Mentalis nerve branches supplying the lower lip revisited: a study of human fetuses and donated elderly cadavers.

PURPOSE: Little information is known about the mentalis nerve course from the lower lip approximation margin (free margin) to the upper lip. Likewise, no difference in nerve distribution has been observed between the cutaneous and mucosal parts of the lip. Therefore, this study reexamined mentalis nerve morphology. METHODS: For macroscopic observations, three fresh cadavers were dissected (one male and two females; aged 78-93). We also evaluated histological sections obtained from five donated elderly cadavers (two males and three females, aged 82-96 years) and 15 human fetuses (11-40 weeks or crown-rump length 80-372 mm). Immunohistochemical analysis for S100 protein and tyrosine hydroxylase was performed. RESULTS: In both fetuses and adult cadavers, one to three nerve branches ran upward in the submucosal tissue from the mental foramen. Near the free margin of the lip, some branches passed through the orbicularis oris muscle layer toward the lip skin, whereas others followed a reversed J-shaped course along the free margin. Nerve twigs ran in parallel beneath the mucosa, whereas wavy nerve twigs attached to the basal lamina of the lip epidermis. The difference in nerve endings abruptly occurred at the skin-mucosal junction. Tyrosine hydroxylase-positive sympathetic nerve twigs surrounded arteries and formed a branch composed of S100-negative unmyelinated fibers. CONCLUSION: The lower lip skin was innervated by a perforating branch passing through the orbicularis oris muscle, that was different from the lip mucosa. A sudden change in the nerve ending configuration at the mucocutaneous junction seemed to develop postnatally.

Growth of the brachial nerve plexus with reference to topographical relation of the medianus nerve ansa with the thoracic wall and shoulder: a histologic study using human embryos and fetuses.

BACKGROUND: There is currently no information on positional changes in the brachial nerve plexus during prenatal growth. The subclavian-axillary artery passing through the medianus nerve ansa is considered a good landmark for evaluating the height of the plexus. MATERIALS AND METHODS: We used histologic sections from 9 embryos and 17 fetuses (approximately 6-15 weeks of gestational age) to identify the height of the ansa by referring to the level of the rib and the glenohumeral joint. RESULTS: The nerve ansa was usually (23 plexuses) observed at the level of the first and/or second ribs. However, it was sometimes observed above the first rib, at a distance equal to or more than an intercostal width (7 plexuses). In the latter group, the ansa was usually located below the glenohumeral joint. Thus, the joint was located higher than the first rib, although the upper extremities were in the anatomic position for all specimens. The left-right difference in the height of the plexus corresponded to or was less than the width of the first intercostal space. Despite the synchronized growth between the thorax and shoulder girdle, the brachial plexus showed a considerable variation in comparative height; the range corresponded to twice of an intercostal width. Whether the nerve plexus is located high or low is determined at an early developmental stage and is maintained during the later growth stages. CONCLUSION: The high-positioned plexus might cause nerve injury at delivery, followed by a glenohumeral joint deformity because of the fragility without fixation in the thorax.

Growth of muscles and nerves in the upper eyelid: a morphometrical and immunohistochemical study using term human fetuses.

BACKGROUND: There is no information about muscle growth in eyelids with infrequent blinking in fetuses. METHODS: To examine the muscle and nerve morphology, we morphometrically and immunohistochemically examined sagittal sections of unilateral upper eyelids obtained from 21 term fetuses (approximately 30-42 weeks of gestation) and, for the comparison, those from 10 midterm fetuses (12-15 weeks). RESULTS: The approximation margin of the upper eyelid always corresponded to the entire free margin in midterm fetuses, whereas it was often (18/21) restricted in the posterior part in term fetuses. Thus, in the latter, the thickness at the approximation site to the lower lid often ranged from 0.8 to 1.6 mm and corresponded to 18-56% of the nearly maximum thickness of the lid. In the lower part of the upper eyelid, a layer of the orbicularis oculi muscles often (14/21) provided posterior flexion at 90-120° to extend posteriorly. Nerve fibers running along the mediolateral axis were rich along the approximation surface at term, but they might not be reported in the upper eyelid of adults. CONCLUSION: Being different from adult morphologies, the term eyelid was much thicker than the approximation surface and it carried a flexed muscle layer and transversely-running nerve. The infrequent blinking in fetuses seemed to provide a specific condition for the muscle-nerve growth. Plastic and pediatric surgeons should pay attention to a fact that infants' upper eyelid was unlikely to be a mini-version of the adult morphology.

