The variations of osseous structure of the internal acoustic canal: an anatomical study.

OBJECTIVES: The internal acoustic meatus is an osseous canal that connects the inner ear to the posterior cranial fossa. It is located in the petrous portion of the temporal bone. A thin cribriform osseous plate known as the fundus is situated at the lateral end of the canal. This study assesses the structural and numerical variations of the fundus formations. METHODS: Fifty-four temporal bones of unknown gender and age were examined with the surgical microscope. RESULTS: The temporal bones analyzed were 46.2% right-sided and 53.7% left-sided. Only one temporal bone had two parallel transverse crests, while three had a single anterior crest that split into two branches posteriorly. The number of foramina at the transverse crest varied, with 29.6% having none, 48.1% having a single foramen, and 22.2% having several foramina. An anterior crest structure was seen in 53.7% of the temporal bones, with 5% having a slightly constricted entry to the facial canal. In cases with a single nerve foramen, 48.1% had one, while 51.8% had more than one, including examples with three or four foramina. A crest was found between the foramina of the single nerve in 7% of patients. Furthermore, a crest between the saccular nerve foramen and the high fiber foramina was seen in 25.9% of cases, and 5% had two saccular nerve foramina. CONCLUSION: We think that revealing the anatomical, structural and numerical variations in the fundus will be useful in explaining the disease-symptom relationship. LEVEL OF EVIDENCE: Level 4.

Topographic and morphometric anatomy of the proximal part of the dorsal scapular nerve.

The dorsal scapular nerve (DSN) entrapment neuropathy has recently been recognized as a common cause of circumscapular pain and cases of winged scapula. Course of the nerve is important because the middle scalene muscle is frequently accessed for surgical treatments. Studies in the literature have not focused on the morphometric relationship of the DSN with the scalene muscles and its relationship with the long thoracic nerve (LTN). The neck regions of 13 adult cadavers were dissected bilaterally. The relationship of DSN with scalene muscles and LTN was evaluated. Cervical spinal nerves involved in the formation of the DSN were identified. Three types of DSN were observed based on the cervical spinal nerves from which it originates, five types of DSN from its relationship with the scalene muscles, and two types of DSN from its relationship with the LTN. The distance from where the nerve pierces the scalene muscle to the mastoid process was found to be greater in DSNs originating from C4 and C5 (93.85 ± 4.11 mm, p = 0.033). In DSNs not connected with LTN, the distance from where the nerve pierces the scalene muscle to the superior trunk/C5 (12.74 ± 7.73 mm, p = 0.008) and the length of the nerve within the scalene muscle (14.94 ± 5.5 mm, p = 0.029) were found to be statistically significantly greater. The topographic and morphometric anatomy of the proximal part of the DSN is important, especially for scalene muscles-focused surgical treatments and interscalene nerve blocks. We believe our results may guide clinical approaches and surgery.

Variations in the course of the externalbranch of the superior laryngeal nerveand their importance in surgicalprocedures: an experimental cadaveric study.

<br><b>Introduction:</b> Injury of the external branch of the superior laryngeal nerve can cause a hoarse or weak voice due to the functional loss (dysergia) of the cricothyroid muscle. Defining the anatomical variations of the external branch of the superior laryngeal nerve and estimating their frequency are crucial for surgical interventions.</br> <br><b>Aim:</b> To reveal the topography of the external branch in the Anatolian population, to prevent injury of it during the surgical intervention in the anterior neck region.</br> <br><b>Material and methods:</b> 26 bilateral hemilarynges (4 females, 22 males) were dissected. The morphometric and morphological features of the external branch were examined. The obtained results were compared statistically, left and right.</br> <br><b>Results:</b> Landmarks such as the thyroid gland and laryngeal prominence were determined for the detection of the external branch. The variations of the course of the external branch and the points of piercing the cricothyroid muscle or inferior pharyngeal constrictor muscle were evaluated.</br> <br><b>Discussion:</b> Although safe approaches have been described for nerve protection during neck surgeries, injuries may occur during preliminary surgery as the mentioned nerve is thinner and more superficial than other branches of the vagus nerve. However, it can be detected more easily and safely by knowing the defined anatomical landmarks and morphological variations of the external branch.</br> <br><b>Conclusion:</b> The anatomical variations described can be a safe and important guide in surgeries of the anterior neck region.</br>.

