An Unexpected Complication Resulting from Radiofrequency Ablation for Treating Facet Joint Syndrome: A Case Report.

Lumbar facet joints have been identified as a potential source of chronic low back pain (LBP) in 15% to 45% of patients, with the prevalence of such pain varying based on specific populations and settings examined. Lumbar facet joint interventions are useful in the diagnosis as well as the therapeutic management of chronic LBP. Radiofrequency ablation (RFA) of medial branch nerves is recognized as a safe and effective therapy for chronic facet joint pain in the lumbosacral spine, and its efficacy has already been established. The use of RFA is currently widespread in the management of spinal pain, but it is noteworthy that there have been works in the literature reporting complications, albeit at a very low frequency. We present a case of third-degree skin burns following radiofrequency ablation (RFA) for the management of facet joint syndrome. Postoperatively, the patient's skin encircling the needle displayed a pallor and exhibited deterioration in conjunction with the anatomical anomaly. The affected area required approximately 5 months to heal completely. During RFA, heat can induce burns not only at the point of contact with the RF electrode but also along the length of the needle. Vigilant attention is necessary to ensure patient safety and to address any potential complications that may arise during the procedure, including the possibility of minor technical errors.

The current status of fibromyalgia in Korea: an electronic population health data study in Korea.

Background: Fibromyalgia (FM) is a complex disorder characterized by widespread chronic pain and tenderness in the muscles, ligaments, and soft tissues. It is a chronic pain condition often accompanied by other symptoms and comorbidities. To effectively manage FM, it is crucial to obtain fundamental epidemiological data pertaining to the target population. Therefore, this study was conducted to elucidate the epidemiological characteristics of FM in the Korean population. Methods: Population-based medical data of 51,276,314 subscribers to the National Health Insurance Service of Korea from 2014 to 2018 were used in this study. Results: The overall incidence of FM ranged from 441 (2014) to 541 (2018) cases per 100,000 person-years, with a higher prevalence observed among female patients compared to male patients. The incidence gradually increased until middle age, followed by a decrease. The highest incidence rates were observed in the fifth decade of life for females and the sixth decade of life for males. When categorizing the affected parts of the body, the shoulder region was observed to be the most frequently affected. A comparison of the drug prescriptions based on medical specialty showed that antidepressants were the most commonly prescribed medications. The management of FM leads to consistent increases in medical expenses, regional disparities, and variations in prescription patterns across different medical specialties. Conclusions: The findings of this study will not only contribute to the understanding of FM characteristics but also provide a vital foundation for efficient management of FM in Korea.

Topographical study of the connections of the rami communicantes from the first to the fifth thoracic sympathetic ganglia.

This study investigated the morphological variations and histological patterns of the rami communicantes (RCs) arising from the first to the fifth thoracic sympathetic ganglia, and considered the clinical significance of these variations. Fifty upper thoracic portions from 26 adult Korean cadavers were used in this study. There were 731 RCs arising from the first to the fifth thoracic sympathetic ganglia. They were classified into three types depending on the connection between the sympathetic ganglion and the intercostal nerves: in type I, the RCs connected the ganglion to the corresponding intercostal nerve, and in types II and III, respectively, they connected it to the nerve one level above or below the corresponding intercostal nerve. Some RCs of types I and II could not be observed without additional preliminary surgical procedures. Diverse combinations of RC types arose from the first to the fifth thoracic sympathetic ganglia, combinations of types I and III being the most common (70%) in the first sympathetic ganglion and those comprising only type I being most frequent in the other ganglia. The RCs could not be identified by the naked eye in either fresh or fixed cadavers, so they were confirmed on the basis of their histological appearance. These results are expected to improve knowledge of morphological variations of the RCs in the upper five thoracic sympathetic ganglia, and to provide helpful information for clinical management in this region. Clin. Anat. 31:1151-1157, 2018. © 2018 Wiley Periodicals, Inc.

Morphological Patterns and Variations of the Nasal Septum Components and Their Clinical Implications.

