TNA, Chapter II
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Intrapartum Lesions to the Lumbar Portion of the Lumbosacral Plexus: an Anatomical Review
REVIEW Eur. J. Anat. 23 (2): 83-90 (2019) Intrapartum lesions to the lumbar portion of the lumbosacral plexus: an anatomical review Shanna E. Williams, Asa C. Black, Jr. Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC, USA SUMMARY Key words: Plexopathy – Radiculopathy – Neu- The lumbosacral plexus is formed by the ventral ropathy – Pregnancy – Foot drop rami of L2-S3 and provides sensory and motor branches to the lower extremity. The spatial orien- INTRODUCTION tation of the lumbar portion of the plexus above the pelvic brim leaves it particularly susceptible to in- The lumbosacral plexus is formed by the ventral trapartum injury by the fetal head. Such lesions are rami of the L2-S3 segments, with some contribu- subdivided into two groups: upper lumbar plexus tions from L1 and S4 segments. It gives rise to six (L1-L4) and lumbosacral trunk (L4-L5). Given the sensory nerves of the thigh and leg, and six major root levels involved, upper lumbar plexus lesions sensorimotor nerves responsible for innervating 43 produce symptoms suggestive of iliohypogastric, muscles of the lower extremity (Van Alfen and ilioinguinal, genitofemoral, femoral, and obturator Malessy, 2013). As the name would suggest, it neuropathies or L4 radiculopathies. Alternatively, consists of two components, the lumbar plexus involvement of the lumbosacral trunk can imitate a and the sacral plexus, which are spatially separat- common fibular (peroneal) neuropathy or L5 ed. This anatomical separation results in a clinical radiculopathy. This symptomatic overlap with vari- division of lumbosacral plexus lesions into those ous neuropathies and radiculopathies, makes di- affecting the lumbar plexus and those affecting the agnosis of such lesions particularly challenging. -
Nerve Ultrasound in Dorsal Root Ganglion Disorders: Smaller Nerves Lead to Bigger Insights
Clinical Neurophysiology 130 (2019) 550–551 Contents lists available at ScienceDirect Clinical Neurophysiology journal homepage: www.elsevier.com/locate/clinph Editorial Nerve ultrasound in dorsal root ganglion disorders: Smaller nerves lead to bigger insights See Article, pages 568–572 After decades of having to make do with electric stimulation representing the fascicles, bundled together in a large outer cable and recording (i.e. nerve conduction studies, electromyography sheath (van Alfen et al., 2018). and evoked potentials), nerve ultrasound now provides the oppor- Next, it is important to realize what the ratio between axon/ tunity to improve neurodiagnostic patient care by deploying a myelin and connective tissue in a given nerve segment is, and powerful tool to detect neuromuscular pathology in an accurate how that ratio changes from the proximal root to the distal end and patient-friendly way (Mah et al., 2018; Walker et al., 2018). branches (Schraut et al., 2016). Connective tissue elements of the Nerve ultrasound is also increasingly providing neurologists and perineurium and epineurium are relatively sparse at the very prox- clinical neurophysiologists with the opportunity to increase their imal root and plexus levels, with an average connective tissue con- insight in the pathophysiology of peripheral nervous system tent of around 25–30%. Ultrasonographically, this means that roots (PNS) pathology. In this issue of Clinical Neurophysiology, Leadbet- will always look rather black in appearance without much dis- ter and coworkers (Leadbetter et al., 2019) describe the results of cernible fascicular architecture, as the sparseness of connective tis- their study on nerve ultrasound for diagnosing sensory neuronopa- sue elements provides relatively few reflectors to create an image thy in spinocerebellar ataxia type 2 and CANVAS syndrome. -
JMSCR Vol||06||Issue||12||Page 318-327||December 2018