Variations of the external branch of the superior laryngeal nerve during its course and its importance in surgical approaches: an experimental cadaveric study.

INTRODUCTION: Injury of the external branch of the superior laryngeal nerve can cause a hoarse or weak voice due to the functional loss (dysergia) of the cricothyroid muscle. Defining the anatomical variations of the external branch of the superior laryngeal nerve and estimating the frequency of it, it makes crucial for surgical interventions. AIM: To reveal the topography of the external branch in the Anatolian population, to prevent injury of it during the surgical intervention in the anterior neck region. MATERIALS AND METHODS: Twenty-six bilateral hemilarynges (4 females, 22 males) were dissected. The morphometric and morphological features of the external branch were examined. The obtained results were compared statistically left and right. RESULTS: Landmarks such as the thyroid gland and laryngeal prominence were determined for the detection of the external branch. The variations of the course of the external branch and the points of piercing the cricothyroid muscle or inferior constrictor pharyngeal muscle were evaluated. DISCUSSION: Although safe approaches have been described for nerve protection during neck surgeries, it can expose injuries during preliminary surgery approaches as the nerve is thinner and more superficial than other branches of the vagus nerve. However, it can be detected more easily and safely during the surgical approach by knowing the defined anatomical landmarks and morphological variations of the external branch. CONCLUSION: The anatomical variations described can be a safe and important guide in surgical approaches to be applied in the anterior neck region.

Evaluation of the Mortality and Morbidity of Premature Infants During a Five-Year Period in the Neonatal Intensive Care Unit.

Background Premature birth is the most important cause of perinatal mortality and morbidity. This study aimed to evaluate mortality and morbidity in premature infants over a five-year period at a university hospital providing tertiary intensive care health services. Methodology All premature infants born alive at ≤37 gestational weeks and hospitalized in neonatal intensive care units were included in the study. Data such as maternal and perinatal characteristics, characteristics of the newborn, respiratory and related problems, neonatal morbidities, and causes of death were retrieved retrospectively from file records. Results A total of 1,780 patients (53.7% male and 46.3% female) were included in the study. High-risk pregnancy was present in 55% of women. Respiratory distress syndrome (RDS) developed in 50.4% of the patients, intracranial hemorrhage in 8.4%, and necrotizing enterocolitis in 5.6%. Mortality was observed in 20.9% of the patients. The most frequent cause of death was RDS and related complications (11.8%), and 66.4% of mortality occurred during the early neonatal period, that is, the first 24 hours of life. Conclusions High-risk pregnancies were significantly associated with neonatal morbidity and mortality. Therefore, the management of maternal health factors should be the priority for controlling neonatal mortality.

The Geometrical Modeling of Aortic Root Complex.

BACKGROUND: This study was designed to investigate the anatomical relationship of the different levels of aortic root. MATERIALS AND METHODS: The morphological features of the aortic root were examined using of 12 adult hearts from fixed male cadavers who had expired due to noncardiac causes by magnetic resonance imaging and applied mathematical analyses to the results. The measurements of the aortic root were done at four levels: at the ventriculoarterial junction (annulus), at the largest level of the Valsalva sinuses (sinus), at the level of commissures (sinotubular junction [STJ]), and at 1 cm above the STJ (aorta ascendens). We derived an equation that allows calculation of the appropriate diameter of the aortic root from four levels. Statistical analysis among the variation of the diameters at the four levels of aortic root was achieved using test one-way analysis of variance. RESULTS: The data showed a geometric pattern of the aortic root. The comparison of the values from four levels showed that the narrowest at the sinotubular junctional level and the widest at the sinus level. CONCLUSION: The analysis of our data shows that the aortic root has a consistent shape with varying size and that is a definable mathematical relationship between root diameter.

