双侧腋动脉分支变异1例

在解剖一成年男尸时发现双侧腋动脉分支变异，此变异较少见，报道如下： 解剖发现双侧腋动脉分支变异相同，腋动脉第一段距第一肋外缘1．2cm处发出胸上动脉（图1），分布于第1，2肋间隙前部；     

腋动脉变异1例

局部解剖学教学中,解剖1具甲醛溶液固定男性尸体,年龄约50岁左右,发现其右上肢血管变异,报道如下。 本例标本右上肢锁骨下动脉在臂丛外侧束上方（胸小肌的下缘）,分出内、外2支腋动脉。腋动脉内支直径较粗约8．0mm,与正中神经相伴,沿肱二头肌内侧沟下行至肘窝分出尺动脉、桡动脉,在距起始点10．5mm处分出胸前动脉;     

腋动脉及其分支的应用解剖学研究

目的探索国人腋动脉(AA)及其分支的类型、量化数据以及他们之间的比例关系。方法解剖观察32具成人尸体标本(男25具、女7具)的腋动脉分支类型、外径及腋动脉起始段的外径与其自身比例,腋动脉3段的长度、外径,计算三者间的自身比例。结果腋动脉分支分为7型及1个变异型。每型又分为若干亚型,以6支型(出现率30.16%)和5支型(出现率26.98%)多见;腋动脉3段长度差异较大,三者之比为1∶1.18∶1.25,外径由第一段至第三段渐细,三者之比为1∶0.89∶0.75,腋动脉的各分支依据其支数及起始位置的不同,分为若干型及亚型。腋动脉起始端与各分支起始端外径之比分别为胸上动脉(TS)1∶0.28,胸肩峰动脉(TA)1∶0.42,胸外侧动脉(TL)1∶0.31,肩胛下动脉(SS)1∶0.63,旋肱前动脉(CHA)1∶0.25,旋肱后动脉(CHP)1∶0.46。结论腋动脉及其分支的变异较大,临床介入放射学及血管外科学对血管处理或选择时,应以出现率高、类型恒定、管径允许者作为应用对象。     

右侧腋动脉分支变异一例

在解剖一成年男尸时发现左侧腋动脉第三段分支变异 ,而肱动脉无分支 ,为积累资料 ,现报道如下 :腋动脉第三段距第一肋外缘 7.5 cm处发现一动脉短干 ,其起始处外径为 0 .6 cm,于腋动脉外下方 0 .7cm处分为二支 ,一支向下行 0 .5 cm,立即分为 :1 .旋肱前动脉 :向外穿肱二头肌短头 ,绕肱骨外科颈前面至三角肌深面。 2 .旋肱后动脉 :与腋神经伴行 ,向后穿四边孔至三角肌深面与旋肱前动脉吻合。 3.肩胛下动脉 :向内下行 1 .8cm,于肩胛下肌下缘分出 :1胸背动脉 :伴胸背神经至背阔肌 ,2旋肩胛动脉 :向后穿三边孔至冈下窝。另一支细长 ,于肱二头肌内…     

双侧腋动脉分支变异1例

<正>腋动脉是上肢的主要动脉干,是锁骨下动脉的直接延续,其分支变异较多^[1]。在目前国内解剖学教材中,仍以腋动脉6支型为标准类型,即以胸小肌为界分为3段,第1段为胸上动脉,第2段为胸外侧动脉、胸肩峰动脉,第3段为肩胛下动脉,旋肱前、后动脉^[2]。在临床解剖学实验操作中,本组对一中年男尸进行解剖操作时,发现其双侧腋动脉在第3段存在多分支共干变异,经查阅文献,发现此种变异十分罕见,为完善人体解剖学数据资料,以期为临床上腋动脉及其他血管的介入治疗提供解剖学依据,现报道如下。     

