MBB: Head & Neck Anatomy
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Middle Cranial Fossa Sphenoidal Region Dural Arteriovenous Fistulas: Anatomic and Treatment Considerations
ORIGINAL RESEARCH INTERVENTIONAL Middle Cranial Fossa Sphenoidal Region Dural Arteriovenous Fistulas: Anatomic and Treatment Considerations Z.-S. Shi, J. Ziegler, L. Feng, N.R. Gonzalez, S. Tateshima, R. Jahan, N.A. Martin, F. Vin˜uela, and G.R. Duckwiler ABSTRACT BACKGROUND AND PURPOSE: DAVFs rarely involve the sphenoid wings and middle cranial fossa. We characterize the angiographic findings, treatment, and outcome of DAVFs within the sphenoid wings. MATERIALS AND METHODS: We reviewed the clinical and radiologic data of 11 patients with DAVFs within the sphenoid wing that were treated with an endovascular or with a combined endovascular and surgical approach. RESULTS: Nine patients presented with ocular symptoms and 1 patient had a temporal parenchymal hematoma. Angiograms showed that 5 DAVFs were located on the lesser wing of sphenoid bone, whereas the other 6 were on the greater wing of the sphenoid bone. Multiple branches of the ICA and ECA supplied the lesions in 7 patients. Four patients had cortical venous reflux and 7 patients had varices. Eight patients were treated with transarterial embolization using liquid embolic agents, while 3 patients were treated with transvenous embo- lization with coils or in combination with Onyx. Surgical disconnection of the cortical veins was performed in 2 patients with incompletely occluded DAVFs. Anatomic cure was achieved in all patients. Eight patients had angiographic and clinical follow-up and none had recurrence of their lesions. CONCLUSIONS: DAVFs may occur within the dura of the sphenoid wings and may often have a presentation similar to cavernous sinus DAVFs, but because of potential associations with the cerebral venous system, may pose a risk for intracranial hemorrhage. -
The Morphometric Study of Occurrence and Variations of Foramen Ovale S
Research Article The morphometric study of occurrence and variations of foramen ovale S. Ajrish George*, M. S. Thenmozhi ABSTRACT Background: Foramen vale is one of the important foramina present in the sphenoid bone. Anatomically it is located in the greater wing of the sphenoid bone. The foramen ovale is situated posterolateral to the foramen rotundum and anteromedial to the foramen spinosum. The foramen spinosum is present posterior to the foramen ovale. The carotid canal is present posterior and medial to the foramen spinosum and the foramen rotundum is present anterior to the foramen ovale. The structures which pass through the foramen ovale are the mandibular nerve, emissary vein, accessory middle meningeal artery, and lesser petrosal nerve. The sphenoid bone has a body, a pair of greater wing, pair of lesser wing, pair of lateral pterygoid plate, and a pair of medial pterygoid plate. Aim: The study involves the assessment of any additional features in foramen ovale in dry South Indian skulls. Materials and Methods: This study involves examination of dry adult skulls. First, the foramen ovale is located, and then it is carefully examined for presence of alterations and additional features, and is recorded following computing the data and analyzing it. Results: The maximum length of foramen ovale on the right and left was 10.1 mm, 4.3 mm, respectively. The minimum length of the foramen in right and left was 9.1 mm, 3.2 mm, respectively. The maximum width of foramen ovale on the right and left was 4.8 mm and 2.3 mm, respectively. The minimum width of the foramen in the right and the left side was 5.7 mm and 2.9 mm, respectively. -
Gross Anatomy Assignment Name: Olorunfemi Peace Toluwalase Matric No: 17/Mhs01/257 Dept: Mbbs Course: Gross Anatomy of Head and Neck
