On the Further History of Five Cases of Arterio-Venous Aneurysm of the Neck, with Some Remarks on the Condition Generally, and Its Treatment

Total Page:16

File Type:pdf, Size:1020Kb

On the Further History of Five Cases of Arterio-Venous Aneurysm of the Neck, with Some Remarks on the Condition Generally, and Its Treatment J R Army Med Corps: first published as 10.1136/jramc-04-06-03 on 1 June 1905. Downloaded from ,41 ON THE FURTHER HISTORY OF FIVE CASES OF ARTERIO-VENOUS ANEURYSM OF THE NECK, WITH SOME REMARKS ON THE CONDITION GENERALLY, AND ITS TREATMENT. By G. H. MAKINS, C.B., F.R.C.S., Surgeon to St. Thomas'8 Hospital, &,c. THE cases upon which this communication are founded have already been published in my book on the ,. Surgery of the South African Campaign," but during the period of five years which has elapsed since, they were first under treatment changes have occurred in their condition which seem to render their history worthy of continuation. In again bringing them forward I take the opportunity of raising Protected by copyright. some questions with regard to arterio-venous communications ID general. (1) CAROTID ARTERIO-VENOUS ANEURYSM. The bullet (Mauser) entered at the right side of the pomum adami, and crossing' the larynx and the course of the left caI;otid vessels, emerged at the anterior border of the left trapezius two inches below the angle of the mandible. Immediate hffimorrhage occurred from the exit wound, but ceased spontaneously. At the end of some four hours, during which the patient had been removed 'to a field hospital, the bleeding recurred, and an incision was made http://militaryhealth.bmj.com/ by the surgeon-in-charge with the intention of ligaturing the carotid artery. During the preliminary stage of the operation, however, the bleeding ceased, and the vessel was not exposed nor ligatured. The patient was kept quiet for three weeks and then sent to the Base Hospital at Wynberg. At that time the external wounds were soundly healed, but there was considerable blood extravasation in , the left posterior triangle of the neck, while swelling, pulsation and thrill were palpable beneath the sterno-mastoid, in the course of the bullet track, over an area It inches in breadth. A widely distributed machinery murmur was audible on auscultation, and this, was on September 24, 2021 by guest. troublesome to the patient himself when he lay with the left side of the head on the pillow. The left eye appeared somewhat prominent, but the pupil reacted. normally to light, and was equal in size with the right. Laryngoscopic examination showed the vocal cords to be intact, but there was swelling of the upper part of the larynx, 49 J R Army Med Corps: first published as 10.1136/jramc-04-06-03 on 1 June 1905. Downloaded from 742 Arterio-Venous Anew"ysm of the Neclc the voice was weak and husky, and there was some cough. The patient complained of giddiness at times, but not of headache. The pulse numbered 100 per minute, it was regular, but irritable in character. During the next four weeks the patient was kept at rest in the supine position and general improvement followed. Meanwhile the swelling became localised into a definite oval tumour in the line of the wound track, 2 inches long by 1! inches wide. After the first fortnight of rest no further diminution of size occurred in the aneurysm, and it was determined to apply a proximal ligature. This procedure at once arrested all pUlsation in the sac, and materially reduced the strength of the purring thrill; but the latter was not extinguished. At the end of a week the wound was dressed and the stitches removed, when it was found that all pulsation in the aneurysm had ceased, although the thrill remained as before. Shortly afterwards the patient returned to England with the aneurysm apparently consolidated, but when I· saw him some six Protected by copyright. months later pUlsation had recurred and a small oval sac was palpable beneath the sterno-mastoid. The thrill was slight com­ pared with the condition prior to the operation and gave rise to little or no trouble. Pulsation was strong in the external carotid, but there was little in the common carotid artery. The patient's general condition was good, but the pulse remained from 110 to 120 in pace. I assumed that the aneurysm was either at the bifurcation of the carotid, or at the immediate commencement of the internal carotid, and proposed to ligate the external carotid, as I thought that this would sufficiently diminish the blood supply to ensure the consoli­ http://militaryhealth.bmj.com/ dation of the aneurysm without endangering the internal jugular vein or further upsetting the cerebral circulation. The patient, however, decided that he would rather await events, as the con­ dition gave rise to little or no inconvenience, and I was