The applied anatomy of the anterior commissure and subglottis.

The applied anatomy of the subglottis and anterior commissure is discussed and an attempt made to correlate the histological anatomy with that clinically accessible. It is suggested that although the undersurface of the vocal fold is classified as part of the glottis by the 1972 UICC and AJC staging system, it should be considered as the roof of the subglottis. The anterior commissure, which is probably a small site within the glottis rather than a true area, is histologically difficult to separate from the anterior subglottis. The characteristic microvasculature of the anterior commissure is presented as being possibly relevant to the mode of spread of tumors at this site.     

The temporomandibular joint in the newborn infant. Oto-meniscal relations]

Although they are anatomically immature at the time of birth, the temporomandibular joints are able to ensure efficient suction due to the branchial blastema interposed between the two articular nuclei. This conjunctive formation is the principal factor in the constitution of the meniscus and its frena, the articular surfaces, the capsule and the ligaments. This constitutes not only an embryological but also a functional entity. The joint runs the risk of paying heavily for this functional availability, by its relationship with the ear-drum which is a potentially infectious cavity. In fact, at birth there is still evidence of the original branchial continuum between the unknit tympanal and squamosal in the shape of the posterior meniscal frenum, the conjunctivo-vascular isthmus which puts the vascularization of the mucosa of the ear-drum in communication with the very rich vascularization of the neonatal temporo-mandibular articulation. Therefore, 1/3 of the so-called congenital temporo-mandibular ankyloses, apparently without cause, could probably be explained by the otomeniscal relationship existing in the new-born baby and continuing during the first few months of life in the atmosphere in the form of a conjunctivo-vascular link.     

Distraction osteogenesis in a newborn infant with Pierre-Robin sequence]

BACKGROUND: The prognosis for Pierre Robin sequence is often closely correlated with direct postnatal asphyxia (ARDS) and permanent cerebral damage. Unfortunately, all of the well-known treatments entail many problems, which often lead to medical care of the patient for many years. Distraction osteogenesis was recently introduced as a very promising procedure. We revised this concept for newborn children aged up to 3 months. MATERIALS AND METHODS: The first patient was operated with an extraoral distractor at an age of approx. 3 months. The second patient was operated at an age of approx. 2 months. A new distractor was used, conceived specifically by our department for newborn children. RESULTS: Distraction osteogenesis was successful in both cases. After 20 days the first patient was able to breathe without the tracheotomy cannula. In the second case, we removed the nasopharyngeal tube successfully on the 7th postoperative day. The bilateral length gain amounted to 20 mm in the first case and 15 mm in the second. DISCUSSION: The usual jaw distraction osteogenesis has many disadvantages in babies: scar formation in the places depressed by pins and early pin loss. For the above-mentioned reasons, we developed a new type of extraoral distractor, which solves these problems. Less required space and the absence of pins resulting in fewer disfiguring scars are the clinical advantages of this new distractor.     

大鼠颞骨显微解剖学研究

目的观察Sprague-Dawley大鼠(S-D大鼠)的中耳和内耳结构,为大鼠耳科实验提供解剖学依据。方法对10只正常健康成年S-D大鼠的中耳和内耳进行显微解剖,对其颞骨的解剖学标志性结构放大6～15倍进行观察并照相。结果观察大鼠颞骨标本的中耳结构:鼓膜、听骨链、卵圆窗、圆窗、咽鼓管、面神经等;内耳结构:耳蜗、半规管、内听道、内淋巴囊等。结论大鼠颞骨解剖结构同人类存在很大相似性,这有助于利用大鼠进行耳科研究时定位中耳和内耳结构。     

Phonation in the newborn, infant cry

Sound spectrographic studies have shown that the crying of newborn infants has a fundamental frequency of about 400-600 cycles per second, and mostly a slightly rising-falling melody contour. In sick infants, and especially those with diseases affecting the central nervous system, abnormal cry characteristics occur. The fundamental frequency has been increased, and the melody contour is unstable. Various cry characteristics, which rarely occur in cries of healthy infants, are more often present in cries of the sick ones. Studies of cries in newborn infants have been especially aimed to determine whether cry analysis could be successful in diagnostics and in the early detection of the infant at risk for developmental difficulties.     

The applied anatomy of the periosteal flap composed of submental artery and dgastric muscle]

OBJECTIVE: To provide anatomical basis for a new style operation using periosteal flap composed of submental artery, anteroventral portion of digastric muscle and submental artery for the renovation of laryngotrachea. METHODS: The anatomical structures correlative with submental artery, submental vein, anteroventral portion of digastric muscle and mandibular periosteum in 23 (46 sides) cephalocervical samples were measured. RESULTS: The periosteal flaps had shown many advantages inculding large transfer capacity, rich blood supply, flexibility. CONCLUSION: It is feasible that the periosteal flap composed of submental artery, anteroventral portion of digastric muscle and mandibular periosteum is useful laryngotracheal renovation.     

