BACKGROUND AND OBJECTIVES:The foramen magnum as a transition area between skull and spine plays an important role as a landmark, because of its close relationship to vital structures such as the brain and spinal cord. Configuration and size of the foramen magnum play an important role for assessing craniovertebral relations. The objectives of the present study are to find out shape and dimensions of foramen magnum in cranial CT scans. All the variables were evaluated by using discriminant function analysis.MATERIALS AND METHODS:The study sample comprised 200 CT scans (110 males and 90 females) of south Indian origin. The shapes of the foramen magnum were classified into 8 types: oval, egg, round, tetragonal, pentagonal, hexagonal, irregular (A), and irregular (B). The parameters were noted meticulously and the statistical analysis for sex comparison was made by Student's t-test and was considered significant whenever P≤0.05. To determine the relationships between the studied parameters, Pearson correlation coefficients were calculated.RESULTS:The foramen magnum was classified into 8 types based on shape. Commonest was oval and pentagonal was the least common type. The anteroposterior diameter, transverse diameter, circumference, and area were significantly greater in males than in females (P<0.001). The mean FM index of male CT scans was 85.01 ± 8.67, whereas in case of female CT scans, it was 83.17 ± 7.78. With all the variables in consideration, overall 65% of cranial CT scans were sexed correctly by using multivariate analysis.CONCLUSION:Several anatomic parameters such as shape and dimensions of FM should be taken into consideration during surgery involving the craniovertebral junction. Also these can be used during forensic and anthropological investigation of unknown individuals for determining gender, ethnicity, and so on. The multivariate analysis is by far the best method for determination of sex of cranium with available resources.
There is a drastic shift in medical curriculum from the traditional medical curriculum where various basic science disciplines are taught separately in the preclinical years to integrated problem-based learning (PBL) in many medical schools across the world. In the integrated PBL, the time for classical anatomy dissection is significantly reduced. There are varying views across the world about the perception of medical students to cadaveric dissection. There is however no research on student's perception of cadaveric dissection in Ghana. The present study was to assess Ghanaian medical student's perception of cadaveric dissection under the PBL curriculum and to assess which educational tool students rely on to study anatomy. An anonymous self-administered, Likert-style questionnaire consisting of 24 questions was administered to 132 second- and third-year students after they had completed the dissection schedules for the musculoskeletal system. Participation was voluntary. In all, 89.5% of the students indicated that they had attended all the dissection sessions. The students generally agreed that dissection deepens their understanding of anatomy (87.9%), provides better understanding of clinical skill examination (66.7%), enhances their respect towards the human body (66.6%), provides better understanding of the effect of trauma (69.7%), and makes learning interesting (90.9). However, 57.5% of them agreed or strongly agreed that dissection was stressful. Majority of the students also disagreed that dissection should be eliminated from the curriculum (100%). This study has shown a strong positive perception towards the use of cadaveric dissections in teaching and learning anatomy regardless of the fact that SMHS/UDS uses the integrated PBL curriculum.
The objective of the research was to study the correlation of internal organ weights with body weight and length in normal adult Zambians. The study involved 114 (83 males and 31 females) forensic autopsies from Ndola Teaching Hospital done over a period of 12 months. The cases included autopsies of unnatural deaths including road traffic accidents and homicide. Cases where information about age and origin of the person was not available were left out of the study. The age of the decedents ranged from 16 to 85 years. The data was analyzed by Pearson correlation coefficient to determine correlation. P values less than 0.05 were considered to be statistically significant. It was observed that the heart, liver, left kidney, right kidney, brain, and left lung were positively correlated to body weight, while only the brain and the left lung were positively correlated to the height in the male population. In the female population, the heart, liver, right kidney, brain, and right lung were positively correlated to the weight of the body, while only the right kidney was positively correlated to the height of the body.