Rectus capitis lateralis muscle revisited: a histological study using human fetuses.

BACKGROUND: Rectus capitis lateralis muscle (RCLM) is located at the border between the ventral and dorsal muscle groups, but the nerve topographical anatomy around the muscle is obscure. MATERIALS AND METHODS: We observed the RCLM in histological sections of 12 midterm and 10 near-term fetal heads (9-18 and 26-40 weeks of gestational age). RESULTS: At midterm, the RCLM wrapped around the inferiorly protruding inferolateral corner of the cartilaginous occipital bone. The muscle was adjacent to, or even continued to, the intertransversarius muscle between the atlas and axis. At near-term, the jugular process of the occipital bone, that is, the RCLM upper insertion, was either cartilaginous or bony, depending on age. The process formed a collar supporting the internal jugular vein from the inferior side. Moreover, the muscle is tightly attached to or inserted into the venous wall itself. The cartilaginous jugular process was adjacent to Reichert's cartilage, and the uppermost muscle fibers passed through a narrow space between these cartilages. The RCLM appeared to accelerate the jugular process elongation, resulting in complete union of the occipital and temporal bones. The ventral ramus of the first cervical nerve passed between the RCLM and rectus capitis anterior muscle to reach the longus capitis muscle. No nerve passed between the RCLM and the obliquus capitis superior muscle (a muscle at the suboccipital triangle). CONCLUSION: The dorsoventral position of the RCLM seemed to correspond to the scalenus posterior muscle in a laminar arrangement of the cervical axial musculature.

The so-called absorption process of the pulmonary vein into the left atrium of the heart: a histological study using human embryos and fetuses.

BACKGROUND: Embryonic pulmonary veins (PVs) are believed to be absorbed into the left atrium (LA) to provide an adult morphology in which "four" veins drain separately into the atrium. MATERIALS AND METHODS: Serial histological sections were obtained from 27 human embryos and fetuses. RESULTS: Between 5 and 6 weeks, the four PVs joined together to form a trunk-like structure (initial spatium pulmonalis) that was larger than the initial LA (two-ostia pattern). The cardiac nerves ran inferiorly along the posterior aspect of the four veins, as well as the spatium. At and until 7 weeks, the cardiac nerves were concentrated to elongate the nerve fold, and the latter separated the left PV trunk from the expanding LA (left spatium). Similarly, the right PV opened to a thick and deep LA recess (right spatium). At 8-12 weeks, depending on the growth of the LA, the opening of the left and right PVs became distant, and the spatium was elongated transversely. The left spatium was enlarged to open widely to the proper left atrium in contrast to the right spatium pushed anteriorly by the right atrium. The three-ostia pattern was transiently observed because of the lost delimitation between the left spatium and proper atrium. The myocardium was thin in the left spatium behind the left atrial nerve fold, whereas the right spatium was tube-like with a thick myocardium. CONCLUSIONS: The four-ostia pattern seemed to be established at birth due to a drastically increased venous return from the lung, resulting in a flat smooth left atrial posterior wall.

Lost or fragmented bony septum of the optic canal facing the sphenoid sinus: a histological study using elderly donated cadavers.