GROSS ANATOMY ASSIGNMENT NAME: OLORUNFEMI PEACE TOLUWALASE MATRIC NO: 17/MHS01/257 DEPT: MBBS COURSE: GROSS ANATOMY OF HEAD AND NECK QUESTION 1 Write an essay on the carvernous sinus. The cavernous sinuses are one of several drainage pathways for the brain that sits in the middle. In addition to receiving venous drainage from the brain, it also receives tributaries from parts of the face. STRUCTURE ➢ The cavernous sinuses are 1 cm wide cavities that extend a distance of 2 cm from the most posterior aspect of the orbit to the petrous part of the temporal bone. ➢ They are bilaterally paired collections of venous plexuses that sit on either side of the sphenoid bone. ➢ Although they are not truly trabeculated cavities like the corpora cavernosa of the penis, the numerous plexuses, however, give the cavities their characteristic sponge-like appearance. ➢ The cavernous sinus is roofed by an inner layer of dura matter that continues with the diaphragma sellae that covers the superior part of the pituitary gland. The roof of the sinus also has several other attachments. ➢ Anteriorly, it attaches to the anterior and middle clinoid processes, posteriorly it attaches to the tentorium (at its attachment to the posterior clinoid process). Part of the periosteum of the greater wing of the sphenoid bone forms the floor of the sinus. ➢ The body of the sphenoid acts as the medial wall of the sinus while the lateral wall is formed from the visceral part of the dura mater. CONTENTS The cavernous sinus contains the internal carotid artery and several cranial nerves. Abducens nerve (CN VI) traverses the sinus lateral to the internal carotid artery. -
Craniotomy for Anterior Cranial Fossa Meningiomas: Historical Overview
Neurosurg Focus 36 (4):E14, 2014 ©AANS, 2014 Craniotomy for anterior cranial fossa meningiomas: historical overview SAUL F. MORALES-VALERO, M.D., JAMIE J. VAN GOMPEL, M.D., IOANNIS LOUMIOTIS, M.D., AND GIUSEPPE LANZINO, M.D. Department of Neurologic Surgery, Mayo Clinic, Mayo Medical School, Rochester, Minnesota The surgical treatment of meningiomas located at the base of the anterior cranial fossa is often challenging, and the evolution of the surgical strategy to resect these tumors parallels the development of craniotomy, and neurosur- gery in general, over the past century. Early successful operations to treat these tumors were pioneered by prominent figures such as Sir William Macewen and Francesco Durante. Following these early reports, Harvey Cushing made significant contributions, allowing a better understanding and treatment of meningiomas in general, but particularly those involving the anterior cranial base. Initially, large-sized unilateral or bilateral craniotomies were necessary to approach these deep-seated lesions. Technical advances such as the introduction of electrosurgery, the operating microscope, and refined microsurgical instruments allowed neurosurgeons to perform less invasive surgical proce- dures with better results. Today, a wide variety of surgical strategies, including endoscopic surgery and radiosurgery, are used to treat these tumors. In this review, the authors trace the evolution of craniotomy for anterior cranial fossa meningiomas. (http://thejns.org/doi/abs/10.3171/2014.1.FOCUS13569) KEY WORDS • intracranial meningiomas • craniotomy • history • anterior cranial fossa ENINGIOMAS of the anterior cranial fossa represent has a few distinct clinical features. However, in practice, 12%–20% of all intracranial meningiomas.5,30 this group of tumors often represents a continuum. -
Anatomic Variations of the Nose and Paranasal Sinuses in Saudi Population
234 Original article Anatomic variations of the nose and paranasal sinuses in saudi population: computed tomography scan analysis Nada Alshaikha, Amirah Aldhuraisb aDepartment of Otolaryngology Head & Neck Background Surgery, Rhinology Unit, Dammam Medical Knowledge of the anatomy constitutes an integral part in the total management of Complex (DMC), bDepartment of ENT, King Fahad Specialist Hospital (KFSH), Dammam, patients with sinonasal diseases. The aim of this study was to obtain the prevalence Saudi Arabia of sinonasal anatomic variations in Saudi population and to understand their importance and impact on the disease process, as well as their influence on Correspondence to Nada Alshaikh, MD, Department of Otorhinolaryngology Head and surgical management and outcome. Neck Surgery, Dammam Medical Complex, Materials and methods Dammam - 31414, Saudi Arabia This study is prospective review of retrospectively performed normal computed e-mail: [email protected] tomography (CT) scans of the nose and paranasal sinuses in adult Saudi Received 13 November 2016 population at Dammam Medical Complex. The scans were reviewed by two Accepted 23 December 2016 independent observers. The Egyptian Journal of Otolaryngology Results 2018, 34:234–241 Of all CT scans that were reviewed, 48.4% were of female patients and 51.6% were of male patients. The mean age of the study sample was 38.5±26.5 years. The most common anatomic variation after excluding agger nasi cell was pneumatized crista galli, which was seen in 73% of the scans. However, the least common variation seen in this series was hypoplasia of the maxillary sinus, which was encountered in 5% of the cases. We did not detect a single pneumatized inferior turbinate among the studied scans. -