JMSCR Vol||06||Issue||12||Page 318-327||December 2018 www.jmscr.igmpublication.org Impact Factor (SJIF): 6.379 Index Copernicus Value: 79.54 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: https://dx.doi.org/10.18535/jmscr/v6i12.50 Routine Ilionguinal and Iliohypogastric Nerve Excision in Lichenstein Hernia Repair - A Prospective Study of 50 Cases Authors Dr Harekrishna Majhi1, Dr Bhupesh Kumar Nayak2 1Associate Professor, Department of General Surgery, VSS IMSAR, Burla 2Senior Resident, Department of General Surgery, VSS IMSAR, Burla Email: [email protected], Contact No.: 9437137230 Abstract Chronic inguinal neuralgia is one of the most significant complications following inguinal hernia repair. Subsequent patient disability can be severe & may often require numerous interventions for treatment. The purpose of the study is to evaluate long term outcomes following nerve excision to nerve preservation when performing lichenstein inguinal hernia repairs. A prospective study of cases with excision of illionguinal & illiohypogastric nerve excision during lichenstein hernia repair with post operative groin repair at 6 month & 1 yrs from May 2015-17 was carried out in the Deptt. of General Surgery, VSSIMSAR, Burla. neuralgia reported for Lichtenstein repair of Introduction inguinal hernias range from 6% to 29%. The No disease of human body, belongs to the probable cause of chronic inguiodynia after province of the surgeon, requires its treatment, a hernioplasty due to entrapment, inflammation, better combination of accurate anatomical ligation, neuroma or fibrotic reactions involving knowledge with surgical skill than hernia in all its ilioinguinal, iliohypogastric & genitial branch of variety. This statement made by SIR Astley genito-femoral nerve. -
Pelvic Anatomyanatomy
PelvicPelvic AnatomyAnatomy RobertRobert E.E. Gutman,Gutman, MDMD ObjectivesObjectives UnderstandUnderstand pelvicpelvic anatomyanatomy Organs and structures of the female pelvis Vascular Supply Neurologic supply Pelvic and retroperitoneal contents and spaces Bony structures Connective tissue (fascia, ligaments) Pelvic floor and abdominal musculature DescribeDescribe functionalfunctional anatomyanatomy andand relevantrelevant pathophysiologypathophysiology Pelvic support Urinary continence Fecal continence AbdominalAbdominal WallWall RectusRectus FasciaFascia LayersLayers WhatWhat areare thethe layerslayers ofof thethe rectusrectus fasciafascia AboveAbove thethe arcuatearcuate line?line? BelowBelow thethe arcuatearcuate line?line? MedianMedial umbilicalumbilical fold Lateralligaments umbilical & folds folds BonyBony AnatomyAnatomy andand LigamentsLigaments BonyBony PelvisPelvis TheThe bonybony pelvispelvis isis comprisedcomprised ofof 22 innominateinnominate bones,bones, thethe sacrum,sacrum, andand thethe coccyx.coccyx. WhatWhat 33 piecespieces fusefuse toto makemake thethe InnominateInnominate bone?bone? PubisPubis IschiumIschium IliumIlium ClinicalClinical PelvimetryPelvimetry WhichWhich measurementsmeasurements thatthat cancan bebe mademade onon exam?exam? InletInlet DiagonalDiagonal ConjugateConjugate MidplaneMidplane InterspinousInterspinous diameterdiameter OutletOutlet TransverseTransverse diameterdiameter ((intertuberousintertuberous)) andand APAP diameterdiameter ((symphysissymphysis toto coccyx)coccyx) -
Nerves of the Orbit Optic Nerve the Optic Nerve Enters the Orbit from the Middle Cranial Fossa by Passing Through the Optic Canal
human anatomy 2016 lecture fourteen Dr meethak ali ahmed neurosurgeon Nerves of the Orbit Optic Nerve The optic nerve enters the orbit from the middle cranial fossa by passing through the optic canal . It is accompanied by the ophthalmic artery, which lies on its lower lateral side. The nerve is surrounded by sheath of pia mater, arachnoid mater, and dura mater. It runs forward and laterally within the cone of the recti muscles and pierces the sclera at a point medial to the posterior pole of the eyeball. Here, the meninges fuse with the sclera so that the subarachnoid space with its contained cerebrospinal fluid extends forward from the middle cranial fossa, around the optic nerve, and through the optic canal, as far as the eyeball. A rise in pressure of the cerebrospinal fluid within the cranial cavity therefore is transmitted to theback of the eyeball. Lacrimal Nerve The lacrimal nerve arises from the ophthalmic division of the trigeminal nerve. It enters the orbit through the upper part of the superior orbital fissure and passes forward along the upper border of the lateral rectus muscle . It is joined by a branch of the zygomaticotemporal nerve, whi(parasympathetic secretomotor fibers). The lacrimal nerve ends by supplying the skin of the lateral part of the upper lid. Frontal Nerve The frontal nerve arises from the ophthalmic division of the trigeminal nerve. It enters the orbit through the upper part of the superior orbital fissure and passes forward on the upper surface of the levator palpebrae superioris beneath the roof of the orbit . -
