Division Of Branches Research Articles

“Feeding the World is a Huge Responsibility”

With its roots firmly in agriculture, AGCO is the parent company of such iconic brands as Massey Ferguson and Fendt, but its Power division branches out into other sectors. The OEM’s senior vice president of engineering Kelvin Bennett talks about this cross-sector pollination, as well as predicting the future of farming… and revealing his love of building things in his garden

Intra-parotid Course and Variations in the Branching Pattern of Facial Nerve: Our Experience.

Facial nerve is responsible for the facial expressions and its preservation during parotidectomy is an important aspect for the operating surgeon. The nerve has a long course and the terminal part traverses through the parotid gland. The branching pattern of the nerve within the gland is highly complex and variable, making parotidectomy a challenging surgery. A cross-sectional record based study was conducted in a tertiary care hospital of a medical college in north India between November 2020 and December 2021 with an aim to describe the branching pattern of the facial nerve within the parotid gland. Patients of all age groups and both genders who underwent superficial parotidectomy for benign parotid gland tumors were taken into consideration. The branching pattern of the nerve was observed and recorded. Twenty patients were included in the study. In seventy percent cases the nerve divided into two main branches whereas in the rest, three branches emerged. In sixty five percent cases, the upper division (temporofacial) further divided into two branches whereas in rest it divided into three. The lower division (cervicofacial) divided into two subdivisions in majority of the cases. Multiple communications were found in the branches given off from the upper division and buccal branch had the most variable origin. A knowledge of branching pattern and the communications between the branches of facial nerve helps in avoiding an iatrogenic injury during parotidectomy and preserving the nerve function.

A transformation of trigeminal neuralgia into SUNCT/SUNA: A case report and literature review

IntroductionTrigeminal neuralgia and Short-lasting Unilateral Neuralgiform Headache with Conjunctival injection and Tearing (SUNCT)/Short-lasting Unilateral Neuralgiform Headache Attacks with Cranial Autonomic Symptoms (SUNA) are characterized by similar clinical manifestations, which may lead to diagnostic confusion. However, the transformation of trigeminal neuralgia into SUNCT/SUNA is a rare phenomenon. This report describes a case of trigeminal neuralgia transformation into SUNCT/SUNA due to neurovascular compression and reviews all previously published cases of trigeminal neuralgia to SUNCT/SUNA transformation in the literature.Case presentationA 49-year-old Thai male patient presented with progressive right facial pain for a period of three months. One year prior, he developed trigeminal neuralgia along the maxillary branch of the trigeminal nerve, characterized by electrical shock-like pain in the right upper molar, exacerbated by eating. His symptoms were effectively managed with carbamazepine. Nine months later, he began experiencing recurrent electrical shock-like pain along the ophthalmic division of the right trigeminal nerve, accompanied by lacrimation, which failed to respond to continued treatment with carbamazepine. Three months prior to presentation, his symptoms evolved into SUNCT/SUNA, characterized by electrical shock-like pain in the right periorbital area and conjunctival injection, lacrimation. Neuroimaging revealed high-grade neurovascular compression of the right trigeminal nerve by the right superior cerebellar artery. The patient's symptoms resolved following microvascular decompression.ConclusionClinicians should be aware that patients with longer disease duration of trigeminal neuralgia who develop new neuralgic pain in the ophthalmic branch division with mild autonomic symptoms may be at risk for transformation into SUNCT/SUNA.

Role of Supratrochlear and Supraorbital Nerve Block in Chronic Atypical Facial Pain Management: A Case Series

Chronic Atypical Facial Pain (CAFP) presents a daunting clinical challenge, characterised by persistent, unexplained facial pain that is resistant to conventional treatments. It poses a significant challenge to both patients and healthcare providers due to its poorly understood aetiologies and resistance to traditional analgesic therapies. As a result, novel approaches are sought to alleviate the suffering of affected individuals. Supratrochlear and supraorbital nerve blocks have emerged as promising interventions for CAFP. These nerve blocks target the supratrochlear and supraorbital nerves, which are branches of the ophthalmic division of the trigeminal nerve. These nerves are frequently implicated in the generation and propagation of facial pain. By interrupting the transmission of pain signals along these nerves, supratrochlear and supraorbital nerve blocks offer a targeted and minimally invasive approach to managing CAFP. Furthermore, their relatively low risk profile makes them an attractive option for individuals who have not responded well to other treatments or who wish to avoid more invasive interventions. The present case series (three males and one female) discusses the anatomical considerations, technique, and potential complications associated with supratrochlear and supraorbital nerve blocks. It also reviews the current body of evidence supporting their use in CAFP management, including outcomes such as pain reduction and improved quality of life. Supratrochlear and supraorbital nerve blocks represent a valuable addition to the armamentarium of therapies available for the management of CAFP.

