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The anatomy of the femoral triangle is explored in various approaches, ranging from pulse verification to invasive catheterization procedures. Within the femoral triangle, the deep femoral artery is one of the vessels reported to present several anatomical variations that must be considered before clinical or surgical interventions. Here, we are reporting a unique bilateral variation of the deep femoral artery for medical education purposes and reflecting on its applied, surgical, and clinical anatomy. During the dissection of the femoral triangle, we observed that the deep femoral artery originated in the vicinity of the inguinal ligament and ran in parallel with the femoral artery in a superficial trajectory on both sides of the donor. On the right side, the DFA continued superficial for 8.8 cm, with an origin of 1.2 cm inferior to the inguinal ligament. On the left side, it presented a similar anatomical arrangement, though with an origin of 1.6cm inferior to the inguinal ligament and a superficial course of 5cm. The position of the lateral circumflex femoral vein posterior to the deep femoral artery played a role in this distinctive, lengthy, and superficial presentation of the deep femoral artery. This anatomical variation directly affects surgical procedures, diagnostics, and endovascular interventions. A deep femoral artery with such a lengthy superficial trajectory can be mistakenly used for catheterization instead of the femoral artery or be injured, disrupting the main blood supply of the thigh muscles.

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ABSTRACT The anatomy of the femoral triangle is explored in various approaches, ranging from pulse verification to invasive catheterization procedures. Within the femoral triangle, the deep femoral artery is one of the vessels reported to present several anatomical variations that must be considered before clinical or surgical interventions. Here, we are reporting a unique bilateral variation of the deep femoral artery for medical education purposes and reflecting on its applied, surgical, and clinical anatomy. During the dissection of the femoral triangle, we observed that the deep femoral artery originated in the vicinity of the inguinal ligament and ran in parallel with the femoral artery in a superficial trajectory on both sides of the donor. On the right side, the DFA continued superficial for 8.8 cm, with an origin of 1.2 cm inferior to the inguinal ligament. On the left side, it presented a similar anatomical arrangement, though with an origin of 1.6cm inferior to the inguinal ligament and a superficial course of 5cm. The position of the lateral circumflex femoral vein posterior to the deep femoral artery played a role in this distinctive, lengthy, and superficial presentation of the deep femoral artery. This anatomical variation directly affects surgical procedures, diagnostics, and endovascular interventions. A deep femoral artery with such a lengthy superficial trajectory can be mistakenly used for catheterization instead of the femoral artery or be injured, disrupting the main blood supply of the thigh muscles.

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Objective This study aimed to perform an imaging evaluation to prove the existence or not of symmetry between the clavicles of healthy subjects from Curitiba, Paraná, Brazil, and identify potential factors influencing the clavicular length. Method The study analyzed chest computed tomography (CT) scans of 211 patients with no clavicular fracture or malformations (100 women and 111 men). We measured the greatest clavicular diagonal on both sides, and the software automatically generated the maximum distance in millimeters. Relative and absolute frequencies described qualitative variables and mean values; quantitative variables used a 95% confidence interval. Value comparisons employed the student's t-test, and correlations determinations used Pearson's correlation coefficient. The significance level adopted was 5%. Results There was a significant difference between the clavicular length (right clavicle, 143.58 mm; left clavicle, 145.72 mm; p = 0.037), indicating asymmetry. On average, the left clavicle was 3.71 mm larger. Asymmetry was significant for both men and women (p < 0.001). The average difference was 4.13 mm for men and 3.23 mm for women. Seventy-three percent of the sample had < 5 mm of asymmetry, 23.7% had 5 to 10 mm, and 3.3% had > 10 mm of asymmetry. Conclusion The studied population did not present clavicular symmetry. On average, the left clavicle was longer than the right clavicle, with differences of 3.71 mm in the general sample, 3.23 mm in women, and 4.13 mm in men. The only significant factor was gender since men presented longer clavicles and higher differences than women.

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Abstract Objective This study aimed to perform an imaging evaluation to prove the existence or not of symmetry between the clavicles of healthy subjects from Curitiba, Paraná, Brazil, and identify potential factors influencing the clavicular length. Method The study analyzed chest computed tomography (CT) scans of 211 patients with no clavicular fracture or malformations (100 women and 111 men). We measured the greatest clavicular diagonal on both sides, and the software automatically generated the maximum distance in millimeters. Relative and absolute frequencies described qualitative variables and mean values; quantitative variables used a 95% confidence interval. Value comparisons employed the student's t-test, and correlations determinations used Pearson's correlation coefficient. The significance level adopted was 5%. Results There was a significant difference between the clavicular length (right clavicle, 143.58 mm; left clavicle, 145.72 mm; p = 0.037), indicating asymmetry. On average, the left clavicle was 3.71 mm larger. Asymmetry was significant for both men and women (p < 0.001). The average difference was 4.13 mm for men and 3.23 mm for women. Seventy-three percent of the sample had < 5 mm of asymmetry, 23.7% had 5 to 10 mm, and 3.3% had > 10 mm of asymmetry. Conclusion The studied population did not present clavicular symmetry. On average, the left clavicle was longer than the right clavicle, with differences of 3.71 mm in the general sample, 3.23 mm in women, and 4.13 mm in men. The only significant factor was gender since men presented longer clavicles and higher differences than women.

