Lateral Border Research Articles

Which is the best imaging modality to diagnose a manica flexoria tear?

SummaryThe manica flexoria (MF) is an extension of the medial and lateral borders of the superficial digital flexor tendon (SDFT) that forms a sleeve around the deep digital flexor tendon (DDFT), within the digital flexor tendon sheath (DFTS), just proximal to the metacarpo/metatarsophalangeal joint. Tears of the MF have been described associated with cases of nonseptic tenosynovitis presenting with lameness, with ponies and cobs being over‐represented. Ultrasonography and contrast tenography are the predominant imaging modalities used to diagnose tears of the MF, with tenoscopic evaluation still serving as the gold standard. However, the sensitivity and specificity of additional techniques such as contrast computed tomographic tenography and MRI are now being investigated as other modalities that could be of value to identify MF tears. Additional techniques have been described to combine with traditional ultrasonography, with the aim to improve the sensitivity of identifying MF tears, such as dynamic extension/flexion techniques and saline injections of the DFTS. The overall aim of this paper was to review current evidence to determine the best noninvasive diagnostic imaging modality, with a high sensitivity and specificity, to more accurately diagnose MF tears and aid more thorough surgical planning.

NTRK Gene Expression Analysis in Oral Squamous Cell Carcinoma Mexican Population.

Oral cancer holds the sixth position in malignancies worldwide; 90% correspond to oral squamous cell carcinoma (OSCC). Diverse reports suggest that NTRK genes and their receptors are key oncogenesis regulators to tumor progression in human cancers. Objective: To analyze the NTRK and Trk expression and their association with clinicopathological features of OSCC in Mexican patients' samples. Material and Methods: We analyzed 95 OSCC cases of pan-trk immunoexpression through a software-assisted method. Gene expression was analyzed by RT-qPCR employing the ΔΔCT method. Kruskal-Wallis and Spearman's correlation tests were performed. Results: Our mean age was 62.4 (±16.9) years. A total of 37 cases were tumors in the lateral border of the tongue. Age was significantly associated with the anatomical site. 42% (40 of 95) cases were pan-trk positive. A total of 21 cases showed intense immunoexpression predominantly in poorly differentiated OSCC, with a significant correlation between immunoexpression and age and gender. Gene expression showed that poorly differentiated cases exhibited higher NTRK2 expression, while well-differentiated cases demonstrated NTRK3 significantly higher expression. Conclusions: Our results suggest that NTRK family expression is present in OSCC, with differential expression related to differentiation degree. Additional information about their activation or mutational status could reinforce their potential as a possible primary or adjuvant treatment target.

Plantar massage or ankle mobilization do not alter gait biomechanics in those with chronic ankle instability: a randomized controlled trial

ABSTRACT Objectives Chronic ankle instability (CAI) is characterized by persistent neuromechanical impairments following an initial lateral ankle sprain. Ankle joint mobilization and plantar massage have improved the range of motion and static postural control in those with CAI. This study aimed to determine the impact of two-week joint mobilization and plantar massage interventions on gait kinematics and kinetics in individuals with CAI. Methods A single-blind randomized trial was conducted with 60 participants with CAI, randomized into three groups: joint mobilization (n = 20), plantar massage (n = 20), and control (n = 20). The two treatment groups received six 5-min sessions manual therapy over a 2-week, while the control group received no intervention. Gait biomechanics were assessed on an instrumented treadmill before and after the intervention using 3D kinematics and kinetics analysis. Analyses compared biomechanical outcomes from each treatment group to the control group individually using a 1-dimensional statistical parametric mapping. The alpha level was set at p < 0.05. Results Eighteen participants per group were part of the final analysis. No significant main or interactions effects were found for ankle sagittal or frontal plane positions following either intervention (p > 0.05 for all comparisons). COP location relative to the lateral border of the foot also did not change (p > 0.05). Conclusion The findings suggest that two-week joint mobilization and plantar massage interventions do not significantly alter gait biomechanics in individuals with CAI. These results support the need for gait-specific interventions to modify biomechanics in this population.

