The posterior superior alveolar artery (PSAA) is a clinically important anatomical landmark in the maxilla and is frequently encountered during surgical procedures such as maxillary sinus augmentation and posterior dental implant placement. Owing to considerable anatomical variations in its course, diameter, branching pattern, and position, accurate preoperative assessment is essential to minimize the risk of intraoperative bleeding and vascular injury. The present systematic review analyzed data extracted from 49 published studies, including cone-beam computed tomography (CBCT), computed tomography (CT), cadaveric, anatomical, and clinical investigations, to comprehensively evaluate the global anatomical variability of the PSAA. Exploratory artificial intelligence (AI)-assisted analyses were performed using pooled study-level variables to support evidence synthesis and population-level anatomical risk stratification. The reviewed studies demonstrated that the reported detection rate of the PSAA ranged from 50% to 91.6%. The intraosseous course was the most frequently observed anatomical pattern, while the mean arterial diameter generally ranged from 1.0 to 1.2 mm and the mean distance from the sinus floor ranged from 8 to 11 mm. Traditional statistical analyses, together with exploratory AI-assisted methods including logistic regression, random forest analysis, principal component analysis (PCA), and K-means clustering, identified an intraosseous course, arterial diameter greater than 1 mm, reduced sinus-floor distance, and increased branching complexity as the principal anatomical characteristics associated with higher surgical risk. Exploratory clustering analysis further identified study populations from Malaysia, South Korea, Italy, Türkiye, and India as having relatively higher anatomical risk characteristics based on the pooled literature-derived variables. These findings indicate that PSAA anatomy exhibits substantial anatomical variability across different populations, emphasizing the importance of routine preoperative CBCT evaluation before sinus augmentation and posterior maxillary implant surgery. AI-assisted exploratory analysis provides a structured framework for anatomical evidence synthesis and population-level risk stratification and should be interpreted as a supportive analytical approach rather than a validated patient-level predictive model.
BACKGROUND: The anatomical relationship between the C2 transverse foramen (TF) and the vertebral artery (VA), particularly at the superior and inferior openings of the C2 TF, is clinically important in upper cervical spine surgery because of the potential risk of VA injury. This study aimed to quantify the morphology of the C2 TF and VA using computed tomography angiography (CTA), compare the superior and inferior openings, and evaluate the correlation between TF area and VA area. MATERIALS AND METHODS: Head and neck CTA images from 80 subjects were retrospectively analyzed. Curved multiplanar reconstruction (CPR) was used to measure the maximum and minimum diameters of the superior and inferior openings of the bilateral C2 transverse foramina. TF area, VA area, and the artery-to-foramen area ratio were calculated. Side-to-side and superior-inferior differences were compared, and correlations between TF area and VA area were analyzed. C2-level VA dominance was determined using the bilateral difference in mean equivalent VA diameter. RESULTS: The left C2 TF and VA areas were larger than those on the right side. VA area and the artery-to-foramen area ratio were higher at the superior opening than at the inferior opening. Bilateral symmetry was the most common C2-level VA dominance pattern, observed in 45 cases (56.3%), followed by left dominance in 27 cases (33.8%) and right dominance in 8 cases (10.0%). TF area was moderately correlated with VA area (r = 0.498, p < 0.001). CONCLUSIONS: The C2 TF and VA showed side- and level-dependent morphometric differences. Combined CTA assessment of C2 TF morphology, VA area, artery-to-foramen area ratio, and C2-level VA dominance may provide useful information for preoperative anatomical assessment before upper cervical spine surgery.
