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It was aimed to reveal whether the positions and dimensions of the extrinsic and intrinsic muscle tendons related to the hallux around the first metatarsal bone are affected by the severity of hallux valgus (HV) and whether tendon positional changes and tendon sizes affect each other. In formalin-fixed 46 feet, three HV angle subgroups (normal, mild and moderate/severe ) were defined. Width, thickness and cross sectional area (CSA) of tendons of the extensor hallucis longus (EHL) and brevis (EHB), abductor hallucis (AH) and flexor hallucis longus (FHL) were measured. On the clock model created in coronal plane, positional variations of each tendon were indicated. In the moderate-severe HV group, thickness and CSA of the EHB, width and CSA of the AH were smaller, compared to mild HV. Width and CSA of the FHL were smaller in moderate/severe HV than in the normal. Regardless of HV, the width and CSA of the FHL was greater in cases where the FHL located more lateral, and the width of both FHL and AT were greater in cases where AH located more plantar. The smaller tendon size of two intrinsic (one plantar and one dorsal) and one extrinsic muscle in the moderate/severe HV group indicates that the changes reflected in the tendons are more pronounced in the case of high HV severity, and the changes are not limited to the tendons on just one side of the foot. The possible biomechanical effects of AH, FHL and EHB tendon dimensional weakness may be important when planning surgery for moderate/severe HV cases.

To determine the incidence of the iliocapsularis muscle in fetal period and its relationship with the hip joint capsule. 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. 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. 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.

Aim Chiasma tendinum (Camper’s chiasm) is of great importance in the delicate movements and stability of the fingers and takes place poorly in the literature. This study aims to reveal the morphometric details of the chiasma tendinum in relation with pulleys and other relevant structures. Materials and methods Palm and 2nd to 5th fingers of 10 (6 male, 4 female) formalin fixed cadavers were used bilaterally. After determining the superficial reference points on the fingers, the skin and the tendon sheath were incised, and then measurements of chiasma tendinum and related tendons were performed. The measurements were analyzed with respect to fingers, genders, and sides. Finally, the types of chiasma tendinum were identified and then grouped as symmetrical, asymmetrical, and pseudo chiasm. Results Pulley and chiasma tendinum positions were correlated with finger length (p Conclusion Findings related to the prediction of location of the pulleys and chiasma tendinum according to the superficial signs, awareness of cases where one of the two arms of the flexor digitorum superficialis is extremely thin and no fiber exchanges that may be risk factors for spontaneous tendon rupture may help provide more accurate approaches in relevant clinical applications.

Informed consent is an integral part of daily anatomical practice. Providing adequate information regarding body donation process and emphasizing the importance of use of donated bodies in anatomy education will help the individuals who consider body donation. Current legislation that regulates body donation in Turkey does not provide details on the consent process. Additionally, recent research showed that registered Turkish body donors have various opinions on the use of their bodies, sharing their personal information with the departments and medical students, and retention time of their bodies or body parts. This resulted in non-standard or modified donation forms across different institutions. Therefore, the Turkish Society of Anatomy and Clinical Anatomy (TSACA) decided that a standard and more comprehensive body donation form that addresses contemporary topics was necessary. The newly established Committee for Body Donation and Cadaver Monitoring has been assigned with this task. As of May 2020, the Committee had finalized the updated body donation form according to departmental feedback and donors’ opinions. This paper outlines the existing data and reasons along with the legal grounds for the current update.