Dermatoglyphics, the study of epidermal ridges on palm, sole, and digits, is considered as most effective and reliable evidence of identification. The fingerprints were studied in 300 Nepalese of known blood groups of different ages and classified into primary patterns and then analyzed statistically. In both sexes, incidence of loops was highest in ABO blood group and Rh +ve blood types, followed by whorls and arches, while the incidence of whorls was highest followed by loops and arches in Rh −ve blood types. Loops were higher in all blood groups except “A –ve” and “B –ve” where whorls were predominant. The fingerprint pattern in Rh blood types of blood group “A” was statistically significant while in others it was insignificant. In middle and little finger, loops were higher whereas in ring finger whorls were higher in all blood groups. Whorls were higher in thumb and index finger except in blood group “O” where loops were predominant. This study concludes that distribution of primary pattern of fingerprint is not related to gender and blood group but is related to individual digits.
Introduction. Congenital Palmaris Longus (PL) absence was found in 15%–20.25% of population globally. This condition and Flexor Digitorum Superficialis (FDS) tendon absence in little finger are not known in Saudi Arabia. We studied prevalence of PL and FDS agenesis in Saudi Arabian population. Methods. A random cross-sectional study was carried out after an ethical approval in the Riyadh universities. Schaeffer's test was used to examine PL absence. The Modified test was used to examine FDS absence. Data was analyzed using Microsoft Excel and the SPSS Software version 22. Results. The volunteers, 331, males 164 (49.5%) and females 167 (50.5%), mean age of 23 (SD ± 5.3), showed right hand dominance in 294 (88.8%) and bilateral absence of PL and FDS in 15.1% and 14.8%, respectively. The hand dominance showed no significant relation between PL and FDS absence, p value = 0.788, 0.835, respectively. Generally, we found a weak correlation between absence of the PL and FDS, p value ≥ 0.595. Conclusion. The bilateral absence of PL and FDS was found as 15.1% and 14.8%, respectively. Variation of the FDS tendon absence was an independent entity for the PL absence. The dominance of hands was not related to the tested variables found in PL and FDS agenesis.
Background. The patella is the largest sesamoid bone in the body; its three-dimensional complexity necessitates biomechanical perfection. Numerous pathologies occur at the patellofemoral unit which may end in degenerative changes. This study aims to test the presence of statistical correlation between the surface areas of patellar facets and other patellar morphometric parameters. Materials and Methods. Forty dry human patellae were studied. The morphometry of each patella was measured using a digital Vernier Caliper, electronic balance, and image analyses software known as ImageJ. The patellar facetal surface area was correlated with patellar weight, height, width, and thickness. Results. Inferential statistics proved the existence of linear correlation of total facetal surface area and patellar weight, height, width, and thickness. The correlation was strongest for surface area versus patellar weight. The lateral facetal area was found persistently larger than the medial facetal area, the p value was found to be <0.001 (one-tailed t-test) for right patellae, and another significant p value of < 0.001 (one-tailed t-test) was found for left patellae. Conclusion. These data are vital for the restoration of the normal biomechanics of the patellofemoral unit; these are to be consulted during knee surgeries and implant designs and can be of an indispensable anthropometric, interethnic, and biometric value.
PURPOSE:The aim of the study was to locate the infraorbital foramen (IOF) in relation to the infraorbital margin (IOM) for proper injections of local anesthetics in skull specimens. Another aim was to determine the depth of needle penetration into pterygopalatine fossa through the greater palatine canal (GPC).MATERIALS AND METHODS:102 skull halves were used to measure the distances between (1) IOF and IOM and (2) IOF and alveolar ridge of maxilla at second premolar. Needles were inserted and bent at a 45° angle, passing through the GPC at the level of hard palate. The depth of the tip of needle emerging out of GPC into pterygopalatine fossa was measured.RESULTS:The mean distance between IOF and IOM was 6.46 ± 1.57 mm on the right side and 6.74 ± 1.72 mm on the left. The mean distance between IOF and alveolar bone process of the maxilla at second premolar was 29.07 ± 3.58 mm on the right side and 29.39 ± 3.78 mm on the left. The mean depth of penetration of the needle into the pterygopalatine fossa was similar on both sides.CONCLUSIONS:Proper identification of IOF and pterygopalatine fossa is of great significance during local anesthesia injections, due to their close proximity to vital anatomic structures.