Variations in the Terminal Branches of Brachial Artery- A Cadaveric Cross-sectional Study

Introduction: Brachial Artery (BA) begins as a continuation of axillary artery at the distal border of teres major, it appears in the cubital fossa, where it ends at the level of the neck of radius by dividing into radial and ulnar arteries. Common Interosseous Artery (CIA) is the largest branch of Ulnar Artery (UA) and arises in the cubital fossa. The terminal branches of BA at elbow are clinically important since they are responsible for the arterial supply to the forearm and hand. These arteries may get damaged during fractures of the elbow. Aim: To know the variations in the terminal branches of the BA at elbow. Materials and Methods: The present cross-sectional cadaveric study was done on 40 upper limbs from embalmed adult human cadavers in the Department of Anatomy, Kamineni Institute of Medical Sciences, Narketpally, Telangana, India, from August 2017 to August 2019. Dissection of BA in arm and cubital fossa was carried out according to Cunningham’s manual of practical anatomy. The distance of division of BA into radial and UA and distance of origin of CIA from Inter Epicondylar Line (IEL) of humerus were noted. Results: In present study, 20 right-side specimens and 20 left- side specimens were obtained. Among 20 cadavers used, 16 were male cadavers and four were female cadavers. The mean distance (D1) of normal division of BA into the Radial Artery (RA) and UA at elbow was 2.8 cm below the imaginary line joining the medial and IEL. The mean distance (D2) of normal origin of CIA was 6.8 cm below the imaginary line joining the medial and lateral epicondyles of the humerus (IEL). CIA arising from the UA was present in 37 specimens (92.5%) and in the rest three specimens Anterior Interosseous Artery (AIA) and Posterior Interosseous Artery (PIA) arose directly from the UA. Conclusion: The present study has found variations in site of division of terminal branches of the BA at elbow in three specimens

Incidental findings involving the temporomandibular joint on computed tomography and magnetic resonance imaging.

The temporomandibular joint (TMJ) is frequently imaged in head and neck computed tomography (CT) and magnetic resonance imaging (MRI) studies. Depending on the indication for the study, an abnormality of the TMJ may be an incidental finding. These findings encompass both intra- and extra-articular disorders. They may also be related to local, regional or systemic conditions. Familiarity with these findings along with pertinent clinical information helps narrow the list of differential diagnoses. While definitive diagnosis may not be immediately apparent, a systematic approach contributes to improved discussions between clinicians and radiologists and better patient management.

THORACIC ANGIO SCANNER IN THE DIAGNOSIS OF PULMONARY EMBOLISM IN BAMAKO

Introduction:Pulmonary embolism is the sudden obliteration (total or partial)of the trunk of the pulmonary artery or one of its branches by a circulating foreign body, most often fibrino-cruoric. Objectives: To study the place of chest CT angiography in the diagnosis of pulmonary embolism Material And Method:This was a descriptive prospective study from February 1, 2020 to January 31, 2021 taking into account all patients referred during this period for clinical suspicion of pulmonary embolism to the medical clinic Marie Curie et les Etoiles. The examinations were performed with a GE 16-bar scanner in helical mode with and without injection of iodinated contrast product by an automatic injector. Results:We diagnosed 43 pulmonary embolisms out of 327 thoracic CT angiography performed by highlighting hypodense gaps inside one or more pulmonary arteries as well as certain branches of division and the sudden interruption of the opacification of certain distal arteries. The prevalence of pulmonary embolism was 13.15%. The female sex predominated with 52% (n=22) and the sex ratio was 1.16. The average age of patients in our series was 45 years with extremes (25 to 85 years). The age group of 41-50 years waspredominant. Dyspnea and chest pain were the most frequent clinical information with44.18% and 18.60% respectively. The seat of the pulmonary embolism concerned the right pulmonary arteries and the seat of the pulmonary embolism concerned the right and left pulmonary arteries in 60.46% and the right side was the most affected. Chronic Obstructive Pulmonary Disease (COPD) Pleurisy and Covid-19 were the lesions most associated with pulmonaryembolism (48.83%, 18.60% and 16.28%) Conclusion: Pulmonary embolism is a serious and life-threatening pathology. Its diagnosis of certainty is made with the thoracic CT angiography, the realization of which must not suffer from any delay.

