Anatomical Variations Research Articles

Relation of native acetabular anteversion to the orientation of transverse acetabular ligament.

Precise positioning of the acetabular component during total hip replacement is the key to achieving optimal implant function and ensuring long-term patient comfort. However, different anatomical variations, degenerative changes, dysplasia, and other diseases make it difficult. In this study, we discuss a method based on the three-dimensional direction of the transverse ligament, predicting native acetabular anteversion with higher accuracy. Angular positions of the acetabulum and direction of the transverse ligament were automatically calculated from routine computed tomography data of 270 patients using a registration algorithm. The relationship between acetabular angles and ligament direction and their relationship with sex, age, and pelvic tilt were sought. These relationships were then modelled using multilinear regression. Including the direction of the transverse ligament in the sagittal and transverse planes as a regressor in the multilinear model explained the variation in acetabular anteversion (R2 = 0.76 for men, R2 = 0.63 for women; standard deviation in prediction: men, 3.92° and women, 4.00°). The results indicate that the ligament was suitable as a guidance structure almost insensitive to the ligament in the sagittal and transverse planes must be considered. Estimation based on the direction in only 1 plane was not sufficiently accurate. The operative acetabular inclination was not correlated with the direction of the ligament. The correlations were higher in men than in women.

Why do thoracic epidurals fail? A literature review on thoracic epidural failure and catheter confirmation.

Thoracic epidural anesthesia (TEA) has been the gold standard of perioperative analgesia in various abdominal and thoracic surgeries. However, misplaced or displaced catheters, along with other factors such as technical challenges, equipment failure, and anatomic variation, lead to a high incidence of unsatisfactory analgesia. This article aims to assess the different sources of TEA failure and strategies to validate the location of thoracic epidural catheters. A literature search of PubMed, Medline, Science Direct, and Google Scholar was done. The search results were limited to randomized controlled trials. Literature suggests techniques such as electrophysiological stimulation, epidural waveform monitoring, and x-ray epidurography for identifying thoracic epidural placement, but there is no one particular superior confirmation method; clinicians are advised to select techniques that are practical and suitable for their patients and practice environment to maximize success.

EP361 - Left Sided Gall Bladder: A Surgical Surprise

Abstract Laparoscopic cholecystectomy is a minimally invasive surgical procedure used for the removal of a diseased gallbladder. Since the early 1990s, this technique has largely replaced the open technique for cholecystectomies. We present a unique incident where a left-sided gallbladder was incidentally discovered during a laparoscopic cholecystectomy, posing a technical challenge for the surgeon. Our patient was a 34-year-old female who visited our hospital with complaints of right upper abdominal pain and postprandial nausea lasting for three months. Ultrasound examination revealed two gallstones measuring 16mm and 13mm in the neck of the gallbladder. During the routine laparoscopic cholecystectomy, the surgeon encountered a left-sided gallbladder. To ensure a safe and effective dissection, an additional port was required during the surgical procedure. The prevalence of this rare congenital anomaly, known as a left-sided gallbladder, ranges from 0.1% to 0.7%. It is characterized by the gallbladder being located on the left side of the ligamentum teres and falciform ligament, with the cystic artery passing in front of the common bile duct from right to left. This anatomical variation is often associated with abnormalities in the biliary tree and the porto-venous system. Failing to recognize these variations can lead to serious complications, particularly in hepatobiliary surgery. Discovering a left-sided gallbladder during surgery is an infrequent finding that can increase the complexity and morbidity rate of the procedure.

A rare combined variation of left renal vasculature in a human cadaver: embryological basis and clinical significance.

Classically, a single renal artery supplies, and a single renal vein drains each kidney. The morphology and variations in the renal vascular structures are of great importance when performing any type of renal surgery. The present case describes a rare combination of renal vasculature variation in a formalin-fixed, Chinese male cadaver. In this case, the left kidney is drained by a main renal vein (MRV) and an inferior renal vein (IRV), the latter might be the remnant of the left dorsal renal vein during the embryonic period. Two sets of renal arteries are present in this case, possibly due to persistent mesonephric arteries during embryonic development. Describing such anatomical variations is not only of academic interest but also important to help radiologists with the correct interpretation of image examinations and for surgeons to be prepared in advance.

