The iliolumbar artery-anatomic considerations and details on the common iliac artery trifurcation.

The iliolumbar artery (ILA) of Haller is the largest nutrient pedicle of the ilium and its detailed knowledge is important for various surgical procedures that approach the lumbosacral junction, the L4/L5 disk space, the sacroiliac joint, the iliac and psoas muscles, or the lumbar spine. Also the ILA is relevant for various techniques of embolization. We aimed to evaluate the anatomic and topographic features of the ILA, by dissection on 30 human adult pelvic halves and on 50 angiograms. ILA was a constant presence and it emerged at Level A (from the common iliac artery (CIA), 8.75%), Level B (from the CIA bifurcation, 2.5%), Level C (from the internal iliac artery (IIA), 52.5%), Level D (from the IIA bifurcation, 3.75%), and Level E (from the posterior trunk of the IIA, 32.5%). Level B of origin of the ILA corresponds to a trifurcated CIA (morphology previously unreported), while Level D corresponds to a trifurcated IIA. A higher origin of the ILA corresponds to a more transversal course of it. A descending lumbar branch that leaves the iliac arterial system independently to enter the psoas major muscle, as seen in 48% of cases, may be misdiagnosed as ILA. Surgical interventions in the lumbar, sacral, and pelvic regions must take into account the variable origins of the ILA from the iliac system that can modify the expected topographical relations and may lead to undesired hemorrhagic accidents.

Typical and atypical neurovascular relations of the trigeminal nerve in the cerebellopontine angle: an anatomical study.

The aim of the present study was to anatomically evaluate in adults the neurovascular trigeminal relations in the cerebellopontine angle (CPA), from a morphological and topographical perspective and thus to improve, detail and debate the pre-existing information, with educational and surgical implications. For the present anatomical study we performed bilateral dissections on 20 human adult skull bases, in formalin-fixed cadavers, at the level of the cerebellopontine angle, using the anatomical superior approach; we also studied 20 additional drawn specimens-cerebellum and brainstems, from autopsied cadavers, in order to better document the vasculature at the trigeminal root entry zone (REZ). The most constant but not exclusive neurovascular relations of the trigeminal nerves were those with the superior cerebellar artery (SCA) and the superior petrosal vein (the petrosal vein of Dandy). The regular possibility for the SCA to appear divided into a medial and a lateral branch and these to represent individual trigeminal relations at the level of the pontine cistern or REZ must not be neglected. The petrosal vein tributaries can also represent superior, inferior, or interradicular trigeminal relations. Arterioles emerging from the SCA or the anterior inferior cerebellar artery (AICA) represented trigeminal relations either at the REZ or were coursing between the trigeminal roots. A dissected specimen presented a radicular trigeminal artery emerging from the basilar artery and entering the trigeminal cavum inferior to the nerve. Another specimen presented two bony lamellae superior to the trigeminal nerve at the entrance in the trigeminal cavum-these lamellae were embedded within the lateral border of tentorium cerebelli and the posterior petroclinoid ligament. So we bring here an evidence-based support extremely useful not only for specialists dealing with this area but also for educational purposes. It appears important not only to consider the typical anatomy at this level but also to take into account the atypical and hardly predictable morphologies that may alter the diagnoses and the specific surgical procedures.

Alveolar bone dehiscences and fenestrations: an anatomical study and review.

AIM: To determine the prevalence and distribution of fenestrations and dehiscences of the jaw bones among the Caucasian population, to find if any correlations can be established between their occurrence and certain teeth characteristics and to discuss the clinical implications the defects of alveolar process could have. MATERIAL AND METHODS: 138 skulls of specimens ranging from 21 to 54 years of age, having either complete dentition or reduced number of missing teeth were studied. Teeth found to have one of the two defects were examined for signs of faceting (attrition) that was considered an indicative for excessive occlusal forces and were submitted (except for the case of the third molars) to an analysis concerning their bucco-lingual inclination in the jaw. RESULTS: High-prevalence rates for both osseous entities were found. Fenestrations were present in 69.565% of the skulls and dehiscences were present in 53.623% of the skulls. More fenestrations were found in the maxilla: 74.679% and more dehiscences were found in the mandible: 71.613%. No correlations could be established between the presence of dehiscences and fenestrations and the development of high-occlusal forces, whereas all teeth affected either by dehiscences or by fenestrations were found to have modifications of the normal bucco-lingual inclination angle's values (p<0.05). DISCUSSION: The interest regarding the correlation between the alveolar processes morphology and the teeth dates back to 1963. The published studies are somewhat consistent with regard to prevalence and distribution of dehiscences and fenestrations, while opinions concerning their etiology are heterogenous. According to our study and the data provided by the specialized literature references, dehiscences and fenestrations are common findings related to the presence of the teeth. CONCLUSIONS: The potential of developing fenestrations and dehiscences must be carefully evaluated through oral surgery procedures. With regard to implant placement, this study aims to help the clinician design and manage treatment, in order to clinically correct the conditions and identify the principles of bone augmentation, so that endo-osseous implants can be properly placed.

