DOCSLIB.ORG

View of Dissertation

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
View of Dissertation DYNAMIC LARYNGO-TRACHEAL CONTROL FOR AIRWAY MANAGEMENT IN DYSPHAGIA By AARON JOHN HADLEY Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy Dissertation Advisor: Dr. Dustin J. Tyler Department of Biomedical Engineering CASE WESTERN RESERVE UNIVERSITY August 2013 CASE WESTERN RESERVE UNIVERSITY SCHOOL OF GRADUATE STUDIES We hereby approve the thesis/dissertation of: Aaron John Hadley candidate for the Doctor of Philosophy degree*. (signed) Dustin J Tyler, Ph.D (chair of the committee) Kenneth Gustafson Michael Broniatowski Patrizia Bonaventura (date) 05/30/2013 *We also certify that written approval has been obtained for any proprietary material contained therein. ii Table of Contents LIST OF FIGURES ........................................................................................................ VI LIST OF TABLES ........................................................................................................ VIII ACKNOWLEDGEMENTS .............................................................................................. IX ABSTRACT .................................................................................................................. 1 CHAPTER 1 : INTRODUCTION ...................................................................................... 3 DYSPHAGIA ......................................................................................................................... 3 PHASES OF SWALLOWING ....................................................................................................... 5 LARYNGEAL ANATOMY........................................................................................................... 8 LARYNGEAL ELEVATION ........................................................................................................ 11 INNERVATION OF LARYNGEAL ELEVATION (HN, CN XII) ............................................................. 16 RECURRENT LARYNGEAL NERVE ............................................................................................. 18 FUNCTIONAL ELECTRICAL STIMULATION FOR LARYNGEAL ELEVATION ............................................ 20 Surface Stimulation for Laryngeal Elevation ............................................................. 20 Intramuscular Stimulation for Laryngeal Elevation ................................................... 22 Nerve Stimulation for Laryngeal Elevation ................................................................ 25 FUNCTIONAL ELECTRICAL STIMULATION FOR VOCAL FOLD CONTROL ............................................. 28 Surface Stimulation of the Vocal Folds ...................................................................... 29 Implanted Stimulation of the Recurrent Laryngeal Nerve ......................................... 31 Transtracheal/Transesophageal stimulation ............................................................ 33 STIMULATION CONTROLLER .................................................................................................. 35 PALATOMETRY ................................................................................................................... 37 Electric Sensors .......................................................................................................... 38 Positive and Negative Pressure Recording ................................................................ 41 PROJECT SPECIFIC AIMS ....................................................................................................... 43 CHAPTER 2 - LARYNGEAL ELEVATION BY SELECTIVE STIMULATION OF THE HYPOGLOSSAL NERVE ............................................................................................... 47 ABSTRACT ......................................................................................................................... 47 INTRODUCTION .................................................................................................................. 49 METHODS ......................................................................................................................... 52 Surgery ....................................................................................................................... 52 Tetanic Stimulation and Video Recording ................................................................. 54 Nerve Stimulation and EMG Twitch Response .......................................................... 55 Video Analysis ............................................................................................................ 55 Selectivity Analysis ..................................................................................................... 57 iii RESULTS ........................................................................................................................... 58 Elevation .................................................................................................................... 58 Elevation Velocity ...................................................................................................... 61 Selectivity ................................................................................................................... 62 DISCUSSION ....................................................................................................................... 63 CONCLUSION ..................................................................................................................... 70 CHAPTER 3 - TARGETED TRANSTRACHEAL STIMULATION FOR VOCAL FOLD CLOSURE 73 ABSTRACT ......................................................................................................................... 