quite inclined to fall in with this view, provided he did not return to active service. During the next six months I saw the patient several times; he was leading an easy life at home, avoiding all strenuous exertion, and the condition steadily improved, the pUlsation becoming less, on September 24, 2021 by guest. and the thrill slighter. At the end of five .months (eleven months from the date of ligature of the common carotid) the aneurysm h.ad apparently under­ gone complete consolidation, its place being occupied by a narrow oval. tumour about 1 inch in length. All pulsation had ceased, and J R Army Med Corps: first published as 10.1136/jramc-04-06-03 on 1 June 1905. Downloaded from G. H. Makins 743 thrill was hardly perceptible. A low, continuous hum was still present on auscultation, but the most striking feature was the presence of a sharp musical systolic murmur, similar to those present with· an arterial cicatrix and contraction of the lumen of the vessel. During tbe next nine months these signs disappeared completely, and since then the patient has been continuously on active service. On March 10th, 1904, the patient wrote as follows about himself: " I am able to give a most satisfactory account of myself. My neck gives me no trouble, my voice is strong again, and I can give words of command just as I did before the wound. I went through the last manoouvres at home in September without inconvenience, and we had a most trying time." Captain Mitchell, R.A.M.C., was kind enough to send me the following report in June, 1904: "I consider the case one of perfect recovery; no signs can now be discovered in the neck to show that a varicose aneurysm has ever existed. The heart and pulse are Protected by copyright. normal. The only trouble ever experienced is shortness· of breath on severe or prolonged exertion, but this is only of. temporary duration." (The patient is 46 years of age.) (2) CAROTID ARTERIO-VENOUS ANEURYSM. The bullet (Mauser) entered at the dimple of the chi.n, imme­ diately below the mandibular symphysis, crossed the car6tids just above the normal point of bifurcation, and emerged at the anterior border of the right trapezius. The patient was lying on his back with the head down at the moment he was struck. Some immediate http://militaryhealth.bmj.com/ hffimorrhage from the exit wound occurred, and later, while being transported to the field hospital, renewed hffimorrhage' was so severe as to almost prove fatal. On the tenth day a considerable secondary hffimorrbage occurred. The patient then came under the care of Mr. Cheatle, ~t Modder River. A large diffuse pulsating swelling, with loud machinery murmur and thrill, had developed. During the next three weeks this st(ladily contracted in size, the patient being kept at rest, and one month after tbe reception of the wound the patient was con­ sidered fit to undertake the journey to Wynberg. on September 24, 2021 by guest. On arrival at the Base Hospital a large aneurysm filled the carotid triangle. It extended from the mid-line of the neck back­ wards to the anterior margin of the trapezius, and vertically from the upper margin of the thyroid cartilage to the mandible. A fairly firm wall had formed, pulsation was both obvious and palpable, J R Army Med Corps: first published as 10.1136/jramc-04-06-03 on 1 June 1905. Downloaded from 744 Arterio-Venous Aneurysm of the Neclc and a well-marked purring thrill with loud machinery murmur was present. The latter worried the patient much when he lay with the right side of his head on the pillow. The pulse numbered 1eo and was somewhat irritable in character, the voice was weak and husky, and there was some difficulty in swallowing solids. The pupils were equal. The outline of the aneurysmal swelling was somewhat remarkable, extending on one hand in the line of the external carotid artery, on the other in .the line. of the wound track backwards to the edge of the trapezius. During the succeeding fortnight the patient was kept at .rest with the head between sand bags, and some further contraction in the size of the aneurysm was noted. A sudden increase then took place, the larnyx became pressed ! inch over to the left of the mid-line, while considerable extension downwards· along the course of the common carotid raised a doubt as to whether it would be possible to expose that vessel on the proximal side without encroaching on the blood sac. It was determined, however, to Protected by copyright. make the attempt, and as it proved, the vessel was tied without difficulty at the upper border of the omo-hyoid. Pulsation and thrill disappeared completely on tightening the ligature. There was no dilatation of the jugular vein. ' Four days later the aneurysm was found to be solid, and appreciably diminished in size. Neither pulsation nor thrill could be.