A Monograph on Anatomy and Variants of Hepatic Resectional Surgery

BACKGROUND: The liver anatomy appears to be very complex due to the enormous number of vascular and biliary branches as well as the fact that the underlying pathology frequently distorts the anatomy. To prevent damage during surgical or invasive procedures, it is advised to be aware of the arteries’ typical structure and variations. Hepatic surgeons, general surgeons, transplant surgeons, interventional radiologists, and other medical specialists who treat liver problems must have this knowledge. MATERIALS AND METHODS: We have retrospectively evaluated the PubMed databases, Embase, and the Cochrane Library by applying various combinations of subject-related terms. The search terms identified with the medical subject heading were “Anatomy, right hepatectomy, resection, variants.” The databases were used to collect the literature published since 1991. RESULTS: Results delineated that 91.6% of patients had a single right hepatic vein, 81% shared a trunk with their middle hepatic vein (MHV) and left hepatic vein (LHV), and 19% had separate MHV and LHV drainage into the inferior vena cava. Overall prevalences of the abnormal hepatic artery, abnormal right hepatic artery (aRHA), abnormal left hepatic artery (aLHA), and combined aRHA/aLHA were found to be 27.41%, 15.63%, 16.32%, and 4.53%, respectively. The most common variation (type 2) is the so-called “portal vein (PV) trifurcation,” in which the main PV divides into the left PV, the right anterior PV, and the right posterior PV. The right posterior sectoral duct joins the left hepatic duct with a supraportal course, the right posterior sectoral duct joins the right anterior sectoral duct with an infraportal course, the trifurcation variation of the biliary tree, retroportal course, and the left lateral segmental ducts caudal to the umbilical portion of the PV are examples of variant biliary anatomy encountered in PV variations. Duplication of the common bile duct is a very uncommon congenital biliary system defect. CONCLUSION: It is very crucial for surgeon to have abreast knowledge of the tributaries, their anatomy, and variations to limit blood loss and operative morbidities.

The Role of CT Angiography in Designing a Hair-Bearing Superficial Temporal Artery Flap for Eyebrow Reconstruction.

The hair-bearing superficial temporal artery flap is one of the traditional options for total eyebrow reconstruction. The anatomical variation of the superficial temporal artery has been well discussed; however, the anatomy of the superficial temporal vein is highly diverse. The authors report the use of preoperative computed tomography (CT) angiography in a 27-year-old man with a total eyebrow defect caused by thermal burn injury. The authors harvested a 6×1.5-cm pedicled hair-bearing superficial temporal artery flap from the area where the parietal branches of the superficial temporal artery and vein were running in close proximity, according to the CT angiography findings. Postoperatively, the flap survived completely without any vascular compromise. The authors believe that preoperative visualization of the superficial temporal vessels with CT angiography is highly beneficial in performing safe eyebrow reconstruction with a hair-bearing superficial temporal artery flap.

Nanoceria-induced variations in leaf anatomy and cell wall composition drive the increase in mesophyll conductance of salt-stressed cotton leaves

Nanomaterials as an emerging tool are being used to improve plant's net photosynthetic rate (AN) when suffering salt stress, but the underlying mechanisms remain unclear. To clarify this, a hydroponic experiment was conducted to study the effects of polyacrylic acid coated nanoceria (PNC) on the AN of salt-stressed cotton and related intrinsic mechanisms. Results showed that the PNC-induced AN enhancement of salt-stressed leaves was strongly facilitated by the mesophyll conductance to CO2 (gm). Further analysis showed that the PNC-induced improvement of gm was related to the increased chloroplast surface area exposed to intercellular airspaces, which was attribute to the increased mesophyll surface area exposed to intercellular airspaces and chloroplast number due to the increased K+ content and decreased reactive oxygen species level in salt-stressed leaves. Interestingly, our results also showed that PNC-induced variations in cell wall composition of salt-stressed cotton leaves strongly influenced gm, especially, hemicellulose and pectin. Moreover, the proportion of pectin in cell wall composition played a more important role in determining gm. Our study demonstrated for the first time that nanoceria, through alterations to anatomical traits and cell wall composition, drove gm enhancement, which ultimately increased AN of salt-stressed leaves.