A new wave of virtual reality headsets has become available. A potential benefit for the study of human anatomy is the reintroduction of stereopsis and absolute size. We report a randomized controlled trial to assess the contribution of stereopsis to anatomy learning, for students of different visuospatial ability. Sixty-three participants engaged in a one-hour session including a study phase and posttest. One group studied 3D models of the anatomy of the deep neck in full stereoptic virtual reality; one group studied those structures in virtual reality without stereoptic depth. The control group experienced an unrelated virtual reality environment. A post hoc questionnaire explored cognitive load and problem solving strategies of the participants. We found no effect of condition on learning. Visuospatial ability however did impact correct answers at F(1)=5.63 and p=.02. No evidence was found for an impact of cognitive load on performance. Possibly, participants were able to solve the posttest items based on visuospatial information contained in the test items themselves. Additionally, the virtual anatomy may have been complex enough to discourage memory based strategies. It is important to control the amount of visuospatial information present in test items.
There is evidence for variation in trabecular bone density and volume within an individual skeleton, albeit in a few anatomical sites, which is partly dependent on mechanical loading. However, little is known regarding the basic variation in trabecular bone density throughout the skeleton in healthy human adults. This is because research on bone density has been confined to a few skeletal elements, which can be readily measured using available imaging technology particularly in clinical settings. This study comprehensively investigates the distribution of trabecular bone density within the human skeleton in nine skeletal sites (femur, proximal and distal tibia, third metatarsal, humerus, ulna, radius, third metacarpal, and axis) in a sample of N = 20 individuals (11 males and 9 females). pQCT results showed that the proximal ulna (mean = 231.3 mg/cm3) and axis vertebra (mean = 234.3 mg/cm3) displayed significantly greater (p < 0.01) trabecular bone density than other elements, whereas there was no significant variation among the rest of the elements (p > 0.01). The homogeneity of the majority of elements suggests that these sites are potentially responsive to site-specific genetic factors. Secondly, the lack of correlation between elements (p > 0.05) suggests that density measurements of one anatomical region are not necessarily accurate measures of other anatomical regions.
Anomalous muscular variants of pectoralis major have been reported on several occasions in the medical literature. Among them, chondroepitrochlearis is one of the rarest. Therefore, this study aims to provide a comprehensive description of its anatomy and subsequent clinical significance, along with its phylogenetic importance in pectoral muscle evolution with regard to primate posture. The authors suggest a more appropriate name to better reflect its proximal attachment to the costochondral junction and distal attachment to the epicondyle of humerus, as “chondroepicondylaris”; in addition, we suggest a new theory of phylogenetic significance to explain the twisting of pectoralis major tendon in primates that may have occurred with their adoption to bipedalism and arboreal lifestyle. Finally, the clinical significance of this aberrant muscle is elaborated as a cause of potential neurovascular entrapment and as a possible hurdle during axillary surgeries (i.e., mastectomy).
The rhomboid fossa of clavicle is used to determine the age and sex in anthropology and forensic sciences. The variant types of rhomboid fossa on inferior surface have been reported in many races except in Thais. This study therefore was aimed at classifying the types of the rhomboid fossa in Northeastern Thais. The identified 476 Northeastern Thais dried clavicles (270 males and 206 females) were observed and recorded for the types of rhomboid fossa. The results showed that Thai-rhomboid fossa could be classified into 4 types: Type 1: smooth; Type 2: flat; Type 3: elevated; and Type 4: depressed, respectively. The incidences of rhomboid fossa were as follows: Type 1: 0.21%; Type 2: 19.75%; Type 3: 76.26%; and Type 4: 3.78%, respectively. Additionally, it was found that the percentage of Type 4 (11.84%) was much greater than that of female (1.94%) compared to other types. This incidence of rhomboid fossa types especially Type 4 may be a basic knowledge to be used in sex identification. The high incidence of rhomboid fossa in both sexes of Northeastern Thai clavicles was Type 3 (elevated type).
