The anatomical variations of the cubital tunnel in a South African body donor sample.

PURPOSE: The ulnar nerve (UN) courses through the cubital tunnel, which is a potential site of entrapment. Anatomical variations of the cubital tunnel may contribute towards cubital tunnel syndrome (CuTS), however, these are not well described. The aim was to compare the range of variations and dimensions of the cubital tunnel and the UN between sexes and sides of the body. METHODS: Sixty elbows from 30 embalmed bodies (17 males and 13 females) were dissected. The prevalence of the cubital tunnel retinaculum (CuTR) or anconeus epitrochlearis (AE) forming the roof of the tunnel was determined. The length, width, thickness, and diameter of the cubital tunnel and its roof were measured. The diameter of the UN was measured. RESULTS: The AE was present in 5%, whereas the CuTR was present in the remaining 95% of elbows. The tunnel was 32.1 ± 4.8 mm long, 23.4 ± 14.2 mm wide, 0.18 ± (0.22-0.14) mm thick, and the median diameter was 7.9 ± (9.0-7.1) mm, while the median diameter of the UN was 1.6 ± (1.8-1.3) mm. The AE was thicker than the CuTR (p < 0.001) and the UN was larger in elbows with the AE present (p = 0.002). The tunnel was longer in males (p < 0.001) and wider on the right (p = 0.014). CONCLUSION: The roof of the cubital tunnel was more frequently composed of the CuTR. The cubital tunnel varied in size between sexes and sides. Future research should investigate the effect of the variations in patients with CuTS.

Profiting from public dissection: A new era of unethical practices.

Historically, adverse events have reflected poorly on both the practice of dissection and the perception of the discipline of anatomy. The recent public dissection of a body donor is a regression to an unethical historical practice and was strongly denounced by anatomists around the world. The individual whose donated body was sourced from a 'for-profit" company in the United States had not given consent for a public dissection. This violates the ethics surrounding consent and body donation and potentially places the future of body donor programs in jeopardy as it compromises community frameworks around epistemic trust. Recent guiding frameworks by international anatomical associations on the ethical use of bodies have cemented the way in which body donor programs should operate. This viewpoint reflects on past and current events pertaining to public dissections and questions how these indignities may influence the public's interaction with human bodies. The authors argue that public dissection should be prohibited as it is against social mores. Social pressure should be applied to individuals or companies who wish to profit from unethical anatomical practice and legislation prohibiting public dissection should be introduced in those countries where it does not yet exist.

Advances in Digital Technology in Teaching Human Anatomy: Ethical Predicaments.

The study of human anatomy has long been inseparable from illustration, as the portrayal of the dissected body alongside a descriptive text supports the understanding of this complex topic. With the advent of new technologies, applications for revealing the details of the human body have increased to include Computed Tomography and Magnetic Resonance Imaging scanning, digital photography and videography, and three-dimensional (3D) printing. In addition, the distribution of the captured image has become widespread in both online teaching and in hard copy textbooks. While these digital images and applications are invaluable for online teaching, particularly during pandemics, anatomists must consider whether the use of the images and data derived from human bodies (either donor or unclaimed) is ethical, as it is not always clear whether permission has been obtained for their creation.Questions regarding the ethical sourcing and use of images will become more urgent as the utilization of electronic data becomes routine. Particularly concerning is the distribution of images and videos in the public domain on social media, where the context and link with education may be severed. Other considerations include respect for the privacy of the deceased, ownership of images, and commercialization. An initial question that should be posed is "Who is responsible for the oversight of digital and 3D printed models of bodies?" The ethical use of such images needs to be considered by the global anatomy community in order to ensure that anatomists do not retreat into the ethical mire of their forefathers.

Anatomical features of the iliocapsularis muscle: a dissection study.