BACKGROUND: The femur, the long bone most strongly correlated with stature, plays a crucial role in forensic identification. When only bone fragments are available, femoral length can be estimated using population-specific regression equations. This study aimed to estimate femoral length from measurements of the proximal and distal femoral extremities. MATERIALS AND METHODS: This study was conducted on 53 intact adult human femora from the Osteological Collection of the Department of Anatomy at the Faculty of Medicine, University of Novi Sad, Serbia. We analyzed a total of eleven parameters of the proximal femoral extremity: proximal width, vertical diameter of the head, transverse diameter of the head, foveal longitudinal and transverse diameters, foveal depth, anterior and posterior neck length, vertical and transverse diameter of the neck and femoral neck–shaft angle. Seven parameters of the distal femoral extremity were also analyzed: intercondylar width and depth, anteroposterior diameter and width of both condyles and bicondylar width. Measurements were performed using an osteometric board, digital caliper and analog goniometer. RESULTS: The length of the femur showed a statistically significant correlation (p < 0.05) with all observed parameters, except those related to the femoral head fovea, with the strongest correlation observed for the vertical diameter of the femoral head (r = 0.796). Simple and multiple linear regression equations were derived to estimate femoral length, with all models explaining a statistically significant proportion of the variance in femoral length, except for simple linear regression models based on foveal parameters. CONCLUSIONS: The derived regression equations aid femoral length estimation, thereby supporting stature reconstruction and forensic identification.
BACKGROUND: Retinal nerve fiber layer (RNFL) thickness varies with age and gender and serves as a reference for the diagnosis and follow-up of retinal and neurological disorders. This study aimed to provide population-specific reference data on RNFL thickness in healthy adults and to analyze its variation with age and gender. MATERIALS AND METHODS: This prospective, cross-sectional study included 320 eyes of 160 healthy participants aged 18 years or older who presented to Bolu Abant Izzet Baysal University (BAİBÜ) Education and Research Hospital and had no ocular pathology. RNFL thickness was measured using spectral-domain optical coherence tomography (OCT) (Heidelberg Engineering, Heidelberg, Germany). After participants were grouped according to age and gender, the global average (G), nasal (N), nasal superior (NS), nasal inferior (NI), temporal (T), temporal superior (TS), and temporal inferior (TI) values were recorded. Statistical analyses were performed using RStudio (version 2024.04.2, Build 764). RESULTS: Statistically significant between-group differences were found for G, NS, NI, and TI, and a significant difference between genders was found for T. Age and gender had a significant interaction effect on TS. Age-related decreases were observed in N, NS, TS, TI, and NI. CONCLUSIONS: In healthy adults, RNFL thickness decreased with age. Because these findings were obtained from a single-center sample, they may serve as preliminary normative data for the diagnosis and follow-up of retinal diseases.
BACKGROUND:The nasopalatine canal (NPC) is a clinically and radiologically significant anatomical structure. This study aimed to comprehensively characterize the morphological, morphometric, and anatomical features of the NPC in individuals with impacted teeth in the anterior maxilla and to classify the spatial relationship between the impacted tooth and the NPC. MATERIALS AND METHODS:A total of 238 cone-beam computed tomography (CBCT) images were evaluated based on the inclusion and exclusion criteria. The NPC was evaluated separately in the axial, coronal, and sagittal planes in all CBCT images. In addition, age, sex, impacted tooth location and position, and its spatial relationship to the NPC (none, apical, middle, or crestal region) were recorded for all images. The independent-samples t-test, Mann-Whitney U test, and Pearson chi-square test were used for statistical analysis. RESULTS:An anatomical relationship between impacted teeth and the NPC was found in 50.4% of cases. Impacted teeth in a mesioangular position were more frequently associated with the NPC than those in other positions. An association was observed between axial NPC shape at all three levels and the relationship of the impacted tooth to the NPC. Differences were found in the external border shape and course of the NPC according to the presence or absence of impacted teeth associated with the NPC. The IF diameter was greater in individuals with impacted teeth associated with the NPC than in those without such an association. CONCLUSIONS:The present study demonstrated that the presence of impacted teeth in the anterior maxillary region may lead to alterations in the morphological and dimensional characteristics of the NPC.
BACKGROUND: Anatomical variations are frequently reported in cadaveric studies, although most reports focus on isolated anomalies rather than multiple concurrent variations. Recognizing such variations is important for clinicians and anatomists because they may influence surgical approaches, diagnostic interpretation, and patient outcomes. CASE REPORT: During dissection of the cadaver of a 60-year-old Asian woman, we identified ten variations involving the muscular, vascular, and nervous systems: (1) pectoralis quartus, (2) extensor carpi radialis intermedius (ECRI), (3) bilateral absence of the plantaris muscle, (4) an aberrant origin of the superior thoracic artery (STA), (5) a persistent median artery (PMA) with a high division of the median nerve, (6) an abnormal origin of the right gastroepiploic artery (RGEA), (7) an atypical origin of the iliolumbar artery (ILA), (8) penetration of the sciatic nerve by the inferior gluteal artery (IGA), (9) bilateral sciatic nerve anomalies, and (10) a variation of the posterior femoral cutaneous nerve (PFCN) in the gluteal region. CONCLUSIONS: To our knowledge, this combination of anatomical variations has not previously been documented in a single cadaver. This case highlights the importance of understanding anatomical variability for surgical planning and diagnostic imaging.