Evaluation of temperature rise following the application of diode and ErCr:Ysgg lasers: an ex vivo study.

PURPOSE: Erbium, chromium: yttrium, scandium, gallium, garnet (ErCr:Ysgg) lasers have been frequently used in oral surgical procedures and are almost seen as alternatives to diode lasers. The aim of this comparative study was to analyze in an animal model the thermal elevation induced by ErCr:Ysgg and diode lasers in soft tissue and bone. MATERIALS AND METHODS: Thirty freshly dissected sheep mandibles containing bone and soft tissue were divided into 120 equal parts. Gallium-aluminum-arsenide (Ga-Al-As) diode laser (λ=940 nm) with 1, 2 and 5 W output powers and ErCr:Ysgg laser (λ=2780 nm) with 2.75, 4.5 and 6 W output powers were used on soft and bone tissues separately for 3 seconds with point application. Mean temperature values before and after application of the lasers were compared in soft tissue and bone. RESULTS: The minimum mean temperature value was observed with 2.75 W ErCr:Ysgg laser while irradiation with 5 W diode laser created the maximum values (p<0.05). CONCLUSION: ErCr:Ysgg laser (λ=2780 nm) with 2.75 W power generates low levels of heat compared to diode lasers and may provide safer surgery in soft and bone tissues without destructive effects of temperature increase.

Current status of cadaver sources in Turkey and a wake-up call for Turkish anatomists.

Persisting difficulties in body procurement in Turkey led to the acquisition of donated, unclaimed, autopsied, and imported bodies regulated under current legislature. Yet, no study had investigated the extent of the on-going cadaver problem. This study was aimed to outline cadaver sources in anatomy departments and their effectiveness by means of an online survey. Additionally, official websites of each department were investigated regarding any information on body donation. Unclaimed cadavers (84.8%) were the major source for anatomy departments, followed by donated (50%) and imported cadavers (39.1%). Foundation-based medical faculties were more likely to import cadavers (P = 0.008). There was a moderate increase (rs = 0.567; P = 0.018) in donation registrations to our department after 2000. The departments in cities with significantly higher City-Based Gross Domestic Product measures (US$9,900 vs. US$16,772, P = 0.041), frequencies for mid- or high-school graduates (30.4% vs. 31.3%, P = 0.041), and frequencies for under- or post-graduates (13.1% vs. 15.8%, P = 0.24) had managed to use donated cadavers. Anatomy departments' major reasons for using unclaimed cadavers were education (45.9%), unclaimed cadavers being the only source (24.3%), and receiving inadequate donations (21.6%). Nine out of seventy-four departments (12.2%) provided information regarding body donation on their websites. Body procurement remains as a serious problem in Turkey and it is apparent that current legislature does not provide a sufficient cadaver inflow. Similarly, anatomy departments' effectiveness in public awareness of body donation and support in the National Body Donation Campaign seems questionable. Anat Sci Educ 11: 155-165. © 2017 American Association of Anatomists.

The effects of irrigation volume to the heat generation during implant surgery

Background: To evaluate the effects of the amount of irrigation on heat generated during implant site preparation. Material and Methods: Ten freshly dissected sheep mandibles were sectioned into 30 equal bone blocks and transferred into a heat-controlled water tank. Implant socket preparations were performed with four consecutive drills. Temperature measurements were performed with a thermocouple inserted into the bone immediately before the preparation and after the drilling using three different physiologic saline irrigation set-ups: 1- No irrigation, 2- 12 ml/min and 3- 30 ml/min irrigation volume. The temperature differences between three different irrigation setups for implant drills 1, 2, 3 and 4, and the temperature differences between the drills for three different irrigation set-ups were separately compared. Results: The temperature difference of no irrigation group was significantly higher than 12 ml/min and 30 ml/min groups for all four drills (p<0.05) The temperature difference of drill 1 is significantly higher than drills 2, 3 and 4 for no irrigation group. (p>0.05) The temperature difference of drill 1 is significantly higher than drills 2, 3 and 4 for no irrigation group. (p<0.05) The temperature differences of drill 1, 2 and 3 were significantly higher than the temperature difference of drill 4 for 12 ml/min irrigation group. (p<0.05). Conclusions: The heat generated during drilling is not directly proportional to the coolant volume. Given that certain amount of irrigation is applied, implant sites can be prepared safely without the need for additional irrigation, which may result in reduced visibility of the surgical site and therefore a suboptimal surgery (AU)

