes between age group of 13 to 18 years. Shape of sella turcica was noted by visual inspection. Length, height anterior, height median, height posterior, distance between frontonasal suture and mental spine to midpoint of posterior clinoid process, and tuberculum sella were measured using digital vernier caliper with reference to Frankfort line. The results of the study revealed that mean length, height anterior, height median, height posterior were larger in females than in males. The morphological types identified include pointed posterior clinoid process with rounded hypophyseal fossa, hooked posterior clinoid process with rounded hypophyseal fossa, hooked posterior clinoid process with flask-shaped hypophyseal fossa. These observations would be beneficial for the clinicians and orthodontists to design treatment planning in pathology of pituitary gland and in correcting dentofacial anomalies.

Assessment of craniometric traits in South Indian dry skulls for sex determination.

The skeleton plays an important role in sex determination in forensic anthropology. The skull bone is considered as the second best after the pelvic bone in sex determination due to its better retention of morphological features. Different populations have varying skeletal characteristics, making population specific analysis for sex determination essential. Hence the objective of this investigation is to obtain the accuracy of sex determination using cranial parameters of adult skulls to the highest percentage in South Indian population and to provide a baseline data for sex determination in South India. Seventy adult preserved human skulls were taken and based on the morphological traits were classified into 43 male skulls and 27 female skulls. A total of 26 craniometric parameters were studied. The data were analyzed by using the SPSS discriminant function. The analysis of stepwise, multivariate, and univariate discriminant function gave an accuracy of 77.1%, 85.7%, and 72.9% respectively. Multivariate direct discriminant function analysis classified skull bones into male and female with highest levels of accuracy. Using stepwise discriminant function analysis, the most dimorphic variable to determine sex of the skull, was biauricular breadth followed by weight. Subjecting the best dimorphic variables to univariate discriminant analysis, high levels of accuracy of sexual dimorphism was obtained. Percentage classification of high accuracies were obtained in this study indicating high level of sexual dimorphism in the crania, setting specific discriminant equations for the gender determination in South Indian people.

Morphological study of styloid process of the temporal bone and its clinical implications.

The objective of this study was to study the morphometry of the styloid process of temporal bone and prevalence of elongated styloid process. The morphology of elongated styloid process along with its embryological and clinical importance are discussed. The present study included 110 human dry skulls which were procured from the bone collections of the department of anatomy. The styloid process was observed macroscopically on both sides of all the skulls, the elongations if any were noted. All the styloids were measured for their length, thickness at different levels and interstyloid distance at various levels. Out of 110 specimens, only 5 skulls (4.5%) exhibited the elongated styloid process. Among them, 3 skulls (2.7%) had unilateral elongation and 2 skulls (1.8%) had bilateral elongation of the styloid process. The mean length of the styloid process was 17.8±9.3 mm and 18.2±5.6 mm for the right and left sides, respectively. The prevalence of elongated styloid process in the present study was 4.5%. The clinical anatomy of this congenital variant is important to the neurosurgeon and radiologist, while interpreting the computed tomogram and magnetic resonance image scans. The morphological knowledge of elongated styloid process is clinically important since the course of the vertebral artery may be distorted in such situations.

Morphometric study of the medial orbital wall emphasizing the ethmoidal foramina.

PURPOSE: Ethmoidal foramina on the medial orbital wall show a higher incidence of variation. Surgeons performing endonasal, anterior cranial fossa and medial orbital wall surgeries must be aware of these variations as they are a source of hemorrhage and also serve as landmark in proximity to the orbital apex. AIM: The present study aims to describe the morphometric distances of various ethmoidal foramina between anterior lacrimal crest to optic canal in south Indian dry human skulls. MATERIALS AND METHOD: The study was done on 44 adult dry human skulls. The occurrence of Ethmoidal foramina was noted by direct inspection. The distance of Ethmoidal foramina from anterior lacrimal crest to optic canal was measured with the help of ruler, probe and magnifying glass. RESULTS: The Posterior ethmoidal foramina were found in all 44 skulls bilaterally. Middle ethmoidal foramen was present in 12 and 13 skulls on right and left, respectively. Anterior ethmoidal foramen was found in 38 and 37 skulls on right and left, respectively. The distance between anterior lacrimal crest (ALC) and posterior lacrimal crest (PLC) was in the range of 3-8 mm and that of ALC to anterior ethmoidal foramen was in the range of 24-30 mm. The range of distance between anterior ethmoidal foramen to posterior ethmoidal foramen was 9-17 mm and that between posterior ethmoidal foramen to optic canal was 5-13 mm. CONCLUSION: These observations would help to predict the anatomical variations in the position of ethmoidal foramina with respect to anterior and posterior lacrimal crest and ensure the safe and precise performance of medial orbital wall surgeries to avoid injuries to the important neurovascular bundles passing through various foramina and fissures.

