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A girl born by normal vaginal delivery at 34 weeks’ gestation was noted to have a discrete midline scalp swelling from birth. This parieto-occipital lesion was non-tender, non-pulsatile and measured 10 mm in diameter. At 4 weeks of age, the lesion remained similar in size and had developed a

Osteoglophonic dwarfism, also known as osteoglophonic dysplasia (OD), is an uncommon skeletal dysplasia with an autosomal dominant mode of inheritance, which equally affects boys and girls. OD is saliently featured by craniosynostosis, dysmorphic facial features, impacted mandibular teeth, rhizomelic limb shortening and non-ossifying fibromas habitually at the metaphyseal regions, which usually disappear after skeletal maturity. The long bones in OD are portrayed by this distinguishable ‘hollowed-out’ appearance with metaphyseal cystic defects that have a natural history of spontaneous resolution. We report a case of a rare and unusual presentation of OD in a 23-year-old woman whom has been diagnosed with OD during her early childhood. She presented with a progressively enlarging right thigh swelling associated with pain for the past 1 year. Her right femur plain radiograph revealed diffuse lysis of the whole femur with cortical thinning. MRI revealed multiple bilateral femur benign cystic lesion synonymous with a severe spectrum of OD. She was started on a trial of oral bisphosphonates, which led to a significant improvement in pain.

Ganglion cysts are the most common soft tissue tumor of the hand and wrist, affecting pediatric and adult populations. Despite their frequency, there is no consensus within the literature regarding the best management of pediatric wrist ganglia, and there are few recent publications examining this topic. We provide an up-to-date literature review examining the current issues and controversies in the management of pediatric wrist ganglia.

The external carotid artery (ECA) is the major blood supply for structures in the head and neck. Typically, it has eight separate branches; but there are many anatomical variations, making it difficult to predict surgical outcomes and complications without three-dimensional imaging. This case study focuses on a cadaver with multiple anatomical variations in the ECA, i.e., lingual, facial, occipital, ascending pharyngeal, and posterior auricular arteries, found during routine dissection of the right cadaveric neck. We also discuss the incidences of several other anatomical variations of the ECA branches and their surgical implications and potential complications.

Background: The aims are to evaluate the morphometry of the sellar region and propose a safety window on the floor of the sella turcica for the transsphenoidal approach in a Hispanic population. Materials and methods: We retrospectively analyzed 150 computed tomographic angiography sellar region images from asymptomatic patients. The images were evaluated intraobservatory by an expert radiologist. We measured: intercarotid distance of cavernous segment; depth of sella turcica; skull base angle; anterior distance, the distance between anterior spinal nasal and floor of the sella turcica; posterior distance, the distance between anterior spinal nasal and posterior wall of the sella turcica; anterior surgical angle, formed between the floor of the nostril and superior limit of the anterior wall of the sella turcica; and posterior angle, formed between the floor of the nostril and the inferior limit of the posterior wall of the sella turcica. Results: Safety window was based on two measures: the intercarotid distance and depth. The mean of the safety window is 151.13 mm 2 and 147.60 mm 2 for men and women respectively. The intercarotid distance was 17.83 mm. The depth of the sella turcica was 8.46 mm. The skull base angle was 112.13 grades. The anterior distance was 76.34 mm. The posterior distance was 87.59 mm. The anterior surgical angle was 32.76 grades. The posterior surgical angle was 87.59 grades. Conclusions: The surgical approach space is smaller in females. It could significate a more complicated surgery in this population. Anatomical understanding could reduce complications in hospitals without a neuronavigation system. The project was previously reviewed and approved by the local ethics and research committees of the University with the approval number AH19-00002 on April 25, 2019.

A 14-year-old female presented with progressive diminution of vision in the right eye. She had left-sided loss of vision since 1 year of age. The patient had aggressive behaviour with irrelevant talking. She was intellectually disabled and had a history of delayed motor and language milestones. On

Weaver’s bottom, popularly known as ischial bursitis, is a highly unusual entity affecting adults and older populations. Ischial bursitis is an inflammation of the ischial bursa and fluid collection and associated changes in the hamstring muscle complex (HMC). The ischial bursa lies near the

Background: Men over the age of 40 are more likely to develop benign prostatic hyperplasia (BPH). BPH is characterized by proliferation of the prostatic epithelium and stroma. Selenium nanoparticles (SeNPs), is an essential metalloid mineral and antioxidant. In this study, SeNPs were tested for their potential protective and curative impacts on BPH in rats. Materials and methods: 50 male Sprague-Dawley rats were randomly divided into five groups: Group I (Control group); Group II (Orchiectomized group): bilateral orchiectomy was conducted on rats; Group III (BPH group): testosterone (TE) enanthate injection was used to induce BPH; Group IV (Protective group): rats were given SeNP before subjecting rats to BPH; Group V (Curative group): rats were succumbed to BPH, followed by administration of SeNP. Measurement of prostate specific antigen (PSA) and TE in serum was performed and prostates were weighed and prepared for histological, immunohistochemical and ultrastructural examination. Results: In the BPH group, serum TE- and PSA-levels, as well as prostate weight, increased significantly and significant decreases in the protective and curative groups. Reduced acinar lumen, expansion of stroma and epithelial hyperplasia were noticed in the BPH group, which were ameliorated significantly both in protective and curative groups. There was an increase in PCNA immunoreaction in the BPH group and a decrease in both the protective and curative groups. On TEM of BPH group, the nuclei appeared irregular with dilated endoplasmic reticulum, loss of cell boundaries and apical microvilli. The protective group showed more improvement than the curative group. Conclusions: The effects of SeNPs on BPH induced by TE in rats, were both protective and curative, although the protective effects were more pronounced.