Resumo Objetivo Realizar avaliação imagiológica com intuito de comprovar a existência ou não de simetria entre as clavículas de indivíduos saudáveis da cidade de Curitiba/PR, aliada à identificação de possíveis fatores de influência no comprimento clavicular. Método Foram analisadas tomografias computadorizadas de tórax de 211 pacientes sem fratura ou malformações na clavícula (100 mulheres e 111 homens). A maior diagonal clavicular foi medida em ambos os lados e o software gerou automaticamente a máxima distância em milímetros. Foram utilizadas frequências relativas e absolutas para descrever variáveis qualitativas e a média e intervalo de 95% de confiança para as quantitativas. As comparações foram feitas com o teste t de Student e correlações calculadas pelo coeficiente de correlação de Pearson. O nível de significância adotado foi de 5%. Resultados Verificou-se diferença significativa entre o comprimento das clavículas (direita 143.58mm e esquerda 145.72mm, p = 0.037), indicando assimetria. Em média, o lado esquerdo é 3.71mm maior. A assimetria foi significativa tanto para homens quanto para mulheres (p < 0.001). A diferença média foi de 4.13mm para homens e 3.23mm para mulheres. 73% da amostra apresentou <5mm de diferença, enquanto 23.7% apresentou 5-10mm e 3.3% apresentou >10mm de assimetria. Conclusão Não foi possível encontrar simetria nas clavículas da população de Curitiba/PR. Em média, a clavícula esquerda é maior que a direita, com diferenças de 3.71mm na amostra geral, 3.23mm para mulheres e 4.13mm para homens. O único fator significativo foi o sexo, com homens tendo maiores comprimentos claviculares e maiores diferenças em comparação às mulheres.

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Objective: To evaluate the volar cortical angle (VCA), the variation in lateral and intermediate columns, the shape and pattern of the watershed line (WL) of the distal radius and its correlation with locking volar plates available. Methods: 27 human cadaveric radial bones of the Department of Morphology and nine locking volar plates of six different companies were analyzed. VCA were measured from lateral and intermediate columns and their corresponding values on plates, as well as comparing the relief of radius and plates. In the WL analysis, we compared the standard format found on the radius and its equivalent on plates and divided into four types: biconvex, convex, ulnar convex and plan. Results: VCA varied between columns of the distal radius extremity. The mean in the lateral column was 153.40 degrees and 146.06 degrees in the intermediate. Four of nine plates showed no variation in volar angulation. From 27 distal radius, 13 showed convex pattern and 12 had biconvex, whereas most plates (seven of the nine analyzed) were biconvex drawing. Conclusion: Radial bone anatomy was variable. The intermediate column was, on average, steeper than lateral column. Synthes®-2 plate presented the closest design to the anatomy of the distal end of the radial bone, followed by Newclip®-2 plate. Level of Evidence II, Anatomic and Descriptive Study.

Objetivos: Avaliar o ângulo palmar cortical (APC) da extremidade distal do rádio, sua variação nas colunas lateral e intermédia, o formato e o padrão da watershed line (WL) e sua correlação com as placas volares bloqueadas disponíveis no mercado. Métodos: Foram analisados 27 ossos rádios do Departamento de Morfologia e nove placas de seis fabricantes diferentes. Medimos os APCs das colunas lateral e intermédia dos rádios e seus correspondentes nas placas, além de compararmos o relevo do terço distal do rádio e das placas. Quanto a WL, comparamos o formato nas peças e seu equivalente nas placas, sendo classificados em quatro tipos: biconvexo, convexo, convexo ulnar e plano. Resultados: O APC variou entre as colunas do rádio, sendo a média da coluna lateral 153,40° e, da intermédia 146,06°. Quatro das nove placas não apresentaram variação na angulação volar. Dos 27 rádios, 13 apresentaram padrão convexo e 12 biconvexo, enquanto a maioria das placas (sete das nove analisadas) tinham desenho biconvexo. Conclusão: A anatomia dos rádios foi variável entre as peças, sendo a coluna intermédia mais inclinada que a coluna lateral. A placa Synthes ® -2 foi a que apresentou relevo mais próximo dos achados anatômicos da extremidade distal do rádio, seguida pela Newclip ® -2. Nível de Evidência II, Estudo Anatômico Descritivo.