This study is intended to obtain the algebraic growth dynamics of the gracilis in fetuses and determine the variations of neurovascular pedicle(s) of the gracilis, to aid infant surgeries. Forty fetuses (19 males and 21 females) were included in the study. Gestational mean age of the fetuses was 22.40 ± 2.67 (range, 18-28) weeks. Numerical values were obtained using a digital caliper and a digital image analysis software. Linear functions for the surface area, width, anterior, and posterior margin lengths of the gracilis were calculated, respectively, as: y = -289.307 + 20.501 × age (weeks), y = -7.113 + 0.622 × age (weeks), y = -24.421 + 3.434 × age (weeks), and y = -24.397 + 3.314 × age (weeks). In addition, length and width of the gracilis tendon were calculated as y = -6.676 + 0.934 × age (weeks) and y = -0.732 + 0.074 × age (weeks), respectively. Parameters of the gracilis had no statistically significant difference regarding side and sex (P > 0.05). In all the specimens, the gracilis was innervated by the anterior branch of the obturator nerve. Blood supply of the gracilis was identified to be derived from 1 single artery in 38 sides of total 80 (47.5%), from 2 arteries in 36 (45%) and from 3 arteries in 6 (7.5%). In 74 sides (92.5%), the nerve was superficial to the main artery, whereas in 6 sides (7.5%), it was deeper. The data of the present study could be beneficial for surgeons in infant surgeries to treat conditions such as obstetrical brachial plexus paralysis, facial palsy, or anal incontinence. Linear functions can be utilized to better evaluate the growth course of the gracilis in fetuses and to predict the dimensions thereof. Additionally, comprehending the structure and recognizing the variations of the gracilis nerves and arteries can help to protect the neurovascular pedicle(s) of the gracilis during the operations.

Background: In neonatal and early childhood surgeries such as meningomyelocele repairs, closing deep wounds and oncological treatment, tensor fasciae lata (TFL) flaps are used. However, there are not enough data about structural properties of TFL in foetuses, which can be considered as the closest to neonates in terms of sampling. This study’s main objective is to gather data about morphological structures of TFL in human foetuses to be used in newborn surgery. Materials and methods: Fifty formalin-fixed foetuses (24 male, 26 female) with gestational age ranging from 18 to 30 weeks (mean 22.94 ± 3.23 weeks) were included in the study. TFL samples were obtained by bilateral dissection and then surface area, width and length parameters were recorded. Digital callipers were used for length and width measurements whereas surface area was calculated using digital image analysis software. Results: No statistically significant differences were found in terms of numerical value of parameters between sides and sexes (p > 0.05). Linear functions for TFL surface area, width, anterior and posterior margin lengths were calculated as y = –225.652 + 14.417 × age (weeks), y = –5.571 + 0.595 × age (weeks), y = –4.276 + 0.909 × age (weeks), and y = –4.468 + 0.779 × age (weeks), respectively. Conclusions: Linear functions for TFL surface area, width and lengths can be used in designing TFL flap dimensions in newborn surgery. In addition, using those described linear functions can also be beneficial in prediction of TFL flap dimensions in autopsy studies.

Although latissimus dorsi (LD) flaps are extensively used in a wide range of interventions, fetus studies on this subject are quite limited. This study aims to obtain detailed information about the morphometric features of LD, thoracodorsal artery (TDA) and nerve (TDN). The study was carried out on both sides of 50 formalin-fixed human fetuses (22 male/28 female) with a mean gestational age of 24.5 ± 4.7 (range 18–36) weeks, which were in the inventory of Anatomy Department of Mersin University Faculty of Medicine. Dimensions of LD, lengths and width of TDA and TDN were measured. Surface area of LD was calculated using digital image analysis software. All samples had LD muscle. Neither gender nor side-significant differences were observed in relation with the numerical data of LD, TDN and TDA. Linear function of surface area was calculated as “y = − 1767.532 + 114.582 × Age (weeks)”. LD was attached directly to the posterior part of iliac crest in 59 of 100 sides meanwhile in the rest 41, it was attached by the thoracolumbar fascia. TDA gave a branch to serratus anterior in 96 cases and 2 branches in 4 cases. TDN passed superficial to TDA in 84 and deep to TDA in 16 samples. TDN had bifurcation in 93, trifurcation in 6 and tetrafurcation in 1 side. Data obtained from this study can be useful for estimating the sizes of LD and related neurovascular structures, especially in neonate surgeries. Linear function of LD surface area can be helpful to design the flap dimensions in newborn surgeries. A throughout knowledge about the branching pattern of TDN and its location-wise relation with TDA should be kept in mind to prevent possible complications during harvesting LD flaps and TDN grafts.