73 INTRODUCTION .................................................................................................................. 74 METHODS ......................................................................................................................... 80 Modified Endotracheal Tube Design.......................................................................... 80 Surgical Preparation .................................................................................................. 81 Stimulation Trials ....................................................................................................... 83 Data Analysis ............................................................................................................. 84 RESULTS ........................................................................................................................... 87 DISCUSSION ....................................................................................................................... 93 CONCLUSION ..................................................................................................................... 98 CHAPTER 4 - NEURAL NETWORK DETECTION OF SWALLOWING USING PALATOMETRY .............................................................................................................................. 100 ABSTRACT ....................................................................................................................... 100 INTRODUCTION ................................................................................................................ 101 Palatometry ............................................................................................................. 104 Time Delay Artificial Neural Networks..................................................................... 106 MATERIALS AND METHODS: ............................................................................................... 108 Subjects and Palatometer Production ..................................................................... 108 Time Delay Artificial Neural Network Analysis ........................................................ 113 RESULTS ......................................................................................................................... 116 Palatometer Recordings .......................................................................................... 116 Intra-Subject and Population-Trained Networks ..................................................... 122 DISCUSSION ..................................................................................................................... 126 Optimizing Thresholds for FES systems ................................................................... 127 CONCLUSION ................................................................................................................... 131 CHAPTER 5 - DISCUSSION AND CONCLUSIONS ......................................................... 133 OVERVIEW OF DISSERTATION .............................................................................................. 133 CONTRIBUTION/RELATIONSHIP TO THE LITERATURE ................................................................. 134 FUTURE STUDIES .............................................................................................................. 136 iv Stimulation ............................................................................................................... 136 Palatometry ............................................................................................................. 138 APPLICATION OF RESEARCH ................................................................................................ 140 Rehabilitation .........................................................................................................
Load more

Recommended publications
  • An Anomalous Digastric Muscle in the Carotid Sheath: a Case Report with Its
    Short Communication 2020 iMedPub Journals Journal of Stem Cell Biology and Transplantation http://journals.imedpub.com Vol. 4 ISS. 4 : sc 37 ISSN : 2575-7725 DOI : 10.21767/2575-7725.4.4.37 8th Edition of International Conference on Clinical and Medical Case Reports - An anomalous digastric muscle in the carotid sheath: a case report with its embryological perspective and clinical relevance Srinivasa Rao Sirasanagandla Sultan Qaboos University, Oman Abstract Key words: Although infrahyoid muscles show considerable variations in Anterior belly, Posterior belly, Variation, Stylohyoid muscle, My- their development, existence of an anomalous digastric muscle lohyoid muscle, Hyoid bone in the neck was seldom reported. During dissection of trian- Anatomy gles of the neck for medical undergraduate students, we came across an anomalous digastric muscle in the carotid sheath of There is a pair of digastric muscles in the neck, and each digas- left side of neck. It was observed in a middle-aged cadaver at tric muscle has the anterior belly and the posterior belly. The College of Medicine and Health Sciences, Sultan Qaboos Uni- anterior belly is attached to the digastric fossa on the base of versity, Muscat, Oman. Digastric muscle was located within the the mandible close to the midline and runs toward the hyoid carotid sheath between the common and internal carotid arter- bone. The posterior belly is attached to the notch of the mas- ies and internal jugular vein. It had two bellies; cranial belly and toid process of the temporal bone and also runs toward the caudal belly which were connected by an intermediate tendon.
