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Home , Head and neck anatomy, Lingual tonsils

Pictorial Essay

Eponyms in and Anatomy and Radiology

Fernando Martín Ferraro1*, Hernán Chaves2*, Federico Martín Olivera Plata3,4*, Luis Ariel Miquelini1,3*, Suresh K. Mukherji5

1 Imaging Service, Hospital Británico, Ciudad Autónoma de Buenos Aires, Argentina 2 Imaging Department, Dr. Raúl Carrea Institute for Neurological Research (FLENI), Ciudad Autónoma de Buenos Aires, Argentina 3Imaging Service, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina 4 Magnetic Resonance and Computed Tomography Service, Centro Médico Deragopyan, Ciudad Autónoma de Buenos Aires, Argentina 5 Radiology Department, Michigan State University, East Lansing, USA

Abstract The use of eponyms in medical language is frequent. While it is commonly thought that eponyms are on their way to extinction, this is not entirely true. There is dissent between those who believe that their use should be abandoned and those who advocate that eponyms make unmemorable terms memorable, convey complex concepts and promote an interest in the history of medicine. We feel part of this second group, and our intention is to make a review of eight eponyms linked to and radiology. We believe that this approach can be useful for the education of medical students, residents and diagnostic imaging specialists.

Keywords Radiology; Eponyms; Anatomy; Head and neck; History of medicine

Introduction for which they are known. Eponyms are illustrated by figures of dissections, radiological images and pictures. We believe When we look up the word eponym in Spanish (epónimo) that this approach can be useful for the education of medical in the dictionary of the Spanish Royal Academy, we find the students, residents and diagnostic imaging specialists. following definition: “A person or thing after whom or after 1 which a town, city, disease, etc. is named” Johann Christian Rosenmüller The use of eponyms in medical language is frequent. Histori- 7,8 cally, family names of recognized physicians have been used (1771-1820) to refer to anatomical structures, diseases and syndromes, usually as a tribute.2 Johann Christian Rosenmüller (Fig. 1) was born on May 25, Even if it is commonly thought that eponyms in medicine are 1771, in Hildburghausen, Germany. His father, Johann Georg on their way to extinction, this is not entirely true, and their Rosenmüller, was a known protestant theologian. His broth- use is present in 2% of titles in current publications.3 There is er, Ernst Friedrich Karl Rosenmüller, followed his father’s foot- dissent between those who believe that the use of eponyms steps and gained great recognition. All three were at Leipzig should be abandoned and those who advocate that eponyms University from 1794 until their deaths. There is no mention make unmemorable terms memorable, convey complex con- of Rosenmüller’s mother in the literature reviewed. cepts, and promote an interest in the history of medicine.4-7 In 1792, Rosenmüller began his studies in medicine at Erlan- We feel part of this latter group, and our intention is to make gen University, receiving his doctorate in 1797 at the Univer- a review of eight eponyms linked to head and neck anatomy sity of Leipzig, and being appointed associate professor of and radiology, putting greater emphasis on the original ar- anatomy and surgery at Leipzig in 1802. He was the Dean of ticles and circumstances that determined their appearance, Leipzig University between 1812 and 1820. He was the au- and less emphasis on the anatomical structures and diseases thor of various dissertations, articles and books. However, his

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Fig. 1. Portrait of Johann Christian Rosenmüller. Fig. 2. Anatomic preparation with stained red and stained blue. The right fossa of Rosenmüller is being indi- cated (arrow), located immediately over the most important work was a handbook of anatomy published (arrowhead). Reprinted with permission from the editor. Copy- in 1808.9 This handbook was 700 pages in length, covering right© 2016 Fronteras de Medicina. All rights reserved. various parts of the human body. This is where Rosenmüller first described the or fossa of Rosenmüller (Figs. 2 and 3). It was in this handbook that he also described the palpebral portion of the lacrimal gland or Rosenmüller gland and the organ of Rosenmüller, a structure of the me- sosalpinx. Rosenmüller also specialized in speleology, the scientific study of caves, including their make-up, structure, and life forms. In 1796, he published a book describing remarkable caves in the Muggendorf area, including one that is currently known as Rosenmüller’s cave, and which can be visited nowadays. His collection of fossil resides in the Museum of Natu- ral Sciences in Berlin. He never married, and he died of a attack at the age of 49.

Charles Bell (1774-1842)10

Charles Bell (Fig. 4) is remembered as a neurophysiologist. However, he was a man of many talents: anatomist, draught- sman, writer, lecturer, surgeon and museum-builder. He was Fig. 3. Axial T2-weighted magnetic resonance (MR) image. born in 1774, the fourth son of an Edinburgh clergyman who The patient presented with a plugged right sensation and died when Charles was only 5 years old. His mother not only loss. A lesion was occupying and obstructing the took charge of his upbringing but also stimulated his other right fossa of Rosenmüller (arrow) associated with ipsilateral serous otitis (arrowhead). The lesion was diagnosed as squa- talents, such as drawing. mous nasopharyngeal carcinoma.

