Frequent Anatomical Variations Research Articles

Evaluating the frequency of anatomical variations of the sinonasal region in pediatric and adult age groups according to gender: computed tomography findings of 1532 cases

BackgroundThe aim of the present study was to evaluate retrospectively the frequency of anatomical variations in sinonasal region, which were frequently seen in our cases, for whom coronal section paranasal computed tomography imaging (CPNCT) was taken, as well as the correlation of these variations with age and gender and correlations of identified anatomical variations with one another.In the study, CBCT scans of a total of 1532 (825 males and 707 females) cases were evaluated in order to determine the prevalence of anatomical variations of the nasal cavity and paranasal sinuses. All the images were taken by a multi-detector CT device (Aquilion, Toshiba medical system, Tokyo, Japan).ResultsMost frequently detected three anatomical variations were septum deviation (79.7%), concha bullosa (40.9%), and ethmoid bulla (21.0%) according to the frequency order. When the frequency of anatomical variations was evaluated according to gender, septum deviation, concha bullosa, and anterior clinoid process pneumatization were more frequently observed in males and Onodi cell in females (p < 0.05).When the relationships of the anatomical variations with one another were evaluated, it was found that the possibility of the presence of concha bullosa in the septum deviation cases and the presence of ethmoid bulla in the cases with Haller cell septum were higher (p < 0.05).In terms of the anatomical variations that were evaluated by taking age as the independent variable, a statistically significant difference was observed in pterygoid process pneumatization, Haller cell, pneumatized crista galli, ethmoid bulla, and paradoxical middle concha between the adult and children age groups (p < 0.05).ConclusionIn terms of the frequency of occurrence to various sinonasal region variations, statistically significant differences were observed between both genders and age groups. The correlations of the detected variations with each other were also remarkable. Consequently, it is believed that comprehensive studies and serious objective evaluations evaluating the change of frequency of anatomical variations according to age and gender besides their correlation with each other are required.

Rare unilateral third head of Biceps brachii - A case report

Biceps Brachii has been described as one of the muscle showing frequent anatomical variation . Third Head of Biceps Brachii arising from Humerus is one of the commonly seen anatomical variation. Understanding the existence of unilateral or bilateral supernumerary heads may influence preoperative diagnosis and surgery of Upper limbs. In this current case report , Inferolateral third head of Biceps Brachij was found in an 85 year old cadaver. The knowledge of such variation will be advantageous to surgeons, radiologists, etc. Keywords: MN-Median Nerve, MCN- Musculocutaneous Nerve, LR – Lateral Root, Biceps brachii

A Combined "Hanging Liver Maneuver" and "Intrahepatic Extra-Glissonian Approach" for Anatomical Right Hepatectomy: Technique Standardization, Results, and Correlation With Portal Pedicle Anatomy.

Background: The hanging liver maneuver and intrahepatic extra-Glissonian approach are distinct modalities to facilitate safe anatomical liver resections. This study reports a standardized combination of these techniques focusing on safety, results and correlation with portal pedicle anatomy in oncological patients.Method: Combined hanging liver maneuver and intrahepatic extra-Glissonian approach for anatomic right hepatectomy was described stepwise. Portal pedicle anatomy was correlated with the Glissonian approach failure and complications. Clinical characteristics of patients, perioperative outcomes, short and long-term survival rates were analyzed.Results: Thirty colorectal liver metastases patients submitted to the combined approach were evaluated. Anatomical variations of the right portal pedicle were present in 26.6%. Hanging liver maneuver was feasible in 100%, and Glissonian approach in 96.7% despite portal pedicle variations. Mean operative time was 326 min. Mean blood loss was 507 ml. Mean hospital stay was 8 days. There was no 90-day operative mortality and no significant morbidity. Oncological surgical margins were free. Overall and disease-free 5-year survival were 59 and 37%.Conclusion: Regardless of frequent anatomical variations of the right portal pedicle, the hanging liver maneuver, and intrahepatic extra-Glissonian approach can be combined, being useful for anatomical right hepatectomies in a safe and reproducible way in most patients.