Insight into Vietnamese women’s internal iliac artery anatomy

This study aims to assess the characteristics of the internal iliac artery and to examine correlations between the internal iliac artery and other anatomic structures in the pelvis. A cross-sectional study was conducted in the period between October 2019 and May 2020. Eighteen samples of the left and right internal iliac arteries were taken from formaldehyde-embalmed female cadavers at the Ho Chi Minh City University of Medicine and Pharmacy Department of Anatomy. The study showed that the origins of most internal iliac arteries were located by the lumbar vertebrae 4-5. The mean distance from the origin of the internal iliac artery origin to the sacral promontory was 33.95 ± 3.35 mm (on the left), and 31.70 ± 4.64 mm (on the right). The internal iliac artery always had two big branches – anterior and posterior. A third branch was an ilio-lumbar artery, often seen by 43.33%. The diameters of those internal iliac artery branches were comparable on both sides, and the branches of similar name had a little larger diameter on the left than on the right. The internal iliac artery always has two large anterior and posterior branches; in some cases, it has a third branch called ilio-lumbar artery. The internal iliac artery’s length from its origin to the initial branch division is comparable for both right and left sides. The distance from the internal iliac artery’s origin to the sacral promontory is suggestive for surgeons to find the internal iliac artery after determining the sacral promontory.

“Mud acoustics” and the ocean acoustics program

Shallow water acoustics is one of the major thrusts of the Office of Naval Research Ocean Acoustics Program and has been an important area of interest to Navy programs since at least the work of Pekeris, Ewing, and Worzel in the 1940’s. In the 1950’s and early 1960’s, there was a flurry of activity both in the US and UK focused on propagation within and reflection from the seabed and the acoustical characteristics marine sediments. This work formed the basis of a research program carried out by the applied ocean acoustics branch of the acoustics division at the Naval Research Laboratory in the 1970’s. In April 1991, with the Cold War coming to an end, and a shift in interest from blue water to the littorals, ONR sponsored a workshop on shallow water acoustics at the Woods Hole Oceanographic Institution. This meeting, including underwater acousticians, geologists, geophysicists, and physical oceanographers, largely set the stage for the next 30 years of shallow water acoustics research supported by ONR. Prominent efforts include the ONR Geoclutter Program and the Shallow Water 2006 experiments, both focused on regions dominated by sandy bottoms. This talk describes more recent efforts in regions characterized by muddy bottoms.

Robotic segmentectomy using a lung base-flip approach.

Robotic segmentectomy using a lung base-flip approach.

Pengembangan Sumber Daya Manusia Dan Penempatan Kerja Terhadap Kepuasan Kerja Karyawan (Studi Empiris Pada PT Marga Maju Mapan Cabang Divisi Proyek Bekasi)

The purpose of this study was to determine the magnitude of the influence of human resource development and job placement on job satisfaction of employees of PT Marga Maju Mapan Bekasi Project Division Branch. The method used in this research is descriptive and associative research with a quantitative approach. The sampling technique in this study used saturated sampling, the samples taken in this study were 38 employees. The data analysis technique used validity and reliability tests, multiple linear regression including correlation coefficients, determination, research model testing and research hypothesis testing. The results of the study using the coefficient of determination (R2) showed that the development of human resources and work placement on employee job satisfaction was 67.4% while the remaining 32.6% was influenced by other factors outside of this study. Based on the multiple correlation coefficient test, it can be seen from the R value of 0.674 which means that there is a very strong relationship between human resource development and job placement on employee job satisfaction. The results of the F test, namely the value of Fcount 14,584>3,26 indicates that Fcount is greater than Ftable. The variables of human resource development and work placement have a positive and significant effect on employee job satisfaction.
 Keywords: Human Resource Development, Job Placement, Employee Job Satisfaction

The Lichen Photobiont Genus Rhizonema (cyanobacteria) Exhibits Diverse Modes of Branching, Both False and True

