Formation and distribution of the sural nerve based on nerve fascicle and nerve fiber analyses

The formation and distribution of the sural nerve are presented on the basis of an investigation of 31 legs of Japanese cadavers using nerve fascicle and fiber analyses. Nerve fibers constituting the medial sural cutaneous nerve were designated as 'T', whereas those constituting the peroneal communicating branch were designated as 'F'. In 74.2% of cases (23/31), the T and F fibers joined each other in the leg, whereas in 9.7% of cases (3/31) they descended separately. In 16.1% of cases (5/31), the sural nerve was formed of only the T fibers. The sural nerve gave off lateral calcaneal branches and medial and lateral branches at the ankle. The lateral calcaneal branches always contained T fibers. The medial branches consisted of only T fibers, whereas most of the lateral branches consisted of only F fibers (71.0%; 22/31). In addition to the T and F fibers, P fibers, which derived from the superficial and deep peroneal nerves, formed the dorsal digital nerves. The P fibers were entirely supplied to the medial four and one-half toes. However, they were gradually replaced by the T and F fibers in the lateral direction. The 10th proper dorsal digital nerve consisted of T fibers only (38.7%; 12/31), of F fibers only (19.4%; 6/31) or of both T and F fibers (38.7%; 12/31). These findings suggest that the T fibers are essential nerve components for the skin and deep structures of the ankle and heel rather than the skin of the lateral side of the fifth toe. The designation of the medial sural cutaneous nerve should be avoided and only the T fibers are appropriate components for naming as the sural nerve.     

A connecting branch between the musculocutaneous nerve and the median nerve

We report here a connecting branch between the musculocutaneous and the median nerves in a 42 years old male cadaver. The connecting branch was 8 cm in length and 3 mm in width. One of the brachial veins and the brachial artery were located between the roots of the median nerve and the second brachial vein was present between the connecting branch and the median nerve. These kinds of variations may effect the venous return and may cause edema in the upper extremities. Additionally, variations of these nerves have an importance during operations of this region.     

肌皮神经并正中神经及尺神经变异1例

在解剖一具老年男性标本时，见左侧肌皮神经并正中神经及尺神经形态变异(附图)。经查有关文献，此类变异较为少见，现报道如下：     

甲状腺手术中对喉返神经和喉上神经保护的临床研究

目的 探讨甲状腺手术中喉返神经(RLN)、喉上神经(SLN)的保护方法,以避免或减少术后永久性神经损伤的发生率。方法 对东南大学医学院附属南京同仁医院耳鼻咽喉头颈外科,2013年6月—2014年11月行甲状腺精细化操作手术治疗141例患者的临床资料进行回顾性分析。其中男37例、女104例,年龄9~78岁。行甲状腺全切54例,甲状腺腺叶切除58例,甲状腺腺叶切除+对侧部分切除29例;其中二次手术者10例,行Ⅵ区清扫者18例。术中RLN显露者121例,未显露者20例。结果 本组141例均顺利完成手术。术后并发RLN暂时性损伤5侧,占2.56%(5/195),给予激素、神经营养药物治疗,并配合发音训练,3个月内神经功能均恢复正常;其中RLN显露组占2.5%(3/121),未显露组占5%(1/20),组间比较差异无统计学意义(χ²=0.396, P＞0.05)。无一例并发RLN永久性损伤和SLN损伤。结论 熟悉RLN、SLN与甲状腺的正常解剖与变异情况,应用被膜解剖技术精细操作,术后可以避免神经的永久性损伤。一旦发生神经损伤,及时给予对症处理,提高患者的生活质量。     

Connections between the accessory nerve and the posterior root of the first cervical nerve

The aim of this study was to demonstrate the incidence of absence of the posterior root of the first cervical nerve, and the relation between the accessory nerve and the posterior root of the first cervical nerve in Turkish population. Dissections of the accessory nerve and the posterior root of the first cervical nerve were performed in 49 specimens from 27 formalin fixed cadavers (25 male and 2 female). The type of the connections between the accessory nerve and the posterior root of the first cervical nerve was classified into four types. Type III was the most common type in present study (30.6%). There was a connection between the accessory nerve and the posterior root of the first cervical nerve in this type. The connections demonstrated in this study are important in the etiology and surgical treatment of the spasmodic torticollis.     

Branching patterns of the facial nerve and its communication with the auriculotemporal nerve

This study examines the anatomic relationships and variability of the facial nerve trunk and its branches, with emphasis on the intraparotid connections between the divisions. Microdissections were performed on 30 Korean half-heads, and the facial nerve trunks and branches were exposed. The average depth of the stylomastoid foramen from the skin surface was 21.0±3.1 mm, and the distance between the stylomastoid foramen and the bifurcation of the temporofacial (upper) and cervicofacial (lower) divisions was 13.0±2.8 mm. In 26 of 30 dissections (86.7%), the facial nerve trunk bifurcated into two main divisions, and a trifurcation pattern was seen in the other four cases (13.3%). According to the origin of the buccal branches, we classified the branching patterns of the facial nerve into four categories. In type I (13.8% of cases), the buccal branches arose from the two main divisions of the trunk but not from other branches of the facial nerve. In type II (44.8% of cases), the buccal branches arising from the two main divisions were interconnected with the zygomatic branch. In type III (17.3% of cases), the marginal mandibular branch sent nerve twigs to the buccal branch, which originated from the upper and lower divisions. In type IV (17.3% of cases), the nerve twigs from the zygomatic and marginal mandibular branches merged to the buccal branch arising from the two main divisions. Communications between the facial and auriculotemporal nerve branches, which are known as communicating auriculotemporal nerves, were observed in 28 of the 30 cases (93.3%). Familiarity with these common variations in the facial anatomy provides useful information for the surgeon in careful dissection, preservation of the facial nerve, and complete removal of the tumors in parotidectomies.     