Digital analysis of the human maxilla to enable semistandardized template tool reconstructions with free fibula transplants

ObjectivesThis study analyzed the human maxilla to support the development of mean-value-based cutting guide systems for maxillary reconstruction, bridging the gap between freehand techniques and virtual surgical planning (VSP).Materials and methodsThis retrospective cohort study used routine CT scans. DICOM data enabled 3D modelling and the maxilla was divided into four regions: paranasal (R1), facial maxillary sinus wall (R2), zygomatic bone (R3) and alveolar process (R4). Surface comparisons were made with a reference skull. Statistical analyses assessed anatomical variations, focusing on mean distance (Dmean), area of valid distance (AVD), integrated distance (ID) and integrated absolute distance (IAD). The study addressed hemimaxillectomy defects for two-segmental reconstructions using seven defined bilateral points to determine segmental distances and angles.ResultsData from 50 patients showed R2 as the most homogeneous and R4 as the most heterogeneous region. Significant age and gender differences were found in R3 and R4, with younger patients and females having more outliers. Cluster analysis indicated that males had R1 and R3 positioned anterior to the reference skull. The mean angle for segmental reconstruction was 131.24° ± 1.29°, with anterior segment length of 30.71 ± 0.57 mm and posterior length of 28.15 ± 0.86 mm.ConclusionsAnatomical analysis supported the development of semistandardized segmental resection approaches. Although gender and anatomical differences were noted, they did not significantly impact the feasibility of mean-value-based cutting-guide systems.Clinical relevanceThis study provides essential anatomical data for creating cost-effective and efficient reconstruction options for maxillary defects, potentially improving surgical outcomes and expanding reconstructive possibilities beyond current techniques.

Bilateral internal carotid artery agenesis coexisting with bovine aortic arch: case report and literature review.

This case study aims to elucidate the rare occurrence of bilateral internal carotid artery agenesis combined with a bovine aortic arch. The main objectives are to explore the incidence, embryological origins, clinical manifestations, and associated anomalies of this unique vascular condition. The study involves a detailed investigation of a 55-year-old male with a history of recurrent transient ischemic attacks (TIAs) using MRI and CT scan. The patient's medical history, clinical examination, and imaging results were systematically analyzed to provide a thorough understanding of the anatomical variations. The main findings include the rare coexistence of bilateral ICA agenesis and a bovine aortic arch, making this the 39th documented occurrence of bilateral ICA agenesis and the first recorded instance of its association with a bovine aortic arch. Also, the study highlighted the demographic characteristics, clinical presentations, and associated anomalies observed in the 38 documented cases of bilateral internal carotid artery agenesis. This case report contributes valuable insights into the rarity of bilateral internal carotid artery agenesis and its unprecedented association with a bovine aortic arch. The findings emphasize the importance of heightened anatomical awareness in clinical practice, particularly. Recognizing and understanding such variations is crucial for accurate diagnosis, appropriate management, and improved patient outcomes. Further research in this area is warranted to deepen our understanding of these complex vascular anomalies.

Comprehensive Review of the Psychosocial Impact on Parents of Newborns With Congenital Heart Disease: A Significant Problem in Low- and Middle-Income Countries.

Congenital heart disease (CHD) is a common and significant congenital disorder. Despite advancements in neonatal care, Congenital heart disease remains a leading cause of death among infants with congenital malformations. Congenital heart disease is responsible for a significant portion of stillbirths and includes several forms with various anatomical variations. A CHD diagnosis leads to significant emotional distress for parents, affecting family dynamics and quality of life. Parents often experience psychological impacts, such as anxiety, depression, and guilt, particularly when diagnoses occur after birth. This literature review explores the psychosocial impact of CHD on families and examines how the timing of diagnosis influences outcomes. Parents face numerous challenges, including managing complex medical care and addressing financial and emotional burdens. Effective communication between healthcare providers and families is crucial, as is providing continuous emotional support and counseling. Early psychological interventions can alleviate depression and anxiety, and pediatric psychologists play a significant role in reducing the negative long-term effects on neurodevelopment. Further research is needed to develop strategies to improve mental health services and enhance the quality of life for families affected by CHD.