Background Sentinel node biopsy in vulvar cancer is associated with much less morbidity than inguinofemoral node dissection. Our study focused on describing the morphology of superficial lymphatic drainage of the vulva and its relationship to regional nodes, which may facilitate orientation during surgery. Materials and methods In 24 female cadavers, injections of patent blue (at various localizations mediallyunilaterally and bilaterally) were used to visualize the lymphatic drainage of the vulva. After dissection of lymphatic vessels and nodes, their course was documented by photograph and then analyzed. Subsequently, a map of vulvar superficial lymphatics was created. Results The cutaneous and subcutaneous tissue of the vulva primarily drained to superficial inguinal nodes. There was no evidence of a solitary lymph node that drained the unilateral vulva. Each area of the vulva drained to its own lymph node, which was variably localized in the subcutaneous groin around the great saphenous vein. Anastomoses between individual inguinal superficial lymph nodes are likely. Right-left symmetry in the course of lymphatic collectors was not detected. Natural drainage of the medial and paramedial areas to contralateral inguinal nodes was also not detected. The drainage pattern to ipsilateral inguinal nodes was consistent in cadavers without evidence of vulvar disease and may be applicable in the early stages of vulvar cancer. Conclusions There was no evidence of a solitary node that drained the unilateral vulva. Each part of the vulva may drain to a corresponding lymph node in a different localization of the groin. The surgeon should take this variability into account.

Background: Venous anomalies of the lower extremity are a challenge when found as rare variations. Physicians should be aware of morphological variations in this region for correct diagnosis and management of diseases such as deep vein thrombosis. Materials and methods: During the routine dissection of the lower extremities of a Caucasian male cadaver, a case of persistent sciatic vein was found. Results: A persistent sciatic vein originating from the saphenopopliteal junction coursed proximally and laterally to enter into the adductor magnus muscle, at the right side. Running through the fibers of the adductor magnus anteriorly, the variant vein drained into the deep femoral vein just medial to the vastus medialis muscle. Conclusions: As being a rare congenital vascular anomaly, the persistent sciatic vein should be correctly diagnosed and defined during the radiologic assessments, surgical interventions and blockades for better outcomes and lesser complications.

Background: Diabetes, among multiple systemic harmful health issues, also may deteriorate normal regenerative and reparative functions of periodontium. The aim of this research was to study the role of periodontal ligament in tissue remodeling under the orthodontic appliance stimulation in two rat experimental models (healthy Wistar rats and Goto-Kakizaki, rodent model of non-obese type 2 diabetes). Materials and methods: It was defined four groups of rats: Wistar (n = 8) and Goto-Kakizaki (n = 8) control groups without orthodontic appliances, and Wistar (n = 16) and Goto-Kakizaki (n = 16) appliance groups with orthodontic appliances. After 42 days, rats were sacrificed and histopathology descriptive analysis about periodontal ligament and adjacent structures was performed as well as cellularity of periodontal ligament and Kappa curvature of tooth roots were measured. Results: Goto-Kakizaki control rats showed statistically significantly higher cellularity in comparison with Wistar control rats (p

The following urogenital and vascular anomalies were observed in the left kidney of an 81-year-old female cadaver during routine dissection: three extrarenal calyces; an accessory renal artery originating directly from the abdominal aorta; and a circumaortic renal vein. The typical renal anatomical structures were identified, from anterior to posterior, as the renal vein, renal artery, and ureter appearing near the hilum of the left kidney. After closer examination, three extrarenal calyces were observed exiting from the hilum of the left kidney to form the pelvis, then narrowed and became the ureter which descended 21.5 cm to empty into the bladder. The accessory renal artery originated from the lateral aspect of the abdominal aorta 7.3 cm below the aortic origin of the left renal artery. A corresponding accessary renal vein, identified as a circumaortic vein, left the hilum 4.5 cm below the left renal vein and travelled posterior to the abdominal aorta to drain into the inferior vena cava. Extrarenal calyces are rare among urogenital tract variations. They can be associated with embryological abnormalities such as renal ectopia, horseshoe kidney or malrotation as well as clinical manifestations such as pelviureteric junction obstruction and hydronephrosis. Compression of the accessory renal artery can cause decreased blood flow to the inferior pole of the left kidney, thereby causing fibrosis, atrophy, or renal failure. The retro-aortic path of the circumaortic renal vein has been associated with posterior nutcracker phenomenon, haematuria, left renal vein thrombus formation, and renal vein hypertension. This unique combination of a collecting system anomaly and extrarenal vessel variations could have significant implications in abdominal surgery.

Abnormal systemic vein development produces anomalous veins, which - in the case of persistent left superior vena cava and/or left brachiocephalic vein - exhibit considerable topographic and morphometric differences in comparison with their usual anatomy. The nature and extent of those developmental anomalies - detected during intravenous procedures, such as cardiac implantable electronic device (CIED) lead insertion or central venous catheter placement - may hinder the procedure itself and/or adversely affect its outcome, both at the stage of cardiac lead advancement through an abnormally shaped vessel and lead positioning within the heart. This may lead to problems in achieving optimal sensing and pacing parameters and in ensuring that the patient cannot feel the pacing impulses. These events accompanied a de novo CIED implantation procedure in the patient with a double superior vena cava and left brachiocephalic vein agenesis, who ultimately required reoperation.

The dominant characteristics of the human foot are its shock-absorbing capability during walking or gait cycle and its adaptation to uneven surfaces. On the stance phase of the gait, the foot has to be flexible at first for shock absorption and adapt to the terrain; whereas, during the propulsive phase, it has to be dynamically rigid to function as a lever. Foot flexibility and rigidity are mainly controlled at the subtalar and midtarsal joints by tendons and ligaments. The subtalar joint is part of the longitudinal arch, but the midtarsal joint along with the tarsometatarsal joint are components of the transverse arch. However, the existence and functional role of transverse arch in human was challenged by some authors. But recent studies have revealed that the transverse arch has a predominant role in midfoot stiffness (Venkadeshan et al., 2020, & Holowoka et al., 2017). This midfoot stiffness allows the human foot to store elastic energy at the time of heel strike, which is utilized during the push-off mechanism for propulsion, thus making bipedalism more energy-efficient. Moreover, the transverse arch allows the longitudinal arch to be flexible like a lever and, at the same time, makes the arch of the foot rigid to behave like a stiff spring lever. Understanding the role of the transverse arch is obligatory to study the biomechanics of foot injuries and Charcot or diabetic foot. Studies on diabetic foot have shown that the modulation of transverse arch biomechanics and off-loading modalities would improve outcomes in the form of wound-healing and prevention of re-ulceration.