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Publication Rates and Inconsistencies of the Abstracts Presented at the National Anatomy Congresses in 2007 and 2008.

BACKGROUND: Despite significant efforts made for, most abstracts presented during a meeting do not proceed and publish as a manuscript in scientific journals. AIMS: To investigate publication rates of national anatomy congresses. STUDY DESIGN: Descriptive study. METHODS: All abstracts presented at two annual meetings in 2007 and 2008 were extracted. PubMed and Google Scholar database search used for publication history. Presentation and study types, publication rates and mean publishing times were evaluated. Inconsistency rates between meeting abstract and final published article were also considered. RESULTS: Among 342 abstracts, 195 (57%) were followed by a full-text article. Publication rates for oral and poster presentations were 75% and 52.2%, respectively. The mean publication time was 23.7±23 months. Overall, 89.2% of the articles were published within 5 years. There were no inconsistencies in 50 (25.6%) articles, while 145 (74.4%) had inconsistencies compared to the abstracts presented at the congress. Getting adequate information for 45 (23.1%) articles was not possible. There was no standard reporting format for the abstracts. CONCLUSION: Our study shows that, overall publication rates for abstracts presented at national anatomy meetings were higher than those presented at national meetings for clinical specialties.

Histological evaluation of the possible transformation of peripheral giant cell granuloma and peripheral ossifying fibroma: A preliminary study.

AIMS: The objective of this study is to describe shared morphological features of peripheral giant cell granuloma (PGCG) and peripheral ossifying fibroma (POF) in detail and discuss the possible relationship between them. MATERIALS AND METHODS: Ten intermediate cases with features resembling to both POF and PGCG were selected and type 3 and 1 collagen immunostainings were performed for evaluation of the connective tissue maturation. Immunohistochemical staining percentage (SP) for stromal cells in the slides of POF and PGCG counterparts of intermediate lesions was scored as 1 when the SP was above 10%, 2 when the SP was above 25%, 3 when the SP was above 50% and 4 when the SP was above 75%. Staining intensity (SI) of immunuhistochemical staining was graded and scored as 1 - mild, 2 - moderate, and 3 - severe. An immunoreactivity score was calculated by multiplying SP and SI. RESULTS: All intermediate lesions comprised osteoclast type multinucleated giant cells and partly mineralized hard tissue component. Parts of intermediate lesions resembling POF showed higher type 1 collagen immunoreactivity compared to the PGCG counterparts of intermediate lesions (P < 0.05). PGCG counterparts showed higher type 3 collagen immunoreactivity compared to the POF counterparts of the intermediate lesions (P < 0.05). CONCLUSION: POF may be a later stage lesion with morphologically more mature components. A possible transformation may be considered for these two lesions.

In the diagnosis of neonatal sepsis importance of gelsolin and relationship with mortality and morbidity.

