RESUMEN
A rare variation was seen in the arterial supply of liver and gall bladder during dissection of an adult female cadaver. The right hepatic artery was having a tortuous course with double loops and cystic artery was arising from the distal loop within the hepatobiliary triangle. There was an accessory cystic artery arising from the superior pancreaticoduodenal artery outside the hepatobiliary triangle which ascended anterior to the common bile duct and cystic duct towards the gall bladder. The knowledge of these vascular variations is very much essential owing to increase in surgical interventions involving the biliary tract. Recognition of such vascular variations is essential for laparoscopic surgeons to reduce complications like uncontrolled intraoperative bleeding, iatrogenic extrahepatic biliary injuries and conversion to open cholecystectomy. This report emphasizes the necessity of all surgeons being well aware of vascular variations and anomalies to be able to accomplish safe and uneventful hepatobiliary surgeries.
RESUMEN
BACKGROUND: Pterygospinous and pterygoalar ligaments present at the cranial base may sometimes get ossified leading to the formation of complete or incomplete bony bars in relation to foramen ovale. These are of clinical importance because these may obliterate the foramen ovale causing mandibular neuralgia. They may cause trouble in performing thermocoagulation and anaesthesia for trigeminal neuralgia. They may pose surgical difficulty in approaching the retro and parapharyngeal spaces and hence the anatomy of these bony bars is very important. MATERIALS AND METHODS: The present study was conducted in 100 dry human skulls of unknown sex to know the incidence, side, degree of ossification (complete/ incomplete) and relation of the pterygospinous and pterygoalar bars to the foramen ovale. RESULTS: Pterygospinous and pterygoalar bars were seen in 41 skulls which were classified into Type I (26.83%), Type II (58.54%) and Type III (14.63%) based on the presence of pterygospinous bar, pterygoalar bar or both together. Pterygospinous bars were seen in 17 skulls of which, one skull (5.88%) had complete and 16 skulls (94.12%) showed incomplete bars. Out of the 30 skulls with pterygoalar bars, complete bar was seen in one (3.33%) and incomplete in 29 skulls (96.67%). These bars were seen more on the left side of the skull than on the right. They were in close relation to the foramen ovale; the pterygospinous bar was inferior or medial to foramen ovale and pterygoalar bar was lateral, inferior or medial to the foramen ovale. CONCLUSION: The presence of the pterygospinous and pterygoalar bars cause variety of symptoms due to neurovascular entrapment and also obstruct surgical approaches to the base of skull. Hence the anatomical knowledge of these osseous bars is essential for anaesthetists, radiologists, dentists and neurosurgeons to increase the success of diagnostic evaluation and surgical approaches to the cranial base.