Dorsal arachnoidal webs are condensations of arachnoidal tissue densely adherent to the pial surface of the posterior aspect of the dorsal spinal cord. Infrequently described in literature they disrupt the flow of CSF in the spinal subarachnoid space leading to syringomyelia and myelopathy. While there are several theories on their origin, the “scalpel sign” on magnetic resonance imaging is considered to be pathognomonic of this condition. An illustrative case of a 58 year old man with syringomyelia and dorsal cord indentation who presented with spastic paraparesis, gait instability, parasthesias and bilateral non radicular upper limb pain that resolved following excision of the web is described to highlight the importance of considering this diagnosis when cases of so called “idiopathic” syringomyelia are encountered.

Background Syringomyelia is a fluid-filled cyst within the spinal cord and usually associated with Arnold-Chiari malformation. Posterior cranial fossa tumours are a rare cause of tonsillar herniation and secondary syringomyelia. Case Presentation: We report a rare case of a 56-year-old female with posterior cranial meningioma and secondary syringomyelia, admitted with headache, nausea, vomiting, and ataxic gait. MRI demonstrated a large posterior fossa lesion causing early ventriculomegaly and syrinx within the upper spinal cord extending from the hindbrain inferiorly to the level of T8. She underwent a posterior fossa craniectomy with left C1 hemilaminectomy and complete excision of the tumour. In 6 months following her procedure, MRI scan showed a significant reduction in the calibre of the syringomyelia throughout its length and there was a significant improvement in symptoms. Literature review: A PubMed literature search was carried out with keywords: “syringomyelia”, “posterior fossa” and “tumour”. 120 articles were reviewed. The inclusion criteria for this study was posterior fossa meningioma causing syrinx formation. A total of 9 isolated similar cases were identified. Discussion Tonsillar herniation and syringomyelia secondary to posterior cranial fossa meningioma are rare. The alteration in the dynamic flow of CSF is likely to be the cause for the formation and enlargement of the syrinx. Conclusion Although the pathophysiology of syrinx formation is still poorly understood, the alteration of CSF dynamic has been implicated, but a common unifying cause appears to be increased transcranial difference in intracranial pressure across the foramen magnum causing tonsillar herniation, irrespective of location in the posterior fossa. Posterior fossa craniotomy and excision of the lesion is the mainstay treatment.

Being unique is good, but not so for conjoined twins. Cephalothoracopagus is a rare type of conjoined twins, which is a rare monozygotic twinning resulting in imperfect fusion of the head, chest and upper abdomen. These twins have separated limbs and pelvis. The incidence of conjoined twins is 1 per 50,000 to 1 per 200,000 births. The cephalothoracopagus however is very rare variant seen in 1 in 3 million births. In literature approximately 200 cases have been reported till now. The cephalothoracopagus janiceps has two types: disymmetros and asymmetros. We present a case of cephalothoracopagus janiceps disymmetros in a 22-year-old gravida at 19 weeks gestation.

Background: Variation in the posterior cord of the brachial plexus is complicated and creates a risky relationship with the neighbouring structures. This is of importance to the surgeons, anaesthetists who must deal with the region in surgeries and procedures. Moreover, any benign tumour like Schwannoma is rare in the plexus comprising 5 % of total head and neck schwannomas. Methods: We present a case of Schwannoma of the brachial plexus in a cadaver during routine anatomy dissection for the medical students. The origin and order of branching of the posterior cord were recorded and photographs were taken. The tumour was present in an accessory branch of the posterior cord and removal was made in-toto. An immunohistochemistry study was done for confirmation of diagnosis. Results: The classical branching of the posterior cord was present. Additionally, a branch existed that was supplying the triceps muscle and emerged directly from the posterior cord. Tumour having the dimension of 2 x 1.8x 0.5 cm was present. Conclusions: Schwannomas are indolent but may cause compression of the nerve and resulting neurological symptoms. They might mimic nodules of supraclavicular fossa in breast carcinoma. Variations of the brachial plexus can also make the surgeons confused during surgery due to which anatomical knowledge of the possible variations is important. Pre- and Post-operative complications can be easily predicted from it. Follow-up of the tumour is essential to track its progress and differentiation.

There are several types of morphea with different levels of connective tissue involvement and morphological manifestations. In this mini review, it was pointed out the most important morphological and clinical aspects of localised scleroderma in the oral cavity. The case presented in this article supports the scientific information and is described with details. The morphea of mucous membrane which was clinically suspected, was proved by histopathological examination of the sample. The unusual location of the local findings posed a diagnostic challenge. The case history should be significant due to the low number of studies. The special attention should be taken to match the clinical with pathomorphological picture in localised scleroderma diagnosis and treatment when the involvement of skin and oral mucosa is.

Background: The aim of this study is to determine the prevalence of styloid process (SP) patterns in Saudi population. Materials and methods: This retrospective, cross-sectional study included 2010 digital panoramic radiographs (PRs) selected randomly for adult patients who visited five major hospitals in the Qassim region, Saudi Arabia, PRs were examined to detect any SP elongation. Data were collected and analyzed using SPSS v22. Results: In this study, positive SP elongation was seen in 25.4% of the total cases, 14.2% and 11.2% male and female respectively. The mean age was 34.3 ± 13.9 years. Type I showed in 19.1%. Type II was seen in 1.7%. While type III came with 4.6% of the cases. Normal SP was seen in 74.7%. Patients between 30-50 years significantly more affected with type I pattern. Normal SP was reported mostly in the youngest age group 18-24 years with 31% of total cases. Conclusions: SP has many patterns and variations that could be detected on digital PRs taken daily in most of dental clinics. Dentists should be trained to detect patients with such variation so that signs associated with Eagle syndrome are not misinterpreted.