7295 Giant Pituitary Adenoma with Rapid Symptomatic Progression and Postoperative Mortality

Abstract Disclosure: R.D. Kennedy: None. M. Nicholson: None. Introduction: Giant pituitary adenomas, defined as pituitary adenomas measuring greater than 4 cm, present a therapeutic challenge because of their size, clinical features, and increased potential for complications following surgical intervention. Early detection and intervention to prevent growth and progression is paramount. We present a case of a patient with a giant 6.3 cm pituitary adenoma who had significant neurologic compromise, requiring surgical intervention, with resultant postoperative complications and death. Case:Patient is a 41 year old male with known history of pituitary adenoma who presented on 11/1/2023, from outside hospital, to the Neuroendocrine clinic with complaints of excessive truncal obesity, impotence, fatigue, and apathy. Vital signs were within normal limits. Physical exam revealed clouding of consciousness, grossly intact cranial nerve function, truncal obesity, and diminished power, tone, and bulk of the extremities. Formal visual field testing revealed bitemporal hemianopsia. A head CT scan revealed a 6.3 cm sellar mass with expansion of the sella, invasion of soft tissue into the sphenoid sinus, and extension of soft tissue cranially to the level of the third ventricle eccentric to the left. There was no evidence of apoplexy. Lab results revealed Prolactin of 924 ng/mL. The patient had been taking Bromocriptine, 2.5 mg daily, for at least three weeks. Less than three weeks after his initial evaluation, he returned to the hospital with complaint of acute ataxia. Pituitary MRI revealed 6.3 cm sellar mass with evidence of acute and subacute blood products, stretching of the optic chiasm from mass effect, extension into the bilateral cavernous sinuses, superior left MCA displacement, posterior left PCA displacement, 5 mm midline shift, uncal herniation and descending transtentorial herniation. The patient underwent endoscopic transsphenoidal resection with subsequent craniotomy for debulking. Postoperatively, he developed new right sided hemiplegia with aphasia with subsequent MRI finding of watershed infarct at the left MCA/PCA lateral posterior border zone territories with increasing mass effect over a 30 day hospital stay. He developed progressive global edema with worsening uncal and tonsillar herniations. Brain death was pronounced on 11/30/23. Discussion:This case highlights the importance of early intervention in patients with giant pituitary adenomas. Our patient had been experiencing right sided weakness for at least one year prior to his admission to our facility. In this case, earlier treatment with a dopamine agonist may have decreased the size of the adenoma or prevented rapid growth. This may have precluded the need for surgical intervention on an adenoma of this size, which carries increased risk for postoperative complications. Presentation: 6/2/2024

Lingual Actinomycosis – A Rare Report of the Ray Fungus

Actinomycosis is an uncommon chronic suppurative infection caused by a Gram-positive anerobic bacterium Actinomyces israelii or Actinomyces gerencseriae. Lingual actinomycosis is a rare form of actinomycosis with a prevalence of 3%. We report a case of a 16-year-old female, with an acute-onset painful ulcer with a yellowish-white slough over the left lateral border of the tongue preceded by a tongue swelling. There was a history of tongue bites before the onset of swelling. Histopathological examination was suggestive of lingual actinomycosis. The lesions resolved 3 weeks after treatment with amoxicillin and clavulanic acid combination, but the patient was advised to complete the 6-week antibiotic course. The patient did not have any new ulcers in the follow-up. The tongue is inherently resistant to bacterial adherence and infection, but a break in the integrity of the skin or the presence of devitalized tissue usually aids in the invasion of the organism into deeper structures. The disease is usually localized to the tongue but can also spread to jaws (osteomyelitis of jaws), lungs, heart, and brain and can lead to death. Although antibiotic therapy remains the mainstay of treatment, surgical excision has a profound positive effect on the antimicrobial treatment. It is worth considering actinomycosis as a possibility in suppurative, granulomatous, and suspicious lesions of the tongue.

Psoas Muscle Morphology: A Novel Classification System and Its Anatomic Relationship with Adjacent Neurovascular Structures.

