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PURPOSE: Atherosclerotic plaques in the brain-supplying arteries are slowly-developing alterations of vascular structures that can lead to neurological impairment due to stenosis and insufficient oxygenation of eloquent brain areas. The aim of this study is to provide detailed demographic information related to the incidence of atherosclerotic plaques in the cerebral arteries. MATERIAL AND METHODS: Forty-eight circles of Willis (21 men, 21 women, mean age: 70.26, six samples unknown) were macroscopically analyzed for length, diameter, and presence of atherosclerotic plaques. Statistical analysis was used to identify potential differences in the locations and frequencies of atherosclerotic plaques in relation to age and sex. RESULTS: The study sample revealed 261 atherosclerotic plaques. The key findings were significant correlations between plaque development and age and between plaque location and age; however, there was no significant sex difference. CONCLUSION: The upper and lower branches of the middle cerebral artery (MCA) were novel locations predisposing to plaque development. A cut-off value at 60 years revealed a significant difference in plaque development and distribution. There were no significant sex differences in the occurrence of atherosclerotic plaques.

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The aim was to determine the variations in the level of origin of carotid bifurcation and diameters of the common, internal, and external carotid arteries which is clinically important for several interventional procedures. Therefore, 165 human embalmed corpses were dissected. The data collected were analyzed using the Chi square-test and the Pearson correlation test. The results of previous studies have been reviewed. In relation to the level of the carotid bifurcation, taking as a reference point the hyoid bone, the values ranged from 4 cm below the hyoid body to 2.5 cm above the body of the hyoid, being the average height-0.33 cm, with a standard deviation of 1.19 cm. The right carotid bifurcation was established at a higher level (x = - 0.19 cm.) than the left one (x = - 0.48 cm.) (p = 0.046). On the contrary, no significant gender differences could be observed. The arterial calibres of the common and internal carotid arteries were higher in male than female. In the internal carotid artery (X = 0.76 cm.), the left was greater than the right (X = 0.72 cm.) (P = 0.047). However, no differences in the distribution of the calibre of the external carotid artery were found neither by side nor gender. Variations in the level of bifurcation and calibres of carotid arteries are relevant for interventional radiology procedures and head and neck surgeries. Knowledge of these anatomical references might help clinicians in the interpretation of the carotid system.

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BACKGROUND: Bleeding within the supraglottic region can be a lethal complication after CO(2) laser microsurgery. Our aim was to propose endoluminal anatomical landmarks to locate the superior laryngeal vessels resulting in a safer microsurgery. METHODS: Endoluminal dissections were made in 22 larynges without laryngeal disease. RESULTS: The neurovascular structures were in the superior third of a triangle defined by the vocal process, the anterior commissure, and the epiglottic attachment of the aryepiglottic fold. They overlapped in 4 different ways: pattern I (70.4%): superior laryngeal vein (SLV), superior laryngeal artery (SLA), and internal laryngeal nerve (ILN); pattern II (13.6%): SLA, SLV, ILN; pattern III (4.6%): SLV, ILN, and SLA; pattern IV (4.6%): SLA, ILN, and SLV. CONCLUSION: Microsurgery in the supraglottic region may be safer if surgeons are aware of the superior third of the above-defined triangle, "danger area", where the vascular elements of this region are located.

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We have divided this article into five sections organised as follows. The first section expresses our views concerning the relevance of anatomy to the training of clinicians and surgeons. The second section analyses clinicians and surgeons perceptions about the relevance of anatomy for their training and is based upon the results of a questionnaire. The third section discusses whether surgeons or anatomists should be organising Continuing Professional Development (CPD) courses. The fourth section attempts to define the criteria for organising and developing surgical training courses. The fifth, and final, section outlines our experiences of planning and initiating surgical training courses (AU)

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We report a case of two variations of the testiculararteries found during routine dissection.These variations have been classified according to the references concerning the topic. We discuss the possible origin of the variations and their clinical implications (AU)