Angiographic Anatomy of the Middle Meningeal Artery in Relation to Chronic Subdural Hematoma Embolization.

Middle meningeal artery (MMA) embolization is emerging as apotential treatment of chronic subdural hematomas (CSDHs). The purpose of this study is to describe MMA angiographic anatomy in relation to CSDH embolization. This retrospective monocentric study was performed on imaging data of MMA embolization procedures for CSDH treatment performed between March15, 2018 and April30, 2020. Imaging data, including digital subtraction angiography (DSA) were reviewed independently by two physicians. Discrepancies were resolved by consensus. The MMA bifurcation pattern was analyzed according to an extended Adachi classification. Relations of the MMA with the ophthalmic artery (OA) were also analyzed. In this study, 140 MMAs were analyzed. Dominance of the anterior branch (typeI) was observed in only 57/140 (41%) MMAs with amoderate interobserver agreement for classifying MMA into typeI against all other (κ = 0.53, 95% confidence interval, CI 0.39-0.67). The posterior branch presented aproximal origin (typeA), at the point of emergence of the MMA from the foramen spinosum or its immediate vicinity, in 48/135 (36%) MMAs with avery good interobserver agreement for classifying MMAs into typeA against all other (κ = 0.82, 95% CI 0.72-0.92). An angiographic relationship with the OA was observed in 26MMAs (19%). In the majority of CSDH patients both anterior and posterior branches of the MMA should be targeted to achieve extensive convexity devascularization. Frequent anatomical variations of the MMA with respect to emergence of the posterior branch and MMA orbital branches are expected to impact CSDH embolization strategy.

A case report: Rare Variation of an extra musculo-tendon with two slips of flexor digitorum profundus muscle

Introduction: Flexor digitorum profundus (FDP) muscle is the muscles of anterior compartments of the forearm with the most frequent anatomical variations. Macalister reported the variations in FDP. The incidences of variation are observed mainly in the number of heads of proximal attachment, though the variation in the tendon of distal attachment is comparatively rare. Methods: A 48-year-old male formalin preserved cadaver, finely dissected at dissection hall. Results: Normally the FDP muscle insert with four tendons. In this present case, the origin of FDP muscle was normal, but its insertion was by five separate tendons variate musculo-tendon which was found arises from FDP muscle in the mid of the 2nd and 3rd tendon with its fibers again dividing and going with them. Macalister reported many variations regarding this muscle but this type of variation is less commonly found. Conclusion: This particular variation is important for a clinical perspective as this extra musculo tendon may cause entrapment syndrome of the median nerve and also for the surgeon to be careful while performing tenoplasty.

Non-surgical rhinoplasty with dermal fillers

With the increase in popularity of non-surgical rhinoplasty, there is an increasing risk of complications arising from this treatment. The nose has a very complex vascularity, with frequent anatomical variations, making it difficult to create a safety rule for practicing dermal fillers. In-depth knowledge of the anatomy, as well as expert and gentle hands, are prerequisites for minimising the risks. Previous surgical rhinoplasty is a risk factor for the treatment with dermal fillers at the nose. Patient selection is of the utmost importance, and practitioners must assess the benefit versus the inherent risk for each patient. Product selection is vital for the prevention of complications, as a large number of cases of blindness derive from fat transfer techniques, and in case of a vascular occlusion affecting the retina, there is only 1 hour to recover blood circulation before the retina suffers permanent damage.