Unmyelinated nerve fibers of the human mandibular nerve

The aim of this research is to find and to evaluate morphometorically the unmyelinated nerve fibers in the human mandibular nerve using a light microscope. Our report demonstrates for the first time the presence of the unmyelinated nerve fibers of the human mandibular nerve stained by a special method. Our results also indicate that there is a morphometric change with aging in the unmyelinated axons of the nerve.     

Ⅵ～Ⅷ对脑神经生物塑化薄片断层解剖与MRI对照研究

目的 :对展神经、面神经、前庭蜗神经进行塑化切片与MRI对照研究 ,获得正常影像和断层解剖资料。方法 :采用生物塑化技术制作脑神经横断位 8例、矢状位和冠状位各 1例薄层切片 ,同时采用FLASH -3D序列完成头颅标本及 3 0例正常人脑干MR扫描 ,以MPR技术完整显示展神经、面神经、前庭蜗神经脑池段全程。结果 :塑化薄片断层、标本和活体MR扫描 ,脑神经行程、解剖形态均有良好的对应关系 ,Dorello管和展神经海绵窦段在塑化切片上显示良好 ,MRI仅能部分显示。结论 :生物塑化薄层切片能够对脑神经及相关结构进行准确显示 ,是脑神经影像学研究的重要对比方法     

A thirteenth cranial nerve: the cloacal nerve

The completion by vertebrates of micturition, defecation, and copulation via the cloaca or its derivatives is hypothesized to be best explained by the existence of a thirteenth cranial nerve, the cloacal nerve, which, similar to the facial and trigeminal nerves, functions as a mixed cranial nerve containing both general and special components.     

Anastomosis between the external branch of the superior laryngeal nerve and the recurrent laryngeal nerve

An incidental finding in the anatomy lab showed up a plexus of the external branch of the right superior laryngeal nerve (SLN), including an anastomosis with the recurrent laryngeal nerve (RLN). The external branch of the SLN divided in two extensions: The ventral extension reached the mesopharynx laterally and by supplying the latter, ended at the cricothyroid muscle. The dorsal extension formed a plexus a finger's breadth beneath the inferior margin of the pharynx, on the lateral aspect of the esophagus. The anastomosis ran from the lower part of the plexus to the RLN along the esophagus, laterally.     

舌咽神经及鼓室神经切除手术入路的应用解剖

在１００个成年颅骨和２４侧尸头上对舌咽神经及鼓室神经切除术的应用解剖进行了研究，提出了乳突、鼓板下缘、茎突等骨性标志可作为手术入路的导向。鼓板下缘距鼓室底的距离为９．４±１．９ｍｍ，最小值为５．３ｍｍ。舌咽神经干在颈动脉鞘的前内侧易与颈动脉鞘分离。舌咽神经在近颈静脉孔处膨大形成下神经节，鼓室神经自下神经节的外侧发起者占４２．８％，后方发起者为４２．９％，前方发起者１４．３％。本文还对手术入路和手术技术问题进行了讨论。     

额神经末支解剖特点及其在前额除皱术中的意义

目的：为了前额除皱术切口位置和分离平面的选择提供解剖学依据。方法：对18例成人头部标本进行大体和显微解剖研究以及组织切片观察。结果：（1）眶上神经绕过眶上缘后分为溶，浅二支，浅支位额肌深面并穿过该肌分布于额部皮肤，深支行于额肌，帽状腱膜与骨膜之间直达人字缝；（2）滑车上神经在皱眉肌外侧和穿经皱眉肌后穿过额肌到达头皮，结论：（1）前额除皱术中冠状切口应尽量靠近人字缝，并在骨膜下剥离皮瓣，以避免损伤眶上神经，（2）切断皱眉肌时宜在直 下仔细操作以减少对滑车上神经的损伤。     

Arborization of the inferior laryngeal nerve and internal nerve on the posterior surface of the larynx

The morphological patterns of the inferior laryngeal nerve and internal laryngeal nerve display complex arborizations. This paper attempts to identify and clarify these patterns. Dissections were performed on 105 adult Japanese cadavers, and observations were made on 201 sides. Results showed that the communications between the inferior laryngeal nerve (ILN) and internal laryngeal nerve (ITLN) could be classified into two types and three subtypes. Also, the ITLN displayed three characteristic patterns at the arytenoid cartilage. These communications produce complex arborizations of the ILN as it enters the larynx. This may explain the variety of potential clinical symptoms observed after thyroid surgery or neck dissections. © 1995 WiIey-Liss, Inc.     

Variation of the spinal nerve compositions of thoracodorsal nerve

Thoracodorsal nerve distributes to the latissimus dorsi muscle. The aim of this study was to investigate the anatomic variation of the spinal nerve compositions of thoracodorsal nerve and to confirm which spinal nerve is a main component in participating amount. The most frequent type was consisted of C7 and C8 in 60%. Next frequent type was C6, C7, and C8 in 25%. Third type was C6 and C7 in 10% and fourth type was C7 alone in 5%. The diameter of each spinal nerve comprising thoracodorsal nerve was 1.20 +/- 0.23 (mean +/- SD) mm at C7, 0.43 +/- 0.15 mm at C8, and 0.33 +/- 0.09 mm at C6. These results show that the C7 nerve was the main component of thoracodorsal nerve and the anatomic variation appeared at the spinal nerve that participate by small amounts, as be excepted (C6 and C8).