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Aim: To compare the accuracy of the panoramic radiography with cone-beam computed tomography (CBCT) scans in measuring the distances between root apexes and the adjacent anatomical structures including the maxillary sinus and the mandibular canal. Material and Methods: A total of 200 CBCT scans (100 maxillary and 100 mandibular) from patients who also had corresponding panoramic radiography were selected. Linear measurements (in mm) presenting centralized image were made between the apexes of the maxillary teeth and the inferior wall of the maxillary sinus, and between the apexes of the mandibular teeth and the superior border of the mandibular canal by using specific software for panoramic radiography and the measurements on the coronal sections in CBCT scans. Data were submitted to inferential statistical analysis and Student's t-test for comparison between measurements. Results: CBCT scans were significantly more accurate than panoramic radiography to measure the distances between the apexes of the maxillary teeth and the inferior wall of the maxillary sinus (p<0.05) and between the apexes of the mandibular teeth and the superior border of the mandibular canal or mental foramen (p<0.05). Conclusion: CBCT scans present more accurate measurements than panoramic radiography.

Objetivo: Comparar la precisión de la radiografía panorámica con las exploraciones de la tomografía computarizada dental de haz en cónico (CBCT) para medir las distancias entre los vértices radiculares y las estructuras anatómicas adyacentes, incluidos el seno maxilar y el canal mandibular. Material y Métodos: Se seleccionaron un total de 200 tomografías CBCT (100 maxilares y 100 mandibulares) de pacientes que además tenían la correspondiente radiografía panorámica. Se realizaron mediciones lineales (en mm) que presentaban imagen centralizada entre los ápices de los dientes maxilares y la pared inferior del seno maxilar, y entre los ápices de los dientes mandibulares y el borde superior del canal mandibular mediante software específico para radiografía panorámica. y las mediciones en las secciones coronales en escaneos CBCT. Los datos se sometieron a análisis estadístico inferencial y prueba t de Student para comparación entre mediciones. Resultados: Las exploraciones CBCT fueron significativamente más precisas que la radiografía panorámica para medir las distancias entre los ápices de los dientes maxilares y la pared inferior del seno maxilar (p<0,05) y entre los ápices de los dientes mandibulares y el borde superior de los dientes mandibulares. canal o agujero mentoniano (p<0.05). Conclusión: Las exploraciones CBCT presentan mediciones más precisas que la radiografía panorámica.

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ABSTRACT Objective: To evaluate the volar cortical angle (VCA), the variation in lateral and intermediate columns, the shape and pattern of the watershed line (WL) of the distal radius and its correlation with locking volar plates available. Methods: 27 human cadaveric radial bones of the Department of Morphology and nine locking volar plates of six different companies were analyzed. VCA were measured from lateral and intermediate columns and their corresponding values on plates, as well as comparing the relief of radius and plates. In the WL analysis, we compared the standard format found on the radius and its equivalent on plates and divided into four types: biconvex, convex, ulnar convex and plan. Results: VCA varied between columns of the distal radius extremity. The mean in the lateral column was 153.40 degrees and 146.06 degrees in the intermediate. Four of nine plates showed no variation in volar angulation. From 27 distal radius, 13 showed convex pattern and 12 had biconvex, whereas most plates (seven of the nine analyzed) were biconvex drawing. Conclusion: Radial bone anatomy was variable. The intermediate column was, on average, steeper than lateral column. Synthes®-2 plate presented the closest design to the anatomy of the distal end of the radial bone, followed by Newclip®-2 plate. Level of Evidence II, Anatomic and Descriptive Study.

RESUMO Objetivos: Avaliar o ângulo palmar cortical (APC) da extremidade distal do rádio, sua variação nas colunas lateral e intermédia, o formato e o padrão da watershed line (WL) e sua correlação com as placas volares bloqueadas disponíveis no mercado. Métodos: Foram analisados 27 ossos rádios do Departamento de Morfologia e nove placas de seis fabricantes diferentes. Medimos os APCs das colunas lateral e intermédia dos rádios e seus correspondentes nas placas, além de compararmos o relevo do terço distal do rádio e das placas. Quanto a WL, comparamos o formato nas peças e seu equivalente nas placas, sendo classificados em quatro tipos: biconvexo, convexo, convexo ulnar e plano. Resultados: O APC variou entre as colunas do rádio, sendo a média da coluna lateral 153,40° e, da intermédia 146,06°. Quatro das nove placas não apresentaram variação na angulação volar. Dos 27 rádios, 13 apresentaram padrão convexo e 12 biconvexo, enquanto a maioria das placas (sete das nove analisadas) tinham desenho biconvexo. Conclusão: A anatomia dos rádios foi variável entre as peças, sendo a coluna intermédia mais inclinada que a coluna lateral. A placa Synthes ® -2 foi a que apresentou relevo mais próximo dos achados anatômicos da extremidade distal do rádio, seguida pela Newclip ® -2. Nível de Evidência II, Estudo Anatômico Descritivo.

