Auricular Deformational Anomalies Detected in Human Fetal Cadavers.

The aim of the study was to investigate the incidence and diversity of deformational auricular anomalies in human fetuses based on their morphologic appearances. A total of 100 auricles from 56 formalin-fixed fetuses (32 female and 24 male), gestational ages ranging from 17 to 36 weeks, were examined. The auricles were categorized according to the morphologic deformities outlined in existing literature. Of the samples analyzed, 67% exhibited auricular deformities, while the remaining 33% showed no auricle anomalies. Among the auricles with deformities, 73% displayed a single type of deformity: Conchal crus, 22%; Stahl's ear, 13%; inverted conchal bowl, 13%; lidding ear, 12%; cup ear, 7%; and constricted ear, 6%. In addition, 27% of the auricles exhibited 2 different deformities on the same side: Conchal crus with lidding ear, 10%; conchal crus with Stahl's ear, 5%; conchal crus with the antihelix 3rd crus, 3%; constricted ear with lidding ear, 5%; constricted ear with cup ear, 2%; and constricted ear with inverted conchal bowl, 2%. The most prevalent deformity was conchal crus, whereas cup ear was the least. Among the fetuses, 10 had bilaterally normal auricles, 8 had unilaterally normal auricles, 12 exhibited the same deformity bilaterally, and 14 displayed different deformities on each side. Auricular deformational variations can vary in shape and symmetry, even in morphologically normal fetuses. Identifying these deformities can contribute to accurate diagnosis and treatment planning for such anomalies in newborns.

Computed Tomography Evaluation of Frontal Sinus Volume in Migraine Patients.

This study aimed to assess the frontal sinus volume (FSV) on computed tomography (CT) scans in migraine patients. Cranial and paranasal CT images from 75 migraine patients (mean age: 39.14±13.63 y) and 23 control cases (mean age: 38.78±13.32 y) were analyzed retrospectively. Three-dimensionally reconstructed images of frontal sinuses were generated. Total FSV, anterolateral, and transverse diameters of the head were measured. The presence/absence and nature of supraorbital foramen and notches were evaluated. The total FSV was 8.02±5.97 cm 3 in the migraine group and 8.38±4.83 cm 3 in the control group, with no significant differences between them. Mean FSV values showed no statistically significant difference between females (7.79±5.85 cm 3 ) and males (9.12±6.66 cm 3 ) within and between the groups. Single notch was the most observed structure in both groups, with bilateral presence being the most common. Double foramen and notch were observed only in the migraine group, and the coexistence of both structures was higher in the migraine patients than in controls. There was no statistical difference in FSV between migraine and control groups, nor based on sex. Overall, the frontal region anatomy, particularly the exit locations of the supraorbital or supratrochlear foramen/notches, may be influenced by hyperplasia/hypoplasia of FSV. Therefore, assessing FSV using CT may be crucial for surgical planning in migraine patients undergoing open or endoscopic approaches to the frontal region.

Anatomical Evaluation of Zygomaticus Major Muscle With Relation to Orbicularis Oculi Muscle and Parotid Duct.

OBJECTIVES: To evaluate morphological properties of the zygomaticus major (ZMj) and demonstrate its detailed anatomical relationships with the orbicularis oculi (OOc) and the parotid duct (PD). METHODS: Fifteen formalin fixed adult cadaver heads (7 males /8 females) aged between 45 and 92 years were dissected to reveal the ZMj, OOc, PD. Shape, lengths and thickness of the ZMj, positional relationships of the ZMj with respect to the OOc and PD (overlap, neighboring, being separate) were determined. Topographic localization of the ZMj according to lateral and medial canthi, tragus, mental tubercle and angle of mandible was evaluated. RESULTS: The shape of the ZMj was observed as band like in 15/29 (51%), fan like in 10/29 (34%) and bifid in 4/29 (13%) sides. Position of the ZMj with respect to the OOc and distal part of the PD was not constant. The ZMj was overlapped by the OOc in 15/29 (52%) sides while they were adjacent in 14/29 (48%) sides. The ZMj overlapped the distal part of PD in 16/29 (%55) sides. They were separate in 10/29 (35%) sides and adjacent in 3/29 (10%) sides. Topographic location of the ZMj with respect to lateral and medial canthii, tragus, angle of mandible and mental tubercle was demonstrated. No statistically significant relationships were found between the ZMj measurements with head circumference and face length. No statistically significant differences were found between sides and gender in terms of the ZMj morphology (P > 0.05). CONCLUSION: This study demonstrates the morphological features and topography of the ZMj along with its relationships with the OOc and PD that would be essential for clinical implications.

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.

Assessment of clitoral anatomy in human fetuses.