Clinical impacts of the Sudanese anatomical variations in a relation of the recurrent laryngeal nerve to the inferior thyroid artery

Background: Until recently, the knowledge of the anatomical variations in the relationship between the recurrent laryngeal nerve (RLN) and the inferior thyroid artery (ITA) combined with visual intraoperative RLN identification are essential for the protection of these life-important structures during surgical exposure and the mobilization of thyroid and parathyroid glands. This leads to the proper treatment of patients and improvement of the surgical techniques.Aim: To describe anatomical variations in the relationship of the recurrent laryngeal nerve to the inferior thyroid artery in the Sudanese population.Patients and methods: Following ethical committee approval, an observational descriptive prospective cross-sectional study in the period between March 2019 and February 2020, for anatomical variations in the relation of the recurrent laryngeal nerve to the inferior thyroid artery in seventy-two cervical sides of thirty-six well-dissected embalmed Sudanese cadavers. The RLN was investigated in three positions: posterior to the ITA main trunk, anterior to the ITA main trunk and between the ITA branches. Then, the results were analyzed according to the gender, age and dissection side.Results: We found that the anatomical variations were more frequent in males (97.2%) than females (2.8%). The age of these variations ranged between 31–45 years which represents (61.1%). On the right side of the neck, the commonest position of the RLN is posterior to the ITA (63.9%) followed by in decreasing order of frequency, the RLNs run between the ITA branches (30.6%) and anterior to the ITA (5.6%). On the left side of the neck, the commonest position of the RLN is posterior to the ITA (69.4%). It passed between the ITA branches in (30.6%) of specimens. There was no anterior location of the RLN to the ITA. Variations in a relationship of the RLN to the ITA on one side is significantly different from the opposite side.Conclusions: Although the risk of potential damage to the RLN during surgical neck procedures involving the thyroid gland and parathyroid glands is well recognized, pre-operative detailed surgeon’s knowledge for these frequent anatomical variations and the usage of the ITA as an anatomical landmark for intraoperative RLN recognition is important. This will lead to a reduction of iatrogenic RLN injury prevalence. Future studies are recommended to compare the findings on this cadaveric study with a larger sample size in the long-term period. Â

Variantes anatómicas del círculo arterial cerebral en un anfiteatro universitario en Bogotá (Colombia)

Introducción: el cerebro es un órgano altamente irrigado, y esta irrigación es suministrada por el círculo arterial cerebral: una red arterial anastomótica con frecuentes variaciones anatómicas, algunas asociadas con patologías. El objetivo es describir las características antropométricas y variaciones anatómicas del círculo arterial cerebral en una muestra de especímenes cadavéricos humanos. Materiales y métodos: se revisaron 50 encéfalos, de los cuales 24 cumplieron con los criterios de inclusión. Se realizaron medidas de diámetro y longitud y también se describieron variaciones anatómicas y variaciones morfométricas. Resultados: siete especímenes evidenciaron variaciones anatómicas (29.1%); 3 (12.5%), arteria cerebral anterior (ACA) ácigos; uno (4.1%), doble ACA en el segmento A1; uno (4.1%), triple ACA en el segmento A2 y doble arteria comunicante anterior (AcomA); uno (4.1%), agenesia de la arteria comunicante posterior (AComP) derecha; uno (4.1%), de la AComP izquierda. El 29.1% presentó variaciones antropométricas; el 12.5 %, hipoplasia de la AComP derecha; el 12.5 %, de la AComP izquierda, y el 4.1 %, hipoplasia bilateral de la AComP. Conclusión: la presencia de variaciones anatómicas fue inferior a la hallada en otros estudios, con predominio de variantes de la circulación anterior. Se describe la presencia de triple aca en el segmento A2 y doble arteria comunicante anterior.

A study to improve identification of the retroperitoneal course of iliohypogastric, ilioinguinal, femorocutaneous and genitofemoral nerves during laparoscopic triple neurectomy.