The recently described genus Rhizonema is among the most important cyanobacterial partners in lichen symbioses, but its morphological characterization in the genus diagnosis-true branching of the T-type-appears at odds with several published figures showing false branching. We investigated cyanobiont branching and cell division with light microscopy in two basidiolichens from Florida and one from Japan, including aposymbiotically cultured material of the latter. Mycobiont species identities (Cyphellostereum jamesianum, Dictyonema darwinianum, and D. moorei) and photobiont genus identity (Rhizonema) were corroborated with ITS and rbcLX sequences, respectively. Single and paired false branching occurred commonly in all three strains examined. False branches developed adjacent to necridic cells or heterocytes, or by separation of vegetative cells at compression folds in the trichome. Non-transverse cell divisions, usually oblique, were observed in two of the three Rhizonema strains examined. T-type true branches sometimes arose from such divisions, although oblique growth from the branch cell often resulted in ambiguous branch junctions. Additionally, Y-type true branches appeared to grow from contorted filaments. In cultured material, a kind of pseudo-branch sometimes arose from single- or several-celled segments liberated from trichome apices. The segments attached secondarily to filaments and grew there as apparent branches. We conclude that Rhizonema is a genus of considerable morphological flexibility, with multiple modes of branching possible in a single strain. While true branching or non-transverse divisions, when observable, may help distinguish Rhizonema from the phenotypically similar Scytonema, false branching occurs commonly in both genera, and therefore cannot be used to distinguish them.

Multiple Bilobed Orbital Schwannomas: A Rare Sight.

A 60-year-old lady presented with long-standing progressive, non-axial proptosis of 8-year duration associated with superior sulcus fullness, significant upper and lower eyelid retraction, and an early grade of cataract in the OD (Fig. A and B). Visual acuity had reduced to 20/100 in the OD with choroidal folds on the posterior pole on fundus examination. The other eye showed a mild grade of upper eyelid retraction with an early grade of cataract with the normal posterior segment. CT-scan of the orbit revealed 2 well-defined heterogenous ovoid lesions in the right intraconal space indenting the globe (dotted lines, Fig. C and D). The optic nerve was made out separately in few cuts. She was planned for an excision biopsy of the orbit via the superior lid crease incision. There were 2 separate lesions an intact capsule. The lesions were removed in toto with the aid of a cryoprobe one after the other. Both the excised lesions were bilobed having different dimensions (*, Fig. E and F). Histopathology showed solid areas within the 2 well-encapsulated solid cystic lesions which were hypercellular with Antoni type A and hypocellular with Antoni type B like areas. The hypercellular areas showed spindle cells with tapering ends and elongated nuclei whereas the hypocellular areas showed numerous foamy macrophages consistent with the diagnosis of Orbital Schwannoma. The proptosis resolved with improvement in the visual acuity to 20/50 at 6 weeks. Orbital schwannomas are known to be isolated in presentation and most commonly arise from the sensory branch of the ophthalmic division of the trigeminal nerve. Bilobed schwannomas and more so, multiple in the same orbit are a rare occurrence. To the best of our knowledge, there has been no report of multiple orbital intraconal bilobed schwannomas in literature.FIG.: Multiple bilobed orbital schwannomas.