PURPOSE: To determine fetal clitoral dimensions in antenatal period and to provide a contribution to external genital morphology determination in premature infants. METHODS: Thirty-one formalin fixed female fetuses aged between 18 and 40 weeks (17 fetuses aged 21.53 ± 1.88 weeks in the second trimester and 14 fetuses aged 31.00 ± 4.90 weeks in the third trimester) were evaluated. 20 (64.5%) fetuses were between 3 and 97% percentile range and within normal limits. Clitoris appearance (completely covered by labium majus/partially showing/prominent), length and width of clitoris, labium minus length, length, and width of labium majus were assessed. RESULTS: Clitoris length during the second trimester was 4.84 ± 1.09 mm, whereas it was 5.43 ± 1.07 in the third trimester. Clitoris width was as 3.35 ± 0.88 mm in the second trimester and as 4.55 ± 0.96 mm in the third trimester. A statistically significant increase was seen in width of clitoris, length, and width of labium majus and length of labium minus with gestational age in the second and third trimesters (p < 0.05). No significant difference was found between the second and third trimesters in terms of clitoris length (p = 0.146). A homogenous spread in clitoris appearance was obtained between the second and third trimesters without any significant difference (p = 0.912). In addition, fetus percentiles showed a homogenous spread without any significant differences between completely covered, partially covered and prominent groups (p = 0.452). CONCLUSION: The anatomical data can be beneficial to the development of fetal radiological screening procedures in females and also in morphological assessment criteria in premature infants, effectively assisting in diagnosing anomalies during the early term.

Anatomic Variations of Paranasal Region in Migraine.

PURPOSE: To assess the incidence of anatomical variations of the paranasal region on computed tomography in migraine patients compared with control subjects. METHODS: Paranasal computed tomography scans of 2 groups consisting of 50 migraine patients and 50 control subjects were evaluated, retrospectively. The presence of anatomic variations and the unilateral or bilateral presence of these variations were noted. Appropriate statistical tests were performed to compare the migraine and control groups, using a threshold P value of 0.05 for statistical significance. RESULTS: The migraine group included 39 female and 11 male patients with mean age of 39.9 (range: 18-65) years. The control subject group included 29 female and 21 male patients with mean age of 41.9 (range: 18-73) years. Anatomic variations noted included nasal septal deviation and spur, paradoxical curvature of middle concha, agger nasi cell, infraorbital ethmoidal (Haller) cells, sphenoethmoidal (Onodi) cells, supraorbital ethmoidal air cells, concha bullosa, uncinate bulla, and pneumatized crista galli. Of these variations, only the presence of Haller cells was statistically significantly higher in the migraine group compared with controls (P = 0.007). The unilateral presence of Onodi (P < 0.001), unilateral presence of supraorbital ethmoidal air cells (P = 0.012), and bilateral presence of concha bullosa (P = 0.016) were statistically significantly higher in the migraine group. There was no statistically significant difference between the unilateral or bilateral presence of Haller cells in migraine patients compared with controls (P > 0.05). CONCLUSION: Radiographic assessment of the paranasal sinuses is useful to elucidate potential points of pathology in migraine patients. The specific contribution of Haller cells to migraine headache symptoms and safe methods for surgical decompression warrant further study.

Radiologic Evaluation of Exiting Points of Supraorbital Region Neurovascular Bundles in Patients With Migraine.

PURPOSE: To reveal the presence and nature of exiting points of supraorbital region neurovascular structures and determine the distances of those structures to midline with computed tomography images by taking into account gender and sides in patients with migraine. METHODS: The study was conducted retrospectively on computed tomography images of 70 migraine and 70 control patients with a mean age of 39.5 ±â€Š13.8 years (range: 18-80). Presence and nature (foramen or notch) of exiting points of neurovascular structures in terms of side and gender in both groups, and the distances of these structures to the midline of the face were evaluated. RESULTS: In migraine and control groups, the most commonly seen structure was single notch. Coexistence of foramen and notch was statistically significant in migraine and female migraine groups than control and female control groups (P < 0.05). Bilateral presence of supraorbital structure was 51.4% in migraine group and 64.3% in control group patients. In all cases, foramen-midline distance was statistically significant longer than the notch-midline distance (P < 0.05). In migraine patients, no statistically significant difference was detected regarding distances of foramen and notch to midline in terms of side and gender. CONCLUSION: Consideration of variable presence and location of the supraorbital notch and foramen, analysis of computed tomography scan might be beneficial in preoperative planning of foraminotomy and fascial band release in adult migraine patients to prevent intraoperative complications. Also, coexistence is more frequent on left side in migraine patients that might cause overlooking those structures during surgery.

