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In the routine anatomic measurement study on Asian dry skulls, a skull of atlanto-occipital fusion with other multiple anatomic variations was observed. The entire right half of the atlas vertebra, including the anterior arch, anterior tubercle, posterior arch, and lateral masses, was fused entirely with the occipital bone, while the left fused partly. Besides the atlanto-occipital fusion, the target skull specimen also includes posterior arch defects of the atlas, metopic suture, and wormian bones. So many anatomical variations rarely exist in one specimen. This paper aims to present detailed anatomic case reports and discuss related diseases in an anatomic and clinical study.

The emergence and spread of COVID-19 infection has set health professionals the task of providing recovery and rehabilitation programs after pneumonia for patients of different age groups.The paper presents the survey results of older people after COVID-19-related pneumonia before and after one- and two-component medical rehabilitation programs.The rationality of using the proposed hypobaric chamber adaptation technique for elderly patients at the outpatient and home stages of medical rehabilitation, the effectiveness of which increased in combination with the appointment of cytoflavin, is shown.An increase of Stange test was found when combined hypobaric adaptation and kinesiotaping of the posterior arch of the diaphragm in order to create a breathing pattern in the examined group of patients. The conducted stabilometric study showed an increase in the stability of older patients after a course of hypobaric chamber adaptation.

For surgical treatment of instable upper cervical injuries, the Harms technique using lateral mass screws provides rigid fixation and favourable clinical outcomes. The use of the posterior arch of C1 as a “pedicle” allows for screw anchorage, giving improved biomechanical stability. Therefore, the aim of this study was to introduce a bilateral safe zone for C1 pedicle screws, regarding screw angulation and pedicle height. We retrospectively reviewed the CT scans of 500 patients. Three-dimensional reformats were generated for detailed measurements. Centre screw entry point (EP), length of lateral mass as screw trajectory, lateral mass width (LMW), length of screw trajectory (ST), maximal divergence (DI) and maximal convergence (CON) from EP without perforation, and pedicle height (PH) of the posterior arch were measured. The 500 cases consisted of 335 males and 165 females, with a mean age of 49.5 years. Measurements did not demonstrate significant side-related differences. The mean screw entry point was 22.8 mm from the midline-axis (left 22.6 mm; right 23.0 mm). From this point, a safe zone between 11.6° of divergence and 19.6° of convergence was detected. Measurements of female patients were generally smaller, with significant differences from male patients (p