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Charles attended philosophy lectures while assisting his 5 and 6).11 This concept differs from the modern definition of brother John in his school of anatomy. He contributed text Bell’s palsy, which is reversible and idiopathic (Fig. 7). Bell died and drawings to his brother’s work “The Anatomy of the Hu- suddenly on April 29, 1842. man Body” and published the work “A System of Dissec- tions” under his own name in 1814. Bell had a special inter- 7,12 est in the Vth and VIIth cranial , as he could not clearly Primo Dorello (1872-1963) differentiate their functions. Such differentiation was clarified by his colleague Herbert Mayo. Bell’s original description of Primo Dorello (Fig. 8) was born in Narni, Italy, in 1872. He facial palsy, in a letter to a colleague could not have been studied medicine at Rome University and obtained his degree more accurate: “…The is twisted to the right side. The in 1897, remaining there as an Assistant Professor in the De- left does not move in respiration. The eye-lids of the partment of Normal Human Anatomy. In 1903, he published left side are not closed when he attempts to wink, although his most well-known paper, entitled “Considerations on the the eye-ball is turned up, his left is relaxed, and the cause of transient paralysis of the abducent in middle ear forehead on the left side unruffled…” inflammation” (Fig. 9).13 The paper describes Dorello’s canal, The original description of Charles Bell’s palsy was based on a depression bounded laterally by the petrous apex and me- two patients with irreversible facial dysfunction: a se- dially by the superolateral portion of the clivus. The superior vere infection and a postoperative sequel of a base tu- margin of the canal is formed by the petrosphenoidal liga- mor resected by Bell himself. This description is included in ment (Figs. 10 and 11). Although he was credited with the the publication entitled: “On the nerves: giving an account discovery of this canal, the canal had been first described in of some experiments on their structure and functions, which 1859 by Wenzel Gruber, who is remembered by the eponym lead to a new arrangement of the system”, a classic of neu- Gruber’s or petrosphenoidal ligament.14 rology, published in Philosophical Transactions in 1821 (Figs. In recent decades, various microsurgical anatomy studies have

Fig. 4. Portrait of Charles Bell. Reprinted with permission Fig. 5. Drawing from the original article published by Charles from the editor. Copyright© 2016 Fronteras de Medicina. All Bell in 1821, where there is a description of the nerves of the rights reserved. face, and in particular, of the .

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allowed a more accurate description of the boundaries and contents of that topography known as the petroclival venous confluence, which includes Dorello’s canal.15 Dorello was nom- inated for the Nobel Prize in Physiology or Medicine in 1939. He was also interested in anthropology and photography. He produced stereoscopic negatives on glass of Italian architecture and city landscapes. He died in Bologna at the age of 90.

Fig. 8. Portrait of Primo Dorello.

Fig. 6. Anatomical preparation of a left hemiface showing the extracranial segment of the facial nerve (arrow) crossing the superficial temporal (arrowhead).

Fig. 7. Axial T1-weighted MR image after contrast administra- tion. The patient presented with left labial commissure drop and impaired hearing on the right side. Post-contrast enhance- ment of the canalicular, labyrinthine, and left tympanic segments of the facial nerve was identified, be- ing pathognomonic of idiopathic facial palsy (or Bell’s palsy). The scan showed a hyperintense rounded focal lesion in the right internal auditory canal, consistent with schwannoma, the main differential diagnosis of Bell’s palsy. Fig. 9. Primo Dorello’s original article.

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Fig. 11. Axial T2-weighted MR images. The patient presented with palsy of the sixth cranial nerve and ipsilateral facial hy- poesthesia. The scan showed a lesion involving the left petro- Fig. 10. Anatomical preparation; posterior view of the left clival region (arrow), which is markedly hyperintense on T2- petrosphenoidal region, where the (long ar- weighted images (probably cartilaginous component). The row) is seen crossing the Dorello’s canal. The petrosphenoidal lesion was diagnosed as chondrosarcoma. Reprinted with ligament (arrowhead), the (short arrow) and permission from the editor. Copyright© 2016 Fronteras de the (star) are indicated. Reprinted with Medicina. All rights reserved. permission from the editor. Copyright© 2016 Fronteras de Medicina. All rights reserved.