In spite of advances in neonatal care and the new generation of antibiotics, neonatal sepsis is still a major cause of morbidity and mortality. Early diagnosis of neonatal sepsis is difficult because clinical signs are non-specific. Thus, new biomarkers are still needed for diagnosis. Gelsolin is an actin-binding plasma protein. Furthermore, extracellular gelsolin binds lipopolysaccharide and lipoteichoic acid, which are major virulence factors of Gram-negative and Gram-positive bacteria. The result of this binding is the inhibition of gelsolin's F-actin depolymerizing activity. Thus, gelsolin inhibits the release of IL-8 from human neutrophils subjected to lipoteichoic acid, lipopolysaccharide and heat-inactivated bacteria treatment. Our hypothesis is that pGSN levels decrease in neonatal infants with sepsis and this decrease might be used as a reliable biological marker. Forty patients who were diagnosed with severe sepsis at a neonatal intensive care unit were enrolled in the sepsis group. Twenty patients who were followed for prematurity were enrolled in the control group. The pGSN level at the time of diagnosis in the sepsis group was 33.98±11.44µg/ml, which was significantly lower than that of control group (60.05±11.3µg/ml, P<0.001) and after treatment (53.38±31.26µg/ml, P=0.003). Area under ROC curve was 0.96 (p: 0.0001, 95% CI; 0.90-0.99). Sensitivity was 90.32 (95% CI; 74.2-97.8), specificity was 95 (95% CI; 75.1-99.2). Plasma gelsolin significantly decreased in septic patient and recovery of decreased gelsolin levels correlated with clinical improvement. Thus, plasma gelsolin may be a usable marker for severe sepsis.

Efficacy of immediate postoperative intramasseteric dexamethasone injection on postoperative swelling after mandibular impacted third molar surgery: A preliminary split-mouth study.

OBJECTIVE: To evaluate the efficacy of immediate intramasseteric injection of dexamethasone on postoperative oedema. METHODS: The prospective study was conducted at the Department of Oral and Maxillofacial Surgery, Ankara University, Ankara, Turkey, in July 2012, and comprised patients aged 15-32 years who presented for the removal of bilateral vertical impacted mandibular third molar teeth.The right and left impacted third molars of each patient were randomly allocated into study and control groups. The impacted teeth in the study group were extracted with surgical bone removal, and 2ml of 8mg/2ml dexamethasone was injected into the ipsilateral masseter muscle immediately after suturing.In the control group, dexamethasone was replaced with 2ml of sterile saline solution. Postoperative facial oedema was measured with a tape scale by calculating the distance between several facial landmarks on postoperative day 2. SPSS 15 was used for data analysis. RESULTS: The mean age of 20 patients was 21.35±4.18 years, and there were 9(45%) patients between 15-20 years of age, while 11(55%) were 21-32 years. IN terms of gender, 9(45%) patients were male and 11(55%) were female. Postoperative oedema was significantly reduced in the study group compared to the control group (p<0.05). CONCLUSIONS: Immediate intramasseteric injection of dexamethasone was effective in reducing postoperative oedema after mandibular impacted third molar surgery.

Sonographic Diagnosis of Fetal Adrenal Hemorrhage Complicating a Vein of Galen Aneurysmal Malformation.

BACKGROUND: The vein of Galen aneurysmal malformation (VGAM) is a rare intracranial vascular malformation which causes end-organ ischemia or venous congestion due to heart failure. Adrenal hemorrhage associated with VGAM has not been reported in the literature. We present the imaging findings of a fetal VGAM with adrenal hemorrhage. CASE REPORT: A 26 year-old primigravida woman whose fetus with VGAM and mild cardiomegaly was scanned in the 34th week. On fetal ultrasound, a hyperechoic, well-circumscribed mass in the left suprarenal region was shown. Fetal and postnatal magnetic resonance imaging confirmed the diagnosis of adrenal hemorrhage. The baby died after delivery. CONCLUSION: Adrenal hemorrhage can complicate VGAM in fetuses with severe heart failure. Evaluation of the adrenal gland in affected cases may contribute to the prenatal counseling, and postnatal management.

A new anatomic trait for identifying the mendosal suture in young children: the mendosal-lambdoidal angle.