Cross-sectional radioanatomic study. To introduce a classification system using MRI to describe psoas morphology and examine the position of nearby neurovascular structures. Oblique lumbar interbody fusion (OLIF) and lateral lumbar interbody fusion (LLIF) offer sagittal malignment correction and reduced morbidity. LLIF has a higher incidence of nerve injuries, while OLIF has a higher incidence of vascular injuries. Measurements were completed on the left psoas at the inferior L4 endplate. Class A was designated if the ventral border of the psoas muscle was >2mm anterior; B if it was ≤ 2mm anterior or posterior to the vertebral body, and C if >2mm posterior to the vertebral body ventral border. Modified oblique corridor, measured as the distance between two lines, one at the medial border of the psoas muscle and the other at the lateral border of the nearest vascular structure, and a preferred LLIF trajectory was projected onto an axial image of the left psoas. If the trajectory violated the posterior third of the psoas, it was considered a dangerous approach due to potential iatrogenic nerve injury. 100 patient MRIs (Class A: 44; Class B: 27; Class C: 29) were analyzed. Average modified oblique corridor was 7.49mm. Modified oblique corridor varied amongst the three types of psoas morphologies (A: 8.99mm vs. B: 8.10mm vs. C: 4.66mm, P=0.040). LLIF trajectory intersected the 'danger zone' in 34.1%, 3.7%, and 0.0% of patients, (P<0.001) respectively. Class A psoas had the largest modified oblique corridor but highest proportion of those with a dangerous LLIF trajectory. Class C psoas had the narrowest modified oblique corridor, but no dangerous LLIF trajectories were identified.

Anatomical variants of the medial synovial fold of the posterior cruciate ligament: morphological classification based on magnetic resonance imaging of the knee.

The medial synovial fold of the posterior cruciate ligament is one of the synovial plicae of the knee joint. The objective of this study was to assess the necessity of reporting the appearance of the medial synovial fold of the posterior cruciate ligament on magnetic resonance imaging of the knee joint and its correlation with side and sex. Patients with normal knee structure on magnetic resonance imaging (MRI) scans between 2018 and 2023 were included in this retrospective study. MRI scans of the knee joints were retrospectively reviewed by two musculoskeletal radiologists independently. The medial synovial fold of the posterior cruciate ligament was divided into three types according to the imaginary line drawn between the lateral border of the medial femoral condyle and the medial tibial intercondylar tubercle. The study included 1147 patients, of whom 478 (41.7%) were female and 669 (58.3%) were male. Among these patients, 580 (50.6%) had a right knee scan, and 567 (49.4%) had a left knee scan. The age range was 15-35 years for both sexes. The frequency of the medial synovial fold types in all patients was as follows: Type A (30.1%), Type B (55.4%) and Type C (14.5%). There was a high level of agreement between the observers. There was a statistically significant difference in the frequency of medial synovial fold types between sexes, with men exhibiting a greater prevalence. Magnetic resonance imaging (MRI) of the knee joint revealed the medial synovial folds of the posterior cruciate ligament (PCL). The most common was Type B (55.4%), followed by Type A (30.1%) and Type C (14.5%) among the MSF types. No statistically significant difference was found between the right and left knees for any of the MSF types.

Malignant transformation of oral leukoplakia: Systematic review and comprehensive meta-analysis.

To update the current evidence on the malignant transformation of oral leukoplakia (OL), including all studies published worldwide on the subject, selected with the maximum rigor regarding eligibility. MEDLINE, Embase, Web of Science and Scopus were searched for studies published before June-2024, with no lower date limit. The risk of bias was analyzed using the Joanna Briggs Institute tool for meta-analyses of proportions. We carried out meta-analyses, explored heterogeneity across subgroups and identified risk factors with potential prognostic value. Fifty-five studies (41,231 with OL) were included. The pooled malignant transformation proportion for OL was 6.64% (95% CI = 5.21-8.21). The malignant transformation did not significantly vary by time periods (p = 0.75), 5.35% prior to 1978, 7.06% from 1979 to 2007 and 6.97% during more recent times. The risk factors that significantly had a higher impact on malignant transformation were the non-homogeneous leukoplakias (RR = 4.23, 95% CI = 3.31-5.39, p < 0.001), the larger size (RR = 2.08, 1.45-2.96, p < 0.001), leukoplakia located on the lateral border of tongue (malignant transformation = 12.71%; RR = 2.09, 95% CI = 1.48-2.95, p < 0.001), smoking (RR = 1.64, 95% CI = 1.25-2.15, p < 0.001), and the presence of epithelial dysplasia (RR = 2.75, 95% CI = 2.26-3.35, p < 0.001). OL presents a considerable malignant transformation probability that is especially increased in large non-homogeneous lesions in smokers, located on the lateral border of the tongue, with epithelial dysplasia.