Background: The carotid arteries serve as major blood supply to the head and neck region of the body. Understanding their structure and function in the pathogenesis of stroke and in interventional neuroradiology due to luminal stenosis, atherosclerosis and wall stiffness is paramount. Doppler ultrasound scan plays key role in the early diagnosis of the pathologies of the arteries as it is an affordable, accessible, reliable and non-invasive clinical tool. Knowing normal average diameter of the carotid arteries among healthy individuals is important in making correct clinical diagnosis in any population. The aim of the study was to determine mean diameters of the carotid arteries among healthy adult Nigerians for reference. Materials and methods: Prospectively studied 104 healthy Nigerians within the ages of 18 and 65 years by taking doppler scans of their carotid arteries (common, internal and external) on both sides and measured each diameter. Using a 95% confident level, P-value of < 0.05 was significant. Results: Of the studied population, 62 were males and 42 were females, and the average age of the subjects was 28.32 ± 9.09 years. From this study, the average luminal diameter of the common carotid artery = 0.61 ± 0.08 cm, internal carotid artery = 0.61 ± 0.08 cm and external carotid artery = 0.49 ± 0.10 cm. The results showed that although, there are differences in measurements between the two sexes (males slightly higher than females in CCA) and between right and left sides (with right side slightly higher), they are not statistically significant. Conclusions: This sonographic study on healthy Nigerian adults has given us normal reference values of the luminal diameters of the carotid arteries among Nigerians, which clinicians can make reference to, when assessing carotid artery diameters of patients in Nigeria.

Background: The study of the cerebellar arteries has increased. The purpose of this study was to determine the morphological expression of posterior inferior cerebellar artery in a sample of Colombian population. Materials and methods: 186 posterior inferior cerebellar arteries of fresh cadavers were studied. In each specimen, vertebral arteries were injected with 100 ml of semi-synthetic resin, dyed with mineral red. Results: The cerebellum evaluated, 174 (93.5%) posterior inferior cerebellar artery were found. Also, there were 12 (6.5%) agenesis. There was single posterior inferior cerebellar artery in 159 (91.4%) samples and duplicate in 10 (5.7%), while five (2.9%) specimens showed hypoplasic. The posterior inferior cerebellar artery originated from the vertebral artery in 121 samples (69.5%) and from the basilar artery in 42 (24.1%) samples; while in 11 (6.4%) originated in a common trunk with the anterior inferior cerebellar artery. In 101 (83.5%) cases, the posterior inferior cerebellar artery originated from the intracranial segment of the vertebral artery, while 20 samples (16.5%) originated from the extracranial segment. The calibers of posterior inferior cerebellar artery in its proximal and distal segments were 1.45±0.37 mm and 1.33 ± 0.31 mm respectively. Conclusions: This study, carried out in cadaveric material, provides relevant qualitative and morphometric information of the posterior inferior cerebellar artery, useful for the diagnosis and clinical management, as well as for the surgical approaches that may compromise this structure.

Background: We aimed to clarify whether pathological changes in skin and subcutaneous tissue with lymphedema affected the skin hardness sensed by palpation. Methods and Results: In 50 patients with unilateral legs with lymphedema (LE), the skin hardness of the lower inner thigh and lower inner calf was determined using a scale ranging from 1 (softest) to 7 (hardest) based on palpation. Then, the skin hardness was correlated with the measurements of skin/subcutaneous tissue ultrasonography images obtained from the palpated parts. Multivariate logistic regression analysis demonstrated that dermal thickness was a significant factor that affected the difference in skin hardness between the LE and the contralateral asymptomatic leg for both thigh (p < 0.05) and calf (p < 0.01). When the thigh and calf in the LE were individually studied, subcutaneous echogenicity (p < 0.05), indicating subcutaneous inflammation/fibrosis, and subcutaneous thickness (p < 0.01) also seemed to affect skin hardness, respectively. Conclusions: The skin hardness sensed in the LE seemed to be affected predominantly by dermal thickening. In addition, the pathological changes in the subcutaneous tissue caused by LE seemed to have an impact on skin hardness. Clinical Trial Registration number 2020-150.

The vallecular cyst is formed due to an obstruction in the collecting duct of a submucosal gland, thereby causing the accumulation of mucus within it. It is also known as a ductal cyst, mucus-retention cyst. DeSanto et al [1][1] identified that these vallecular cysts are due to distended ducts and

A bursa is a fluid-filled sac meant to reduce the friction between surfaces.[1][1] A bursa can be superficial when present between the skin and underlying tendon or bone such as the prepatellar, infrapatellar, olecranon bursa or superficial calcaneal.[2][2] Deep bursae are located deep to the facia

Non-ambulant adults with cerebral palsy (CP) are commonly affected by progressive secondary debilitating musculoskeletal issues, which may be clinically measured using the Goldsmith Indices of Body Symmetry (GIofBS). The primary aim of this study was to explore relationships between clinical outcomes and relevant radiographic measures in non-ambulant adults with CP. Thoracic shape and symmetry, pelvic orientation, and hip range were measured using the GIofBS. Radiographs of the pelvis and spine were reviewed. The Pearson correlation (r) or Pearson’s r was used to assess the relationships between clinical and radiographic measures. The positioning and readability of radiographic data in 30 non-ambulant adults with CP were variable. Minimal to no correlation between paired measures of radiographic and clinical data for trunk, pelvis, and hips were found, ranging from the lowest correlation of r(15) = –0.09, p = 0.620 (left migration percentage and hip range) to the highest of r(15) = –0.25, p = 0.200 (right hip morphology scale and hip range). The complex three-dimensional nature of asymmetries of the thorax, pelvis, and hips, measured clinically with the CIofBS, provides valuable, yet different, postural information to that obtained by radiographs. Inclusion of both radiographs and the GIofBS would enable a comprehensive lifespan assessment for postural management of adults with CP.