右侧腋动脉分支和臂丛变异1例

作者在硕士研究生局部解剖学操作教学指导中,对一老年男尸进行解剖操作时,发现右侧腋动脉分支以及臂丛变异1例,归纳报道如下:1腋动脉分支变异     

左侧腋动脉分支变异1例

腋动脉分支变异较多,我们在解剖1具成人男尸时发现其存在一罕见变异(图1),特此报道,以期为临床外科手术注意特例情况提供解剖学依据。     

右侧腋动脉分支变异1例

腋动脉分支变异较多,笔者在解剖1具成人男尸时发现其变异程度大,较罕见,特此报道,为国人统计腋动脉分支变异积累资料,也为临床外科手术注意特例情况提供解剖学依据(图1)。     

右侧腋动脉分支与正中神经变异1例

笔者在局部解剖学实验操作中观察到腋动脉分支和正中神经的位置均出现走行异常,为积累解剖学资料以及为临床应用提供参考,我们仔细解剖了腋腔内的结构,观察其内血管神经的走行及毗邻关系,并测量了有关数据,现报告如下。     

Morphological variability of the renal artery branching pattern: a brief review and an anatomical study

The segmental branches of the renal artery vary in number and origin. The 1998, Terminologia Anatomica homologates two branches of the renal artery (anterior, posterior) and five segmental arteries: four from the anterior branch and one from the posterior one. The purpose of this study is to evaluate the renal artery branching pattern, the number and origin of the segmental arteries, as well as to review data from similar studies. The study material consisted of 60 formalin-fixed adult kidneys. Dissections and microdissections were performed on the renal arteries and their branches. The branching of the renal artery was prehilar in 81.67% of cases, hilar in 10% and intra-sinusal in 8.33%. The number branches varied as follows: two branches in 42 cases (70%), three branches in 14 cases (23.33%) and four branches in four cases (6.67%). We subsequently analyzed the origin of the segmental arteries and found that in 53% of the cases the segmental arteries arose independently from the renal artery's branches, while in 47% of the cases they derived from common trunks of type I (85%) or II (15%). Type I trunks are those that originate directly from the main renal artery. They divide either into 2-3 segmental branches, or into just 1-2 branches and a smaller trunk (type II). The type II trunks further divide into 2-3 other segmental branches. These common trunks must be taken into account to avoid confusion with the segmental arteries. Knowledge of these variations is useful not only morphologically, but also clinically.     

Peri-hilar branching patterns and morphologies of the renal artery: a review and anatomical study

The peri-hilar (extra-parenchymal) branching pattern of the renal artery is important for surgeons to know prior to kidney transplantation. The aim of this study was to identify the variations in peri-hilar branching pattern and morphology of the main renal artery. Arteriograms of 81 kidneys were examined. After marking the renal shadow, the main renal artery was traced laterally from its origin. Morphologically, the arterial branching patterns were classified into ladder (with sequential branching points) and fork (with a common branching point) types. The latter was either duplicated or triplicated. The peri-hilar morphology of the main renal artery was then categorized according to its primary and secondary divisions and their patterns. If a single category encompassed at least 5% of the observed figures, it was recorded as a "cardinal" peri-hilar arterial morphology. Otherwise, it was counted within the category of "infrequent" morphologies. At the level of the main artery, a fork pattern was observed in 92.6% (n = 75) (80.2% duplicated (n = 65) and 12.4% triplicated (n = 10)) and a ladder pattern in 7.4% (n = 6) of kidneys. Of 160 primary branches off the fork-type main artery, a secondary division was found in 68.8%. Only one further division (4.4%) was noted from the ladder-type primary arteries. Eight "cardinal" peri-hilar renal arterial morphologies were identified and represented 82.7% of all cases. At least ten "infrequent" morphologies were also found. These patterns showed some alteration with the presence of a supernumerary renal artery. We concluded that the peri-hilar branching of main renal artery is highly variable, though this may follow certain patterns. We believe that the results may be useful to surgeons operating at the renal hilum especially during kidney transplantation.     

