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PURPOSE: This study was conducted to demonstrate morphological pattern of the ulnar artery and to evaluate morphometrically its anatomical branching pattern in human fetuses. METHODS: Branching pattern of ulnar artery was evaluated on 121 upper limbs of dissected 63 of formalin-fixed fetus cadavers with gestational age ranging from 17 to 40 weeks. In order to obtain second and third trimester data, according to their gestational age, two groups were determined. RESULTS: In 79 of all 121 upper limbs (65%) ulnar artery gave anterior and posterior ulnar recurrent arteries as separate branches. In this study frequency of presence of a median artery was 46.28% among total examined 121 upper limbs. Median arteries originated from ulnar artery (3.57%) and from the common interosseous artery (53.57%) and anterior interosseous artery (42.85%). Mean distances of the measured parameters were demonstrated according to the gestational age and differences between group I (second trimester) and group II (third trimester). No statistical difference for groups was observed for gender and between right and left sides. CONCLUSIONS: Ulnar artery shows predictable patterns during second and third trimester of fetal period and can be suitable access effective alternative for diagnostic and therapeutic coronary interventions. Persistent median artery is important variation and knowledge of its incidence is important for diagnostic difficulties and also during awareness of its injury during surgical approaches.

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BACKGROUND: The differences at the attachment site of peroneus brevis (PB) to the fifth metatarsal bone is important in terms of the forces exerted on the bone and hence the mechanism of fractures involving this structure. In this study, we investigated the anatomical properties of PB at the insertion site to the base of fifth metatarsal bone, its possible intertendinous connections with peroneus tertius (PT) and their possible effects on the fracture occurrence at the bony attachment site. METHODS: The length and the width of PB tendons at their mid- and end-points were measured and classified according to the insertion types. Besides, the length and the width of the base of fifth metatarsal bone were assessed. The slips extending from the PB tendons and their relationship with PT were also evaluated. The data was compared statistically with each other and between the right and left sides. RESULTS: The length of PB tendon was measured 79.57±15.40mm on the right side; 81.48±14.31mm on the left. The width of PB tendon at the mid-point was 4.46±0.80mm on the right side; 4.42±0.94mm on the left. The width of the tendon at its insertion point was measured 14.85±3.40mm and 15.16±3.42mm on the right and left sides respectively. PB was divided into three types according to its attachment to base of fifth metatarsal bone (5thMB). Type I, Type II and Type III were observed at the rates of 59.5%, 28.6% and 11.5% respectively. It was observed that the slips to the bone were extending more commonly from PB than from PT and that the large majority of them were single having their insertions on the base of the proximal phalanx of the fifth toe. CONCLUSIONS: Knowing the width and insertional types of PB aids in understanding the mechanism of fractures at the site of bony attachment. The existence of slips may help the surgeon in the procedures involving PB or the lateral side of the forefoot.

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The present study was performed to describe the morphologic characteristics of the peroneus tertius (PT) tendon, evaluate the variations in its insertion point, investigate the interconnections with the tendons of the extensor digitorum longus, and discuss whether these insertion differences of the muscle tension might have an effect on fracture formation. The length and width of the PT tendon and the width at its midpoint were measured in 44 lower extremities. The data obtained were compared statistically. The PT was found to occur in 2 types according to the number of tendons: type 1, a single tendon without a slip; and type 2, 2 tendons with a slip. It has been suggested that the PT tendon could contribute to avulsion fractures of the tuberosity of the fifth metatarsal bone. Therefore, to understand the mechanism of Jones fracture, knowledge of the PT tendon would be beneficial to determine the insertion points.

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The aim of this study was to examine the morphology of submandibular fossae at edentulous posterior regions of dried mandibles and to determine a safe range for proper lingual angulation during the placement of a dental implant in the posterior mandibular region, with a computerized tomographic scan study. Spiral computed tomographic images of 77 dry adult human mandibles were evaluated to determine the deepest area in the submandibular fossa. Then, the proper lingual angulations for the placement of a dental implant at these regions were measured. Pearson's correlation coefficient was calculated to show the relation between the depths of submandibular fossa and lingual implant angulations. "Paired t test" was used for differences between the lingual implant angulations and the depths of submandibular fossa on each side of the mandibles. Depths of the submandibular fossa and lingual implant angulations were varied between 1.1 and 4.6 mm: 62°-84° on right side of the mandibles, and 1.1-4.5 mm, 65°-83° on left side of the mandibles. There were statistically medium negative correlations between the degree of lingual implant angulations and the depth of submandibular fossa on each side of the mandible (r = -0.44, p < 0.001, and r = -0.38, p = 0.001). There was a statistically significant difference between the right and left sides of the mandibles in terms of the depth of submandibular fossa (p = 0.01). Within the limits of this study, the depth of submandibular fossa was measured as ≥ 2 mm in around 71.5 % of examined regions, and lingual implant angulations were between 62° and 84°. These results may be considered by clinicians who are planning the dental implant placement in posterior mandible to avoid potential risk of lingual cortical plate perforation.

