Adult Cadavers Research Articles

The influence of rehydration on decomposition in the Highveld region of South Africa-Using a pig model.

Researchers have observed that rainfall may re-initiate decomposition in desiccated tissue; however, no conclusive research-based evidence exists on the specific effects of rehydration on decomposition. Therefore, this study aimed to assess the effects of artificial rehydration on the progression of decomposition following the advanced stage of decomposition. Twelve adult pig cadavers (8 experimental; 4 controls) were placed in the central Highveld of South Africa during cooler (April-July 2021) and warmer (August-November 2021) months. Decomposition was scored approximately biweekly to obtain the total body score, and accumulated degree days (ADD) were calculated for each pig. All pig cadavers were covered by chicken wire cages with transparent tarps to control for natural rehydration and scavenging. Once the experimental pig cadavers reached a three-visit stasis in the advanced phase of decomposition, they were artificially rehydrated, and changes in the progression of decomposition between the control and experimental groups were plotted (ADD against TBS) for observation. The rehydrated experimental pig cadavers showed re-initiation of decay and insect re-colonization, while the control cadavers mainly remained in a state of stasis with insect activity ceased altogether. Greater cadaver decomposition islands and a color change post-rehydration were also noted in some experimental cadavers. This supports the need for future research on the impact of rehydration, including associated soil moisture on decomposition rates, progression, and invertebrate colonization, which will enhance our understanding of the effects these environmental factors have on the accuracy of post-mortem interval estimation.

Mentalis nerve branches supplying the lower lip revisited: a study of human fetuses and donated elderly cadavers.

Little information is known about the mentalis nerve course from the lower lip approximation margin (free margin) to the upper lip. Likewise, no difference in nerve distribution has been observed between the cutaneous and mucosal parts of the lip. Therefore, this study reexamined mentalis nerve morphology. For macroscopic observations, three fresh cadavers were dissected (one male and two females; aged 78-93). We also evaluated histological sections obtained from five donated elderly cadavers (two males and three females, aged 82-96 years) and 15 human fetuses (11-40 weeks or crown-rump length 80-372mm). Immunohistochemical analysis for S100 protein and tyrosine hydroxylase was performed. In both fetuses and adult cadavers, one to three nerve branches ran upward in the submucosal tissue from the mental foramen. Near the free margin of the lip, some branches passed through the orbicularis oris muscle layer toward the lip skin, whereas others followed a reversed J-shaped course along the free margin. Nerve twigs ran in parallel beneath the mucosa, whereas wavy nerve twigs attached to the basal lamina of the lip epidermis. The difference in nerve endings abruptly occurred at the skin-mucosal junction. Tyrosine hydroxylase-positive sympathetic nerve twigs surrounded arteries and formed a branch composed of S100-negative unmyelinated fibers. The lower lip skin was innervated by a perforating branch passing through the orbicularis oris muscle, that was different from the lip mucosa. A sudden change in the nerve ending configuration at the mucocutaneous junction seemed to develop postnatally.

Is the collateral circulation pattern in the hard palate affected by cleft deformity?

ObjectivesTo evaluate the influence of collateral vascularization on surgical cleft palate closure and deformities.Materials and methodsCorrosion casting was performed using red-colored acrylic resin in twelve fresh adult cadavers with a normal hard palate. Additionally, white-colored barium sulfate was injected into a fetus with a unilateral complete cleft palate, and layer-by-layer tissue dissection was performed. Both substances were injected into the external carotid arteries. Corrosion casting involved dissolving the soft and hard tissues of the orofacial area utilizing an enzymatic solution.ResultsIn normal palates, bilateral intraosseous infraorbital arteries formed a network in the premaxilla with the intraosseous nasopalatine- and greater palatine arteries (GPAs). The perforating GPAs anastomosed with the sphenopalatine artery sub-branches. Bilateral extraosseous GPA anastomoses penetrated the median palatine suture. Complex vascularization in the retrotuberal area was detected. In the cleft zone, anastomoses were omitted, whereas in the non-cleft zone, enlarged GPAs were distributed along the cleft edges and followed the anatomical course anteriorly to initiate the network with facial artery sub-branches.ConclusionsThe anatomical subunits of the palate exhibited distinct anastomosis patterns. Despite omitted anastomoses with collateral circulation in the cleft zone, arteries maintained their anatomical pattern as seen in the normal specimen in the non-cleft zone.Clinical relevanceBased on the findings in normal- and cleft palates, surgeons may expect developed anastomosis patterns in the non-cleft zone. Due to the lack of microcirculation in the cleft zone, the existent anastomoses should be maintained as much as possible by the surgical technique. This applies anteriorly in the incisive canal territory, alveolar ridges, and posteriorly in the retrotuberal area.