The aim of this study was to assess the efficacy of quantitative ultrasound imaging in characterizing cancer cell death caused by enhanced radiation treatments. This investigation focused on developing this ultrasound modality as an imaging-based non-invasive method that can be used to monitor therapeutic ultrasound and radiation effects. High-frequency (25 MHz) ultrasound was used to image tumor responses caused by ultrasound-stimulated microbubbles in combination with radiation. Human prostate xenografts grown in severe combined immunodeficiency (SCID) mice were treated using 8, 80, or 1000 µL/kg of microbubbles stimulated with ultrasound at 250, 570, or 750 kPa, and exposed to 0, 2, or 8 Gy of radiation. Tumors were imaged prior to treatment and 24 hours after treatment. Spectral analysis of images acquired from treated tumors revealed overall increases in ultrasound backscatter intensity and the spectral intercept parameter. The increase in backscatter intensity compared to the control ranged from 1.9±1.6 dB for the clinical imaging dose of microbubbles (8 µL/kg, 250 kPa, 2 Gy) to 7.0±4.1 dB for the most extreme treatment condition (1000 µL/kg, 750 kPa, 8 Gy). In parallel, in situ end-labelling (ISEL) staining, ceramide, and cyclophilin A staining demonstrated increases in cell death due to DNA fragmentation, ceramide-mediated apoptosis, and release of cyclophilin A as a result of cell membrane permeabilization, respectively. Quantitative ultrasound results indicated changes that paralleled increases in cell death observed from histology analyses supporting its use for non-invasive monitoring of cancer treatment outcomes.

The nerve to mylohyoid muscle supplies the mylohyoid and the anterior belly of the digastric muscles, with terminal sensory branches that might innervate the submental skin and mandibular teeth. The nerve to mylohyoid muscle typically originates from the posterior surface of the inferior alveolar nerve right before entering the mandibular foramen. In rare cases, the nerve to mylohyoid muscle arises from the lingual nerve. The variations of the nerve to mylohyoid muscle might have led to failure of an inferior alveolar nerve blockade. During the routine dissection of a cadaveric head, a rare case was identified where the nerve to mylohyoid muscle had origins from both the inferior alveolar and lingual nerves. This case is reviewed and salient literature reviewed.

A glandular odontogenic cyst (GOC), a rare type of cyst occurring in the jawbone, comprises about 0.2 % of all odontogenic cyst cases. Recurrence is likely, thus long-term follow-up examinations are necessary. The present patient was a 24-year-old Japanese female with a multilocular GOC that was extirpated following marsupialization. Two years after the initial extirpation, the GOC recurred and re-extirpation was performed, with no recurrence noted at two years after the second procedure. Although extirpation of a GOC after marsupialization can cause recurrence, it allows for preservation of teeth in the area of the lesion and maintenance of occlusion. The present case report includes a comparison of reports of GOC in Japan with those reported in other countries.

Summary The superior and inferior gemelli are deep muscles of the gluteal region, that facilitate the maintenance of a dynamic stability of the hip joint. Their absence could increase the chances of failure in the management of total hip anthroplasty and column acetabular ring fractures. We present a case of an adult female cadaver, with bilateral absence of the superior and inferior gemelli muscles.

Omental herniation, located between the rectus abdominis muscle and the anterior blade of the rectus sheath, can be triggered after a transverse suprapubic incision. It causes the development of an incisional interstitial hernia (IIH), which is an extremely rare and poorly understood condition. Based on this information, our work presents the first anatomical description of incisional interstitial hernia found during routine dissection at the Human Anatomy Laboratory of the Federal University of Ceará in a formalized female corpse.

Background: The sciatic nerve is a peripheral nerve and is more vulnerable to compression with subsequent short- or long-term neuronal dysfunction. The current study was designed to elucidate the possible ameliorative effect of L-carnitine and sildenafil (SIL) on sciatic nerve crush injury. We sought to determine the effects of L-carnitine, a neuroprotective and a neuro-modulatory agent, and sildenafil citrate, a selective peripheral phosphodiesterases inhibitor on modulating neuro-degenerative changes due to sciatic nerve compression. Materials and methods: The comparative effect of L-carnitine (at an oral dose of 20 mg/kg/day) or SIL citrate (20 mg/kg/day orally) administration for 21 days was studied in a rat model of sciatic nerve compression. Sciatic nerve sections were subjected to biochemical, histological, ultrastructure, and immunohistochemical studies to observe the effects of these treatments on neurofilament protein. Results: The sciatic nerve crush injury group (group II) showed a significant decrease in tissue catalase (CAT), superoxide dismutase (SOD) and increase in malondhyde (MDA) as compared to control group (P < 0.01). Histological changes in the form of degenerated and vacuolated axoplasm with areas of nerve fiber loss and pyknotic nuclei were reported. The blood vessels were dilated, congested with areas of hemorrhage and mononuclear cell infiltration. Histo-morphometrically, a statistically significant reduction in the nerve fibers number, mean axon cross-sectional area, myelin sheath thickness and a significant increase in collagen fibers percentage (P < 0.05) as compared to control group. Immunohistochemically, neurofilament protein was significantly downregulated as proved by a significant reduction in mean area % of neurofilament expression. L-carnitine ameliorated the studied parameters through it`s neuroprotective effect while Sildenafil (SIL) is a selective peripheral phosphodiesterases (PDE-5) inhibitor had improved crush injury parameters but with less extent than L-carnitine. Conclusions: These findings indicate the valuable effects of L-carnitine administration compared to that of SIL citrate in alleviating the serious debilitating effects of sciatic nerve crush injury. Our results provide a new insight into the scope of neuroprotective and, neuro-regenerative effects of L-carnitine in a sciatic nerve compression model.