P391 A ‘FAKE’ PERIPARTUM CARDIOMYOPATHY: THE KEY ROLE OF CARDIAC MRI

Abstract K.M. Woman, 47 years old; Moroccan–born, she doesn’t speak Italian. History limited by the language barrier Medical histroy: caesarean section two months prior to admission (pluriparae with 6 births) In home therapy with estrogen–progestin pill Access to the emergency room for thoraco–abdominal pain of not exactly onset with dyspnoea (Killip II) EKG: sinus tachycardia, poor progression of the R wave in the precordial leads with mild ST–elevation in the same leads TTS echocardiographic: slightly dilated left ventricle, hypo / akinesia of the apex in its entirity with LVEF 38%; mild mitral regurgitation. Normal size and fuction of RV, PAPS slightly elevated; no pericardial effusion. Coronarography: mild non–critical atheroma of the main vessels. Occlusion of a small branch of division of OM Ventriculography (suspected Tako–Tsubo): reduced contractile function of the LV in relation to akinesia of the apex in its entirety Chest CT without contrast: diffuse areas of parenchymal nodular thickening >> lower lobes, thickening of interlobular and intralobular septa, mild pericardial effusion Blood sampling: elevated cardiac troponin hs in the absence of a typical curve for ACS; high inflammation markers Admission to cardiology with diagnosis of acute heart failure in PPCM (vs myocarditis.) Pneumonia. Slow and progressive improvement of the hemodynamic status and of the septic status with diuretic and antibiotic therapy. Prolactin antagonist (cabergoline) therapy and therapy for heart failure was started. During the hospital stay the patient was asymptomatic, not more angor, no arrhythmias on the EKG monitor, hemodynamic stability. Upon completion of the diagnosis, cardiac MRI was performed which modifies the diagnosis: dilated eccentric remodeling of the left ventricle with moderate reduction of global systolic function; akinesia of the lateral segments on the mid–basal, septal and lower apical planes and of the apex which corresponds to LGE ischemic–type enhancement for MI– outcomes. No evident endoventricular thrombi. Faded reactive signs of the pericardium with a slight fluid share Acute heart failure in hypokinetic heart disease with ischemic etiopathogenesis due to undated anterior silent MI (likely due to spontaneous coronary dissection)

A cadaveric study on the origins of the uterine artery

The uterine artery (UA) is a visceral branch from the anterior division of the internal iliac artery (IIA). Knowledge of the variant origins of this artery is critical during radiologic and surgical procedures of the pelvis, especially those involving the uterus, where managing blood flow is vital. Though its path and destination are well agreed upon, the origin of the UA differs notably, and has led many anatomists to create numerous descriptions for the distinctive variation. This project investigated the origin of the UA in the unique South Texas population of female cadavers donated to the UT Health San Antonio and established a fundamental and comprehensive classification system of the origin of this vessel which readily accommodates previous systems while improving its descriptive terminology. As the UA was identified, its origin was classified into three different ranks—primary, secondary, or tertiary. Primary‐ranked vessels originated directly from the internal iliac artery (IIA) and took three different formations as a separate branch, bifurcation with another vessel, or trifurcation with two other vessels. Secondary‐ranked UAs originated from primary vessels and tertiary‐ranked vessels originated from secondary vessels. 58.97% (23/39) of the UAs studied arose from the IIA as a primary‐ranked vessel, 38.5% (15/39) as a secondary rank, and 2.6% (1/39) as a tertiary rank. 21.7% (5/23) of primary‐ranked UAs took origin from IIA as a separate branch, 56.5% (13/23) as bifurcation with another vessel and 21.7% (5/23) as trifurcation with two other vessels. The UA originated as a bifurcation with the umbilical artery (UmbA) in 13/13 cases. UA origin as a trifurcation was observed in 3 different patterns: 40% (2/5) with the UmbA and the superior vesical artery (SVA); 40% (2/5) with the UmbA and vaginal artery (VA); 20% (1/5) with SVA and the internal pudendal artery (IPA). 93.3% (14/15) of secondary‐ranked UA arose from the UmbA and 6.7% (1/15) from the IPA. We observed a single tertiary ranked UA arising from the vaginal artery (VA), which took origin from the UmbA, a branch of the anterior division of the IIA. It is imperative that the prevalence of these primary‐ranked UA bifurcations and trifurcations be further established since permanent occlusion at the vessel’s origin may subsequently lead to necrosis of unintended tissues. Larger sample sizes amongst differing populations may lead to the discovery of uncommon bifurcation and trifurcation patterns, or with similar vessels in differing proportions. It would also be important to translate the evaluation criteria used in this study into 3D and 4D digital subtraction angiography or cone‐beam computed tomography software for clinical studies. Increasing awareness of the variant origins of the UA will ultimately improve patient treatment outcomes, particularly for female reproductive health.

