Variation in the formation of the retromandibular and the external jugular veins with embryological overview: A case report.

Awareness of the formation and termination of the head & neck's superficial vein, such as jugular veins, are imperative for anatomists, surgeons, and radiologists during interventional procedures. We report an uncommon variation in the formation of the retromandibular vein and external jugular vein (EJV) in an embalmed male cadaver's right side. The joining of the facial vein and superficial temporal vein within the parotid gland formed the retromandibular vein (RMV). The anterior division joined with the submental vein forming an anomalous venous trunk. The anomalous vein united with the EJV forming a common trunk in the lower third of the neck and terminated into the subclavian vein. We compared the available literature and justified the embryological development of this rare variation.

Clinically Relevant Morphometry of Sacral Hiatus and Morphology of Sacrum.

AIM: To outline the variations in morphology and a few clinically relevant morphometric parameters of the sacral hiatus. MATERIAL AND METHODS: The study included 50 dry human sacra, of unspecified sex, in the Department of Anatomy at a medical college in South India. The sex was determined using the sacral, auricular and curvature index. The variations and morphometry of the sacra were documented and tabulated. RESULTS: It was observed that the inverted U shape of sacral hiatus was common in both males (n=24) and females (n=26). There was one female sacrum with complete dorsal wall agenesis. In males, the length of the apex of sacral hiatus from 1st sacral spine was 5.82 cm ± 1.27 and in females, it was 6.02 cm ± 1.08. Sacral hiatus depth in males was 0.56 cm ± 0.16 and in females 0.54 cm ± 0.14. The width of sacral hiatus at the cornua in males was 1.42 cm ± 0.29 and in females, it was 1.46 cm ± 0.38 CONCLUSION: Knowledge of incidences of variations in the morphology and morphometry of the sacral hiatus across various population groups is paramount for the success and reliability of epidural anesthesia. The success rate of such procedures depends on the clinicians' understanding of the discrepancy in the sacral hiatus.

Unexplored parameters of ulnar nerve in the palm and its clinical implications; A cadaveric study.

OBJECTIVES: Several studies have been conducted on the variations and branching pattern of the ulnar nerve in the hand. There are few studies conducted on defining the distance of ulnar nerve from bony landmarks in the palm. Ulnar nerve is closely related to the pisiform and hook of hamate which act as important landmarks. METHODS: The study was conducted on 30 formalin fixed adult hand specimens in the department of Anatomy. Various measurements related to the ulnar nerve in the palm were taken using a divider and Vernier Calipers and the values were tabulated after obtaining the mean and standard deviation. RESULTS: The average distance seen in the hand specimens [n = 30] from pisiform to the division of ulnar nerve into superficial and deep branch was 0.89 ± 0.25cm and the distance between pisiform bone up to the division of superficial branch of ulnar nerve into proper and common digital branches was 1.36 ± 0.59 cm. The average distance from the origin of proper digital branch of ulnar nerve to the head of fifth metacarpal bone was 5.25 ± 0.59 cm. The length of common digital branch of ulnar nerve from its origin to division into 2 sensory branches was 4.31 ± 1.09 cm. CONCLUSION: This study provides the metric parameters of the ulnar nerve in the hand from its significant bony landmarks which should be kept in mind during surgical procedures to minimize the incidence of injury to its branches. It would assist the orthopedic surgeon in the treatment of ulnar nerve compression in the Guyon's canal.

Morphology of the papillary muscles and the chordae tendineae of the ventricles of adult human hearts.

INTRODUCTION: The papillary muscles (PM) play a vital role in atrioventricular (AV) valve function. The PM and their chordae tendineae (CT) regulate the closure of the AV valve during systole. The present study was undertaken to categorize the PM based on their shapes and variant patterns and CT based on their types and the branching pattern. METHODS: This study included formalin-fixed ten adult cadaveric heart specimens. We observed the number, shape, length, breadth, pattern, and presence of extra PM. The number of chordae attached to the tip of each PM was quantified. We classified the types and branching patterns of the chordae and their pattern of attachment to the cusps. RESULTS: In the right ventricle, conical, truncated, and flat-topped PM were observed. The anterior PM had 5.3 ± 1.9, the posterior PM had 2.7 ± 2.1, and the septal PM had 3.5 ± 2.3 CT attached to it. In the left ventricle, we observed conical, truncated, flat-topped, bifurcate, and trifurcate shapes of PM. The anterior and the posterior PM had 7.7 ± 2.8 and 7.7 ± 2.7 CT attached to them, respectively. The true CT were cusp, cleft, and commissural and the false CT were pillar-wall, inter-pillar, and strut. We also found 3 branching patterns for the chordae (single, fan-shaped, and web forming). CONCLUSION: The study explored the comparative morphology of PM and chordae in the right and left ventricles. The knowledge of the morphological pattern of PM and CT would contribute to the valvular function and aid in diagnosing conditions such as valve prolapse or regurgitation.

