A Plea for Extension of the Anatomical Nomenclature. Part 1: Nervous System and Senses D

Home , Terminologia Anatomica

A plea for extension of the anatomical nomenclature. Part 1: Nervous system and senses D. Kachlik1, 2, V. Musil3, V. Baca2

1Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic 2Department of Health Care Studies, College of Polytechnics Jihlava, Czech Republic 3Centre of Scientific Information, Third Faculty of Medicine, Charles University, Prague, Czech Republic

[Received: 7 June 2016; Accepted: 3 August 2016]

A correct, exact, concise and detailed anatomical nomenclature is a cornerstone of communication not only in anatomy and related subjects but also in other medical branches and in the whole medical education. Terminologia Anatomica fulfils this task but some important structures are still missing there. The authors have col- lected and present here a list of terms including their definitions or explanations to provoke discussion about possible extension of the Terminologia Anatomica. The first part of this contribution, presented in this article, comprises 113 terms concerning the regulation systems of the human body: endocrine glands, central and peripheral nervous system, and senses. It also contains some corrections of anatomical mistakes, systemic inconsistencies and grammar changes. (Folia Morphol 2017; 76, 2: 168–177)

Key words: anatomy, anatomical terminology, anatomical nomenclature

INTRODUCTION fused and understandable communication between The anatomical nomenclature already exists for medical specialists. 121 years. The first and huge step was done by the The plea for better, more accurate, more detailed Anatomical Society of German speaking Anatomists and uniform anatomical nomenclature is a never-ending (Anatomische Gesellschaft) by creation, codification story. Although anatomy belongs to the oldest scientific and publication of the Basiliensia Nomina Anatomica medical branches and first terms come from the Egyp- (BNA) in 1895 [28]. After some years of quarrels, the tian papyri (e.g. Papyrus of Edwin Smith and Papyrus full consensus in the Latin anatomical nomencla- of Ebers from 16th century BC), there still exists some ture was achieved by issuing the Parisiensia Nomina incoherence between the scientific knowledge and its Anatomica (PNA) in 1955 [28]. It was later revised mirror in the anatomical terminology and nomenclature. 5-times and finally replaced by the Terminologia Ana- Terminology is a system of terms used in the specific tomica (TA) [7]. Nowadays, the terminological organ scientific field, and nomenclature, comprising the terms of the International Federation of Associations of created within the scope of terminology, is a normal- Anatomists (IFAA), termed the Federative Interna- ised system (usually processed as a systematised list) of tional Programme on Anatomical Terminology (FIPAT), exactly defined terms which are arranged according to has been continuously working on the other mor- certain classification principles. Nomenclature is then phological nomenclatures since 2009 and prepares approved by an official organ of the specific scientific a new revised edition of the anatomical nomenclature branch and is usually worldwide accepted and used by which should be published in near future. Such tool the professional community. Some well-known, estab- which is concise and precise, worldwide accepted and lished and used terms (parts of terminology) have not acknowledged, clear and simple, is viable for uncon- yet pertained to the nomenclature.

Address for correspondence: Dr. V. Musil, Centre of Scientific Information, Third Faculty of Medicine, Charles University, Prague, Ruská 87, 100 00, Prague 10, Czech Republic, e-mail: [email protected]

168 D. Kachlik et al., Nervous system and senses nomenclature

The anatomical nomenclature is a very useful and And several grammar changes have to be dis- moreover necessary and inevitable tool for both the cussed, although majority of them has been solved pedagogic and scientific life. Naming parts of the hu- and proposed in our previous articles [13–16]. man body should be unanimous, unique and common —— The developmental term ductus thyroglossalis worldwide to avoid confusion, errors, misunderstand- (A05.1.04.021) should match the other terms con- ing, redundant learning and time loss. That is why, cerning the tongue, e.g. musculus styloglossus, from the first attempt in 1895 (BNA), generations of nervus hypoglossus, and the change back to the anatomists spent hours and days to refine it and to term from the PNA (1955) — “ductus thyreoglos- create a world consensus. The revision of TA which is sus” would be reasonable and consistent; the cor- now in progress (by FIPAT) will bring for the first time rect modern form should be ductus thyroglossus a nomenclature featuring only one term applied to as already listed in the Terminologia Embryologica every structure in two languages, Latin and English, (E5.4.2.0.0.1.22) [8]. completed with other terminological and eponymous —— “Introitus oesophagei” (mouth of Killian) at the synonyms. Several manuscripts drawing attention to the transition between the pharynx and the oesopha- problems of TA have been published [3, 9, 11, 22–25]. gus, which is narrowed ventrally by the cartilago The purpose of this article is to suggest incorpo- cricoidea, now termed constrictio pharyngooe- ration of following terms to the new version of TA sophagealis (A05.3.01.026), should be slightly but before that to subject them to a wide discussion changed to constrictio pharyngooesophagea and criticism of anatomical experts throughout the to be consistent with other structures using the world who are not directly involved in the revision adjective “oesophageus”. Moreover, as a non- process but who are interested in reaching the above preferred synonym, the term constrictio cricoidea mentioned common aim. FIPAT expects and welcomes can be added. any proposal or commentary on this topic. —— “Impressio oesophageale” for the oesophageal The terms have been gathered during the educa- impression of the liver is a grammatically incor- tional and scientific process in which our team was rect term. Firstly, impressio is a feminine, secondly involved in last 15 years. They are either known from “oesophagealis” is inconsistent with other terms recent and old anatomical atlases, detailed textbooks using the preferred adjective oesophageus [15]. of the certain specific fields or from repetitive scien- That is why the correct term should be impressio tific researches that is why in most of cases, references oesophagea (hepatis). are not necessary. Some proposals have already been —— There are inconsistencies in using terms “per- published by other authors but scattered in the indi- oneus“ and “peronealis“. The former is applied in vidual articles and it is practical to mention them and the chapter ’General anatomy‘ and for “trochlea to draw attention to them again. After discussion it is peronealis“, the latter for muscles and nerves. useful to consider them and if agreed, introduce them From the grammatical point of view, the term into the new version of TA. Some of the structures “peroneus“ should be chosen but as proposed in lack their precise denomination and that is why new our previous articles, the term fibularis should be terms are proposed for discussion. In general, the the preferred one for all the structures [13–15]. terms comprise systemic, topographic, clinical and —— Also, there are inconsistencies of the adjective form variational anatomies. in terms related to the musculus sphincter: majority At first, some anatomical mistakes have to be solved: of them uses the non-concordant adjective such —— articulationes costochondrales are not synovial as musculus sphincter urethrae externus, muscu- joints but cartilaginous junctures (synchondroses) lus sphincter vesicae, musculus sphincter ductus between the bony rib and the cartilago costalis choledochi, musculus sphincter ampullae, muscu- (except for the ninth and tenth ribs which con- lus sphincter ani (externus et internus), musculus nection is fibrous) that is why the term should be sphincter pupillae, but one of them, musculus corrected to synchondroses costochondrales; sphincter pyloricus, uses the concordant adjective. —— the term nucleus ventralis posterolateralis is It would be reasonable to unify it to the former type listed twice in TA, first subordinated to nuclei (non-concordant adjective), i.e. to use musculus ventrobasales under the identification number sphincter pylori which was already part of BNA, A14.1.08.640, and second independently under Ienaiensia Nomina Anatomica (INA) and PNA. A14.1.08.656. It seems to be a mistake because —— Nodus lymphoideus/nodus lymphaticus/lympho- only one such structure exists in thalamus. nodus* are synonyms listed in TA although the