Objectives: Today, the internal thoracic artery and great saphenous vein are the most used coronary bypass grafts. Patency of the arterial grafts is better than vein grafts. Alternative arterial grafts are needed in the following cases: when the internal thoracic artery and great saphenous vein cannot be used or they were used in the previous operations, when more than one coronary artery is needed for grafting, or more than one graft is neded at the operation.Material and Methods: This study aims to reveal whether lateral thoracic and thoracodorsal arteries taken from 9 male cadavers at 56,67±6,38 years old, bilaterally are available to be used as a graft in coronary bypass surgery. The morphologic properties (length, lumen diamater, thickness of tunica intima and media, properties of internal and external elastic lamina, elastic and smooth muscle component of tunica media) of the proximal, middle and distal parts of these arteries are compared with internal thoracic, radial and coronary arteries’s (anterior interventricular branch, circumflex branch, right coronary artery).Results: It is determined that the lateral thoracic and thoracodorsal arteries have well-developed internal elastic lamina. Furthermore thickness of tunica intima and externa of the lateral thoracic and thoracodorsal arteries are observed to be similar or thinner than of the internal thoracic and radial arteries. These data are evaluated as positive properties in terms of using both of these arteries as graft in coronary bypass surgery.Conclusions: Length and lumen diameter of thoracodorsal artery are found adequate while lateral thoracic artery is not found adequate for single free graft. Neverthless, both of these arteries are found suitable to be used as composite grafts (as Y graft) with other grafts in terms of lenght and lumen diameter.

Two cadavers (ages of 54 and 68, male) were presented with the variative inferior lateral genicular artery which was passing superficial to the plantaris instead of deep to it. Soleus attached to popliteus tendon with the absence of plantaris was encountered in the other extremity of one of those cases. The cases were evaluated regarding clinical and developmental aspects. This case is the first to our knowledge to describe inferior lateral genicular artery passing superficial to the plantaris. Positional variations of the artery could be taken into account related with during radiological assessments regarding misdiagnosis. The case that soleus attached to the popliteus tendon in the absence of plantaris has not been mentioned in the literature.

Objectives: To evaluate the origin, distribution pattern, branches, and neighboring structures of the iliolumbar artery (ILA) concerning the anterolateral surgical approaches to the spine. Methods: This study was performed in the Anatomy Department of Medical School, Mersin University, Mersin, Turkey between 2014 and 2015. Pelvises of 11 male formalin-fixed human cadavers were dissected by anterior and posterior approaches under surgical microscope. The origins, distribution patterns, calibers, and distances to certain structures were measured. Results: The ILA was found as a single trunk on 17 sides arising either from the IIA (12 sides, 70.6%) or the PT (5 sides, 29.4%). The average caliber of those originated from the posterior trunk was significantly larger ( p =0.010). The ILA started as a single trunk in 17 sides, while its lumbar and iliac branches separately originating from different arteries in 4 sides. The close relation of the posterior rami of both the lumbar and iliac branches with transverse process and spinal nerve were noted. Conclusion: Findings suggest that the ILA and its branches may have different and significant patterns, which may be crucial to consider during certain surgical procedures, such as far lateral disc herniation and posterior pelvic fixations. Saudi Med J 2016; Vol. 37 (4): 457-460 doi: 10.15537/smj.2016.4.12665 How to cite this article: Koc T, Gilan IY, Aktekin M, Kurtoglu Z, Dagtekin A, Aytac G, et al. Evaluation of the origin and branching patterns of the iliolumbar artery and its implications on pelvic and vertebral surgery. Saudi Med J 2016; 37: 457-460.

In human anatomy, piriformis muscle and peripheral nerve variants may represent an unrecognized etiology. These variations in the gluteal region may cause entrapment of the sciatic nerve and induce to the piriformis syndrome. We present a case of accessory piriformis muscle accompanying to high divisions of sciatic nerve, unusual course of nerves and fusion of the piriformis muscle with gluteus medius in the left gluteal region of a 64-year-old male cadaver. The nerves which are originating from dorsal part of the sacral plexus, inferior gluteal nerve, common fibular part of the sciatic nerve and posterior femoral cutaneous nerve are located between the piriformis and accessory piriformis muscles make this case the most interesting of its kind. Awareness of these variations may prove to be useful for surgeons during the surgery of the gluteal region and the clinician when treating patients with buttock pain. Additionally, the possible role of aberrant anatomical variations of the related region in causing piriformis syndrome must be taken into consideration as one of the contributing factors.