Introduction. Cadaveric dissections and prosections have traditionally been part of undergraduate medical teaching. Materials and Methods. Hundred and fifty-nine first-year students in the Faculty of Medicine, University of Colombo, were invited to participate in the above study. Students were randomly allocated to two age and gender matched groups. Both groups were exposed to identical series of lectures regarding anatomy of the abdomen and conventional cadaveric prosections of the abdomen. The test group (n = 77, 48.4%) was also exposed to cadaveric cross-sectional slices of the abdomen to which the control group (n = 82, 51.6%) was blinded. At the end of the teaching session both groups were assessed by using their performance in a timed multiple choice question paper as well as ability to identify structures in abdominal CT films. Results. Scores for spatial and radiological anatomy were significantly higher among the test group when compared with the control group (P < 0.05, CI 95%). Majority of the students in both control and test groups agreed that cadaveric cross section may be useful for them to understand spatial and radiological anatomy. Conclusion. Introduction of cadaveric cross-sectional prosections may help students to understand spatial and radiological anatomy better.
Anatomical variations of the recurrent laryngeal nerve (RLN), such as an extralaryngeal terminal bifurcation (ETB), threaten the safety of thyroid surgery. Besides the morphology of the nerve branches, intraoperative evaluation of their functional anatomy may be useful to preserve motor activity. We exposed 67 RLNs in 36 patients. The main trunk, bifurcation point, and terminal branches of bifid nerves were macroscopically determined and exposed during thyroid surgery. The functional anatomy of the nerve branches was evaluated by intraoperative nerve monitoring (IONM). Forty-six RLNs with an ETB were intraoperatively exposed. The bifurcation point was located along the prearterial, arterial, and postarterial segments in 11%, 39%, and 50% of bifid RLNs, respectively. Motor activity was determined in all anterior branches. The functional anatomy of terminal branches detected motor activity in 4 (8.7%) posterior branches of 46 bifid RLNs. The motor activity in posterior branches created a wave amplitude at 25–69% of that in the corresponding anterior branches. The functional anatomy of bifid RLNs demonstrated that anterior branches always contained motor fibres while posterior branches seldom contained motor fibres. The motor activity of the posterior branch was weaker than that of the anterior branch. IONM may help to differentiate between motor and sensory functions of nerve branches. The morphology and functional anatomy of all nerve branches must be preserved to ensure a safer surgery.
I recently came across an interesting and useful article on " Variability in the Branching Pattern of the Internal Iliac Artery in Indian Population and Its Clinical Importance, " by Sakthivelavan et al. [1]. As a practicing obstetrician who has served in several parts of developing countries, I would first like to thank the authors for their commendable desire to contribute to a topic of great clinical significance. Hemorrhage is one of the common causes of maternal deaths in the developing nations [2, 3]. Pelvic hemorrhage is also a major cause of morbidity and mortality in gynecological surgeries [4]. Kelly [5] was the first to describe ligation of the internal iliac artery (IIA) as a method to control hemorrhage during pelvic surgery in 1894. Since then, this procedure has helped save many lives and uteruses for over a century. It was long believed that ligation of the hypogastric arteries would lead to complete cessation of blood flow in the area supplied by these vessels. Yet, owing to the activation of the anastomotic network immediately after ligation, blood is never completely drained from the hypogastric artery distally to the site of ligation as demonstrated by Burchell in 1968 [6]. Bleeding from the uterus diminishes because there is no arterial pressure or pulsation in the arteries after ligation; instead, pressure becomes the same as that in the venous system. The use of IIA ligation in current obstetrics and gynecol-ogy is controversial due to the technical challenges the procedure involves and the variation in success rates. The efficacy of this procedure in controlling obstetrical hemorrhage has been reported to range within 42–75% [7–10]. Despite the fact that this procedure is mostly done as an emergency, it still requires the surgeon to have a thorough understanding of the anatomy to prevent iatrogenic injury and to have adequate hemostasis. It was interesting to read about the different anatomical variations of the IIA in the Indian population. Conventionally, the IIA is ligated 5 cm distal to the bifurcation of the common iliac artery as it is said to spare the posterior division and avoid gluteal ischemia and necrosis. However, I was quite surprised to see that in as high as 25.9% of the cases this might not be the case due to anatomical variation [1]. It was also interesting to note the anomalous origin of the obturator artery from the posterior division in 6.8% of cases …