Laparoscopic triple neurectomy is an available treatment option for chronic groin pain, but a poor working knowledge of the retroperitoneal neuroanatomy makes it an unsafe technique. Describe the retroperitoneal course of iliohypogastric, ilioinguinal, lateral femoral cutaneous and genitofemoral nerves, to guide the surgeon who operates in this region. Fifty adult cadavers were dissected resulting in 100 anatomic specimens. Additionally, 30 patients were operated for refractory chronic inguinal pain, using laparoscopic triple neurectomy. All operations and dissections were photographed. Measurements were made between the nerves of the lumbar plexus and various landmarks: interneural distances in a vertical midline plane, posterior or anterior iliac spine and branch presentation model. The ilioinguinal and iliohypogastric nerves were independent in 78% (Type II) and separated by an average of 2.5 ± 0.8cm. In surgery study, only 38% were recognized as Type II and at a significantly greater distance (3.5 ± 1.2cm, p < 0.001). The distance between ilioinguinal and lateral femoral cutaneous nerves was also greater during surgery, with statistical significance (5.1 ± 1.5 versus 4.2 ± 1.5, p < 0.005). The distance of the nerves to their bone references were not statistically different. The genitofemoral nerve emerged from the psoas major muscle in 20% as two separate branches (Type II), regardless of the study. The lateral femoral cutaneous nerve had a mean distance of 0.98 ± 1.6cm medial to the anterior superior iliac spine. The identification of the IH, II, FC and GF nerves is essential to reduce the rate of failures in the treatment of CGP. The frequent anatomical variations of the lumbar plexus nerves make knowledge of their courses in the retroperitoneal space essential to ensure safe surgery. The location of the nerves in the LTN is distorted by up to 1cm. regarding references in the cadavers.

Frequency of Anatomic Variations on Hepatic Arteries and Types of Reconstruction Employed: Study on Livers Prepared for Transplantation

BackgroundRecognition of anatomic variations in the hepatic artery is important at the time of organ uptake and at the back table for transplantation. PurposeTo know the frequency of these variations, in a 5-year series of liver transplantation and the various types of arterial reconstruction used in back table surgery. MethodsWe analyzed 340 donor files and calculated the frequencies of the various anatomic variations of the hepatic artery, according to Hiatt, and the types of vascular reconstruction employed. ResultsIn total, 225 cases (66.17%) had a single hepatic artery, considered unchanged (type I), originating from the celiac trunk. Forty-six (13.52%) and 44 (12.94%) were, respectively, type II and III. Eight cases (2.35%) had a type II and III association (type IV), and another 8 (2.35%) were type V. There were no type VI cases. Nine cases were not described in the Hiatt classification. The most common reconstruction was right hepatic and splenic artery anastomosis, performed in 53 cases (91.37%). In 4 cases, this reconstruction was performed with the gastroduodenal (6.89%). In 1 case of 3 arteries with independent origins, in the aorta, reconstruction was performed using the iliac artery graft (common and its bifurcation), taken from the organ donor (1.72%). ConclusionsThe most common variations were the presence of a left or right hepatic artery alone, each with a frequency of 13%, and the most commonly used reconstruction was the right hepatic with splenic arteries anastomosis.

Image Guided Endoscopic Sinus Surgery: First Experience from Kashmir Valley.

