M3 – Female Muscle Figure
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Identification of the External Branch of the Superior Laryngeal Nerve During Thyroidectomy
ORIGINAL ARTICLE Identification of the External Branch of the Superior Laryngeal Nerve During Thyroidectomy Nitin A. Pagedar, MD; Jeremy L. Freeman, MD, FRCSC Objectives: To determine the feasibility of identifica- sition according to Cernea classification and correlation tion of the external branch of the superior laryngeal nerve with patient and gland characteristics. (EBSLN) during routine thyroidectomy and to describe the EBSLN position according to the Cernea classifica- Results: Three of 178 EBSLNs (1.7%) could not be iden- tion system. tified using the routine technique. The EBSLN was found in the highest-risk position (Cernea type 2b, crossing the Design: Prospective case series. superior vascular pedicle below the upper border of the gland) in 48.3% of cases, and in the lowest-risk position Setting: Academic tertiary care center. (Cernea type 1, crossing more than 1 cm above the up- per border) in 7.3%. Specimens larger in weight and in Patients: One hundred twelve consecutive patients un- dimension were correlated with type 2b nerves. dergoing hemithyroidectomy or total thyroidectomy by the senior author between August 15 and December 31, Conclusions: The EBSLN can be routinely identified dur- 2007. ing thyroidectomy. Moreover, many EBSLNs are in po- sition to be at high risk of injury during ligation of the Interventions: None. superior vascular pedicle. Main Outcome Measure: Proportion of EBSLNs iden- tified. Secondary outcome measures included EBSLN po- Arch Otolaryngol Head Neck Surg. 2009;135(4):360-362 TUDIES HAVE SHOWN THAT SUB- identified than in cases in which no search jective voice disturbance after was performed. thyroidectomy is very com- Anatomic studies have sought to delin- mon,1,2 even without injury to eate the course of the nerve near the supe- the recurrent laryngeal nerves. -
Superior Laryngeal Nerve Identification and Preservation in Thyroidectomy
ORIGINAL ARTICLE Superior Laryngeal Nerve Identification and Preservation in Thyroidectomy Michael Friedman, MD; Phillip LoSavio, BS; Hani Ibrahim, MD Background: Injury to the external branch of the su- recorded and compared on an annual basis for both be- perior laryngeal nerve (EBSLN) can result in detrimen- nign and malignant disease. Overall results were also com- tal voice changes, the severity of which varies according pared with those found in previous series identified to the voice demands of the patient. Variations in its ana- through a 50-year literature review. tomic patterns and in the rates of identification re- ported in the literature have discouraged thyroid sur- Results: The 3 anatomic variations of the distal aspect geons from routine exploration and identification of this of the EBSLN as it enters the cricothyroid were encoun- nerve. Inconsistent with the surgical principle of pres- tered and are described. The total identification rate over ervation of critical structures through identification, mod- the 20-year period was 900 (85.1%) of 1057 nerves. Op- ern-day thyroidectomy surgeons still avoid the EBSLN erations performed for benign disease were associated rather than identifying and preserving it. with higher identification rates (599 [86.1%] of 696) as opposed to those performed for malignant disease Objectives: To describe the anatomic variations of the (301 [83.4%] of 361). Operations performed in recent EBSLN, particularly at the junction of the inferior con- years have a higher identification rate (over 90%). strictor and cricothyroid muscles; to propose a system- atic approach to identification and preservation of this Conclusions: Understanding the 3 anatomic variations nerve; and to define the identification rate of this nerve of the distal portion of the EBSLN and its relation to the during thyroidectomy. -
A Handy Guide to the Male and Female Reproductive Tracts