The use of unclaimed bodies for anatomical dissection has been the main method of instruction at our institution. There is however a shortage of cadavers for dissection given the increase in the number of medical schools as well as in the number of students enrolling in these schools. This shortage could be mitigated by having voluntary human body donation programs. This study aimed at assessing the attitudes of medical students and surgical residents towards body donation for anatomy learning. We conducted an online survey involving 72 first-year medical students and 41 surgical residents at University of Nairobi who had completed one year of anatomy dissection. For the medical students, this was their first dissection experience while it was the second exposure for the surgery trainees. Most of the surgical trainees (70.7%) and medical students (68.1%) were opposed to self-body donation. This was mainly due to cultural (37%) and religious (20%) barriers. Surprisingly, of those not willing to donate themselves, 67.9% (82.8% surgical trainees, 59.2% medical students) would recommend the practice to other people. Exposure to repeated dissection does not change the perceptions towards body donation. It is noteworthy that culture and religion rank high as clear barriers amongst this "highly informed" group of potential donors.
Introduction. Submammary adipofascial flap (SMAF) is a valuable option for replacement of the inferior portion of the breast. It is particularly useful for reconstruction of partial mastectomy defects. It is also used to cover breast implants. Most surgeons base this flap cranially on the submammary skin crease, reflecting it back onto the breast. The blood vessels supplying this flap are not well defined, and the harvest of the flap may be compromised due to its uncertain vascularity. The aim of the work was to identify perforator vessels supplying SMAF and define their origin, site, diameter, and length. Materials and Methods. The flap was designed and dissected on both sides in 10 female cadavers. SMAF outline was 10 cm in length and 7 cm in width. The flap was raised carefully from below upwards to identify the perforator vessels supplying it from all directions. These vessels were counted and the following measurements were taken using Vernier caliper: diameter, total length, length inside the flap, and distance below the submammary skin crease. Conclusions. The perforators at the lateral part of the flap took origin from the lateral thoracic, thoracodorsal, and intercostal vessels. They were significantly larger, longer, and of multiple origins than those on the medial part of the flap and this suggests that laterally based flaps will have better blood supply, better viability, and more promising prognosis. Both approaches, medially based and laterally based SMAF, carry a better prognosis and lesser chance for future fat necrosis than the classical cranially based flap.
Surgical anatomy of carotid bifurcation is of unique importance for numerous medical specialties. Despite extensive research, many aspects such as precise height of carotid bifurcation, micrometric values of carotid arteries and their branches as their diameter, length, and degree of tortuosity, and variations of proximal external carotid artery branches are undetermined. Furthermore carotid bifurcation is involved in many pathologic processes, atheromatous disease being the commonest. Carotid atheromatous disease is a major predisposing factor for disabling and possibly fatal strokes with geometry of carotid bifurcation playing an important role in its natural history. Consequently detailed knowledge of various anatomic parameters is of paramount importance not only for understanding of the disease but also for design of surgical treatment, especially selection between carotid endarterectomy and carotid stenting. Carotid bifurcation paragangliomas constitute unique tumors with diagnostic accuracy, treatment design, and success of operative intervention dependent on precise knowledge of anatomy. Considering those, it becomes clear that selection and application of proper surgical therapy should consider anatomical details. Further research might ameliorate available treatment options or even lead to innovative ones.