169 Folia Morphol., 2017, Vol. 76, No. 2

term “lymphoid” means from the linguistic point —— denominations of liver segment V, VI and VIII lack the of view only “similar to lymph” (‘eidos’ is a Greek side indication; the anterior medial segment (seg- term for form) and that is why the term lymphatic ment V) should be specified as right anterior me- should be preferred. dial segment and similarly for segment VI and VIII; —— The English synonyms of pili — hairs; capili — hairs —— the term round ligament of the liver should be of head; pubes — pubic hairs, according to the slightly changed to round ligament of liver be- grammar, should be stated as singular, i.e. hair; cause the definite article is not commonly used hair of head; pubic hair, as they do not represent in the list of terms in TA; the exact number of the hair but only its type. —— there are mistakes in denominations of structures There are also some systemic inconsistencies of the tympanic membrane related to the mal- which should be solved: leus — the incorrect terms “anterior and poste- —— the term cavitas conchae has a non-preferred rior malleolar folds, malleolar stria and malleolar synonym cavum conchae. As the only surviving prominence” should be changed to anterior and example of “cavum” in TA is the dural duplica- posterior mallear folds, mallear stria and mal- tion cavum trigmeniale and the others have been lear prominence because the term “malleolar” replaced with cavitas, it should be reasonable to is related to malleolus of the leg and the term delete the remaining ones as well; “mallear” to the auditory ossicle malleus. —— there is inconsistency in denomination of the sen- Some terms deserve further scientific research sory ganglion of nervus vestibularis (ganglion of as their anatomy is not either well known and un- Corti): in chapter ’Systema nervosum‘ two syno- derstood or precisely and correctly described and nyms are listed – ganglion cochleare; ganglion presented. This can be shown using the example of spirale cochleae (A14.2.01.134) but in chapter ‘Or- an eponymic lymph node. gana sensuum’ only the latter term is used. To be “Delphian (Delphic) node” is a dubious anatomical consistent with the name of the other ganglion of term. Clinically it is applied to a pathological enlarged the nervus vestibulocochlearis, the ganglion vestib- lymph node in front of the lower respiratory tract on ulare, the only term should be ganglion cochleare; the neck. It is described as one or more (1–4) lymph —— the term radiatio optica is stated under substan- nodes within the fascia in the midline above the tia alba thalami (item A14.1.08.673) as well as isthmus glandulae thyroideae (but can encompass under capsula interna. But the latter position any lymph node located ventral to the inferior half comprises two items — once accompanied with of the cartilago thyroidea, in front of the membrana a non-preferred synonym fibrae geniculocalcari- cricothyroidea or cartilago cricoidea), usually closely nae (A14.1.09.542) as a part of pars retrolenti- associated with the lobus pyramidalis glandulae thy- formis capsulae internae and then alone, without roideae (if present) and denominated as the “nodus a synonym (A14.1.09.547) as a part of pars sub- lymphoideus prelaryngeus, precricoideus seu crico- lentiformis capsulae internae. These discrepancies thyroideus”. It seems it belongs to the group called must be resolved in a clear and clever way; nodi prelaryngei but a precise terminology should —— the inexact term prominentia canalis facialis is be useful to state the exact location of this/these derived from the term canalis nervi facialis and lymph node(s). that is why it should be refined as prominentia It was hypothesised that metastasis to this lymph canalis nervi facialis. node foretells a “terrible” end-result from the cancer As for the English terminology, there are incon- that is why its name was inspired by the Oracle of sistencies as well: Delphi, the most important religious prophet in an- —— transverse plane is a virtual plane situated strictly cient Greece. If enlarged, it is indicative of disease of horizontal and it corresponds to what is in clinical either the thyroid gland or the larynx [12]. medicine often termed as the axial plane or cross- The term “innominatus” seems to be a joke in section. To avoid any ambiguity or uncertainty, the anatomical terminology and nomenclature. It only the term transverse plane (and projection) designates a structure without a proper name but should be preferred. Similarly, frontal plane is such a structure is already recognised and described a virtual plane situated strictly vertical and parallel and deserves a specific term, based on its morphology with the forehead and it corresponds to what is and/or localisation and/or function. Here are listed in clinical medicine often termed as the coronal structures which were and/or even still are denomi- plane; only the term frontal plane should be used; nated with this queer term:

170 D. Kachlik et al., Nervous system and senses nomenclature

—— former “tuberculum innominatum”, now proposed GLANDULAE ENDOCRINAE as tuberculum vastoadductorium is a projecting —— Capsula fibrosa glandulae thyroideae is com- distal end of the trochanter major femoris, serving posed of two layers and encloses a venous plexus for the origin of the musculus vastus medialis and for between them. the insertion of the musculus gluteus medius [15]; —— Tuberculum posterius glandulae thyroideae (of —— “canaliculus innominatus (of Arnold)” is an obso- Zuckerkandl) is a pyramidal extension of the glan- lete term for the foramen petrosum; dula thyroidea, located at the most dorsal side of —— “arteria anonyma” is an obsolete term used as each lobe. It is closely related to the nervus laryn- the official term until 1935 when it was replaced geus recurrens and the arteria thyroidea inferior. by the currently valid truncus brachiocephalicus —— Crista glandulae suprarenalis on the facies (other obsolete synonyms were “truncus anony- posterior, separates the facies posterior leaning mus” in Latin and “innominate artery” and “in- against the diaphragm, and the facies renalis nominate trunk” in English); adhering to the kidney. The gland itself can be —— “vena anonyma dextra et sinistra” are obsolete divided into the caput, corpus et cauda; the terms used as the official terms until 1935 when cauda contains no medulla. On the transverse they were replaced by the currently valid vena section, for purposes of pathologists, the gland brachiocephalica dextra et sinistra; can be divided into the paired lateral alae and the —— “arteria anonyma iliaca” and “vena anonyma ili- unpaired middle pars centralis. aca” are obsolete terms used by Jacob Henle for vasa iliaca communia; SYSTEMA NERVOSUM —— “lobulus anonymus” is an obsolete term for the Systema nervosum centrale lobus quadratus hepatis; Although this chapter has been substantially ex- —— “os innominatum” is an obsolete term for the tended in TA, some terms can be also added: os ilium; —— Epiconus medullaris (or simply epiconus) is —— substantia innominata (of Reichert) is the only a part of the spinal cord covering three segments currently valid term (A14.1.09.426) of anatomi- (L5, S1, S2) above the conus medullaris. Its lesion/ cal nomenclature, describing the area of basal compression causes typical neurological symp- forebrain below the commissura anterior, deep tomatology (epiconus syndrome). to the globus pallidus and dorsal to the corpus —— Fissura cerebellomesencephalica is located amgydaloideum. Based on the above mentioned above the pedunculi cerebellares superiores, sepa- explanation, it should be revised to e.g. substan rates the culmen and the alae lobuli centralis from tia basalis (telencephali) according to its localisa- the brainstem, relates to the superior half of the tion and contents (nucleus basalis of Meynert). roof of the fourth ventricle and contains the ar- The last and the largest part of the article contains teria superior cerebelli, vena precentralis cerebelli a list of terms classified according to the existing and the nervus trochlearis. chapters of the TA, related to the individual parts of —— Fissura cerebellomedullaris separates the uvula, the human body. It comprises terms concerning the tonsillae cerebelli and the lobuli biventri from the regulation systems of the human body: endocrine dorsolateral surface of the medulla oblongata, glands, central and peripheral nervous system, and relates to the inferior half of the roof of the fourth senses. To introduce following paragraphs, the terms ventricle and contains the arteria inferior posterior in bold Italics are the new proposed terms to be cerebelli, a vein and the nervus trigeminus, facialis, incorporated into TA, the terms in Italics are existing glossopharyngeus et vagus. terms of TA, terms in parentheses can be eponyms, —— Fissura cerebellopontina separates the cerebel- former terms (obsolete or non-recommended terms, lum and the pons with pedunculi cerebellares in- synonyms or explanations), and terms marked with feriores, relates to the recessus lateralis ventriculi asterisk have been already mentioned in our previous quarti and contains the arteria inferior anterior articles but it is necessary to emphasize them again. cerebelli and a vein. Totally 113 terms: 8 in Glandula endocrinae, 25 in —— Tuberculum acusticum is a slight pear-shaped Systema nervosum centrale, 12 in Systema nervosum prominence of the floor of the recessus lateralis periphericum, 16 in Oculus et structurae accessoriae, ventriculi quarti, corresponding to the underlying and 52 in Auris are presented here. nucleus cochlearis posterior.