The maxillary recess of the sphenoid sinus.

The most studied recess of the sphenoid sinus seems to be the lateral one, which is highly variable. Less attention seems to be paid to the maxillary recess, extending anterior, inferior and lateral towards the maxillary sinus. Twenty patients were referred for CT of the paranasal sinuses (axial CT), during a 3-month period. After examining the morphology of the sphenoid sinuses, the authors found bilateral maxillary recesses in one patient. On either side, the maxillary recess of the sphenoid sinus was directed anterior and lateral, being separated from the maxillary sinus by a distinctive bony wall; the longitudinal size of these recesses was 1.36 cm, on the left, and 1.22 cm, on the right. As it becomes part of the antero-medial wall of the pterygopalatine fossa, the maxillary recess of the sphenoid sinus should be evaluated prior to the endoscopic endonasal approach of the fossa; the detail becomes more relevant when one takes into account the fact that in our case, on the right side, the CT-scan suggested that the sphenopalatine artery could traverse directly through the maxillary recess. Therefore, such a maxillary recess of the sphenoid sinus seems to be anatomically located in the situs of the orbital process of the palatine bone and thus, it assumes the respective topography. The differential diagnosis with a Haller cell is relevant--the surgical procedures that approach a Haller cell could lead to a misdiagnosed maxillary recess of the sphenoid sinus into the middle nasal meatus. This aspect determined us to consider the maxillary recess of the sphenoid sinus as a false Haller cell and to claim the imperative of a CT-evaluation performed prior to interventions.

Computer Tomograph (CT) imaging of mandibular anatomical substrate in animal model restored with nanostructured hydroxyapatite compounds.

INTRODUCTION: This study was meant to test a new type of bone graft on an animal model. This material was a nanostructured hydroxyapatite. MATERIALS AND METHODS: the study was conducted according to Ethic Committee Regulation on animal model (Oryctolagus cuniculus - rabbit) between August and November 2014, at "Carol Davila" University of Medicine and Pharmacy, Bucharest. The animals were tested by using a CT at the level of the mandible before and after using the nanostructured hydroxyapatite. RESULTS: The animals were CT scanned at 1, 2 and respectively 3 months, noticing a growth of the mandibular bone density. After 3 months, a bone density equal with the density of the healthy bone was noticed. CONCLUSIONS: The use of the bone graft could be a viable alternative to available materials. The advantage was that bone recovery had a density similar to the density of the healthy bone and the cost of production was low because it was made out of Calcium azotate and monobasic ammonium phosphate.

Fallopian tubes--literature review of anatomy and etiology in female infertility.

RATIONALE: Around 30% of the infertile women worldwide have associated Fallopian tubes pathology. Unfortunately, for a long time, this aspect of infertility has been neglected due to the possibility of bypassing this deadlock through IVF. OBJECTIVE: Up to date free full text literature was reviewed, meaning 4 major textbooks and around 100 articles centered on tubal infertility, in order to raise the awareness on this subject. METHODS AND RESULTS: The anatomy of the Fallopian tube is complex starting from its embryological development and continuing with its vascular supply and ciliated microstructure, that is the key to the process of egg transport to the site of fertilization. There are many strongly documented causes of tubal infertility: infections (Chlamydia Trachomatis, Gonorrhea, and genital tuberculosis), intrauterine contraceptive devices, endometriosis, and complications after abdominal surgery, etc. DISCUSSIONS: Although there are still many controversies about the etiology of tubal sterility with the advent of molecular diagnosis of infections there has been cleared the pathway of infection through endometriosis or through ciliary immobility towards the tubal obstruction.