The eustachian tube in HR computerized tomography. Imaging in the fetus, newborn infant and infant

The lumen of the eustachian tube in foetuses, neonates and infants was demonstrated in cadaver temporal bones immediately after death by air and contrast medium using high-resolution computed tomography with axial and coronal projections. Special consideration was given to the deviation of the tube from the sagittal and horizontal plane and the functional unit consisting of the processes of tensor palatini muscle. At this stage of development the lumen of the cartilaginous portion shows a constant almost circular form, quite unlike the shape in adults. A well developed isthmus between the bony and cartilaginous part is absent. In a 6-month-old foetus the tube is horizontal to the base of the skull, whereas in a 6-month-old infant it forms an angle of approximately 10 degrees. The angle to the sagittal plane changes in the same period from approximately 37 degrees to 40 degrees. In a 6-month-old foetus the fibres of the tensor palatini muscle also run in an almost horizontal line because of the tiny processus pterygoideus and are forced into a steeper direction as a result of its gradual growth. As there is almost no fulcrum function, a tubal opening effect or mechanism of the muscle fibres at this stage of development seems extremely doubtful.     

内耳道内神经问吻合及位置关系的显微解剖研究

目的 探讨内耳道内神经走行及相互吻合关系.方法 在手术显微镜下对30例成人颞骨标本进行显微解剖学研究,观察神经走行、面神经与前庭神经之间的吻合及耳蜗神经与前庭神经之间的吻合.结果 (1)30例颞骨标本中,37%(11例)的面神经在内耳道内一直在前上位置;63%(19例)的面神经从内耳道底至内耳道口过程中均有围绕前庭神经纵轴不同程度的向前下旋转,旋转范围大致在30°～90°之间,旋转的方向与耳蜗旋转的方向相同. (2)30例标本中,17%(5例)的标本没有发现前庭神经与面神经吻合支;83%(25例)的面神经与前庭神经之间存在吻合支,并且形态和数目存在差异.67%(16例)的吻合支在接近内耳道口部位;33%(8例)的吻合支在接近内耳道底的外1/3的内耳道内.吻合支直径不等,约在0.5～1 mm之间.(3)30例标本中,80%(24例)存在前庭耳蜗神经吻合支.在内耳道外1/3部位.13例标本中可明显看到一些刷状的神经纤维束直接进入球囊,15例在内耳道外1/3段有横行的吻合支,2例标本可以看到有多个吻合支,部分为两种形式共存.仅在内耳道中段有吻合支者1例;20%(6例)的标本未见有明显的前庭耳蜗神经吻合.结论 在内耳道内,神经走行关系及神经之间的吻合均存在着个体差异.熟悉这些关系有助于手术中保护神经功能,以及探讨面神经、前庭及耳蜗疾病之间的关系.     

Radiologic anatomy of the labyrinth artery]

Carotid and vertebral angiographic investigations were performed to study x-ray anatomy of the artery of the labyrinth (AL) in 96 inpatients admitted to the N. F. Sklifosovsky emergency care clinic. According to the angiograms, AL originated from the distal parts of the inferior anterior cerebellar artery in 66.3% of the patients. In this case it has a straight form. When initiating from the proximal parts of the basilar artery (33.7% of the patients), AL was shorter (0.8 +/- 0.3 against 2.5 +/- 0.8 cm) and curved. In any case AL was situated along the upper edge of the pyramid before it entered the internal acoustic meatus. By the meatus or inside it AL forms a characteristic loop or semiloop. A complete AL left-right symmetry was observed in 61.8% of the cases.     

Applied anatomy for the reinnervation of posterior cricoarytenoid muscle by phrenic nerve for bilateral vocal cord paralysis]

OBJECTIVE: To study the anatomic basis for the anastomosis of phrenic nerve (PN) to the anterior branch of recurrent laryngeal nerve(RLN) for the treatment of the injured bilateral RLN. METHODS: The origin and the nutritive arteries and the adjacent tissue construction of PNs in 46 cases were studied. The longest utilizable length of PNs and the distance from the root of PN to cricothyroid joint were measured. The sectional area and the number of myelinated fibers of PNs and the anterior branch of RLNs were measured by computer image processing system. RESULTS: PNs coming from C4 comprised of 93.5%, 95.6% (44/46) of the nutritive arteries came from the ascending carotid artery and got into the cervical segment of PN from its root. The common trunk of PN was very deep, to the external of the common carotid artery and the vertebral vein, and deep to the internal jugular vein and thoracic duct (left), and in the superficies of the subclavian artery and in the deep of the subclavian vein when it was crossing the thoracic entrance. The distance from the root of PN to the level of the subclavian vein and to cricothyroid joint were (7.2 +/- 1.6) cm and (5.5 +/- 1.4) cm, respectively. The former was at least 1.5 cm longer than the latter. The average number of myelinated fibers and the sectional area of the PNs were 2.41 times and 2.15 times as many as those of the anterior branch of RLNs, respectively. The single-fasciculated PNs comprised of about 75.0% (18/24)). CONCLUSION: Clinically, it may be safe and available for cutting PN off at the level of the subclavian vein. The length of PN is enough for the anastomosis of PN to the anterior branch of RLN.