Image guidance is best suited to paranasal sinus surgeries as these demand a high degree of anatomical precision because of close proximity to orbit and cranial cavity which at times is challenging in patients with frequent anatomical variations. This study is aimed to describe our first experience of using image guided endoscopic sinus surgery in Kashmir valley in terms of real time correlation between the operative field and the preoperative imaging; to evaluate its utility in disease clearance and to evaluate patient reported outcome measures using (pre and post-op) VAS, SNOT-22, Lund Mackey endoscopic and radiological scores. This prospective observational study was conducted from September 2016 to August 2018. Patients with the specific inclusion and exclusion criteria were operated using image guidance system. Pre and post operative SNOT-22, VAS, Lund Mackey endoscopic and radiological scoring were compared. Operative time, Instrument accuracy and complications were noted. Out of twenty cases enrolled in this study majority (14) patients (70%) were cases of uncomplicated chronic rhinosinusitis with nasal polyposis. Mean number of sinuses operated were 7.8 ± 2.14. Set up time for installing navigation system in first 10 cases was on an average 17 ± 1.67min and in second 10 cases it was 12 ± 1.42min. Mean operative time recorded was 112 ± 17.32min. Accuracy of our system was 1.25 ± 0.73mm (0.50-1.80) and average blood loss was 100 ± 23.54ml. There was statistically significant reduction in postoperative VAS score, SNOT-22 score, Lund Mackey endoscopic and radiological scoring. Revision FESS was done in 12 cases and most common intraoperative absent nasal landmark was middle turbinate in these cases. No orbital or intracranial complication was seen. Minor complications were seen. Image guided surgery is a valuable tool worth use in difficult and revision cases. It makes the surgeon comfortable and saves patient from any major complication.

Management of accessory renal arteries during aneurysm repair in a patient with end-stage renal failure

The presence of accessory renal artery is a frequent anatomic variation that can challenge abdominal aortic aneurysm (AAA) repair. Here, we show an image of an abdominal aortic aneurysm extended to multiple accessory renal arteries in a patient known for an end-stage renal failure. This case raises the questions of the criteria that should be taken in consideration for an optimal management of accessory renal artery during AAA repair.

Morphology and morphometry of the foramen venosum: a radiographic study of CBCT images and literature review.

The goal of this study was to assess the morphological variations, location, and morphometric measurements of the foramen venosum (FV) and analyse its interrelationships with other foramina on cone-beam computed tomography (CBCT) scans. A total of 269 individual CBCT scans were evaluated retrospectively. The presence or absence of FVs and their diameter, shape, and confluence to foramen ovale were recorded. The distances between anatomic structures and the FV were calculated. Appropriate statistical analysis was performed for the collected data. Of the 269 cases studied, nine were excluded due to duplicate foramina that made statistical analysis difficult. In the 260 evaluated scans, the FV was identified in 190 individuals (73.1%). The incidence was 148 (56.9%) on the right side and 152 (58.5%) on the left side. The FV was present unilaterally in 80 (30.8%) and bilaterally in 110 (42.3%) out of the 260 individuals. The mean maximum diameter of FV was 1.75 ± 1.27mm, and no significant differences related to gender and age were detected (p < 0.05). The most prevalent foramen shape was the oval type (45.9% on the right side and 40.8% on the left side). FV is a very frequent anatomical variation. This foramen can exist either bilaterally or unilaterally. No significant differences related to sex, side, or age could be found in the present study. The anatomic characteristics of FV should be considered during interventions in the middle cranial fossa. CBCT imaging with lower radiation doses and thin slices may prove useful before surgical skull-base procedures.

The Roles of Celiac Trunk Angle and Vertebral Origin in Median Arcuate Ligament Syndrome

Median arcuate ligament syndrome (MALS) is a rarely diagnosed condition resulting from compression of the celiac trunk (CT) by the median arcuate ligament (MAL) of the diaphragm. Ischemia due to reduced blood flow through the CT and/or neuropathic pain resulting from celiac ganglion compression may result in a range of gastrointestinal symptoms, including nausea, postprandial discomfort, and weight loss. However, the mechanism of compression and its anatomical correlates have been incompletely delineated. It has been hypothesized that CT angle of origination may be more acute in individuals with MALS. Here, frequency of anatomical variation in the MAL and CT were assessed in 35 cadaveric subjects (17M/18F), including the vertebral level of origin of CT and superior mesenteric artery (SMA), the distance between CT and MAL and SMA, the angles of origination of CT and SMA, the diameter at the CT base, and MAL/CT overlap. Females exhibited significantly higher rates of inferred MAL/CT overlap than males. Significant correlations were revealed between MAL/CT overlap and angles of origination of the CT and SMA. Vertebral level of origin of the CT in individuals with MAL/CT overlap was not significantly more superior than in those without. This study also revealed a significant relationship between MAL/CT overlap and angle of origination of the CT, which has clinical implications for understanding the anatomy associated with MALS.