The anatomy of the first vertebra, namely atlas, has significant clinical implications. Atlas is situated between the occipital bone and the second cervical vertebra (axis) and is one of the main points of head movement. Most congenital anomalies of the vertebra are diagnosed incidentally during imaging investigations and can be associated with cervical spine anomalies. The neurological symptoms may include weakness in the four limbs, acute neurologic deficits such as transient quadriparesis, paraparesis, Lhermitte's sign, chronic neck pain, and headache. This anomaly is also commonly seen in gonadal dysgenesis, Klippel-Feil syndrome, Arnold-Chiari malformations, and Turner and Down syndrome. Unlike other variations, which arise due to disturbances of ossification posterior midline clefts of the atlas, are different since they are a developmental failure of chondrogenesis. We therefore present an anatomical case and analysis of the literature about posterior arch clefts of atlas., {"references":["Covantev S, Mazuruc N, Belic O. Kimmerle Anomaly – An Important Anatomical Variation. Online J Health Allied Scs. 2018;17(3):8.","Pacheco Fernandes RM, Sarmento Pires LA, Martins Manaia JH, Cisne de Paula R, Babinski MA. Agenesis of the posterior arch of the atlas: an incidental finding in a polytraumatized patient. Coluna/Columna. 2019;18:81-3. doi: 10.1590/S1808-185120191801187278.","Kwon JK, Kim MS, Lee GJ. The incidence and clinical implications of congenital defects of atlantal arch. J Korean Neurosurg Soc. 2009;46(6):522-7. doi: 10.3340/jkns.2009.46.6.522.","Prempe RC, Gibson JC, Bhattacharya JJ. Mid-line clefts of the atlas: a diagnostic dilemma. Spinal Cord. 2002;40(2):92-3. doi: 10.1038/sj.sc.3101230.","Jefferson G. Fracture of the atlas vertebra. Report of four cases, and a review of those previously recorded. Br J Surg. 1919;7(27):407-22. doi: 10.1002/bjs.1800072713.","Currarino G, Rollins N, Diehl JT. Congenital defects of the posterior arch of the atlas: a report of seven cases including an affected mother and son. AJNR Am J Neuroradiol. 1994;15(2):249-54.","Geipel P. [Studies on the fissure formation of the atlas and epistropheus. IV]. Zentralbl Allg Pathol. 1955;94(1-2):19-84.","Schulze PJ, Buurman R. Absence of the posterior arch of the atlas. AJR Am J Roentgenol. 1980;134(1):178-80. doi: 10.2214/ajr.134.1.178.","Sabuncuoglu H, Ozdogan S, Karadag D, Kaynak ET. Congenital hypoplasia of the posterior arch of the atlas: case report and extensive review of the literature. Turk Neurosurg. 2011;21(1):97-103.","Hadley MN, Dickman CA, Browner CM, Sonntag VK. Acute traumatic atlas fractures: management and long term outcome. Neurosurgery. 1988;23(1):31-5. doi: 10.1227/00006123-198807000-00007.","Gehweiler JA Jr, Daffner RH, Roberts L Jr. Malformations of the atlas vertebra simulating the Jefferson fracture. AJR Am J Roentgenol. 1983;140(6):1083-6. doi: 10.2214/ajr.140.6.1083.","Chambers AA, Gaskill MF. Midline anterior atlas clefts: CT findings. J Comput Assist Tomogr. 1992;16(6):868-70. doi: 10.1097/00004728-199211000-00007.","Kumar R, Kalra SK, Vaid VK, Sahu RN, Mahapatra AK. Craniovertebral junction anomaly with atlas assimilation and reducible atlantoaxial dislocation: a rare constellation of bony abnormalities. Pediatr Neurosurg. 2008;44(5):402-5. doi: 10.1159/000149909.","Sharma A, Gaikwad SB, Deol PS, Mishra NK, Kale SS. Partial aplasia of the posterior arch of the atlas with an isolated posterior arch remnant: findings in three cases. AJNR Am J Neuroradiol. 2000;21(6):1167-71.","Sagiuchi T, Tachibana S, Sato K, Shimizu S, Kobayashi I, Oka H, et al. Lhermitte sign during yawning associated with congenital partial aplasia of the posterior arch of the atlas. AJNR Am J Neuroradiol. 2006;27(2):258-60.","Connor SE, Chandler C, Robinson S, Jarosz JM. Congenital midline cleft of the posterior arch of atlas: a rare cause of symptomatic cervical canal stenosis. Eur Radiol. 2001;11(9):1766-9. doi: 10.1007/s003300000755.","Devi BI, Shenoy SN, Panigrahi MK, Chandramouli BA, Das BS, Jayakumar PN. Anomaly of arch of atlas--a rare cause of symptomatic canal stenosis in children. Pediatr Neurosurg. 1997;26(4):214-7; discussion 217-8. doi: 10.1159/000121194.","Hegazy A. Clinical embryology for medical students and postgraduate doctors. Lap Lambert Academic Publishing; 2014."]}

Odontoid fractures are one of the most common injuries to the cervical spine in geriatric patients. Congenital C1 arch absence, however, is a very rare anomaly found in the population. We describe the first reported case of a congenital C1 posterior arch absence and C1 anterior cleft presenting with odontoid fracture. We present the case of a 58-year-old male who was found to have a comminuted type III odontoid fracture with significant angulation and displacement. CT scan demonstrated this fracture and also demonstrated congenital cleft of his left anterior arch and absence of left C1 posterior arch. Given his anatomic anomaly, we elected to perform occipitocervical fusion. The patient underwent occipito-cervical fusion to avoid iatrogenic vertebral artery injury. He was also immobilized in a halo vest given patient-specific social factors and compromised bone quality. The patient had no intra- or post-operative complications, but a prolonged hospital stay due to alcohol withdrawal. At 3-month postoperatively the patient had no neck pain and return to baseline function. This case highlights the importance of obtaining a CT scan preoperatively to not only to further characterize the fracture but also for surgical planning and recognition of anatomic anomalies as this may significantly impact the operative strategy.