Convergence of the right and left external jugular veins to the midline: a rare finding of anatomical variation

Venous blood from the head and neck are drained mainly by the internal and external jugular veins. The external jugular vein is located in the anterolateral region of the neck taking a complex pathway perpendicularly down the neck to join the subclavian vein, however, there can be anatomical variations that affect its course. To describe an anatomical variation in the left and right external jugular veins discovered during the dissection of a cadaver in Human Anatomy class. The present study is a case report describing an anatomical variation in the external jugular veins observed during a routine dissection for Human Anatomy class at the Faculty of Medical Sciences of Minas Gerais on an adult male cadaver of unknown age, preserved in formaldehyde solution. the dissection showed that the right and left external jugular veins converged toward the midline, joining just above the level of the jugular notch. Knowledge of variations in the neck superficial venous system is crucial to avoid complications from medical procedures. The present variation was not found described in the literature.

Morphometry of the thyroid cartilage, epiglottis and piriform sinus: An anatomical study

Background The goal was to measure the piriform sinus, epiglottis, and thyroid cartilage in our sample population. Methods This study included 22 adult embalmed cadavers available in the Department of Anatomy. Dimensions were measured using a digital Vernier caliper. Results The mean height of the thyroid laminae was 27 ± 1.4 mm at the right side and 25.5 ± 1.4 mm at the left side. Mean width of the thyroid lamina was 27.1 ± 1.3 mm at the right side and 27.4 ± 0.9 mm at the left side. The mean thickness of thyroid cartilage was found to be 4.4 ± 0.4 mm and 3.9 ± 0.5 mm over the right and left sides. The mean length, width and thickness of the epiglottis were 29.1 ± 0.5 mm, 22.2 ± 0.6 mm and 2.6 ± 0.3 mm correspondingly. The height, width and thickness of the right piriform sinus were 25 ± 0.5 mm, 14.2 ± 0.5 mm and 12.6 ± 0.5 mm, the same parameters were 25.3 ± 1.3 mm, 15.1 ± 0.7 mm and 13.3 ± 0.4 mm for the left side. Conclusions The height and thickness of the thyroid cartilage were greater on the right side than on the left side (p<0.05). It was statistically observed that the width and thickness were greater on the left side than on the right side (p < 0.05). The data about the height, width and thickness of the thyroid cartilage, epiglottis and piriform sinus are essential during the laryngeal and other neck surgeries. They guide in the preoperative positioning, predicting the difficulty of intraoperative exposure and retractor pulling.

Reappraisal of the morphological and morphometric study of the psoas minor muscle with clinical and developmental insights: cadaveric study.

The Psoas Minor (PMi) is the most unstable muscle of the psoas group of the posterior abdominal muscle. This muscle has a fusiform shape and consists of a short fusiform belly continuing distally as a long tendon inserted on the pecten pubis and the iliopectineal arch. The present study was conducted to obtain more detailed information about the muscle and to expand knowledge about its morphology and morphometry. The posterior abdominal wall of 30 adult cadavers was dissected. Anatomical variabilities in origin, insertion, length, width, and muscle-to-cone ratio were measured when PMi was found. The data collected was interpreted descriptively. PMi was found in 12 cases, ten bilateral and two unilateral. The origin was constant in all cases and, except for three cases, extended into the iliac fascia and the iliopubic eminence. Morphometric analysis revealed that the average length of the proximal muscle belly and distal tendons was 4.52 ± 1.35 cm and 13.05 ± 0.90 cm, respectively. The mean width of the muscle belly was 1.71 ± 0.17 cm, and that of the tendon was 0.47 ± 0.10 cm. On average, the muscle belly occupied the proximal 33.71 ± 6.15% of the total musculotendinous unit. Findings confirm the inconsistency of PMi in the study population. Morphological variations became more evident as the tendon approached the insertion level. The muscle's distal attachment to the iliac fascia may partially control the position, mechanical stability of the underlying iliopsoas and this circumstantial function may be clinically related to iliopsoas inflammation and pathology. However, further studies recommended to determine biomechanical validity and clinical applicability of this vestigial muscle in human.