Objectives: The aim of this study was to evaluate the certain radiological hip parameters and the effects of these parameters on the functional capacity of cerebral palsy (CP) children, to compare the Gross Motor Function Measure (GMFM-66 scores) of hemiparetic and diparetic children with spastic CP in Gross Motor Function Classification System (GMFCS) level 1, and to define possible differences or similarities with the control group. Methods: The radiographic parameters measured for CP and control groups were caput-collum-diaphyseal angle (CCD), migration index (MI), center edge angle (CEA), acetabular index (AI) and pelvic obliquity. The functional capacity of the CP group was assessed by GMFM-66. Results: No significant differences were found in terms of sides of the same individual in each group. Significant differences were found between groups for left CCD, right MI, right and left AI, and right and left CEA. Correlation analyses revealed significant relationships between radiological parameters. Hemiparetics had statistically higher GMFM-66 dimension E score than diparetics. Conclusion: The threshold values for hip parameters were determined with CP in GMFCS level 1. The hemiparetic and diparetic children with CP, who were at the GMFCS level I and age group, had similar hip morphology. Development of femoral head and acetabulum in these children were not different from control group. Evaluating the functional levels of patients according to GMFM-66 scores with radiographic parameters is believed to contribute to the monitoring CP children.

The main objective of the study was to investigate the morphometric properties of the stapedial tendon (ST) for pediatric otosurgeons and anatomists. The present study was placed on 15 fetuses (8 females, 7 males) aged from 20 to 30 weeks of gestation (at mean, 24.27 ± 3.24 weeks) using the collection of the Anatomy Department of Medicine Faculty, Mersin University. All measurements were obtained with a digital image analysis software. In terms of male/female or right/left comparisons, no statistically significant difference was found in relation with the numerical data of ST. The surface area, length, and width of ST were detected as follows: 0.61 ± 0.15 mm2, 1.27 ± 0.30 mm, and 0.45 ± 0.08 mm, respectively. The absence of ST was observed in two fetuses with and without severe malformations. In another fetus with cleft lip and polydactyly, multiple abnormalities were bilaterally identified in the middle ear: (1) the absence of the incudostapedial joint and (2) the presence of an abnormal tissue attaching to the stapes. The abnormal tissue was determined to be irregular dense connective tissue using light microscope and electron microscope. Our findings showed that ST did not proportionally grow according to increasing gestational weeks. In the light of the numerical data, we thought that similar to stapes, ST attains the adult size in the fetal period. As ST anomalies may accompany severe malformations (e.g., cleft lip, polydactyly or syndactyly) that can be easily detected on observation by clinicians, we suggest that the detailed examination of middle ear in newborns should be taken into account for early diagnosis of conductive hearing loss to prevent any management delays.

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. 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. 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. 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 CHARGE syndrome characterized by coloboma, heart defects, atresia of the choanae, retarded growth, genitourinary hypoplasia, and ear anomalies is one of the rare syndromes. Although certain clinical issues (scapular winging, sloping shoulder, Sprengel's deformity, kyphosis and scoliosis) which could be related to abnormalities in musculoskeletal structures of the neck and shoulder have been identified in CHARGE syndrome, data on details of muscle anomalies seem to be quite limited in the literature. In this case report, bilateral multiple muscular abnormalities (agenesis of the trapezius, presence of the rhombo-atloid muscle, and presence of the bipartite rhomboid minor with superficial and deep parts) was presented in a fetus cadaver with atypical CHARGE syndrome to attract the attention of clinicians for definitive diagnoses and surgical reconstruction of the shoulders deformity such as scapular winging and Sprengel's deformity. By considering the previous studies, we propose that the absence of the trapezius, as well as the other muscle abnormalities around the neck and shoulder, should be revised as being a component of CHARGE syndrome.