BACKGROUND: A myocardial bridge (MB) is a congenital coronary anomaly most commonly located in the mid-segment of the left anterior descending coronary artery (LAD). This study aimed to evaluate the impact of mid-LAD myocardial bridges on coronary artery segment diameters and the development of supportive collateral circulation using coronary computed tomography angiography (CCTA). MATERIALS AND METHODS: In this retrospective cross-sectional study, CCTA scans of patients with mid-LAD MB and frequency-matched control subjects without coronary anomalies were evaluated. Luminal diameters of all epicardial coronary artery segments were measured during mid-diastole. The presence of deep MBs (depth ≥ 2 mm) and associated supportive collateral channels was systematically recorded. RESULTS: A significant reduction in luminal diameter was identified exclusively in the middle segment of the LAD underlying the bridged segment in the MB cohort compared with controls. Across all other epicardial coronary segments, luminal diameters did not differ significantly between groups. Subgroup analyses demonstrated that female patients had consistently smaller coronary luminal diameters than male patients across both cohorts. Notably, a prominent parallel diagonal vessel supporting post-bridge circulation was identified in a substantial proportion of patients with deep MBs, whereas no such supportive vascular structures were observed in the control cohort. CONCLUSIONS: Myocardial bridges, particularly deep variants, are associated with localized compensatory collateral vessel development without inducing generalized anatomical changes in other epicardial coronary segments. This adaptive vascular remodeling may play a protective role in maintaining perfusion distal to the bridged segment.
BACKGROUND: Additional branches of the celiac trunk (CT) pose a serious risk during procedures in the upper abdomen, as the CT supplies organs essential for the body’s functioning. Therefore, it is important to document every rare anatomical variation, as this contributes to expanding specialists’ knowledge, particularly because there are only a few studies describing the variation presented below. CASE REPORT: During the dissection of an 82-year-old man, a rare hexafurcated CT was identified in the epigastric region. Measurements were taken using a digital caliper with an accuracy of 0.02 mm. No signs of previous surgical procedures were observed in this area. RESULTS: CT measured 6.93 mm in diameter and 19.96 mm in length. The left gastric artery (LGA), with a diameter of 3.75 mm, branched off from the CT 13.73 mm before its two remaining branches, namely the common hepatic artery (CHA), 5.43 mm in diameter, and the splenic artery (SA), with a diameter of 5.03 mm. There were three additional branches of the CT — symmetrical left and right inferior phrenic arteries (LIPA and RIPA), with diameters of 2.35 mm and 2.79 mm, respectively, and the dorsal pancreatic artery (DPA), with a diameter of 2.87 mm. This variant is extremely rare, and there are only a few documented cases of this anomaly. CONCLUSIONS: Although research on the hexafurcated CT is limited, knowledge of this area is critical to the proper conduct of many medical procedures. Therefore, identification of such variations is essential, as they may significantly impact surgical procedures and patient outcomes.
BACKGROUND: The aberrant right subclavian artery (ARSA), or arteria lusoria, is an aortic arch variant in which the right subclavian artery arises distal to the left subclavian artery and typically follows a retroesophageal course. Although often asymptomatic, ARSA can present with clinical symptoms and complicate surgical procedures, particularly when associated with other anatomical variants such as a non-recurrent laryngeal nerve (non-RLN). MATERIALS AND METHODS: During routine dissection of a donated cadaver, variations in the aortic arch and laryngeal nerves were identified. Arterial dimensions and branching relationships were measured using a string, hemostats, and calipers. RESULTS: We present a cadaveric case of a 74-year-old African American male with a retroesophageal ARSA and a right non-RLN. Our group’s dissection revealed the absence of a brachiocephalic trunk, with the right common carotid artery originating directly from the arch of the aorta. The ARSA arose as the fourth branch of the arch and measured 46 mm in circumference and 19.15 mm in width at its origin. Additionally, the non-RLN branched from the cervical vagus nerve and traveled directly to the larynx, consistent with a Type I course. CONCLUSIONS: This case highlights the embryological link between vascular and neural development and underscores the clinical importance of identifying such variants preoperatively to avoid complications during head, neck, and thoracic surgery.