BASICS OF LIFE BY LES SELLNOW eproduction in all species borders on the miraculous. at the reproductive organs of both the mare and the stallion How else can one describe a process where two infini- and discuss just how they function in their effort to produce Rtesimal entities, one from the male, the other from the another “miracle.” Once again, sources are too numerous to female, join forces to produce living, breathing offspring? mention, other than to say that much of the basic informa- Reproductive capability or success varies by species. Mice tion on reproduction available today stems from research at and rabbits, for example, are prolific producers of offspring. such institutions as Colorado State University, Texas A&M Horses, on the other hand, fall into a category where it is University, and the University of Minnesota. There are many much more chancy. others involved in reproductive research, but much of the in- When horses ran wild, this wasn’t a serious problem. There formation utilized in this article emanated from those three were so many of them that their numbers continued to ex- institutions. pand even though birth rate often was dictated by the avail- ability of food and water. Once the horse was domesticated, The Mare however, organized reproduction became the order of the We’ll begin with the mare because her role in the repro- day. Stables that depend on selling the offspring of stallions ductive process is more complicated than that of the stallion. and mares have an economic stake in breeding success. Yet, Basically, the mare serves four functions: the process continues to be less than perfect, with success 1) She produces eggs or ova; rates hovering in the 65-70% range, and sometimes lower. -
Larynx Anatomy
LARYNX ANATOMY Elena Rizzo Riera R1 ORL HUSE INTRODUCTION v Odd and median organ v Infrahyoid region v Phonation, swallowing and breathing v Triangular pyramid v Postero- superior base àpharynx and hyoid bone v Bottom point àupper orifice of the trachea INTRODUCTION C4-C6 Tongue – trachea In women it is somewhat higher than in men. Male Female Length 44mm 36mm Transverse diameter 43mm 41mm Anteroposterior diameter 36mm 26mm SKELETAL STRUCTURE Framework: 11 cartilages linked by joints and fibroelastic structures 3 odd-and median cartilages: the thyroid, cricoid and epiglottis cartilages. 4 pair cartilages: corniculate cartilages of Santorini, the cuneiform cartilages of Wrisberg, the posterior sesamoid cartilages and arytenoid cartilages. Intrinsic and extrinsic muscles THYROID CARTILAGE Shield shaped cartilage Right and left vertical laminaà laryngeal prominence (Adam’s apple) M:90º F: 120º Children: intrathyroid cartilage THYROID CARTILAGE Outer surface à oblique line Inner surface Superior border à superior thyroid notch Inferior border à inferior thyroid notch Superior horns à lateral thyrohyoid ligaments Inferior horns à cricothyroid articulation THYROID CARTILAGE The oblique line gives attachement to the following muscles: ¡ Thyrohyoid muscle ¡ Sternothyroid muscle ¡ Inferior constrictor muscle Ligaments attached to the thyroid cartilage ¡ Thyroepiglottic lig ¡ Vestibular lig ¡ Vocal lig CRICOID CARTILAGE Complete signet ring Anterior arch and posterior lamina Ridge and depressions Cricothyroid articulation -
Thoracic Outlet and Pectoralis Minor Syndromes
S EMINARS IN V ASCULAR S URGERY 27 (2014) 86– 117 Available online at www.sciencedirect.com www.elsevier.com/locate/semvascsurg Thoracic outlet and pectoralis minor syndromes n Richard J. Sanders, MD , and Stephen J. Annest, MD Presbyterian/St. Luke's Medical Center, 1719 Gilpin, Denver, CO 80218 article info abstract Compression of the neurovascular bundle to the upper extremity can occur above or below the clavicle; thoracic outlet syndrome (TOS) is above the clavicle and pectoralis minor syndrome is below. More than 90% of cases involve the brachial plexus, 5% involve venous obstruction, and 1% are associate with arterial obstruction. The clinical presentation, including symptoms, physical examination, pathology, etiology, and treatment differences among neurogenic, venous, and arterial TOS syndromes. This review details the diagnostic testing required to differentiate among the associated conditions and recommends appropriate medical or surgical treatment