PURPOSE: Iliocapsularis (IC) overlies the anteromedial hip capsule and is an important landmark in anterior approaches to hip arthroplasty. Previously believed to be part of iliacus, few publications describe the prevalence, attachments, fibre direction, blood supply, innervation, and size of IC. This study was aimed to determine these anatomical features using embalmed bodies and whether they vary between sides, sex, and age. METHODS: Thirty-eight formalin-fixed adult bodies were dissected and the prevalence, presence of a connective tissue raphe, attachments, fibre direction, blood supply, and innervation, were documented. Length and width were measured, and significant differences were investigated with t tests. RESULTS: Iliocapsularis was present in all bodies examined, originating from the inferior border of the anterior inferior iliac spine, and inserting 20 mm distal to the lesser trochanter in 54 muscles (71%). Iliocapsularis was supplied by a thin branch from the femoral nerve and by branches of the lateral circumflex femoral and deep femoral arteries and veins. Muscle fibre direction was from superolateral to inferomedial. Mean length was 116.8 ± 11.2 mm and width was 12.8 ± 3.1 mm, with no significant differences between sides, sex, and age. CONCLUSION: This was the first study to document the venous drainage and compare the dimensions with sides, sex, and age, using adult bodies. However, the true function of IC is still unknown. Iliocapsularis is a constant muscle, distinct from iliacus, which is relevant to orthopaedic surgeons and physical rehabilitation specialists, particularly for postoperative patient care.

A systematic review and meta-analysis of iliocapsularis muscle: an important landmark in orthopedic surgery.

PURPOSE: Iliocapsularis (IC) is a small muscle overlying the capsule of the hip joint. Although recent attention is being given to this muscle by orthopedic surgeons who encounter it during the anterior approach to total hip arthroplasty, little is known about its anatomical features. The aim of this study was to review the anatomy of IC, and describe its' origin, insertion, blood supply, innervation, muscle fiber characteristics and size. The function, clinical relevance and comparative anatomy of IC were also appraised. METHODS: Using Evidence-Based Anatomy methodology, electronic databases were searched with the terms "iliocapsularis", "iliacus minor", "iliotrochantericus", and "ilioinfratrochantericus" to identify eligible studies. RESULTS: Six studies (n = 287 lower limbs) examining the anatomy of IC were included. The pooled prevalence (PP) of the IC was 98.7% (95% CI 96.5-100.0). It arises from the inferior facet of the anterior inferior iliac spine (AIIS) and attaches inferior to the lesser trochanter. Attached to the anteromedial capsule along its entire length, IC has the largest capsular contribution of any of the hip muscles (73.8 ± 27.3 × 16.1 ± 4.4 mm). Thus, it is an important landmark in anterior surgical approaches to the hip joint. CONCLUSION: The anatomy of IC is becoming more relevant with the increasing use of anterior approaches to hip surgery. With attachments to the AIIS, the lesser trochanter as well as the length of the capsule, this muscle is an important landmark in total hip arthroplasty. LEVEL OF EVIDENCE: Level V.

Development of a Virtual Journal Club in Anatomy: a Responsive Pandemic Pedagogy.

The COVID-19 pandemic forced changes to online teaching worldwide. The Clinical Anatomy journal club (JC) is key in the Bachelor of Science Honours (BScHons) programme and aims to improve scientific appraisal and communication abilities in anatomical research. An online JC through synchronous contact between members was deemed fitting as it could bridge the newly enforced geographical limitations due to the national lockdown in South Africa. Although common in clinical specialties, there are no published reports of anatomy themed online JCs. This project aimed to develop, implement, and appraise a synchronous virtual JC for Clinical Anatomy during the COVID-19 South African lockdown. A qualitative exploratory study design within an interpretive/constructivist paradigm was followed and aimed to explore students' perceptions of a virtual anatomy JC during the lockdown. The study was conducted at a South African institution, within the BScHons programme, and all enrolled students were invited to participate. Upon receipt of informed consent, an anonymous questionnaire was administered via Moodle for the BScHons students. The responses were analysed by thematic analysis, codes were developed, and themes were generated. Two main themes were generated from the results: the first related to the virtual format of the JC and the second focused on the content and topics covered during the JC sessions. The Clinical Anatomy staff and students adapted rapidly to the virtual JC and formed a community of practice. The benefits of teaching and learning within JC were maintained during the virtual format. It is envisioned that the JC will continue in a hybrid format (face-to-face and virtual) in future academic years. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40670-021-01325-8.