The present study was conducted to ascertain the shape, size, presence of accessory foramina, direction, and the precise position of the infraorbital foramen (IOF) in relation to the inferior orbital margin (IOM), anterior nasal spine (ANS), nasion (Na), maxillary teeth, and supraorbital foramen/notch (SOF/N) in adult skulls in a Sri Lankan population. Fifty-four skulls (42 males and 12 females) were analyzed. The IOF was oval in shape (38.6% and 36.3% on the right and left side, resp.) in a majority of skulls. The direction of the IOF was mostly medially downward (48.6%). Accessory foramina were found in 7.4% of the skulls. The infraorbital foramina were located at a mean distance of 6.52 ± 2.03 mm and 7.30 ± 1.57 mm, vertically below the IOM on the right and left side, respectively; 33.81 ± 2.68 mm and 34.23 ± 2.56 mm from the ANS on the right and left side, respectively; and 42.37 ± 3.52 mm and 42.52 ± 3.28 mm from the Na on the right and left side, respectively. In relation to the upper teeth the majority of IOF (37.5% and 55.9% on the right and left side, resp.) were located in the same vertical axis as the tip of the buccal cusp of the maxillary second premolar tooth.
Purpose. This study was conducted to identify the surface projection of the interosseous foramen and associated structures of the proximal leg using the average clinician's thumb width as a quick measurement to assist in differential diagnosis and treatment. Methods. Twelve cadavers (5 males and 7 females, age range = 51-91 years, and mean age = 76.9) were dissected for analysis. Location and size of interosseous foramen, location of anterior tibial artery, location of deep fibular nerve, and corresponding arterial branches were measured and converted into thumb widths. Results. Mean thumb width measured among the cadavers was 17.94 ± 3.9 mm. The interosseous foramen measured was approximately 1 thumb width vertically (18.47 ± 3.0 mm) and 1/2 thumb width horizontally (7.32 ± 2.1 mm) and was located approximately 1 thumb width distally to the tibial tuberosity (20.81 ± 6.8 mm) and 2 thumb widths (37.47 ± 4.7 mm) lateral to the tibial ridge. The anterior tibial artery and deep fibular nerve converged approximately 4 thumb widths (74.31 ± 14.8 mm) inferior to the tibial tuberosity and 2 thumb widths (33.46 ± 4.9 mm) lateral to the tibial ridge. Conclusion. Clinicians may identify anatomical structures of the proximal leg with palpation using the thumb width for measurement.
The cystic artery is the key structure sought to be clipped or ligated during laparoscopic or conventional cholecystectomy. The possible complications like hemorrhage or hepatobiliary injury are always centered on the search, dissection, and clipping or ligation of the cystic artery, many a time because of possibility of variations in its course and relations to the biliary ducts. This descriptive study was carried out to document the normal anatomy and different variations of the cystic artery to contribute to improve surgical safety. This study conducted on 82 cadavers revealed cystic artery with mean length of 16.9 mm (ranged between 2 mm and 55 mm) and mean diameter of 1.6 mm (range between 1 mm and 5 mm). The origin of cystic artery from celiac right hepatic artery was found in 79.3% and in the remaining 20.7% it was replaced. Single cystic artery was present in 72% and double cystic artery in 28%. Considering the site of origin of the cystic artery with reference to Calot's triangle, it was observed within the triangle in 62.2% and outside it in 37.8%. All the cystic arteries passed through Calot's triangle except for 3.6%. The cystic artery crossed the common hepatic duct anteriorly in 26.8% and posteriorly in 6.1%. It crossed common bile duct anteriorly in 1.2% and posteriorly in 3.7%. The knowledge of such variations and its awareness will decrease morbidity and help to keep away from a number of surgical complications during cholecystectomy.
