Surgical and radiologic anatomy : SRA
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The authors describe the distribution of the medial branches of the upper thoracic dorsal rami (T1 to T5 levels). At each level, after travelling through the erector spinae, they become superficial, and reach the apex of the spinous process of the corresponding vertebra. ⋯ Anastomosis of the dorsal cutaneous branch of the second thoracic nerve (T2) with the descending lateral branch of the accessory nerve has been observed. Its presence could explain the occasional clinical situations where there is no resultant paralysis from accidental surgical section of the latter nerve.
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This study concerns the posterior ramus of the second cervical spinal n., or greater occipital of Arnold. By means of dissections in formalin embalmed cadavers, an attempt was made to define its winding course and to locate it in relation to clinical or radiographic landmarks, so as to provide a guide for infiltration of the nerve with local anesthetic. At the same time a dynamic study was made to elucidate the relations of the nerve to adjacent structures during the different movements of the neck. This allowed us to propose clinical tests of nerve involvement and to reveal the zones where the nerve is anatomically vulnerable.
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Starting from about the 40th year of life the lumbar spinous processes of man undergo morphological changes, which mainly affect their posterior edges. These changes consist of asymptomatic osseous appositions or spurs radiologically visible in the lateral view, with a major incidence in the elderly. Spondyloarthritis is a constant accompanying finding. ⋯ While in the young adult fibrocartilaginous metaplasia is limited to the bony attachments of the spinous ligaments, in the elderly it spreads to the greater part or to all of their thickness. The author believes that such a phenomenon is due to a reduced flexibility of the vertebral column as a whole and to exaggerated lumbar lordosis with ageing. The elongation of the lumbar spinous processes secondary to osseous appositions increases the posterior arm of the lever and favours the "extensores spinae" m.
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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.