PURPOSE: Radiologic diagnosis of skull fractures in young children is difficult due to numerous accessory sutures. This is especially true around the occipital bone because it has more than one ossification center. Normal anatomic variants, such as the mendosal suture, may be misinterpreted as a skull fracture. We investigated the anatomic traits of the mendosal suture in young children. METHODS: We retrospectively evaluated 52 children, aged between 1 month and 4 years, who had undergone head computed tomography with three-dimensional reconstructions. We evaluated the presence or absence of the mendosal suture. If present, then we measured the length of the suture and the angle between the lambdoidal and mendosal suture lines. RESULTS: The presence of the mendosal suture was bilateral in 12 children and unilateral in 5 children. The mendosal suture had a mean length of 13.9 ± 3.4 mm on the right side and 11.2 ± 4 mm on the left side. The angle between the mendosal and lambdoidal sutures had a mean value of 54.2° ± 11° for the right side and 53.6° ± 13.9° for the left side. The 95 % confidence interval for the mean value of the angle had a lower and upper bounds of 48° and 60° on the right side and 46° and 61° on the left side, respectively. CONCLUSIONS: The angle between mendosal and lambdoidal suture lines may help radiologists to identify the mendosal suture.

Effect of parenterally L-arginine supplementation on the respiratory distress syndrome in preterm newborns.

L-Arginine (L-Arg) is the precursor of nitric oxide which plays an important role on pulmonary circulation and pulmonary vascular tone. Earlier studies suggested that L-Arg levels in preterm newborns with respiratory distress syndrome (RDS) were low due to its consumption and L-Arg supplementation may reduce the severity of RDS. Our aim was detect the effect of the parenterally L-Arg supplementation on RDS severity. The subjects were chosen between preterm newborns (gestational age <34 weeks) (n = 30). Twenty of the subjects were diagnosed with permaturity and RDS, and 10 of the subjects were healthy preterm newborns. Ten of the subjects was taken L-Arg (1.5 mmol/kg/d) in addition to routine RDS treatment and assumed as "Group 1". In this group, daily L-Arg supplementation was started end of the first day, and continued at end of fifth day. The others of the subjects diagnosed with RDS was take routine RDS treatment and assumed as "Group 2". Healthy preterm newborns assumed as "Group 3". Blood collections for L-Arg levels via tandem mass spectrometry were made in first day and repeated on the seventh days. Oxygenation index was used to determine severity of RDS. L-Arg consentrations in Group 1 were 8.7 ± 4.1 µM/L and 11.9 ± 5.0 µM/L in first and seventh day, respectively. L-Arg consentrations were 12.6 ± 4.5 µM/Land 10.9 ± 5.4 µM/L in Group 2 and 8.6 ± 5.1 µM/L and 9.4 ± 4.1 µM/L in Group 3. There is no correlation between L-Arg concentrations and OI also duration of the mechanical ventilation of the subjects in patient groups (Group 1 and 2).

Anatomical relations between anterior coracoscapular ligament and suprascapular neurovascular structures and a proposal for classification.

OBJECTIVE: Although suprascapular nerve entrapment is rare, the most common site of compression is the suprascapular notch. The anterior coracoscapular ligament (ACSL), which lies inferior to the superior transverse scapular ligament (STSL), may also be a cause of entrapment. We aimed to investigate the presence of ACSL and its relations to the suprascapular nerve and vessels. METHODS: We dissected 50 shoulders of 26 cadavers. We excluded 2 shoulders due to previous shoulder surgery. We observed the course of the suprascapular nerve, artery, and vein(s), and examined whether they passed between STSL and ACSL or under ACSL. We classified the anatomical relations between neurovascular structures, STSL, and ACSL. In Type I, the suprascapular nerve passed between STSL and ACSL; in Type Iia, the suprascapular nerve and a single suprascapular vein passed between STSL and ACSL; in Type Iib, a suprascapular vein passed under ACSL and the suprascapular nerve passed between STSL and ACSL; in Type III, the suprascapular artery, vein, and nerve passed between STSL and ACSL. RESULTS: ACSL was present in 16 shoulders (32%). The suprascapular nerve passed between STSL and ACSL in all cases. We observed Type I, Type Iia, Type Iib, and Type III anatomical relations in 14%, 12%, 2%, and 4% of cases, respectively. CONCLUSION: Vascular structures that pass under STSL may cause suprascapular nerve entrapment. Presence of ACSL with vessel(s) passing under it and/or between it and STSL may increase the risk of nerve entrapment.