Individual variability of human cerebellar arteries and their perfusion territories

Background. Three paired arteries provide the blood supply of the cerebellum: the superior cerebellar artery, anterior inferior cerebellar artery, and posterior inferior cerebellar artery. The origin of these arteries, the extent of their development and their duplication may serve as factors influencing variations in the vascular supply territories. The aim of this study was to determine the characteristics of individual variability of the human cerebellar arteries and their perfusion territory. Methods. The study was conducted on 100 samples. Each sample included cerebellum and an adjacent brainstem. They were obtained from adult human cadavers (67 male and 33 female) who died of causes unrelated to brain pathology at the age between 20 and 92. To analyze the variability of perfusion territories of the cerebellar arteries, a method involving sectorial division of the superior and inferior surfaces of the cerebellum was proposed. Results and conclusion. In 95 samples, the SCA arose from the basilar artery on both sides as a single vessel. In two samples, it arose as a duplicate trunk from the basilar artery bilaterally. We also found unilateral duplication of the left SCA in three samples. The AICA arose from the lower third of the basilar artery in 69 samples on the right and in 77 on the left; from the middle third in 11 on the right and 11 on the left. It was presented as a common trunk with the PICA in 18 samples on the right and 10 on the left. The AICA was found duplicated in one sample bilaterally. In two samples it was absent on one side. The PICA most often arose from the vertebral artery (82 samples), rarely as a common trunk with AICA. It was duplicated in two samples on the left and absent in four samples on the right and four on the left. In cases of duplication of the PICA, its perfusion territory expands towards the central sectors of the inferior surface of the cerebellum. In the absence of the AICA, the PICA enlarges its perfusion territory, replacing it, and vice versa. Occasionally, the absent or poorly developed PICA is replaced by a PICA from the opposite hemisphere. There were not any cases of simultaneous absence of both AICA and PICA on one side. The probability of the extension of branches of the AICA onto specific sectors of the inferior surface of the cerebellum decreases from anterior to posterior and from the sides towards the center, while for the PICA there is an opposite trend. Additionally, this study describes three variations of the course of the arteries when both AICA and PICA originate as a common trunk from the basilar artery.

139 Alternative Anatomical Landmarks for the Lateral Femoral Cutaneous Nerve: Cadaveric Study With Implications for Difficult Decompressive Cases

INTRODUCTION: During decompressive procedures, localizing the lateral femoral cutaneous nerve (LFCN) using only the anterior superior iliac spine (ASIS) can be difficult due to variations in nerve course and specific patient anatomy, e.g., body habitus. Therefore, the present anatomical study was performed to provide additional landmarks for localizing this nerve. METHODS: The LFCN was dissected in 30 adult cadavers (60 sides). The nerve was exposed distal to the ASIS in the proximal thigh and along an imaginary line connecting the ASIS to the midpoint of the patella with the lower limb in a neutral position. RESULTS: The main trunk of the LFCN was identified deep to the fascia lata on all sides, 5-8 cm distal to the ASIS along the ASIS-patella line. The nerve was bordered by the sartorius muscle superficially and medially, the tensor fasciae latae muscle laterally, and the proximal rectus femoris tendon on its deep surface. Proximal to this triangular region, the LFCN was found to cross superficially to the proximal sartorius muscle on 58 sides and through the muscle on two sides. CONCLUSIONS: The study findings suggest an alternative method for identifying the LFCN, which could help locate the nerve during challenging cases and reduce the incidence of iatrogenic LFCN injuries resulting from inadequate anatomical landmarks.

An anatomical study on the variations and clinical significance of the corona mortis within a South African sample