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. 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. 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

A case of replaced right hepatic artery arising from the superior mesenteric artery is presented with its segmental distribution and the morphometric features. The case was encountered in a 66-year-old formalin-fixed male cadaver during dissection for undergraduate lab education. Length and diameter of the replaced right hepatic artery were measured 63.10 mm and 3.6 mm, respectively. The replaced right hepatic artery coursed posterior to the portal vein initially, and then lateral to it. One of its branches entered into liver segments V and VIII, and the other entered into segments VI and VII. Left hepatic artery arose from the common hepatic artery and gave the middle hepatic artery 11.9 mm distal to its origin. Length and diameter of the middle hepatic artery were measured 30.2 mm and 1.2 mm, respectively. After giving a small branch to caudate lobe, the middle hepatic artery reached the quadrate lobe. The diameter and segmental distribution of replaced right hepatic artery was similar to the normal right hepatic artery described in earlier studies. The middle hepatic artery arose from the left hepatic artery at a substantial distance from the liver tissue in the presence of a replaced right hepatic artery. This is of clinical significance in liver transplantations as the arterial supply of segment IV is from the middle segmental artery. Keywords: liver; liver transplantation; replaced right hepatic artery; segmental distribution

Objectives: The anatomical relationship of the fibrous structures in the posterolateral corner of the knee is highly complex, with many different descriptions of these structures in the literature. Discrepancy in the definitions of FF, AL and PF are a problem for both clinicians and anatomists. This study aimed to examine these structures and describe their features to clarify our understanding of their morphology. Methods: The posterolateral corner of the knee joint was bilaterally dissected in 10 male cadavers. Fibrous structures originating from the fibular head as a common mass were defined in relation to their attachment sites and positions according to the inferior lateral genicular vessels. The fabellofibular ligament (FF) was grouped into two categories, depending on the presence of a dense, fibrous tissue band. The arcuate popliteal ligament components were grouped into superficial (ALs) and deep (ALd) by their position relative to the inferior lateral genicular vessels. The popliteofibular ligament (PF) was identified as the fibrous bundle attached to the inferior border of popliteus tendon (PT). Dimensions of these structures were measured, and statistical analyses undertaken using paired and independent t-tests (p

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.

To reveal the detailed morphological features of the fibular collateral (fibular) ligament, popliteus tendon, popliteofibular ligament and the synovial components regarding to achieve data for surgical and biomechanical utilization. Knees of 10 formalin-fixed male cadavers were dissected bilaterally. Bursae around the lateral collateral ligament and the relation of popliteus tendon with lateral collateral ligament at the femoral attachment site were noted. The positional relation between both ends of popliteofibular ligament was evaluated statistically. The PT exceeded the anterior margin of lateral collateral ligament in 11 sides, the posterior margin of lateral collateral ligament in 3 sides and exceeded both the anterior and posterior margins of lateral collateral ligament in 5 sides. The shape of lateral collateral ligament was narrower at the lower part than the upper in 14 sides. The width of lower part of lateral collateral ligament was found narrower in the cases with sheath-like bursa (vagina synovialis). The relation between both ends of popliteofibular ligament was as followed: the more anteriorly the fibular head attachment was located, the more anteriorly popliteofibular ligament was attached to the popliteus tendon. To resolve the posterolateral corner of the knee with regard to surgical anatomy and biomechanics, individual and concerted morphometric characteristics of lateral collateral ligament, popliteus tendon and PF should be evaluated together with accompanied synovial structures.

ABS TRACT During the dissection of the left thoracoaxillary region of a 55 year-old male cadaver, a “pectoralis quartus muscle” and an “axillary arch” were encountered. Both complete and incom plete forms of arch were observed in this case. These structures that show variation are known to be the remnants of “panniculus carnosus” and were discussed with their innervation patterns. A fora men and a pouch which were formed by the axillary arch and the accompanying fascial structures were encountered at the axillary region in this case. These structures which have not been described in the literature previously were named “axillary foramen” and “axillary fascial pouch”, respectively. We suggest that the surgery of the region which already has the pectoralis quartus muscle and the axillary arch becomes more complicated in cases with the axillary foramen and axillary fascial pouch.