Locating the anterior interosseous nerve in relation to the surgically relevant landmarks of the forearm: A cadaveric study.

BACKGROUND: This study emphasizes locating the anterior interosseous nerve (AIN) related to its level of origin, number, and lengths of its muscular branches and relation to surgically important landmarks such as the bi-epicondylar line, pronator teres, and Gantzer muscles. METHODS: The study was undertaken at a private Medical school in south India during 2019-20. The level of origin of AIN was measured from the bi-epicondylar line and its length was measured up to the upper border of the pronator quadratus using 44 cadaveric upper limbs. The number of branches given to flexor digitorum profundus (FDP) and flexor pollicis longus (FPL) was quantified and their lengths were measured. RESULTS: The nerve originated at a mean distance of 41.56 mm from the bi-epicondylar line. In 12 upper limbs, FDP received two branches and in two limbs, it received three branches. In 13 upper limbs, FPL received two branches from AIN. It was observed that the muscular branches for FDP were shorter than those for FPL. Gantzer muscle was observed in 18 (40%) specimens and was found superficial to the nerve. CONCLUSION: The muscular branches of AIN had a variable pattern of innervation. Multiple muscular branches to the FPL and FDP were observed in the upper 2/3rds of the forearm. These branches to FPL and FDP would aid as a source of nerve grafting and nerve transfer in the cases of upper extremity nerve palsies.

Knowledge and Training of Primary School Teachers in First Aid - A Questionnaire Based Study.

BACKGROUND: Students at schools may need first aid due to illness or accident. Therefore, teachers at school should know first aid measures and be able to put them into practice. The aim of this study is to assess awareness regarding first aid training among primary school teachers. METHODS: Subjects were 150 primary school teachers from nine schools in the Udupi district of Karnataka. They were assessed by predesigned questionnaire proforma, after which each teacher was interviewed and responses were discussed separately in smaller groups. RESULTS: Of the subjects, 11.3% felt that first aid is important and 87.7% said that it is very important and wanted to learn first aid. About a third (30.2%) of the teachers knew some basic treatments for minor emergencies but they didn't recognize such treatments were called first aid. Most of the subjects (69.8%) were unfamiliar with the expression "first aid". CONCLUSION: First aid training should be included in the teacher training curriculum, and such training should be updated regularly.

A morphologic and histologic study of the radial nerve and its branches at potential compression sites.

OBJECTIVES: This study examined variations in the termination level of the radial nerve (RN) and the morphometry of the RN and its branches at potential compression sites. Additionally, we digitally analysed histological sections of the RN, the superficial branch of the radial nerve (SBRN), and the posterior interosseous nerve (PIN). METHODS: We conducted this study on 14 formalin fixed adult cadavers. The lengths of the RN, SBRN, and PIN were measured up to potential compression sites, using appropriate surface skeletal landmarks as reference points. We histologically evaluated the fascicular and non-fascicular areas and the number of axons in each nerve. All parameters were statistically analysed using a paired t-test. RESULTS: We found variations in the bifurcation of the RN with respect to the biepicondylar line (BEL). However, the course of RN terminal branches was constant in the forearm. There was a significant histological difference between the fascicular and non-fascicular areas of the PIN. There was no significant difference in the total number of axons in the SBRN and PIN. Finally, we observed that the intramuscular length of the PIN within the supinator muscle was variable and that the SBRN had more fascicles compared to the RN and PIN. CONCLUSIONS: In our study, the RN and PIN had more variable morphometry compared to that of the SBRN. The histologic evaluation and quantification of these nerves at their potential compression sites could serve as a guide for surgeons planning nerve reconstruction procedures.

Development of the Gall Bladder, and Caudate and Quadrate Lobes of the Liver: A Fetal Morphometric Study.

