The location of mandibular foramen relative to the occlusal plane: a study on anatolian dry mandible.

Purpose: The study aims to evaluate the location of mandibular foramen (MF) with respect to the occlusal plane (OP) and its location on the ramus using Anatolian dry mandibles. Materials and methods: A total of 115 dry mandibles with mandibular molars were analyzed. The distance between the MF and the OP was examined with a flat metal plate. Group A was above the OP; group L was at level, and group B was below the OP. The distances between the MF and anterior border (A-MF), sigmoid notch (U-MF), posterior border (P-MF), and lower border (L-MF) were measured. The symmetry between the two sides was examined. Pearson chi-square and Student's t-test were performed for statistical analysis. Results: According to the analysis, 50.23% of MF was located below the OP (p<0.05). The mean distances of Groups A and B were 3.45 and 4.78 mm, respectively. There was no difference between the left and right in groups (p>0.05). The distance A-MF was 14.71 mm. There was no statistical difference between the distances A-MF and P-MF or U-MF and L-MF. Conclusion: Half of the MF (50.23%) was located below the occlusal plane with a mean distance of 4.78 mm. It may be helpful to place the needle 3-4 mm above the OP and 1.5-2 mm back of the anterior border to obtain a successful inferior alveolar nerve block. The MF was located at the center of the medial surface of the ramus.

Anatomical variations of the superficial palmar arch in human fetuses.

The superficial palmar arch is an important anatomical structure that contributes to the arterial supply of the palmar side of the hand in the upper extremity. However, there is limited information on the embryological morphological structure of the superficial palmar arch in the literature. We studied the types of the superficial palmar arch and determined their variations by dissecting 80 upper extremities of 40 formalin-fixed human fetuses (19 males, 21 females) 18-37 weeks of age. The types and variations of the superficial palmar arch were examined, and the median artery was imaged. The superficial palmar arch type was complete in 58 hands (72.5%) and incomplete in 22 hands (27.5%). The complete group consisted of type A (47.5%), type B (16.25%), type C (3.75%), type D (1.25%), and type E (3.75%). On the other hand, the incomplete group consisted of type F (15%), type G (8.75%), type H (2.5%), and type I (1.25%). A median artery that originated from the ulnar artery and passed through the carpal tunnel during its course was detected in two hands (2.5%). Knowledge of the superficial palmar arch variations will contribute to hand microsurgery particularly in vascular graft and free flap application interventions for arterial bleeding in the palmar region.

Innervation Patterns of the Psoas Major and Iliacus Muscles in Fetal Cadavers.

AIM: We aimed to investigate in detail the innervation patterns of the psoas major and iliacus in fetal cadavers. MATERIAL AND METHODS: The innervation patterns of 94 psoas major and 94 iliacus belonging to 47 fetuses (28 males, 19 females) aged between the 18th-40th gestational weeks in the laboratory of the Department of Anatomy at the Faculty of Medicine were examined. The nerve branches innervating the psoas major and iliacus and the origin levels of these branches were determined. The branches innervating the psoas major and iliacus were classified as L1, L1-L2 level, L2, L2-L3 level, L3, L3-L4 level, L4 and femoral nerve according to the levels at which they originate from the spinal nerves. RESULTS: It was determined that the psoas major was innervated by the ventral branches of the L1-L4 spinal nerves and the femoral nerve. It was observed that the iliacus was innervated only by the femoral nerve. The mean number of branches innervating each psoas major and iliacus was determined as 4.69±2.02 and 3.07±1.14 respectively. It was observed that the branches innervating the psoas major originated at least at the level between the L1-2 spinal nerves and most at the level between the L2-3 spinal nerves. CONCLUSION: The spinal nerves innervating the psoas major are at risk of injury during lateral transpsoas surgery, lateral discectomy, and spinal fusion surgery. Therefore, it may be useful for surgeons to know the innervation patterns of the psoas major in surgical interventions to be performed in this region. Furthermore, it will be useful for surgeons to know the innervation of the iliacus in various surgical interventions on the iliac fossa.

Intrauterine maxillary development and maxillary dental arch biometry: a fetal cadaver study.