Recommended publications
  • Gross Anatomy
    www.BookOfLinks.com THE BIG PICTURE GROSS ANATOMY www.BookOfLinks.com Notice Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy are required. The authors and the publisher of this work have checked with sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical sciences, neither the authors nor the publisher nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they disclaim all responsibility for any errors or omissions or for the results obtained from use of the information contained in this work. Readers are encouraged to confirm the infor- mation contained herein with other sources. For example and in particular, readers are advised to check the product information sheet included in the package of each drug they plan to administer to be certain that the information contained in this work is accurate and that changes have not been made in the recommended dose or in the contraindications for administration. This recommendation is of particular importance in connection with new or infrequently used drugs. www.BookOfLinks.com THE BIG PICTURE GROSS ANATOMY David A. Morton, PhD Associate Professor Anatomy Director Department of Neurobiology and Anatomy University of Utah School of Medicine Salt Lake City, Utah K. Bo Foreman, PhD, PT Assistant Professor Anatomy Director University of Utah College of Health Salt Lake City, Utah Kurt H.
    [Show full text]
  • Variant Origins of Arteries in the Carotid Triangle - a Case Report
    Case Report 281 Variant Origins of Arteries in the Carotid Triangle - A Case Report B. V. Murlimanju, MD; Latha V. Prabhu, MS; Mangala M. Pai, MD; Dhanya Jayaprakash, MBBS; Vasudha V. Saralaya, MS The left superior laryngeal artery was observed arising from the external carotid artery instead of the superior thyroid artery in the cadaver of an approximately 70 year-old Asian man. In addition, on the same side, the superior thyroid artery arose from the common carotid artery 2 cm before the bifurcation instead of its usual origin from the external carotid artery. From the external carotid artery, the lingual and facial arteries arose from the com- mon linguofacial trunk. The nerves in the carotid triangle were normal in course. No varia- tions were observed on the right side carotid system. The multiple variations in this case have not been previously described. The embryogenesis of this combination of variations is not clear, but the anatomic consequences may have important clinical implications. As angiography has gained popularity in diagnostic approaches in recent years, it is essential to be aware of these variations so that they are not overlooked in differential diagnoses. (Chang Gung Med J 2012;35:281-4) Key words: artery, superior laryngeal, superior thyroid, common carotid, external carotid, vari- ant origin natomical variations in the carotid triangle in the STA from the left CCA is reported here. In the Athe neck are important, especially during surgi- literature, a few variations in origin have been cal and radiological intervention in the region. reported for both arteries,(1-3) but the combination of Normally, the superior laryngeal artery (SLA) is a variations reported in this case has not been previ- branch of the superior thyroid artery (STA).