Ardipithecus Ramidus and the Evolution of the Human Cranial Base
Ardipithecus ramidus and the evolution of the human cranial base William H. Kimbela,1, Gen Suwab, Berhane Asfawc, Yoel Raka,d, and Tim D. Whitee,1 aInstitute of Human Origins and School of Human Evolution and Social Change, Arizona State University, Tempe, AZ 85287; bThe University Museum, University of Tokyo, Bunkyo-ku, Tokyo 113-0033, Japan; cRift Valley Research Service, Addis Ababa, Ethiopia; dDepartment of Anatomy and Anthropology, Sackler School of Medicine, Tel Aviv University, 69978 Ramat Aviv, Israel; and eDepartment of Integrative Biology, Human Evolution Research Center, University of California, Berkeley, CA 94720 Contributed by Tim D. White, December 5, 2013 (sent for review October 14, 2013) The early Pliocene African hominoid Ardipithecus ramidus was di- We report here results of a metrical and morphological study agnosed as a having a unique phylogenetic relationship with the of the Ar. ramidus basicranium as another test of its hypothesized Australopithecus + Homo clade based on nonhoning canine teeth, phylogenetic affinity with Australopithecus and Homo. We ana- a foreshortened cranial base, and postcranial characters related to lyzed the length and breadth of the external cranial base and the facultative bipedality. However, pedal and pelvic traits indicating structural relationship between the petrous and tympanic elements substantial arboreality have raised arguments that this taxon may of the temporal bone in Ar. ramidus, Australopithecus (including instead be an example of parallel evolution of human-like traits Paranthropus of some authors), and mixed-sex samples of extant among apes around the time of the chimpanzee–human split. Here African hominoid (Gorilla gorilla, Pan troglodytes, Pan paniscus) we investigated the basicranial morphology of Ar. -
Septation of the Sphenoid Sinus and Its Clinical Significance
1793 International Journal of Collaborative Research on Internal Medicine & Public Health Septation of the Sphenoid Sinus and its Clinical Significance Eldan Kapur 1* , Adnan Kapidžić 2, Amela Kulenović 1, Lana Sarajlić 2, Adis Šahinović 2, Maida Šahinović 3 1 Department of anatomy, Medical faculty, University of Sarajevo, Čekaluša 90, 71000 Sarajevo, Bosnia and Herzegovina 2 Clinic for otorhinolaryngology, Clinical centre University of Sarajevo, Bolnička 25, 71000 Sarajevo, Bosnia and Herzegovina 3 Department of histology and embriology, Medical faculty, University of Sarajevo, Čekaluša 90, 71000 Sarajevo, Bosnia and Herzegovina * Corresponding Author: Eldan Kapur, MD, PhD Department of anatomy, Medical faculty, University of Sarajevo, Bosnia and Herzegovina Email: [email protected] Phone: 033 66 55 49; 033 22 64 78 (ext. 136) Abstract Introduction: Sphenoid sinus is located in the body of sphenoid, closed with a thin plate of bone tissue that separates it from the important structures such as the optic nerve, optic chiasm, cavernous sinus, pituitary gland, and internal carotid artery. It is divided by one or more vertical septa that are often asymmetric. Because of its location and the relationships with important neurovascular and glandular structures, sphenoid sinus represents a great diagnostic and therapeutic challenge. Aim: The aim of this study was to assess the septation of the sphenoid sinus and relationship between the number and position of septa and internal carotid artery in the adult BH population. Participants and Methods: A retrospective study of the CT analysis of the paranasal sinuses in 200 patients (104 male, 96 female) were performed using Siemens Somatom Art with the following parameters: 130 mAs: 120 kV, Slice: 3 mm. -
Morphological and Topographical Study of Wormian Bones in Cadaver Dry Skulls