INTRODUCTION: This study's goal was to determine normal maxillary development on fetal cadavers. MATERIALS AND METHODS: This study was carried out on 45 fetuses aged between the 17th - 40th weeks of gestation (24 male, 21 female). The distance between the widest left and right points of the maxillary dental arch (MDA) on the transverse plane, the distance of the papilla incisiva (PI) to the widest left and right points of the maxillary dental arch (MDAW), and the PI and posterior nasal spine (PNS) were measured. The average arch forms of the MDA were created according to trimester groups using the MATLAB program. The one-way ANOVA test was used to make a comparison between trimester groups, and ANOVA followed by post hoc analysis using the Bonferroni test was applied for comparisons. Pearson's correlation analysis was used for correlation analysis. RESULTS: The data in the present study did not differ between genders. In the comparison between trimester groups, we did not find any difference between the 3rd trimester and full-term groups only in the PI-MDAW measurement. Other parameters increased with age. In the correlation analysis, the measurement values by age showed a strong positive correlation. The MDAW exhibited the best correlation with age (rweek = 0.919). When the average MDA forms created using the MATLAB program were evaluated, it was observed that the PI-MDAW of the average MDA in the 3rd trimester and full-term intersected. CONCLUSIONS: This study provides a basis for a better understanding of fetal maxillary growth processes and can be useful to standardize the detection of malformations or intrauterine growth restrictions.

Anatomical variations of the extensor tendons of the fetal thumb.

PURPOSE: The extensor pollicis longus (EPL) and brevis (EPB) and abductor pollicis longus (APL) are muscles located in the posterior compartment of the forearm. These muscles allow the thumb to move independently from the other four fingers by attaching to the thumb separately. This study's goal was to investigate the tendon variations and insertions of these muscles. METHODS: Our study was conducted on 43 fetal cadavers (86 upper extremities) aged between 17 and 40 weeks of gestation. This study investigated the tendon numbers and insertions of the EPL, EPB, and APL. RESULTS: The tendon numbers of the EPL and EPB were observed to range between 1 and 2, and the tendon numbers of the APL ranged between 1 and 5. The EPL was found to insert into the distal phalanx via the dorsal aponeurosis in all extremities. It was observed that the EPB tendons inserted into the proximal phalanx, distal phalanx, and dorsal aponeurosis. It was determined that the APL tendons inserted into the basis of the first metacarpal, abductor pollicis brevis, opponens pollicis, and trapezium bone. CONCLUSION: Knowing the tendon variations and insertions of the EPL, EPB, and APL muscles during the fetal period will be useful in planning treatments to correct the congenital thumb anomalies and the loss of function after injury.

Morphometric Development of the Mandible in Fetal Cadavers.

PURPOSE: The aim of this study is to present reliable data by measuring the morphometric properties of the mandible in the fetal period. METHODS: A study was performed on mandibles of 35 fetuses (18 male fetuses and 17 female fetuses), aged between 21 and 40 weeks of gestation. Fetuses were examined in 3 groups according to their developmental stages: 2nd trimester, 3rd trimester, and full-term. Morphometric measurements were performed for both the right and left sides of each mandible. The measurements of the mental foramen were performed using a digital caliper, and other measurements were performed using the ImageJ program. The data obtained were analyzed using the SPSS 20 for Windows program. RESULTS: There was no significant gender difference for all parameters. When the parameters were compared by the trimesters, no significant difference was determined in the 2nd trimester - 3rd trimester, 3rd trimester-full-term, and second trimester - full-term comparisons of the angle of the mandible, and there was a significant difference in all other parameters (P < 0.05). According to the trimesters, all parameters, except the angle of the mandible, increased naturally with the development of the mandible. It was observed that the angle of the mandible decreased from the 2nd trimester to the 3rd trimester and increased from the 3rd trimester to the full term. When the right and left measurements were compared, no significant difference was found for all parameters in both general and trimester groups. CONCLUSION: The present study includes fetal mandibular parameters that have not been reported elsewhere. It is thought that the obtained data will contribute to the determination of anomalies, pathologies, and variations.

A case with multiple accessory foramina of mandible in a fetus.

It is aimed to better recognize the mandibular variations by understanding the diversity and positions of accessory foramina better. Accessory formations on a full-term fetal mandible dissected for a mandibular study were examined under a microscope. To observe these formations more clearly, they were photographed with the help of a camera and microscope. In one of the mandibles dissected for a fetal mandibular study, a lateral accessory foramen (LAF1) was detected in the right half just near the mental foramen, and also a medial accessory foramen (MAF1) was detected over the mandibular foramen. In the left half, on the lateral surface relative to the mental foramen, one in the medial (LAF3) and one just above it (LAF2), and last one is near to the ramus of mandible (LAF4), three lateral accessory foramina, were detected. Again, a medial accessory foramen just above the left mandibular foramen (MAF3), and another foramen is near to mandibular symphysis (MAF2), also two medial accessory foramina on the lateral surface were detected. Detection and recognition of such variations are quite important for clinicians in the diagnostic methods and prevention of possible surgical complications.