IntroductionAnterior orthopaedic approaches, much like the Modified Stoppa approach, target fractures of the anterior column of the pelvis and acetabulum. The approach is described as a minimally invasive technique that may lead to iatrogenic haemorrhage and fatality in patients. Such mortality is due to the inadvertent severing of the corona mortis vessels, a clinical term referring to the anastomosis between the obturator vessels and the external iliac vessels typically via an accessory obturator vessel that courses over the pelvic brim. Knowledge regarding the prevalence and clinical significance of the corona mortis, especially within the South African population is lacking, and therefore further investigation of this anomaly is necessary. Materials and methodsThis study investigated the incidence and variations of the corona mortis vessels in a South African sample using 63 adult cadavers obtained from the Department of Anatomy, University of Pretoria. After careful dissection of the blood supply to the pelvis, the prevalence of corona mortis was investigated. Variations regarding the composition of the corona mortis and the incidence of aberrant obturator vessels were documented. ResultsThe incidence of corona mortis was observed in 67.5% of the study sample, with 91.6% being venous and 8.4% being arterial in composition. An incidence of 26.0% of aberrant obturator arteries and 8.1% of aberrant obturator veins were observed originating or draining directly into the external iliac system, respectively. A single rare instance of corona mortis was observed and involved an anastomosis with the superior vesical vein rather than the typical obturator vein. While variations amongst anomalous accessory vessels were observed which resulted in as many as 3 aberrant vessels coursing over the pelvic brim. No significant difference was concluded for the incidence of corona mortis between the left and right sides or between males and females. ConclusionMapping out the parameters of the corona mortis and examining the variation linked with the anomaly will aid orthopaedic surgeons in implementing anterior approaches with reduced vascular damage and iatrogenic deficit. Further understanding of its incidence in the South African population will in turn assist in interpreting its clinical significance.

408 Nerve to Subclavius for Neurotization Procedures: An Anatomical Feasibility Study

INTRODUCTION: Injuries to the inferior trunk (IT) of the brachial plexus and its components can be debilitating. As such injuries are prioritized by surgeons during repair, an additional nerve transfer is considered. METHODS: 13 adult cadavers (26 sides) underwent dissection of the nerve to subclavius and proximal brachial plexus. Once the nerve was isolated from origin to termination, the C8 and T1 roots and IT were identified. The distal end of the nerve to subclavius was transected and swung to these roots and the IT. Once the nerves to subclavius were transposed and in a tension-free manner, the length of excess nerve following being brought to each of these nerves was measured. RESULTS: A nerve to subclavius originated from the superior trunk and traveled anterior to the middle and inferior trunks on all sides. The mean diameter of the nerve to subclavius was 0.8 mm and the mean length was 57 mm. After cutting the nerve to subclavius at its entrance into the subclavius muscle, the distal nerve could be transferred tension free to the IT of the brachial plexus and T1 ventral ramus on all sides. The distal nerve to subclavius reached the T1 ventral ramus with an average of 18 mm of additional length and to the C8 ventral ramus with an average of 19 mm. The nerve also could be transferred to the IT of the brachial plexus with an average of 20 mm of additional length. The nerve to subclavius was found to have approximately 3,000 axons. CONCLUSIONS: To our knowledge, use of the nerve to subclavius has previously not been used for nerve transfer procedures. Based on our cadaveric study, this often-overlooked nerve can be easily transposed to other regional nerves such as the IT of the brachial plexus.

Prevalence and Variations of the Median Artery: A Pilot Study in a Sample of Lithuanian Cadavers.

Objective This pilot project aimed to assess the prevalence and variations of the median artery (MA) on a small scale in preparation for a large-scale study investigating MA in Lithuanian cadavers. Methods Eight formalin-fixed adult female cadavers were used in this study. Dissection was performed to allow for the observation of MA presence, type, origin, termination, and relations with other structures. The gathered data was analyzed, and a literature search was performed to compare the findings. Results MA was found in 10 of the 16 upper limbs examined; therefore, the incidence of MA in the present study was 62.5%. Of the 10 MAs found, six (60%) were of the antebrachial type (a-MA), and four (40%) were palmar (p-MA). Thus, the prevalence of a-MA and p-MA in the upper limbs examined was 37.5% (N = 6/16) and 25% (N = 4/16), respectively. Among the six cadavers that were found to possess MA, it was identified bilaterally in four (66.7%) and unilaterally in two (33.3%). The associations between the antimere and the presence of MA or MA-type were not statistically significant. MA most commonly originated from the common interosseous artery (50%, N = 5/10), followed by the ulnar artery (UA) (40%, N = 4/10), and the anterior interosseous artery (10%, N = 1/10). Two (33.3%) of the six a-MAs terminated in the mid-forearm, while four (66.7%) a-MAs ended in the distal forearm. Meanwhile, three (75%) of the four p-MAs terminated by joining the UA, while one (25%) terminated as the first common palmar digital artery. In the forearm, nine (90%) of the 10 MAs traveled anteriorly to the anterior interosseous nerve (AIN), and only one (10%) traveled posteriorly to the AIN. Additionally, one (10%) of the 10 MAs was found to pierce the median nerve. Conclusions Our findings confirm the variability in MA characteristics reported by previous studies. The high incidence of MA discovered in our sample calls attention to the importance of being aware of MA in a clinical setting, as this would allow for a timely and accurate response to a potential pathology associated with this structure.