The aim of this study was to clarify the morphological patterns and proportions of the components of the nasal septum. Anatomical examinations were performed on 70 nasal septums of embalmed Korean adult cadavers. The septal deviation was checked before cutting the nasal cavity midsagittally with the aid of a laryngoscope. The shape of each component of the nasal septum was identified, and photographs were taken from a midline sagittal view. A line was drawn on each photograph between the septal components, and then the area of each septal component was measured using software. The mean area proportions of the septal cartilage (SC), the perpendicular plate of the ethmoid bone (PPE), the vomer, and the nasal crest of the maxilla relative to the total area of the nasal septum were 25.6%, 43.0%, 25.8%, and 5.6%, respectively. The morphology of the nasal septum was classified into 3 main patterns according to the proportion of each septal component. The proportions of the SC, the PPE, the vomer, and the nasal crest of the maxilla were similar to the mean values of the present study in 45.7%. The proportions of the SC, the PPE, and the vomer were similar to each other (with a difference of <15%) in 24.3%. The proportion of the PPE exceeded 50% of the total area of the nasal septum in 22.9%. The results reported herein provide detailed anatomical knowledge that can be used as a valuable reference for rhinoplasty procedures.

Topographical relationships between the obturator nerve, artery, and vein in the lateral pelvic wall.

INTRODUCTION AND HYPOTHESIS: The aims of this study were to determine the topographical relationships between the obturator nerve (ON), artery (OA), and vein (OV) in the lateral pelvic wall. METHODS: One hundred and fifty hemipelvises of 84 Korean cadavers were dissected. RESULTS: The ON, OA, and OV ran in that order (from upper to lower) within the lateral pelvic wall in 46.7 % of specimens. In 32 % of cases, the three structures were separated at the posterior portion of the wall and then converged toward the obturator canal (OC). In 10 %, the OA and OV were in contact with each other and separate from the ON; in 2 %, the ON was contiguous with the OA and separate from the OV; in 2.7 %, all three structures were in contact with each another. Alternately, the order of ON, OA, and OV was altered in the lateral pelvic wall in 41.3 % of specimens. Finally, in 12 % specimens, either the OA or OV or both were absent from the lateral pelvic wall. CONCLUSIONS: The possibility of the presence of either the OA or OV being between the ON and the external iliac vein, and the potential contact between the ON and either the OA or OV in the lateral pelvic wall, should be borne in mind during pelvic procedures.

Classification system for flexor digitorum accessorius longus muscle variants within the leg: clinical correlations.

The flexor digitorum accessorius longus (FDAL), a variant leg muscle, can cause tarsal tunnel syndrome. This study was performed to classify the variants of the FDAL by dissection and to correlate the dissection results with clinical cases of tarsal tunnel syndrome caused by this muscle. Eighty lower limbs of embalmed Korean cadavers were dissected. MR images of two clinical cases of tarsal tunnel syndrome caused by the FDAL were correlated with the dissection results. The FDAL was observed in nine out of 80 specimens (11.3%) and it was classified into three types depending on its site of origin and its relationship to the posterior tibial neurovascular bundle (PTNV) in the leg. In Type I (6.3%), the FDAL originated in the leg and ran superficially along the PTNV, either not crossing (Type Ia, 3.8%) or crossing (Type Ib, 2.5%) the neurovascular bundle. In Type II (6.3%), it originated in the tarsal tunnel. Most FDALs followed a similar course in the tarsal tunnel and the plantar pedis. On correlating the MR images of the clinical cases with this classification, the FDAL corresponded to Types Ia and II. All three types of FDAL can compress the tibial nerve in the tarsal tunnel or the distal leg. Clarification of the topographical relationship between this muscle and the PTNV would help to improve the results of surgery for tarsal tunnel syndrome caused by the FDAL.

Superior and middle thyroid arteries arising from the common carotid artery.

We report a rare case of a left middle thyroid artery in a 71-year-old male cadaver. The middle thyroid artery arose from the anterior surface of the left common carotid artery. This artery ran anteroinferiorly and then bifurcated as it entered the lower lateral part of the left thyroid lobe. Both the right and left superior thyroid arteries arose from the common carotid arteries below the carotid bifurcation. The presence of a middle thyroid artery may cause unexpected bleeding during thyroid or neck surgery, and this rare variation needs to be kept in mind during the surgery.

Topographic variations of the optic chiasm and the foramen diaphragma sellae.