Background: In case of long-term and physiological loads (e.g. during pregnancy or regular athletics training), reversible morphological changes occur in the heart - cardiomyocytes undergo hypertrophy, however, this is not accompanied by impairment of left ventricular function or myocyte metabolism. However, in the course of various pathological processes, as time goes by, gradually permanent morphological changes occur. These changes are referred to as remodeling of the heart muscle, which, regardless of the primary cause, can lead to the development of chronic heart failure. Materials and methods: The study was performed on post-mortem material of 35 human hearts obtained from forensic sections and anatomopathological sections of people who died of non-cardiac causes (mainly traffic accidents, suicide attempts, strokes, acute infections); material was fixed in a 4% formalin solution. The hearts were subjected to macro- and microscopic assessment. During microscopic assessment the features of remodeling were evaluated. Results and conclusions: In vivo and echocardiographic tests, as well as macroscopic evaluation of post-mortem material, suggest the presence of some kind of right ventricular muscle remodeling, however classic microscopic observations, presented in this study do not provide such unambiguous evidence. Thus, the question arises: why and how the right ventricular function is disturbed, sometimes at early stages of arterial hypertension.

Background: The topographic location of the superior mesenteric artery (SMA) and its branching pattern are usually arbitrary in textbooks. This study, therefore, aims to provide topographic information of SMA with reference to the vertebral bodies, ventral branches of aorta and branching pattern of SMA. Materials and methods: The study was conducted on 35 embalmed adult human cadavers. We performed detailed dissection of the SMA to topographically locate its origin in respect to vertebral level and other ventral branches of the abdominal aorta. We have categorised the branching pattern of SMA into three different types depending upon the number of arterial pedicles, traced from proximal to distal to look into their anastomoses and formation marginal artery of Drummond. Results: Vertebral level of origin of SMA varied between the lower third of twelfth thoracic vertebra (T12) to lower third of first lumbar vertebra(L1), most commonly arose at the level of the lower third of L1(77.14%). The average distances between the origin of SMA and celiac trunk (CT), inferior mesenteric artery (IMA) and aortic bifurcation were 1.84 cm, 6.67 cm and 10.39 cm respectively. Depending on the branching pattern, type A was found in 29 (82.85%) cases, type B in 5 (14.28%) and type C in one (2.85%). In two cases (both of type B), the marginal artery was incomplete. Conclusions: The most common topography of origin of the SMA was opposite the lower third of L1. The celiac-superior mesenteric relationship was most consistent than between any other two points on the abdominal aorta; 85% of the SMAs were concentrated within a space of 1.00 cm (0.60-1.50 cm) from the CT. Type A branching pattern was most commonly seen in our study population.

Background: Intervertebral disc (IVD) degeneration plays a crucial role in the pathophysiology of low back pain. Several grading systems have been developed for both morphological and radiological assessment. The aim of this study was to assess the morphological and radiological characteristics of IVD degeneration and validate popular radiological Pfirrmann scale against morphological Thompson grading system. Material and methods: Full spinal columns (vertebrae L1-S1 and IVD between them) were harvested from cadavers through an anterior dissection. MRI scans of all samples were conducted. Then, all vertebral columns were cut in the midsagittal plane and assessed morphologically. Results: A total of 100 lumbar spine columns (446 IVDs) were included in the analysis of the degeneration grade. Morphologic Thompson scale graded the majority of discs as grade 2 and 3 (44.2% and 32.1%, respectively), followed by grade 4 (16.8%), grade 1 (5.8%) and grade 5 (1.1%). The Radiologic Pfirrmann grading system classified 44.2% of discs as grade 2, 32.1% as grade 3, 16.8% as grade 4, 5.8% as grade 1 and 1.1% as grade 5. The analysis on the effect of age on degeneration revealed significant, although moderate, positive correlation with both scales. Analysis of the agreement between scales showed weighted Cohen’s kappa equal to 0.61 (p

Purpose Anterior cruciate ligament (ACL) injury induces anterior and rotatory instability of the knee. However, the effect of this instability on the stress distribution in the knee joint in living participants is not clear. The aim of this study was to compare the distribution pattern of subchondral bone density across the proximal tibia in the knees with and without ACL injury, and to investigate the correlation between the distribution patterns of the subchondral bone density and the duration of ACL-deficiency. Methods Radiographic and computed tomography (CT) data pertaining to 20 patients with unilateral ACL injury without combined injury (ACL-deficient group) and 19 nontraumatic subjects (control group) were collected retrospectively. Subchondral bone density of the proximal tibia was assessed using CT-osteoabsorptiometry. Both the medial and lateral compartments of the proximal tibia were divided into three subregions of equal width in the sagittal direction. The percentage of high subchondral bone density areas (HDA%) in each subregion was quantitatively analyzed. Results HDA% of the posteromedial region was significantly higher in the ACL-deficient group (mean: 21.6%) than in the control group (14.7%) (p = 0.002). In contrast, HDA% of the anteromedial region was significantly lower in the ACL-deficient group (9.4%) than in the control group (15.3%) (p = 0.048). The logarithm of the time elapsed from ACL injury to CT examination showed a significant correlation with HDA% in the posteromedial region (p = 0.032). Conclusions Subchondral bone density in the posteromedial region significantly increased after ACL injury and correlated with the duration of ACL-deficiency in semi-log manner in meniscus intact knees. The increase in stress on the posteromedial region after ACL injury, which induces a change in the subchondral bone density, justifies early ACL reconstruction after ACL injury.