    [Show full text]
  • Breathing Modes, Body Positions, and Suprahyoid Muscle Activity
    Journal of Orthodontics, Vol. 29, 2002, 307–313 SCIENTIFIC Breathing modes, body positions, and SECTION suprahyoid muscle activity S. Takahashi and T. Ono Tokyo Medical and Dental University, Japan Y. Ishiwata Ebina, Kanagawa, Japan T. Kuroda Tokyo Medical and Dental University, Japan Abstract Aim: To determine (1) how electromyographic activities of the genioglossus and geniohyoid muscles can be differentiated, and (2) whether changes in breathing modes and body positions have effects on the genioglossus and geniohyoid muscle activities. Method: Ten normal subjects participated in the study. Electromyographic activities of both the genioglossus and geniohyoid muscles were recorded during nasal and oral breathing, while the subject was in the upright and supine positions. The electromyographic activities of the genioglossus and geniohyoid muscles were compared during jaw opening, swallowing, mandib- ular advancement, and tongue protrusion. Results: The geniohyoid muscle showed greater electromyographic activity than the genio- glossus muscle during maximal jaw opening. In addition, the geniohyoid muscle showed a shorter (P Ͻ 0.05) latency compared with the genioglossus muscle. Moreover, the genioglossus muscle activity showed a significant difference among different breathing modes and body Index words: positions, while there were no significant differences in the geniohyoid muscle activity. Body position, breathing Conclusion: Electromyographic activities from the genioglossus and geniohyoid muscles are mode, genioglossus successfully differentiated. In addition, it appears that changes in the breathing mode and body muscle, geniohyoid position significantly affect the genioglossus muscle activity, but do not affect the geniohyoid muscle. muscle activity. Received 10 January 2002; accepted 4 July 2002 Introduction due to the proximity of these muscles.
    [Show full text]
  • Regional Variation in Geniohyoid Muscle Strain During Suckling in the Infant Pig SHAINA DEVI HOLMAN1,2∗, NICOLAI KONOW1,3,STACEYL
    RESEARCH ARTICLE Regional Variation in Geniohyoid Muscle Strain During Suckling in the Infant Pig SHAINA DEVI HOLMAN1,2∗, NICOLAI KONOW1,3,STACEYL. 1 1,2 LUKASIK , AND REBECCA Z. GERMAN 1Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland 2Department of Pain and Neural Sciences, University of Maryland School of Dentistry, Baltimore, Maryland 3Department of Ecology and Evolutionary Biology, Brown University, Providence, Rhode Island ABSTRACT The geniohyoid muscle (GH) is a critical suprahyoid muscle in most mammalian oropharyngeal motor activities. We used sonomicrometry to evaluate regional strain (i.e., changes in length) in the muscle origin, belly, and insertion during suckling in infant pigs, and compared the results to existing information on strain heterogeneity in the hyoid musculature. We tested the hypothesis that during rhythmic activity, the GH shows regional variation in muscle strain. We used sonomicrometry transducer pairs to divide the muscle into three regions from anterior to posterior. The results showed differences in strain among the regions within a feeding cycle; however, no region consistently shortened or lengthened over the course of a cycle. Moreover, regional strain patterns were not correlated with timing of the suck cycles, neither (1) relative to a swallow cycle (before or after) nor (2) to the time in feeding sequence (early or late). We also found a tight relationship between muscle activity and muscle strain, however, the relative timing of muscle activity and muscle strain was different in some muscle regions and between individuals. A dissection of the C1 innervations of the geniohyoid showed that there are between one and three branches entering the muscle, possibly explaining the variation seen in regional activity and strain.
    [Show full text]
  • Anatomy Module 3. Muscles. Materials for Colloquium Preparation
    Section 3. Muscles 1 Trapezius muscle functions (m. trapezius): brings the scapula to the vertebral column when the scapulae are stable extends the neck, which is the motion of bending the neck straight back work as auxiliary respiratory muscles extends lumbar spine when unilateral contraction - slightly rotates face in the opposite direction 2 Functions of the latissimus dorsi muscle (m. latissimus dorsi): flexes the shoulder extends the shoulder rotates the shoulder inwards (internal rotation) adducts the arm to the body pulls up the body to the arms 3 Levator scapula functions (m. levator scapulae): takes part in breathing when the spine is fixed, levator scapulae elevates the scapula and rotates its inferior angle medially when the shoulder is fixed, levator scapula flexes to the same side the cervical spine rotates the arm inwards rotates the arm outward 4 Minor and major rhomboid muscles function: (mm. rhomboidei major et minor) take part in breathing retract the scapula, pulling it towards the vertebral column, while moving it upward bend the head to the same side as the acting muscle tilt the head in the opposite direction adducts the arm 5 Serratus posterior superior muscle function (m. serratus posterior superior): brings the ribs closer to the scapula lift the arm depresses the arm tilts the spine column to its' side elevates ribs 6 Serratus posterior inferior muscle function (m. serratus posterior inferior): elevates the ribs depresses the ribs lift the shoulder depresses the shoulder tilts the spine column to its' side 7 Latissimus dorsi muscle functions (m. latissimus dorsi): depresses lifted arm takes part in breathing (auxiliary respiratory muscle) flexes the shoulder rotates the arm outward rotates the arm inwards 8 Sources of muscle development are: sclerotome dermatome truncal myotomes gill arches mesenchyme cephalic myotomes 9 Muscle work can be: addacting overcoming ceding restraining deflecting 10 Intrinsic back muscles (autochthonous) are: minor and major rhomboid muscles (mm.