Variations in the bony architecture of the greater palatine canal: An anatomical report

IntroductionThe greater palatine canal route has been well‐described in adults for the purposes of anesthetizing the branches of the maxillary division of trigeminal nerve for the relief of sphenopalatine neuralgia [11]. The canal also provides direct access to the contents of the PPF [12]. A complex array of vascular and neural structures characterizes this posterior maxillary region where the GPC is located. Its surgical anatomy can get further complicated by any anatomic variations and identification of vital structures becomes difficult, especially when bleeding during surgery obscures the region. Accurate knowledge of normal anatomy and common anatomical variations therefore remain crucial in minimizing intraoperative and postoperative complications associated with invasive microsurgical approaches to this region. The aim of this study was to explore the architecture of the GPC for any anatomic variations.Material & MethodIn total, 30 adult dried and intact skull specimens were selected. The selection criteria included an intact hard palate with erupted 3rd molars and an intact lateral nasal wall on both sides. The exclusion criteria included any major craniofacial deformities, excessive bone resorption, very old specimens. The bony walls of the GPC were observed by passing a black wire.Findings4 out of 30 specimens showed marked variations in the bony medial wall of the greater palatine canal (GPC). Partial to complete malfusion between the posterior surface of the maxilla and the perpendicular plate of palatine bone was observed. This might be the result of embryological malformation.ConclusionThe present study provided information regarding the existence of some degree of anatomical variation in the bony architecture of greater palatine canal.SignificanceThis might help surgeons visualize over the possibility of the existence of any such variation while performing any surgical procedure in the posterior maxillary area. In order to establish the embryological basis of these findings, investigation on a larger number of specimens is highly suggested by the authors.

Complex Neurovascular Syndromes: Is the Compressing Vessel Alone the Culprit?

Objective To describe and correlate the clinical, radiological, and intraoperative findings in patients with refractory neurovascular syndromes (NVS) not responding to conventional medical management and to determine the surgical outcome of the microvascular decompression (MVD) procedure. Methods Medical records of 17 patients with NVS (trigeminal neuralgia [TN] = 14 and hemifacial spasm = 3) who underwent surgery for symptom relief from January 2018 to July 2021 with follow-up data (1–36 months) were retrospectively analyzed. Patient demographics (age, sex), clinical features (site, duration of symptoms, distribution), magnetic resonance imaging (MRI) findings, micro-neurosurgical details (type of surgery, obstructive vessel), and postoperative outcome and complications were recorded. Statistical Analysis Descriptive analysis was performed. Variables were presented as either mean and standard deviation or frequency and percentages. Results The mean (standard deviation) age of patients in our study cohort was 52.6 (12.2) years. TN was common in females (64.3%). The mean duration of symptoms was longer in patients with hemifacial spasms than in patients with TN (3.3 vs. 2.7 years). While the right side was commonly affected in TN (64.3%), the left side was common in hemifacial spasm (66.7%). Most common neuralgia symptoms were distributed along the V2V3 (maxillary and mandibular division) branches (42.9%). MRI revealed neurovascular conflict in nine patients, epidermoid tumor in three patients, classical vestibular schwannoma in two patients, and short cisternal segments in three patients. Intraoperatively, superior cerebellar artery was the main offending vessel in TN followed by anterior inferior cerebellar artery (AICA) and venous compression, while tortuous vertebral artery and AICA along with thickened entangled arachnoid were seen in hemifacial spasms. Almost all patients (88.2%) reported immediate postoperative complete pain relief. One patient died secondary to chest infection after a month. Conclusion Arachnoid entanglement around the neurovascular bundle along with vascular compression over the cranial nerves is the main cause of NVS. Advanced micro-neurosurgical techniques used in MVD achieve excellent outcomes with improved quality of life. However, identifying the refractory NVS not responding to conventional medical management and early surgical management are paramount.

LINGUAL NERVE IN RELATION TO MANDIBULAR THIRD MOLAR REGION: A CADAVERIC STUDY

Background: The lingual nerve is the terminal branch of the mandibular division of trigeminal nerve. The spatial relationship of lingual nerve to the mandibular alveolar crest varies widely. This variation can be among the gender, age, dental status and between the right and left side of the same sample. This study was aimed to determine the relationship of lingual nerve to mandibular third molar region. Methods: An observational study was carried out from January 2021 to December 2021.The study sample was 15 cadavers including both right and left sides. The lingual nerve was exposed by dissecting the infra temporal region following the standard procedures of Cunninghams Manual of Dissection. The diameter of the lingual nerve, vertical and horizontal distance were measured. The results of all these measurements were tabulated and mean standard deviation were calculated using SPSS version 16. Results: Out of 30 lingual nerves examined, the mean horizontal distance was 3.99 ± 0.96 mm, the mean vertical distance was 12.67 ± 1.76 mm while the diameter of the lingual nerve was 2.46 ± 0.54 mm. Conclusions: The lingual nerve always lies in close proximity of alveolar bone and surgeons operating in this region need to be aware during any surgical interventions or any procedures in this region. A thorough apprehension of the spatial location of the lingual nerve enable to lessen the lingual nerve injury.