for each compression syndrome. The long- term outcomes of patients with TOS and pectoralis minor syndrome also vary and depend on duration of symptoms before initiation of physical therapy and surgical intervention. Overall, it can be expected that 480% of patients with these compression syndromes can experience functional improvement of their upper extremity; higher for arterial and venous TOS than for neurogenic compression. & 2015 Published by Elsevier Inc. 1. Introduction compression giving rise to neurogenic TOS (NTOS) and/or neurogenic PMS (NPMS). Much less common is subclavian Compression of the neurovascular bundle of the upper and axillary vein obstruction giving rise to venous TOS (VTOS) extremity can occur above or below the clavicle. Above the or venous PMS (VPMS). -
Diagnosis of Zygomaticus Muscle Paralysis Using Needle
Case Report Ann Rehabil Med 2013;37(3):433-437 pISSN: 2234-0645 • eISSN: 2234-0653 http://dx.doi.org/10.5535/arm.2013.37.3.433 Annals of Rehabilitation Medicine Diagnosis of Zygomaticus Muscle Paralysis Using Needle Electromyography With Ultrasonography Seung Han Yoo, MD, Hee Kyu Kwon, MD, Sang Heon Lee, MD, Seok Jun Lee, MD, Kang Wook Ha, MD, Hyeong Suk Yun, MD Department of Rehabilitation Medicine, Korea University College of Medicine, Seoul, Korea A 22-year-old woman visited our clinic with a history of radiofrequency volumetric reduction for bilateral masseter muscles at a local medical clinic. Six days after the radiofrequency procedure, she noticed a facial asymmetry during smiling. Physical examination revealed immobility of the mouth drawing upward and laterally on the left. Routine nerve conduction studies and needle electromyography (EMG) in facial muscles did not suggest electrodiagnostic abnormalities. We assumed that the cause of facial asymmetry could be due to an injury of zygomaticus muscles, however, since defining the muscles through surface anatomy was difficult and it was not possible to identify the muscles with conventional electromyographic methods. Sono-guided needle EMG for zygomaticus muscle revealed spontaneous activities at rest and small amplitude motor unit potentials with reduced recruitment patterns on volition. Sono-guided needle EMG may be an optimal approach in focal facial nerve branch injury for the specific localization of the injury lesion. Keywords Ultrasonography-guided, Zygomaticus, Needle electromyography INTRODUCTION are performed in only the three or four muscles [2]. Also, anatomic variation and tiny muscle size pose difficulties Facial palsy is a common form of neuropathy due to to electrodiagnostic tests in the target muscles. -
Upper Lid Orbicularis Oculi Muscle Strip and Sequential Brow Suspension with Autologous Fascia Lata Is Beneficial for Selected P
Eye (2009) 23, 1549–1553 & 2009 Macmillan Publishers Limited All rights reserved 0950-222X/09 $32.00 www.nature.com/eye Upper lid orbicularis B Patil and AJE Foss CLINICAL STUDY oculi muscle strip and sequential brow suspension with autologous fascia lata is beneficial for selected patients with essential blepharospasm Abstract Introduction Purpose Severe cases of blepharospasm Patients with severe blepharospasm, whose resistant to botulinum toxin represent a symptoms are not controlled by botulinum challenging clinical problem. Over the toxin injections, are a difficult management last 10 years, we have adopted a staged problem for whom a number of surgical options surgical management of these cases have been tried. with an initial upper lid orbicularis Two operations, in particular, have been tried; myectomy (combined with myectomy the orbicularis myectomy (or strip) and brow of procerus and corrugator supercilius as suspension. The choice of the procedure appropriate) and then 4–6 months later classically depends upon the clinical a brow suspension with autologous fascia presentation, with all types being offered the Department of lata. The aim of this study was to orbicularis myectomy except for the apraxic (also Ophthalmology, assess the outcome of this staged surgical called the pre-tarsal) type. The proposed Queen’s Medical Centre, approach. aetiology of the apraxic type is considered to Nottingham University, Materials and methods A questionnaire differ and to represent a failure of eyelid opening Nottingham, UK was sent to all patients who had undergone and is clinically characterized by the eyebrows Correspondence: AJE Foss, the procedure and the clinical records going up and not down with the spasms. -