To study the direction and biomechanical consequences of hip center of rotation (HCOR) migration in Crowe type III and VI hips after total hip arthroplasty, post-operative radiographs and CT scans of several unilaterally affected hips were evaluated. Using a three-dimensional model of the human hip, the HCOR was moved in all directions, and joint reaction force (JRF) and abductor muscle force (AMF) were calculated for single-leg stance configuration. Comparing to the normal side, HCOR had displaced medially and inferiorly by an average of 23.4% and 20.8%, respectively, of the normal femoral head diameter. Significant decreases in JRF (13%) and AMF (46.13%) were observed in a presumptive case with that amount of displacement. Isolated inferior displacement had a small, increasing effect on these forces. In Crowe type III and IV hips, the HCOR migrates inferiorly and medially after THA, resulting in a decrease in JRF, AMF, and abductor muscle contraction force.

Introduction: compression of the labyrinthine segment of the facial nerve by edema has been considered as an important pathology in the majority of the cases of idiopathic facial nerve paralysis. Hence, it is suggested that total decompression of the facial nerve should also include the labyrinthine segment by a middle fossa approach. However, the middle fossa approach requires craniotomy and temporal lobe retraction, which increases the morbidity. The labyrinthine segment of the facial nerve can also be reached through mastoidectomy. However, many ear surgeons are not familiar with this approach due to the lack of anatomical data on this surgical area. Objective: to study the anatomical limitations of decompression of the labyrinthine segment via transmastoid approach. Methods: complete mastoidectomy was performed in six adult cadavers heads. Dissection was extended in the zygomatic root and posterior bony wall of the external auditory canal to visualize the incudomallear joint completely. The bone between tympanic segment, lateral and superior semicircular canal's ampullas and middle fossa dural plate was removed. Fine dissection was carried out over tympanic segment of the facial nerve in an anterosuperomedial direction the labyrinthine segment was reached. Results: all the mastoids were well pneumatized. Distances between the labyrinthine segment and middle fossa dura, and between the labyrinthine segment and superior semicircular canal, were 2.5 and 4.5 mm on average, respectively. In addition, distances between the middle fossa dura and dome of the lateral semicircular canal, and between the middle fossa dura and tympanic segment were 4.6 mm and 4.3 mm on average, respectively. Conclusion: it is possible to expose the labyrinthine segment of the facial nerve through mastoidectomy by dissecting the bone in the area between the tympanic segment of the facial nerve, middle fossa dural plate and ampullary ends of the lateral and superior semicircular canals., NA

Agenesis of the piriformis muscle is an extremely rare occurrence. Knowledge about this anatomic variant is important because of its close proximity with the sciatic nerve and sacral plexus. The piriformis muscle also serves as an important anatomic landmark for image-guided intervention and hip surgery. We report a case of piriformis muscle agenesis in a 28-year-old woman, incidentally detected on magnetic resonance imaging of the lumbosacral spine and pelvis, performed for low back pain.

This report highlights a striking image of incidentally discovered selective symmetrical chronic bilateral globus pallidus infarction in a 28-year-old man as a result of cocaine use. He presented to the emergency department for evaluation of acute onset of left arm weakness, most prominent distally

Flexor digitorum accessorius (quadratus plantae) is a muscle of second layer of the sole of the foot. Though it is not a very important muscle in terms of movements or stability of foot, it could pose problems when it presents variations. We observed a novel, accessory slip of flexor digitorum accessorius. The slip arose from the fascia covering abductor digiti minimi muscle and got inserted into the tendon of the flexor digitorum longus muscle. It was supplied by a branch from lateral plantar nerve. The proximal part of this accessory slip surrounded the lateral plantar nerve and vessels. Compression of lateral plantar nerve by this accessory slip might produce symptoms similar to that of tarsal tunnel syndrome and lead to misdiagnosis. The case could be of importance to foot and ankle surgeons and radiologists.

Orbital hematic cyst is characterized by cystic accumulation of hematogenous debris surrounded by a wall of fibrous tissue without an epithelial lining. It is a relatively uncommon benign cyst and occurs secondary to blunt trauma in most cases. We experienced a case of 53-year-old male who presented with proptosis of the left eye. A cystic lesion was found at the superolateral orbital rim of the patient. We report a case of orbital hematic cyst that was resected completely through the sub-brow approach.

The masticator space is an anatomical and functional entity centered on the mandibular ramus, which divides it into medial and lateral compartments. The masticator spaces considered paired supra-hyoid cervical spaces on each side of the face that extend from the angle of the mandible to the parietal bone. The masticator space contains the mastication muscles, posterior mandible, and mandibular nerve. They are separated from the nasopharynx by the parapharyngeal spaces bilaterally. Primary malignancy of the masticator space is very uncommon.Here we report a diagnostic dilemma of primary masticator space malignancy mistaken by nasopharyngeal carcinoma as the patient 40-year old gentleman presented with left lateral rectus palsy and left nasopharynx fullness. Keywords: Masticator space, Nasopharynx, Lateral rectus palsy, Primary masticator space malignancy.

Background: Commonly, arterial anatomic variants are reported as single entities. However, different such variants can occur in a single patient. Materials and methods: During a retrospective study of computed tomography angiograms of 52 adult patients, two cases were found with unilateral maxillofacial trunks. In each case different other anatomic variants were documented. Results: The maxillofacial trunk in the first case was associated with bilateral posterior kinks of the internal carotid artery which passed beyond the transverse processes of the atlas vertebra and indented and displaced the internal jugular veins. Common carotid origins of the superior thyroid arteries were found, as well as a high origin of the contralateral facial artery. In the second case a plethora of variants were associated with a unilateral maxillofacial trunk: (1) direct occipital-vertebral arterial anastomosis; (2) ipsilateral atresia of the distal vertebral artery and of the A1 segment of the anterior cerebral artery; (3) bilateral atresia of posterior communicating arteries; (4) linguofacial and labiomental trunks; (5) terminal trifurcation of the external carotid artery. Conclusions: The arterial anatomical variants of the head and neck should be carefully documented prior to specific surgical and interventional procedures, as well as for understanding the compensatory anatomical pathways of circulatory insufficiencies.