Congenital Anomalies of the Tracheobronchial Tree: A Meta-Analysis and Clinical Considerations.

BACKGROUND: The aim of this study was to determine the prevalence and anatomic features of major tracheobronchial anomalies. METHODS: Major electronic databases were systematically searched to identify eligible studies. Data were extracted and pooled into a meta-analysis. The primary outcome was the prevalence of major tracheobronchial anomalies, specifically tracheal bronchus (TB) and accessory cardiac bronchus (ACB). Secondary outcomes included the origin and types of TB and ACB. RESULTS: A total of 27 studies (n = 119,695 patients) were included. A TB was present in 0.99% (95% confidence interval, 0.67 to 1.37) of patients, and an ACB was present in 0.14% (95% confidence interval, 0.09 to 0.20). The overall prevalence of TB was higher in imaging than in operative studies (1.81% vs 0.82%). It was also higher in pediatric (2.55%) than in adult studies (0.50%). Patients with other congenital anomalies were 15 times more likely to have a TB (odds ratio 14.89; 95% confidence interval, 7.09 to 31.22). The most common origin of TBs was from the trachea (81.42%), primarily from the right side (96.43%). The most common origin of ACBs was from the intermediate bronchus (74.32%). The ACBs terminated as blind-ending diverticulum in two thirds of cases. CONCLUSIONS: Major tracheobronchial anomalies are present in approximately 1% of the population, although the prevalence is higher among pediatric patients and patients with accompanying congenital anomalies. Although rare, major tracheobronchial anomalies can be associated with significant respiratory morbidities and present challenges during airway management in surgical and critical care patients. Establishing a preoperative diagnosis of these variations is essential for planning and implementing an appropriate airway management strategy to minimize attendant complications.

The inferior intercavernous sinus: An anatomical study with application to trans-sphenoidal approaches to the pituitary gland.

OBJECTIVES: The inferior intercavernous sinus is located below the pituitary gland in the sella turcica. Its presence has been controversial among anatomists because it is not always found on radiological imaging or during cadaveric dissections; however, it is becoming a better-known structure in the neurosurgical and radiological fields, specifically with respect to transsphenoidal surgery. Therefore, the present study was performed to better elucidate this structure at the skull base. PATIENTS AND METHODS: Fifty adult, latex injected cadavers underwent dissection. The presence or absence of the inferior cavernous sinus was evaluated and when present, measurements of its width and length were made. Its connections with other intradural venous sinuses were also documented. RESULTS: An inferior intercavernous sinus was identified in 26 % of specimens. In all specimens, it communicated with the left and right cavernous sinus. The average width and length were 3 mm and 9.5 mm, respectively. In the sagittal plane, the inferior intercavernous sinus was positioned anteriorly in 31 %, at the nadir of the sella turcica in 38 %, and slightly posterior to the nadir of the sella turcica in 31 %. In two specimens (15.4 %), the sinus was plexiform in its shape. In one specimen a diploic vein connected the basilar venous plexus to the inferior intercavernous sinus on its deep surface. CONCLUSION: An improved understanding of the variable anatomy of the inferior intercavernous sinus is important in pathological, surgical, and radiological cases.

The bridging bronchus: A comprehensive review of a rare, potentially life-threatening congenital airway anomaly associated with cardiovascular defects.

The bridging bronchus is a rare congenital airway anomaly in which the right upper lobe of the lung is supplied by the right main bronchus while the right lower lobe, and often the right middle lobe is supplied by an aberrant bronchus arising from the left main bronchus. The aberrant bronchus crosses (bridges) the lower part of the mediastinum, hence the term bridging bronchus (BB). This potentially life-threatening condition, usually accompanied by diffuse or focal airway stenosis, commonly presents with signs and symptoms related to large airway obstruction, such as respiratory distress, apnea, wheezing, stridor, and recurrent respiratory tract infections. Diagnosis of the BB is often challenging because the associated signs and symptoms mimic those of common conditions such as bacterial and viral bronchiolitis, bronchial asthma, cystic fibrosis, and foreign body aspiration. The BB is also often accompanied by congenital cardiovascular anomalies, including left pulmonary artery sling, atrial, and ventricular septal defects, tetralogy of Fallot, patent ductus arteriosus, and coarctation of the aorta. Patients presenting with the above signs and symptoms who are not responsive to standard treatment modalities, and have accompanying cardiovascular congenital anomalies should, therefore, be investigated for the BB. Herein, we review the anatomy, embryology, clinical presentation, differential diagnosis, imaging techniques and surgical management of the BB.

