Mapping the Vascular and Muscular Topography of the Glabellar Region: Implication for Improving Safety and Efficacy of the Glabellar Injections.

BACKGROUND: Botulinum neurotoxin (BoNT) and filler injections into the highly vascularized glabellar region for aesthetical purposes are extremely common. Injections into the glabellar region without precise anatomical knowledge of its vascular and muscular topography may pose the risk of severe complications. OBJECTIVES: We aimed to improve the safety and efficacy of the glabellar injections by mapping the regional muscles and vasculature in relation to the medial canthus and the defined reference lines. METHODS: Meticulous dissection was performed to reveal glabellar region muscles and arteries under surgical microscope, in 16 hemifaces of whom arteries are injected with red-dyed latex. Location of the angular artery (AA) along with its branches was noted in relation to glabellar muscles. RESULTS: The AA was always located superficial to the levator labii superioris alaeque nasi muscle (LLSAN) and then coursed toward the medial canthus to anastomose with the supratrochlear artery deep to the origin of the depressor supercilii (DS). The AA gave subcutaneously located central and paracentral branches coursing close to the mid-face line in 14 out of 16 hemifaces. Variable muscular connections were also present between the LLSAN, the DS and the procerus (P) muscles. No arteries were detected at the base of the medial eyebrow to which the DS, the P, and the frontalis (F) inserted. CONCLUSIONS: This study provides a detailed map of muscular and vascular anatomy of the glabellar region to facilitate safe and efficient filler and BoNT injections without complications. NO LEVEL ASSIGNED: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Precise localization of parotid duct: a cadaveric study.

This study aimed to determine the precise localization and course of parotid duct based on morphometric data obtained by measurements regarding several superficial landmarks and lines. Totally, 46 parotid ducts of 24 formalin-fixed adult amputated heads (12 female and 12 male) aged between 45 and 92 years, present in the collection of Anatomy Department, School of Medicine, Mersin University, were evaluated. First, three reference lines were defined: L1: between intertragic notch and labial commissure, L2: between intertragic notch and nasal wing, and L3: between intertragic notch and lateral palpebral commissure. The location of the parotid duct with respect to these lines were recorded. In all sides, parotid duct was detected in the middle 1/3 of L1. In 71.7% of all hemifaces, the parotid duct was making an upward curve around L1. Its proximal end exiting from the anterior border of the parotid gland was 12.34 ± 28.83 mm below the proximal 1/3 point of L1. Then, it was crossing L1 at a point with a mean distance of 53.90 ± 9.69 mm from the labial commissure where it is almost at L1 midpoint. Its distal end was located 9.61 ± 2.88 mm above the distal 1/3 point of L1. In 21.7% of all hemifaces, PD was observed totally above L1, while the shortest distances of its proximal and distal ends to L1 were 4.35 ± 2.45 mm and 13.17 ± 4.52 mm, respectively. In 6.5% of all hemifaces, its proximal end was located just on L1, coursing upwards and terminating 11.76 ± 2.53 mm above L1.

Microsurgical anatomy of the spinal cord in human fetuses.

PURPOSE: To determine the microsurgical features of the spinal cord and ventral and dorsal rootlets in fetal period. METHODS: Twelve formalin-fixed fetuses (six females and six males) with a mean gestational age of 27.0 ± 2.04 weeks (range between 25 and 32 weeks) were dissected to evaluate morphological properties of the spinal cord and rootlets. RESULTS: Length and width of each spinal cord segment, number of dorsal and ventral rootlets, length of dorsal root entry and ventral root exit zones of each spinal nerve, spinal cord termination level, and the whole spinal cord length were determined in all fetuses. Contrary to previous reports, the number of ventral rootlets was always more than that of dorsal rootlets in all segments. No statistically significant gender difference was found for all parameters. Rootlet number and segment width in cervical region were larger than those of thoracic, while the lengths of dorsal root entry and ventral root exit zones in thoracic region were longer than those of cervical. In lumbar region, dorsal and ventral rootlet numbers were increasing again, while lengths of dorsal root entry and ventral root exit zones were decreasing. Number of dorsal and ventral rootlets of C5 and C6 segments was statistically higher than other cervical segments. The mean spinal cord length was found as 105.55 ± 11.30 mm and there was a positive significant relationship with gestational age. Conus medullaris level was detected between L1 and L3 segments. CONCLUSION: Detailed microsurgical data about the fetal spinal cord and the dorsal and ventral rootlets presented in this study provide significant information which may be essential during surgical interventions in early postnatal period and childhood targeting the spinal cord and spinal nerve roots.