An unreported accessory muscle on the neck region

Anatomical variations or accessory muscles on the neck region are important for clinicians and surgeons. This case report aims to contribute to the literature by demonstrating the presence of a previously unrecognized muscle on the lateral neck region. During routine gross anatomy dissection of a 59-year-old male cadaver; an unreported muscle was observed next to the scalene muscles on the left lateral neck region. The distance between the center of the scalenus medius and the insertion of the muscle was 6.17 cm, and the distance between the scapular notch and the insertion of the muscle was 1.56 cm. The distance between the aponeurosis that connects the superior and the inferior bellies of the omohyoideus muscle and the first head of the muscle was 6.24 cm. This anatomical formation, which is not included in the literature, has anatomical and clinical importance in controversial clinical cases in neck pathologies.

The neurocranium of Potamotrygonidae: morphology and phylogenetic significance

Abstract The family Potamotrygonidae is part of the Neotropical ichthyofauna and has the largest diversity of freshwater elasmobranchs in the world. The neurocranium in Potamotrygonidae is an elongated and dorsoventrally flattened structure that articulates anterolaterally with the anterior portion of the propterygium, posteriorly with the sinarcual, and posterolaterally with the hyomandibula. This anatomical structure is comparatively described in Potamotrygonidae in an effort to reveal new phylogenetically relevant characters. Additionally, a new genus-level phylogeny of the family is proposed herein based on 60 novel morphological characters. The subfamily Potamotrygoninae, whose monophyly is well sustained by previous studies, is further supported herein by a variable number of cranial synapomorphies (up to 17), depending on the optimization adopted. Furthermore, we also recovered Potamotrygon and Plesiotrygon as consecutive sister-groups to a clade including Heliotrygon and Paratrygon. The neurocranium of potamotrygonids and its anatomical variation is also discussed in the context of previous morphological and molecular phylogenies of Neotropical freshwater stingrays.

Non-osseous coalition of accessory anterolateral talar facet-A case series.

The accessory anterolateral talar facet (AALTF) is an anatomical variation that broadens the apex of the lateral talar process. Studies have associated it with other tarsal coalitions as a cause of rigid painful flatfoot. However, a coalition of an AALTF has never been described before. With the advent of MRI, there has been an increase in the detection of these accessory facets. Nevertheless, owing to its small size and unfamiliarity, it is not easily identified. Proper assessment of imaging findings and associated conditions is needed to confirm the diagnosis. Imaging findings in a series of four patients with painful rigid flatfoot revealed the presence of an AALTF with adjacent marrow edema and reduced joint space. This was associated with hindfoot valgus and subfibular impingement. Radiographic suspicion of a non-osseous coalition of AALTF was raised, which was confirmed intraoperatively in one of the patients and demonstrated on CT and MR images in the other patients. This case series presents rare cases of non-osseous coalition of AALTF with a new radiographic sign, the 'reverse tip of the iceberg sign'.

Frequency of bile duct variant anatomy on MRCP on 3.0t in liver donors.