    [Show full text]
  • DEPARTMENT of ANATOMY IGMC SHIMLA Competency Based Under
    DEPARTMENT OF ANATOMY IGMC SHIMLA Competency Based Under Graduate Curriculum - 2019 Number COMPETENCY Objective The student should be able to At the end of the session student should know AN1.1 Demonstrate normal anatomical position, various a) Define and demonstrate various positions and planes planes, relation, comparison, laterality & b) Anatomical terms used for lower trunk, limbs, joint movement in our body movements, bony features, blood vessels, nerves, fascia, muscles and clinical anatomy AN1.2 Describe composition of bone and bone marrow a) Various classifications of bones b) Structure of bone AN2.1 Describe parts, blood and nerve supply of a long bone a) Parts of young bone b) Types of epiphysis c) Blood supply of bone d) Nerve supply of bone AN2.2 Enumerate laws of ossification a) Development and ossification of bones with laws of ossification b) Medico legal and anthropological aspects of bones AN2.3 Enumerate special features of a sesamoid bone a) Enumerate various sesamoid bones with their features and functions AN2.4 Describe various types of cartilage with its structure & a) Differences between bones and cartilage distribution in body b) Characteristics features of cartilage c) Types of cartilage and their distribution in body AN2.5 Describe various joints with subtypes and examples a) Various classification of joints b) Features and different types of fibrous joints with examples c) Features of primary and secondary cartilaginous joints d) Different types of synovial joints e) Structure and function of typical synovial
    [Show full text]
  • Parts of the Body 1) Head – Caput, Capitus 2) Skull- Cranium Cephalic- Toward the Skull Caudal- Toward the Tail Rostral- Toward the Nose 3) Collum (Pl
    BIO 3330 Advanced Human Cadaver Anatomy Instructor: Dr. Jeff Simpson Department of Biology Metropolitan State College of Denver 1 PARTS OF THE BODY 1) HEAD – CAPUT, CAPITUS 2) SKULL- CRANIUM CEPHALIC- TOWARD THE SKULL CAUDAL- TOWARD THE TAIL ROSTRAL- TOWARD THE NOSE 3) COLLUM (PL. COLLI), CERVIX 4) TRUNK- THORAX, CHEST 5) ABDOMEN- AREA BETWEEN THE DIAPHRAGM AND THE HIP BONES 6) PELVIS- AREA BETWEEN OS COXAS EXTREMITIES -UPPER 1) SHOULDER GIRDLE - SCAPULA, CLAVICLE 2) BRACHIUM - ARM 3) ANTEBRACHIUM -FOREARM 4) CUBITAL FOSSA 6) METACARPALS 7) PHALANGES 2 Lower Extremities Pelvis Os Coxae (2) Inominant Bones Sacrum Coccyx Terms of Position and Direction Anatomical Position Body Erect, head, eyes and toes facing forward. Limbs at side, palms facing forward Anterior-ventral Posterior-dorsal Superficial Deep Internal/external Vertical & horizontal- refer to the body in the standing position Lateral/ medial Superior/inferior Ipsilateral Contralateral Planes of the Body Median-cuts the body into left and right halves Sagittal- parallel to median Frontal (Coronal)- divides the body into front and back halves 3 Horizontal(transverse)- cuts the body into upper and lower portions Positions of the Body Proximal Distal Limbs Radial Ulnar Tibial Fibular Foot Dorsum Plantar Hallicus HAND Dorsum- back of hand Palmar (volar)- palm side Pollicus Index finger Middle finger Ring finger Pinky finger TERMS OF MOVEMENT 1) FLEXION: DECREASE ANGLE BETWEEN TWO BONES OF A JOINT 2) EXTENSION: INCREASE ANGLE BETWEEN TWO BONES OF A JOINT 3) ADDUCTION: TOWARDS MIDLINE