The anatomical features of denticulate ligament in human fetuses.

PURPOSE: To determine the morphological features of the denticulate ligament in fetal period. METHODS: Twelve formalin-fixed fetuses (six females and six males) with a mean gestational age of 27.0 ± 2.04 weeks (range between 25 and 32 weeks) were dissected to reveal morphological properties of the denticulate ligaments. RESULTS: Denticulate ligament was observed as a continuous ligament extending throughout the length of spinal cord in all fetuses. It separated the vertebral canal into two as anterior and posterior parts and was anchored to the dura mater on either side of the spinal cord with mostly triangular processes as well as thin band-like extensions. The first denticulate ligament process was always a large and prominent fibrous band and was arising from the spinal cord surface, extending in an oblique direction upward to the anterolateral rim of foramen magnum, below and posterior to the hypoglossal canal. The last denticulate ligament process was observed either in the T11-12 (2 sides, 8%), T12-L1 (15 sides, 62%) or L1-2 (7 sides, 30%) and all were band-like processes. At certain spinal cord levels, denticulate ligament had no processes to attach duramater while in some other fetuses double denticulate ligament processes were detected within the same interval. The distance between the denticulate ligament process and the superior spinal nerve root and the distance between the denticulate ligament process and the inferior spinal nerve root were measured at each spinal level. This distance was found to be increased from upper to lower levels of the spine. CONCLUSION: Detailed morphological data about fetal denticulate ligament presented in this study provide significant information which may be essential during several surgical interventions performed in early postnatal period and childhood focusing on the spinal cord, spinal nerve roots and meningeal structures.

The Comparison of the Right and Left Sigmoid Sinus Cross-Sectional Areas in Fetal Period and the Factors Affecting the Venous Dominance.

OBJECTIVES: Skull base is an important and a challenging area for surgeons. Success in skull base surgery depends on various factors such as pre-operative evaluation, appropriate surgical technique, anesthesia duration, intraoperative neuromonitorization and wound care. MATERIALS AND METHODS: This study was performed in the Anatomy dissection laboratory of M.U. Medical Faculty (Ethical committee approval number 2010-103). Twelve fetuses between 17-33 gestational weeks fixed with formaldehyde were enrolled to the study. RESULTS: This study was planned to investigate the cross sectional areas of the sigmoid sinus in three levels to compare the right-left sides and the probable relationship among the levels in fetuses to further delineate the developmental factors on jugular foramen asymmetry. The cross-sectional measurements of sigmoid sinus lumen were done on 3 levels which are described as A1 level; sinodural angle, A2 level; the midpoint between the sinodural angle and endocranial orifice and A3 level as the entrance (endo-cranial orifice) of the jugular foramen. There is a strong positive correlation between left (L) A1 and L A2 and also the same for L A1 and right (R) A2. These strong and positive correlations are all valid between L A2-L A3, L A2-R A2, L A2-R A3, L A3-R A3, R A1-R A2. CONCLUSION: Multicenter studies would be beneficial to investigate the topic with greater number of fetuses also on the different regions for genetic differences.

Iliocapsularis muscle in human fetuses.