BACKGROUND:Anterior approaches to the lumbar spine, particularly anterior lumbar interbody fusion (ALIF) at L4-L5 and L5-S1, are increasingly common. Vascular injury involving the aortic bifurcation (AB) is a serious, potentially fatal complication, so precise knowledge of the AB's relationship to adjacent vertebrae is essential for safe planning. This study determined the vertebral level of the AB and measured the perpendicular distance (X) between the AB and the anterior vertebral surface using multidetector computed tomography angiography (MDCT-CTA), and evaluated variation by sex and age. MATERIALS AND METHODS:Ninety individuals (47 males, 43 females; age range, 5-89 years; mean age, 55.3 ± 14.8 years) who underwent thoracoabdominal MDCT-CTA between 2010 and 2012 were studied retrospectively; individuals with scoliosis were excluded. A novel 15-quadrant grid template mapped the coronal position of the AB on each lumbar vertebral body and disc, and X (mm) was measured. Reporting follows an established checklist for anatomical variation studies. Nonparametric tests were applied where appropriate. RESULTS:The AB was most frequently at the L4 vertebral body level (58.9%; n = 53), followed by the L3-4 (17.8%) and L2-3 (12.2%) discs. Mean X was 5.07 ± 3.44 mm (range, 1.10-25.90 mm). No significant difference in X was found between sexes or quadrant positions. A trend toward caudal AB displacement with advancing age was observed. CONCLUSIONS:The AB most commonly lies at the L4 vertebral body level in adults, with notable variability. X provides novel preoperative data that may guide safer retraction during anterior lumbar surgery; caudal migration in elderly patients warrants particular attention.
BACKGROUND:This study aimed to characterize the morphometric features and three-dimensional spatial orientation of the coronary sinus ostium (CSO) within the right atrium using computed tomography angiography, and to identify demographic and anatomical determinants of CSO level. MATERIALS AND METHODS:A total of 300 individuals (147 women and 153 men; mean age, 50.27 ± 10.39 years) who underwent coronary computed tomography angiography (CTA) were included in this retrospective cross-sectional study. Morphometric parameters included the proximal and distal coronary sinus diameters, CSO diameter, CSO-right atrial floor distance (CSO level), mean left ventricular wall thickness, septal wall thickness, proximal diameters of four major coronary arteries, and axial, coronal, and sagittal spatial angles of the CSO. RESULTS:All coronary artery diameters and both ventricular wall-thickness measures were significantly greater in men. Coronary sinus and CSO diameters increased with age, whereas CSO level decreased (r = -0.221, p < 0.001). The CSO formed angles of 65.15° ± 11.08°, 33.51° ± 17.95°, and 32.58° ± 17.47° with the axial, coronal, and sagittal planes, respectively, with no significant sex differences. In multivariable logistic regression analysis, male sex was independently associated with a higher CSO level, whereas older age, greater septal wall thickness, larger CSO diameter, and a larger sagittal angle were associated with a lower CSO level; mean left ventricular (LV) free-wall thickness (anterior and lateral) was not an independent predictor. CONCLUSIONS:Selected coronary sinus and cardiac morphometric parameters exhibited sex-related differences, while coronary sinus and CSO diameters increased progressively with age. The three-dimensional spatial orientation of the CSO within the right atrium appears to be a sex-independent anatomical parameter.Preoperative CTA may contribute to a better understanding of coronary sinus anatomy and, in selected cases, may facilitate procedural planning for coronary sinus-based cardiac interventions.