Renal vein valves: a prevalence, microanatomical and histological study.

In the modern era of robotic renal procedures and diagnostics, an even more detailed anatomical understanding than hitherto is necessary. Valves of the renal veins (RVV) have been underemphasized and have been disputed by some authors, and few textbooks describe them. The current anatomical study was performed to address such shortcomings in the literature. One hundred renal veins were studied in fifty adult formalin-fixed cadavers. Renal veins were removed from the abdomen after sectioning them flush with their entrance to the renal hilum. The inferior vena cava was then incised longitudinally and opened, and RVV were examined grossly and histologically. A classification scheme was developed and applied to our findings. Nineteen RVVs were observed in the fifty cadavers (38%). Four (8%) valves were found on right sides and fifteen (30%) on left sides. The valves were seen as cord/band-like, folds, and single and double leaflets. Histologically, they were all extensions of the tunica intima. On the basis of our study, RVV are not uncommon. They were more common on left sides, and on both sides, they were found within approximately one centimeter of the junction of the inferior vena cava and renal vein. Although the function of such valves cannot be inferred from this anatomical study, the structures of the Single leaflet valve (TS2) and Double leaflet valve (TS3) valves suggest they could prevent venous reflux from the IVC into the kidney.

Cadaveric study of the ultrasound-guided erector spinae plane block over the transverse process of the twelfth thoracic vertebra in dogs: Transversal vs longitudinal approach

This study describes a transversal (TV) ultrasound-guided erector spinae plane (ESP) block technique over the transverse process of T12. And evaluates the distribution of the dye and affected nerves branches compared to a longitudinal (LNG) approach over the transverse process of T12 in canine cadavers. Secondly, it also compares de anatomy and dimensions of the transverse processes of T12 with T9 and T5. For this double-masked, cadaveric experimental study, 12 adult Beagle cadavers were injected with 0.6 mL/kg of dye/contrast. Spread was evaluated by computed tomography (CT) and dissection.Mean bodyweight was 9.76 (±0.59) kg. The TV and LNG approaches stained a median (range) of four (2–6) and three (1–6) medial branches of the dorsal rami of the spinal nerves, three (2–6) and three (2–5) lateral branches, and one (0−3) and one (0−4) ventral branches, respectively. Dye was detected in the epidural space in 55.6% and 66.7% of cases for the TV and LNG approaches, respectively (P=0.63). And in the ventral paravertebral compartment in 22.2% and lymphatics in 88.8% in both approaches. There were no statistical differences for the spread. The dorsolateral edge of the transverse process (TP) was not visible with CT at T12. The mean (±SD) length of the TP was significantly shorter at T12 [3.34 (±0.22)] mm, compared to T9 [6.08 (±0.47)] mm and T5 [5.93 (±0.62)] mm (P <0.001). This study showed similar distribution whether using a TV or LNG approach and differences in the anatomy and length of the T12 TP.

New insight into the vasto-adductor membrane for safer adductor canal blockade.

: This study aimed to identify exact anatomical landmarks and ideal injection volumes for safe adductor canal blocks (ACB). : Fifty thighs from 25 embalmed adult Korean cadavers were used. The measurement baseline was the line connecting the anterior superior iliac spine (ASIS) to the midpoint of the patellar base. All target points were measured perpendicular to the baseline. The relevant cadaveric structures were observed using ultrasound (US) and confirmed in living individuals. US-guided dye injection was performed to determine the ideal volume. : The apex of the femoral triangle was 25.3 ± 2.2 cm distal to the ASIS on the baseline and 5.3 ± 1.0 cm perpendicular to that point. The midpoint of the superior border of the vasto-adductor membrane (VAM) was 27.4 ± 2.0 cm distal to the ASIS on the baseline and 5.0 ± 1.1 cm perpendicular to that point. The VAM had a trapezoidal shape and was connected as an aponeurosis between the medial edge of the vastus medialis muscle and lateral edge of the adductor magnus muscle. The nerve to the vastus medialis penetrated the muscle proximal to the superior border of the VAM in 70% of specimens. The VAM appeared on US as a hyperechoic area connecting the vastus medialis and adductor magnus muscles between the sartorius muscle and femoral artery. : Confirming the crucial landmark, the VAM, is beneficial when performing ACB. It is advisable to insert the needle obliquely below the superior VAM border, and a 5 mL injection is considered sufficient.