Original article Morphological and topographical study of Wormian bones in cadaver dry skulls Murlimanju, BV.*, Prabhu, LV., Ashraf, CM., Kumar, CG., Rai, R. and Maheshwari, C. Department of Anatomy, Manipal University, Centre for Basic Sciences, Kasturba Medical College, Mangalore, India *E-mail: [email protected] Abstract Introduction: The Wormian bones are formations associated with insufficient rate of suture closure and regarded as epigenetic and hypostotic traits. It was reported that there exists racial variability among the incidence of these bones. In the present study, the aims were to find the incidence of Wormian bones in Indian skulls and to analyze them topographically. Material and methods: The study included 78 human adult dry skulls of Indian population which were obtained from the neuroanatomy laboratory of our institution. They were macroscopically observed for the incidence and topographical distribution of the Wormian bones. Results: The Wormian bones were observed in 57 skulls (73.1%) of our series. Remaining 21 skulls (26.9%) didn’t show these variant bones. They were observed at the lambdoid suture in 56.4% cases (44 skulls; 14-bilateral; 18-right side; 12-left side), at the asterion in 17.9% (14 skulls; 3-bilateral; 2-right side; 9-left side), at the pterion in 11.5% (9 skulls; 4-right side; 5-left side), at the coronal suture in 1.3% (only one skull) and at the sagittal suture in 1.3% cases (only one skull). Conclusion: The current study observed Wormian bones in 73.1% of the cases from Indian population. This incidence rate is slightly higher compared to other reports and may be due to racial variations. -
Morfofunctional Structure of the Skull
N.L. Svintsytska V.H. Hryn Morfofunctional structure of the skull Study guide Poltava 2016 Ministry of Public Health of Ukraine Public Institution «Central Methodological Office for Higher Medical Education of MPH of Ukraine» Higher State Educational Establishment of Ukraine «Ukranian Medical Stomatological Academy» N.L. Svintsytska, V.H. Hryn Morfofunctional structure of the skull Study guide Poltava 2016 2 LBC 28.706 UDC 611.714/716 S 24 «Recommended by the Ministry of Health of Ukraine as textbook for English- speaking students of higher educational institutions of the MPH of Ukraine» (minutes of the meeting of the Commission for the organization of training and methodical literature for the persons enrolled in higher medical (pharmaceutical) educational establishments of postgraduate education MPH of Ukraine, from 02.06.2016 №2). Letter of the MPH of Ukraine of 11.07.2016 № 08.01-30/17321 Composed by: N.L. Svintsytska, Associate Professor at the Department of Human Anatomy of Higher State Educational Establishment of Ukraine «Ukrainian Medical Stomatological Academy», PhD in Medicine, Associate Professor V.H. Hryn, Associate Professor at the Department of Human Anatomy of Higher State Educational Establishment of Ukraine «Ukrainian Medical Stomatological Academy», PhD in Medicine, Associate Professor This textbook is intended for undergraduate, postgraduate students and continuing education of health care professionals in a variety of clinical disciplines (medicine, pediatrics, dentistry) as it includes the basic concepts of human anatomy of the skull in adults and newborns. Rewiewed by: O.M. Slobodian, Head of the Department of Anatomy, Topographic Anatomy and Operative Surgery of Higher State Educational Establishment of Ukraine «Bukovinian State Medical University», Doctor of Medical Sciences, Professor M.V. -
The Neurocranium Forms the Cranial Cavity That Surrounds and Protects the Brain and Brainstem. the Neurocranium Is Formed from T
Name: Wokoma Olobo Benebo Department: Medical Laboratory Science Course: ANA 208 Matric Number: 18/MHS06/055 Assignment 1. Discuss the differences between viscerocranium and neurocranium The neurocranium forms the cranial cavity that surrounds and protects the brain and brainstem. The neurocranium is formed from the occipital bone, two temporal bones, two parietal bones, the sphenoid, ethmoid and frontal bones; they are all joined together with sutures. The viscerocranium bones form the anterior and lower regions of the skull and include the mandible, which attaches through the only truly motile joint found in the skull. The facial skeleton contains the vomer, two nasal conchae, two nasal bones, two maxilla, the mandible, two palatine bones, two zygomatic bones, and two lacrimal bones. 2. Femoral triangle is a special area of the thigh, Discuss Answers: The femoral triangle is a wedge-shaped area formed by a depression between the muscles of the thigh. It is located on the medial aspect of the proximal thigh. It is the region of the passage of the main blood vessels between the pelvis and the lower limb, as well as a large nerve supplying the thigh. It has several Borders and Contents. BORDERS: a. Lateral Border b. Medial Border c. Superior Border CONTENTS: a. Femoral Artery b. Femoral Vein c. Femoral Nerve d. Femoral Canal e. Lymphatics 3. Describe all the muscles of the lower limb that participates during 1/metre social distancing at the period of Covid 19. Answers: a. Rectus Femoris b. Vastus Medialis c. Vastus Lateralis d. Sartorius e. Gracilis f. The Hamstrings g.The Iliopsoas in the hips h. -