Carlo Mondini (1729-1803)16

Carlo Mondini (Fig. 12) was an Italian anatomist and physi- cian. He was born in Bologna, Italy, in 1729. He obtained his degree in philosophy and medicine at the University of Bologna in 1757. It was at this University that he was first ap- pointed professor, being in charge of anatomical dissections and finally becoming Head of Department. Mondini worked with great dedication in ear malformations, especially in cochlear morphology. He was also the one to first identify and describe the ovaries. Mondini had twelve children, with Francesco being the one who continued his anatomical studies. He died in 1803 at the age of 74. He first described Mondini’s malformation in an 8-year-old boy with congenital deafness who died of sep- sis as a consequence of an accident. Mondini knew the boy, and therefore performed the dissection of the temporal (Figs. 13 and 14).17 He described the malformation of the cochlea, of one and a half turns and deformed modiolus. He also described an enlarged vestibular aqueduct and dilated vestibule (Fig. 15), malformations that may also be observed Fig. 12. The tomb of Carlo Mondini and his family in the Cer- in the enlarged vestibular aqueduct syndrome. tosa Monumental Cemetery in Bologna.

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Fig. 13. Anatomical preparation. Posterior, superior and me- dial view of the right temporal bone, which is partially dis- sected. The entry of the internal auditory canal is indicated (arrow).

Fig. 14. Drawing from Mondini’s original article. The dissec- tion performed by Mondini shows fusion of the middle and apical turns of the cochlea and widening of the vestibular aqueduct.

Wilhelm Waldeyer (1836-1921)18

Heinrich Wilhelm Gottfried Waldeyer (Fig. 16) was born on October 6, 1836 in Hehlen, a small town in the Kingdom of Prussia. He married and had four children. After attending a lecture by the famous anatomist Jakob Henle, he made the Fig. 15. Axial computed tomography (CT) slices of the left decision to study medicine, and initiated his medical studies, temporal bone. Patient with congenital bilateral sensorineu- graduating in 1862 in Berlin. ral hearing loss. Fusion of apical and middle turns of the co- Waldeyer was appointed Full Professor of Pathology in 1867. chlea (a) with preserved basal turn (b). Also notice the pres- He published 269 works throughout his career, including vari- ence of dilated vestibule (c) and vestibular aqueduct (d).

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Fig. 17. Anatomical preparation. Sagittal and coronal sections showing Waldeyer’s ring structures. The main structures that make up Waldeyer’s ring are shown: palatine (long ar- rows), pharyngeal tonsils or (short arrow) and lingual (arrowhead).

Fig. 18. Sagittal and Coronal CT scans of the . Asymp- tomatic 16-year-old patient. The physiological hypertrophy of the main structures that make up Waldeyer’s ring is shown: palatine tonsils (long arrows), pharyngeal tonsils or adenoid Fig. 16. Portrait of Wilhelm Waldeyer. (short arrow) and (arrowhead). ous topics such as: macroscopic anatomy, histology, pathol- ogy, anthropology, education, history and art. In 1884, he suggested the presence of lymphatic tissue surrounding the nasal, oral cavities and the pharynx, with larger concentra- tions of this tissue in the pharyngeal and palatine tonsils, cur- rently known as Waldeyer’s ring (Figs. 17 and 18). Waldeyer also described other structures: Waldeyer’s sheath (the fibrovascular sheath surrounding the intra-mural part of the ureter), Waldeyer’s (or perirectal fascia), Waldeyer’s fossa (a peritoneal sac which is occasionally found behind the superior mesenteric artery) and the marginal layer of Waldey- er (apex of the posterior horn of the spinal gray matter).19

Thomas Wharton (1614 – 1673)20

Thomas Wharton (Fig. 19) was born to John and Elizabeth Hodson on August 31, 1614 in Winston-on-Tees, England, in a well-established family. His childhood was passed in a pe- riod of civil, political and religious unrest in England. He ob- Fig. 19. Portrait of Thomas Wharton.

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tained his degree in medicine at Oxford University in 1647. In 1650, he became a Fellow of the Royal College of Physicians and in 1652 he received an honorary degree at Cambridge University. He is recognized for being one of the physicians who remained at his post during the Great Plague of 1665. In 1656 he published “Adenographia sive glandularum totius coporis descriptio” where he makes a detailed description of the glands of the human body. In this book, he describes the duct of the (or Wharton’s duct) and the gelatinous substance that constitutes and protects the um- bilical cord (or Wharton’s jelly), which is rich in mucopolysac- charides (Figs. 20 and 21).21 Wharton was also interested in philosophy and arts, mainly poetry. He married Jane Aldridge and had three children, two of whom died in their childhood. The other, Thomas, became a physician as his father. Thomas Wharton died on November 15, 1673 and he was buried in the church of Saint Michael in Fig. 20. Anatomical preparation. Medial view of the oral cav- London. ity and floor of the . The picture shows the tract of the left Wharton’s duct (in light blue), in the floor of the mouth ending in the homolateral umbilical orifice (long arrow). No- Niels Stensen/Nicolas Stenon tice the presence of the major sublingual duct (arrowhead), (1638-1686)22,23 accompanying Wharton’s duct in its distal portion. Reprinted with permission from the editor. Copyright© 2016 Fronteras Niels Stensen (Fig. 22) was born in Copenhague, Denmark de Medicina. All rights reserved. in 1638. While studying medicine, he Latinized his name as Nicolai Stenonis. However, in several documents, his name also appears as Nicolaus Stenonis, Nicolas Stenon or Niccolo Stenone. He was deeply involved in anatomy research during his career. He completed his medical studies at the University of Leiden, Holland.