171 Folia Morphol., 2017, Vol. 76, No. 2

—— Lamina medullaris medialis thalami is a plate of composed of two bands, termed ligamentum white matter in the thalamus which bifurcates petroclinoideum anterius et posterius. rostrally and the nuclei anteriores thalami are —— “A cauliflower-like tuft of grains” (original descrip- situated between the split parts of the lamina tion by Bochdalek) is a part of the plexus choroi- — these extensions can be termed crus mediale deus ventriculi quarti protruding from the apertura et crus laterale laminae medullaris medialis lateralis ventriculi quarti (foramen of Luschka) into thalami. the cisterna cerebellomedullaris lateralis. Bochdalek —— Fissura telodiencephalica is a very common syn- compared it to a round small basket of flowers onym for the fissura transversa cerebri and should or a cornucopia (Fig. 1) that is why it is termed be listed as the second, non-preferred synonym. flower basket or flower spray in English (‘Blumen- —— Sulcus intraparietalis has two extensions: sulcus körbchen’ in German; ‘Бохдалека корзиночка’ in parietalis transversus (of Brissaud) is a smaller Russian; ‘Bochdalkův keříček’ in Czech) but it pos- superior vertical branch from the sulcus intra- sesses no Latin term. A proposal to denominate this parietalis, and sulcus intermedius (of Jensen) wonderful structure can be fruticulus, a diminutive is a larger inferior vertical branch from the sul- from word “frutex”, meaning a bush [2, 6]. cus intraparietalis, separating the gyrus supra- —— Canalis nervi abducentis (of Dorello) is a bow- marginalis from the gyrus angularis (or it can be shaped bony enclosure surrounding the nervus a distal and superior vertical branch of the gyrus abducens and sinus petrosus inferior as the two temporalis superior). structures merge with the sinus cavernosus. It is —— Sulcus diagonalis (of Eberstaller) is a variable found at the apex partis petrosae ossis temporalis, branch from the sulcus lateralis cerebri (of Sylvius), cranially bounded by the ligamentum petrosphe- running from front to back, dividing the ante- noidale (of Gruber). rior portion of the pars opercularis gyri frontalis —— Ligamentum petrosphenoidale (of Gruber) is inferioris into two triangular portions that are a fibrous band located between the apex partis positioned inversely to each other. petrosae ossis temporalis and the processus cli- —— The superior and inferior surfaces of the corpus noideus posterior. callosum are large but innominate structures —— Tractus opticus is a continuation of the nervus which are well visible using computed tomogra- opticus fibres beyond the hemidecussation in the phy or magnetic resonance imaging. The superior chiasma opticum and most of its fibres terminate surface covered by archicortex (indusium griseum) in the corpus geniculatum laterale (radix later is in close relation to the cortex and its gyrus alis; radix metathalamica); a smaller number cinguli, and it can be called facies corticalis. The of fibres enters the brachium colliculi superioris opposite inferior surface, building the roof of the to terminate in the colliculus superior and the ventriculus lateralis and being in smaller extent in area pretectalis (radix medialis; radix mesence close relation to the septum pellucidum and fornix phalica); some fibres turn into the hypothalamus can be called facies profunda, as proposed by to end in the nucleus suprachiasmaticus (radix Malobabić and Štimec [21]. hypothalamica). —— Nucleus accumbens is composed of two function- —— Spatium perivasculare (space of Virchow-Robin) ally and structurally different parts: the central is a very narrow space between a larger vessel part termed core (pars nuclearis) and the medially (artery or vein) and the pia mater. The vessel takes located part termed shell (pars tegens). the pia mater with when entering the mass of the —— Incisura tentorii is a notch only in a separate speci- brain. The pia mater is reflected from the surface men of the dura mater cranialis but a foramen of the brain onto the surface of blood vessels (“foramen ovale” [of Pacchioni]) in its original in the subarachnoid space. These perivascular location, containing the brainstem and the nervus spaces contain interstitial fluid and are a region oculomotorius. This anatomical relations should of leukocyte aggregation. evoke a discussion about possible replacement with the term foramen tentorii/tentoriale. Systema nervosum periphericum —— Ligamentum petroclinoideum is a fold of the —— Ramus trapezius nervi accessorii is a muscular dura mater cranialis that extends between the branch from the eleventh cranial nerve coursing processus clinoideus anterior et posterior and within the lateral cervical region to supply the the pars petrosa ossis temporalis, and can be homonymous muscle.

172 D. Kachlik et al., Nervous system and senses nomenclature

Figure 1. Fruticulus or flower basket or cornucopia (of Bochdalek [2])