BACKGROUND: The celiac trunk and superior mesenteric artery (SMA) are developmentally interconnected, and variations in one system often directly influence the other. Although classifications have been proposed for each structure, combined variations involving the celiac trunk, SMA, and their branches remain rare. CASE REPORT: We report combined variations involving the celiac trunk, SMA, and their branches, identified during routine educational dissection of an 80-year-old male cadaver in 2025. RESULTS: A rare combined vascular variation comprising an incomplete celiac trunk and a hepato-mesenteric trunk was identified: (1) a gastro-hepatic trunk that bifurcated into the left gastric artery and a replaced left hepatic artery; (2) a gastroduodenal- splenic trunk that bifurcated into the gastroduodenal artery and splenic artery; (3) absence of the common hepatic artery; and (4) a hepato-mesenteric trunk that gave rise to a replaced right hepatic artery and then continued as the SMA. The replaced hepatic arteries correspond to the type IV variant in the Michels and Hiatt classifications, which do not account for an incomplete celiac trunk. CONCLUSIONS: This case demonstrates a unique combined variation involving an incomplete celiac trunk, the SMA, and their branches. Awareness of such patterns and their embryologic basis may reduce iatrogenic vascular injury during upper abdominal and hepatobiliary procedures.
BACKGROUND:Acromial morphology has been implicated in subacromial impingement and may influence the planning of arthroscopic subacromial decompression. Three-dimensional computed tomography (3D-CT) allows standardized anatomical reformatting and quantitative assessment of acromial parameters, but data from Vietnamese surgical patients remain limited. MATERIALS AND METHODS:This single-center descriptive study included 50 patients who underwent arthroscopic treatment for subacromial impingement between January 2023 and June 2025. Acromial morphology was classified according to the Bigliani classification on reconstructed outlet views derived from 3D models. Quantitative measurements included the critical shoulder angle (CSA), acromion index (AI), lateral acromial angle (LAA), and acromiohumeral distance (AHD) in both static and simulated dynamic positions. RESULTS:Preoperatively, no patient had a type I acromion. Type II and type III acromial morphologies were identified in 39/50 (78.0%) and 11/50 (22.0%) patients, respectively. Mean preoperative values were 0.82 ± 0.03 for AI, 38.29 ± 0.63° for CSA, 61.47 ± 2.26° for LAA, 5.26 ± 0.66 mm for static AHD, and 0.96 ± 0.57 mm for simulated dynamic AHD. AI showed a moderate inverse correlation with LAA (r = -0.44, p < 0.01). CONCLUSIONS:In this Vietnamese surgical cohort, 3D-CT enabled standardized characterization of acromial morphology and related anatomical indices. These findings offer a preliminary morphological description of the cohort and may contribute to a better understanding of subacromial anatomy in patients undergoing arthroscopic treatment for subacromial impingement. Further studies including asymptomatic controls and correlations with clinical outcomes are needed to clarify the broader clinical relevance of these measurements.
BACKGROUND:The aim of this systematic review and meta-analysis was to provide a comprehensive quantitative evaluation of the origin, morphology, branching patterns, topography, and cranial nerve relationships of the superior cerebellar artery (SCA) to inform surgical planning and reduce iatrogenic risk. MATERIALS AND METHODS:A systematic search of major medical databases, including PubMed, Scopus, Embase, Web of Science, and the Cochrane Library, was performed to identify all relevant studies on SCA anatomy. RESULTS:Data from a total of 85 articles (1907-2026) were included. The pooled prevalence of a single SCA was 89.35% [95% confidence interval (CI): 86.56-91.85%]. The pooled prevalence of an SCA originating from a common trunk with the posterior cerebral artery (PCA) or directly from the proximal segment of the PCA was 1.18% (95% CI: 0.21-2.77%) and 2.21% (95% CI: 0.84-4.13%), respectively. The pooled mean outer diameter of the proximal SCA was 1.69 mm [standard error (SE) = 0.22] in cadaveric studies and 1.51 mm (SE = 0.16) in computed tomography (CT) studies. CONCLUSIONS:This systematic review and meta-analysis provide a comprehensive synthesis of the anatomical variability, morphometry, and neurovascular relationships of the superior cerebellar artery. Despite its generally consistent origin and course, clinically relevant variations are common and should be anticipated during surgical and radiological procedures involving the posterior fossa. Awareness of these patterns is essential to minimize iatrogenic injury, particularly to cranial nerves and perforating branches. The pooled quantitative data presented here may serve as a practical anatomical reference for safer surgical planning and more accurate imaging interpretation.