    [Show full text]
  • Genioglossus Muscle Is the Largest Extrinsic Tongue Muscle and Upper Airway Dilator
    PLEASE TYPE THE UNIVERSITY OF NEW SOUTH WALES Thesis/Dissertation Sheet Surname or Family name: Kwan First name: Benjamin Other name/s: Chi Hin Abbreviation for degree as given in the University calendar: PhD School: Prince of Wales Hospital Clinical School Faculty: Medicine Title: Breathing movements of the human tongue and genioglossus measured with ultrasound imaging Abstract 350 words maximum: (PLEASE TYPE) Genioglossus muscle is the largest extrinsic tongue muscle and upper airway dilator. To maintain pharyngeal patency within and between breaths, delicate moment-to-moment coordination of pharyngeal muscles activity and drive is required. Dynamic pharyngeal muscle movement in response to the neural input during sleep/wake states is not clearly understood. This thesis reports a novel ultrasound method to visualise and measure dynamic genioglossus motion in healthy and OSA subjects. In Chapter 2, the method revealed ~1 mm predominantly anterior peak displacement within a 50 mm2 area in the infero-posterior genioglossus in healthy awake subjects during quiet breathing. Motion within this area was non-uniform. The method has good reliability, intraclass correlation coefficient (ICC) of 0.85 across separate imaging sessions. Chapter 3 reported good agreement between ultrasound and tagged MRI in measuring regional tongue motion in healthy and OSA subjects, with an ICC of 0.79. Compared to MRI, ultrasound revealed greater anterior displacement in the posterior tongue (mean difference of 0.24 ± 0.64 mm, 95% limits of agreement: 1.03 to -1.49). Chapter 4 examined influence of respiratory mechanics and drive on genioglossus movement. Inspiration against a resistive load increased posterior genioglossus motion, but it had less anterior and more inferior displacement at the highest inspiratory resistance.
