Unusual Branching Pattern of the Lateral Cord of the Brachial Plexus Associated with Neurovascular Compression: Case report.

The brachial plexus consists of a network of nerves that innervates the upper limbs and its musculature. We report a rare formation of the lateral cord of the brachial plexus observed during the dissection of a 47-year-old male cadaver at the Department of Anatomy, Vardhman Mahavir Medical College, New Delhi, India, in 2016. The lateral cord was exceptionally long with twin lateral pectoral nerves and twin lateral roots of the median nerve. The proximal lateral root of the median nerve was thin in comparison to the medial root of the median nerve. The distal lateral root of the median nerve was thicker and followed an unusual course through the coracobrachialis muscle. In the lower third of the arm, the median nerve and the brachial artery-along with its vena comitans-spanned through the brachialis muscle. Surgeons, anaesthesiologists, radiologists and anatomists should be aware of such anatomical variations as they may result in neurovascular compression.

Peripheral communications of intercostobrachial nerve Peripheral communications of the intercostobrachial nerve in relation to the alar thoracic artery.

The intercostobrachial nerve (ICBN) is often encountered during axillary dissection for axillary lymph node dissection (ALND) for diagnostic and therapeutic surgery for mastectomy. The present report is a case observed in the Department of Anatomy at Vardhman Mahavir Medical College, Delhi during routine dissection of the upper extremity of a male cadaver for first year undergraduate medical students. On the right side, the medial cord of brachial plexus gave two medial cutaneous nerves of arm. Both the nerves were seen communicating with the branches of the ICBN. The ICBN and one of its branches were surrounding the termination of an alar thoracic artery. These peripheral neural connections of the ICBN with the branches of the medial cord can be a cause of sensory impairment during axillary procedures done for mastectomy or exploration of long thoracic nerves. The alar thoracic artery found in relation to the ICBN could further be a cause of vascular complications during such procedures.

Unduly extensive uncinate process of pancreas in conjunction with pancreatico-duodenal fold.

Anatomical variations of pancreatic head and uncinate process are rarely encountered in clinical practice. These variations are primarily attributed to the complex development of the pancreas. An unduly enlarged uncinate process of the pancreas overlapping the third part of duodenum was discovered during dissection. This malformation of the pancreatic uncinate process was considered to be due to excessive fusion between the ventral and dorsal buds during embryonic development. On further dissection, an avascular pancreatico-duodenal fold guarding the pancreatico-duodenal recess was observed. The enlarged uncinate process can cause compression of neurovascular structures and also cause compression of adjoining viscera. The pancreatico-duodenal recess becomes a potential site for internal herniation. This case is of particular interest to the gastroenterologists and surgeons performing surgical resections. Precise knowledge of embryogenesis of such pancreatic anomalies is necessary for understanding and thus treating many diseases of the pancreas.

Anomalous superior thyroid artery.

The variations in the pattern of distribution of superior thyroid artery assume paramount importance for neck surgeons, in view of its vital topographical relationship to the external laryngeal nerve. In this study, we report an unusual variation in the arterial supply of the thyroid gland, which was detected during a routine dissection of an adult male cadaver. The right superior thyroid artery was absent whereas the left superior thyroid artery took origin from the left common carotid artery and showed a dominant pattern of distribution supplying the superior aspect of both the left and right lobes of the thyroid gland. It exhibited a usual relationship with the left external laryngeal nerve. The inferior thyroid arteries did not show any unusual distribution. Knowledge of such arterial variations related to the thyroid gland is immensely helpful for surgeons in order to put ligature on anomalous artery and to avoid damage to vital structures in this area, such as the external laryngeal nerve.

A supernumerary maxillary tooth: its topographical anatomy and its clinical implications.

A supernumerary tooth was detected in the left maxilla during an osteology teaching session with undergraduate medical students. Supernumerary teeth have previously been detected in individuals who have approached a dental surgeon with a complaint and who have then been diagnosed by X-ray. Asymptomatic cases are frequently not diagnosed in time and it is only the malalignment or delayed eruption of the tooth which raises the suspicion that this type of dental anomaly is present. The present paper highlights the anatomico-radiological study of a supernumerary maxillary tooth in a bone specimen and describes its clinical implications. Precise anatomical details of the supernumerary maxillary tooth might be of significant clinical interest to dental and maxillofacial surgeons in drawing up a plan for orthodontic treatment and may thus minimise the possible complications involved.

An anatomico-radiological study of an accessory mandibular foramen on the medial mandibular surface.

Unnamed foramina are known to be present in the mandible. The present research paper reports the presence of an accessory foramen on the medial surface of the mandible, highlighting its anatomico-radiological details. Accessory foramina in the mandible have been known to transmit branches of nerves supplying the roots of the teeth. Nerve block techniques by local anaesthetics might fail if any of these nerves or their branches pass through these accessory foramina and thus escape the nerve block. Dental surgeons performing extractions should be aware of accessory foramina on the mandible and thus plan anaesthesia at an appropriate anatomical site. The presence of such foramina might also be an alternate route for tumour spread following radiation therapy. Precise knowledge and awareness of such accessory mandibular foramina would therefore be important for dental surgeons performing nerve block and also for oncologists in planning radiation therapy.