Objective: To determine the frequency of bile duct variant using magnetic resonance cholangiopancreatography (MRCP) on a magnetic field strength of 3.0 Tesla in liver donors. Study Design: Descriptive Cross-sectional study. Setting: Department of Radiology, Armed Forces Institute of Radiology and Imaging, Military Hospital Rawalpindi. Period: May 2019 to November 2019. Methods: The research comprised people who went to the hospital for magnetic resonance cholangiopancreatography. 85 liver transplant recipients between the ages of 20 and 70 were chosen for the research. According to Yoshida categorization, bile duct variation was noted. The MRCP methodology includes multiplanar imaging, maximum intensity projection pictures, thin slab axial HASTE, thick slab coronal HASTE, and T2 3D sequence. The Siemens Avanto 3 Tesla machine was used for the study. Results: The study's participants ranged in age from 20 to 70, with a mean age of 41.73 ± 10.03 years. The majority of the 54 patients (63.53 percent) were aged 20 to 45. The male to female ratio was 1:1 among the 85 patients, with 43 (50.59 percent) men and 42 (49.41 percent) women. In my research of liver donors, 57 (67.05 percent) showed normal biliary tree structure and 28 (32.95 percent) exhibited abnormalities. Conclusion: This study concluded that normal biliary tree anatomy was seen in 67.05% and 32.95% had variations in biliary anatomy on MRCP on 3.0T in liver donors.

Anatomical Factors Affecting the Complexity of Maxillary Sinus Augmentation in Saudi Patients: A Cone Beam Computed Tomography (CBCT) Study.

This study aims to evaluate the anatomical variations of the maxillary sinus and determine the difficulty score of maxillary sinus augmentation (MSA) in Saudi patients seeking dental implant rehabilitation of the posterior maxilla using cone beam computed tomography (CBCT). CBCT records of dental patients seeking treatment at a University Dental Teaching Hospital between 2019 and 2023 were retrospectively analyzed. Measurements were obtained from CBCT images, including membrane thickness, sinus width, buccal bone thickness, presence of maxillary sinus septa, residual alveolar ridge height, angle of the buccolingual sinus wall, and the presence of the alveolar antral artery (AAA). The difficulty score for MSA was determined based on these anatomical factors. A total of 107 maxillary sinuses in 86 subjects were evaluated. The average membrane thickness was 2.23 mm, with males showing significantly higher thickness than females. Sinus septa were found in 54 (50.5%) sinuses, with 18 (17%) of sinuses having interfering septa. Twenty-three (21.5%) sinuses had a residual alveolar ridge height of less than 4 mm. The average angle of the buccolingual sinus wall was 79.39°, indicating a high prevalence of wide-shaped sinuses. The average sinus width was 14.09 mm, with 55 sinuses (51.4%) less than 15 mm. The average buccal bone thickness was 1.07 mm, in29 (27%) sinuses, the thickness was more than 2 mm. AAA was visualized in 60 (56%) of sinuses, with 45 (42%) of sinuses having AAA interfering with the MSA window. In this study, most sinuses were classified as simple or moderate difficulty, with higher membrane thickness, presence of septa, and AAA being the significant risk factors for complications. These findings provide valuable insights for implant surgeons in Saudi patients seeking dental implant rehabilitation of the posterior maxilla, enabling them to anticipate and minimize potential complications during MSA procedures.

Left atrial septal pouch thrombus: An unusual cause of an embolic stroke

Key Clinical MessageLeft‐atrial septal pouch (LASP) is a newly described anatomical variant caused by incomplete fusion of the septa primum and secundum. This case visualizes LASP as a potential nidus for blood stasis and cardiac embolism and highlights the need for consideration of TEE in the work up of cryptogenic stroke.

Reappraisal of the Variations in the Origin of the Obturator Artery With Clinical and Developmental Perspectives: A Cadaveric Analysis.

Background The obturator artery (OA), typically originating from the anterior division of the internal iliac artery (ADIIA), shows significant variability in its origin. Such variations can present clinical challenges during pelvic surgeries, potentially causing unnoticed bleeding and complicating effective treatment. This study aims to thoroughly document the diverse anatomical variations of the OA and explore their implications for surgical practice. Materials and methods Forty-eight hemipelvis specimens from adult human cadavers were dissected. The origin of each OA was meticulously documented, photographed, and analyzed descriptively. Results In 38 specimens (79.2%), the OA originated from the IIA. It branched off at various levels from either the ADIIA or the posterior division of the IIA (PDIIA), either individually or in combination with other named branches. In nine cases (18.8%), the OA originated directly from the external iliac artery (EIA), either as a distinct branch or alongside the inferior epigastric artery (IEA). Additionally, one specimen (2%) exhibited a dual origin involving both the ADIIA and the IEA. Conclusion These findings highlight the frequent anatomical variations in the origin and pathway of the OA. Understanding these variations is crucial for accurately assessing pelvic anatomical relationships, which is essential for effective surgical planning and ensuring procedural safety. This knowledge is particularly important during vascular and surgical procedures, as it can impact the risk of bleeding and the effectiveness of treatment strategies.