Maxillary Nerve-Mediated Postseptoplasty Nasal Allodynia: a Case Report
E CASE REPORT Maxillary Nerve-Mediated Postseptoplasty Nasal Allodynia: A Case Report Shikha Sharma, MD, PhD,* Wilson Ly, MD, PharmD,* and Xiaobing Yu, MD*† Endoscopic nasal septoplasty is a commonly performed otolaryngology procedure, not known to cause persistent postsurgical pain or hypersensitivity. Here, we discuss a unique case of persis- tent nasal pain that developed after a primary endoscopic septoplasty, which then progressed to marked mechanical and thermal allodynia following a revision septoplasty. Pain symptoms were found to be mediated by the maxillary division of the trigeminal nerve and resolved after percuta- neous radiofrequency ablation (RFA) of bilateral maxillary nerves. To the best of our knowledge, this is the first report of maxillary nerve–mediated nasal allodynia after septoplasty. (A&A Practice. 2020;14:e01356.) GLOSSARY CT = computed tomography; FR = foramen rotundum; HIPAA = Health Insurance Portability and Accountability Act; ION = infraorbital nerve; LPP = lateral pterygoid plate; MRI = magnetic reso- nance imaging; RFA = radiofrequency ablation; SPG = sphenopalatine ganglion; US = ultrasound ndoscopic nasal septoplasty is a common otolaryn- septoplasty for chronic nasal obstruction with resection of gology procedure with rare incidence of postsurgical the cartilage inferiorly and posteriorly in 2010. Before this Ecomplications. Minor complications include epistaxis, surgery, the patient only occasionally experienced mild septal hematoma, septal perforation, cerebrospinal fluid leak, headaches. However, his postoperative course was compli- and persistent obstruction.1 Numbness or hypoesthesia of the cated by significant pain requiring high-dose opioids. After anterior palate, secondary to injury to the nasopalatine nerve, discharge, patient continued to have persistent deep, “ach- has been reported, but is usually rare and temporary, resolv- ing” nasal pain which radiated toward bilateral forehead ing over weeks to months.2 Acute postoperative pain is also and incisors. -
Clinical Presentations of Lumbar Disc Degeneration and Lumbosacral Nerve Lesions
Hindawi International Journal of Rheumatology Volume 2020, Article ID 2919625, 13 pages https://doi.org/10.1155/2020/2919625 Review Article Clinical Presentations of Lumbar Disc Degeneration and Lumbosacral Nerve Lesions Worku Abie Liyew Biomedical Science Department, School of Medicine, Debre Markos University, Debre Markos, Ethiopia Correspondence should be addressed to Worku Abie Liyew; [email protected] Received 25 April 2020; Revised 26 June 2020; Accepted 13 July 2020; Published 29 August 2020 Academic Editor: Bruce M. Rothschild Copyright © 2020 Worku Abie Liyew. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Lumbar disc degeneration is defined as the wear and tear of lumbar intervertebral disc, and it is mainly occurring at L3-L4 and L4-S1 vertebrae. Lumbar disc degeneration may lead to disc bulging, osteophytes, loss of disc space, and compression and irritation of the adjacent nerve root. Clinical presentations associated with lumbar disc degeneration and lumbosacral nerve lesion are discogenic pain, radical pain, muscular weakness, and cutaneous. Discogenic pain is usually felt in the lumbar region, or sometimes, it may feel in the buttocks, down to the upper thighs, and it is typically presented with sudden forced flexion and/or rotational moment. Radical pain, muscular weakness, and sensory defects associated with lumbosacral nerve lesions are distributed on -
Tentorium Cerebelli: the Bridge Between the Central and Peripheral Nervous System, Part 2