INTRODUCTION: The gall bladder (GB) is a storage reservoir that allows bile acids to be delivered in a high concentration. The quadrate (QL) and caudate lobes (CL) are functional parts of the liver. The knowledge of the gross and developmental anatomy of GB and CL and QL of liver is important for surgeons who operate in this region. The present study was conducted to examine the developmental sequence and morphometry of the GB, and CL and QL of liver. MATERIALS AND METHODS: In the present cross sectional study the parameters measured were length of GB from the neck to the lowest point on the fundus, and the length and width of QL and CL measured at the midpoint. The data was analyzed statistically and the various parameters were correlated using Pearson's correlation. RESULTS: There was a statistically significant correlation indicating that the growth of GB, QL and CL was proportional to the gestational age (GA). The variations in the morphology of the GB were also noted. In two specimens it was found that the GB was embedded partially in the substance of the liver and failed to reach the inferior border of the liver. CONCLUSION: The regression equations calculated in the study provide a tool to estimate the lengths of GB, QL and CL prenatally.

Morphometric Study of Anterior Clinoid Process and Optic Strut and the Ossification of Carotico-Clinoid Ligament with their Clinical Importance.

INTRODUCTION: Knowledge about the ossification of the Carotico-Clinoid Foramen (CCF), as it forms a potential site for compression of the internal carotid artery may be beneficial for neurosurgeons and radiologists. AIM: To obtain a detailed knowledge of morphometry of Anterior Clinoid Process (ACP) and Optic Strot (OS) and the type of ossification of CCF which would be necessary to increase the success of surgeries related to the cavernous sinus and internal carotid artery. MATERIALS AND METHODS: Parameters such as the length of ACP from its base to the tip, the width at its base and the distance between the tip of ACP to optic strut were measured in mm using digital calipers. SPSS version 17 was used for the statistical analysis. Paired t-test was applied to compare between right and left sides. Presence of carotico-clinoid foramen was observed and was classified as incomplete, contact form or complete. RESULTS: The average length of ACP ranged from 12 to 15mm on right side and 11 to 16mm on the left side. Paired t-test was applied to compare the means between the right and left sides. The width of ACP varied between right and left sides and this difference was statistically significant (p<0.05). Out of 12 CCF observed, the commonest type was incomplete (N=7) followed by complete (N=3) and contact form (N=2). CONCLUSION: Considering the immense anatomical surgical and radiological importance of morphology of ACP, OS and CCF, this study highlighted the detailed morphometry of these structures. The study also has explained the sexual dimorphism in their morphology.

Multiple variations in the branches of the coeliac trunk.

Here we present a unique case of variation in the branching pattern of the coeliac trunk. In the present case, the coeliac trunk was replaced by two separate arterial trunks. The first arterial trunk bifurcated into the left gastric and the left hepatic arteries. The second arterial trunk bifurcated into a splenic artery and a hepato-gastroduodenal trunk. The hepato-gastroduodenal trunk presented an unusual course and termination. The right hepatic artery arising from the hepato-gastroduodenal trunk also showed a variant course. Such rare variations are important for gastroenterological surgeons and interventional radiologists due to increase in number of transplantation surgeries and live donor liver transplantations.

The study of antilingula and its relation to the lingula and mandibular foramen, the presence of mylohyoid bridging in dry mandibles of South Indian population.

BACKGROUND AND OBJECTIVES: The mandibular foramen and the lingula, because of their relation to the inferior alveolar nerve are of clinical significance for the orodental surgeons. Identification of the antilingula is important in mandibular ramus surgery in which the medial surface of the ramus is not visualized. METHODS: The present study includes adult dry 50 mandibles of unknown age and sex. The measurements were taken using vernier calipers. The points taken for measurements were most prominent point on antilingula, tip of lingula, most anterior, posterior and inferior points of mandibular foramen. The measurements were denoted as A, B, C and D which represent the anterior, posterior, superior and inferior distances. RESULTS: Antilingula was present on right side in 25 and on left side in 28 mandibles. There was a significant difference in distances in mean between the antilingula and mandibular foramen of both the sides (p < 0.001). Retromolar foramen was observed in 6 mandibles. Mylohyoid bridging was seen in 3 mandibles. CONCLUSION: The mandibular foramen was located posterosuperior to the antilingula on both the sides. There was no statistical significance in the distances between the lingula and the antilingula. Therefore antilingula can be used as an important surgical landmark for locating the mandibular foramen in mandibular ramus osteotomies.