PURPOSE: To determine the incidence of the iliocapsularis muscle in fetal period and its relationship with the hip joint capsule. METHODS: Twenty-one formalin-fixed fetuses (12 female and 9 male) with a mean gestational age of 29 ± 3.89 weeks (range 25-36) were dissected to reveal morphological properties of iliocapsularis muscle. RESULTS: Iliocapsularis muscle was observed in 39 out of 42 sides (92%). Its proximal attachment was detected either below the proximal attachment of rectus femoris muscle in 21 out of 39 sides (54%), or it was forming a common tendon with rectus femoris on the anterior inferior iliac spine in 10 out of 39 sides (26%), or it was forming an arch along the superior-medial-inferior sides of the proximal attachment of rectus femoris muscle in 8 out of 39 sides (20%). Muscle fibers originating from the anteromedial part of hip joint capsule were also constant in all sides. Distal attachment of iliocapsularis muscle was distal to the lesser trochanter in all specimens. Its form was as a broad muscle in 32 out of 39 sides (82%) and as a thin rectangular muscular slip in 7 out of 39 sides (18%). Iliopsoas and iliocapsularis muscles had their particular fascia in 34 out of 39 sides (87%), and in the other 5 sides, there was no fascia which prominently separated the two muscles. Its length was longer in females than males (p = 0.031) and it was wider on the right side (p = 0.029). Linear functions were y = 0.49 + 0.17 × weeks and y = 6.94 + 0.89 × weeks for width and length, respectively. CONCLUSION: Data obtained with the present study about iliocapsularis muscle in fetal period revealed that it is an individual and constant muscle. Its dimension, location, and course over the hip joint capsule support the idea that it tightens the hip capsule and stabilizes the femoral head.

Fetal anatomy of the facial nerve trunk and its relationship with posterior auricular artery.

PURPOSE: The aims of the study are to define anatomy of the facial nerve (FN) and its main trunks as well as their relationship with the posterior auricular artery in fetal period to evaluate the data for regional surgery in newborns and young infants. METHODS: Formalin-fixed 34 fetuses from anatomy laboratory collection with a mean gestational age of 26.4 ± 4.6 (20-36) weeks were dissected. Parameters regarding the presence of major or minor trunks, width, length, branching pattern of FN were evaluated according to side, gender and trimester. The positional relationship of posterior auricular artery with the FN trunk was inspected. RESULTS: On all sides only the major trunk of the FN was detected. For length and width parameters, there was no statistically significant difference for side and gender except for trimester. Linear functions were found as 0.329 + 0.025 × weeks for width and 5.264 + 0.185 × weeks for length. There are statistically significant linear relationships between width and length of the FN trunk and week parameters as r = 0.507, p < 0.001 and r = 0.484, p < 0.001, respectively. Posterior auricular artery crossed FN trunk laterally in 42 of 53 sides, medially in 9 sides while it was puncturing it proximally in 2 sides. In all cases, it was in close contact to the FN trunk. FN trunk showed bifurcation in 82% and trifurcation in 18%. CONCLUSION: Dimensions of FN trunk, growth ratio and linear functions can be beneficial in understanding the fetal growth of FN trunk and its usage for grafts. Data about the relationship of the posterior auricular artery with FN trunk may be crucial in avoiding iatrogenic injuries during surgery in early ages.

Let's Kahoot! anatomy / Utilicemos Kahoot! anatomía

Anatomy education in medical schools has always been considered demanding, as students need to learn and remember vast amount of information about the human body. Since ongoing technological innovation, is changing how humans interact with information, integrating the web in anatomy education can provide students a way to revise what they have learned in an interactive and competitive means. There has been research on the use of game-based response systems to engage learners during lectures; however, a significant gap exists in demonstrating the value of game-based learning to motivate medical students learning anatomy. This study aims at revealing the effects of using mobile phones and a game-based classroom response system as a closure activity to foster anatomy learning. To that end, 45 medical school students were given a Kahoot! quiz at the end of each anatomy lecture during two semesters. Higher attendance and participation and more focused and engaged students in class have been the observed benefits of the application. The findings suggest that game-based response systems can be used in core subjects like anatomy education as a closure activity.