    [Show full text]
  • FIPAT-TA2-Part-2.Pdf
    TERMINOLOGIA ANATOMICA Second Edition (2.06) International Anatomical Terminology FIPAT The Federative International Programme for Anatomical Terminology A programme of the International Federation of Associations of Anatomists (IFAA) TA2, PART II Contents: Systemata musculoskeletalia Musculoskeletal systems Caput II: Ossa Chapter 2: Bones Caput III: Juncturae Chapter 3: Joints Caput IV: Systema musculare Chapter 4: Muscular system Bibliographic Reference Citation: FIPAT. Terminologia Anatomica. 2nd ed. FIPAT.library.dal.ca. Federative International Programme for Anatomical Terminology, 2019 Published pending approval by the General Assembly at the next Congress of IFAA (2019) Creative Commons License: The publication of Terminologia Anatomica is under a Creative Commons Attribution-NoDerivatives 4.0 International (CC BY-ND 4.0) license The individual terms in this terminology are within the public domain. Statements about terms being part of this international standard terminology should use the above bibliographic reference to cite this terminology. The unaltered PDF files of this terminology may be freely copied and distributed by users. IFAA member societies are authorized to publish translations of this terminology. Authors of other works that might be considered derivative should write to the Chair of FIPAT for permission to publish a derivative work. Caput II: OSSA Chapter 2: BONES Latin term Latin synonym UK English US English English synonym Other 351 Systemata Musculoskeletal Musculoskeletal musculoskeletalia systems systems
    [Show full text]
  • Head and Neck of the Mandible
    Relationships The parotid duct passes lateral (superficial) and anterior to the masseter muscle. The parotid gland is positioned posterior and lateral (superficial) to the masseter muscle. The branches of the facial nerve pass lateral (superficial) to the masseter muscle. The facial artery passes lateral (superficial) to the mandible (body). On the face, the facial vein is positioned posterior to the facial artery. The sternocleidomastoid muscle is positioned superficial to both the omohyoid muscle and the carotid sheath. The external jugular vein passes lateral (superficial) to the sternocleidomastoid muscle. The great auricular and transverse cervical nerves pass posterior and lateral (superficial) to the sternocleidomastoid muscle. The lesser occipital nerve passes posterior to the sternocleidomastoid muscle. The accessory nerve passes medial (deep) and then posterior to the sternocleidomastoid muscle. The hyoid bone is positioned superior to the thyroid cartilage. The omohyoid muscle is positioned anterior-lateral to the sternothyroid muscle and passes superficial to the carotid sheath. At the level of the thyroid cartilage, the sternothyroid muscle is positioned deep and lateral to the sternohyoid muscle. The submandibular gland is positioned posterior and inferior to the mylohyoid muscle. The digastric muscle (anterior belly) is positioned superficial (inferior-lateral) to the mylohyoid muscle. The thyroid cartilage is positioned superior to the cricoid cartilage. The thyroid gland (isthmus) is positioned directly anterior to the trachea. The thyroid gland (lobes) is positioned directly lateral to the trachea. The ansa cervicalis (inferior root) is positioned lateral (superficial) to the internal jugular vein. The ansa cervicalis (superior root) is positioned anterior to the internal jugular vein. The vagus nerve is positioned posterior-medial to the internal jugular vein and posterior-lateral to the common carotid artery.
    [Show full text]
  • A Design of Laryngeal Structures for a Physiological Articulatory Model
    A Design of Laryngeal Structures for a Physiological Articulatory Model Chao-Min WU’, Jianwu DANG’,‘, and Kiyoshi HONDA’ ’ ATR Human Information Processing Res. Labs., 2-2 Hikaridai, Seika-cho, Soraku-gun, Kyoto, 619-02, Japan ‘Dept. of Electrical and Comuter Eng. Univ. Waterloo, Waterloo, Ontario, Canada, N2L 3Gl Summary: A model of the hyoid-larynx complex is designed to be incorporated into a physiological articulatory model. The previously reported articulatory model consists of the tongue, mandible, hyoid bone, and vocal tract wall. The aim of this work is to include the laryngeal structures to simulate the tongue-larynx interaction which is observed in natural speech. The framework of laryngeal structures is composed of the thyroid, cricoid, and arytenoid cartilages, which are connected by muscles, ligaments and joints. The form and geometry of the cartilages are extracted from volumetric MR images of a male speaker and represented in a quasi-3D shape. They are modeled to yield joint rotation and translation as well as vertical movements. The ligaments and muscles are represented by mass-points with viscoelastic springs, and the cartilages are composed by springs with an extremely large stiffness. Laryngeal factors of FO control such as cricothyroid rotation and laryngeal vertical movement are demonstrated in the simulation, and plausible dynamic behaviors of the tongue-larynx interaction are observed. INTRODUCTION It is generally accepted that laryngeal control for fundamental frequency (FO) change often involves the interaction between laryngeal and supralaryngeal articulators. This interaction results in the action of the cricothyroid joint and changes in vocal fold length. For example, the interaction between the tongue and larynx is mediated by the hyoid bone via muscles and connective tissues.