PURPOSE: To histologically describe a direct contact (the so-called dehiscence) of the optic nerve (ON) and/or internal carotid artery (ICA) to the mucosa of posterior paranasal sinuses represented by the sphenoid sinus (SS). METHODS: Observations of histological sections of unilateral or bilateral skull bases (parasellar area and orbital apex) from 22 elderly cadavers were made. RESULTS: A bony septum was less than 300 µm between the SS and ICA and 200 µm between the SS and optic nerve. Parts of the septa were sometimes absent due to fragmentation and holes of the bony lamella (2/22 facing the ICA; 4 facing the ICA in combination with an absent bony septum facing the nerve). In these dehiscence sites, the SS submucosal tissue attached to a thick sheath (50-100 µm in thickness) enclosing the optic nerve and ophthalmic artery and/or the ICA adventitia (50-200 µm in thickness). The ICA sometimes contained a sclerotic plaque that attached to or even protruded into the SS. With or without dehiscence, the SS mucosa was always thin (50-100 µm in thickness) and accompanied no mononuclear cellular infiltration or tumor. CONCLUSIONS: A thin bony septum of the optic nerve or ICA had been notable as a danger point during surgery, but even a 0.05-mm-thick bone lamella might be an effective barrier against cellular infiltration or bacterial invasion from the SS. Fragmentation and holes of the bony lamella in 4 cadavers might allow cellular invasion to the optic nerve. Accordingly, unknown immunological cross talks might occur to cause demyelination.

Distribution of sole Pacinian corpuscles: a histological study using near-term human feet.

INTRODUCTION: Fast-adapting afferent input from the sole Pacinian corpuscles (PCs) is essential for walking. However, the distribution of PCs in the plantar subcutaneous tissue remains unknown. MATERIALS AND METHODS: Using histological sections tangential to the plantar skin of eight near-term fetuses, we counted 528-900 PCs per sole. RESULTS: Almost half of the sole PCs existed at the level of the proximal phalanx, especially on the superficial side of the long flexor tendons and flexor digitorum brevis. Conversely, the distribution was less evident on the posterior side of the foot. The medial margin of the sole contained fewer PCs than the lateral margin, possibly due to the transverse arch. In contrast to a cluster formation in the anterior foot, posterior PCs were almost always solitary, with a distance greater than 0.5 mm to the nearest PC. DISCUSSION AND CONCLUSION: Because a receptive field of PCs is larger than that of the other receptors, fewer solitary PCs might cover the posterior sole. In infants, the amount of anterior sole PCs seemed to determine the initial walking pattern using the anterior foot without heel contact. Anterior PCs concentrated along flexor tendons might play a transient role as tendon organs during the initial learning of walking. During a lesson in infants, mechanical stress from the tendon and muscle was likely to degrade the PCs. In the near term, the sole PCs seemed not to be a mini-version of the adult morphology but suggested an infant-specific function.

Fetal development and growth of the human erector spinae with special reference to attachments on the surface aponeurosis.

PURPOSE: The longissimus (LO) and iliocostalis (IC) of adults consist of myofibers extending from the superolateral to the inferomedial side of the back and, because of the same course, they are fused in the thoracolumbar region. The LO also has a medial attachment to the long myofibers of the transversospinalis (TS) showing a course from the superomedial to the inferolateral side. However, there is apparently no information regarding when and how these similar longitudinal muscles differentiate from a cluster of dorsomedial myotome cells. METHODS: We examined sagittal and horizontal sections of the trunks of 39 human embryos and fetuses (18-330 mm crown-rump length). RESULTS: At 6-7 weeks gestational age (GA), the surface aponeurosis appeared prior to and independent of the thoracolumbar fascia. At 6-9 weeks GA, the LO myofibers had a postero-inferior course, from the transverse process to the initial aponeurosis, whereas the TS myofibers had a postero-superior course, from a lateral extension of the intertransverse ligament to the aponeurosis. However, the IC consisted of supracostal longitudinal myofibers and was distant from the LO until 12 weeks GA. Because of the lack of ligamentous attachments and ribs, myofibers of the TS, LO, and IC took a similar inferior course in the lumbar region. When the early TS was represented by the transverso-aponeurotic muscle, consequently, the LO corresponded to the aponeuro-transversal muscle and was independent from the IC. CONCLUSION: The classical model of TS and LO development does not recognize the essential role of the aponeurosis identified here.