Development of Hard and Soft Palate During the Fetal Period and Hard Palate Asymmetry.

In the present study, it was aimed to perform the morphometric analysis of the hard and soft palate in fetal cadavers and evaluate hard palate asymmetry during the fetal development. The development of the palate was investigated in 40 (21 males, 19 females) fetal materials aged between the 17th and 40th gestational week. In this study, distances between the incisive papilla-staurion (Ip-Sr), staurion-posterior nasal spine (Sr-Pns), incisive papilla-greater palatine foramen (Ip-Gpf) on the right and left sides, Sr-Gpf, and Pns-Gpf were measured. In cases with asymmetry, the ratio of asymmetry was determined in percentage using the asymmetry index. Moreover, angular values between Ip-Sr-Gpf and Ip-Pns-Gpf on the right and left sides were measured, and the right and left side values were compared with each other. The hard and soft palate lengths were measured on the planum medianum. Upon comparing the measured parameters between males and females, the mean values of male fetuses were higher in all parameters, but a significant difference was found only in the Sr-Pns distance among these parameters. Upon comparing the angular data and asymmetry index data on the hard palate between the trimester groups, a significant difference was found only in the Ip-Sr-Gpf (left) parameter. The mean ratio of the hard palate to the soft palate was found as 1.90. It is believed that the obtained data will contribute to studies to be conducted in fields such as plastic surgery, maxillofacial surgery, intrauterine surgery, fetopathology, embryology, anatomy, and obstetrics.

Evaluation of fibular muscles and prevalence of accessory fibular muscles on fetal cadavers.

PURPOSE: The purpose of this study was to determine clinical importance and morphology of the fibularis longus, brevis, tertius muscles (presented as fibular muscles in this study), and prevalence of accessory fibular muscles (AFM) on fetal cadavers. MATERIALS AND METHODS: In this study, 200 limbs from 100 embalmed fetuses (54 male and 46 female) were studied. Morphology of fibular muscles and the presence of AFM were observed through dissection on fetal legs bilaterally. The absence of fibularis tertius muscle (FT) and the presence of AFM were identified. Length and length of the tendon of AFM were measured. Insertion of AFM was also identified. RESULTS: Mean values and standard deviations of all parameters according to trimesters were calculated. All parameters were increased with age during the fetal period. We determined the absence of FT; no FT was observed in 40 legs of 200 extremities (20%). The AFM was present in 7 of 200 specimens (3.5%). AFM muscles were classified into two types according to their site of origin. CONCLUSION: The present study has revealed the morphology of the fibular muscles and prevalence of the presence of AFM on fetal cadavers. In addition, it has revealed the morphometric development and prevalence of the absence of FT in a large series, and their clinical importance was discussed.

Motor branching patterns of the ulnar nerve in the forearms of fetal cadavers.

PURPOSE: The aim of this study was to investigate the branches of the ulnar nerve given to forearm muscles [flexor carpi ulnaris (FCU) and flexor digitorum profundus (FDP)] and typing of ulnar nerve according to distribution of these branches to the muscles. METHODS: From the collection of Anatomy Department Laboratory, Faculty of Medicine, Suleyman Demirel University, 116 upper limbs of fetuses showing no external anomaly and aging between 12th and 40th weeks of pregnancy, were included in this study for anatomical dissection. Parameters about the branching of fetal ulnar nerve were set as follows: branch/branches to FCU muscle and branch/branches to FDP muscle. RESULTS: Ulnar nerve was typed according to number, sequence, and distribution of motor branches of ulnar nerve. As a result of this typing, eight type branching model of ulnar nerve was confirmed. CONCLUSIONS: Our study is critically important for implementing successful surgical interventions and minimizing complications especially in ulnar nerve and forearm muscles surgery also in nerve replacement on this area.

The morphometry of patella and patellar ligament during the fetal period.

This study aims to determine the development and morphology of the patella and patellar tendon and to obtain morphometric data about these structures during the fetal period. One hundred five human fetuses (55 males and 50 females) aged 9-40 weeks were used in this study. Fetuses were divided into four groups between gestational weeks; Group I (9-12 weeks), Group II (13-25 weeks), Group III (26-37 weeks), and Group IV (38-40 weeks). The patella and patellar ligament were exposed via anatomical dissection; the dimensions (length, width, thickness) and the width of the lateral and medial articular surfaces of the patella, and the length and width of the patellar ligament, were measured using a Vernier's caliper. No significant differences were observed between genders or sides for any of the parameters (P > 0.05), and a significant correlation was found between gestational age and all parameters (P < 0.001). All parameters of the patella and patellar ligament were found to be different statistically between trimesters (P < 0.05). This study reveals the development, morphological changes, and the morphometric measurements of the patella and patellar ligament during the fetal period. We hope that the present results can be useful for future studies.