La educación sobre la anatomía en las escuelas de medicina siempre ha sido considerada exigente, ya que los estudiantes necesitan aprender y recordar gran cantidad de información sobre el cuerpo humano. Debido a que la innovación tecnológica en curso, principalmente en lo que respecta a la web, está cambiando la forma en que los humanos interactúan con la información, la integración de la web en educación anatómica puede proporcionar a los estudiantes una manera de revisar lo que han aprendido de manera interactiva y competitiva. Se han realizado investigaciones sobre el uso de sistemas de respuesta basados en juegos para involucrar a los estudiantes durante las clases; sin embargo, existe una brecha significativa para demostrar el valor del aprendizaje basado en juegos para motivar a los estudiantes de medicina a aprender anatomía. Este estudio tiene como objetivo revelar los efectos del uso de teléfonos móviles y un sistema de respuesta en el aula basado en juegos como una actividad de cierre para fomentar el aprendizaje de la anatomía. Con ese fin, ¡45 estudiantes de medicina relizaron una prueba con Kahoot! Una prueba al final de cada conferencia de anatomía durante dos semestres. Mayor asistencia y participación y más estudiantes enfocados y comprometidos en clase han sido los beneficios observados de la aplicación. Los hallazgos sugieren que los sistemas de respuesta basados en juegos se pueden usar en las materias básicas como la educación de la anatomía como una actividad de cierre.

Modified Composite-Flap Facelift Combined With Finger-Assisted Malar Elevation (FAME): A Cadaver Study.

BACKGROUND: Inadequate release of retaining ligaments during facelift surgery may lead to an unnatural appearance. However, most facelift surgeons are hesitant in transecting these ligaments to avoid possible injury to facial subbranches. OBJECTIVES: In the authors' surgical practice for modified composite flap rhytidectomy, the authors employed the finger-assisted malar elevation (FAME) technique in order to enable safe release of the zygomatic cutaneous ligaments through the prezygomatic space under direct vision. The aim was to evaluate the anatomical basis and safety measures of this technique through a cadaveric dissection study. METHODS: Modified composite-flap facelift with the FAME technique was carried out in 22 fresh cadaver hemi-faces. All facial nerve subbranches were dissected thoroughly to assess for any evidence of injury during facelift, and to evaluate the safety of the operation. The relations among the facial nerve, zygomatic cutaneous and masseteric ligaments, orbicularis oculi muscle, and malar fat pad were investigated. RESULTS: Finger dissection of the prezygomatic space allows safe release of the zygomatic cutaneous ligaments as well as adequate entry to a proper surgical plane above the zygomatici muscles under direct vision, while leaving the malar fat pad and overlying structures attached to the skin without the need of a transblepharoplasty approach. CONCLUSIONS: This study by the authors shows that a modified composite-flap facelift with FAME technique is a safe procedure that allows adequate and effective repositioning of an en-bloc composite flap that produces balanced and harmonious rejuvenation of the midface and lower face without the need of a separate midface lift.

The Measurement of Various Anatomical Structures and Assessment of Morphometric Development of Fetal Skull Base.

BACKGROUND: As the skull base has a complex anatomy, we underline the importance of anomalies for side asymmetry. It is useful to investigate relationship between anatomical structures for the surgical procedure orientations. Dural adherence, enlarged superior petrosal sinus, influence of neural crest cells, and cranial base ossification are among the factors in morphometric growth on skull base. MATERIAL AND METHODS: Twenty-five fetuses of an estimated gestational age ranging from 17 to 34 weeks were studied in the Anatomy Laboratory of Mersin University Medical Faculty. Craniotomy was made to each fetus and brain hemispheres were dissected. We put plates, passing from the external points of lateral and anterior-posterior borders of fetus heads that are perpendicular to each other. An analytical calculation was formulated for the angle of foraminae to the root of zygoma by using different formulations depending on their posterior or anterior location to the root of zygoma. Statistical method was based on correlation analysis, simple regression, independent 2 group t tests, SPSS20.0, and MedCalc 11.5 (MedicReS, New York, NY). RESULTS: Neither side dominance for the jugular foramen, nor the differences of foramen rotundum, spinosum, and ovale to anterior skull wall, root of zygoma, and to midline were found to be significant. CONCLUSION: There is a debate on asymmetry of foramina of the skull base. No certain consensus about the initiation time and the causes of asymmetry in the past was documented. Studies are to be encouraged to further enlighten pre-postnatal factors affecting the fetal skull base morphometrism.

The Relationship of the Temporal Branch of the Facial Nerve to the Fascial Planes of Temporal Region in Human Fetuses.

The aim of this study was to obtain information by assessing the relationship between temporal region fascial structures, fat pads, and temporal branches of facial nerve in human fetuses to use the knowledge on treatment of early childhood period surgeries. This anatomic dissection study was conducted on 40 hemifaces with no visible external abnormalities on their faces. Fascial layers and related fat pads of temporal region were dissected layer by layer beginning from superficial to deep. The relations of temporal branches of facial nerve and temporoparietal fascia and the structures of these fascial layers were evaluated. Temporoparietal fascia showed continuity below zygomatic arc with superficial musculoaponeurotic system. Temporal branches of facial nerve showed a multiple branching. Parotid-masseteric fascia became very thin on the superficial of zygomatic arch and ran with superficial layer of temporal fascia above without attaching to periosteum. Temporal branches of facial nerve entered between multilayered layers of temporoparietal fascia. Temporoparietal fascia became thicker on anterior and middle parts because of the localization of superficial temporal fat pad. Temporal fascia was a 2-layered thick and fibrous tissue enveloping intermediate fat pad. Deep layer connected to periosteum of zygomatic arch and superficial layer continued passing superficial of zygomatic arch and connected to the parotid-masseteric fascia. Deep temporal fat pad was found on the deep to deep layer of temporal fascia and surface of temporal muscle. The findings of this study may contribute to the knowledge of the topographical localization of temporal branches of facial nerve with temporal region fascial structures and fat pads in fetuses.

Morphological features of the popliteus tendon, popliteofibular and lateral (fibular) collateral ligaments / Características morfológicas del tendón del músculo poplíteo, y ligamentos popliteofibular y colateral fibular

To reveal the detailed morphological features of the fibular collateral (fibular) ligament, popliteus tendon, popliteofibular ligament and the synovial components regarding to achieve data for surgical and biomechanical utilization. Knees of 10 formalin-fixed male cadavers were dissected bilaterally. Bursae around the lateral collateral ligament and the relation of popliteus tendon with lateral collateral ligament at the femoral attachment site were noted. The positional relation between both ends of popliteofibular ligament was evaluated statistically. The PT exceeded the anterior margin of lateral collateral ligament in 11 sides, the posterior margin of lateral collateral ligament in 3 sides and exceeded both the anterior and posterior margins of lateral collateral ligament in 5 sides. The shape of lateral collateral ligament was narrower at the lower part than the upper in 14 sides. The width of lower part of lateral collateral ligament was found narrower in the cases with sheath-like bursa (vagina synovialis). The relation between both ends of popliteofibular ligament was as followed: the more anteriorly the fibular head attachment was located, the more anteriorly popliteofibular ligament was attached to the popliteus tendon. To resolve the posterolateral corner of the knee with regard to surgical anatomy and biomechanics, individual and concerted morphometric characteristics of lateral collateral ligament, popliteus tendon and PF should be evaluated together with accompanied synovial structures.