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The authors describe a rare unilateral muscle variation in the thoracic wall combining the pectoralis quartus and chondro-epitrochlearis muscles. A routine dissection was performed in the upper right limb of a male adult cadaver with approximately 35-50 years of age, embalmed in formalin 10%. An accessory muscle, the pectoralis quartus, was identified and was associated with a tendon that was inserted in the medial humeral epicondyle, characteristic of the chondro-epitrochlearis muscle tendon. Such variations have significant clinical relevance to orthopedics, mastology, neural and vascular surgery, and other specialties, for surgical approaches in both the axillary and brachial regions.

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The median artery is usually a transient vessel during the embryonic period. However, this artery can persist in adult life as the persistent median artery. This paper aims to describe this relevant anatomical variation for surgeons, review the literature and discuss its clinical implications. A routine dissection was performed in the upper left limb of a male adult cadaver of approximately 50-60 years of age, embalmed in formalin 10%. The persistent median artery was identified emerging as a terminal branch of the common interosseous artery with a path along the ulnar side of the median nerve. In the wrist, the persistent median artery passed through the carpal tunnel, deep in the transverse carpal ligament. The dissection in the palmar region revealed no anastomosis with the ulnar artery forming the superficial palmar arch. The common digital arteries emerged from the ulnar artery and the persistent median artery. Such variation has clinical and surgical relevance in approaching carpal tunnel syndrome and other clinical disorders in the wrist.

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ABSTRACT BACKGROUND AND OBJECTIVES: There are very few instruments in the literature that allow for the precise identification of neuropathic pain, that are easy to apply and can represent the pain intensity and location within the plexus path, as well as be used for pain management. The objective of this study was to validate a visual instrument made from a color scale and a body diagram to locate and measure the pain intensity in adults with brachial plexopathy. METHODS: This exploratory study used a quantitative approach. The sample was composed of 35 patients presenting brachial plexus pain and who underwent surgery. The instrument is composed of a four-color scale and a body diagram. Each patient identified a color on the scale for each pain intensity and then colored the representative pain area in the diagram using one or more colors. Criterion validation was used to prove the correlation between the scores obtained by the instrument and the surgical reports, which were used as the external criterion. RESULTS: A significant agreement was observed between the representation of pain in the diagram and the surgical report in all nerve trunks. CONCLUSION: The instrument was found to be useful for locating the pain and measuring its intensity in patients with brachial plexopathy.

RESUMO JUSTIFICATIVA E OBJETIVOS: Na literatura são escassos os instrumentos que permitem identificar precisamente a dor neuropática, sejam de fácil aplicação, possam representar a intensidade e a localização da dor dentro do trajeto plexular e ser utilizados no manejo da dor. O objetivo deste estudo foi validar um instrumento visual composto por escala de cores e diagrama corporal para localização e mensuração da intensidade da dor em adultos com plexopatia braquial. MÉTODOS: Estudo exploratório, com abordagem quantitativa. A amostra foi composta por 35 pacientes com plexobraquialgia submetidos a tratamento cirúrgico. Foi utilizado um instrumento imagético composto por uma escala de quatro cores e um diagrama corporal. Os pacientes identificaram na escala uma cor para cada intensidade de dor e coloriram no diagrama a sua área representativa, utilizando uma ou mais cores. A validação de critério foi utilizada para comprovar a correlação entre os escores do instrumento criado e os laudos cirúrgicos que corresponderam ao critério externo. RESULTADOS: Observou-se concordância significativa entre a representação da dor no diagrama corporal e o laudo cirúrgico em todos os troncos nervosos. CONCLUSÃO: O instrumento imagético se mostrou útil para localização e mensuração da intensidade da dor em pacientes com plexopatia braquial.