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OBJECTIVE: Medial canthal ligament (MCL) and lacrimal system are often associated with naso-orbitoethmoidal fractures. The MCL anchors tarsal plate to medial orbit and has an important role in lacrimal pump system. The purpose of this study was to describe the anatomy of the MCL and present the anthropometric measurements on cadaveric specimens. METHODS: Dissections were performed on 14 formalin-fixed cadavers. The length, thickness, width of the MCL, width of the nasal dorsum, and intercanthal distance were measured with a digital caliper. A surgical microscope and an digital photo camera were used in all dissections. Means, SDs, and paired-samples t test were computed. RESULTS: The mean lengths of the right and left MCLs were measured as 8.01 (SD, 2.27) and 7.93 (SD, 2.43) mm. The mean thicknesses of the right and left MCLs were 1.63 (SD, 2.41) and 1.75 (SD, 2.44) mm. The mean widths of the right and left MCLs were 4.20 (SD, 0.75) and 4.17 (SD, 0.61) mm. The intercanthal distance was 31.7 (SD, 1.7) mm. The width of the nasal dorsum was measured as 14.37 (SD, 1.9) mm. Length and thickness differed on both sides. Asymmetric insertion of medial canthi was observed in 5 specimens. CONCLUSIONS: Reconstruction of traumatic telecanthus requires reaproximation of medial canthi and the displaced nasoethmoid bony fragment with transnasal wiring or microplates. Identification and reconstruction of detached medial canthi could be accomplished successfully with anatomic familiarity of the region. The most developed and firmly adherent was the anterior limb of the MCL. Reattachment of that part seems to be adequate for repair of a detached canthus.

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The aim of this study is to evaluate the anesthetic efficacy of mylohyoid and buccal nerve anesthesia at the posterior edentulous mandible versus regional anesthetic block to the inferior alveolar nerve in dental implant surgery. The study was composed of 2 groups. In the first group (group A), 14 voluntary adults (7 female and 7 male) received local infiltrations of 1 mL articaine HCl 4% with epinephrine 1/200,000 to the ipsilateral mylohyoid and buccal nerves. In the second group (group B, control; 9 female and 5 male adults), the inferior alveolar and the buccal nerve blocks were performed. Visual analog scales were obtained from patients to determine the level of pain during incision, drilling, implant placement, and suturing stages of implant surgery. A combination of buccal and mylohyoid nerve block offered an acceptable level of anesthesia. Two patients from group A stopped the ongoing surgery and had extraregional anesthesia by inferior alveolar nerve block. In group B, patients were operated on successfully. Local anesthetic infiltrations of the mylohyoid and the buccal nerve may be considered alternative methods of providing a convenient anesthetic state of the posterior mandibular ridge.

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OBJECTIVES: Mandibular osteotomies and resection of the temporomandibular joint (TMJ) ankylosis are the mostly performed surgical procedures in the infratemporal fossa, which is in close proximity with the main trunk of the maxillary artery (MA). It is imperative to avoid the trunk or branches of the maxillary artery, otherwise, massive intraoperative or postoperative hemorrhage may develop. The goal of the study was to investigate the position of the maxillary artery in the infratemporal fossa and the lingula of the mandible. METHODS: Significant landmarks were selected on the mandibles of formalin fixed cadavers, and the distances were measured between the maxillary artery and the bony landmarks with a digital caliper. RESULTS: The average distances between the MA and the articular eminence, the medial cortex of the mandibular ramus, the inferior border of the pterygoid fovea and the mandibular notch were 1.67+/-0.48 mm, 5.38+/-2.47 mm, 16.84+/-1.74 mm, 2.94+/-0.52 mm, respectively. Course pattern of the MA at the subcondylar level was also mapped. In order to determine the position of the lingula, the average distances between the tip of the lingula and the mandibular notch, the inferior border of the ramus, the anterior margin of the ramus and posterior margin of the ramus were measured and found as 15.4+/-2.1 mm, 49.5+/-4.3 mm, 18.1+/-2.7 mm, 16.6+/-2.5 mm, respectively. No significant differences were found between the right and left sides, for all parameters. CONCLUSIONS: The studied parameters will assist and navigate clinicians to determine the anatomic proximity to the maxillary artery, and, minimize the risk of damaging the vessel.

