ABSTRACT
The modern principles in pelvic surgery imply the preservation of the nervous structures that are involved in the physiological functioning of the pelvic and genital organs. The main pelvic nervous element is represented by the inferior hypogastric plexus. This plexus receives sympathetic afferent fibres from the hypogastric nerve, parasympathetic afferent fibres from the pelvic splanchnic nerves and also sympathetic afferent fibres coming from the sympathetic sacral chain via the sacral splanchnic nerves. We aimed to demonstrate the anatomy of these structures through dissection and we exposed the origins, pathway and manner of distribution of the splanchnic nerves of the pelvis. We managed to clarify the main anatomical relations of these nerves, among which we highlighted the relation to the branches of the internal iliac artery. The parasympathetic fibres reach the pelvis by running through the anterior rami of the spinal nerves, which are the origin of the sacral plexus. We managed to exhibit the way in which the parasympathetic fibres emerge from the sacral nerves and form the pelvic splanchnic nerves. Pelvic surgery nowadays is focused on nerve-sparing, which essentially means the conservation of the integrity of splanchnic nerves, hypogastric nerves and inferior hypogastric plexuses in order to maintain the normal functioning of the anatomical sphincters and genital organs. In this respect, it is crucial for the surgeon who performs pelvic procedures to be more than well-acquainted to the anatomy of the pelvic splanchnic nerves, which are considered to be the erectile nerves, and to that of the sacral splanchnic nerves.
ABSTRACT
Introduction:Safe and effective procedures in the perioral region rely on a clear understanding of the facial anatomy, as insufficient knowledge of this aspect can lead to severe complications. Materials and methods:We performed thorough layer-by-layer dissections of the perioral region on 11 freshly formalinized cadaver heads. Dissections were performed between 2020 and 2022 in the dissection laboratory of the Anatomy Department, where the ethical conducts were regulated by "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania, and fall under its jurisdiction. Dissections were digitally photographed and edited without altering the scientific content. By performing minute dissections, a considerable amount of attention has been paid to the trajectory and diameter of the superior and inferior labial arteries and their relations with the surrounding structures. Results:We demonstrated the presence of the fibro-muscular compartment above the philtrum, where the superior labial artery passes and gives off the columellar and septal branches, and where it can be compressed in case of either the migration of the filler or quick bolus injections of substance. We also emphasized the importance of the labial salivary glands as risk elements in the perioral region. The depth of the inferior labial artery varied between 4.1-5.4 mm and that of the superior labial artery between 4.8-5.6 mm. Discussion: Safe and complication-free procedures require an exact knowledge of the anatomy of the main neurovascular bundle of each facial region and their anatomical variability should be highlighted. Conclusion:The clinically relevant anatomical observations and descriptions of landmarks presented in our research serves as crucial information for plastic, reconstructive and aesthetic surgeons and dentists. Doppler ultrasound imaging has a considerable potential for both diminishing the risk and facilitating the prompt treatment of complications, especially because it is an affordable, repeatable, quick and reliable procedure. Cadaveric dissection for anatomy training provides an unparalleled opportunity to precisely understand the structure of actual human tissue and the clinical and structural relationships between the multitude of anatomical risk elements.