—— The general term for descriptive areas of innerva- the nervus iliohypogastricus can be termed ra tion are used in neurology: area radicularis senso mus communicans iliohypogastricus; similarly, ria is the dermatome (area of skin) and the internal a short branch emanating from the ramus anterior organs and muscles area innervated by one radix nervi lumbalis quarti (LIV) and joining the descend- posterior nervi spinalis (somatic and visceral sen- ing branch of the ramus anterior nervi lumbalis sory innervation); area radicularis motoria is the quiti (LV) to form the truncus lumbosacralis can myotome (several muscles or their parts) innervated be termed ramus communicans lumbosacralis. by one radix anterior nervi spinalis (somatic motor —— Sensory innervation of the thigh is mediated by innervation) and area nervina is the peripheral four nerves — two direct branches from plexuses nerve field innervated by one peripheral nerve. (nervus cutaneus femoris lateralis from the plexus —— Ganglion sensorium nervi spinalis is a general term lumbalis, and nervus cutaneus femoris posterior listed under the ganglion craniospinale sensorium from the plexus sacralis) and two indirect branches but a specific term for the ganglion related to the (ramus cutaneus rami anterioris nervi obturatorii, radix posterior nervi spinalis is missing. The gen- and rami cutanei anteriores nervi femoralis). To be eral term needs a counterpart, as in case of the consistent, the indirect branches can be termed cranial nerves, and the simple and already widely similarly to the direct ones, i.e. ramus cutaneus used one is ganglion spinale. femoris medialis from the ramus anterior nervi —— Ansa cervicalis superficialis is a nerve loop be- obturatorii, and rami cutanei femoris anteriores tween the ramus colli nervi facialis and the ramus from the nervus femoralis. superior nervi transversi colli, situated between —— Ansa sacralis is a nerve cord connecting both trun- the platysma and the musculus sternocleidomas- ci sympathici with the ganglion impar (of Walther). toideus in the upper ventrolateral part of the neck. Thus the term ansa cervical profunda should ORGANA SENSUUM replace the until now used ansa cervicalis (nerve Oculus et structurae accessoriae loop from the plexus cervicalis supplying the mus- —— Orbiculus ciliaris is the flatter posterior two thirds culi infrahyoidei). of the corpus ciliare and is in clinical practice called —— A short branch emanating from the ramus anterior pars plana corporis ciliaris (e.g. pars plana vit- nervi thoracici duodecimi (anterior branch of the rectomy); corona ciliaris is the folded anterior one spinal nerve TXII) and joining the branch of the third of the corpus ciliare, producing the humor ramus anterior nervi lumbalis primi (LI) to form aquosus and suspending the lens, and is in clini-

173 Folia Morphol., 2017, Vol. 76, No. 2

cal practice called pars plicata corporis ciliaris. Auris The clinical terms sound more reasonable as they —— The auricle features two until now innominate sur- reflex the morphology and should be preferred. faces — facies lateralis (comprising the positive —— Expansions of the sheaths of the musculus rectus and negative spatial structures including cavitas medialis et lateralis of the eyeball that are at- conchae, the entrance to the meatus acusticus tached to the bony wall of the orbit (medial to externus), and facies medialis (with opposite the os lacrimale, lateral to the tuberculum orbitale structures to the former ones). Crura antihelicis ossis zygomatici), serve individually to prevent can be classified as crus antihelicis superius et exaggerated action of the muscle from which inferius bounding the fossa triangularis. they extend, and together they form a support- —— Between the eminentia fossae triangularis and ing hammock-like formation suspending the eye- the eminentia conchae, there is a shallow groove ball in the orbit. The latter is known as lacertus termed sulcus transversus antihelicis which musculi recti lateralis (check ligament of lateral corresponds to the course of the crus antihelicis rectus muscle), the former can be denominated in inferior. There is an oblique crest — ponticu a similar way — lacertus musculi recti medialis lus auriculae — running across the eminentia (check ligament of medial rectus muscle). conchae serving for insertion of the musculus —— There are two palpebral arterial arcades which are auricularis posterior. the major source of the blood supply of conjunc- —— There exist ligaments of the auricle which fix it to tiva. Arcus palpebralis marginalis is an anas- the head (ligamentum auriculae anterius, posterius tomosis between the rami palpebrales mediales et superius), and small proper ligaments between and the rami palpebrales laterales in both eyelids, certain structures of the auricle itself: ligamentum located 2 mm from the margo palpebrae, in the tragohelicinum extending between the tragus submuscular plane in front of the tarsus. Arcus and the spina helicis which contributes to the car- palpebralis centralis is an anastomosis between tilaginous border of the entrance into the concha another branches from the rami palpebrales me- auriculae; and ligamentum helicoantihelicinum diales and the rami palpebrales laterales in both extending between the cauda helicis and the anti- eyelids, located near the peripheral border of helix filling the fissura antitragohelicina. tarsus. Both arcades send rami perforantes for —— Porus acuticus externus is a term designed for two nutrition of the tarsus and the tunica conjunctiva. different structures: first it is the bony entrance to —— The eyelid features two margins: a visible margo the bony meatus acusticus externus, termed the ex- liber palpebrae is the free margin heading to- ternal acoustic opening in English, and listed in the wards the rima palpebrarum; margo orbitalis chapter ‘Ossa’ under A02.1.06.054; second it is the palpebrae is the hidden one fixating the eyelid cartilaginous entrance (covered with skin) to the to the septum orbitale, and consequently to the meatus acusticus externus cartilagineus, termed bony wall of the orbit. the external acoustic pore or the external acoustic —— The upper lid can be divided into two parts: the aperture in English, located in the cavitas conchae upper pars orbitalis, and the lower pars tarsalis, and partly covered with the tragus, listed in the containing the tarsus superior. chapter ‘Organa sensuum’ under A15.3.01.046. —— Sulcus subtarsalis is a groove in the facies pos- These two terms should be distinguished by speci- terior palpebrae near the margo liber palpebrae, fying adjectives: porus acusticus externus osseus a free margin of the eyelid, and which is also paral- et cartilagineus, and unified in English as well. In lel to it. It separates the pars marginalis tunicae a similar way, the bony and cartilaginous parts (seg- conjunctivae palpebrarum from the pars tarsalis ments) of the meatus acusticus externus should be tunicae conjunctivae palpebrarum, and provides refined as the general termmeatus acusticus ex potential space for lodging of foreign bodies. ternus featuring pars ossea et pars cartilaginea —— Canaliculus lacrimalis communis is a short duct meatus acustici externi, instead of the meatus (present in 90% of cases) formed by fusion of acusticus externus cartilagineus and the nonspe- the canaliculus lacrimalis superior et inferior, and cificmeatus acusticus externus, the latter listed in empties into the saccus lacrimalis. the chapter ‘Ossa’ under A02.1.06.055, and in the —— Saccus lacrimalis can be divided into two parts: fun chapter ‘Organa sensuum’ under A15.3.01.045. dus projecting above the ligamentum palpebrale —— There are two physiological narrowings (constric- mediale, and corpus, being the larger part below. tions) in the meatus acustici externi. The lateral

