Surgical and radiologic anatomy : SRA
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Case Reports
Anatomic and magnetic resonance imaging bases for the naso-maxillo-cheek flap technique.
A transfacial approach to the deep cranio-maxillo-facial areas by the naso-maxillo-cheek flap technique (NMCF) is indicated for the treatment of some bulky tumors of the naso-pharynx. The procedure requires precise preoperative imaging. This study presents the morphologic bases of this surgical access and the reasonable limits of the excision preoperatively determined by magnetic resonance imaging (MRI). 18 facial and skull specimens were submitted to surgical facial dismantling by the NMCF technique according to Curioni's method. ⋯ It is essential to preserve the lateral facial neurovascular pedicle to prevent necrosis of the midface structures. Preservation of the bony architecture surrounding the osteotomy sites is of great importance to allow precise final bone reassembly. Preoperative MRI appears of paramount importance to determine the borders of the lesion and the possibility of block resection.
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The object of this retrospective study was to determine the sites of abdominal aortic bifurcation and inferior vena cava confluence in relation to age and sex. The study group comprised 180 subjects (90 males and 90 females) divided into 9 groups by age (in decades). The positions of the aortic bifurcation and the inferior vena cava confluence were evaluated by CT, and linear regression models were fitted to the data. ⋯ The mean site of the venous confluence for the whole group was at disc L4-L5 (range, lower L3 to upper S1); in males, it was at disc L4-L5 (range, upper L4 to disc L5-S1), and in females at disc L4-L5 (range, lower L3 to upper S1). Thus, the aorta and the inferior vena cava can extend as low as the level of S1. These data are of relevance in laparoscopic procedures, especially in laparoscopic lumbar discectomy.
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Our anatomic findings have led us to define conflictual relations that may be encountered in their course by the pudendal n. and its branches. Starting from the clinical study of a group of patients suffering from chronic perineal pain in the seated position, we have defined, beginning with the cadaver, three possible conflictual settings: in the constriction between the sacrotuberal and sacrospinal ligaments; in the pudendal canal of Alcock; and during the straddling of the falciform process of the sacro-tuberal ligament by the pudendal n. and its branches. Consequently, considering so-called idiopathic perineal pain as an entrapment syndrome, the clinical and neurophysiologic arguments and infiltration tests have led us to define a surgical strategy which has currently given 70% of good results in 170 operated patients. Earlier diagnosis should improve on this.
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An anatomic study of the sacral dorsal root ganglia (DRG) was performed to determine the location and dimensions of the S1-4 DRGs and to correlate this information to sacral nerve root ganglion lesions. S1 DRGs were located in the intraforaminal region in 55-60% and in the intracanalar region in 40-45%. S2 DRGs were in the intraforaminal region in 15-50% and in the intracanalar region in 50-85%. ⋯ The intraforaminal position of the S1 and S2 ganglia renders them vulnerable to compression caused by sacral fractures involving the sacral foramina because of the little space available for these ganglia in the foraminal region. The S1 DRG, with its its relatively larger dimensions and its intracanalar position relative to the other sacral DRGs, may be susceptible to compression by the L5-S1 disk herniation. Its intraforaminal position may predispose it to injury during S1 or S2 pedicle screw placement.