Anatomical Study of the Inferior Oblique Muscle and Its Innervation: Morphometric Characteristics, Anatomical Variations, and Histological Evaluation of the Nerve to the Inferior Oblique Muscle.

This report aims to supplement the existing knowledge on the inferior oblique muscle. In particular, this study presents detailed anatomical and histological data concerning the muscle's entry point (or entry zone) of the nerve to the inferior oblique muscle. Particular attention was paid to the topographical relationships of the nerve to the inferior oblique muscle (NTIO), including the location of its entry point to the muscle's belly and its anatomical variations. Sixty orbits from cadaveric hemi-heads fixed in 10% formalin were studied. The course of the NTIO was traced along the lateral border of the inferior rectus muscle as far as its entry point to the inferior oblique muscle. Particular attention was paid to the various ways in which the NTIO's muscular sub-branches penetrated between the fibers of the inferior oblique muscle. Three types of NTIO entries to the inferior oblique muscle's belly were distinguished. In the most common type (48.3%), the nerve entered the muscle's inferior (orbital) surface. In the next most common type (36.7%), terminal muscular sub-branches of the NTIO joined the superior (also referred to as ocular or global) surface of the inferior oblique muscle. In the remaining four cases (15%), the terminal sub-branches of the NTIO were divided into two main groups (superior and inferior) that joined both the superior and inferior surfaces of the muscle. Histological examination confirmed that the distal part of the NTIO shows a characteristic arcuate course (angulation) just before reaching the muscle's belly. The process for splitting and forming separate muscular sub-branches of the NTIO was observed for all the examined histological specimens at the level of the nerve's angulation. The presented findings enhance the understanding of the anatomical variations and precise distribution of motor sub-branches reaching the inferior oblique muscle, which may deepen anatomical knowledge and potentially enhance the management of ocular motor disorders.

Exploring the Therapeutic Implications of Co-Targeting the EGFR and Spindle Assembly Checkpoint Pathways in Oral Cancer.

Head and neck cancer (HNC), the sixth most common cancer worldwide, is increasing in incidence, with oral squamous cell carcinoma (OSCC) as the predominant subtype. OSCC mainly affects middle-aged to elderly males, often occurring on the posterior lateral border of the tongue, leading to significant disfigurement and functional impairments, such as swallowing and speech difficulties. Despite advancements in understanding OSCC's genetic and epigenetic variations, survival rates for advanced stages remain low, highlighting the need for new treatment options. Primary treatment includes surgery, often combined with radiotherapy (RT) and chemotherapy (CT). Cetuximab-based chemotherapy, targeting the overexpressed epidermal growth factor receptor (EGFR) in 80-90% of HNCs, is commonly used but correlates with poor prognosis. Additionally, monopolar spindle 1 (MPS1), a spindle assembly checkpoint (SAC) component, is a significant target due to its role in genomic fidelity during mitosis and its overexpression in several cancers. This review explores EGFR and MPS1 as therapeutic targets in HNC, analyzing their molecular mechanisms and the effects of their inhibition on cancer cells. It also highlights the promise of combinatorial approaches, such as microtubule-targeting agents (MTAs) and antimitotic agents, in improving HNC therapies, patient outcomes, and survival rates.

Three-dimensional joint inversion of surface wave dispersion and gravity data using a petrophysical approach: an application to Los Humeros Geothermal Field

SUMMARY We present a method to jointly invert surface wave dispersion data and gravity measurements for 3-D shear wave velocity and density models. We implemented a petrophysical approach to combine the kernels of both methodologies in a single process. The synthetic experiments show that jointly inverted models recover shear wave velocity and density better than separate inversions. In particular, density models benefit from the good vertical resolution of surface wave dispersion data, while shear velocity models benefit from the good lateral resolution of gravity data. We also proposed two methods to stabilize the solution when using high-grade polynomials. We applied the methodology to the Los Humeros Geothermal area to demonstrate its applicability in a complex geological scenario. Compared with separate inversion, the joint inversion contributes to enhancing key aspects of the geothermal system by (i) delimitating better the geometry of the caldera deposits in the first 0–2.8 km deep by increasing the vertical resolution in density, (ii) delimitating better the lateral borders of low-Vs bodies at different depths interpreted as a part of a complex magmatic chamber system and (iii) estimating the local shear wave velocity–density relationship that conforms to other known relationships for sedimentary and igneous rocks but with some differences that bring us additional information.