Evaluation and Management of Idiopathic Unilateral Footdrop.

We evaluated patients who were followed after acutely developing single-sided footdrop and improving with conservative management or spontaneously. In 2019 and 2020, ten patients were retrospectively evaluated for unilateral weakness of the lower extremity in the form of absent dorsiflexion at the ankle joint and were given a diagnosis of footdrop without etiologic cause. Patients were followed for 18 months. Patients were evaluated for acute footdrop of the affected extremity with electromyography, lumbar spine magnetic resonance imaging (MRI), knee MRI, peripheral MRI neurography, and noncontrast brain MRI. Each patient was evaluated for a history of COVID-19 infection during the past year. Patients with any identified cause were excluded. Initial evaluation of muscle strength revealed 0/5 by the Medical Research Council muscle testing scale. In two patients, muscle strength was 3/5 at month 6 and in eight patients it was 4/5. Muscle strength of all of the patients improved to 5/5 at 1 year. Six patients were dispensed an ankle-foot orthosis, and nine patients performed physical therapy. Electromyography identified significant neuropathy at the level of the common peroneal at the fibular head in all of the patients. Compared with peroneal nerve stimulation below and above the fibular head in the lateral popliteal fossa, a 50% reduction in sensory amplitude and motor conduction slowing greater than 10 m/sec were present. Knee MRI revealed no masses, edema, or anatomical variations at the level of the fibular head. Spontaneous resolution of unilateral acute footdrop without an etiologic cause can occur within 1 year.

Phlebactasia A Unique Anatomical Variation: A Case Series

Background Internal jugular vein (IJV) ectasia is an uncommon condition, often presenting as a soft, compressible neck swelling that exacerbates with actions increasing intrathoracic pressure, such as straining or coughing. This condition typically affects one side of the neck and is more common in children and young adults. The IJV plays a crucial role in draining the head and neck and is an important surgical landmark for various structures. Deviations from normal IJV anatomy due to embryological dysgenesis can lead to significant clinical implications, particularly during surgical procedures. This article presents four cases of patients who were incidentally found to have abnormal IJV during neck dissection for head and neck cancers. These cases highlight the importance of recognizing IJV variations to avoid surgical complications. The discussion includes the anatomy and function of the IJV, the rare condition of phlebectasia, and the potential complications of such anomalies. Increased awareness and further research into these anatomical variations are necessary to improve surgical outcomes and reduce morbidity

Preoperative Cone Beam Computed Topography Assessment of Maxillary Sinus Variations in Dental Implant Patients.

The study included a cohort of 200 patients recommended for CBCT as part of their preoperative evaluation. The methodology involved detailed CBCT image analysis to identify and document various anatomical variations due to pneumatization, exostosis, hypoplasia, polyps, cysts, foreign bodies, and anthroliths within the maxillary sinus. Pneumatization was the most common variation, present in 77.5% of subjects. Polypoid lesions were found in 17.5% of patients, with a higher prevalence in younger age groups (57.1% in ages 20-35). Cysts and polyps affected 17.5% of subjects, predominantly males (65.7%). Anthroliths were observed in a minimal percentage (2%), and foreign bodies were found in 1.5% of the patients. Positive correlations were observed between the patient's age and both mucosal thickness and polypoid lesions and between the patient's gender and bone thickening (p-values < 0.05). The study concluded that CBCT is essential in the preoperative assessment of the maxillary sinus in dental implant candidates due to its superior imaging capabilities, allowing for the identification of critical anatomical variations and pathologies. This thorough evaluation is imperative to ensure the success of implant placement and to mitigate potential complications. However, further research with larger, more diverse populations is recommended to confirm these findings.