“Axillary Arch” (AA) is the main musculotendinous variation of the axillary region. The aim of this study was to reveal the frequency, anatomical properties, and innervation of AA and its relation with brachial plexus in human fetuses. In this study, 50 human fetuses (male: 20, female: 30), gestation age varied between 16 and 38 weeks (mean ± SD: 23.3 ± 5.3 week), were dissected at the anatomy laboratory of Mersin University, Faculty of Medicine. AA was found in 11 of the 50 fetuses, and in 3 of 11, it was bilateral. Among both sides, 6 of 14 AAs were on the right and 8 were on the left side. Seven of AA’s (7% of the specimens) were in muscular and 7 (7%) of them were in musculotendinous structure. With regard to Testut’s classification, six (6%) of them were of complete type, six (6%) were incomplete and two (2%) were concordant with both types. Three different types of AA were defined considering the shapes of the arches. According to our classification, seven of the AAs were of type 1, two of them were of type 2 and five of them were of type 3. Additionally, the incidence of the T2 spinal nerve joining the brachial plexus was significantly higher in the specimens with AA (p = 0.001). Each type of AA described in this study is thought to have individual clinical significance. Being aware of AA and its types can be important to determine a safe approach to the axillary region for surgeons. In addition, our results show the relation between the occurrence of AA and the variations in the formation of the proximal part of brachial plexus.

Anencephaly occurs in 1:1,000 to 1:20,000 infants who are potential donors in pediatric heart transplantation, so it is important to define any morphologic differences between the anencephalic and normal heart in newborns. The dimensions of the heart in anencephalics, however, may differ. For example, the absence of cerebral tissue in anencephalic fetuses may decrease the heart load resulting in a smaller heart. The position of the heart in the thoracic cavity of an anencephalic fetus may affect the size and shape of the heart. This study compares the ventricular volumes and the inlet and outlet lengths of right and left ventricles in 11 normal and 11 anencephalic fetuses of gestational ages between 27 and 35 weeks. There was no statistically significant difference between the right ventricular volumes of normal and anencephalic fetuses, however, the difference between the left ventricular volumes was found to be almost statistically significant (P = 0.07). No statistically significant difference was found between the right and left ventricular volumes of normal fetuses; in anencephalic fetuses left ventricular volumes were found to be significantly smaller than right ventricular volumes (P = 0.05). The outlet length of the right ventricle and the inlet and outlet lengths of left ventricle in anencephalic fetuses were found to be short in comparison with those of normal fetuses (P = 0.01, P = 0.008, P = 0.01). It is proposed that anencephalics, because of these morphologic differences, should be reconsidered as possible donors for heart transplantation. Clin. Anat. 17:487–491, 2004. © 2004 Wiley-Liss, Inc.

The heart of an anencephalic baby can be used as a donor after death. There exists insufficient information in literature, however, for the possible morphological differences in anencephalic hearts. This study compares ventricular myocardial thicknesses of anencephalic fetuses with normal fetuses in the same gestational age group. The comparison was made histologically on the slices taken from three levels of anterior and posterior walls of the left and right ventricles and from two levels of the interventricular septum. When each level was taken into account separately, the middle part of the left ventricular anterior wall was detected thinner in anencephalics (P = 0.010). When the mean value for each wall (anterior and posterior) was taken into account, left ventricular anterior wall was found thinner in anencephalics (P = 0.005). When the mean value for each ventricle was compared, the left ventricular wall was detected thinner in anencephalics (P = 0.025). These results support the idea that absence of the cerebral cortex results in modifications of the fetal heart. Because differences were limited to the left ventricular anterior wall non-homogenously, factors other than the decrease in the heart load (e.g., changes in intrathoracic anatomy) might also affect the myocardial features. When the mean value of right ventricle was compared to the left within the normal and anencephalic groups separately, the left ventricle was thicker than the right in normal fetuses (P = 0.016). In anencephalics the difference between two ventricular walls was insignificant (P = 0.084). This supports the left ventricular dominance in normal fetuses but not in anencephalics for the 27–34 weeks of age group. We suggest that when an anencephalic heart is intended to use as a donor, possible alterations presented in this article should be taken into account. Clin. Anat. 17:492–496, 2004. © 2004 Wiley-Liss, Inc.