Duplicated internal jugular vein: a case report

Anatomical variants of the venous central system are very infrequent; nevertheless, it is useful to be aware of them in order to avoid complications during common procedures. The purpose of the present study is to describe an anatomical variant of the Right Internal Jugular Vein (RIJV), and to investigate the frequency of this variant reported in the current literature. Authors present an anatomical variant of RIJV, found during the dissection of an adult male cadaver, previously fixed in a formaldehyde-based solution, who was voluntarily donated to the Faculty of Medicine of Universidad de la República in Montevideo, Uruguay. The cadaveric material was used taking into account the Helsinki Declaration regarding prior live donation and informed consent. A photographic record and a bibliographic search in electronic bases were carried out in order to discover the frequency with which this variant occurs. It was described as an isolated duplicated RIJV, which had its origin at the level of the right jugular foramen, and had its division next to the thyroid cartilage after a path of 6.5 cm into two branches (anteromedial and posterolateral) that ended separately, and were 7.2 cm and 5.4 cm in length, respectively. The relations with near structures such as the accessory nerve and the omohyoid muscle were also described and compared with the literature reviewed.

Surgical anatomy of superior gluteal artery in relation to lumbosacral plexus – A cadaveric study in the Indian population

Background: The superior gluteal artery (SGA) passes in between branches of the lumbosacral plexus after arising from the internal iliac artery. Variations in the course of SGA from the internal iliac artery till it passes out of the pelvis through the greater sciatic foramen are very important during pelvic surgeries. Pseudoaneurysm of SGA caused by iatrogenic injuries can compress branches of the lumbosacral plexus, causing foot drops and sciatica. Aims and Objectives: The aim is to study the course of the SGA in relation to branches of the lumbosacral plexus. Materials and Methods: A cross-sectional observational study was done on 25 formalin-fixed human adult cadavers. Dissections were performed in the pelvic region and branches of the internal iliac artery and lumbosacral plexus were identified. SGA was traced on both sides from origin till passing out of the greater sciatic foramen and its relation to branches of lumbosacral plexus was recorded. Results: Three types of pathways taken by SGA were identified in relation to the lumbosacral plexus. The most common path taken by the SGA was between the lumbosacral trunk (LST) and the first sacral nerve. Thirty-five out of 50 were of this type (70%). Ten out of 50 had the second most common type which was between L4 and L5 branches of LST (20%). Five cadavers had SGA lateral to LST (10%). Ten cadavers out of 25 (40%) had side differences in the type of course taken by SGA in relation to the lumbosacral plexus. Conclusion: A surgeon must keep in mind variations in the path taken by SGA in relation to the lumbosacral plexus to prevent pseudoaneurysms of SGA, which in turn can compress branches of lumbosacral plexus, causing foot drop and sciatica.

Localization of Maxillary Artery for Cerebral Revascularization: L-Shaped Perpendicular Two-Step Drilling Technique Stretching from the Foramen Ovale to Rotundum

The use of maxillary artery (MA) as a donor has increasingly been utilized as an alternative method for cerebral revascularization. Localization difficulties emerge due to rich infratemporal anatomical variations and MA's complicated relationships with neuromuscular structures. Our aim is to propose an alternative localization method via the interforaminal route along the middle fossa floor. Five silicone injected adult cadaver heads (10 sides) were dissected. Safe and effective localization of the MA was also evaluated. MA displayed anatomical variations in relation to the lateral pterygoid muscle (LPM) and the mandibular nerve (V3) branches. The proposed L-shaped perpendicular two-step drilling technique revealed a long MA segment that allowed generous rotation to the intracranial area for an end-to-end anastomosis. The first step of drilling involved medial to lateral expansion of foramen ovale up to the lateral border of the superior head of the LPM. The second step of drilling extended at an angle approximately 90 degrees to the initial path and reached anteriorly to the foramen rotundum. The MA was localized by gently retracting the upper head of the LPM medially in a posterior to anterior direction. Considering all anatomical variations, the L-shaped perpendicular two-step drilling technique through the interforaminal space is an attainable method to release an adequate length of MA. The advantages of this technique include the early identification of precise landmarks for the areas to be drilled, preserving all V3 branches, the deep temporal arteries and maintaining the continuity of the LPM.