This Letter to the Editor refers to the article: Bagci G, Karabulut AK, Batur A, et al. Evaluation of changes in posterior cranial fossa and cerebellum in patients with Chiari type 1 malformation. Folia Morphol. 2026; 85: e01726038, doi: 10.5603/fm.110689, indexed in Pubmed: 41925688.
BACKGROUND: Anatomical variations of the palmar digital arteries are reported less frequently than variations of the superficial and deep palmar arches, particularly regarding their precise topographic relationships within the intermetacarpal spaces. The common palmar digital arteries are classically described as running volar to the deep transverse metacarpal ligament. MATERIALS AND METHODS: During routine anatomical dissection of a cryopreserved upper limb from an adult donor injected with red latex, the arterial pattern of the palm was examined with particular attention to the vessels supplying the fourth intermetacarpal space. RESULTS: The fourth common palmar digital artery was absent. A branch arising from the ulnar proper palmar digital artery of the little finger coursed from the hypothenar region toward the fourth intermetacarpal space, passed deep to the flexor digitorum profundus tendon of the little finger, and crossed beneath the deep transverse metacarpal ligament. Distal to the ligament, the vessel divided into the ulnar proper palmar digital artery of the fourth finger and the radial proper palmar digital artery of the fifth finger. CONCLUSIONS: This arterial configuration represents an uncommon topographic relationship between the palmar digital arteries and the deep transverse metacarpal ligament and differs from standard anatomical descriptions. Awareness of such variations contributes to anatomical knowledge and may be clinically relevant during surgical procedures involving the fourth web space of the hand.
BACKGROUND:The supraclavicular nerves (SCNs) are sensory branches of the cervical plexus that may exhibit clinically important anatomical variations. Variants involving transosseous clavicular passage may predispose individuals to nerve entrapment and increase the risk of iatrogenic injury during clavicular surgery. This cadaveric case series describes three unusual variations of the intermediate supraclavicular nerve (ISCN). MATERIALS AND METHODS:Nine formalin-fixed adult cadavers (comprising five males and four females; mean age, 79.1 years; median age, 78 years; age range, 69-91 years) were examined between 2024 and 2026 at the Department of Anatomy and Surgical Anatomy, Aristotle University of Thessaloniki, with one sufficiently preserved supraclavicular region assessed per cadaver. The contralateral regions of the three variant cases could not be reliably evaluated because embalming- related tissue alterations hindered precise dissection. The SCNs were identified along the posterior border of the sternocleidomastoid muscle and traced distally toward the clavicle. In cases suspected of transosseous variants, the clavicle was sectioned sagittally to verify intraclavicular nerve passage. RESULTS:Variations were identified in 3 of 9 cadavers (3 of 9 examined sides); this descriptive proportion should not be interpreted as an estimate of population prevalence. Case 1 demonstrated an unusually long distal course of the ISCN and medial supraclavicular nerve (MSCN), extending into the anterior thoracic wall superior to the mammary papilla. Case 2 demonstrated intraclavicular passage of the ISCN through a clavicular tunnel, confirmed by sagittal clavicular sectioning. Case 3 demonstrated clavicular perforation by an atypical secondary common trunk that divided into medial and intermediate terminal branches after emerging inferior to the clavicle. CONCLUSIONS:These findings expand the known anatomical spectrum of the ISCN and emphasize the marked variability of its distal course and branching pattern. Recognition of such variants is important because they may predispose to nerve entrapment and increase the risk of iatrogenic injury during clavicular surgery, fracture fixation, and related surgical procedures involving the clavicular region.