Background: The objective of this study is to investigate the position and frequency of dehiscences in the medial orbital wall and to reveal that dehiscences and orbital adipose tissue hernias are distinct entities. Materials and methods: Two hundred-thirty medial orbital walls of 115 patients with a preliminary diagnosis of headache and sinusitis but without active ethmoidal sinusitis were examined by computer tomography in the axial plane. Two separate radiologists assessed continuity of the medial orbital wall and orbital fat tissue herniation in ethmoid cells. The medial orbital wall was divided into four quadrants and the dehiscence distribution was evaluated. Results: Bone defects were detected in 71 patients (30.9%) in 230 orbital medial wall reviews of 115 patients (59 males, 56 females). Eight of these cases (4 male, 4 female) (3.5%) had herniation of the orbital adipose tissue into the ethmoid sinus. Of the 108 dehiscences, 47 were localized in the posterior upper quadrant. A statistically significant difference was found in the dehiscence distribution according to the quadrants. No significant relationship was found among age, gender, side of dehiscence and frequency of dehiscence. Conclusions: Dehiscences in the posterior upper quadrant are more common in the medial orbital wall. Although bone dehiscences in the medial orbital wall and the herniation of the orbital fat tissue are two different entities, they are used interchangeably in most of the literature and in radiological reporting.

To evaluate the relationship between femoral version (FV) and α angle (AA) in a large osteological collection of human femurs.The University of Iowa-Stanford osteological collection was used to evaluate the research aims. To measure FV and AA, axial photographs of the proximal femurs were taken, referenced from the posterior condylar axis. FV and AA measurements were obtained using ImageJ software, and the relationship between FV and AA was assessed with repeated-measures analysis of variance and generalized linear models. A P value of.05 was considered statistically significant.A total of 1321 cadaveric femurs (666 left and 655 right) in 721 cadavers were examined. The average AA for all femurs was 47.8° ± 10.9°, and the average FV for all femurs was 8.53° ± 8.09°. Overall, 191 femurs (14.5%) exhibited cam morphology (AA ≥ 60°). Of the 721 cadavers, 600 had both femurs available for side-to-side comparison. The average FV of femurs with cam morphology was significantly higher than that of femurs without cam morphology (11.70° ± 8.82° vs. 7.99° ± 8.82°, P.001). Linear regression analysis demonstrated that increased AA was significantly correlated with increased FV (β ± standard error of the mean = 0.21 ± 0.02, P.0001).In a large osteological collection of human femurs, a significant positive relationship between AA and increasing FV was identified.FAI and hip impingement morphology are more complex than cam or pincer morphology. Cam morphology with high femoral anteversion may allow for normal or near-normal hip mechanics without impingement, and this may partially explain the high rates of asymptomatic cam-type femoroacetabular impingement (FAI) morphology in active and general populations. Given the multiple morphological factors implicated in the development of FAI syndrome, these findings warrant further investigation.

This study was performed to compare the orbital and peri-orbital morphological variations in Apert syndrome patients with different cranial vault suture synostosis, so as to provide an anatomic basis for individualized surgical planning. Computed tomography scans of 57 unoperated Apert syndrome patients and 59 controls were subgrouped as follows: type I, bilateral coronal synostosis; type II, pansynostosis; type III, perpendicular combinations of cranial vault suture synostoses. Orbit bony cavity volume was significantly reduced in type I and type II, by 19% (P 0.001) and 24% (P 0.001), respectively. However, the reduction of orbital cavity volume in type III did not reach statistical significance. Globe volume projection beyond the orbital rim, however, increased by 76% (P 0.001) in type III, versus an increase of 54% (P 0.001) in type I and 53% (P 0.001) in type II, due to different ethmoid and sphenoid bone malformations. Maxillary bone volume was only significantly reduced in type I bicoronal synostosis (by 24%, P = 0.048). Both type I and type II developed relatively less zygoma and sphenoid bone volume. Different cranial vault suture synostoses have varied influence on peri-orbital development in Apert syndrome. Instead of mitigating the abnormalities resulting from bicoronal synostosis in type I, additional midline suture synostosis worsens the exorbitism due to a more misshaped ethmoid.

Rationale and Objectives To detect the diffusion characteristics of lumbosacral nerve roots in patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and further to explore their correlations with electrophysiological parameters of lower extremity nerves. Materials and Methods Eighteen CIDP patients and 18 age and sex-matched healthy volunteers were enrolled in this study from August 2019 to August 2020. Axial diffusion tensor imaging (DTI) of lumbosacral plexus was performed in all subjects and fractional anisotropy (FA), axial diffusivity (AD), radial diffusivity (RD), and mean diffusivity (MD) of lumbosacral nerve roots were measured. Two-sample t test or Mann–Whitney U test was used to compare the difference of DTI parameters between two groups. Receiver operating characteristic curves were plotted to determine the diagnostic accuracy. All patients also underwent nerve conduction studies. Correlations between DTI parameters of lumbosacral nerve roots and electrophysiological parameters were analyzed with Pearson or Spearman coefficients. Results CIDP patients showed significantly lower FA as well as higher AD, RD, and MD values of lumbosacral nerve roots (FA:0.24±0.054, 0.32±0.044; AD:2.31±0.256, 2.11±0.230 (×10−3mm2/s); RD:1.28±0.189, 1.13±0.106 (×10−3mm2/s); MD:1.68±0.268, 1.45±0.186 (×10−3mm2/s) in CIDP and control group, respectively, all p Conclusion DTI can be used to assess the microstructure alterations of lumbosacral nerve roots in CIDP patients. FA and RD may serve as potential markers reflecting the conduction function of tibial and common peroneal nerves.