Reporting sex or gender in anatomical research: Which is appropriate?

Sex- and gender-based differences need to be considered in evidence-based medical research as there are anatomical and physiological differences between males and females. Females are underrepresented in studies, with results from males often generalized to both sexes. The Sex and Gender Equity in Research (SAGER) guidelines were published in 2016 to address sex- and gender-bias in research. Correct understanding and appropriate use of the terms "sex" and "gender" are essential. These terms are discussed in an anatomical context and recommendations are made as to how the SAGER guidelines can guide the reporting of anatomical studies to minimize the risk of reporting bias. Clin. Anat. 32:697-698, 2019. © 2019 Wiley Periodicals, Inc.

Variations in the branching pattern of the aortic arch: an African perspective

Variation in the branches of the aortic arch is higher in individuals of African descent. However, published studies are few. The aims were to document variations in the branching pattern of the aortic arch in a South African sample, determine whether these variants are more common than other populations, and determine whether there are any significant differences in the prevalence of variation between males and females. The aortic arch and main branches were dissected in 733 cadavers. All branching patterns were documented and classified as types. Chi-Square tests were used to determine whether there were any significant differences in prevalence of variation between males and females. The diameters of the main branches were measured and compared between sexes.The standard branching pattern was present in 65% of individuals, similar to that reported for other African studies, but lower than other studies from around the world. Variations were more prevalent in males than in females (p = 0.025), while only the diameter of the left vertebral artery, when arising from the arch was significantly larger in females, with no differences between sexes for the other vessel diameters. The results of this study support the hypothesis that variations in the branching pattern of the aortic arch are more common in African individuals. These individuals may be at increased risk of associated although rare, clinical symptoms or iatrogenic injury

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An unusual case of three branches arising from the aortic arch: bicarotid trunk, left subclavian artery and aberrant right subclavian artery

The presence of an aberrant right subclavian artery originating as the last branch of the aortic arch is a rare variation. A single case of this aberrant vessel, together with a bicarotid trunk, was observed in an 80-year-old female during dissection. A small, atherosclerotic saccular aneurysm was present at the origin of the aberrant vessel. The aberrant right subclavian artery coursed posterior to the esophagus and trachea to reach the right upper limb. Surgeons operating on structures in the mediastinum, including the esophagus, should be aware of the existence of this variant vessel to avoid accidental injury

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Variation in the anatomy of the ligamentum arteriosum in a South African simple

The ligamentum arteriosum is a remnant of the ductus arteriosus, which connects the aortic arch and the pulmonary trunk during fetal life. Variation in the anatomy of the ligamentum arteriosum, its connections with the aorta and pulmonary trunk and the course of the left recurrent laryngeal nerve relative to the ligamentum arteriosum were investigated. Dissection of the superior mediastinum was performed on 40 cadavers. The anatomy of the ligamentum arteriosum and its relationship to the aortic arch, pulmonary trunk and left recurrent laryngeal nerve were documented. The dimensions of the ligamentum arteriosum were measured with a caliper. Ligamenta arteriosa in which presence of a lumen was suspected were examined histologically. Variation in the structure and size of the ligamenta arteriosa was found to be common. A 'line' on the luminal surface of the aorta at the attachment site of the ligamentum arteriosum was observed in 26%. A shallow fossa or depression was found on the luminal surface of the pulmonary trunk in all but one individual. The left recurrent laryngeal nerve was situated lateral to the ligamentum arteriosum in 97%. Variation in the anatomy of the ligamentum arteriosum was found to be common, whereas variation in the position of the left recurrent laryngeal nerve was rare. This information is relevant for surgeons to avoid accidental injury to variant structures. Remnants, in the form of 'lines' or depressions, of the anatomical association between the ductus arteriosus and the aorta and pulmonary trunk were present

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