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Knowledge of variations of the circumflex femoral arteries is important when undertaking clinical procedures within the femoral region and in hip joint replacement. Since the 19th century, many different patterns have been proposed to classify their origins. This work studied a statistically reliable sample, the lower limbs of 221 embalmed human cadavers (equal right-left and approximately equal sex distributions), and reviewed the previous literature to propose a unified and simple classification that will be useful to clinicians. Statistical comparisons were made using the chi(2) test. The medial and lateral circumflex femoral arteries have been classified into three different patterns based on the levels of their origin. Distribution related to sex and side was also studied. Pattern I: Both arteries arose from the deep femoral artery (346 cases, 78.8%). This pattern was more frequent in females, P = 0.01. There was no significant difference between sides. Type Ia, medial circumflex femoral artery origin was proximal to the lateral circumflex femoral artery origin (53.2%); Type Ib, lateral circumflex femoral artery origin was proximal to medial circumflex femoral artery origin (23.4%); Type Ic, both arteries arose from a common trunk (23.4%). Pattern II: One of the arteries arose from the femoral artery and the other from the deep femoral artery (90 cases, 20.5%). Type IIa, the medial circumflex femoral artery arose from the femoral artery (77.8%) and Type IIb, the lateral circumflex femoral artery arose from the femoral artery (22.2%). There were no significant differences between sexes or sides. Pattern III: Both arteries arose from the femoral artery (2 cases, 0.5%). In every disposition there was a significantly higher prevalence of unilateral rather than bilateral occurrence. In one dissection the medial circumflex femoral artery was absent. Awareness of these variations could avoid unexpected injuries.

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Compression of the femoral nerve in the iliac fossa has been reported as a consequence of several pathologies, but never as a result of muscular compression. Aberrant slips of iliacus, however, have occasionally been reported to cover or split the femoral nerve. This study aimed to assess such variations as potential factors in femoral nerve compression. A large and homogeneous sample of 121 embalmed cadavers (242 specimens) was studied. Statistical comparisons were made using the chi-squared test. Muscular slips from iliacus and psoas, piercing or covering the femoral nerve, were found in 19 specimens (7.9%). No significant differences by sex or side were found. The more frequent variation was piercing of the femoral nerve by a muscular slip (17 specimens, 7.0%). The nerve then entered the thigh as one or more branches. The less frequent variation found was a muscular slip or sheet covering the femoral nerve as it lay on iliacus (2 specimens, 0.8%). Each disposition may be a potential risk for nerve entrapment.

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Los nervios laríngeos recurrentes (NLR) de los mamíferos son diferentes en longitud entre ambos lados. Esta asimetría implica, a priori, diferentes tiempos de conducción del estímulo a la musculatura laríngea controlada por cada nervio, postulándose diversos modelos para explicar el cierre glótico sincrónico más allá de la citada diferencia. Varios son los estudios publicados en esta materia aunque, no obstante, presentan carencias en datos relevantes. Utilizando dos grupos de 10 y 6 ratas, respectivamente, nuestro estudio compara la longitud de los NLR por lado y, mediante microscopía óptica acoplada a un sistema de análisis morfométrico, el número y características de las fibras mielínicas que los componen. Los resultados muestran que el NLR izquierdo (NLRi) es, de promedio, 0,84 cm más largo que el NLR derecho (NLRd). No hay diferencias estadísticamente significativas en el número de fibras por lado pero sí en el grosor de las mismas, mayores en el NLRd. Estos datos se analizan valorando los posibles mecanismos de compensación de la diferencia de longitud de los NLR

In mammals the recurrent laryngeal nerves are dissimilar in length between both sides. This asymmetry involves different time of arrival of the stimulus to the laryngeal musculature controlled by each nerve. Thus, several explanations have been addressed to elucidate the closest of the glottis at the same time despite the unlike length of the nerves. However, previous works on the topic lack of several important data. The present study compares, in two groups of 10 and 6 rats, the length and the composition of myelinated fibers in the recurrent laryngeal nerves of both sides, by means of light microscopy and a computerized morphometric analysis. The results show a mean difference of 0,84 cm longer the left than the right recurrent laryngeal nerve. No statistical differences were observed in the number of myelinated fibers between both sides. However, the myelinated fibers of the right side were statistically bigger in diameter than the fibers of the left side. The data are discussed in the context of the mechanisms for the compensation of the dissimilar length of both recurrent laryngeal nerves