Fig. 21. Axial CT slice at the level of the floor of the mouth. The patient presented with pain and swelling in the mandibular re- gion, exacerbated with salivation. The lower slice of the image after intravenous contrast administration (A) shows asymmetri- cal enhancement of the right submandibular gland (long ar- row) as compared to the left gland. There is also a slight thick- ening of the adjacent superficial cervical fascia (arrowhead). The upper slice of the image obtained before intravenous contrast administration (B) shows the presence of a calculus in the distal portion of the , at the level of the salivary caruncle (short arrow). Such findings are attributed to acute sialadenitis.Reprinted with permission from the editor. Copyright© 2016 Fronteras de Medicina. All rights reserved. Fig. 22. Portrait of Niels Stensen / Nicolas Stenon.

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In 1664, he moved to France, where he continued his anat- id gland duct (or Stensen´s/Stenon´s duct) occurred in 1660 omy research and started to carry out dissections as dem- during his stay in Amsterdam, and it happened by chance. onstrations, not only for physicians but also for the general Stensen had bought a sheep’s head with an intention to dis- public, charging an admission fee. The discovery of the parot- sect the animal’s . However, he decided to expand the dissection to other regions. On April 22, 1661, he wrote a letter to Thomas Wharton telling him about his discovery of the (Figs. 23 and 24). Early in his career, he wrote a comprehensive description of the glands and lymphatics of the head. It was Stensen who first described the cardiovascular malformation now known as the Tetralogy of Fallot. It was him, too, who discovered the follicles of the ovary, but his friend and colleague Reinier de Graaf published his account before Stensen did.

Marie-Francois Xavier Bichat (1771-1802)24,25

Marie-Francois Xavier Bichat (Fig. 25) was a prominent French anatomist during a time of revolution and one of the found- ers of scientific medicine in France. He conducted several experimental studies, which laid the foundation for the de- Fig. 23. Anatomic preparation of the left hemiface. The pic- velopment of modern physiology. Based on autopsy findings, ture shows the tract of Stenon’s duct in green (arrow) in the deep planes of the face, emerging from the Bichat introduced 21 tissues as the basic elements of all or- (star) and in contact with the (M). Branches gans. His name is remembered by several medical eponyms of the facial nerve appear in yellow and branches of the su- such as Bichat’s fossa (pterygopalatine fossa) and Bichat’s perficial temporary artery appear in red. protuberance (). (Figs. 26 and 27).

Fig. 24. Axial CT with intravenous contrast. Patient with fe- ver and pain in the left parotid region. The arrow points at an ovoid, irregular lesion with predominantly peripheral en- hancement after intravenous contrast administration, which may be attributed to an abscess of Stenon’s duct. Fig. 25. Portrait of Marie-Francoise Xavier Bichat.

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Conclusion The use of eponyms is frequent in head and neck anatomy and radiology. We believe that knowledge of eponyms and of the events leading to their appearance may be helpful resources to memorize important anatomic-radiologic land- marks. Last, but not least, we think that it is also important to honor these historical figures of Medicine.

Confidentiality of data. The authors declare that they have followed the protocols of their work center on the publication of patient data and that all the patients included in the study have received suf- ficient information and have given their informed consent in Fig. 26. Anatomic preparation of the right hemiface. The im- writing. age depicts a dissection of the right hemiface and shows Bi- chat’s protuberance in the deep planes. Conflicts of interest The authors declare no conflicts of interest, except for Dr. Chaves and Miquelini, who declare a possible conflict of in- terest as consultants for RAR.

Acknowledgements We are grateful to Prof. Dr. Horacio Conesa (1944-2015), a mentor and master in anatomy, a mainstay in the develop- ment of neuroanatomy at the University of Buenos Aires. Martín Fernando Ferraro thanks Prof. Dr. Conesa for his transfer of anatomical preparation images during his work at the Neuroanatomy Laboratory at Instituto de Morfología Juan José Naón. We also thank Dr. Lucía Tomassi, for her untiring efforts in the education of assistants in anatomy at the University of Buenos Aires and her ongoing promotion of learning about the history of medicine.

References

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