Surgical Anatamic of Paranasal Sinuses
SURGICAL ANATAMIC OF PARANASAL SINUSES DR. SEEMA MONGA ASSOCIATE PROFESSOR DEPARTMENT OF ENT-HNS HIMSR MIDDLE TURBINATE 1. Anterior attachment : vertically oriented, sup to the lateral border of cribriform plate. 2. Second attachment :Obliquely oriented- basal lamella/ ground lamella, Attached to the lamina papyracea ( medial wall of orbit anterior, posterior air cells, sphenopala‐ tine foramen 3. Posterior attachment :medial wall of maxillary sinus, horizontally oriented. , supreme turbinate 3. Occasionally 4. fourth turbinate, 5. supreme meatus, if present 6. drains posterior ethmoid drains inferior, middle, superior turbinates and, occasionally, the supreme turbinate, the fourth turbinate. e. Lateral to these turbinates are the corresponding meatuses divided per their drainage systems ANATOMICAL VARIATIONS OF THE TURBINATES 1. Concha bullosa, 24–55%, often bilateral, 2. Interlamellar cell of grunwald: pneumatization is limited to the vertical part of middle turbinate, usually not causing narrowing of the ostiomeatal unit 3. Paradoxic middle turbinate: 26%,. Occasionally, it can affect the patency of the ostiomeatal unit 4. Pneumatized basal lamella, falsely considered, posterior ethmoid air cell Missed basal lamella – attaches to lateral maxillary sinus wall Ostiomeatal unit Anterior ostiomeatal unit, maxillary, anterior ethmoid, frontal sinuses, (1) ethmoid infundibulum, (2) middle meatus, (3) hiatus semilunaris, (4) maxillaryOstium, (5) ethmoid bulla, (6) frontal recess, (7) uncinate process. , sphenoethmoidal recess Other draining osteomeatal unit, posterior in the nasal cavity, posterior ethmoid sinus, lateral to the superior turbinate, . sphenoid Sinus medial to the superior turbinate Uncinate Process Crescent‐shaped, thin individual bone inferiorly- ethmoidal process of inferior turbinate, anterior, lacrimal bone, posteriorly- hiatus Semilunaris, medial -ethmoid infundibulum, laterally, middle meatus superior attachment- variability, direct effect on frontal sinus drainage pathway. -
A New Radiological Classification for the Risk Assessment of Anterior Skull
www.nature.com/scientificreports OPEN A new radiological classifcation for the risk assessment of anterior skull base injury in endoscopic sinus surgery Baharudin Abdullah 1*, Shiun Chuen Chew1, Mohd Ezane Aziz2, Norasnieda Md Shukri1, Salina Husain3, Sng Weirong Joshua4, De Yun Wang4 & Kornkiat Snidvongs5 Keros and Gera classifcations are widely used to assess the risk of skull base injury during endoscopic sinus surgery. Although, both classifcations are useful preoperatively to stratify risk of patients going for surgery, it is not practical to measure the respective lengths during surgery. In this study, we aimed to propose a new radiological classifcation (Thailand-Malaysia-Singapore (TMS)) to assess the anatomical risk of anterior skull base injury using the orbital foor (OF) as a reference. A total of 150 computed tomography images of paranasal sinuses (300 sides) were reviewed. The TMS classifcation was categorized into 3 types by measuring OF to cribriform plate and OF to ethmoid roof. Most patients were classifed as TMS type 1, Keros type 2 and Gera class II, followed by patients classifed as TMS type 3, Keros type 1 and Gera class 1. TMS has signifcant correlation with Keros classifcation (p < 0.05). There was no signifcant correlation between Keros and Gera classifcations (p = 0.33) and between TMS and Gera classifcations (p = 0.80). The TMS classifcation has potential to be used for risk assessment of skull base injury among patients undergoing ESS. It serves as an additional assessment besides the Keros and Gera classifcations. Endoscopic sinus surgery (ESS) has an overall complication rate of 0.5% with the specifc complications of cere- brospinal fuid leak, orbital injury, haemorrhage requiring surgery, blood transfusion and toxic shock syndrome at 0.09%, 0.09%, 0.10%, 0.18%, and 0.02%, respectively1.