There is detailed knowledge regarding the morphological features of the axillary nerve in adults, however, it in the fetal period we encountered no information. Brachial plexus injuries have been reported with a rate of 0.38-2.6 per thousand live births. Shenaq et al1 mentioned that the diagnosis, observation, and therapy are the initial approaches to these injuries, and should be initiated immediately. They also stated that early surgical intervention is essential to maximizing the long-term improvements in selected patients by helping to prevent residual growth deformities and underdevelopment of the affected limbs. The surgical treatment options include the reconstruction and neurotization.2 For the axillary nerve injuries, for example in case of C5-C6 avulsion, in which the upper roots have been avulsed from the spinal cord, and the clinical picture is that of a classic Erb palsy, they preferred to use neurotization technique. In this type of avulsion, the upper roots are not available as donors, and the C7-T1 roots are uninvolved. So, the suprascapular nerve is neurotized by the ipsilateral spinal accessory nerve, and the axillary nerve is neurotized by redundant branches to the triceps to ideally restore shoulder and elbow function. The thoracodorsal or the subscapular branches can also be neurotized to the axillary nerve to provide better shoulder function. Thus, anatomical details of the axillary nerve in fetal period become essential for such operations. We carried out this study to evaluate these parameters regarding the axillary nerve anatomy, which may be helpful to surgeons in certain conditions, such as end-to-side neurorrhaphy in brachial plexus reconstruction, neurotization, proximal humeral fracture repair, and shoulder dislocation treatment in the early childhood.

During abdominal dissection of a male cadaver, aged 60 years at death, a peritoneal fold formed by mesentery of the terminal ileum and attached to the anterior wall was encountered in the abdominal cavity. Distal part of the terminal ileum, cecum, and colon ascendens were herniated from the medial inguinal fossa. The unusually located peritoneal fold was interpreted as a predisposing factor for the accompanying direct inguinal hernia. The subject is discussed in terms of embryonic development of the midgut.

Objectives: The aim of the study was to evaluate the morphological features of the mediopatellar and lateral folds in fetal knees in the absence of any exposure to certain stress factors such as exercise or trauma. Methods: The study was performed in the knee joints of 15 fetuses (6 males, 9 females) obtained as spontaneous abortion material at 20-34 weeks of gestation. The mediopatellar and lateral folds of the fetuses were classified into eight subgroups according to the following morphological features: A- Absence of folds; B- Short vertical band; C- Long vertical band; D- Narrow horizontal band; E- Broad horizontal band; F- Horizontal band accompanied by a vertical band; G- Horizontal band without a vertical band; H- Fenestrated band. Results: The synovial membrane, covering the infrapatellar fat pad and forming the alar folds, extended upwards and formed the medial and lateral horizontal folds that covered the inferior part of the posterior aspect of the patella. These horizontal folds were thicker in the lower parts (close to their insertions) and became thinner towards the free ends. The horizontal band of the mediopatellar fold was observed in all cases, with an accompanying vertical band in 76.7% of the cases. A horizontally located lateral fold was absent in both knees of one fetus. The frequency of a horizontally located lateral fold was 93.3% and a vertical fold was accompanying in only 28.6% of these cases. It is of note that the horizontal band of the mediopatellar fold observed in all specimens has never been defined in previous classifications. In 10% of the knees, the vertically located part of the mediopatellar fold presented as a large band extending upward and being squeezed between the articular surface of the patella and the medial condyle of the femur. The lateral fold was observed as a large band in 10% of the knees. Another observation was that the higher level the vertical band of the mediopatellar and lateral folds began, the wider the horizontal band was, occupying more place in the patellofemoral space. It was remarkable that the frequencies of the vertically located parts of the lateral and mediopatellar folds in fetuses were higher than those reported for the adults in the literature. Conclusion: Our findings suggest that the resorption process of the mesenchymal tissue, particularly in the lateral part, continues until adulthood and causes age-dependent alterations in the formation of intra-articular folds. The synovial folds occupy more space between the patella and femur in the early stages of life than seen in adults. This may be a more frequent cause of unexplained knee pain in children than expected.

Aim The aim of this study was to better define the microsurgical anatomy of the supra/parasellar region and describe variations of the anterior clinoid process (ACP). Material and methods Fifteen formalin-fixed cadaver heads and 25 dry skulls were used to define the microsurgical anatomy of the ACP and related structures. The presence of the caroticoclinoid foramen (CaCF) as well as other relevant measurements were all noted. Radiological examination of the CaCF was also demonstrated on dry skulls. Results Interosseous bridges, which form between the anterior and middle clinoid processes or connect all three (anterior, middle and posterior) clinoid processes, were found in 30% of the specimens. The average basal width, length and thickness of the ACP were 7.3 mm, 9.7 mm and 5.4 mm, respectively. Length of the optic nerve (ON) up to the falciform ligament (FL) was 10.9 mm; length of the ON under the FL was 2.7 mm; length of ON after removal of the ACP and unroofing the optic canal was 21.1 mm. Conclusion This study contributes to the relationship of important vascular, neural, bone and dural layers of this region and also demonstrates the variations of ACP by means of microsurgical dissections and radiological examinations.