    [Show full text]
  • Ultrasonographic Evaluation of Geniohyoid Muscle Mass in Perioperative Patients
    Kawasaki Medical Journal 42（2）：47－56，2016 doi：1 0 .11482/KMJ-E42（2）47 47 〈Regular Article〉 Ultrasonographic evaluation of geniohyoid muscle mass in perioperative patients Sayako SHIMIZU１）, Kozo HANAYAMA１）, Rui NAKATO２）, Takefumi SUGIYAMA１）, Akio TSUBAHARA１） 1) Department of Rehabilitation Medicine, 2) Department of Gastroenterology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan ABSTRACT Surgical invasion and postoperative disuse are known to promote systemic skeletal muscle atrophy; however, similar effects on the mass of the muscles of deglutition have yet to be confirmed. Our method of using ultrasonography to measure the area of the geniohyoid muscle (GM), to evaluate the mass of the muscles of deglutition, has been shown to have high reliability. In the present study, we measured the GM area before and after surgery in patients to investigate changes in their muscle mass. Parameters including GM area, quadriceps femoris muscle (QF) thickness, hand grip strength (HGS), and arm muscle circumference were measured preoperatively and at 7 and 14 days postoperatively in patients who underwent thoracotomy and laparotomy. Patient height, weight, and serum albumin (Alb) level were also obtained from medical charts. Comparison of each evaluation parameter between measurement time points demonstrated significant decreases in GM area, QF thickness, HGS, and Alb between preoperatively and both postoperative day (POD) 7 and POD 14. The patients were divided into good (n = 19) and poor (n = 12) postoperative oral intake groups for comparison of GM area. The percentage decrease in GM area was significantly greater in patients with poor oral intake. To our knowledge, this is the first study to demonstrate that muscle atrophy due to surgical invasion or disuse may occur in the muscles of deglutition, as in the limb muscles.
    [Show full text]
  • Landmarks of the Skull: LANDMARK DEFINITION Glabella Nasion Bregma Vertex Lambda Asterion Inion Pterion
    Landmarks of the skull: LANDMARK DEFINITION Glabella Nasion Bregma Vertex Lambda Asterion Inion Pterion Sutures of the skull: Fibrous joints that hold the skull bones together SUTURE DEFINITION Coronal suture Sagittal suture Lambdoid suture Squamosal suture Metopic suture Fontanelles: Little fountains of CSF; present in kids to allow growth FONTANELLE DEFINING FEATURES Anterior fontanelle Posterior fontanelle Anterolateral fontanelle Posterolateral fontanelle Cranial fossae: CRANIAL FOSSA CONTENTS Anterior cranial fossa Middle cranial fossa Posterior cranial fossa Cranial bones: CRANIAL BONE DEFINING FEATURES Frontal bone Parietal bones Occipital bone Temporal bone Sphenoid bone Ethmoid bone Facial bones: FACIAL BONE DEFINING FEATURES Nasal bone Lacrimal bones Palatine bones Vomer Inferior nasal concha Zygomatic bone Maxillae Mandible Foramina: . Foramen of cribriform plate: olfactory bulb nerve 1 . Optic canal: optic nerve and ophthalmic artery pass through this . Superior orbital fissure: between the greater and lesser wing of sphenoid bone; oculomotor, trochlear, lacrimal, frontal and masociliary branches of ophthalmic, abducent nerves and superior ophthalmic vein pass through this . Foramen rotundum: round shape; nerves 2 and 5 pass through this . Foramen ovale: oval shaped; nerves 3 and 5 and accessory meningeal artery pass through this . Foramen spinosum: middle meningeal artery and vein and meningeal branch of mandibular nerve pass through this . Foramen lacerum: has little spikes; nothing passes through it; covered by a plug of cartilage . Carotid canal: internal caortid artery and internal carotid nerve plexus pass through this . Internal acoustic meatus: nerves 7 and 8 and labyrinthine artery pass through this . Jugular foramen: nerves 9, 10, and 11 and posterior meningeal artery passes through this . Hypoglossal canal: nerve 12 pass through this .