Human orbital muscle in adult cadavers and near-term fetuses: its bony attachments and individual variation identified by immunohistochemistry.

PURPOSE: To compare fetal and adult morphologies of the orbital muscle (OM) and to describe the detailed topographical anatomy in adults. METHODS: Using unilateral orbits from 15 near-term fetuses and 21 elderly cadavers, semiserial horizontal or sagittal paraffin sections were prepared at intervals of 20-100 µm. In addition to routine histology, we performed immunohistochemistry for smooth muscle actin. RESULTS: At near term, the OM consistently extended widely from the zygomatic bone or the greater wing of the sphenoid to the maxilla or ethmoid. Thus, it was a large sheet covering the future inferior orbital fissure. In contrast, the adult OM was a thin and small muscle bundle connecting (1) the greater wing of the sphenoid to the maxilla (11/19 cadavers), (2) the lesser wing of the sphenoid to the maxilla (5/19) or the greater wing (3/19). The small OM was likely to be restricted within the greater wing (5/19 cadavers) or the maxilla (3/19). Two of these five types of OM coexisted in eight orbits. OM attachment to the lesser wing was not seen in fetuses, whereas ethmoid attachment was absent in adults. CONCLUSIONS: The lesser wing attachment of the OM seemed to establish after birth. A growing common origin of the three recti was likely involved in "stealing" the near-term OM attachment from the ethmoid. The strong immunoreactivity of remnant-like OM in the elderly suggests that OM contraction is still likely to occur against the increased flow through a thin vein. However, the contraction might have no clinical significance.

Cavernous sinus and abducens nerve in human fetuses near term.

A long tortuous course of the abducens nerve (ABN) crossing a highly curved siphon of the internal carotid artery is of interest to neurosurgeons for cavernous sinus surgery. Although a "straight" intracavernous carotid artery in fetuses can change into an adult-like siphon in infants, there is no information on when or how the unique course of ABN is established. Histological observations of 18 near-term fetuses (12 specimens of frontal sections and 6 specimens of sagittal sections) demonstrated the following: (I) the ABN consistently took a straight course crossing the lateral side of an almost straight intracavernous carotid artery; (II) the straight course was maintained when sympathetic nerves joined; (III) few parasellar veins of the developing cavernous sinus separated the ABN from the ophthalmic nerve; and (IV) immediately before the developing tendinous annulus for a common origin of extraocular recti, the ABN bent laterally to avoid a passage of the thick oculomotor nerve. Since the present observations strongly suggested morphologies at birth and in infants, major angulations of the ABN as well as the well-known course independent of the other nerves in the cavernous sinus seemed to be established during childhood. In the human body, the ABN might be a limited example showing a drastic postnatal change in course. Consequently, it might be important to know the unique course of ABN before performing endovascular interventions and skull base surgery for petroclival and cavernous sinus lesions without causing inadvertent neurovascular injuries to neonates or infants.

Suboccipital myodural bridges revisited: Application to cervicogenic headaches.

There seems to be no complete demonstration of the suboccipital fascial configuration. In 30 human fetuses near term, we found two types of candidate myodural bridge: (1) a thick connective tissue band running between the rectus capitis posterior major and minor muscles (rectus capitis posterior major [Rma], rectus capitis posterior minori [Rmi]; Type 1 bridge; 27 fetuses); and (2) a thin fascia extending from the upper margin of the Rmi (Type 2 bridge; 20 fetuses). Neither of these bridge candidates contained elastic fibers. The Type 1 bridge originated from: (1) fatty tissue located beneath the semispinalis capitis (four fetuses); (2) a fascia covering the multifidus (nine); (3) a fascia bordering between the Rma and Rmi or lining the Rma (13); (4) a fascia covering the inferior aspect of the Rmi (three); and (5) a common fascia covering the Rma and obliquus capitis inferior muscle (nine). Multiple origins usually coexisted in the 27 fetuses. In the minor Type 2 bridge, composite fibers were aligned in the same direction as striated muscle fibers. Thus, force transmission via the thin fascia seemed to be effective along a straight line. However, in the major Type 1 bridges, striated muscle fibers almost always did not insert into or originate from the covering fascia. Moreover, at and near the dural attachment, most composite fibers of Type 1 bridges were interrupted by subdural veins and dispersed around the veins. In newborns, force transmission via myodural bridges was likely to be limited or ineffective. The postnatal growth might determine a likely connection between the bridge and headache. Clin. Anat. 32:914-928, 2019. © 2019 Wiley Periodicals, Inc.