174 D. Kachlik et al., Nervous system and senses nomenclature

one is located just internally to the transition be- by the crista infrapyramidalis, and medially by tween the pars cartilaginea et ossea, the medial the promontorium; one is situated in the pars ossea approximately • sinus tympanicus lateralis laterocaudally — 20 mm from the floor of the concha auriculae. bordered by three eminencies of the “styloid They can be termed and distinguished as isthmus complex”: eminentia pyramidalis, prominentia meatus acustici externi medialis et lateralis. styloidea, and eminentia chordae tympani; —— Meatus acusticus externus cartilagineus is continu- • sinus facialis (in TA as “recessus facialis”) lat- ous with the cartilago auriculae ventrally, where erocranially — a triangle bordered cranially by it merges with the lamina tragi but discontinuous the fossa incudis and on sides by the chorda caudally and dorsally where both cartilages are tympani and the nervus facialis. separated with a deep notch — incisura termi There are three additional structures in this area: nalis auris — filled with collagenous tissue. Both • an innominate communication beneath the cartilages are thus connected by a narrow bridge ponticulus between the cranial sinus tympani- called the isthmus (isthmus cartilaginis auris) cus posterior and the caudal sinus tympanicus; and that is why the complex of the cartilage au- • fossa suprapyramidalis (of Sappey) is an air riculae and the cartilago meatus acustici should cell of the sinus facialis at the laterocaudal be termed cartilago auris. part of the sinus, just above the crista chorda —— A membrane between crus anterius et posterius tympani; stapedis is innominate and can be simply termed • pseudosubiculum is an additional bony ridge membrana stapedia; the free space bordered by caudal to the subiculum and separating the the crura stapedis and the basis stapedis, filled sinus tympanicus and a depression of the with the membrana stapedia, should be termed (in fenestra cochleae. a similar way to the foramen obturatum located —— Paries caroticus cavitatis tympani contains several among three bones and closed with a membrane) openings or passages for air, muscle, nerve and as foramen stapedis. vessels. These openings should be termed similarly —— A fibrous juncture between the membrana tym- to other such structures and completed within pani and the manubrium mallei is innominate and the subchapter concerning the middle ear and can be termed syndesmosis tympanomallearis. the tympanic cavity: —— A space in the posterior part of the cavitas tympani • ostium tympanicum canalis nervi petrosi (“retrotympanum”) extends into four recesses minoris is located at the transition of the bordered by four bony ridges, some of them are anterior and superior wall of the tympanic officially termed, some still lack their valid terms. cavity, serving for the nervus petrosus minor The central bony landmark of the paries mastoi- and the vasa tympanica superiora; deus is the eminetia pyramidalis and small bony • fissura petrotympanica(of Glaser) in the lower ridges are detached in different direction: part of the anterior wall, containing the vasa • crista chordae tympani (chordal ridge) laterally; tympanica anteriora and the ligamentum mal- • crista infrapyramidalis (pyramidal ridge) lei anterius; caudally; • canaliculus chordae tympani anterior (of • crista suprapyramidalis cranially; Huguier and Civinini) is a short canal in the me- • ponticulus medially. dial part of the fissura petrotympanicatrans - These ridges then form four recesses between the mitting the chorda tympani, and canaliculus promontorium and the sinus tympanicus (which chordae tympani posterior is a short canal terminology is ameliorated here): branching from the pars mastoidea canalis • sinus tympanicus posterior (in TA as “sinus nervi facialis and opening on the paries mas- posterior”) mediocranially — bordered medi- toideus cavitatis tympani into the tympanic ally by the commissura posterior fenestrae cavity, containing the chorda tympani and the vestibuli, laterocranially by the prominentia vasa tympanica posteriora; canalis nervi facialis, and caudally by the pon- • canaliculi caroticotympanici connect the tym- ticulus; panic cavity and the canalis caroticus, trans- • sinus tympanicus (in TA as “sinus tympani”) mitting the rami et nervi caroticotympanici; mediocaudally — bordered cranially by the • canalis musculotubarius, composed of two ponticulus, caudally by the subiculum, laterally parts — the upper semicanalis musculi tenso-