    [Show full text]
  • 7. the Tongue This Portion of the Dissection Will Concentrate on the Muscles of the Tongue
    7. The Tongue This portion of the dissection will concentrate on the muscles of the tongue. These muscles are divided into extrinsic (originating outside the tongue) and intrinsic (situated within the tongue) muscles. First, we examine the attachments of the tongue's extrinsic muscles and attempt to understand how they serve to move and shape the tongue during speech. Then, we bisect the tongue and excise one half This will allow us to examine the tongue's intrinsic muscles and how they serve to move and shape the tongue during speech. The four major extrinsic muscles of the tongue are shown in figure 7.1: The mylohyoid muscle, which is responsible for raising the body of the tongue in high vowels and velar consonants. The hyoglossus, which pulls it downwards (and slightly backwards). The styloglossus, which pulls the tongue upwards and backwards. The genioglossus, which forms the bulk of the inferior part of the tongue and pulls the body of the tongue forwards. styloglossus stylohyoid hyoglossus geniohyoid genioglossus Figure 7.1. The extrinsic muscles of the tongue. We have already observed the mylohyoid muscle in Section 4. It forms the floor of the mouth and controls the raising of the tongue. It is also an elevator of the hyoid bone, and hence elevates the larynx. The hyoglossus is a broad, flat muscle running from the greater horn of the hyoid to the posteroinferior lateral aspects of the tongue (on the sides of the lower back of the tongue). It is a depressor (lowerer) of the tongue. The styloglossus extends from the styloid process, a projection of the skull at about the level of the ear down into the lateral aspect of the tongue, interdigitating with the inserting fibers of the hyoglossus.
    [Show full text]
  • Latin Term Latin Synonym UK English Term American English Term English
    General Anatomy Latin term Latin synonym UK English term American English term English synonyms and eponyms Notes Termini generales General terms General terms Verticalis Vertical Vertical Horizontalis Horizontal Horizontal Medianus Median Median Coronalis Coronal Coronal Sagittalis Sagittal Sagittal Dexter Right Right Sinister Left Left Intermedius Intermediate Intermediate Medialis Medial Medial Lateralis Lateral Lateral Anterior Anterior Anterior Posterior Posterior Posterior Ventralis Ventral Ventral Dorsalis Dorsal Dorsal Frontalis Frontal Frontal Occipitalis Occipital Occipital Superior Superior Superior Inferior Inferior Inferior Cranialis Cranial Cranial Caudalis Caudal Caudal Rostralis Rostral Rostral Apicalis Apical Apical Basalis Basal Basal Basilaris Basilar Basilar Medius Middle Middle Transversus Transverse Transverse Longitudinalis Longitudinal Longitudinal Axialis Axial Axial Externus External External Internus Internal Internal Luminalis Luminal Luminal Superficialis Superficial Superficial Profundus Deep Deep Proximalis Proximal Proximal Distalis Distal Distal Centralis Central Central Periphericus Peripheral Peripheral One of the original rules of BNA was that each entity should have one and only one name. As part of the effort to reduce the number of recognized synonyms, the Latin synonym peripheralis was removed. The older, more commonly used of the two neo-Latin words was retained. Radialis Radial Radial Ulnaris Ulnar Ulnar Fibularis Peroneus Fibular Fibular Peroneal As part of the effort to reduce the number of synonyms, peronealis and peroneal were removed. Because perone is not a recognized synonym of fibula, peronealis is not a good term to use for position or direction in the lower limb. Tibialis Tibial Tibial Palmaris Volaris Palmar Palmar Volar Volar is an older term that is not used for other references such as palmar arterial arches, palmaris longus and brevis, etc.
    [Show full text]