El objetivo de este trabajo consistió en descubrir las características morfológicas detalladas del ligamento colateral fibular, del tendón del músculo poplíteo (TMP), del ligamento popliteofibular y de los componentes sinoviales relacionados con la obtención de datos para la aplicación quirúrgica y biomecánica. Se disecaron bilateralmente rodillas de 10 cadáveres de sexo masculino fijados con formalina. Se identificó la bursa alrededor del ligamento colateral fibular y la relación del tendón del músculo poplíteo con el ligamento colateral fibular en el sitio de la inserción femoral. La relación posicional entre ambos extremos del ligamento popliteofibular se evaluó estadísticamente. El TMP excedió el margen anterior del ligamento colateral fibular en 11 casos, el margen posterior del ligamento colateral fibular en 3 casos y superó los márgenes anterior y posterior del ligamento colateral fibular en 5 casos. La forma del ligamento colateral fibular fue más estrecha en la porción inferior que en la porción superior en 14 casos. El ancho de la porción inferior del ligamento colateral fibular fue más estrecha en los casos con bursa del tipo vaina (vagina synovialis). La relación entre ambos extremos del ligamento popliteofibular fue la siguiente: cuanto más anteriormente se localizó la inserción de la cabeza fibular, más anteriormente el ligamento popliteofibular se unió al TMP. Para intervenir el ángulo posterolateral de la rodilla con respecto a la anatomía quirúrgica y la biomecánica, se deben evaluar las características morfométricas individuales y concertadas del ligamento colateral fibular, el TMP y el ligamento popliteofibular, junto con las estructuras sinoviales correspondientes.

Relations of Facial Nerve With Retromandibular Vein in Human Fetuses.

The relationship of facial nerve (FN) and its branches with the retromandibular vein (RMV) has been described in adults, whereas there is no data in the literature regarding this relationship in fetuses. The study was conducted to evaluate the anatomic relationships of these structures on 61 hemi-faces of fetuses with a mean age of 26.5 ±â€Š4.9 weeks with no visible facial abnormalities. The FN trunk was identified at its emergence at the stylomastoid foramen. It was traced till its ramification within the parotid gland. In 46 sides, FN trunk ramified before crossing RMV and ran lateral to it, while in 8 sides FN trunk ramified on the lateral aspect of the RMV. In 3 sides, FN trunk ramified after crossing the RMV at its medial aspect. In only 1 side, FN trunk trifurcated as superior, middle, and inferior divisions and RMV lied anterior to FN trunk, lateral to superior division, medial to middle and inferior divisions. In 2 sides, FN trunk bifurcated as superior and inferior divisions. Retromandibular vein was located anterior to FN trunk, medial to superior division, lateral to inferior division in both of them. In 1 side, RMV ran medial to almost all branches, except the cervical branch of FN. Variability in the relationship of FN and RMV in fetuses as presented in this study is thought to be crucial in surgical procedures particularly in early childhood.

Topographic methods to expose the exiting points of supratrochlear, supraorbital, and zygomaticotemporal nerves

Background/aim: We evaluated the relations of the exiting points of supratrochlear (STN), supraorbital (SON), and zygomaticotemporal (ZTN) nerves with certain landmarks to provide improved anatomic knowledge. Materials and methods: The twenty-eight hemifaces of 5 fresh frozen and 11 embalmed heads (5 female and 11 male cadavers) were dissected. Distance and angular measurements were made between the exiting points of the nerves to the midline, lateral, and medial canthi. Comparisons of side, sex, and cadaver groups were evaluated.Results: Mean values were determined for all parameters. There was no difference between side measurements. There were significant differences between sexes and cadaver groups regarding STN and lateral canthus in both sides. The angle of the ZTN to the lateral canthus was found to be higher in embalmed cadavers than in fresh frozen ones.Conclusion: This study is the first to supply both distance and angular measurements to reach the exact locations of the nerves. Quantitative and topographic information about the localizations of the STN, SON, and ZTN is crucial for forehead lifting and migraine treatment, as well as for injection and local surgical interventions.