    [Show full text]
  • 432 Surgery Team Leaders
    3 Common Neck Swellings Done By: Reviewed By: Othman.T.AlMutairi Ghadah Alharbi COLOR GUIDE: • Females' Notes • Males' Notes • Important • Additional Outlines Common Anatomy of the Neck Neck Ranula Swellings Dermoid cyst Thyroglossal cyst Branchial cysts Laryngocele Carotid body tumor Hemangioma Cystic Hygroma Inflammatory lymphadenopathy Malignant lymphadenopathy Thyroid related abnormalities Submandibular gland related abnormalities Sjogren's syndrome 1 Anatomy of the Neck: Quadrangular area (1): A quadrangular area can be delineated on the side of the neck. This area is subdivided by an obliquely prominent sternocleidomastoid muscle into anterior and posterior cervical triangles. Anterior cervical triangle is subdivided into four smaller triangles: -Submandibular triangle: Contains the submandibular salivary gland, hypoglossal nerve, mylohyiod muscle, and facial nerve. -Carotid triangle: Contains the carotid arteries and branches, internal jugular vein, and vagus nerve. -Omotracheal triangle: Includes the infrahyoid musculature and thyroid glands with the parathyroid glands. -Submental triangle: Beneath the chin. Figure 1: Anterior cervical muscles. 2 Posterior cervical triangle: The inferior belly of the omohyoid divides it into two triangles: -Occipital triangle: The contents include the accessory nerve, supraclavicular nerves, and upper brachial plexus. -Subclavian triangle: The contents include the supraclavicular nerves, Subclavian vessels, brachial plexus, suprascapular vessels, transverse cervical vessels, external jugular vein, and the nerve to the Subclavian muscle. The main arteries in the neck are the common carotids arising differently, one on each side. On the right, the common carotid arises at the bifurcation of the brachiocephalic trunk behind the sternoclavicular joint; on the left, it arises from the highest point on arch of the aorta in the chest.
    [Show full text]
  • Ana Tomical Triangles J
    43 ANA TOMICAL TRIANGLES J. LESLIE PACE, M.D. Department of Anatomy, Royal University of Malta Anatomical description is given of certain areas in the human hody which have :.l triangular sha!)e and which are of anatomical or surgical importance. There are at lea;,t 30 describe,d ,anatomical triangles, many of which receive eponymous names. Some are of nUlrked importance and well known e.g. Scarpa's femoral triangle, Hesselbach's inguinal triangle, H!ld Petit '5 lumbar triangle; others arc of relative1y minor importance and n.ot so well-known e.g. Elau's, Friteau's and Assezat's triangles. Anatomical trianlfles are described in various regions .of the body e.g. Macewen's ana Trautmann's in the head regiml, Beclaud's and PirDgoff's in the neck region, He'lSelbach '5, Henke '5, Petit's amI Grynfeltt's in the ,abdominal wall region and Searpa's Hnd Weber's in the lower limb Tf~gion. Their size varies, some being large e.g. Scarpa's triangle, others being very small e.g. Macewen's triangle. The bDundaries of these triangular areas may cDnsist of muscle borders e.g. the triangle .of Lannier and the variDUS tria,ngles of the neck; of n111sc1e borders and· bony cn1"fac(1,~ e.g. P(~lit'.~l tri,f)ng]c, t]1(' tria11['1]" ,C)f M'll"('ille J;lIlfl t1H~ tl"i[J11~le of Auscultation; of muscle borders and blood ves,ds e.g. Uesselbach's; of imaginary line, clrawn hetween fixed bony points e.g.