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We aimed to make first demonstration of the course and branching pattern of deep branch of the radial nerve (DBRN) in relation to the supinator muscle in the forearms of fetuses and make morphological measurements in both fetuses and adults. We carried out dissection on 80 radial nerves from 20 adult cadavers (16 males and 4 females), ranging from 30 to 56 years old and 20 formalin-fixed, spontaneously aborted fetuses (10 males and 10 females) without detectable malformations, ranging from 20 to 37 weeks of gestation. There were three different branching patterns of the DBRN in fetuses. It divided its terminal branches at entrance of the supinator in 2 (5%), after entry of the supinator in 4 (10%) and after the supinator in 34 (85%) forearms. The course was bilaterally same in fetuses. Dividing pattern at the entrance of the supinator was not seen in adults. Only 4 (10%) were seen at after entering to the supinator and 36 (90%) were seen at after the supinator. We saw in fetuses neither fibrous band deep from the extensor carpi radialis longus nor upper border of the supinator. We assume that these fibrous structures appear after birth, perhaps favored by physical exercise, such as repeated pronation-supination movements. We think that it is one of the reasons why DBRN compression has never been reported in children. This is the first fetal study about the course and branching pattern of the DBRN and there is a constant ratio (mean 4.3) between the measurements of the fetuses and adults.

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Bile ducts of Luschka (also called subvesical or supravesicular ducts) can cause bile leakage during laparoscopic cholecystectomy, especially if surgery is carried out in ignorance of such variations. The aim of this study was to clarify the clinical anatomy of these ducts in human fetuses and frequency of the ducts locating near gallbladder fossa. Thirty-two fetal cadaver livers were dissected and the gallbladders were separated from the livers and ducts were investigated under a surgical microscope. All observed ducts were examined microscopically and connective tissue cords were excluded. Bile ducts of Luschka locating near cystic fossa were found in 7 of 32 fetuses (21.9%). Three of the seven ducts ran towards to liver segment 5 (S5); three ducts were found in the gallbladder fossa; and one duct ran towards to liver segment 4 (S4). Also it was found that three of the seven ducts drained into the subsegmental duct of S5, two ducts drained into the right hepatic duct, one duct drained into the right anterior branch bile duct, and one duct drained into the subsegmental duct of S4. Subvesical ducts running along the gallbladder fossa between the gallbladder and the liver parenchyma were found in a relatively high incidence in fetuses than adults. Awareness and knowledge about incidence of such ducts alerts the surgeon during laparoscopic cholecystectomy. Therefore morbidity due to bile leaks can be reduced.

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Our main aim was to study the mylohyoid nerve, but during cadaveric dissections an unnamed branch of the lingual nerve was encountered incidentally. Dissections of sublingual and pterygomandibular spaces on 13 cadavers preserved in formalin showed an unnamed branch present bilaterally in 11 specimens, which had not been identified before in any of the anatomical textbooks. The branch extended horizontally from the medial mandibular cortex at the level of the retromolar pad to mesial of the lower first molars-second premolars. It was supplying the lingual periosteum, gingiva, and mucosa that were overlying the medial alveolar process. The mean (SD) diameter of the left and right branches was 0.66 (0.1) mm at the branching side. The mean (SD) length of the right and left sides was 28.7 (4.4) mm. The mean (SD) distance from the alveolar crest was 5.8 (0. 9) mm. The lingual nerve supplies the lingual soft tissues; however, none of the anatomical textbooks mention such a subdivision or a branch supplying that part of the oral cavity. We describe the site and the morphological characteristics of this unnamed branch, and recommend that it be named "the gingival branch of the lingual nerve".

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The pudendal nerve is a considerably large branch of the sacral plexus. There are many articles in the literature concerning the pudendal nerve in adults, but as far as we know, there is none on the branching pattern and variations in pudendal nerve anatomy in fetus. This study investigates the pudendal nerve trunking with respect to the piriformis muscle in 25 formalin-fixed fetuses (50 sides of pelves, 15 females, 10 males), ranging from 20 to 37 weeks of gestation. We investigate pudendal nerve trunking in four types: Type I-a is defined as single-trunk with the inferior rectal nerve branching proximal to the dorsal nerve of penis/clitoris (38%), Type I-b is also single-trunk with the dorsal nerve of penis/clitoris branching proximal to the inferior rectal nerve (24%), Type II is double-trunk with medial trunk as an inferior rectal nerve (34%), and Type III is triple-trunk (4%). We measured the average diameter of the main trunk of pudendal nerve in Type I-a and I-b groups to be 0.98 +/- 0.33 mm. We also measured the average length of the pudendal nerve trunks before the dorsal nerve of penis/clitoris branch to be 7.35 +/- 3.50 mm. There was no significant statistical difference in the average length, diameter, number of trunks, and pudendal nerve variations between male and female and also right and left sides of the pelves. This first and detailed fetal study of pudendal nerve trunking with respect to the piriformis muscle would be useful for educational anatomy dissections and anatomical landmark definitions for relevant clinical procedures.