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The authors describe a rare unilateral muscle variation in the thoracic wall combining the pectoralis quartus and chondro-epitrochlearis muscles. A routine dissection was performed in the upper right limb of a male adult cadaver with approximately 35-50 years of age, embalmed in formalin 10%. An accessory muscle, the pectoralis quartus, was identified and was associated with a tendon that was inserted in the medial humeral epicondyle, characteristic of the chondro-epitrochlearis muscle tendon. Such variations have significant clinical relevance to orthopedics, mastology, neural and vascular surgery, and other specialties, for surgical approaches in both the axillary and brachial regions.

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Objective: to investigate the influence of the application of new methodologies on learning and the motivation of students of the Anatomy discipline. Method: randomized, longitudinal, prospective, intervention study. Sixty-two students were recruited to assess the impact of different methodologies. The sample was randomized to compare the results of teaching with a 3D atlas, ultrasound and the traditional method. The parameters were assessed through a satisfaction evaluation questionnaire and anatomical charts. Repeated measures ANOVA was used to determine statistical significance. Results: in terms of the usefulness of the seminars, 98.1% of the students considered them to be very positive or positive, stating that they had stimulated their interest in anatomy. The students who learned with the 3D atlas improved their understanding of anatomy (p=0.040). In general, the students improved their grades by around 20%. Conclusion: the traditional method combined with new technologies increases the interest of students in human anatomy and enables them to acquire skills and competencies during the learning process.

Objetivo: investigar a influência da aplicação de novas metodologias na aprendizagem e a motivação de alunos da disciplina de Anatomia. Método: estudo de intervenção, prospectivo, longitudinal e randomizado. Um total de 62 alunos foram recrutados para se avaliar o impacto de diferentes metodologias. Eles foram distribuídos de forma aleatória para comparar os resultados de ensino usando o atlas 3D, o ultrassom e o método tradicional. Os parâmetros foram medidos por meio de um questionário de avaliação de satisfação do aluno e uma prova usando lâminas anatômicas. O teste ANOVA de medidas repetidas foi usado para determinar significância estatística. Resultados: relativo à satisfação dos alunos, 98,1% consideraram muito positivo ou positivo o uso dos seminários, além de afirmarem que o seminário havia estimulado seu interesse pela anatomia. Os alunos submetidos ao método com o atlas 3D apresentaram uma melhora em sua compreensão de anatomia (p=0,040). De forma geral, os alunos melhoraram suas pontuações em aproximadamente 20%. Conclusão: o método tradicional, junto com as novas tecnologias, contribui para aumentar o interesse dos alunos pela Anatomia Humana assim como na aquisição de habilidades e competências em seu processo de aprendizagem.

Objetivo: investigar la influencia de la aplicación de nuevas metodologías en el aprendizaje y en la motivación de los alumnos en la asignatura Anatomia. Método: estudio de intervención, prospectivo, longitudinal y aleatorizado. Fueron convocados 62 alumnos para evaluar el impacto de diferentes metodologías. Se los dividió aleatoriamente para comparar resultados entre enseñanza con atlas 3D, ultrasonido y metodología tradicional. Los parámetros fueron analizados mediante un cuestionario de evaluación de satisfacción y láminas anatómicas. Se usó ANOVA de medidas repetidas para determinar la significancia estadística. Resultados: el 98,1% de los alumnos consideraron muy positiva o positiva la utilización de los seminarios, afirmaron asimismo que el seminario había estimulado su interés por la anatomía. Los alumnos que realizaron el aprendizaje con atlas 3D mejoraron su compresión de la anatomía (p=0,040). En general, los alumnos mejoraron sus puntajes en alrededor del 20%. Conclusión: el método tradicional con el agregado de las nuevas tecnologías permite a los alumnos incrementar su interés por la Anatomía Humana, así como adquirir habilidades y competencias en su proceso de aprendizaje.

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The median artery is usually a transient vessel during the embryonic period. However, this artery can persist in adult life as the persistent median artery. This paper aims to describe this relevant anatomical variation for surgeons, review the literature and discuss its clinical implications. A routine dissection was performed in the upper left limb of a male adult cadaver of approximately 50-60 years of age, embalmed in formalin 10%. The persistent median artery was identified emerging as a terminal branch of the common interosseous artery with a path along the ulnar side of the median nerve. In the wrist, the persistent median artery passed through the carpal tunnel, deep in the transverse carpal ligament. The dissection in the palmar region revealed no anastomosis with the ulnar artery forming the superficial palmar arch. The common digital arteries emerged from the ulnar artery and the persistent median artery. Such variation has clinical and surgical relevance in approaching carpal tunnel syndrome and other clinical disorders in the wrist.