During the abdominal dissection of a 67-year-old male cadaver, an unusual peritoneal fold was encountered on the inner surface of the anterior abdominal wall. The peritoneal fold had two parts: the anterior part was located at the midsagittal plane including dispersed urachus remnants, the other part was located at the coronal plane with a triangular shape at the posterior edge of the sagittal part. Remnants of the umbilical arteries were ascending in the lateral margins of the coronal part. Accordingly, two peritoneal sacs were formed on both sides of this abnormal fold. Part of the small bowel herniated into the left peritoneal sac situated on the left side of the bladder. Although the aperture of the hernia sac was at the lateral side of the remnant of the umbilical artery which is concordant with the normal position of the medial inguinal fossa, the bottom of the sac was found to be located at the supravesical region. Therefore, this case was interpreted as an internal supravesical hernia with an unusual course. Although these rarely seen internal supravesical hernias in the literature were reported to be observed either preoperatively or postoperatively, to our knowledge our case is the first to be revealed in a cadaver which in detail enabled us to examine the features of this unique peritoneal variation and accompanying anatomic structures that caused hernia formation.

Bilateral large variant veins were encountered in the lower extremity. It was aimed to identify the structural characteristics of this rare case and then, regarding the structural features, to overview its formation process and denomination. During the routine dissection of a 93-year-old male cadaver, bilateral large variant veins were found at the thigh. Valves of the veins were examined and evaluated together with the vascular wall histology. The variant vein was loosely attached to the sciatic nerve by fibrous tissue and had anastomoses with the popliteal vein in the popliteal fossa on each side. The popliteal veins were hypoplastic on both sides. The right variant vein was passing through the fibers of the adductor magnus muscle 56.2 mm above the adductor hiatus, which corresponds to the third perforating branch of deep femoral vein. The left one was turning to the front over the adductor magnus muscle, at the lower border of quadratus femoris muscle. The left variant vein was corresponding to the descending branch of the medial circumflex femoral vein. Both variant veins had one incomplete and three well-developed valves. In accordance with the findings, the variant vein was concluded to be an embryonic remnant, rather than an acquired one subsequent to any obstruction of the femoral vein. Regarding their connection with the popliteal vein but not with the internal iliac vein, both variant veins were denominated as “lower type persistent sciatic vein”. Such a variation would be important with respect to the risk of complication during popliteal sciatic nerve blockade.

PURPOSE The lack of certain quotable landmarks and not taking the morphometric variations into consideration for mandibular nerve blockade can cause some complications. The aim of this study was to ensure there are data for more feasible and successful lateral extraoral approach to block the mandibular nerve by proposing reliable and quotable landmarks. METHODS The current study was carried out on 55 skulls at the anatomy departments of the Universities of Mersin and Ankara. The length of the zygomatic arch, measurements indicating the puncture point (PP), injection depth, and injection angle were revealed. The differences between sides and the relationships between the parameters were evaluated by using paired t-test and Pearson correlation test, respectively. RESULTS Of all skulls, it is observed that the injection line passed anterior to the articular surface of the temporomandibular joint. The distance between external acoustic opening and PP showed positive correlation with the distance between oval foramen and the midpoint of the zygomatic arch on the left side (r = 0.364, P = 0.001). On the right, the correlation was close to the statistically significant level (r = 0.280, P = 0.072). The distance between external acoustic opening and PP that can be adapted to the living subjects was found as 26.31 ± 1.95 mm. Injection angle to the coronal plane was measured to be 16.39 ± 2.96 degrees. The difference between sides for this parameter was not statistically significant. CONCLUSIONS The determined parameters are suggested to be convenient and quotable to help in successful direct application under three-dimensional computed tomography or computed tomography-fluoroscopy for blocking the mandibular nerve.