Surgical and radiologic anatomy : SRA
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The transoral approach (Fang and Ong 1962) allows direct free exposure of the atlas and axis. However, a morphologic description of certain structures at risk corresponding to the views at operation has so far been lacking. The present study is intended to fill this gap by giving the surgeon a transoral view of the peripharyngeal structures. This is a further instance of how classical gross anatomy needs to be continuously rediscovered in the light of clinical activities.
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The courses of the iliohypogastric and ilioinguinal nerves were studied in 44 adult human cadavers, in order to clarify their relations to incisions in the abdominal wall in appendectomy, inguinal hernial repair, caesarean section and lumbar nephrectomy. If either of these nerves is trapped during suturing of the abdominal layers, especially after inguinal hernia repair and appendectomy typical nerve irritation in the inguinal region is observed. To avoid cutting the anterior branches of the iliohypogastric and ilioinguinal nerves in appendectomy, incisions should be placed at a distance of not less than 3 cm from the anterior superior iliac spine. ⋯ During oblique lumbar incision for nephrectomy (Bergmann-Israel) the iliohypogastric nerve can easily be found in the middle third of the lateral margin of the quadratus lumborum muscle. The nerve should be displaced carefully downwards. Positional changes of the kidney or ureter, perinephric inflammation, etc. are often referred to the skin areas (Head, Mackenzie) of the iliohypogastric and ilioinguinal nerves.