Evaluation of the origin and branching patterns of the iliolumbar artery and its implications on pelvic and vertebral surgery.

OBJECTIVES: To evaluate the origin, distribution pattern, branches, and neighboring structures of the iliolumbar artery (ILA) concerning the anterolateral surgical approaches to the spine. METHODS: This study was performed in the Anatomy Department of Medical School, Mersin University, Mersin, Turkey between 2014 and 2015. Pelvises of 11 male formalin-fixed human cadavers were dissected by anterior and posterior approaches under surgical microscope. The origins, distribution patterns, calibers, and distances to certain structures were measured. RESULTS: The ILA was found as a single trunk on 17 sides arising either from the IIA (12 sides, 70.6%) or the PT (5 sides, 29.4%). The average caliber of those originated from the posterior trunk was significantly larger (p=0.010). The ILA started as a single trunk in 17 sides, while its lumbar and iliac branches separately originating from different arteries in 4 sides. The close relation of the posterior rami of both the lumbar and iliac branches with transverse process and spinal nerve were noted. CONCLUSION: Findings suggest that the ILA and its branches may have different and significant patterns, which may be crucial to consider during certain surgical procedures, such as far lateral disc herniation and posterior pelvic fixations.

Axillary nerve course and position in the fetal period. An anatomic dissection study for surgical practice.

OBJECTIVE: To examine the fetal axillary nerve to reveal and compare its morphometric features within the second and third trimester. METHODS: This study was conducted at the Anatomy Department, School of Medicine, Mersin University, Mersin, Turkey. Thirty-five fetal shoulders were studied to provide anatomic data and to describe its position with regard to certain landmarks around the shoulder. RESULTS: The shortest distance between the axillary nerve and the glenoid labrum was found 2.27 mm and 2.89 mm in the second and third trimester fetuses, respectively. The shortest distances between the anterior and posterior acromial tips and the axillary nerve were also measured and were used with arm length measurements to define the anterior and posterior indexes. CONCLUSION: The indexes show that the distance between the axillary nerve and the anterior/posterior acromial tips are approximately one-fourth of the arm length in both the second and third trimester fetuses. The data presented in this study will be of use to surgeons, particularly to pediatric and orthopedic surgeons who will undertake surgical procedures in the axilla and arm in the newborn or early childhood.

Discovering the "anatomy" in students' mind through metaphors.

PURPOSE: This study aims to obtain clues about the beliefs of medical students on learning anatomy through metaphor analysis which has not been used in this field before. METHODS: A questionnaire was given to 174 medical students. Students were asked to complete the statement with a metaphor and to provide an explanation for it. All metaphors were grouped under 8 categories. RESULTS: The most frequently produced metaphors were collected in two categories, namely "being lost/unknown situation" and "hopeless struggle." These were the positions in which students feel themselves desperate, confused and lost (25%) or they consider their efforts to learn anatomy as an activity that is waste of time, ineffectual, and hopeless (24%). Only three out of eight categories (26%) had positive connotation. CONCLUSIONS: Metaphors acquired here reflect distress in anatomy learning. These results would direct the educators to revise educational methods and instruments to provide more efficient anatomy education.

The morphological features of the mediopatellar and lateral folds of the developing knee joint: a fetus cadaveric study.