Open Access Review Article DOI: 10.7759/cureus.5679 Tentorium Cerebelli: the Bridge Between the Central and Peripheral Nervous System, Part 2 Bruno Bordoni 1 , Marta Simonelli 2 , Maria Marcella Lagana 3 1. Cardiology, Foundation Don Carlo Gnocchi, Milan, ITA 2. Osteopathy, French-Italian School of Osteopathy, Pisa, ITA 3. Radiology, IRCCS Fondazione Don Carlo Gnocchi Onlus, Milan, ITA Corresponding author: Bruno Bordoni, [email protected] Abstract The tentorium cerebelli is a meningeal portion in relation to the skull, the nervous system, and the cervical tract. In this second part, the article discusses the systematic tentorial relationships, such as the central and cervical neurological connections, the venous circulation and highlights possible clinical alterations that could cause pain. To understand the function of anatomy, we should always remember that every area of the human body is never a segment, but a functional continuum. Categories: Physical Medicine & Rehabilitation, Anatomy, Osteopathic Medicine Keywords: tentorium cerebelli, fascia, pain, venous circulation, neurological connections, cranio Introduction And Background Cervical neurological connections The ansa cervicalis characterizes the first cervical roots and connects all anterior cervical nerve exits with the inferior floor of the oral cavity, the trigeminal system, the respiratory control system, and the sympathetic system. The descending branch of the hypoglossal nerve anastomoses with C1, forming the ansa hypoglossi or ansa cervicalis superior [1]. The inferior root of the ansa cervicalis, also known as descendens cervicalis, is formed by ascendant fibers from spinal nerves C2-C3 and occasionally fibers C4, lying anteriorly to the common carotid artery (it passes laterally or medially to the internal jugular vein upon anatomical variations) [1]. -
Anatomy of Spinal Nerves in the First Turkish Illustrated Anatomy Handwritten Textbook
View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by DSpace@HKU Childs Nerv Syst DOI 10.1007/s00381-016-3136-9 COVER EDITORIAL Anatomy of spinal nerves in the first Turkish illustrated anatomy handwritten textbook Murat Çetkin1 & Mustafa Orhan1 & İlhan Bahşi1 & Begümhan Turhan2 Received: 26 May 2016 /Accepted: 30 May 2016 # Springer-Verlag Berlin Heidelberg 2016 BTeşrih-ül Ebdan ve Tercümânı Kıbale-i Feylesûfan^ is the the book, İtâḳî acknowledges the contributions of the Grand first handwritten anatomy textbook with illustrations written Vizier [4, 7]. in Turkish in 17th century by Şemseddîn-i İtâḳî. BTeşrih^ has Not many textbooks about anatomy existed in the Islamic different meanings such as anatomy, skeleton, and cutting a World and the Ottoman Empire until İtâḳî’sbook[9]. In other corpse into pieces [1]. BTeşrih-ül Ebdan ve Tercümânı Kıbale- medical textbooks, anatomy occupies only a few pages in i Feylesûfan ^ means dissection of the body and scholars’ different sections [4]. İtâḳî’s book is a pioneer in its area as birth knowledge [2]. Since this is the first handwritten text- it is written in Turkish, and it is supported with illustrations book in Turkish, it has great importance in the development of [4]. In addition to Turkish, the book contains mostly Arabic medicine in Ottoman Empire. This book was written while and rarely Persian terms as well [4, 6, 7]. Some editions of this Grand Vizier Recep Pasha was in power, and it was dedicated book which was written in the 17th century were reprinted in to the Sultan of that period, Murat the IVth [3, 4]. -
The Mandibular Nerve - Vc Or VIII by Prof
The Mandibular Nerve - Vc or VIII by Prof. Dr. Imran Qureshi The Mandibular nerve is the third and largest division of the trigeminal nerve. It is a mixed nerve. Its sensory root emerges from the posterior region of the semilunar ganglion and is joined by the motor root of the trigeminal nerve. These two nerve bundles leave the cranial cavity through the foramen ovale and unite immediately to form the trunk of the mixed mandibular nerve that passes into the infratemporal fossa. Here, it runs anterior to the middle meningeal artery and is sandwiched between the superior head of the lateral pterygoid and tensor veli palatini muscles. After a short course during which a meningeal branch to the dura mater, and the nerve to part of the medial pterygoid muscle (and the tensor tympani and tensor veli palatini muscles) are given off, the mandibular trunk divides into a smaller anterior and a larger posterior division. The anterior division receives most of the fibres from the motor root and distributes them to the other muscles of mastication i.e. the lateral pterygoid, medial pterygoid, temporalis and masseter muscles. The nerve to masseter and two deep temporal nerves (anterior and posterior) pass laterally above the medial pterygoid. The nerve to the masseter continues outward through the mandibular notch, while the deep temporal nerves turn upward deep to temporalis for its supply. The sensory fibres that it receives are distributed as the buccal nerve. The 1 | P a g e buccal nerve passes between the medial and lateral pterygoids and passes downward and forward to emerge from under cover of the masseter with the buccal artery. -
How to Ensure Clitoral Bud Survival in a Sexual Reassignment Surgery for Transsexualism
How We Do It J Cosmet Med 2018;2(1):57-62 https://doi.org/10.25056/JCM.2018.2.1.57 pISSN 2508-8831, eISSN 2586-0585 How to ensure clitoral bud survival in a sexual reassignment surgery for transsexualism Juthapot Pumsup, MD Juthapot Clinics,Trad, Thailand Background: Sexual reassignment surgery (SRS) is the complicated procedure as it has a very high risk of complications. The loss of clitoris is the ones. Accordingly, surgeons should carefully consider the surgical technique and ensure no mistakes during operation. Although most surgeons perform the operation carefully, a considerable incidence of clitoral bud necrosis has been reported. Thus, finding techniques that improve the success rates in surgeries is very important. Objective: We aimed to study the cause of neo-clitoral bud necrosis after SRS in order to devise a mechanism to avoid neo-clitoral bud necrosis, and to find a surgical technique for ensuring the survival of the clitoral bud. Methods: The study was conducted in 20 patients, who underwent a male-to-female SRS via Author technique From Juthapot Clinics, Trad Hospital, and Private Hospital (couldn’t mention) during September 2016 to August 2017. This intervention included various factors as mention below. Results: Of the 20 patients who underwent the procedure with this technique, 18 patients were without clitoral bud necrosis and 2 patients had partial clitoral bud necrosis at the tip. Sensation was preserved in these patients, although it was decreased. The sensation has 2 part: the 1st part is neoclitoris and the 2nd is at the anterior vagina, that made by the urethral lining after spatulation, that can serve the sensation. -
Unit #2 - Abdomen, Pelvis and Perineum
UNIT #2 - ABDOMEN, PELVIS AND PERINEUM 1 UNIT #2 - ABDOMEN, PELVIS AND PERINEUM Reading Gray’s Anatomy for Students (GAFS), Chapters 4-5 Gray’s Dissection Guide for Human Anatomy (GDGHA), Labs 10-17 Unit #2- Abdomen, Pelvis, and Perineum G08- Overview of the Abdomen and Anterior Abdominal Wall (Dr. Albertine) G09A- Peritoneum, GI System Overview and Foregut (Dr. Albertine) G09B- Arteries, Veins, and Lymphatics of the GI System (Dr. Albertine) G10A- Midgut and Hindgut (Dr. Albertine) G10B- Innervation of the GI Tract and Osteology of the Pelvis (Dr. Albertine) G11- Posterior Abdominal Wall (Dr. Albertine) G12- Gluteal Region, Perineum Related to the Ischioanal Fossa (Dr. Albertine) G13- Urogenital Triangle (Dr. Albertine) G14A- Female Reproductive System (Dr. Albertine) G14B- Male Reproductive System (Dr. Albertine) 2 G08: Overview of the Abdomen and Anterior Abdominal Wall (Dr. Albertine) At the end of this lecture, students should be able to master the following: 1) Overview a) Identify the functions of the anterior abdominal wall b) Describe the boundaries of the anterior abdominal wall 2) Surface Anatomy a) Locate and describe the following surface landmarks: xiphoid process, costal margin, 9th costal cartilage, iliac crest, pubic tubercle, umbilicus 3 3) Planes and Divisions a) Identify and describe the following planes of the abdomen: transpyloric, transumbilical, subcostal, transtu- bercular, and midclavicular b) Describe the 9 zones created by the subcostal, transtubercular, and midclavicular planes c) Describe the 4 quadrants created