Tree of Vater-Pacinian corpuscles in the human finger and thumb: a comparison between the late fetal stage and old age.

Using histological sections of 12 hands from 12 human fetuses at 20-34 weeks of gestation (150-290 mm) and 14 fingers (index and small) from seven donated cadavers of elderly individuals (aged 78-95 years), we compared the features of Vater-Pacinian corpuscles between these two stages of life. Corpuscles with thin, tightly packed lamellae appeared to undergo a change to thick, loosely packed lamellae at 23-32 weeks. The typical fetal corpuscle had two parts: (1) a rod-like proximal part (0.2-0.6 mm in length) extending along the proximodistal axis of the finger, and (2) a distal end (0.1 mm) after acute bending of the proximal part. Corpuscles were associated with palmar digital nerves in the fingers, but were also present along the dorsal nerves in the thumb. A flower bouquet- or tree-like arrangement including 5-10 corpuscles extended to the dermis of the skin along a perforating artery. Serial sections of the thumb and fifth finger revealed approximately 80-180 corpuscles in the distal phalangeal segment. In elderly individuals, the corpuscles were distributed along the palmar digital nerve, but (1) their density was much lower than in fetuses and (2) a bouquet- or tree-like arrangement was rarely seen. In the distal segment, there were fewer than 40 adult corpuscles, being 0.2-0.5 mm thick and 1.0-2.5 mm long. Wavy or coiled corpuscles were evident. Because of the considerable differences in the distribution and number of corpuscles between the fetus and adult, they appear to undergo considerable depletion with age, especially along thin, superficial nerve branches.

Fetal facial nerve course in the ear region revisited.

PURPOSE: The aim of this study was to re-examine the structures that determine course of the facial nerve (FN) in the fetal ear region. MATERIALS AND METHODS: We used sagittal or horizontal sections of 28 human fetuses at 7-8, 12-16, and 25-37 weeks. RESULTS: The FN and the chorda tympani nerve ran almost parallel until 7 weeks. The greater petrosal nerve (GPN) ran vertical to the distal FN course due to the trigeminal nerve ganglion being medial to the geniculate ganglion at 7 weeks. Afterwards, due to the radical growth of the former ganglion, the GPN became an anterior continuation of the FN. The lesser petrosal nerve ran straight, parallel to the FN at 7 weeks, but later, it started to wind along the otic capsule, possibly due to the upward invasion of the tympanic cavity epithelium. Notably, the chorda tympanic nerve origin from the FN, and the crossing between the vagus nerve branch and the FN, was located outside of the temporal bone even at 37 weeks. The second knee of the FN was not evident, in contrast to the acute anterior turn below the chorda tympanic nerve origin. In all examined fetuses, the apex of the cochlea did not face the middle cranial fossa, but the tympanic cavity. CONCLUSION: Topographical relation among the FN and related nerves in the ear region seemed not to be established in the fetal age but after birth depending on growth of the cranial fossa.

Distance between intramuscular nerve and artery in the extraocular muscles: a preliminary immunohistochemical study using elderly human cadavers.