    [Show full text]
  • Clinical Anatomy of the Neck Region
    MINISTRY OF HEALTH OF THE REPUBLIC OF MOLDOVA STATE UNIVERSITY OF MEDICINE AND PHARMACY "NICOLAE TESTEMIȚANU" DEPARTMENT TOPOGRAPHIC ANATOMY AND OPERATIVE SURGERY Gheorghe GUZUN, Radu TURCHIN, Boris TOPOR, Serghei SUMAN CLINICAL ANATOMY OF THE NECK REGION Methodical recommendations for students CHISINAU, 2017 CZU 611.93(076.5) C 57 Lucrarea a fost aprobată de Consiliul Metodic Central al USMF “Nicolae Testemițanu”; proces-verbal nr. 2 din 10.03.2017 Autori: Gheorghe GUZUN – dr. med, conf. univ. Radu TURCHIN – dr.șt.med., conf. univ. Boris TOPOR – dr.hab.șt.med., prof. univ. Serghei SUMAN – dr.hab.șt.med., conf. univ. Recenzenți: Ilia catereniuc – dr.hab.șt.med., prof. univ. Nicolae Fruntașu – dr.hab.șt.med., prof. univ. Machetare: Serghei Suman – dr.hab.șt.med., conf. univ. DESCRIEREA CIP A CAMEREI NAȚIONALE A CĂRȚII Clinical anatomy of the neck region : Methodical recommendations for students / Gheorghe Guzun, Radu Turchin, Boris Topor [et al.] ; State Univ. of Medicine and Pharmacy "Nicolae Testemiţanu", Dep. Topographic Anatomy and Operative Surgery. – Chişinău : S. n., 2017 (Tipogr. "Print-Caro"). – 52 p. : fig. 100 ex. ISBN 978-9975-56-466-3. 611.93(076.5) C 57 ISBN 978-9975-56-466-3. CEP Medicina, 2017 Gheorghe Guzun, Radu Turchin, Viorel Nacu, Boris Topor, 2017. © Gheorghe Guzun, 2017 CLINICAL ANATOMY OF THE NECK The upper limit of the neck (cefalocervical limit) is a conventional line that crosses the lower jaw (basis of mandible) and its angle, the bottom of the external auditory canal, the apex of mastoid process (procesuus mastoideus) and superior nuchal line (linea nuchae superior) to the external occipital protuberance (occipitalis external protuberance).
    [Show full text]
  • Surface Anatomy
    BODY ORIENTATION OUTLINE 13.1 A Regional Approach to Surface Anatomy 398 13.2 Head Region 398 13.2a Cranium 399 13 13.2b Face 399 13.3 Neck Region 399 13.4 Trunk Region 401 13.4a Thorax 401 Surface 13.4b Abdominopelvic Region 403 13.4c Back 404 13.5 Shoulder and Upper Limb Region 405 13.5a Shoulder 405 Anatomy 13.5b Axilla 405 13.5c Arm 405 13.5d Forearm 406 13.5e Hand 406 13.6 Lower Limb Region 408 13.6a Gluteal Region 408 13.6b Thigh 408 13.6c Leg 409 13.6d Foot 411 MODULE 1: BODY ORIENTATION mck78097_ch13_397-414.indd 397 2/14/11 3:28 PM 398 Chapter Thirteen Surface Anatomy magine this scenario: An unconscious patient has been brought Health-care professionals rely on four techniques when I to the emergency room. Although the patient cannot tell the ER examining surface anatomy. Using visual inspection, they directly physician what is wrong or “where it hurts,” the doctor can assess observe the structure and markings of surface features. Through some of the injuries by observing surface anatomy, including: palpation (pal-pā sh ́ ŭ n) (feeling with firm pressure or perceiving by the sense of touch), they precisely locate and identify anatomic ■ Locating pulse points to determine the patient’s heart rate and features under the skin. Using percussion (per-kush ̆ ́ŭn), they tap pulse strength firmly on specific body sites to detect resonating vibrations. And ■ Palpating the bones under the skin to determine if a via auscultation (aws-ku ̆l-tā sh ́ un), ̆ they listen to sounds emitted fracture has occurred from organs.
    [Show full text]
  • The Terminologia Anatomica Matters: Examples from Didactic, Scientific, and Clinical Practice B
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE Foliaprovided Morphol. by Via Medica Journals Vol. 76, No. 3, pp. 340–347 DOI: 10.5603/FM.a2016.0078 R E V I E W A R T I C L E Copyright © 2017 Via Medica ISSN 0015–5659 www.fm.viamedica.pl The Terminologia Anatomica matters: examples from didactic, scientific, and clinical practice B. Strzelec1, 2, P.P. Chmielewski1, B. Gworys1 1Division of Anatomy, Department of Human Morphology and Embryology, Faculty of Medicine, Wroclaw Medical University, Wroclaw, Poland 2Department and Clinic of Gastrointestinal and General Surgery, Wroclaw Medical University, Wroclaw, Poland [Received: 19 August 2016; Accepted: 20 October 2016] The proper usage of the anatomical terminology is of paramount importance to all medical professionals. Although a multitude of studies have been devoted to issues associated with the use and application of the recent version of the anatomical terminology in both theoretical medicine and clinical practice, there are still many unresolved problems such as confusing terms, inconsistencies, and errors, including grammar and spelling mistakes. The aim of this article is to describe the current situation of the anatomical terminology and its usage in practice, as well as explain why it is so important to use precise, appropriate, and valid anatomical terms during the everyday communication among physicians from all medical branches. In this review, we discuss some confusing, obsolete, and erroneous terms that are still commonly used by many clinicians, and surgeons in particular, during the process of diagnosis and treatment. The use of these ambiguous, erroneous, and obsolete terms enhances the risk of miscommunication.