Mullan's triangle or anteromedial triangle of the middle cranial fossa: a cadaveric study with its surgical importance.

Surgical approaches to the cavernous sinus (CS) and middle cranial fossa (MCF) can be challenging, particularly for young neurosurgeons. The anteromedial (Mullan's) triangle is a triangle by the side of the CS and constitutes part of the floor of the MCF. The contents include the sphenoid sinus, superior ophthalmic vein, and sixth cranial nerve. The literature contains very little research that has precisely defined and measured the anteromedial triangle while considering anatomical variances minimally. The present study was conducted on the skulls of 25 adult human cadavers which were dissected to expose the anteromedial (Mullan's) triangle on both sides. After precisely defining the triangle on each side, measurements of the three borders were taken, and using Heron's formula, the area of each triangle was calculated. On average, the length of the medial border was 12.5 (+ 3.1mm); the length of the lateral border was 9.9 (+ 3.1mm); the length of the base was 10.75 (+ 2.4mm) and the area of the anteromedial triangle was 43.9 (+ 15.06mm2). Precise anatomical knowledge of the Mullan's triangle enables the treatment of disorders in often deformed anatomy or difficult-to-access structures. That is the reason it is important to gain a thorough understanding of the surgical anatomy and to adopt a safe procedure.

Drivers of vessel progenitor fate define intermediate mesoderm dimensions by inhibiting kidney progenitor specification

Proper organ formation depends on the precise delineation of organ territories containing defined numbers of progenitor cells. Kidney progenitors reside in bilateral stripes of posterior mesoderm that are referred to as the intermediate mesoderm (IM). Previously, we showed that the transcription factors Hand2 and Osr1 act to strike a balance between the specification of the kidney progenitors in the IM and the vessel progenitors in the laterally adjacent territory. Recently, the transcription factor Npas4l – an early and essential driver of vessel and blood progenitor formation – was shown to inhibit kidney development. Here we demonstrate how kidney progenitor specification is coordinated by hand2, osr1, and npas4l. We find that npas4l and the IM marker pax2a are transiently co-expressed in the posterior lateral mesoderm, and npas4l is necessary to inhibit IM formation. Consistent with the expression of npas4l flanking the medial and lateral sides of the IM, our findings suggest roles for npas4l in defining the IM boundaries at each of these borders. At the lateral IM border, hand2 promotes and osr1 inhibits the formation of npas4l-expressing lateral vessel progenitors, and hand2 requires npas4l to inhibit IM formation and to promote vessel formation. Meanwhile, npas4l appears to have an additional role in suppressing IM fate at the medial border: npas4l loss-of-function enhances hand2 mutant IM defects and results in excess IM generated outside of the lateral hand2-expressing territory. Together, our findings reveal that establishment of the medial and lateral boundaries of the IM requires inhibition of kidney progenitor specification by the neighboring drivers of vessel progenitor fate.

Types of high-riding vertebral artery: a classification system for preoperative planning of C2 instrumentation based on 908 potential screw insertion sites