BACKGROUND: Branches of the lumbar plexus, including the genitofemoral, lateral femoral cutaneous, and femoral nerves (FN), exhibit well-known anatomical variations, but the coexistence of such variations in a single specimen is rarely documented. MATERIALS AND METHODS: Bilateral dissections were performed on two formalin- fixed cadavers (one male and one female, aged 74 and 68 years at death, respectively) to expose the lumbar plexus. Morphometric data, including nerve diameters, distances from anatomical landmarks, and distances to branching points, were recorded. RESULTS: Specimen 1 (right side) showed a parallel course of the femoral branch of the genitofemoral nerve (GFN) and the lateral femoral cutaneous nerve (LFCN). In the same specimen, the LFCN displayed a branching variation with multiple terminal branches. In Specimen 2, the LFCN could not be identified bilaterally, and the FN showed early bifurcation. Morphometric data quantified these variations: the GFN branched 13.2 mm proximal to the inguinal ligament; the LFCN pierced the psoas major muscle 28.5 mm medial to the anterior superior iliac spine; and the FN bifurcated at distances of 18.7 mm on the right and 20.1 mm on the left from its origin. CONCLUSIONS: These findings indicate that lumbar plexus branches can exhibit complex combined variations in origin, course, branching pattern, and pelvic exit. Morphometric data provide additional details regarding these variant anatomies. Such variations should be considered during surgery, nerve block procedures, and evaluation of neuropathic symptoms. The coexistence of multiple well‑known variations in two specimens underscores the spectrum of lumbar plexus variability rather than describing entirely new patterns.
BACKGROUND: The superior thyroid artery (STA) shows considerable anatomical variability with important implications for thyroid and laryngeal surgery. Although the external carotid artery (ECA) is the most commonly reported origin, alternative origins and variable relationships with the external branch of the superior laryngeal nerve (EBSLN) may increase intraoperative risk. This study aimed to evaluate STA morphology using computed tomography angiography (CTA) and to integrate these findings with a global meta-analysis. MATERIALS AND METHODS: A retrospective CTA analysis of 157 hemi-necks was performed to assess STA origin and branching patterns. In parallel, a systematic review and meta-analysis were conducted according to PRISMA guidelines and registered in PROSPERO (CRD42023393213). Ninety-three studies (12,022 arteries) were included to evaluate STA origin, Cernea classification, trunk formation, arterial diameter, and vertical level relative to the thyroid cartilage. Random-effects and compositional meta-analytic models were applied. RESULTS: In the CTA cohort, the STA most frequently originated from the ECA on the right side and from the carotid bifurcation (CB) on the left (p < 0.001). The meta-analysis confirmed ECA predominance (57.6%). Cernea types I and IIa were most prevalent. Trunk formation was uncommon (3.6%). The pooled radiologic STA diameter was 1.73 mm, and more than half of arteries originated above the thyroid cartilage. CONCLUSIONS: Despite marked variability, STA morphology shows recurring overall patterns. Combined CTA-based and meta-analytic findings highlight the importance of standardized anatomical definitions and careful identification of vascular and neural structures to reduce surgical risk in anterior neck surgery.
BACKGROUND:The supraorbital foramen or notch constitutes an important anatomical landmark for maxillofacial surgery, regional anesthesia, and ophthalmologic procedures. Considerable variability in its morphology and location has been reported in different groups. The aim of the study was to assess the morphological and morphometric variability of the supraorbital foramen in medieval and contemporary skulls and to analyze its asymmetry and clinical relevance. MATERIALS AND METHODS:The study included 234 adult male skulls originating from Central European skeletal samples: 87 contemporary skulls from the early 20th century and 147 medieval skulls (11th-16th centuries). Morphological assessment included identification of the supraorbital notch, complete foramen, and incomplete foramen. Morphometric measurements were performed using an electronic caliper and included distances between the supraorbital foramen and selected anthropometric landmarks. Statistical analysis was performed using Student's t-test, paired Student's t-test, and chi-square test with Yates correction. RESULTS:The supraorbital notch occurred in 54.5% of contemporary skulls and 71% of medieval skulls. The frequency of a complete supraorbital foramen did not differ significantly between the groups. In the contemporary group, significantly greater distances were observed between the supraorbital foramen and the frontozygomatic suture as well as the superior temporal line. Most other morphometric parameters did not show statistically significant differences between the groups. A small but consistent side asymmetry of the supraorbital region was observed. CONCLUSIONS:The supraorbital notch is the predominant morphological variant in both medieval and contemporary groups. Although certain differences in lateral frontal bone measurements were observed, the general topography of the supraorbital foramen appears relatively stable. The observed variability and asymmetry should be considered during surgical and anesthetic procedures involving the supraorbital region.