Branches of ulnar artery in human fetuses: anatomical and morphometric study.

PURPOSE: This study was conducted to demonstrate morphological pattern of the ulnar artery and to evaluate morphometrically its anatomical branching pattern in human fetuses. METHODS: Branching pattern of ulnar artery was evaluated on 121 upper limbs of dissected 63 of formalin-fixed fetus cadavers with gestational age ranging from 17 to 40 weeks. In order to obtain second and third trimester data, according to their gestational age, two groups were determined. RESULTS: In 79 of all 121 upper limbs (65%) ulnar artery gave anterior and posterior ulnar recurrent arteries as separate branches. In this study frequency of presence of a median artery was 46.28% among total examined 121 upper limbs. Median arteries originated from ulnar artery (3.57%) and from the common interosseous artery (53.57%) and anterior interosseous artery (42.85%). Mean distances of the measured parameters were demonstrated according to the gestational age and differences between group I (second trimester) and group II (third trimester). No statistical difference for groups was observed for gender and between right and left sides. CONCLUSIONS: Ulnar artery shows predictable patterns during second and third trimester of fetal period and can be suitable access effective alternative for diagnostic and therapeutic coronary interventions. Persistent median artery is important variation and knowledge of its incidence is important for diagnostic difficulties and also during awareness of its injury during surgical approaches.

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.

Anatomic and histological analyses of chiasma plantare and long flexor tendons of the foot on human fetuses.

PURPOSE: The aim of present study was to reveal slip transfers related to flexor hallucis longus (FHL) and flexor digitorum longus (FDL) by dissection and to investigate detailed structure of chiasma plantare composed of FHL-FDL tendons and quadratus plantae (QP), with precise composition of the long flexor tendons of lesser toes by histological sections in human fetuses. METHOD: Slip transfers related to FHL and FDL tendons were identified and the related morphometric measurements were taken with dissection in 28 formalin-fixed fetuses (25-40 weeks). Composition and restoration of chiasma plantare and long flexor tendons of lesser toes were traced histological by analyzing movements of the tissues on the sequential coronal sections in five fetuses in the third trimester. The numbers of layers constituting chiasma plantare and the muscles that formed layers were specified. Each of two to five flexor tendons arising from the chiasma plantare was analyzed regarding its formation and contribution of FHL slip. RESULTS: Slip transfers were found as FHL slip in 86% and cross-connections in 14%. The ratios of the slip width to that of FHL and FDL tendons were found higher than in adult literature. Variance in the involvement of slip to FDL and QP, formation and layering of chiasma plantare and formation of long flexor tendons from chiasma plantare were revealed and great similarities were found with data from dissection of adult in literature. CONCLUSION: Slip transfers between FHL and FDL tendons, and layering properties of chiasma plantare were largely finalized during intrauterine period, while structural changes in slip seem to continue in the later stages of life, possibly by the effects of growth and usage of the extremity. In addition to individual variations, investigating the contribution of FHL slip, FDL and QP to long flexor tendons by different methods in literature is also suggested to be responsible for some diversities of our histological study.

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.

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.

Anogenital distance and anal position index in cadaveric human fetuses.

The aim of this study is to contribute to the determination of the normal values of human anogenital distance (AGD) and anal position index (API) in the antenatal period. 59 formalin-fixed human fetuses were examined. AGD was measured by the distance between the center of the anus and the posterior fourchette in females, and the distance between the center of the anus and the posterior scrotal raphe in males. API in female fetuses was determined with the formula API = fourchette-center of anus/fourchette-coccyx formula, and API = posterior scrotal raphe-center of anus/posterior scrotal raphe-coccyx in males. The mean AGDs of the female and male fetuses in the second trimester were 5.60 ± 1.60 mm and 9.64 ± 2.75 mm and 12.88 ± 4.14 mm and 17.26 ± 5.55 mm in the third trimester, respectively. The AGD values were found to be significantly higher in the males (p = 0.002). While the API values detected in the female and male fetuses were 0.43 ± 0.085 and 0.55 ± 0.072 in the second trimester, they were 0.46 ± 0.079 and 0.55 ± 0.058 in the third trimester. The API values were found to be significantly higher in the male fetuses (p < 0.001). When the distribution of API values of the fetuses in the second and third trimesters was examined, no significant difference was found (p = 0.499). In addition, no significant correlation was found between API and AGD values and percentile groups of fetuses (p Ëƒ 0.05). The AGD and API differed significantly between female and male fetuses starting from the antenatal second trimester, and the difference was preserved independently of the fetal percentile in the later stages of pregnancy.

Accessory head of flexor pollicis longus muscle in fetuses and adult cadavers and its relation to anterior interosseous nerve.