Pituitary adenomas can expand upward through the foramen diaphragma sellae (FDS), compress the visual pathways on the suprasellar region, and cause diverse visual defects. However, the relationship between the FDS and the visual pathway has not been thoroughly clarified. This study was thus performed to determine the topographic relationship between these two structures. One hundred heads of adult cadavers were examined in this study. The FDS was classified into five types (Ia, Ib, Ic, II, and III) according to its location relative to the four parts of suprasellar region of the visual pathways. The midpoint of the optic chiasm (OC) was located on the midline passing through the crista galli in 70% of cases, but to the left and right sides of the midline in 9 and 21% of cases, respectively. The FDS was completely covered by OC in 30% of the cases, but it was partly seen superiorly in 70%. The pituitary infundibulum passed mainly through the center middle or posterior middle part of nine partitions of the FDS. The horizontal and vertical diameters of the foramen were 7.9 +/- 2.0 and 7.6 +/- 1.9 mm, respectively. The length of the optic nerve was 9.7 +/- 1.9 mm on the left side and 9.5 +/- 1.9 mm on the right side. The angle between the optic nerve and the midline was 34.5 degrees +/- 5.7 degrees on the left side and 36.0 degrees +/- 6.3 degrees on the right side. The results of this study are expected to further the current knowledge of the topographic anatomy on suprasellar structures.

Cutaneous perforators of the forearm: anatomic study for clinical application.

We studied the distribution of constant cutaneous perforators of the forearm.A total of 25 amputated forearms of 13 Korean fresh cadavers were used for the study. The specimens were fixed in formaldehyde solution and phenol mixture in low concentration. Red latex was injected into the axillary arteries of 8 specimens, and lead oxide-gelatin mixture (radiopaque material) was given into another 8. And then the cutaneous perforators were isolated by dissection and radiographed. Free fasciocutaneous flaps with the pedicles of cutaneous perforators were exploited in 9 specimens. Two fasciocutaneous perforators were constant on the flexor surface and 3 on the extensor side. Most of the emerging points of 2 flexor perforators were within each circle, with 2.5 cm (87.5%) and 3.0 cm (75%) in diameter, respectively. Most of the emerging points of 3 extensor perforators were within each circle, with 2.0 cm (87.5%), 1.5 cm (75%), and 2.0 cm (87.5%) in diameter, respectively.A knowledge of constant perforators of the forearm is conducive to the free skin cutaneous flaps to be designed safely.

Anatomy of superficial thoracic artery related to subpectoral augmentation mammoplasty.

The aim of this study is to elucidate the anatomic details of superficial thoracic artery related to transaxillary subpectoral augmentation mammoplasty.Thirty-three breasts of Korean cadavers (11 males, 6 females) were dissected. The superficial thoracic artery was found at the lateral part of the pectoralis (P.) major muscle in all cases. It originated mostly from the lateral thoracic artery (42%), thoracoacromial artery (38%), and partly from axillary artery (19%). Most of (82%) the muscle entering point was included in the circle of 2.5-cm radius. The center was located 2.5 cm superior from the intersection of the lateral border of the P. major and inferior border of the fourth rib. It was distant from 12 cm lateral to the midline and 6 cm below the sternal notch. We think that the superficial thoracic artery might be the culprit of bleeding and severe hematoma in transaxillary subpectoral mammoplasty.

Innervation of calf muscles in relation to calf reduction.

Plump and muscular calves, a so-called radish-like leg, embarrass young women and cause a feeling of inferiority in Korea. Damage to motor nerves innervating a muscle makes the muscle paralyzed and dystrophic, with loss of muscle volume. The authors studied the morphometry of the motor branches of the tibial nerve innervating the gastrocnemius and soleus muscle and sensory medial sural cutaneous nerve in popliteal fossa. Dissection and exploration of the tibial nerve were performed in the popliteal fossae of 70 legs (of 18 males and 17 females) of embalmed Korean cadavers. The main branch of the tibial nerve innervating medial and lateral gastrocnemius muscle originated 3 cm above and below the popliteal crease. The medial gastrocnemius muscle had an additional nerve (49%). The medial sural cutaneous nerve came off the nerve into the medial gastrocnemius muscle (30%) and diverged 5.5 mm from the tibial nerve. The nerve into the soleus muscle originated from the nerve innervating the lateral gastrocnemius muscle (30%) and was 12.3 mm away from it. Surgeons should keep in mind that the medial sural cutaneous nerve originates from the nerve to medial gastrocnemius in 30% and the nerve to soleus muscle originates from the nerve to lateral gastrocnemius in 30%.