Morphometry of the gallbladder during the fetal period.

PURPOSE: In this study, our objective was to investigate the development of the gallbladder, its morphological structure and relationship with the adjacent organs during the fetal period. MATERIALS AND METHODS: A total of 118 human fetuses (60 males, 58 females) between 9 and 40 weeks of gestation without any external anomaly or pathology were included. They were divided into four groups according the gestational age: I (9-12 weeks), II (13-25 weeks), III (26-37 weeks) and IV (term, 38-40 weeks). The location of gallbladder on the visceral surface of liver has been identified. The gallbladders have been classified into four different types. Width and length of the gallbladder were measured and the relationship between fundus of gallbladder and inferior margin of the liver was noted. FINDINGS: The gallbladder was located on the visceral surface of liver in all cases during the fetal period. There were no differences between males and females by means of length and width. There was a statistically significant relationship between the size of gallbladder and the gestational age (P < 0.001). There was also a significant difference in the distribution of gallbladder types among the groups during the fetal period. The fundus of gallbladder was under the transverse plane passing from the part of inferior margin of the liver near the gallbladder in 14% of the cases. RESULTS: We concluded that there could be different types of gallbladders during the fetal period. We believe that the data collected in our study may contribute to the evaluation of the gallbladder development during the intrauterine period.

The development of fetal pylorus during the fetal period.

OBJECTIVE: The objective of this study was to explore the localization of the pylorus, its macroscopic and microscopic development and relationship with neighboring structures. MATERIALS AND METHODS: The study is carried out on 160 human fetuses aged between 9 and 40 weeks of gestation. Abdomen was divided into four quadrants by horizontal and vertical planes passing through the umbilicus. Topographical localization of the pylorus in reference to these quadrants and its distance were determined. Pylorus was divided into pre-pyloric, pyloric, and post-pyloric regions. Starting from the pre-pyloric end, serial sections spanning whole pyloric part were obtained. Wall thickness, the thickness of the muscular coat were measured under light microscope using sections stained with hematoxylin eosin. Sections with the thickest muscular coat were considered as the region where pyloric sphincter was. FINDINGS: Pylorus was located in the right upper quadrant, on the median plane and in the left upper quadrant. There was a significant relation between the thickness of the muscular coat in the stomach, duodenum and the pyloric region and gestational age. In the region of the pyloric sphincter, the rate of increase in the thickness of the muscular coat was higher in the first and the first half of the second trimesters than term fetuses. CONCLUSION: We believe that data obtained in the present study will contribute to the assessment of development of the pyloric region in intra-uterine cases.

Development of spleen during the fetal period.

OBJECTIVE: This study was aimed to determine the location and development of the spleen in the human fetuses. MATERIALS AND METHODS: The study was carried on 141 dead human fetuses aged between 9 and 40 weeks with no marked pathology and anomaly in the years 2002-2003. The location of spleen with the neighboring structures, the existence of accessory spleens, notches on the borders, fissures on the surfaces, major ligaments and the shape of spleen and its hilum were established. The spleen was completely observed intraperitoneally (except at the hilum), in the left hypochondrium throughout the fetal period. The length, width, thickness, weight, volume, and the hilum dimensions of spleen were measured. RESULTS: The dimensions, weight, and volume of the spleen were increased with the gestational age, and positive significant correlations were determined (P < 0.001). There was no difference between sexes in all parameters (P > 0.05). The length of the spleen has ranged between 3.1 and 35.6 mm, between 9 weeks old and 40-week-old fetuses, respectively. One or more accessory spleens have been found in 14% of cases. CONCLUSION: The measurements and location of the spleen according to the gestational age were determined by the present study. The expression of morphometric parameters of the spleen at different gestational ages can be used in determination of pathologies of the spleen and may also contribute to future studies on this issue.

The proportions of the white and red pulps of the human fetal spleen.