Current management of tubal infertility: from hysterosalpingography to ultrasonography and surgery.

RATIONALE: The development of IVF techniques has diminished the importance of tubal infertility but recent discoveries shed a new light on reproductive tubal surgery prior to any IVF cycle. OBJECTIVE: To adapt current state of the art recommendations concerning tubal factor infertility to actual possibilities in Romanian healthcare system and to grow the awareness of fellow fertility specialists and general practitioners to the improved outcomes of novel management and treatment modalities. METHODS AND RESULTS: 67 free full text articles centered on the subject of management in tubal infertility were identified in international databases. Four articles described general diagnosis using data from medical history, 21 works approached the diagnosis through hysterosalpingography, 14 papers introduced the use of different sonographic procedures, 8 files analyzed the importance of exploratory laparoscopy and 20 articles reviewed different treatment modalities. DISCUSSIONS: Current data show that active implementation of the large scale use of tubal surgery prior to any IVF cycle will reduce up to 30% the costs associated with obtaining a viable pregnancy in cases with tubal factor sterility.

The morphology and topography of the superior laryngeal artery.

The aim of this study was to investigate and correlate the anatomical parameters of the superior laryngeal artery (SLA). For the study, 50 adult, human specimens were used; laryngeal pieces were drawn from 16 cadavers and the arteries were dissected intralaryngeally. In 68%, the SLA originated from the superior thyroid artery and in 32%, directly from the external carotid artery. In five sides, an aberrant superior laryngeal artery (ASLA) was entering the larynx through a foramen thyroideum. The normal superior laryngeal artery (NSLA) had a short extralaryngeal part and continued intralaryngeally, with two segments and a point of inflexion; the first segment ran along the superior border of the thyroid cartilage, the point of inflexion of the NSLA was at a minimal distance of 1.1 cm anterior to the superior horn of the thyroid cartilage and from this point the NSLA continued in the paraglottic space. The ASLA had a constant origin from the superior thyroid artery; it then traversed the foramen thyroideum and reached the paraglottic space-at the superior border of the lateral cricoarytenoid muscle, it ended in two terminal branches. We constantly evidenced the following collateral branches of the NSLA: superior, anterior and postero-medial. The terminal branches are the antero-inferior branches that constantly anastomose with the cricothyroid artery and the postero-inferior branch anastomosed with the inferior laryngeal artery. Occasionally, additional branches of the NSLA were found. In conclusion, the intralaryngeal branching patterns of the NSLA and the ASLA are similar, the differences being given by the entry point into the larynx that will make the superior and anterior branches of the ASLA longer, will eliminate the transversal segment of the NSLA, and will shorten the descending segment in the paraglottic space in the case of ASLA. The base of the upper horn of the thyroid cartilage, the oblique line and its tubercles, the cricothyroid membrane and the cricothyroid joint are constant landmarks that allow a precise intralaryngeal identification of the SLA. These findings can improve performances during surgical manipulations of the larynx and laryngeal transplants.

Apoptosis in human embryo development: 2. Cerebellum.

We analysed the spatial and temporal distribution of apoptosis in human cerebellum development, during embryonic and fetal periods. Cerebella excised from two human embryos (8 weeks old) and eight fetuses (12-22 weeks old), were paraffin embedded and serially sectioned. Apoptotic cells were identified by propidium iodide staining, and TUNEL. In addition, immunohistochemistry for suicide receptor Fas(APO-1/CD95) was performed. We determined the distribution and percentage of apoptotic cells as well as Fas(APO-1/CD95)-positive cells in different regions and stages of development. Apoptotic cells were seen in both proliferative zones and postmitotic regions along the migratory pathways as well as in the developing cerebellar cortex in all examined stages. The Fas(APO-1/CD95) immunoreactivity was present in all examined stages in a small population of apoptotic cells: either neuroblasts or differentiated cells in postmitotic zones. These findings suggest that apoptosis drives the selection of the cells which are committed to differentiate during the early stages of cerebellar development. The differences between apoptotic cells distribution and Fas receptor expression suggest that cell selection is driven by different apoptotic pathways.