PURPOSE: Extraocular muscles are quite different from skeletal muscles in muscle fiber type and nerve supply; the small motor unit may be the most well known. As the first step to understanding the nerve-artery relationship, in this study we measured the distance from the arteriole (25-50 µm in thickness) to the nerve terminal twigs in extraocular muscles. MATERIALS AND METHODS: With the aid of immunohistochemistry for nerves and arteries, we examined the arteriole-nerve distance at 10-15 sites in each of 68 extraocular muscles obtained from ten elderly cadavers. The oblique sections were nearly tangential to the muscle plate and included both global and orbital aspects of the muscle. RESULTS: In all muscles, the nerve twigs usually took a course parallel to muscle fibers, in contrast to most arterioles that crossed muscles. Possibly due to polyinnervation, an intramuscular nerve plexus was evident in four rectus and two oblique muscles. The arteriole-nerve distance usually ranged from 300 to 400 µm. However, individual differences were more than two times greater in each of seven muscles. Moreover, in each muscle the difference between sites sometimes reached 1 mm or more. The distance was generally shorter in the rectus and oblique muscles than in the levator palpebrae muscle, which reached statistical significance (p < 0.05). CONCLUSIONS: The differences in arteriole-nerve distances between sites within each muscle, between muscles, and between individuals might lead to an individual biological rhythm of fatigue in oculomotor performance.

The Filum Terminale Revisited: A Histological Study in Human Fetuses.

Previous studies have suggested that secondary neurulation provides no functional neurons but only the filum terminale. However, no studies have confirmed that the coccygeal and lower sacral nerves do not originate from the secondary neural tube but only from the primary tube. To obtain a better understanding of these relationships, we examined sagittal or frontal sections from 20 embryonic and fetal specimens ranging from 6 to 14 weeks of gestation. During the growth of the vertebral column as well as the subsequent upward migration of the caudal end of the dural sac, the secondary neural tube was stretched to maintain the original attachment to the coccyx or the lower sacral vertebra. The filum-like structure showed much individual variability but in all cases appeared to be derived from the stretched neural tube. Intermediate age morphology revealed that the secondary neural tube itself provided an initial filum terminale before the ascent of the dural sac. Given that the coccygeal and lower sacral nerves are likely to originate from the secondary neural tube, these parts of the tube persisted and differentiated into spinal neurons to form the anococcygeal nerves. Likewise, the filum terminale was also most likely to contain some neurons that persisted postnatally. Depending on the timing and site of degeneration of the secondary neural tube, individual variations could occur in proportion to the amount of sensory and motor elements in the anococcygeal nerve supply.

Anterior Corticospinal Tract Revisited: A Study Using Human Fetuses.

In the human corticospinal tract (CST), the anterior CST is known to be much thinner than the lateral CST, but fetal development of the CST remains obscure. In this study, we examined horizontal histological sections of the cervical spinal cord from 50 midterm fetuses (crown-rump length, CRL, 70-150 mm; 12-18 weeks) as well as 15 late-stage fetuses (CRL 230-250 mm; 28-30 weeks). While the lateral CST appeared at 14-15 weeks in the cervical cord of the midterm fetuses, we found the anterior CST in only 3 fetuses: CRL 117 mm (15 weeks), and CRL 144 and 150 mm (18 weeks). However, in the late-stage fetuses, the anterior CST exhibited a spectrum of variations, including bilaterally thick tracts (3 fetuses), a unilaterally thick tract (5 fetuses) and a thin or absent tract (7 fetuses). In the group with the thickest anterior CST, the cross-sectional area reached 40% of that of the lateral CST. In contrast to the stable morphology of the lateral CST, the shape of the anterior tract varied slightly between the cervical segments. Immunohistochemical observations demonstrated no difference between the lateral and anterior CSTs: (1) in macrophage infiltration, which suggests apoptosis, and (2) in the arrangement of radial glial fibers. Our findings indicate that the development of the anterior CST starts later than that of the lateral tract, with significant individual variations. The functional relevance of the anterior CST, if present, might not be found in an independent cortical input to motor neurons but in a remodeling of the ascending tracts.

Anti-Inflammatory and Cytoprotective Effects of TMC-256C1 from Marine-Derived Fungus Aspergillus sp. SF-6354 via up-Regulation of Heme Oxygenase-1 in Murine Hippocampal and Microglial Cell Lines.