Anomalous Branching Pattern of the Popliteal Artery (PA): A Case Report.

The Popliteal Artery (PA), which is the continuation of the Femoral artery, crosses the popliteal fossa at the distal border of popliteus; it divides into the Anterior and Posterior Tibial arteries. The Posterior Tibial Artery (PTA) divides into terminal branches proximal to popliteus, in which case the Anterior Tibial Artery (ATA) sometimes descends anterior to the muscle. Either the Anterior tibial or the PTA may be reduced or increased in size. The dorsalis pedis artery (DPA) is the continuation of the ATA, distal to the ankle. It passes to the proximal end of the first intermetatarsal space, to complete the plantar arch, and provides the first plantar metatarsal artery. In the present case the PA bifurcates into two terminal branches at a higher level than the normal. The ATA was hypo plastic and entered the anterior crural region in front of the popliteus muscle and finally terminated above the knee joint. Further the PTA was also hypo plastic giving off a hyperplastic PL which pierced the interosseous membrane and on entering the dorsum of the foot, it prolonged as the DPA. The rest of the PTA continued its course distally and divided into its usual branches, the medial and lateral planter arteries. Awareness of these variations in the vascular branching patterns of the lower limb, acts as a guide during femero distal bypass grafting procedures and surgical and percutaneous vascular reconstructions.

An unusual right popliteal vein aneurysm in an adult cadaver: A case report.

The incidence of venous aneurysm is less than arterial aneurysms. Most are incidental findings with no major clinical significance. However, popliteal vein aneurysms (PVA) may be potentially life threatening, as they can be a source of pulmonary embolism and potentially even death. We report a case of right PVA in a 67-year-old male cadaver. Information from this case study may contribute to an improved understanding of these phenomena, including early detection of these or similar thromboembolic events.

Anatomical variations in the left coronary artery and its branches.

INTRODUCTION: Proficiency in the anatomy of coronary arteries and their variations is important for proper interpretation of coronary angiographies. The left coronary artery (LCA) commonly originates at the level of the left posterior aortic sinus and normally bifurcates into the anterior interventricular artery and circumflex artery. This study aimed to determine the variations in the LCA and its branches. METHODS: The study was conducted on 30 heart specimens. We observed the origin, length and branching pattern of the LCA and its coronary dominance. RESULTS: We found a short main LCA trunk in three specimens and a long main LCA trunk in one specimen. In two specimens, the division of the LCA led to three branches. With regard to 'dominance', one specimen showed left dominance while another showed codominance. CONCLUSION: Variations of the LCA are clinically relevant, especially when a perioperative coronary perfusion or coronary arteriography is performed.

Human cadaveric study of the morphology of the basilar artery

<p><b>INTRODUCTION</b>Nourishment for the brain, a highly vascular organ, is derived from a unique structure called the 'circle of Willis', which is formed by the terminal branches of the internal carotid arteries (ICAs) and basilar arteries (BAs). The circle of Willis forms an anastomotic link between the carotid and vertebrobasilar systems in the arterial supply of the brain, while the BA forms an important component of the brain's posterior circulation and supplies its many vital parts.</p><p><b>METHODS</b>A study was performed on 20 brain specimens used for routine dissections at the Anatomy Department, Kasturba Medical College, in order to examine the morphology of BAs in the brain.</p><p><b>RESULTS</b>In most specimens, the position of the termination of BA was normal, although variations were present in the mode of termination. In one specimen, the BA terminated by dividing into two superior cerebellar arteries. The posterior cerebral arteries (PCAs) arose from ICAs on both sides in this specimen, and a communicating branch was present between the terminal point of the BA and PCA on the left. In another specimen, unilateral variation was seen, with the PCA arising from the ICA on the right and a posterior communicating artery arising from the PCA, connecting it with the BA. The anatomy on the left side was normal.</p><p><b>CONCLUSION</b>We highlight the morphological aspects of the BA, the knowledge of which would help neurosurgeons safely diagnose, as well as plan and execute vascular bypass and shunting procedures for the treatment of stenosis, aneurysms and arteriovenous malformations in the posterior cranial fossa.</p>