OBJECTIVES: The aim of the study was to evaluate the morphological features of the mediopatellar and lateral folds in fetal knees in the absence of any exposure to certain stress factors such as exercise or trauma. METHODS: The study was performed in the knee joints of 15 fetuses (6 males, 9 females) obtained as spontaneous abortion material at 20-34 weeks of gestation. The mediopatellar and lateral folds of the fetuses were classified into eight subgroups according to the following morphological features: A- Absence of folds; B- Short vertical band; C- Long vertical band; D- Narrow horizontal band; E- Broad horizontal band; F- Horizontal band accompanied by a vertical band; G- Horizontal band without a vertical band; H- Fenestrated band. RESULTS: The synovial membrane, covering the infrapatellar fat pad and forming the alar folds, extended upwards and formed the medial and lateral horizontal folds that covered the inferior part of the posterior aspect of the patella. These horizontal folds were thicker in the lower parts (close to their insertions) and became thinner towards the free ends. The horizontal band of the mediopatellar fold was observed in all cases, with an accompanying vertical band in 76.7% of the cases. A horizontally located lateral fold was absent in both knees of one fetus. The frequency of a horizontally located lateral fold was 93.3% and a vertical fold was accompanying in only 28.6% of these cases. It is of note that the horizontal band of the mediopatellar fold observed in all specimens has never been defined in previous classifications. In 10% of the knees, the vertically located part of the mediopatellar fold presented as a large band extending upward and being squeezed between the articular surface of the patella and the medial condyle of the femur. The lateral fold was observed as a large band in 10% of the knees. Another observation was that the higher level the vertical band of the mediopatellar and lateral folds began, the wider the horizontal band was, occupying more place in the patellofemoral space. It was remarkable that the frequencies of the vertically located parts of the lateral and mediopatellar folds in fetuses were higher than those reported for the adults in the literature. CONCLUSION: Our findings suggest that the resorption process of the mesenchymal tissue, particularly in the lateral part, continues until adulthood and causes age-dependent alterations in the formation of intra-articular folds. The synovial folds occupy more space between the patella and femur in the early stages of life than seen in adults. This may be a more frequent cause of unexplained knee pain in children than expected.

Examination of the accessory tendons of extensor hallucis longus muscle in fetuses.

There are various data about the incidence of accessory tendons (AT) of extensor hallucis longus (EHL) muscle; however, their function is unknown. This study aimed to determine the incidence and morphometric features of the AT of EHL muscle in fetuses in order to provide more information to discuss its possible function. Forty-five fetuses (26 female and 19 male) were used in this study. Fetuses were grouped as Group A (16-21 weeks), Group B (22-27 weeks), and Group C (28-34 weeks) according to their age. In 23 (51%) out of 45 fetuses, there were AT. These were bilateral in 15 fetuses (65%) and unilateral in eight fetuses (35%). Fifty-two percent of the fetuses in group A, 43% in group B, and 67% in group C had AT. AT were observed in 14 female (54%) and 9 male (47%) fetuses. In all cases, the AT were always diverging to the medial side of the main EHL tendons and attached to the metatarsophalangeal joint capsule distal to the joint space. Significant correlations were observed in this study between EHL and AT widths as well as between EHL width and EHL-AT distance on both sides. The present study is the first to provide morphometric data about the AT of EHL muscle in fetuses which will be of use in understanding their function, particularly in biomechanics of the great toe.

Corpus callosum and optic chiasm in early blind adults.

OBJECTIVES: Certain callosal dimensions, callosal areas, and the optic chiasm (OC) thickness were measured in order to detect any morphometric difference that would imply plastic changes in a selected group of adults. METHODS: Seventeen early blinds were selected among a group of blind adults after performing interviews. These selected blind subjects, and 23 adults with normal vision of both genders were examined by MRI. The study was conducted in Mersin, Turkey between the years 2004 and 2006. RESULTS: Only 14 early blind subjects completed the MR imaging procedure. Statistically significant difference between the OC thicknesses of 2 groups was found whereas no statistically significant difference was detected for the callosal dimensions. CONCLUSION: The difference in the OC dimensions of the 2 groups may be explained by the disuse atrophy. It has been known that if a cortical area of any sense is deprived of stimulus within the critical period, then it may take on another cortical activity. The reasons for the unaffected dimensions of the corpus callosum (CC) in this study may be either the relatively small percentage of the fibers related to vision within the total CC, such as auditory function, of the "normally" visual cortex.