OBJECTIVE: To compare the proportions of white and red pulps of the human spleen during the fetal period. METHODS: We performed this study in the Department of Anatomy and Pathology of Suleyman Demirel University, Faculty of Medicine, Isparta, Turkey, from the period between 2002-2003. Spleens from 137 dead fetuses aged between 9 and 40 weeks were embedded into paraffin blocks following classical histological steps and stained with hematoxylin and eosin. White and red pulps could be differentiated only in 25 cases (13 males, 12 females). The proportions of the areas of white and red pulps (the trabeculae were included into the red pulp and the groups of lymphocytes were included into the white pulp) were estimated by point counting method on the sections taken from different parts of the spleens by systematic randomized sampling technique. RESULTS: It has been ascertained that the white pulp has been distinguished from 20th week onwards during the fetal period. The proportion of the white pulp area has been found to be 22.3% (of total white and red pulp areas) at the 20th week and has come to 37.6% at the 40th week. Concerning the trimesters, the proportion of the white pulp area has been found to be 30% (of total white and red pulp areas) at the 2nd trimester and has come to 36% at full term. While the white pulp area had a positive correlation with the gestational age (r: 0.34), the red pulp area had a negative one (r: -0.34). No difference has been found among gender. CONCLUSION: Reference values have been obtained about the proportions of white and red pulp areas of human fetal spleen.

The development of stomach during the fetal period.

The objective of this study was to explore the fetal development of the stomach, its morphology and relationship with neighboring structures. The study is carried out in 2003 using 160 human embryos and fetuses (81 males and 79 females) aged between 9 and 40 weeks of gestation. None of the cases had any external pathology or anomaly. Its topographical localization and relationship with surrounding structures were revealed with anatomical dissections. Width and height of the stomach, lengths of the greater and lesser curvatures, the angle between horizontal and vertical axes of the stomach and types of stomach were established. During the fetal life stomach was most commonly located above the transverse axis passing through the umbilicus, in left and right hypochondrium (81%). There were significant differences among trimester groups with respect to the localization of the stomach in the quadrants (P < 0.001). There were no significant sex differences in parameters. After the second trimester, the height of the stomach increased more than the width of the stomach and anterior abdominal height. The angle of stomach decreased from 100 degrees to 50 degrees throughout the fetal period. During the fetal period, wide angles stomach was more common in the first(f) and second trimesters while acute-angled stomach was more common in the third trimester and term fetuses. Diagnosis and treatment of fetal anomalies and pathologies of the stomach requires knowledge of fetal anatomy of the stomach. Data acquired in this study are believed to contribute to the studies of obstetrics, perinatology, forensic medicine and fetal pathology on fetal development of the stomach, and diagnosis and treatment of its anomalies, pathologies, and variations.

Development of the liver during the fetal period.

OBJECTIVE: To investigate the development of the liver in human fetuses aged between 9-40 weeks. METHODS: We studied 121 human fetuses (62 males, 59 females) with no external anomalies aged between 9-40 postmenstrual weeks during 2003-2004 in Suleyman Demirel University, Isparta, Turkey. The fetuses were divided into four groups as 1st, 2nd and 3rd trimesters and full term fetuses. We measured fetal weight, length, width, thickness, and volume of the liver. We established localization of the liver and its relation with the neighboring structures, its ligaments, and size of itself and its lobes, shapes of the liver and the localization of the porta hepatis on the visceral surface of the liver. RESULTS: We found significant correlations between the size, weight, volume of the liver, sizes of its lobe and gestational age (p<0.001). Group comparisons disclosed significant differences between groups in all parameters except between 3rd and 4th groups with respect to the heights of the liver and the caudate lobe (p<0.05). During the fetal period, the proportion of the distance between the porta hepatis and the right margin of the liver to the distance between the porta hepatis and the left margin of the liver did not change significantly (p>0.05). However, the proportion of the distance between the porta hepatis and the upper margin to the distance between the porta hepatis and the lower margin decreased significantly with gestational age (p<0.05). Type 3 liver (square) was the most commonly observed type of fetal liver (53%). CONCLUSION: Our opinion is that the parameters obtained can be useful to diagnose pathologies of liver development and anomalies concerning several branches of medicine such as anatomy, pathologic anatomy (fetopathology), forensic medicine, medical imaging, obstetrics and pediatrics.

Ovarian arteries with bilateral unusual courses.

Bilateral unusual coursed ovarian arteries were found in a 45-year-old female cadaver. The ovarian arteries arose from the abdominal aorta at a level inferior to the corpus of L1 vertebra bilaterally. The right ovarian artery was coursing behind the inferior vena cava. The left one was coursing between the left renal artery and vein upward to the level of the inferior part of the body of Th12 vertebra. At the level of Th12 vertebra, it turned caudally and proceeded downward between the anterior-inferior and posterior segmental renal veins. On both sides, ovarian arteries were on their normal routes below the L2 vertebra accompanying the ovarian veins. The variation determined by this study would reduce possible complications of nephrectomy operations that urologists, gynecologists and other related surgeons may encounter.