This study was conducted to examine the accessory head of flexor pollicis longus muscle (ahFPL) and its relation with the anterior interosseous nerve (AIN) in human fetuses and adult cadavers. Ninety fetus forearms and 52 adult cadaver forearms were dissected to evaluate the incidence, morphology, and innervation of the ahFPL. The ahFPL was observed in 29/90 (32%) of the fetus forearms and 20/52 (39%) of the adult cadaver forearms. The overall side incidence was 34.5% (49/142) among total forearms examined. On the other hand, the population incidence of ahFPL was 42% (19/45) in fetuses while it was 50% (12/24) in adult cadavers. So, the overall incidence in humans was 44.9% (31/69) in the population studied. Compression of the AIN in the forearm by the ahFPL is known as one of the causes of the anterior interosseous nerve syndrome (AINS). So, the relation of ahFPL with the AIN was evaluated, and in light of previous classifications a modified new classification is proposed. The most common relation detected in this study was Type IVa (71.4%) (AIN and its branches coursed posterior to the ahFPL). While Type I was not observed in this study, the incidences of Type II, Type III, and Type IVb (all AIN branches 'without AIN itself' coursed posterior to the ahFPL) were 2%, 14.3%, and 12.3%, respectively. The Types I, IVa, and IVb are thought to be associated with complete or incomplete types of AINS and Type III with incomplete type of AINS only.

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.

Biomechanical and Morphometric Properties of the Long Flexor Tendons of the Toes: A Cadaver Study.

BACKGROUND: We sought to show the biomechanical and morphometric properties of flexor hallucis longus (FHL) and flexor digitorum longus (FDL) tendon grafts harvested by specific surgical approaches and to assess the contribution of FHL slips to the long flexor tendons of the toes. METHODS: Thirteen fresh-frozen amputated feet (average age, 79 years) were dissected. The connections between the FHL and FDL tendons and the contribution of FHL slips to the long flexor tendons were classified. The biomechanical properties of the tendons and slips were measured using a tensile device. RESULTS: The connections between the FHL and FDL tendons were reviewed in two groups. Group 1 had FHL slips (11 cases) and group 2 had cross-slips (two cases). The FHL slips joined the second and third toe long flexor tendon structures. Tendon length decreased significantly from the second to the fifth toe (P < .001). Apart from the second toe tendon being thicker than that of the fourth toe (P = .02) and Young's modulus being relatively smaller in the third versus the fourth toe tendon (P = .01), biomechanical and morphometric properties of second to fourth tendons were similar. Mechanical properties of those tendons were significantly different from fifth toe tendons and FHL slips. Morphometric and biomechanical properties of FHL slips were similar to those of the fifth toe tendon. CONCLUSIONS: Herein, FHL slips were shown to have biomechanical properties that might contribute to flexor functions of the toes. During the harvesting of tendon grafts from the FHL by minimally invasive incision techniques from the distal plane of the master knot of Henry, cutting slips between FHL and FDL tendons could be considered a cause of postoperative function loss in toes.

Anatomy of Master Knot of Henry: A morphometric study on cadavers.

OBJECTIVE: The objective of this study was to evaluate the features of flexor hallucis longus (FHL), flexor digitorum longus (FDL) and flexor digitorum accessorius (FDA) muscles with relevance to the tendon grafts and to reveal the location of Master Knot of Henry (MKH). METHODS: Twenty feet from ten formalin fixed cadavers were dissected, which were in the inventory of Anatomy Department of Medicine Faculty, Mersin University. The location of MKH was identified. Interconnections of FHL and FDL were categorized. According to incision techniques, lengths of FHL and FDL tendon grafts were measured. Attachment sites of FDA were assessed. RESULTS: MKH was 12.61 ± 1.11 cm proximal to first interphalangeal joint, 1.75 ± 0.39 cm below to navicular tuberosity and 5.93 ± 0.74 cm distal to medial malleolus. The connections of FHL and FDL were classified in 7 types. Tendon graft lengths of FDL according to medial and plantar approaches were 6.14 ± 0.60 cm and 9.37 ± 0.77 cm, respectively. Tendon graft lengths of FHL according to single, double and minimal invasive incision techniques were 5.75 ± 0.63 cm, 7.03 ± 0.86 cm and 20.22 ± 1.32 cm, respectively. FDA was found to be inserting to FHL slips in all cases and it inserted to various surfaces of FDL. CONCLUSION: The exact location of MKH and slips was determined. Two new connections not recorded in literature were found. It was observed that the main attachment site of FDA was the FHL slips. The surgical awareness of connections between the FHL, FDL and FDA, which participated in the formation of long flexor tendons of toes, could be important for reducing possible loss of function after tendon transfers postoperatively.

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.