In the course of searching for bioactive secondary metabolites from marine fungi, TMC-256C1 was isolated from an ethyl acetate extract of the marine-derived fungus Aspergillus sp. SF6354. TMC-256C1 displayed anti-neuroinflammatory effect in BV2 microglial cells induced by lipopolysaccharides (LPS) as well as neuroprotective effect against glutamate-stimulated neurotoxicity in mouse hippocampal HT22 cells. TMC-256C1 was shown to develop a cellular resistance to oxidative damage caused by glutamate-induced cytotoxicity and reactive oxygen species (ROS) generation in HT22 cells, and suppress the inflammation process in LPS-stimulated BV2 cells. Furthermore, the neuroprotective and anti-neuroinflammatory activities of TMC-256C1 were associated with upregulated expression of heme oxygenase (HO)-1 and nuclear translocation of nuclear factor-E2-related factor 2 (Nrf2) in HT22 and BV2 cells. We also found that TMC-256C1 activated p38 mitogen-activated protein kinases (MAPK) and phosphatidylinositol 3-kinase (PI3K)/Akt signaling pathways in HT22 and BV2 cells. These results demonstrated that TMC-256C1 activates HO-1 protein expression, probably by increasing nuclear Nrf2 levels via the activation of the p38 MAPK and PI3K/Akt pathways.

Topographical relationships of intramuscular nerves and vessels of the motor endplates in the thigh and gluteal regions of human fetuses: an immunohistochemical study.

PURPOSE: The aim of this study was to describe topography of vessels and nerves in striated muscles to understand individual muscle function. MATERIALS AND METHODS: Immunohistochemistry for nerve and artery was used to examine the thigh and gluteal muscles of six human midterm fetuses. RESULTS: The supplying nerves often accompanied arteries along epimysium bundling muscle fibers as well as in the covering fascia surrounding the entire muscle mass. However, courses of nerve twigs were usually independent of those of vessels in muscle bundles. Notably, irrespective of whether or not the vascular bundle accompanied the nerves at the muscle surface or hilus, most of the motor endplate bands did not accompany the vessels. CONCLUSION: Since the motor endplates were low vascularised, a chemical induction of vessels for nerve terminal development (or the reversed induction) seemed unlikely in striated muscles. In contrast to proprioceptive neuromuscular facilitation, manual stimulation of the endplate bands may stimulate muscle activity without sympathetic reflexes through vessel-accompanying nerves.

Sensory pathways in the human embryonic spinal accessory nerve with special reference to the associated lower cranial nerve ganglia.

BACKGROUND AND PURPOSE: Muscles supplied by the spinal accessory nerve are particularly prone to the development of trigger points characteristic of myofascial pain. This study aimed to confirm sensory pathways in the spinal accessory nerve and to describe sensory ganglion cell distributions along the lower cranial nerve roots. METHODS: Using sagittal sections of ten human embryos at 6-7 weeks and horizontal sections of three 15- to 16-week-old embryos, we analyzed ganglion cell distributions along the lower cranial nerve roots, including the spinal accessory (XI) nerve. RESULTS: In all ten 6- to 7-week-old embryos, the XI nerve root contained abundant ganglion cells, which were evenly distributed along the XI nerve root at levels between the jugular foramen and the dorsal root of the second cervical nerve. However, the hypoglossal (XII) nerve roots did not contain ganglion cells and did not communicate with nearby roots in the dural space. Thus, the so-called Froriep's occipital ganglion is unlikely to be associated with the XII nerve but rather with the XI nerve roots. According to observations of three larger fetuses (15-16 weeks), most of Froriep's ganglion cells seemed to have degenerated during early fetal life. CONCLUSION: Nociceptive sensory pathways in the adult human XI nerve may be much more limited in number than would be expected based on previous animal studies. However, it is possible that sensory ganglion cells in the embryonic XI nerve root send axons toward the developing spinal accessory nerve fibers outside of the jugular foramen.