Anatomical and morphometric analysis of accessory infraorbital foramen.

The aim of the present study was to analyze the anatomical and morphometric variation in shape, frequency of occurrence, direction, and position of accessory infraorbital foramen (AIOF) in relation to infraorbital foramen (IOF) in cadaveric dry skulls to minimize clinical complications and aid in surgical maneuvering in the maxillofacial region and implementing the regional block anesthesia. The IOF is an important anatomical landmark in these surgical manipulations. Because there is limited literature available on AIOF, which transmits accessory branch of the infraorbital nerve, the present study was designed. In the current study, 45 human dry skulls and 20 disarticulated maxillae have been used irrespective of sex. The other parameters included measuring the distance of AIOF from anterior nasal spine, frontomaxillary suture, infraorbital margin, IOF, and zygomaticomaxillary suture. The transverse and vertical diameter of foramen was also noted. All these measurements were taken using a digital caliper. The result of our study reveals that the presence of AIOF is more on the right side compared with the left side. Because the presence of accessory infraorbital nerve needs to be taken care of during maxillofacial surgical interventions, knowledge regarding the presence of AIOF should be taken into consideration for preoperative evaluation.

Effect of sildenafil-induced nitric oxide on the histomorphology of cardiomyocytes in male rats.

INTRODUCTION: Although sildenafil citrate, one of the selective phosphodiesterase-5 (PDE5) inhibitors, is considered the best treatment for erectile dysfunction, studies have shown that it has also a beneficial effect on a variety of cardiovascular conditions. In spite of reports of a significant protective effect of sildenafil against necrosis in intact hearts, there are also contradictory reports regarding its beneficial effect on the heart. Since there are not enough reports regarding the histomorphological changes in the cardiomyocytes after exposure to sildenafil citrate, the present study was conducted to observe the same along with other biochemical parameters. MATERIALS AND METHODS: Adult male albino rats of Wistar strain were used in the present study. The animals were divided into a control group and two experimental groups containing six rats each. The animals were treated with a solution of sildenafil citrate dissolved in distilled water. Histomorphological changes were observed by light microscopy and the levels of nitric oxide (NO) and PDE in the heart were measured by spectrophotometry. RESULTS: It was observed that animals treated with sildenafil citrate showed a highly significant increase in NO and a decrease in PDE level, but the histological architecture of the cardiomyocytes did not show much change other than a slightly elongated and swollen nucleus. CONCLUSIONS: This study shows that sildenafil citrate at low dosage is well tolerated by cardiac muscle cells, but as dosage increases, it may become detrimental through its NO and PDE activity.

Superficial palmar arch completion at the first interdigital cleft: a case report.

Knowledge of variations in the formation of superficial palmar arch is beneficial for successful vascular surgery in the hand as well as for plastic surgeons. The authors describe an unusual completion of superficial palmar arch by first dorsal metacarpal branch of radial artery at the first interdigital cleft which was encountered during routine upper limb dissection for undergraduates. The arteria princeps pollicis and arteria radialis indicis also were the branches of first dorsal metacarpal artery at the first interdigital cleft.

Accessory neurovascular foramina on the lingual surface of mandible: incidence, topography, and clinical implications.