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Laryngeal nerves contain the fibres that control the laryngeal function. On the rat, the studies on the functional components and the real origin of the fibres conveyed by the superior laryngeal nerve (SLN) are few. No one of such works were developed using biotinylated dextrane amines (BDA), a powerful tool for tracing neural pathways. The aim of our study was to identify by using BDA, in the rat, the nuclei of real origin of the fibres of the SLN, knowing in this way the functional components of this nerve. The study has been developed in 11 adult male Sprague-Dawley rats, applying the BDA into the damaged SLN. The results obtained in all the animals shown that the rat SLN carries efferent fibres originated within the ipsilateral nucleus ambiguous (NA) and dorsal nucleus of the vagus (DNV), and that afferent fibres reach the tractus solitari and the nucleus tractus solitari. So, in the rat, the SLN seems to convey efferent fibres from the NA and DNV and, probably, all the laryngeal afferent fibres.

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Los nervios laríngeos contienen las fibras que controlan la función laríngea. Son escasos los estudios que se han realizado en la rata para conocer los componentes funcionales y el origen real de las fibras que componen el nervio laríngeo superior (NLS). En ninguno de estos estudios se ha utilizado dextranos, potentes herramientas para el trazado nervioso. El objetivo de nuestro estudio es identificar en la rata los núcleos de origen de las fibras que porta el NLS, conociendo así los componentes funcionales del mismo, mediante el trazado con dextranos biotinados (BDA). El estudio se ha realizado en 11 ratas Sprague-Dawley machos adultos, aplicando el BDA en el NLS previamente lesionado. Los resultados en todos los animales muestran que el NLS de la rata contiene fibras eferentes originadas en el núcleo ambiguo (NA) y el núcleo dorsal del vago (NDV) ipsilaterales, así como fibras aferentes que se conducen al tracto solitario (TS) y el núcleo del tracto solitario (NTS) ipsilaterales. Por lo tanto, en la rata, el NLS parece conducir las fibras eferentes viscerales especiales del NA, las fibras eferentes viscerales generales del NDV y, probablemente, todas las fibras aferentes laríngeas

Laryngeal nerves contain the fibres that control the laryngeal function. On the rat, the studies on the functional components and the real origin of the fibres conveyed by the superior laryngeal nerve (SLN) are few. No one of such works were developed using biotinylated dextrane amines (BDA), a powerful tool for tracing neural pathways. The aim of our study was to identify by using BDA, in the rat, the nuclei of real origin of the fibres of the SLN, knowing in this way the functional components of this nerve. The study has been developed in 11 adult male Sprague-Dawley rats, applying the BDA into the damaged SLN. The results obtained in all the animals shown that the rat SLN carries efferent fibres originated within the ipsilateral nucleus ambiguous (NA) and dorsal nucleus of the vagus (DNV), and that afferent fibres reach the tractus solitari and the nucleus tractus solitari. So, in the rat, the SLN seems to convey efferent fibres from the NA and DNV and, probably, all the laryngeal afferent fibres

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Laryngeal nerves contain the fibres that control the laryngeal function. The studies carried out on the rat with the purpose of having a better knowledge of the functional components and the real origin of the fibres conveyed by the recurrent laryngeal nerve (RLN) are few and in disagreement. No one of such papers were developed using biotinylated dextrane amines (BDA), a powerful tool for tracing neural pathways. The aim of our study was to identify in the rat using BDA, the nuclei of real origin of the fibres of the RLN, knowing in this way the functional components of this nerve. The study has been developed in 31 adult male Sprague-Dawley rats, applying the BDA into the lesioned RLN. The results obtained in all the animals show that the rat's RLN does not contain afferent fibres, whereas the efferent fibres were originated within the ipsilateral nucleus ambiguus (NA). So, in the rat, the RLN seems to contain exclusively efferent fibres, probably been the superior laryngeal nerve who conveyed the afferent fibres.

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Los nervios laríngeos contienen las fibras que controlan la función laríngea. Pocos y discrepantes son los estudios que se han realizado en la rata para conocer los componentes funcionales y el origen real de las fibras que componen el nervio laríngeo recurrente (NLR). En ninguno de estos estudios se ha utilizado dextranos, potentes herramientas para el trazado nervioso. El objetivo de nuestro estudio es identificar en la rata los núcleos de origen de las fibras que porta el NLR, conociendo así los componentes funcionales del mismo, mediante el trazado con dextranos biotinados (BDA). El estudio se ha realizado en 31 ratas Sprague-Dawley machos adultos, aplicando el BDA en el NLR previamente lesionado. Los resultados en todos los animales muestran que el NLR de la rata no contiene fibras aferentes, mientras que las fibras eferentes se originan en el núcleo ambiguo (NA) ipsilateral. Por lo tanto, en la rata, el NLR parece contener exclusivamente fibras eferentes, debiendo de ser las fibras aferentes conducidas, muy probablemente en su totalidad, por el nervio laríngeo superior

Laryngeal nerves contain the fibres that control the laryngeal function. The studies carried out on the rat with the purpose of having a better knowledge of the functional components and the real origin of the fibres conveyed by the recurrent laryngeal nerve (RLN) are few and in disagreement. No one of such papers were developed using biotinylated dextrane amines (BDA), a powerful tool for tracing neural pathways. The aim of our study was to identify in the rat using BDA, the nuclei of real origin of the fibres of the RLN, knowing in this way the functional components of this nerve. The study has been developed in 31 adult male Sprague-Dawley rats, applying the BDA into the lesioned RLN. The results obtained in all the animals show that the rat’s RLN does not contain afferent fibres, whereas the efferent fibres were originated within the ipsilateral nucleus ambiguus (NA). So, in the rat, the RLN seems to contain exclusively efferent fibres, probably been the superior laryngeal nerve who conveyed the afferent fibres

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In mammals the recurrent laryngeal nerves are dissimilar in length between both sides. This asymmetry involves different time of arrival of the stimulus to the laryngeal musculature controlled by each nerve. Thus, several explanations have been addressed to elucidate the closest of the glottis at the same time despite the unlike length of the nerves. However, previous works on the topic lack of several important data. The present study compares, in two groups of 10 and 6 rats, the length and the composition of myelinated fibers in the recurrent laryngeal nerves of both sides, by means of light microscopy and a computerized morphometric analysis. The results show a mean difference of 0,84 cm longer the left than the right recurrent laryngeal nerve. No statistical differences were observed in the number of myelinated fibers between both sides. However, the myelinated fibers of the right side were statistically bigger in diameter than the fibers of the left side. The data are discussed in the context of the mechanisms for the compensation of the dissimilar length of both recurrent laryngeal nerves.

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A retrospective study of the unilateral and bilateral vocal fold immobility cases diagnosed at our hospital between 1985 and 1998 was carried out. Of the 229 cases studied, vocal fold immobility was bilateral in 58 patients (25%), unilateral right in 60 (26%), and unilateral left 111 (49%). The most frequent etiologies in the bilateral cases were thyroid surgery (38%) and prolonged intubation (31%); idiopathic cases (32%) and thyroid surgery (23%) in the unilateral right cases; and idiopathic cases (28%) and extralaryngeal tumors (22%) in the unilateral left cases. Clinical compensation was achieved in more than 85% of cases of unilateral immobility when the etiology was idiopathic or due to surgical damage to the recurrent or vagus nerves, 70% when it was a prolonged intubation, 56% in neurological patients and 38% in extralaryngeal tumors. In patients with bilateral vocal fold immobility, 14% did not require any treatment, 34% had a permanent tracheostomy, and 52% recovered adequate naso-oral ventilation after surgery (tracheostomy only in 12 patients and arytenoidectomy in 18 patients).

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Se ha llevado a cabo un estudio retrospectivo de los casos de inmovilidad glótica uni o bilateral diagnosticados en nuestro centro entre los años 1985 y 1998. De los 229 casos analizados, 58 (25 por ciento) correspondían a una inmovilidad glótica bilateral, 60 (26 por ciento) a una inmovilidad unilateral derecha y 111 (49 por ciento) a una inmovilidad unilateral izquierda. Las etiologías más frecuentes responsables en los casos bilaterales fueron la cirugía tiroidea (38 por ciento) y la intubación prolongada (31 por ciento), en los casos unilaterales derechos las formas idiopáticas (32 por ciento) y la cirugía tiroidea (23 por ciento), y en los casos unilaterales izquierdos las formas idiopáticas (28 por ciento) y los tumores extralaríngeos (22 por ciento). Tras una parálisis unilateral se consiguió una compensación clínica en más del 85 por ciento de las ocasiones cuando la etiología era idiopática o una lesión quirúrgica de los nervios recurrente o vago, del 70 por ciento en el caso de intubación prolongada, del 56 por ciento ante patología neurológica y del 38 por ciento en caso de tumor extralaríngeo. De los pacientes afectos de inmovilidad glótica bilateral un 14 por ciento no requirieron tratamiento, un 34 por ciento requirieron una traqueostomía permanente, y un 52 por ciento recuperaron una ventilación oro-nasal adecuada tras cirugía (traqueostomía transitoria en 12 casos y aritenoidectomía en 18 casos) (AU)

A retrospective study of the unilateral and bilateral vocal fold immobility cases diagnosed at our hospital between 1985 and 1998 was carried out. Of the 229 cases studied, vocal fold immobility was bilateral in 58 patients (25%), unilateral right in 60 (26%), and unilateral left 111 (49%). The most frequent etiologies in the bilateral cases were thyroid surgery (38%) and prolonged intubation (31%); idiopathic cases (32%) and thyroid surgery (23%) in the unilateral right cases; and idiopathic cases (28%) and extralaryngeal tumors (22%) in the unilateral left cases. Clinical compensation was achieved in more than 85% of cases of unilateral immobility when the etiology was idiopathic or due to surgical damage to the recurrent or vagus nerves, 70% when it was a prolonged intubation, 56% in neurological patients and 38% in extralaryngeal tumors. In patients with bilateral vocal fold immobility, 14% did not require any treatment, 34% had a permanent tracheostomy, and 52% recovered adequate naso-oral ventilation after surgery (tracheostomy only in 12 patients and arytenoidectomy in 18 patients) (AU)

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OBJECTIVE: To systematize the anatomy of the connecting branches between laryngeal nerves. METHODS: Microdissection of 90 larynges obtained from necropsies (57 men and 33 women; age range, 41-95 y). RESULTS: Anastomoses between the internal and recurrent nerves appeared in four different patterns: 1) Galen's anastomosis, as the connection between the dorsal branches of both nerves (100%); 2) arytenoid plexus, as the connection between the arytenoid branches of both nerves, in relation with the arytenoid muscle, and divided in a deep part (100%) and a superficial part (86%); 3) cricoid anastomosis, previously only described in cows, located in the front of the cricoid lamina (6/10 cases); and 4) thyroarytenoid anastomosis, as the connection of a descending branch of the internal laryngeal nerve and an ascending branch of the recurrent nerve (14%). Anastomosis between the internal laryngeal and the external laryngeal nerves appeared as a connecting branch throughout the foramen thyroideum (21%). Anastomosis between the external laryngeal and recurrent nerves appeared as a connecting branch throughout the cricothyroid muscle (68%). CONCLUSION: At least two anastomoses (Galen's anastomosis and arytenoid plexus) appeared in 21% of hemilarynges, and 79% of cases had three or more anastomoses between the laryngeal nerves. The different prevalence of this complex anastomotic pattern suggests functional differences in the sensory and motor innervation of individual subjects.

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The incidence and characteristics of foramen thyroideum (FT) in embryonic and/or fetal larynges have not been established. In the present study, 90 adult larynges and 53 embryonic-fetal larynges were studied. The incidence of FT during the embryonic-fetal period (57%) was statistically different from the adult period (31%) (P = 0.005). All the FT found in the adult period contained vessels and/or nerves, while in the embryonic and fetal period only 63% presented neurovascular elements (P < 0.001). The origin of FT in the embryonic period and its persistence during adult life is discussed.

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