A guideline for femoral nerve block with the age-related formulas obtained from the distances between the femoral nerve and surface anatomical landmarks in fetal cadavers / Una guía para el bloqueo del nervio femoral con fórmulas relacionadas con la edad obtenidas a partir de las distancias entre el nervio femoral y los puntos de referencia anatómicos superficiales en cadáveres fetales

SUMMARY: The femoral nerve (FN) is used for nerve block in many surgeries and provides effective postoperative analgesics in the pediatric population. However, although there are sufficient anatomical maps and signs for femoral nerve blockades in adults, there is not enough information for the pediatric group. Therefore, in our study, we tried to determine an effective area for safe block blocking with the help of bone structures in order to perform effective blockade in younger age groups. The study was conducted on 60 lower limbs. The exit point of the FN was identified. The measurements were examined in two regards, namely the level of the FN and the relationship of the FN with the surrounding structures. For the right and left sides, all the parameters showed increases with age. A significant relationship was found between all the parameters of the fetal cadavers (p<0.01). It was determined that there was a strong correlation between all parameters related to FN and surrounding bone structures (p<0.01). Sex was not found to be significantly related to the other parameters (p<0.05 Among all the fetal cadavers, high-level division was observed in six limbs (10 %), mid-level division in 33 limbs (55 %), and lower-level division in 21 limbs (35 %). Gestational age-based regression equations from my study showed that the site of the blockage could be effectively performed with the aid of palpable bone structures from the outside without the need for technical assistance.

RESUMEN: El nervio femoral (NF) se utiliza para el bloqueo nervioso en muchas cirugías y proporciona analgesia posoperatoria eficaz en la población pediátrica. Sin embargo, aunque existen suficientes mapas anatómicos y signos de bloqueo del NF en los individuos adultos, no hay suficiente información para el grupo pediátrico. Se intentó determinar una área exacta para el bloqueo del NF junto con estructuras óseas para realizar un bloqueo efectivo. El estudio se realizó en 60 miembros inferiores. Se identificó el punto de salida del NF. Las mediciones se realizaron en dos puntos, nivel del NF y la relación de éste con las estructuras circundantes. Para los lados derecho e izquierdo, todos los parámetros mostraron incrementos con la edad. Se encontró una relación significativa entre todos los parámetros de los cadáveres fetales (p<0,01). Se determinó que existía una fuerte correlación entre todos los parámetros relacionados con el NF y las estructuras óseas circundantes (p <0,01). No se encontró que el sexo se relacionara significativamente con los otros parámetros (p<0,05 Entre todos los cadáveres fetales se observó un alto nivel de división en seis miembros (10 %), una división de nivel medio en 33 miembros (55 %) y división de nivel inferior en 21 miembros (35 %). Las ecuaciones de regresión basadas en la edad gestacional del estudio mostraron que el sitio de bloqueo se podría realizar eficazmente con la ayuda de estructuras óseas palpables desde el exterior sin necesidad de asistencia técnica.

Internal acoustic opening: different osseous landmarks and their clinical implications / Poro acústico interno: diferentes hitos óseos y sus implicaciones clínicas

SUMMARY: Internal acoustic opening is a space that opens to facies posterior of the petrous piece of temporal bone that goes inside facial nerve, vestibulocochlear nerve, intermedial nevre and labyrinthine artery. The purpose of this study is the assessment of internal acoustic opening from a morphometric perspective, determination of the shape of the hole and determination of the distance to some important anatomic formations. This study is conducted on 166 temporal bones with unknown sex formation which are part of the skull collection in NEU and KTO Karatay University, Anatomy Department. In this study, the vertical and diameter of internal acoustic meatus, its distance to the bottom and top sides of posterior surface of the petrous part, its distance to groove for superior sagittal sinus and its distance to apex were measured. Moreover, in this study internal acoustic opening spaces are categorized into six groups as round, oval, U-shaped, fissure, irregular and V shape. Digital caliper was used for internal acoustic meatus measurements. While the vertical horizontal diameters and distance to groove for superior sagittal sinus of internal acoustic opening on the right side are 4.12 mm, 6.83 mm and 19.64mm respectively, they are 4.56 mm, 7.10 mm and 21.06 mm on the left side respectively. We have observed in this study, 37.3 % of the internal acoustic opening as round, 34.3 % as oval, 6.6 % as U-shaped, 6.6 % as fissure, 12.7 % as irregular and 2.4 % as V-shaped. We believe that these measurements can provide guidance and help in surgical procedures.