Potential axillary nerve stretching during RSA implantation: an anatomical study

Clinical and subclinical neurological injury after reverse shoulder arthroplasty (RSA) may jeopardize functional outcomes due to the risk of irreversible damage to the axillary nerve. We proposed a simple anatomical study in order to assess the macroscopic effects on the axillary nerve when lowering the humerus as performed during RSA implantation. We also measured the effect on the axillary nerve of a lateralization of the humerus. Between 2011 and 2012, cadaveric dissections of 16 shoulder specimens from nine fresh human cadavers were performed in order to assess the effects on the axillary nerve after the lowering and lateralization of the humerus. We assessed the extent of stretching of the axillary nerve in four positions in the sagittal plane [lowering of the humerus: great tuberosity in contact with the acromion (position 1), in contact with the upper (position 2), middle (position 3) and lower rim of the glenoid (position 4)] and three positions in the frontal plane [lateralization of the humerus: humerus in contact with the glenoid (position 1), humerus lateralized 1 cm (position 2) and 2 cm (position 3)]. When the humerus was lowered, clear macroscopical changes appeared below the middle of the glenoid (the highest level of tension). As regards the lateralization of the humerus, macroscopic study and measurements confirm the absence of stretching of the nerve in those positions. Lowering of the humerus below the equator of the glenoid changes the course and tension of the axillary nerve and may lead to stretching and irreversible damage, compromising the function of the deltoid. Improvements in the design of the implants and modification of the positioning of the glenosphere to avoid notching and to increase mobility must take into account the anatomical changes induced by the prosthesis and its impact on the brachial plexus. Level of Evidence and study type Level IV.     

Terminal branching pattern of the right coronary artery in left-dominant hearts: a cadaveric study

BackgroundLeft coronary dominance has been reported to be associated with increased mortality and severity in case of myocardial ischemia involving left coronary artery. The present cadaveric study was proposed to objectively study and document the termination and branching pattern of the right coronary artery in left-coronary-dominant hearts in relation to the blood supply to the posterior surface of the right ventricle.MethodsSeventy-five cadaveric hearts were studied. The coronary vessels were injected with colored cellulose acetate butyrate and dissected. The coronary dominance was determined. In left-dominant hearts, branches and termination of the right coronary artery were studied.ResultsLeft coronary dominance was found in 13% of the specimens. The number of ventricular branches was found to be present as 0, 1, 2, and 4 in two, four, two, and two of the cases, respectively. The average length of the ventricular branch was 12.7 mm with a range of 5–35 mm. The atrial branch was found in 50% of hearts, varying from 2 to 3 mm in length. In three hearts, the acute marginal artery did not give any posterior ventricular branch, while two, three, and five posterior ventricular branches were seen in four, two, and one heart(s), respectively. The length of the posterior ventricular arteries was between 5 and 15 mm.ConclusionThe RCA is an inconstant and unreliable source of posterior right ventricular perfusion in a significant percentage of population with left-coronary-dominant hearts. This might be the reason for the increased morbidity and mortality seen in the event of left coronary ischemia.     

Variations in the branching pattern of posterior division of mandibular nerve: a case report

Purpose

Abnormal communications among the branches of mandibular nerve especially the posterior division are significant due to various procedures undertaken in this region. These variations are worth reporting as they pose serious implications in several interventions in this region, and may even lead to false diagnosis.

Methods

During routine dissection, the mandibular nerve and its branches were dissected in the infratemporal fossa. The branches from the posterior division of the mandibular nerve namely the inferior alveolar and auriculotemporal nerves were carefully dissected, and their abnormal branching pattern was noted.

Results

There was a communicating branch between left inferior alveolar and auriculotemporal nerve. There was also a variant recurrent branch from the left inferior alveolar nerve that supplied the lateral pterygoid muscle.

Conclusions

Such variant branches and communications between the branches of mandibular nerve as seen in this case have an embryological basis and are clinically important in this region especially for dental surgeries and anesthesia.     