    [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]
  • A Mnemonic for Neck Triangles
    iology: C s ur hy re P n t & R y e s m e o Anatomy and Physiology: Current a t r a c n h A ISSN: 2161-0940 Research Original Article A Mnemonic for Neck Triangles Abdulrauf Badr MI* Department of Surgery, King Faisal Specialist Hospital and Research Center Jeddah, Saudi Arabia ABSTRACT Anatomical Neck Triangles are imaginary to some extent. Their significance to many surgical specialties is invaluable. Among all basic Medical sciences subjects, Anatomy is most prone to be forgotten. None of the other subjects has the amount of mnemonics described or invented compared to it. Junior years students of Medical schools need to memorize anatomy with no or very little knowledge of its clinical applications. Relatively speaking, that can be quite cumbersome for them compared to those who are already involved in surgical residency training program, when anatomy knowledge is concerned. Surgeons who specialize or exclusively work in a selected anatomic region, they become experts and famous in their field and in that particular operation, mostly because they subconsciously become oriented to that region’s anatomy. However, those who work on various anatomical areas, frequently need to refresh their anatomy knowledge. Mnemonics, therefore are helpful for various level medical professionals. The Neck represents a relatively limited transition zone or passage of various tissue structures besides great vessels and nerves between Head, Chest and Upper extremities, very much like a three-way connector. Unless the concept of Neck triangles was there, it would have been very difficult to discuss or communicate about neck related procedures.
    [Show full text]
  • An Investigation of Virgin Variation of Branching Pattern of ECA and CCA: a Case Report
    Case report http://dx.doi.org/10.4322/jms.096715 An investigation of virgin variation of branching pattern of ECA and CCA: a case report RAJANI, S.* Department of Anatomy, All India Institute of Medical Sciences, Rishikesh, Uttrakhand, India *E-mail: [email protected] Abstract Introduction: Common carotid and its two major branches, external and internal carotid arteries form arterial network for blood supply in the head and neck region. Variations in configuration and branching pattern of these arteries change the irrigation pattern and complicate the identification of specific arteries during surgical intervention coupled with imagery interpretation for diagnosis. Though handful variations have been documented yet there is strong need to report unusual, new and virgin organization of configuration and branching pattern in these arteries. Case Report: During dissection of head and neck region, anomalous branching pattern consisting of bilateral trifurcation/quadrification of common and external carotid arteries and abnormal trifurcation of distal external carotid artery was observed. Conclusion: Lack of knowledge of these variants in branching configuration may lead to unfortunate differential diagnosis and iatrogenic complications. Keywords: common carotid, external carotid artery, quadrification, trifurcation, branching pattern. 1 Introduction The common carotid artery (CCA) bifurcating into CCA bifurcated into ECA, ICA and also gave off superior external and internal carotid arteries at the level of superior thyroid artery bilaterally in this cadaver at 2 cm above thyroid border of thyroid cartilage in carotid triangle (STANDRING, cartilage in right (Figure 1R) and just below the level of angle 2008) plays major role for blood supply to the head and neck of mandible at 2.5 cm above the upper border of thyroid region.
    [Show full text]