Surgical and radiologic anatomy : SRA
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The lower cervical pedicle size differs between the Chinese and the non-Chinese population. Knowledge of pedicle dimensions and surface landmarks is crucial for the safe placement of screws, but few quantitative data concerning the lower cervical pedicle using CT scan and multiplanar reformations (MPR) in a Chinese population exist. The aim of this study was to evaluate lower cervical pedicle (C3-C7) dimensions in a Chinese population by computed axial tomography for surgical application. ⋯ The cervical spinal cord or vertebral artery may be at risk of injury if the angulation of the screw insert is over-medial or over-lateral in the transverse plane. Therefore, preoperative CT evaluation of pedicle transverse angle is very important. Considering the amount of variation among individuals, our data on CT measurements of pedicle in a Chinese population in conjunction with evaluation of the results of preoperative CT may enhance the safety of transpedicular screw fixation in the lower cervical spine.
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The complex architecture of the anterior clinoid process (ACP), which is usually removed during the surgical elimination of tumors or aneurysms of sellar region, has surgical importance. For effective clinoidectomy, a neurosurgeon must have the prior knowledge of anatmoical variations of ACP. The purpose of this study was to investigate the dimensions and variation in the shape of ACP in dry adult skulls of South Indian origin. ⋯ The result of the present investigation suggests that ACPs of South Indian skulls are highly variable and, are marginally larger and thicker than ACPs of Nepalese and Korean origin.
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Nerve injury is a common complication during anterior shoulder surgery. The purpose of the study was to evaluate the musculocutaneous nerve (MN) anatomically and to clarify the relationship of the MN to the glenoid labrum and coracoid process in different arm positions. The study was carried out on 40 shoulders of 20 adult cadavers fixed in 10% formaldehyde. ⋯ The results of this study might be of use in avoiding the MN especially during Bristlow operations and certain rotator cuff procedures. Transferring the coracoid process during Bristow operations or placing arthroscopic portals when the arm is abducted to 45 degrees appears to be the safest position in terms of MN injury. Based on our results, when the arm needs to be abducted to 90 degrees during operation, externally rotating it may decrease the tension on the brachial plexus thus increasing the distance between the MN and the portals or retractors.
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The discomallear ligament (DML) runs through a narrow space of bony petrotympanic fissure, which joins the articular disc of the temporomandibular joint (TMJ) and the malleus in the tympanic cavity. Previous report suggest that an anatomical feature gives rise to TMJ pain and dysfunction. Recently, the movement of the malleus caused by hypertension on the discomallear ligament is important to the function of the TMJ. ⋯ It is revealed that a wide tunnel-like structure was found on CBCT images in the middle region of the petrotympanic fissure to the malleus in the tympanic cavity consisting of mainly three types: a wide tunnel-shaped structure (29.2%, 7/24, type 1), a tunnel-shaped structure widely open in the entrance of the petrotympanic fissure to the mandibular fossa and gradually thinning out in the tympanic cavity (20.8%, 5/24, type 2), and a tunnel-shaped structure widely open in the entrance of the mandibular fossa, middle region with flat-shaped tunnel structure and narrow exit in the tympanic cavity (41.7%, 10/24, type 3). These structures between the entrance of the petrotympanic fissure and the exit at the tympanic cavity are important to define the limited movement of the malleus. Therefore, morphological feature of the ligaments in malleus may relate to TMJ pain, dysfunction and hearing function.
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The fibula free flap has become the dominant free flap for all mandible reconstructions, except in case of severe peripheral vascular disease. In these cases we propose to use the pedicled osteo-muscular dorsal scapular flap as an alternative technique. This flap is an original technique, it is pedicled on the dorsal scapular vessels with harvesting of the medial border of the scapula and the lateral part of the rhomboid muscles. ⋯ In this technique, after harvesting the medial border of the scapula and the lateral part of the rhomboid muscles, the flap has been transposed in the cervical region through a tunnel under the superior part of the trapezius. This technique has been used in three patients after lateral resection of the mandible. The functional results were good, allowing the preservation of the scapular elevation.