BACKGROUND CONTEXTOur recent studies indicated that a high-riding vertebral artery (HRVA) is a common variant posing a risk of injuring the vessel during C2 instrumentation. However, several different types fit in the current definition of HRVA, which may require a different strategy for C2 screw placement. PURPOSETo classify HRVA and provide a clinical aid for preoperative planning of C2 instrumentation. A secondary goal was to estimate coexistence of each HRVA type with the ipsilateral narrow C2 pedicle (NP). STUDY DESIGNA retrospective observational study involving radiologic measurements of the estimated number of anonymized cervical computed tomography (CT) scans. STROBE checklist was applied. PATIENT SAMPLEA total of 908 potential screw insertion sites (PSIS) of 454 consecutive cervical CT scans were analyzed. The sample size was estimated using ScalaR SP function in RStudio. OUTCOME MEASURESThree types of HRVA based on a series of C2 vertebral morphological parameters including the C2 isthmus height (C2IsH) and C2 internal height (C2InH). Also, the prevalences of each HRVA type and coexisting NP based on the C2 pedicle width (C2PW). METHODSHRVA was defined as C2IsH of ≤5 mm and/or C2InH of ≤2 mm measured 3 mm lateral to the lateral border of the spinal canal. A narrow pedicle was defined as C2PW of ≤4 mm. Measurements were done using Syn.govia software. Interobserver, intraobserver, and inter-software agreement coefficients for C2IsH, C2InH, and C2PW parameters were adopted from our previous study. K-means cluster analysis was applied. RESULTSPrevalence of at least 1 HRVA was 24.9% (n=113 subjects) and 16.2% of PSIS (n=147 sites). Based on the measurements and K-means clustering, the following 3 types of HRVA have been distinguished: type 1—isthmic with only C2IsH being reduced and normal C2InH; type 2—internal with only C2InH being reduced and C2IsH within normal limits; type 3—isthmo-internal with both C2IsH and C2InH being reduced. Kruskal-Wallis test followed by unadjusted and Bonferroni-adjusted post-hoc multiple comparison analysis detected significant differences across the types. The prevalences of the newly identified types were as follows: 78.2%, 8.8%, and 12.9% for type 1, type 2, and type 3, respectively. 73.9% of type 1 HRVA, 53.8% of type 2 HRVA, and 100% of type 3 HRVA had a concomitant ipsilateral NP. Prediction of the HRVA types by the K-means clustering has been evaluated. Screw placement techniques for each type are proposed and discussed. CONCLUSIONWe present the first classification system for the high-riding vertebral artery distinguishing 3 types based on the large homogenous cohort, which may serve as an adjunct to preoperative planning of C2 instrumentation. External validation of this classification scheme shall determine its further clinical utility.

One stone two birds - Submucosal tunneling endoscopic resection for a large esophageal submucosal mass and esophageal diverticulum.

A-35-year-old woman presented our hospital with half a year's history of solid food dysphagia. An upper gastrointestinal endoscopy revealed a large submucosal mass in an esophageal diverticulum near the gastroesophageal junction. Endoscopic ultrasound (EUS) confirmed a hypoechoic lesion arising from the muscularis propria layer with the size of 25*14 mm. Therefore, submucosal tunneling endoscopic resection (STER) was proposed to remove the large submucosal lesion in addition to targeted septotomy of the esophageal diverticula. A 2-cm longitudinal mucosal access was made at 3 cm above the submucosal lesion, and a submucosal longitudinal tunnel was created until the submucosal lesion revealed using a DualKnife (Olympus, Japan). Meticulous resection was performed with the DualKnife, and the lateral border of the lesion was dissected from muscularis propria layer. It was completely removed the lesion with en bolc resection, and dissected the septum of the diverticulum using the DualKnife. The tunnel access was closed with several hemoclips. Finally, it has been demonstrated to achieve a perfect outcome for the patient. The patient was discharged three days later with symptom resolved on follow-up and to date.

The Significance of Clinical Examination in Diagnosing Oral Squamous Cell Carcinoma

Oral squamous cell carcinoma (OSCC) is a malignant tumor that arises from the squamous epithelium in the oral cavity. Timely identification of this condition is essential for effective treatment and improved patient outcomes. In this regard, clinical examination plays a pivotal role in the accurate detection and diagnosis of oral lesions, particularly OSCC located on the lateral border of the tongue. This case report aims to underscore the significance of a thorough clinical examination as an effective method for screening and diagnosing OSCC on the lateral border of the tongue. A precise and systematic clinical examination is crucial for the early detection of OSCC on the lateral border of the tongue, achieved through diligent visual assessment and careful palpation of suspicious areas. Emphasizing this approach by dental professionals enhances early diagnosis rates, leading to improved clinical outcomes and prognosis for patients affected by this severe condition.

Tongue Ulceration as a First Symptom of Pulmonary Tuberculosis: A Case Report.

Since the introduction of effective chemotherapy, the development of new diagnostic tools, and raising public awareness of the devastating health, social, and economic consequences of tuberculosis (TB), the frequency of this disease has decreased. Pulmonary TB is the most common form of the disease, but TB bacilli can spread to other organs including lymph nodes, and the oral cavity especially the tongue with very unusual features. Oral lesions, although rare, are very important for early diagnosis and interception of primary TB. The bacteriological and histopathological results are important to confirm the diagnosis. Oral TB lesions may be either primary or secondary. The evolution is generally good under a medical treatment. A 35-year-old patient was admitted to our department for an ulcerous tumor in the lateral border of his tongue. The biopsy of the ulceration confirmed the diagnosis of TB. A concomitant pulmonary localization has been found. This case report aims to attract the attention of TB, which can be located in some uncommon regions, and have unusual clinical presentations.