Maxillary-to-petrous internal carotid artery bypass: an anatomical feasibility study

The possibility for maxillary artery (MA) to petrous internal carotid artery (ICA) bypass was investigated. Five adult cadavers were dissected bilaterally. After zygomatic arch osteotomy, the coronoid process was sectioned at its base. An extensive infratemporal craniotomy was performed at the level of foramina ovale, rotundum and spinosum. The petrous portion of the ICA was exposed by drilling away the floor of the middle fossa, posterior to the foramen ovale and medial to the foramen spinosum. The MA was identified medial to the infratemporal crest and was followed in the pterygopalatine fossa, then transected at the origin of the infraorbital artery. The MA graft was brought posteromedially to reach the petrous ICA. The mean caliber of the MA before the origin of the infraorbital artery was 2.54±0.31 mm, 2.76±0.14 mm at the site of anastomosis, and 3.46±0.32 mm after giving off the middle meningeal artery. The average length of the MA between the middle meningeal artery and the infraorbital artery was 43.4±2.35 mm, and up to the site of anastomosis was 37.64±1.68 mm. We conclude that the length and diameter of the MA are sufficient for a tension-free anastomosis between MA and petrous ICA, and such a procedure could be used in the treatment of patients with tumors of the infratemporal fossa invading the high cervical ICA.

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Electronic Supplementary Material The french version of this article is available in the form of electronic supplementary material and can be obtained by using the Springer Link server located at

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Étude anatomique des possibilités de by-pass entre la partie pétreuse de l'artère carotide interne et l'artère maxillaire

Résumé La possibilité d'un by-pass entre l'artère maxillaire et la partie pétreuse de l'artère carotide interne a été étudiée. Cinq cadavres adultes ont été disséqués des deux côtés. Après ostéotomie de l'arcade zygomatique, le processus coronoïde était sectionné à sa base. Une large craniotomie infra-temporale était effectuée au niveau du foramen ovale, du foramen rond et du foramen épineux. La partie pétreuse de l'artère carotide interne était exposée par fraisage du plancher de la fosse cérébrale moyenne, en arrière du foramen ovale et en dedans du foramen épineux. L'artère maxillaire était identifiée en dedans de la crête infra-temporale et suivie dans la fosse ptérygo-palatine, puis sectionnée à l'origine de l'artère infra-orbitaire. Le greffon d'artère maxillaire était transposé en dedans et en arrière pour atteindre la partie pétreuse de l'artère carotide interne. Le calibre moyen de l'artère maxillaire était de 2,54±0,31 mm à l'origine de l'artère infra-orbitaire, 2,76±0,14 mm au niveau de l'anastomose, et 3,46±0,32 mm après la naissance à l'artère méningée moyenne. La longueur moyenne de l'artère maxillaire entre l'artère méningée moyenne et l'artère infra-orbitaire était de 43,4±2,35 mm et au-delà du site d'anastomose était de 37,64±1,68 mm. Nous en avons conclu que la longueur et le diamètre de l'artère maxillaire était suffisant pour une anastomose sans tension entre l'artère maxillaire et la partie pétreuse de l'artère carotide interne. Ainsi, une telle technique pourrait être utilisée pour le traitement de patients porteurs d'une tumeur de la fosse infra-temporale envahissant la partie cervicale haute de l'artère carotide interne.

     

An anatomical study of the recurrent laryngeal nerve: its branching patterns and relationship to the inferior thyroid artery

Abstract: The aim of this study was to provide information about the morphology and topography of the recurrent laryngeal nerve (RLN), its external features and branches, as well as its relationship to the inferior thyroid artery, the inferior horn of the thyroid cartilage and the thyroid gland. The RLNs in 50 adult cadavers (100 sides) were dissected and analyzed. A communicating loop connecting one branch of the RLN to another or a twig originating from the cervical sympathetic trunk was present in 13 of 100 sides. A double left RLN appeared in 2 sides; a right non-recurrent inferior laryngeal nerve appeared in one side. All of the RLNs, including looped ones, bifurcated into laryngeal branches and extralaryngeal branches, with most of the former further dividing into the anterior and posterior branches entering the larynx. The relations of the RLN to the inferior thyroid artery, the inferior horn of the thyroid cartilage and the thyroid gland were inconstant. The information gained from this study will be of value in thyroid surgery.