KONKA BÜLLOZA ALT TİPLERİ ÜZERİNE GENİŞLETİLMİŞ BİR ÇALIŞMA

To determine the concha bullosa subtypes and their possible associations with chronic sinusitis, osteomeatal complex obstruction, mucosal thickening and other sinonasal anatomic variations, in a large group of patients with concha bullosa. This retrospective study was conducted between January 2019 and March 2020 in two different institutions. The paranasal CT sections and medical records of 850 patients (1700 sides) were evaluated, and the association of concha bullosa subtypes with other sinonasal variations like chronic sinusitis, osteometal complex obstruction and mucosal thickening was investigated. Concha bullosa was observed in 430 (25.2%) of 1700 sides. Of 430 bullous conchas, 160 were bilateral (37%), 245 were on the right (56.9%), 185 were on the left (43.1%). Extensive type in 202 sides, bulbous type in 118 sides and lamellar type in 100 sides were observed. A significant association of extensive type concha bullosa with chronic sinusitis (p: 0.025), osteometal complex obstruction (p: 0.043) and septum deviation was found (p: 0.013). Additionally, a significant association of lamellar type concha bullosa with female gender (p: 0.021) and of bulbous type concha bullosa with osteomeatal complex obstruction (p: 0.038) was evident. The most frequent anatomical variation was septal deviation, found in (73.1%) 256 of 350 patients with concha bullosa. The frequency of chronic sinusitis, osteomeatal complex obstruction and septal deviation were significantly higher in extensive type concha bullosa than in the other subtypes. Familiarity of surgeons and radiologists with concha bullosa subtypes might be important for determining the treatment algorithm during endoscopic sinus surgery.

CT angiographic determination of most frequent anatomic variations of coronary arteries in Erbil population

Background and objective: Computed tomography angiography is one of the best methods for knowing the detailed anatomy of coronary arteries and can successfully detect any variation of coronary arteries. Anatomic variations of coronary arteries have not been studied among Erbil population which is mostly inhabited by Kurds. This study was conducted to compare the incidence of the anatomic variations of coronary arteries in Erbil population with international standards. Methods: Variations of coronary arteries were retrospectively studied by using computed tomography angiography of 412 cases (214 males 198 females) with mean age 51.5 ± 13.5 years (mean ± SD) who underwent this procedure on suspicion of coronary artery disease. The main indication was chest pain in patients with low to intermediate probability of ischemic heart disease. The present study was carried out in the Department of Radiology, Surgical Specialty Hospital/Cardiac Center in Erbil city. Results: The right coronary artery was dominant in 86.4% of cases, while the left main coronary artery was dominant in 10.92% of cases. Co-dominance was observed in 2.67% of cases, and Double Ostia of right aortic sinus was observed in 25% of cases. Long left main coronary artery was observed in 10.68 % of cases. Myocardial bridging was observed in 7.04% of cases. Other variations were also observed, and their prevalence was recorded. Conclusion: Variations of coronary arteries among Erbil population were recorded and were near to the international standards.

Deep palmar tumorous conditions of the hand.