CONTEXT: It was suggested that the accessory neurovascular foramina of the mandible might be of significance in relation to the effectiveness of local anesthesia following the routine inferior alveolar nerve block. AIMS: To investigate the incidence of neurovascular foramina over the lingual surface of the mandible in South Indian population. SETTINGS AND DESIGN: The study was conducted at the department of anatomy. MATERIALS AND METHODS: The study included 67 human adult dry mandibles, the exact ages and sexes of which were not known. The location and number of neurovascular foramina were topographically analyzed. STATISTICAL ANALYSIS USED: Descriptive statistics. RESULTS: The foramina were observed in 64 mandibles (95.5%) and were often multiple in most of the cases. They were located between the two medial incisors in 8 mandibles (1.9%), between the medial and lateral incisor in 34 mandibles (50.7%; 25-bilateral; 7-right; 2-left), between the lateral incisor and canine in 7 mandibles (10.4%; 2-bilateral; 3-right; 2-left), between the canine and first premolar in 6 cases (8.9%; 3 on each side). Foramina were also present around the genial tubercle in 56 mandibles (83.6%). Among them, 52 mandibles showed a single foramen just above the genial tubercle, 34 mandibles had foramina below the tubercles, 13 mandibles had foramina on the right side of genial tubercle and 17 were having on the left side. CONCLUSION: Since the anatomical details of these foramina are important to various fields of dentistry and oncology, the present investigation was undertaken. The clinical significance and implications are emphasized.

Variant facial artery in the submandibular region.

Facial artery has been considered to be the most important vascular pedicle in facial rejuvenation procedures and submandibular gland (SMG) resection. It usually arises from the external carotid artery and passes from the carotid to digastric triangle, deep to the posterior belly of digastric muscle, and lodges in a groove at the posterior end of the SMG. It then passes between SMG and the mandible to reach the face after winding around the base of the mandible. During a routine dissection, in a 62-year-old female cadaver, in Kasturba Medical College Mangalore, an unusual pattern in the cervical course of facial artery was revealed. The right facial artery was found to pierce the whole substance of the SMG before winding around the lower border of the mandible to enter the facial region. Awareness of existence of such a variant and its comparison to the normal anatomy will be useful to oral and maxillofacial surgeons.

Prevalence of bifid tongue and Ankyloglossia in South Indian population with an emphasis on its embryogenesis / Prevalencia de lengua bífida y anquiloglosia en el Sur de la población India con énfasis en su embriogénesis

Disturbance in the organogenesis of tongue might lead to some malformations like tongue tie, bifid tongue and hairy tongue. Severe degrees of these anomalies may cause speech impairment or periodontal defects. The present study was done on patients of the southern coastal belt of India during the past two years, on gross tongue anomalies. The results of the present study reveal that occurrence of tongue tie is 0.2 percent and bifid tongue is 0.3 percent in the southern coastal population. Since great majority of these oral anomalies have genetic basis the purpose of the present report is to highlight that these anomalies can exist without any familial background and also to suggest that environmental factor may play a role in the etiogenesis of these anomalies.

La alteración en la organogénesis de la lengua puede dar lugar a algunas malformaciones como anquiloglosia, lengua bífida y lengua vellosa. Grados severos de estas anomalías puede provocar un trastorno del habla o defectos periodontales. El presente estudio se realizó, durante los últimos dos años, en pacientes de la franja costera del Sur de la India con anomalías graves en la lengua. Los resultados del estudio revelaron que, en la población costera del sur, la incidencia de anquiloglosia era de 0,2 porciento y de lengua bífida de 0,3 por ciento. Dado que la gran mayoría de estas anomalías orales tienen base genética, el propósito del presente informe fue poner de relieve que estas anomalías pueden existir sin ningún tipo de antecedentes familiares y también sugerir que los factores ambientales podrían jugar un papel en el etiogenesis de estas anomalías.

Unique distribution by the peroneal nerves: a case report.

PURPOSE: Among the branches of common peroneal nerve, the superficial peroneal provides cutaneous innervation to major part of the dorsum of the foot and deep peroneal nerve supplies the skin over the first interdigital cleft region. METHODS: The present rare case was observed during routine dissection of leg for undergraduate students, in a 52-year-old male, formalin fixed cadaver. RESULTS: The superficial peroneal nerve provided solely motor branches to peroneus longus and brevis, whereas cutaneous branches were provided by deep peroneal nerve. In the lower one-third of the leg deep peroneal nerve divided into medial and lateral branches. The medial branch supplied tibialis anterior and the lateral branch supplied skin of medial three and half toes. Moreover, the sural nerve supplied the skin of lateral one and a half toes. CONCLUSION: Awareness of this type of variations in the course of nerves helps to alert the surgeons when there are complaints of atypical or unique pain in that particular region.