The purpose of this work was to evaluate the arteries supplying the pancreaticoduodenal (PD) complex. The study was conducted on 15 fresh enbloc pancreatic specimens by latex injection method which enabled the visualization of the peripancreatic arteries and their minute branches. The gastroduodenal (GDA), anterior superior pancreaticoduodenal (ASPD), and anterior inferior pancreaticoduodenal (AIPD) artery was found in all the cases, whereas the posterior superior pancreaticoduodenal (PSPD) and posterior inferior pancreaticoduodenal (PIPD) artery was present in 93.34% cases. The ASPD artery originated from GDA in all the cases. Two types of variations were observed in the origin of PSPD artery and four types each in the origin of AIPD and PIPD artery. Anatomical and numerical variations were observed in both anterior and posterior arches, posterior arch being absent in 20% cases. In the present study, an attempt was made to systematically describe the individual arterial configurations of the PD complex. The information provided here has important implications for preoperative planning of technically challenging surgeries and interventions around the pancreatic head.

Background To describe the feasibility of the posterior arch of C2 accepting two crossing screws in the Spanish population. Methods One hundred and fifty patients who underwent a routine neck CT scan for non-cervical pathology were enrolled. Submillimeter slices (thickness 0.7 mm) every 0.4 mm were performed with a 64 multi-detector CT scan, which allows isometric measurements. We measured the length and height of the cortical and cancellous (endomedullar) region of the lamina and the spinous process, inclination, maximal screw length and spinolaminar angle. Results The average (standard deviation) measurements of the lamina were: width of the left cortical 7.2 (1.5) mm, right cortical 6.9 (1.3) mm, width of the cancellous part of the left lamina 4.8 (1.5) mm, right side 4.6 (1.4) mm. The mean left cortical height was 13.0 (1.5) mm and 13.1 (1.6) mm for the right. The mean height of the cancellous part was 9.0 mm for both sides. The average measurements of the spinous process were: cortical length 15.7 (3.5) mm, endomedullar length 12.5 (3.9) mm; cortical height 11.9 (2.2) mm, endomedullar height 8.4 (2.1) mm; spinolaminar angle 49º (4); the maximum screw length 3.18 cm, and the inclination angle 143º. Conclusion A CT scan with submillimeter slices is necessary in order to avoid malpositioning of the screws. The outer cortical measurements are 2 to 4 mm bigger than the endomedullar ones. Taking into account the dimensions of the spinous process, 24% of the population would not be candidates for this crossing screw technique.

Objectives: 1. To formulate a normative data/Research data of maxillary arch dimension and cleft width in UCLP patients. 2. To formulate a Posterior cleft width prediction equation using anterior cleft width, which will help in organising the future treatment plan in the required sequence. Materials and Methods: A Sample of 20 unilateral CLP patients were selected from a patient pool who had reported to CMCH, for treatment. This study was approved by ethical committee at CMCH, Vellore. Inclusion criteria: 1. Models of patients with unilateral CLP were selected. 2. Models were taken before any Presurgical manipulation of hard or soft tissues was done. 3. Age of the patient was 3 to 4 months without any treatment began. Methods: The landmarks anterior, mid, posterior arch width was marked on the Study Model measurements were made using the digital Vernier caliper Figure and documented on excel worksheets. Data were summarized using mean and standard deviation. We used a linear regression model to identify the prediction equation of posterior having posterior as an outcome and anterior as predictor. The scatterplot with the linear fit was used to visualize the prediction. All the data were analyzed using STATA IC/16.0. Results: 1. Normative data was tabulated. 2. Prediction equation of posterior from anterior width Posterior= 39.25-0.21*(anterior). The equation explains that when anterior increase posterior decrease and this can quantify as for one-unit increase in anterior there will be 0.21 decrease in posterior width, but this change is not statistically significant (p=0.447). Conclusion: 1. A normative data of maxillary arch dimension and cleft width in UCLP patients was developed and tabulated which will be also be useful as Research data. 2. The Posterior cleft width prediction equation using anterior cleft width, will help in formulating the future treatment plan in required sequence and ease the method of impression making in unilateral Cleft lip and palate patients.