175 Folia Morphol., 2017, Vol. 76, No. 2

ris tympani and the lower semicanalis tubae and the process is still continuing. This set of articles auditivae. should provoke further discussion as we have noticed —— Ponticulus promontorii is a thin bony bridge from that many tiny groups of neurons are listed in TA as the eminentia pyramidalis to the promontorium. nuclei and their subnuclei, but many gross anatomical —— Angulus sinuduralis (of Citelli) is formed by dura structures are missing there. This discrepancy caused mater of the fossa cranii media and the ventrocra- by tremendous research boom in the neuroscience nial surface of the sinus sigmoideus. The floor of should be balanced by incorporating all structures the angle is bound by the sinus petrosus superior. of the human body, visible by naked eye, and usually In a well pneumatized bone, small air cells occupy already described years ago. the angle. This list of terms brings a proof that an extension —— Lamina petrosquamosa (of Körner; clinically of TA is one of the processes which will probably termed Körner’s septum) is a bony plate sepa- never end but is one of the most important tasks in rating the cellulae squamosae, and the cellulae the terminological work and research. From 1895, petrosae, lying deep to the sutura petrosquamosa, the number of terms within the anatomical nomen- and stretching from the posterior aspect of the clature has doubled. Until now the only officially fossa mandibularis, extending above the cavitas valid language in the anatomical nomenclature has tympani, coursing caudally and passing laterally to been Latin. Worldwide, it is a gold standard in the the canalis nervi facialis towards the apex of the description of any morphological structure or unit. processus mastoideus. It serves as an important But the current language of science is the English. surgical landmark within the cellulae mastoideae. The plan for the next edition of TA is to have both —— Corpus adiposum tubae auditivae (of Ostmann) Latin and English terms official, and to have only one is a triangular fat pad located mediocaudally to the preferred term; the other terms shall be listed as mere tuba auditiva, and laterocranially to the musculus (non-preferred) synonyms, e.g. fibularis(because we tensor veli palatini, and is thought to be impor- use the term fibula as well) as the preferred term, tant in normal closure of the tube, preventing and “peroneus” as a mere (non-preferred) synonym transmission of nasopharyngeal pressure to the (because the term “perone” (peróuh) is a Greek word middle ear cavity. for the calf-bone but it is used as a technical term —— The mastoid air cell system (cellulae mastoideae) neither in anatomy nor in clinical practice). is categorised according to various regions of the Another aspect concerns the clinical extensions of temporal bone [1]: TA. Until now, only anatomists have been involved in • cellulae squamomastoideae include the an- its amelioration, with an exception of the phlebologi- trum mastoideum and the adjacent air cells: cal field. Fortunately, in years 2002 and 2005, two central mastoid tract (cellulae mastoideae consensus documents extending and revising the centrales), and peripheral air cell tract (cel venous parts of TA have been approved by IFAA and lulae mastoideae periphericae); International Union of Phlebology. They concern the • cellulae perilabyrinthicae, which can be fur- superficial and deep veins of the lower limb [5, 17, ther divided according to their relationship to 18, 20] and the veins of the pelvis [4, 19]. Although the labyrinthus osseus into cellulae supra they are quite detailed and involve even the venous labyrinthicae et infralabyrinthicae; perforators, some structures situated mainly within • cellulae petrosae located inside the pars the foot are missing [27]. Such activities of the clini- petrosa ossis temporalis, and their subgroup cians and clinical anatomists are cordially welcome within the apex partis petrosae termed cel and principal for further life and credit of TA. lulae petrosae apicales; Some terms, proposed in articles, are open to further • cellulae accessoriae comprise the air cells in- discussion, such as fascia postauricularis [26], or they side the processus zygomaticus ossis temporalis lack their Latin counterparts, and have to be completed (cellulae zygomaticae), cellulae occipitales, and ameliorated [10]. The process of nomenclature cellulae squamosae et cellulae styloideae. revision is a never-ending story but it must not cease or stop otherwise the communication would become more DISCUSSION difficult, unprecise and misleading in future. The problem of a precise, correct and detailed The aims of this series of articles are to evoke a dis- anatomical nomenclature is bothering anatomists cussion concerning the above listed terms if necessary from the 19th century. Many steps were achieved but mainly to show the way how to ameliorate the