RESUMEN: El poro acústico interno es un espacio que se abre en la cara posterior de la parte petrosa del hueso temporal, donde entran los nervios facial, intermedio y vestibulococlear, además de la arteria laberíntica. El propósito de este estudio fue la evaluación del poro acústico interno desde una perspectiva morfométrica, determinación de la forma del foramen y de la distancia a algunas formaciones anatómicas importantes. Este estudio se realizó en 166 huesos temporales de individuos de sexo desconocido que forman parte de la colección de cráneos del Departamento de Anatomía en NEU y KTO, Universidad de Karatay, Se midió la altura vertical y el diámetro del poro acústico interno, su distancia a los lados inferior y superior de la superficie posterior de la parte petrosa, su distancia al surco del seno sagital superior y su distancia al vértice. Además, el poro acústico interno se clasificó en seis grupos: redondos, ovalados, en forma de U, de fisura, irregulares y en forma de V. Se utilizó un calibrador digital para las mediciones del meato acústico interno. Mientras que los diámetros horizontales, verticales y la distancia al surco para el seno sagital superior del poro acústico interno en el lado derecho fue de 4,12 mm, 6,83 mm y 19,64 mm respectivamente, en el lado izquiedo fue de 4,56 mm, 7,10 mm y 21,06 mm, respectivamente. Hemos observado que en el 37,3 % de los casos el poro acústico interno era redondo, el 34,3 % ovalado, el 6,6 % en forma de U, el 6,6 % de fisura, el 12,7 % irregular y el 2,4 % en forma de V. Estas medidas pueden servir de guía y ayuda en los procedimientos quirúrgicos.

Sural nerve harvest for infants: integrated with information based on anatomical dissections

Background/aim: The aim of the present study was to determine the course and possible variations of the sural nerve with all anatomical details in human fetal cadavers. Materials and methods: This study was performed on 60 fetal cadavers. Formation type and level of the sural nerve was detected. Results: According to trimesters, it was determined that the mean transverse and vertical distance between the lowest point of the LM and the SN varied between 1.1 and 2.9 mm and 1.54 and 3.58 mm, respectively. Type 2 was the most common seen type of sural nerve (35.83%). It was determined that the sural nerve was mostly formed at the middle third of the leg (42.5%). Conclusion: Sural nerve graft with the knowledge of the anatomical details may be used for peripheral nerve reconstruction is required in congenital lesions, such as facial paralysis, obstetric brachial paralysis, and posttraumatic lesions in infants and children.

Morphological structure and variations of fetal lateral meniscus: the significance in convenient diagnosis and treatment.

PURPOSE: The aim of this study is to evaluate of morphometry of the lateral meniscus (LM) and determine incidence of the LM shapes. METHODS: This study was performed on fetal cadaver collection of Anatomy Department of Necmettin Erbakan University. Fifty human fetal cadavers (25 female, 25 male human fetal cadavers) were used in this study. Microdissection was performed. Morphometric measurements were performed. LM were classified into four types and five subtypes. RESULTS: In this study, it was identified that all parameters which were measured were found to be increased with gestational ages. Four morphological types and five morphological subtypes were determined. It was found that 12% of the LM were crescent-shaped, 66% of the LM were C-shaped, 14% of the LM were incomplete-disc-shaped, 2% of the LM were disc-shaped, 6% of the LM were variant C-shaped. CONCLUSIONS: A few studies on fetal meniscal anatomy and its development were performed. Each new study is important for having detailed anatomy and development of the fetal menisci which will have both clinical and anatomical impacts during childhood and adulthood for orthopedic surgeons and anatomists, respectively. The most important results of this study were the detailed objective analysis of the macroscopic fetal growth of LM. It was significantly observed that four morphological types and five morphological subtypes of LM. The results of the present study related with both the observation of morphological development of the fetal meniscal anatomy, and its morphological variants, are important in terms of improving our knowledge, and clinical approach on the description, and the management of the symptomatic lateral discoid meniscus tears in children, adolescents, and adults. The clinical relevance of this study was that this classification of fetal menisci could ameliorate our current understanding of the morphology of lateral meniscus in adult, further.