Morphology of cranial sutures and radiologic evaluation of the variations of intersutural bones.

BACKGROUND: As far as our literature searches showed us, morphological characteristics of cranium such as sutures, sutural bones and fontanelles had been examined in the skulls in the museums and dry specimens until now. As a modern method, three-dimensional virtual reconstruction of cranial bones by using multidetector computed tomography-computed tomography angiography (MDCT-CTA) can display in vivo morphological characteristics. In our study, we aimed to determine the presence and incidence of these morphological characteristics that can be clinically significant in our population, by using radiologic methods. MATERIALS AND METHODS: We examined head and neck regions of 185 patients via MDCT-CTA. We evaluated radiologically detectable variations of the metopic sutures, lambda, bregma, asterion and pterion, which can be very easily confused with fractures. Additionally, the differences between the genders and incidence of coexistence of these variations were evaluated. RESULTS: According to our study, the incidence of persistent metopic suture was 8.1% and the incidence of lambda variations was 5.9%. Variations were most commonly encountered on the left asterion, and least commonly on the bregma and left pterion. In the evaluation of the coexistence of the parameters and combinations, the Wormian bones located at the right and left asterions were detected. There were no statistically significant differences between genders. CONCLUSIONS: Variations of the sutures and sutural bones can be easily misdiagnosed with the fractures of related bony regions in unconscious patients with multiple traumas. During surgical interventions in these patients, surgeons must take this fact into consideration in order to make differential diagnosis of fractures and intersutural bone variations.

Revisiting the relationship between the submandibular duct, lingual nerve and hypoglossal nerve.

BACKGROUND: The aim of the study was to evaluate the relations between submandibular duct, lingual nerve and hypoglossal nerve for making a reassessment of this area in fresh frozen specimens. Also, the distance between the angle of the mandible and the vertical line drawn from the point where submandibular duct crossed lingual nerve to the base of the mandible was measured to determine a new landmark for neck surgeons. MATERIALS AND METHODS: Fourteen fresh frozen head and neck specimens were dissected and evaluated. A marginal mandibular incision was made from the mastoid process to the chin. RESULTS: In 8 cases, lingual nerve was crossing the submandibular duct superiorly; in 5 cases, lingual nerve was crossing the duct infero-medially and in 1 case it was parallel to the duct. In 1 case, lingual nerve subdivided into anterior and posterior branches. In 2 cases, 2 parallel submandibular ducts were found and the lingual nerve was crossing the upper duct from superior. In 1 case, lingual nerve was crossing the duct infero-medially and then it was subdividing into branches superior to mylohyoid. In 12 cases, the course of hypoglossal nerve was classical. In 1 case, hypoglossal nerve crossed the submandibular duct medially and coursed parallel to the tendon of posterior belly of digastric. And in another case, hypoglossal nerve crossed the inferior branch of submandibular duct medially. The other structures in this area were as usual. CONCLUSIONS: The main factor for reducing nerve damage during surgery is the understanding of the anatomy of this area.

Quantitative analysis of the terminal branches of facial nerve in fresh frozen head and neck specimens.

BACKGROUND: The first aim of this study was the quantification of nerve fibres found in terminal branches of facial nerve and the second aim was the ultrastructural analysis of these terminal branches in order to observe their ultrastructural differences, if present. In the examination of literature; we could not find any studies related to this subject. MATERIALS AND METHODS: Four fresh frozen head and neck specimens were used and the dissections were done bilaterally. Therefore; totally 8 samples were examined. The samples were prepared according to routine transmission electron microscopic tissue preparation technique. The semi-thin sections were examined under light microscope by camera lucida. In every sample, the quantitative analysis was performed in 5 different areas in an area of 0.01 mm2 and statistical analysis was done. Secondly; the ultrastructural appearance of these terminal branches were examined under transmission electron microscope. RESULTS: In the quantitative analysis of terminal branches of facial nerve in an area of 0.01 mm2; the least number of nerve fibres were found in temporal branches and the highest number were detected in cervical branches. In transmission electron microscopic examination, no significant difference was found in between these branches. In the statistical analysis; statistically significant differences were obtained in between the temporal and buccal, marginal mandibular, cervical branches; zygomatic and marginal mandibular, cervical branches; buccal and marginal mandibular, cervical branches; marginal mandibular and cervical branches. CONCLUSIONS: These numerical data will have an importance during the nerve repair process of terminal branches of facial nerve in various injuries.

Association between frontal sinus development and persistent metopic suture.

BACKGROUND: Frontal sinuses are 2 irregular cavities, placed between 2 lamina of frontal bone. Expansion continues during childhood and reaches full size after puberty. Persistent metopic suture is one of the factors that are related to abnormal frontal sinus development. In this study, we want to discuss about the coexistence of persistent metopic suture and abnormal frontal sinus development using radiological techniques. MATERIALS AND METHODS: In this retrospectively planned study, images of 631 patients were examined, 217 (34.4%) of them were men and 414 (65.6%) of them were women. Brain computed tomography and magnetic resonance images were retrieved from the electronic archive for analysis. RESULTS: In this study, frontal sinus development is categorised as right side atrophy, left side atrophy, bilateral atrophy and bilaterally developed sinuses. The presence of metopic suture was accepted as persistent metopic suture. Frontal sinus atrophy was found in 22.7% and persistent metopic sutures were found in 9.7% of overall. CONCLUSIONS: In this study, no significant results were detected that were relatedto the frontal sinus agenesis or dismorphism associated with persistent metopicsuture. We conclude that, although publications propounding metopism thatleads to abnormal frontal sinus development are present in the literature, noreasonable explanation has been mentioned in these articles; and we believe thatthese findings are all incidental.

A combined anatomical variation of inferior epigastric vessels.

During the routine gross anatomical dissection of the right inguinal region of a 45-year-old male cadaver, a variation was observed both in the inferior epigastric artery and the inferior epigastric vein. In this case, the right inferior epigastric artery originated from the femoral artery 13 mm inferior to the inguinal ligament. Additionally, in this cadaver, the single right inferior epigastric vein drained into femoral vein 8 mm inferior to the inguinal ligament. The distal origin of the inferior epigastric artery from the femoral artery and the lower drainage of the single inferior epigastric vein to the femoral vein must be taken into consideration by surgeons.

Cor triatriatum sinister: two cases diagnosed in adulthood and a review of literature.

Cor triatriatum sinister is a rare condition caused by a membrane within the left atrium that separates the pulmonary veins from the mitral valve. While the condition is usually diagnosed in childhood, a rare presentation during adulthood is observed when the membrane is incomplete. We report two cases of incomplete cor triatriatum sinister diagnosed during adulthood and review the literature for this rare anomaly.