176 D. Kachlik et al., Nervous system and senses nomenclature

anatomical nomenclature to all the morphologists, 11. Hirsch BE. Does the Terminologia Anatomica really matter? physicians, scientists and other people interested in Clin Anat. 2011; 24(4): 503–504, doi: 10.1002/ca.21140, indexed in Pubmed: 21509816. this topic. Detailed, unanimous and precise nomencla- 12. Iyer NG, Shaha AR, Ferlito A, et al. Delphian node metas- ture is a necessary tool for librarians and IT specialists tasis in head and neck cancers--oracle or myth? J Surg dealing with databases and searching tools, for cor- Oncol. 2010; 102(4): 354–358, doi: 10.1002/jso.21640, rectors and reviewers, for translators and teachers. indexed in Pubmed: 20589710. 13. Kachlik D, Baca V, Bozdechova I, et al. Anatomical terminology and nomenclature: past, present and highlights. CONCLUSIONS Surg Radiol Anat. 2008; 30(6): 459–466, doi: 10.1007/ Terminologia Anatomica is strong in anatomical s00276-008-0357-y, indexed in Pubmed: 18488135. communication but it should reach such position 14. Kachlik D, Bozdechova I, Cech P, et al. Mistakes in the usage of anatomical terminology in clinical practice. Biomed Pap. also among all medical specialists. Opened discussion 2009; 153(2): 157–161, indexed in Pubmed: 19771143. about its fundamental points, grammatical aspects, 15. Kachlik D, Musil V, Baca V. Terminologia Anatomica after contents and clinical extensions is the only way to 17 years: inconsistencies, mistakes and new proposals. Ann achieve this goal. Otherwise, TA would slowly sink to Anat. 2015; 201: 8–16, doi: 10.1016/j.aanat.2015.04.006, indexed in Pubmed: 26094127. the dust of forgotten shelves in our libraries. 16. Kachlik D, Musil V, Baca V. Contribution to the anatomical nomenclature concerning general anatomy and Acknowledgements anatomical variations. Surg Radiol Anat. 2016; 38(7): The authors thank Miroslava Plecitá for help in 757–765, doi: 10.1007/s00276-016-1627-8, indexed in Pubmed: 26946463. obtaining the cited articles. The study was supported 17. Kachlik D, Pechacek V, Baca V, et al. The superficial by the Charles University, Project PRVOUK #33. venous system of the lower extremity: new nomenclature. Phlebology. 2010; 25(3): 113–123, doi: 10.1258/ References phleb.2009.009046, indexed in Pubmed: 20483860. 1. Allam AF. Pneumatization of the temporal bone. Ann Otol 18. Kachlik D, Pechacek V, Musil V, et al. Information on the Rhinol Laryngol. 1969; 78(1): 49–64, doi: 10.1177/00034 changes in the revised anatomical nomenclature of the 8946907800105, indexed in Pubmed: 5763190. lower limb veins. Biomed Pap. 2010; 154(1): 93–97, in- 2. Bochdalek VA. Anleitung zur praktischen Zergliederung dexed in Pubmed: 20445717. des menschlichen Gehirnes, nebst einer anatomischen 19. Kachlik D, Pechacek V, Musil V, et al. The venous system Beschreibung desselben; mit besonderer Rücksicht auf das of the pelvis: new nomenclature. Phlebology. 2010; 25(4): kleine Gehirn. Gottlieb Haase Söhne, Prag 1833. 162–173, doi: 10.1258/phleb.2010.010006, indexed in 3. Bradford MD, Thorpe D, DeLuna V, et al. Frequency in Usage Pubmed: 20656953. of Terminologia Anatomica Terms by Clinical Anatomists. 20. Kachlik D, Pechacek V, Musil V, et al. The deep venous sys- J Biomed Edu. 2014; 2014: 1–9, doi: 10.1155/2014/950898. tem of the lower extremity: new nomenclature. Phlebolo- 4. Caggiati A, Bergan JJ, Gloviczki P, et al. International gy. 2012; 27(2): 48–58, doi: 10.1258/phleb.2011.010081, Interdisciplinary Consensus Committee on Venous Ana- indexed in Pubmed: 21821722. tomical Terminology. Nomenclature of the veins of the 21. Malobabić S, Štimec B. A note to corpus callosum’s no- lower limb: extensions, refinements, and clinical applica- menclature. Fol Anat Iugoslavia. 1989-1990: 19–20:13–16. tion. J Vasc Surg. 2005; 41(4): 719–724, doi: 10.1016/j. 22. Manzanares-Céspedes MC. On-line Terminologia Ana- jvs.2005.01.018, indexed in Pubmed: 15874941. tomica: a proposal. Anat Sci Educ. 2010; 3(3): 154–155, 5. Caggiati A, Bergan J, Gloviczki P, et al. Nomenclature of the doi: 10.1002/ase.149, indexed in Pubmed: 20496437. veins of the lower limbs: An international interdisciplinary 23. Martin BD, Thorpe D, Barnes R, et al. Frequency in usage of consensus statement. J Vasc Surg. 2002; 36(2): 416–422, FCAT-approved anatomical terms by North American anat- doi: 10.1067/mva.2002.125847. omists. Anat Sci Educ. 2009; 2(3): 94–106, doi: 10.1002/ 6. Chvátal A, Kachlík D. Vincenc Alexandr Bohdálek (1801– ase.83, indexed in Pubmed: 19459207. –1883): Czech anatomist and neuroscientist of the nineteenth 24. Martin BD, Thorpe D, Merenda V, et al. Contrast in us- century. J Hist Neurosci. 2017; 26(2): 125–139, doi: 10.1080 age of FCAT-approved anatomical terminology between /0964704X.2016.1150671, indexed in Pubmed: 26927541. members of two anatomy associations in North America. 7. FCAT Terminologia anatomica. Thieme Verlag, Stuttgart 1998. Anat Sci Educ. 2010; 3(1): 25–32, doi: 10.1002/ase.114, 8. FICAT Terminologia Embryologica: International Embryo- indexed in Pubmed: 19890984. logical Terminology. Thieme Verlag, Stuttgart 2013. 25. Pawlina W, Drake R. Moving forward with Terminologia 9. Gobée O, Jansma D, DeRuiter M. AnatomicalTerms.info: Anatomica. Anat Sci Educ. 2009; 2(3): 93, doi: 10.1002/ Heading for an online solution to the anatomical synonym ase.89, indexed in Pubmed: 19496153. problem hurdles in data-reuse from the Terminologia 26. Shokrollahi K, Taylor JP, Le Roux CM, et al. The postauricular Anatomica and the foundational model of anatomy and fascia: classification, anatomy, and potential surgical appli- potentials for future development. Clin Anat. 2011; 24(7): cations. Ann Plast Surg. 2014; 73(1): 92–97, doi: 10.1097/ 817–830, doi: 10.1002/ca.21185. SAP.0b013e31826cb2b5, indexed in Pubmed: 23657044. 10. Hennekam RCM, Allanson JE, Biesecker LG, et al. Elements 27. Uhl JF, Gillot C. The plantar venous pump: Anatomy and physi- of morphology: standard terminology for the external ological hypotheses. Phlebolymphology. 2019; 17: 151–158. genitalia. Am J Med Genet A. 2013; 161A(6): 1238–1263, 28. Woerdeman MW. Nomina anatomica parisienssia (1955) doi: 10.1002/ajmg.a.35934, indexed in Pubmed: 23650202. et BNA (1895). Ossthoek, Utrecht 1957.

177