Cranial nerve involvement in mucormycosis in post-COVID patients: a case series

BackgroundOne of the largest outbreaks of rhinosinocerebral mucormycosis (RSCM) occurred in India close to the second wave of the SARS-CoV-2 infection. RSCM is a rare infection caused by several fungal species occurring in immunocompromised subjects. Mucor shows a high propensity to invade the central nervous system. There have been limited studies, mostly isolated case reports, on the neurological manifestations of RSCM. The outbreak of mucormycosis infection was thus the most opportune to study the neurological manifestations and cranial nerve involvement in mucormycosis in greater depths.Aim of the studyThe purpose of the study was to investigate and review the involvement of cranial nerves in a series of cases of rhinosinocerebral mucormycosis associated with the novel coronavirus disease caused by SARS-CoV-2.ResultsIt was a retrospective cross-sectional study of seven patients who were undergoing treatment of RSCM with a recent history of coronavirus disease caused by SARS-CoV-2 infection within the last 3 months. Patients with cranial nerve involvement were identified by magnetic resonance imaging (MRI) at a single institution. Demographic details of the patients, clinical presentation, imaging, microbiological and pathological findings were recorded. All subjects had two or more cranial nerves affected by fungal infection. The most commonly involved cranial nerve was found to be the optic nerve followed by the trigeminal nerve and its branches. We document three cases with extensive involvement of the inferior alveolar branch of the mandibular division of the trigeminal nerve (V3), a previously unreported finding. In one case, in addition to the second and fifth cranial nerves, the third, fourth, sixth, seventh, eighth, and twelfth cranial nerves were involved without any sensory or motor long tract involvement, suggestive of Garcin syndrome secondary to intracranial abscesses and skull base osteomyelitis due to invasive fungal infection. This case is of rare occurrence in the literature, and our study provides one such example.ConclusionCranial nerve involvement in patients of mucormycosis tends to have a poor prognosis, both cosmetic and functional. Radical surgeries and aggressive medical management is needed in such cases to improve the outcome.

Moyamoya Disease Associated with Hyperhomocysteinemia: A Rare Cause of Stroke in Sub-Saharan Africa

Introduction: Moyamoya disease (MMD) is a chronic cerebrovascular disorder characterized by progressive bilateral occlusion of the supraclinoid internal carotid artery (ICA) and its main branches, associated with the development of fine collateral networks, especially adjacent to the site of occlusion in the deep areas of the brain. MMD frequently occurs in East Asian populations, including pediatric and adult patients, and may lead to ischemic or hemorrhagic stroke, headache, epilepsy or transient ischemic attack. The majority is presumed to be of genetic origin and few cases of thrombophilia have been reported in MMD. We report a case of MMD in a young sub-Saharan African woman associated with Hyperhomocysteninemia (HHCys). Observation: A 33-year-old female was seen for aphasia, which had suddenly appeared fourteen days before, and was associated with memory impairment. She mentioned chronic headaches during the 10 previous years, of frontal seat, without migraine criteria. She had no history of hypertension, no obesity, no known dyslipidemia, and there was no family history of stroke. Neurological examination noted Wernicke’s aphasia, with discreet right central facial palsy, associated with memory impairment. The brain MRI revealed semi recent infarct in the left parietal lobe, sequelae in the left temporo-occipital and right frontal with lacunar ischemic lesions, associated with several foci of sub- cortical demyelination. MRA showed stenosis of the supraclinoid carotid arteries and their division branches. In addition, there was a stenosis of the posterior cerebral arteries, with a network of anastomosis at the level of the base of the skull. An investigation of thrombophilia showed hyperhomocysteinemia (HHCys). The diagnosis of moyamoya disease associated with hyperhomocysteinemia was mentioned. She was treated by Aspirin combined to folic acid. After a 3-year setback the patient was asymptomatic. Conclusion: MMD is a rare cause of stroke in sub-Saharan Africa. MRA should be performed whenever possible, as well as investigation for thrombophilia when it’s available. Combined antiplatelet agent with folic acid for ischemic stroke prevention is effective.