A cadaveric study on prevalence, morphology, morphometry, and histology of os peroneum in the South Indian population

Background: The complex framework of the human foot enables movement and weight support. The os peroneum (OP) is a sesamoid bone located in the tendon of peroneus longus. Though tiny, it plays crucial roles in foot movement and arch stability injuries to the tendon are significant, and the OP itself can fracture, dislocate, or impinge. Its presence, size, and even histological type influence the proper functioning of the foot. Studying this sesamoid bone, with its variable prevalence and morphology, can fill gaps in foot and ankle pathology research.  Aims and Objectives: To analyze the prevalence, morphology, morphometry, and histology of OP in human adult cadavers in the South Indian population. Materials and Methods: Forty-two formalin-fixed human adult cadaveric free lower limbs were selected and studied from the Department of Anatomy, Pushpagiri Institute of Medical Sciences and Research Centre, Tiruvalla, Kerala. The prevalence of OP in peroneus longus tendons (PLT) and its various configurations were carefully observed, along with their histological types, and then statistical analysis of the data was done using SPSS version 20. Results: Thirty-nine out of the forty-two free lower limbs showed the presence of an OP bearing a smooth oval facet, except for one OP with a round facet. All OP were invariably present in the tunnel for PLT on the plantar surface of the cuboid bone. Three different histological types of this tissue were observed, i.e., osseous, cartilaginous, and fibrous. Conclusion: The present study has attempted to fill the gap in the research data regarding OP in the adult South Indian population. In addition, the knowledge of OP and its configuration in PLT could provide a better radiological and clinical approach to mid- and fore-foot pathologies.

A novel technique for decortication of the lumbar facet joints for posterolateral fusion with percutaneous exposure: A cadaveric feasibility study

BackgroundPercutaneous approaches to the spine have been explored recently for various procedures, including transforaminal lumbar interbody fusion. It is known that facet decortication leads to higher rates of fusion, but effective percutaneous approaches have not been well documented. There are a set of instruments used in the cervical spine for percutaneous decortication, the CORUS™ Spinal System-X (DI# 00852776006508), which may be useful in this setting. Our aim was to investigate the feasibility of decorticating the lumbar facet joints with these instruments in cadavers to aid in minimally invasive lumbar fusion. MethodsWe performed percutaneous facet joint decortication at each facet joint in the lumbar spine in two adult cadavers. We tested varying degrees of laterality for entry points and angulation for access at each level to optimize the innovative procedure. ResultsWhen using the CORUS™ Spinal System-X to obtain percutaneous access for facet decortication in the lumbar spine, we successfully dissected down to the facet joint without neurovascular injury. At the L1-L2 and L2-L3 levels, access was best obtained at 4 cm from midline with an angulation of 10°. At the L3-L4 and L4-L5 level, access was best obtained at 4 cm from midline with an angulation of 20°. ConclusionsThis study demonstrates that percutaneous lumbar facet joint decortication is feasible with the CORUS™ Spinal System-X instruments, and warrants further, comparative study in the clinical setting

Anatomical Bases of the Temporal Muscle Trigger Points.

Temporal muscles of 14 adult cadavers were studied. The muscle bellies were divided into six areas, three superior (1.2 and 3) and three inferior areas (4, 5, and 6) lower, according to a Cartesian plane to analyze and describe the entry points of the branches of the deep temporal nerves into the muscle. The branching distribution was analyzed using Poisson log-linear tests with Bonferroni post hoc tests for comparison between groups (sextants) (p < 0.05). Deep temporal nerve entry points were found in the temporal muscle in all areas. Most of the branches were observed in areas 2 and 5, which coincide with the muscle fibers responsible for mandible elevation and related to the previously described MTPs. Fewer branches were found in areas 1 and 6, where contraction produces mandible retraction. There is an anatomical correlation between the branching pattern of the deep temporal nerve and temporal muscle trigger points. Adequate knowledge of the innervation of the temporal muscle may help elucidate the pathophysiology of myofascial syndromes and provide a rational basis for interventional or conservative approaches and help surgeons avoid iatrogenic lesions to the deep temporal nerve lesion.