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In this study the authors aimed to show variations of the nutrient artery of the fibula, which is important for more effective vascularized fibular grafts. Thirty intact legs were examined to determine the number, location, and diameter of the nutrient arteries in the shaft. In 27 of these specimens (90%) there was single nutrient artery; two legs (6.6%) had double nutrient artery. In one leg (3.3%) no nutrient artery was observed. The number of nutrient arteries found on each of the surfaces was summarized as follows. Most of the nutrient arteries pierced the fibula at its medial crest, while only one entered from the posterior surface. Most nutrient arteries were near the middle third of the fibula. The most frequent diameter of the nutrient artery was 0.9-1.5 mm. The authors think that their results about the variations of the nutrient artery supplying the fibula will contribute to the clinical and vascular anatomy knowledge.

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During the dissection of the right and left upper limbs of a 70-year-old female cadaver, we encountered combined vascular anomalies. On the left side, we observed the presence of a lateral inferior superficial brachial artery, large anterior interosseous artery and an absence of a radial artery, which is quite a rare anomaly. The lateral inferior superficial brachial artery that arose 39 mm distal to the brachial artery descended to the wrist. The anterior interosseous artery originated from the brachial artery at the level of 12 mm distal to the head of the radius and descended on the anterior aspect of the interosseous membrane with the anterior interosseous branch of the median nerve. On the right side, a trifurcation of the brachial artery was observed. It gave off three terminal branches: the radial, ulnar and a muscular artery at the proximal one-third of the humerus. It is obvious that accurate information concerning unusual patterns of the arteries in the upper limbs is relevant clinically, especially in order to avoid accidental injury or intra-arterial injection.

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In this study, we aimed to investigate some features of the central retinal artery (CRA), which supplies the internal aspect of the retina. The CRA is the main vessel supplying blood to the retina. The origin, course and penetration point of the optic nerve by the CRA were studied in 30 human orbits. We compared the right sides to the left sides on the basis of gender in order to statistically analyse the relation between them. The CRA arose directly from the ophthalmic artery in 28 specimens. In two specimens, however, it arose in common with the medial posterior ciliary artery. When we observed the penetration point (site) of the CRA into the optic nerve, in 28 of 30 (93.3%) cases, the artery entered the nerve from the lower medial aspect and in two (6.7%) cases from the upper lateral aspect. The CRA penetrated the optic nerve between 6.4 and 15.2 mm behind the eyeball and reached the eyeball through the centre of the optic nerve. Because of the small diameter of the artery, it has a high risk of getting damaged during a surgical approach to the orbit. Therefore the anatomical relationships of this artery must be well known.

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The aim of this study was to determine number of ocular vortex veins, their scleral coordinates, and their relationship with nearby extraocular muscles. Sixty intact cadaver orbits having no history of eye or orbital disorders during life were carefully dissected under stereomicroscopic magnification to expose vortex veins and their exit sites from the eyeball. The number of vortex veins per eye varied from four to eight. Eyes having four (35%) or five (30%) vortex veins were observed most frequently. Three eyes (5%) had eight vortex veins. Although the incidence of the vortex veins was variable, there was at least one vein in each quadrant of the sclera. Knowledge of the approximate location of the vortex vein exit sites is very important for surgeons because damage to these veins during eye surgery could produce potential complications, especially choroidal detachment.

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PURPOSE: In this study, we aimed to investigate the muscular bridge between the inferior oblique (IO) and inferior rectus (IR) muscles of the eye. DESIGN: Cohort study. METHODS: The orbits of sixty intact cadavers with no history of eye muscle or orbital disorders during life were carefully dissected to expose the muscular bridge between the IO and IR muscles. Numbers of the bridges, their length and width were recorded. RESULTS: We observed muscular bridge between IO and IR muscles in 6.6% of 60 orbits. They originated from the lateral side of the IR muscle, and joined to posteromedial side of the IO muscle. Mean length and width were 14.2 +/- 6.3 and 1.3 +/- 0.2 mm, respectively. CONCLUSIONS: Muscular bridges were found in 6.6% of orbits dissected. We conclude that muscular bridges are important due to potential cause of failed IO or IR muscles surgery. In this respect, before surgery of the extraocular muscles, the muscular bridges should be kept in mind and demonstrated by computed tomography or magnetic resonance imaging in transverse, sagittal, and coronal planes.

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