Morphological and topographical anatomy of nutrient foramina in human upper limb long bones and their surgical importance.

OBJECTIVES: To study the morphology and topography of nutrient foramina and to determine the foraminal index of the upper limb long bones. MATERIALS AND METHODS: The study comprised 243 upper limb long bones, which included humeri, radii, and ulnae. The nutrient foramina were identified macroscopically in all the bones and an elastic rubber band was applied around these foramina. The bones were photographed with the digital camera and foramen index was calculated. Each bone was divided into five equal parts and was analyzed topographically. RESULTS: From our observations, 93.8% of the humeri had single nutrient foramen. The double foramen was observed in 3.1% of the cases and the foramen was found absent in 3.1% of the humeri. In case of radius, 94.4% had single foramen, 1.4% had double foramen, and in 4.2% of the cases it was absent. With respect to ulna, all the 75 bones had single foramen. The mean foraminal index was 57.6 for the humerus, 34.4 for both the ulna and radius. The majority (70%) of the foramina in humerus were located at the 3/5th part, 83.6% of the ulnae foramina at the 2/5th part and 87.7% of the radii foramina at the 2/5th part. CONCLUSIONS: The study has provided additional information on the morphology and topography of nutrient foramina in upper limb long bones. The knowledge about these foramina is useful in certain surgical procedures to preserve the circulation. As microvascular bone transfer is becoming more popular, a convention for the anatomical description of these foramina is important.

Accessory transverse foramina in the cervical spine: incidence, embryological basis, morphology and surgical importance.

AIM: To study the incidence of accessory foramina transversaria in cervical spine and to analyze them morphologically with emphasize on their embryological and surgical importance. MATERIAL AND METHODS: The study included 363 human cervical vertebrae which were procured from the bone collections of the Department of Anatomy. The foramen transversarium was observed macroscopically on both sides of all the vertebras, the accessory foramina were noted. RESULTS: Out of 363 specimens, only 6 (1.6%) vertebrae showed the accessory foramina. Among them 5 (1.4%) vertebra had double foramina and only 1 (0.3%) vertebra showed three foramina. Only 1 (0.3%) vertebrae showed the foramen on both sides and the remaining 5 (1.4%) had unilateral foramina. Among the unilateral, 4 were present on the right side and only 1 was on the left side. No vertebrae showed the absence of foramen transversarium. CONCLUSION: The present study observed the accessory foramina transversarium in 1.6% of cases. The unilateral presence was more common than the bilateral. The surgical anatomy of these variations is important for the neurosurgeons and radiologists for interpreting the computed tomogram and magnetic resonance image scans. Their morphological knowledge is clinically important since the course of the vertebral artery may be distorted in such situations.

Anomalous location of facial nerve deep to parotid gland.

The knowledge of normal and variant anatomy of the facial nerve is essential for safe surgery of the parotid gland. The location of a parotid mass in relation to the course of the facial nerve determines whether superficial or total parotidectomies should be performed. The variant course of the facial nerve within the parotid may endanger the nerve during parotid surgeries. The present report is an attempt to help the surgeons to minimize the error that can damage the nerve without previous knowledge of such type of rare variation.

An anatomical and clinical insight on brachialis with emphasis on portal's muscle.

There have been conflicting descriptions regarding the anatomy of portal's muscle in the literature. The purpose of the present study seeks to clarify the presence, morphology, and potential function of this muscle in order to refine surgical techniques around the elbow. Forty-eight formalin fixed upper extremities were dissected and observed for attachments of brachialis meticulously and particularly over the anterior elbow joint capsule with special emphasis to the anatomical relation of the deeper fibers to the joint. It was found that there were varying patterns of muscular attachments over the anterior joint capsule with majority of the fibers of brachialis simply passing superficial to the joint capsule. The highest concentration of fibers was noted on the inferior part of the joint capsule, which was attached via connective tissue. These fibers were the deepest fibers of brachialis muscle that had no affect on the joint capsule following tension. Knowledge of this muscle may help the surgeons who operate in the elbow region to be tension free in preserving such fibers of clinically less importance.