The presence of an aberrant anterior tibial artery does not depend on the patient's morphotype.

The aberrant anterior tibial artery (ATA) runs along the posterior surface of the tibial cortex making it, particularly, at risk during high tibial osteotomy (HTO). This study aimed to analyze the prevalence of the ATA according to global morphotype and its anatomical features in consideration of knee surgery. This retrospective study included 1589 knees on magnetic resonance imaging (MRI) studies with long-leg radiographs. The anatomical characteristics of the ATA, its distance in surgical areas at risk and its lumen were defined on MRI. Its presence according to the patient's morphotype (varus, valgus or neutral) was assessed using a χ2 test. The ATA was present in 33 of 1589 knees, resulting in a prevalence of 2.1%. The anteroposterior distance of the ATA to the tibial head was 6.6 ± 2.5 mm at the height of the tibial plateau, 2.7 ± 1.6 mm at the footprint of the posterior cruciate ligament and 1.0 ± 0.6 mm under the top of the fibula (p < 0.01). For these three levels, the ratio between the distance from the ATA to the lateral tibial border and the total tibial width decreases progressively (p < 0.001). The mean lumen area of the ATA was 4.2 ± 2.5 mm2, and the lumen of the popliteal artery was 9.2 ± 3.6 mm2, representing a ratio of 49.4 ± 27.0%. The prevalence of ATA was similar between varus and valgus patients (n.s). The presence of an ATA is rare, found in one out of 50 cases, but can be easily identified on MRI in patients before knee surgery, especially before HTO. The patient's morphotype did not influence its presence, the lumen diameter is highly variable and its clinical impact has yet to be determined. Cross-sectional study. Level 3.

Unilateral and Bilateral Axillary Arches in Male and Female Cadavers

Among sixteen donors (32 axillae) dissected in our gross anatomy lab, axillary arch was incidentally observed in three cases (five axillae). In three cases, the axillary arch was observed in five axillae-bilateral in one male and one female donor, and unilateral in one male donor. In all the three cases, the five arches consisted of muscular and connective tissue (aponeurotic/tendinous) parts. The muscular parts originated as slips from the lateral borders of the latissimus dorsi muscles and their connective tissue parts ascended and crossed anterior to the axillary neurovascular bundles to attach to various non-osseus structures on the proximal aspects of the arms. This created a canal dorsal to the axillary arch (designated here as axillobrachial canal or ABC) through which the axillary neurovascular bundles ran to enter the proximal aspect of the arms. The presence of such variant fibromuscular slip can be a cause of neurovascular compression syndrome of the upper limb and may complicate surgical procedures in the axillary region. Therefore, it should be considered in the differential diagnosis of neurovascular compression syndromes of the upper limb and axillary mass to avoid misdiagnosis and unintended damage or injury causing complications.

Relation of Transversus Abdominis to Rectus Abdominis Muscle in Various Anatomical Landmark Levels: A Cadaveric Study

Abstract Background Posterior Component Separation (PCS) is a surgical technique used in abdominal wall reconstruction. Understanding the relationship between the rectus abdominis and transversus abdominis muscles and the location of intercostal nerves is crucial for minimizing nerve injury during PCS. This cadaveric study aimed to investigate these anatomical relationships and propose practical guidelines for safer PCS procedures. Methods Eighteen fresh cadavers were dissected to assess the overlap or separation of the rectus abdominis and transversus abdominis muscles at seven abdominal levels. The distance of intercostal nerves from the lateral border of the rectus abdominis was measured. Results The study found that the muscles overlapped at the xiphoid and upper abdominal levels but began to separate below the 2/4 upper to umbilicus level. Intercostal nerves entered at varying distances from the lateral edge of the rectus abdominis, suggesting that levels above the 3/4 upper to umbilicus level are relatively safe for dissection. Conclusion The study recommends initiating the first incision for PCS between the subxiphoid and 2/4 upper to the umbilicus, based on observed muscle relationships and nerve distances. This practical approach enhances safety and simplifies decision-making during surgery.