Vascularization of the Penis of a Man
Roczniki Akademii Medycznej w Białymstoku · Vol. 49, 2004 · Annales Academiae MedicaeVascularization Bialostocensis of the penis of a man 285 Vascularization of the penis of a man Okolokulak E, Volchkevich D The Human Anatomy Department, Grodno State Medical University, Grodno, Belarus Abstract Conclusions: The penis receives blood from external and internal pudendal arteries, which are very variable. The Purpose: The study of the features of the blood supply of venous blood of the penis flows off in three types of veins. a penis of the man. Material and methods: Macromicropreparation, angio- graphy, corrosion method, morphometry, statistical method. Key words: penis, veins of penis, arteries of penis, erectile Results: The penis has three venous collector-execut- dysfunction. ing outflow of blood. First of them is submitted surface dorsal vein, which is shaped from small-sized venous ves- sels of skin, subcutaneous fat and surface fascia of penis. Introduction The beginning deep dorsal vein, which will derivate second venous collector, gives veniplex of head of the penis. The The development of the medical technology has deepened spongy veins outstanding as third venous collector, reach the knowledge of organic violations of gears of erection. It was the bulb of penis, where they receive small-sized bulbar vein. straightened out, that more than 50% from them cause vascular The arterial blood supply of penis happens at the expense of disorders [1-4]. It has given a particular push to more detailed external and internal pudendal arteries. The external puden- learning extra- and intraorgans vessels of the penis. At the same dal artery starts from an internal wall of femoral artery on time, the problems of vascularization and relationships of blood 2.5-2.7 cm below inguinal ligament. -
Using Neutrality to Increase Shoulder Strength
Using Neutrality To Increase Shoulder Strength SUSAN M. T. McKAY, OTR/L [email protected] GOAL Look at shoulder rehab in a different way. Strength can come from increasing flexibility and placing a joint in proper alignment. Conversely, strengthening a shoulder in improper alignment can cause injury. WHY PICK ON THE SHOULDER? . Impairs function/limits ADL’s . Pain in shoulder . Compensatory patterns can lead to back pain . Elderly rely on upper body to move/ambulate . The sooner issues are treated, the less physiological damage there is SHOULDER ANATOMY . Muscles and how they move . A basic review and more . Important to know… SHOULDER ANATOMY . Supraspinatus . Initiates and assists deltoid in abduction of arm and acts with other rotator cuff muscles. SHOULDER ANATOMY . Infraspinatus . Laterally rotate arm; helps to hold humeral head in glenoid cavity of scapula SHOULDER ANATOMY . Subscapularis . Medially rotates arm and adducts it; helps to hold humeral head in glenoid cavity of scapula SHOULDER ANATOMY . Teres Minor . Laterally rotate arm; helps to hold humeral head in glenoid cavity of scapula SHOULDER ANATOMY . Deltoid . Anterior part: flexes and medially rotates arm; Middle part: abducts arm; Posterior part: extends and laterally rotates arm SHOULDER ANATOMY . Latissimus dorsi . Extends, adducts, and medially rotates humerus; raises body toward arms during climbing SHOULDER ANATOMY . Teres Major . Adducts and medially rotates arm SHOULDER ANATOMY . Pectoralis major . Adducts and medially rotates humerus; draws scapula anteriorly and inferiorly; Acting alone: clavicular head flexes humerus and sternocostal head extends it SHOULDER ANATOMY . Pectoralis Minor . Stabilizes scapula by drawing it inferiorly and anteriorly against thoracic wall SHOULDER ANATOMY . -
An Anatomic Study on the Upper Lip Elevator Muscles in Koreans for Application of Botulinum Toxin