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Coronary arteries establish a complex blood vessel system, right and left coronary arteries commonly originate from the aortic sinuses and divide into multiple branches that supply the heart with several important variations between species. Diaphanization is a preservative technique which allows internal structures visualization, maintaining the three-dimensionality of the specimen. In this study, human (Homo sapiens), goat (Capra aegagrus hircus), bovine (Bos Taurus), equine (Equus caballus), porcine (Sus scrofa domesticus), canine (Canis lupus familiaris) and feline (Felis silvestris catus) coronary arteries were injected with selfcuring methyl-methacrylate and posteriorly diaphanized. The coronary vasculature was adequately observed in all models while keeping the three-dimensional relation with surrounding cardiac structures, except for septal arteries which were not visualized. As incidental findings, anatomical variations in canine and human hearts were observed. Repletion-diaphanization is a useful blended method to visualize the morphology of superficial coronary arteries. It could be a valuable tool in anatomical teaching and research, but further research needs to be done to prove its effectiveness in different vessel systems.

Las arterias coronarias son un complejo de vasos sanguíneos que usualmente se originan en los senos aórticos y que al dividirse en múltiples ramas suplen los requerimientos metabólicos del tejido cardiaco; cabe aclarar que la anatomía de estas estructuras posee variaciones importantes entre especies. La diafanización es una técnica de preservación que permite observar estructuras internas de un espécimen sin dañar su tridimensionalidad. En este estudio las arterias coronarias del corazón humano (Homo sapiens), caprino (Capra aegagrus hircus), bovino (Bos Taurus), equino (Equus caballus), porcino (Sus scrofa domesticus), canino (Canis lupus familiaris) y felino (Felis silvestris catus), fueron repletadas con metil-metacrilato y posteriormente diafanizados. Se observa la irrigación coronaria de cada uno de los corazones y su relación con las demás estructuras cardiacas, exceptuando las arterias septales. Como hallazgos incidentales se observaron variaciones anatómicas en los corazones canino y humano. Finalmente, esta técnica resultó de utilidad para evaluar la anatomía coronaria, lo que puede ser valioso para educación e investigación. Posteriores investigaciones deben ser realizadas para probar su utilidad en otros sistemas vasculares.

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Introdução: Embora realizada há muito tempo, a remoção da bola de Bichat ganhou notoriedade nos últimos anos devido a sua grande procura nos consultórios do cirurgião plástico. Mesmo quando adequadamente indicada, ainda é considerada um procedimento controverso, uma vez que ainda não existe uma técnica cirúrgica sistematizada na literatura atual, visando torná-la segura e reprodutível. Métodos: A técnica da bichectomia intraoral descrita no trabalho foi aplicada de maneira sistemática em uma série de 27 pacientes consecutivos, no período de 5 de janeiro de 2016 a 15 de dezembro de 2016. Resultados: A idade média dos pacientes foi de 32 anos, sendo 15% do sexo masculino e 85% do sexo feminino. A bichectomia foi realizada isoladamente em 6 pacientes (22%) e em conjunto com outros procedimentos em 21 pacientes (78%). O procedimento mais comumente associado foi a lipoaspiração cervical, realizada em 55% dos pacientes. A imensa maioria dos casos foram operados com anestesia geral (93%). Nenhuma complicação permanente e importante foi verificada no pósoperatório, apenas um caso de neuropatia transitória do ramo bucal e um caso de edema mais pronunciado, que prontamente se resolveram nas semanas seguintes. Conclusão: A remoção de gordura bucal pode ser realizada de forma previsível, rápida e segura, proporcionando diminuição volumétrica do terço inferior facial, com maior realce dos contornos faciais. Quando aplicada em um ambiente cirúrgico seguro, seguindo todos os padrões de segurança da cirurgia e respeitando os complexos limites anatômicos da região, nossa técnica levará os cirurgiões e pacientes a um resultado seguro e satisfatório.

Introduction: Despite buccal fat removal having been performed for a long time, its popularity has increased only in recent years, leading to a rise in the demand for bichectomy in plastic surgery clinics. Buccal fat pad removal is still considered controversial, even when properly indicated, especially with the lack of a systematized surgical technique to make it safe and reproducible. Methods: The intraoral bichectomy described herein was systematically applied in 27 consecutive patients from January 5, 2016 to December 15, 2016. Results: The mean patient age was 32 years; 15% were men, and 85% were women. Isolated buccal fat pad removal was performed in six patients (22%) and in combination with other procedures in 21 patients (78%). The main procedure combined was neck liposuction (55%), and most patients were operated under general anesthesia (93%). No permanent or significant complications occurred, and there were only two minor complications, i.e., inferior mandibular neuropathy and significant swelling, which improved without treatment during the following weeks. Conclusions: Buccal fat removal can be performed in a predictable, fast, and safe manner, leading to volumetric reduction of the lower third of the face, enhancing facial shape. When applied in a safe surgical environment, following all surgical security standards and considering the complex anatomical boundaries of the cheek, our technique can yield secure and satisfactory outcomes both for surgeons and patients.

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RESUMO Objetivo: descrever a presença de linfonodos e suas relações com características demográficas e antropométricas em uma região específica ainda não descrita pelos compêndios de anatomia, por nós denominada de Recesso Carotídeo Recorrencial (RCR), localizada entre o nervo laríngeo recorrente direito, a artéria carótida comum direita e a artéria tireoidea inferior direita. Métodos: foram dissecadas 32 regiões cervicais à direita de cadáveres com até 24 horas de post mortem. O tecido fibrogorduroso do RCR foi ressecado e preparado com fixação em formol. Em seguida, foi submetido a uma sequência crescente de álcoois (70%, 80% e 90%), posteriormente a uma solução de Xilol e, por fim, a uma solução de Salicilato de Metila, respeitando o tempo necessário de cada etapa. O estudo macroscópico foi realizado na peça diafanizada, observando a presença ou não de linfonodos. Quando presentes, foram fotografados e suas medidas foram aferidas com um paquímetro digital. No estudo microscópico, foi utilizada a coloração hematoxilina-eosina para confirmação do linfonodo. Resultados: observou-se a presença de linfonodos em 22 dos 32 espécimes (68,75%), com o número de linfonodos por cadáver variando de zero a seis (média de 1,56±0,29) e tamanho com média de 7,82mmx3,86mm (diâmetros longitudinal x transversal). Conclusão: a relação entre dados antropométricos e presença de linfonodos no RCR (teste exato de Fischer) foi significante para indivíduos normolíneos (p=0,03) e também significante entre a etnia branca (p=0,04).

ABSTRACT Objective: to describe the presence of lymph nodes and their relationships with demographic and anthropometric characteristics in a specific region, not yet described in anatomy compendiums, called by us Recurrent Carotid Recess (RCR) and located among the right recurrent laryngeal nerve, the right common carotid artery, and the right inferior thyroid artery. Methods: 32 right cervical regions were harvested from cadavers within 24 hours post-mortem. The fibro-fatty tissue of the RCR was resected and prepared with formalin fixation. It was then subjected to an increasing sequence of alcohols (70%, 80%, and 90%), subsequently to a solution of Xylol, and finally to a solution of Methyl Salicylate, respecting the time required for each step. The macroscopic study was carried out on the diaphanized piece, observing the presence or not of lymph nodes. When present, they were photographed and their measurements were gauged with a digital caliper. In the microscopic study, hematoxylin-eosin staining was used to confirm the lymph node. Results: the presence of lymph nodes was observed in 22 (68.75%) of the 32 specimens. The number of lymph nodes ranged from zero to six (mean of 1.56±0.29), per cadaver, and their mean size was 7.82mmx3.86mm (longitudinal x transversal diameters). Conclusion: the relationship between anthropometric data and presence of lymph nodes in the RCR (Fisher's exact test) was significant for medium-height individuals (p=0.03) and also white ones (p=0.04).

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Objetivo: Caracterizar e comparar as posições e dimensões de abertura dos Forames Mentuais (FM) entre áreas edêntulas e dentadas em imagens por tomografia computadorizada de feixe cônico (TCFC). Material e Métodos: Analisou-se 72 exames de TCFC, abrangendo toda a mandíbula, obtidos em tomógrafo da marca i-CAT Next Generation (imaging Sciences International, Hatfield, PA, EUA). Estes foram divididas em 02 grupos: Grupo D (dentados) apresentando o 1º e 2º pré-molares inferiores correspondentes e Grupo E (edêntulos) sem ambos os pré-molares inferiores correspondentes. Foram realizadas, nos cortes transversais, 02 medidas em cada região: altura FM – correspondente à distância vertical entre o ponto mais inferior do canal mentual à cortical externa da base da mandíbula (AlFM) e abertura FM - correspondente à maior distância vertical entre as corticais externas superior e inferior do FM (AbFM). Adicionalmente, no Grupo D, foi estudada a posição do FM em relação a 04 referenciais: 1º pré-molar, entre 1º e 2º pré-molares, 2º pré-molar e outras localizações. Foi realizado o Teste t para amostras independentes e a análise descritiva. Resultados: Os resultados evidenciaram que houve diferença, estatisticamente significante, apenas na AbFM, entre os dois grupos, com tendência a um aumento desta no grupo D. No Grupo E, a houve diferença estatisticamente significante entre os sexos em relação à AbFM, com tendência a um maior valor para o sexo masculino. No grupo D, a localização do FM de maior frequência foi na região de 2o pré- molares (65,9%) e a de menor frequência na região de 1o pré-molares (4,9%). Conclusão: o edentulismo influenciou, apenas a dimensão da abertura do FM, com redução da mesma, pacientes edêntulos do gênero masculino, tendem a ter um valor maior de abertura de forame que pacientes edêntulos femininos.

Objective: To characterize and compare the positions and dimensions of the mental foramen (MF) openings between dentate and edentulous areas on cone beam computed tomography (CBCT) images. Material and Methods: Seventy-two CBCT images (i-CAT Next Generation, Imaging Sciences International, Hatfield, PA, USA) of the mandible were analyzed. The CBCT images were divided into two groups: Group D (dentate) - with first and second mandibular premolars; Group E (edentulous) - without first and second mandibular premolars. At the transversal cuts, two measurements were obtained: MF height – the vertical distance between the lowest point of the mandibular canal to the external cortical of the mandible’s base (MFH); MF opening – the greatest vertical distance between the superior and inferior MF external corticals (AbMF). Also, in Group D, the MF position was studied in relation to four landmarks: 1st premolar, between 1st and 2nd premolar; 2nd premolar; and other locations. Independent sample t-test and descriptive analysis were applied. Results: Only the distance AbMF showed statistically significant difference between groups, with tendency towards increasing in group D. Group E exhibited statistically significant difference between genders for the distance AbMF, with tendency towards greater values for males. Group D showed that MF was more frequently located at the area of the 2nd premolars (65.9%), while the area of the 1st premolars was that of smallest frequency (4.9%). Conclusion: the edentulism only reduced the dimension of MF opening. Edentulous males had a greater MF opening than edentulous females

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OBJECTIVE: To determine the distance between the axillary nerve and the antero-lateral (AL) edge of the acromion, its anatomical variability and relationship to humeral length and body height. METHODS: Twenty-two shoulders were dissected. The anterosuperior (AS) approach was used; the deltoid was detached from the acromion and the distance between the AL portion and the axillary nerve was measured and submitted to statistical analysis. RESULTS: The distance varied from 4.3 to 6.4 cm (average 5.32 ± 0.60 cm). The axillary nerve distance increased as the humeral size (p<0.05) and the height of each cadaver increased. However, the correlation with the specimens height was not significant (p=0.24). CONCLUSIONS: The distance between the acromion and the axillary nerve on the AS approach was 5.32 ± 0.60 cm in both shoulders, and increasing the humeral length there is also an increase in the axillary nerve distance. Level of Evidence IV, Case Series - Anatomic Study.

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Objective: To determine the distance between the axillary nerve and the antero-lateral (AL) edge of the acromion, its anatomical variability and relationship to humeral length and body height. Methods: Twenty-two shoulders were dissected. The anterosuperior (AS) approach was used; the deltoid was detached from the acromion and the distance between the AL portion and the axillary nerve was measured and submitted to statistical analysis. Results: The distance varied from 4.3 to 6.4 cm (average 5.32 ± 0.60 cm). The axillary nerve distance increased as the humeral size (p<0.05) and the height of each cadaver increased. However, the correlation with the specimens height was not significant (p=0.24). Conclusions: The distance between the acromion and the axillary nerve on the AS approach was 5.32 ± 0.60 cm in both shoulders, and increasing the humeral length there is also an increase in the axillary nerve distance. Level of Evidence IV, Case Series - Anatomic Study.

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PURPOSE: To determine the minimum volume of methylene blue (MB) to completely color the brachial plexus (BP) nerves, simulating an effective anesthetic block in cats. METHODS: Fifteen adult male cat cadavers were injected through subscapular approach with volumes of 2, 3, 4, 5 and 6 ml in both forelimbs, for a total of 30 brachial plexus blocks (BPB). After infusions, the specimens were carefully dissected preserving each nervous branch. The measurement of the effective area was indicated by the impregnation of MB. Nerves were divided into four segments from the origin at the spinal level until the insertion into the thoracic limb muscles. The blocks were considered effective only when all the nerves were strongly or totally colored. RESULTS: Volumes of 2, 3 and 4 ml were considered insufficient suggesting a failed block, however, volumes of 5 and 6 ml were associated with a successful block. CONCLUSIONS: The injection of methylene blue, in a volume of 6 ml, completely colored the brachial plexus. At volumes of 5 and 6 ml the brachial plexus blocks were considered a successful regional block, however, volumes of 2, 3 and 4 ml were considered a failed regional block. .

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