Deep palmar tumors of the hand are very rare, and reported cases are usually benign. The most important issue is frequent anatomical variations with challenging surgical exposure and excision of these lesions. Some case reports or a small series of patients have been reported in the literature. The aim of this study was to present our experience with the deep palmar tumors of the hand. In the study, retrospective analyses of 43 patients treated with deep palmar tumors of the hand between January 1998 and June 2015 were evaluated. Tumors and tumor-like pathologies of the deep palmar space of the hand were retrospectively evaluated according to age, gender, localization, preoperative symptoms, size, site, treatment methods, histopathology, and early and late complications. Statistics and data analyses were also performed. All 43 pathologies were benign, and histopathologic diagnoses were 10 lipomas, 8 ganglions, 5 giant cell tumor of the tendon sheath, 4 schwannomas, 3 hemangiomas, 3 palmar fibromatosis, 2 epidermal cysts, 2 neurofibroma, 1 angiolymphoid hyperplasia with eosinophilia, 1 granuloma, 1 calcifying aponeurotic fibroma, 1 digital fibroma, 1 foreign body granuloma, and 1 lipofibromatous hamartoma. The most common complication was temporary numbness and paresthesias of the digits. Marginal excision was performed in 40 patients, excision with nerve grafting in 2 patients (with neurofibroma) and carpal tunnel release in one patient with lipofibromatous hamartoma. In the deep palmar space of the hand, pathologies are closely associated with tendons, muscles, and neurovascular structures. Preoperative magnetic resonance imaging is helpful for the preoperative diagnosis, evaluating tumor extension, and successful surgical planning. Level of Evidence: IV Therapautic.

Normal Anatomy and Traumatic Injury of the Midtarsal (Chopart) Joint Complex: An Imaging Primer.

The midtarsal (Chopart) joint complex consists of the talonavicular and calcaneocuboid joints and their stabilizing ligaments. Detailed assessment of this complex at MRI can be challenging owing to frequent anatomic variation and the small size of the structures involved. Nevertheless, a wide spectrum of pathologic conditions affect the joint complex, and its imaging evaluation deserves more thorough consideration. This review focuses on MRI evaluation of normal ligamentous anatomy and common variations about the Chopart joint, presenting practical imaging tips and potential diagnostic pitfalls. Imaging findings across a spectrum of traumatic Chopart joint injuries are also reviewed, from midtarsal sprains to Chopart fracture-dislocations. Midtarsal sprains-commonly associated with ankle inversion injuries-are emphasized, along with their often predictable radiographic and MRI injury patterns. Online DICOM image stacks are available for this article. ©RSNA, 2018.

Paediatric auditory brainstem implantation: The South Asian experience

IntroductionPaediatric Auditory Brainstem Implantation (ABI) is indicated for children with congenital cochlear aplasia, absent/hypoplastic vestibulocochlear nerve, for whom cochlear implantation is not possible. Knowledge of the anatomical landmarks and variants in anatomy of the brainstem is vital for ABI surgery. MethodStudy was done at Auditory implant centre in Madras ENT research foundation, which includes 24 children who had undergone ABI surgery and are being followed up for 1 year, post operatively. Aims were to study the anatomical variants and the outcomes of ABI implantation. To determine if different anatomical variants effect placement of ABI electrode. To assess the patient outcomes by Categories of auditory Performance (CAP) scores and Speech Intelligibility Ratings (SIR) scores. ResultsAll the candidates showed gradual improvement in audiological and verbal outcomes after the ABI. The mean CAP and SIR scores after 6 months of AVHT were 2.07 and 1.37 respectively. After 1 year of auditory verbal rehabilitation therapy CAP was 3.42 and SIR was 2.33. Flocculus of the cerebellum can be of different grades. Though, there was difficulty in insertion of the electrode in subjects with anatomical variants, the outcomes were comparable with other subjects. ConclusionABI surgery involves frequent anatomical variations surrounding the lateral recess which makes the positioning of the auditory prosthesis difficult. Variants during the surgery can make the placement of ABI electrodes difficult, but promising results were seen all the implantees.

The anatomical variations of pancreatic duct in the patients with pancreatic diseases

There are many anatomic variations of pancreatic duct and congenital anomalies of pancreas, which have been described in the literature. Most of them has no clinical significance and is used to be incidentally discovered in radiological examinations. We have demonstrated in our paper that the most frequent anatomical variations of pancreatic duct in the patients with pancreatic diseases are pancreas divisum as well as ansa pancreatica.