An Anatomic Study on the Upper Lip Elevator Muscles in Koreans for Application of Botulinum Toxin Woo-Sang Hwang The Graduate School Yonsei University Department of Dental Science An Anatomic Study on the Upper Lip Elevator Muscles in Koreans for Application of Botulinum Toxin A Masters Thesis Submitted to the Department of Dental Science And the Graduate School of Yonsei University in partial fulfillment of the requirements for the degree of Master of Dental Science Woo-Sang Hwang July 2007 This certifies that the masters thesis of Woo-Sang Hwang is approved. Thesis Supervisor : Kee-Joon Lee Hyoung-Seon Baik Hee-Jin Kim The Graduate School Yonsei University July 2007 감사의 글 이 논문이 완성되기까지 따뜻한 배려와 함께 세심한 지도와 격려를 아끼지 않으신 이기준 지도 교수님께 먼저 깊은 감사를 드립니다. 귀중한 시간을 내주시어 부족한 논문을 살펴주신 백형선 교수님, 김희진 교수님께 감사드리며 교정학을 공부할 수 있도록 기회를 주시고 제가 이 자리에 설 수 있도록 인도해주신 손병화 교수님, 박영철 교수님, 황충주 교수님, 유형석 교수님, 차정열 교수님, 김경호 교수님, 최광철 교수님, 정주령 선생님께도 감사드립니다. 바쁜 와중에도 연구 방법과 세부적인 사항에 대해 많은 도움과 조언을 해주신 허경석, 허미선 선생님을 비롯한 해부학 교실 선생님들께 감사의 말씀을 드립니다. 이 논문이 나오기까지 격려해주고 조언해주었던 동기들, 이태연, 조용민, 서승아, 이한아, 정시내, 조선미 선생과 의국 선배님과 후배님 모두에게 이 자리를 빌어 감사의 마음을 전합니다. 마지막으로 항상 변함없는 사랑으로 돌봐주시고 저를 이끌어주신 아버지와 어머니, 대구에서 힘들게 군복무 중인 동생, 그리고 옆에서 항상 힘이 되어준 레미에게 감사의 마음을 전하며 이 작은 결실을 드립니다. 2007년 7 월 저자 씀 Table of Contents Tables and Figures ................................................................................................................... ii Abstract (English) ...................................................................................................................iii 1. Introduction .......................................................................................................................... 1 2. -
M1 – Muscled Arm
M1 – Muscled Arm See diagram on next page 1. tendinous junction 38. brachial artery 2. dorsal interosseous muscles of hand 39. humerus 3. radial nerve 40. lateral epicondyle of humerus 4. radial artery 41. tendon of flexor carpi radialis muscle 5. extensor retinaculum 42. median nerve 6. abductor pollicis brevis muscle 43. flexor retinaculum 7. extensor carpi radialis brevis muscle 44. tendon of palmaris longus muscle 8. extensor carpi radialis longus muscle 45. common palmar digital nerves of 9. brachioradialis muscle median nerve 10. brachialis muscle 46. flexor pollicis brevis muscle 11. deltoid muscle 47. adductor pollicis muscle 12. supraspinatus muscle 48. lumbrical muscles of hand 13. scapular spine 49. tendon of flexor digitorium 14. trapezius muscle superficialis muscle 15. infraspinatus muscle 50. superficial transverse metacarpal 16. latissimus dorsi muscle ligament 17. teres major muscle 51. common palmar digital arteries 18. teres minor muscle 52. digital synovial sheath 19. triangular space 53. tendon of flexor digitorum profundus 20. long head of triceps brachii muscle muscle 21. lateral head of triceps brachii muscle 54. annular part of fibrous tendon 22. tendon of triceps brachii muscle sheaths 23. ulnar nerve 55. proper palmar digital nerves of ulnar 24. anconeus muscle nerve 25. medial epicondyle of humerus 56. cruciform part of fibrous tendon 26. olecranon process of ulna sheaths 27. flexor carpi ulnaris muscle 57. superficial palmar arch 28. extensor digitorum muscle of hand 58. abductor digiti minimi muscle of hand 29. extensor carpi ulnaris muscle 59. opponens digiti minimi muscle of 30. tendon of extensor digitorium muscle hand of hand 60. superficial branch of ulnar nerve 31. -
MRI Patterns of Shoulder Denervation: a Way to Make It Easy
MRI Patterns Of Shoulder Denervation: A Way To Make It Easy Poster No.: C-2059 Congress: ECR 2018 Type: Educational Exhibit Authors: E. Rossetto1, P. Schvartzman2, V. N. Alarcon2, M. E. Scherer2, D. M. Cecchi3, F. M. Olivera Plata4; 1Buenos Aires, Capital Federal/ AR, 2Buenos Aires/AR, 3Capital Federal, Buenos Aires/AR, 4Ciudad Autonoma de Buenos Aires/AR Keywords: Musculoskeletal joint, Musculoskeletal soft tissue, Neuroradiology peripheral nerve, MR, Education, eLearning, Edema, Inflammation, Education and training DOI: 10.1594/ecr2018/C-2059 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to third- party sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations.