INTRODUCTIONThe sternocleidomastoid (SCM) muscle is a major muscle of the neck. Classically, this muscle is attached below the sternum and clavicle, although the mode of attachment might vary. As the SCM is related to numerous important neurovascular structures, its variable anatomy is clinically relevant, particularly for neck surgeries. A cadaveric study was performed to establish the variations present in the mode of attachment of the SCM muscle in an Indian population.

METHODSWe studied the variations in the attachment of the SCM muscle during the dissection of 18 cadavers for undergraduate teaching in two medical colleges in West Bengal, India.

RESULTSVariations in the attachment of the SCM muscle were found in 5 (27.8%) specimens. Of these five specimens, three had unilateral variations and two had bilateral variations. In each specimen, the modes of presentation of the SCM and its fusion with the major bulk were also different.

CONCLUSIONIn this study, we found variations in the attachment of the SCM muscle in more than a quarter of the specimens dissected. Surgeons should bear in mind such variations when performing neck surgeries.

Cadaver ; Clavicle ; anatomy & histology ; Dissection ; Female ; Humans ; India ; Male ; Neck ; anatomy & histology ; Neck Muscles ; anatomy & histology ; Sternum ; anatomy & histology

OBJECTIVETo study on the anatomical layers and depth of Yifeng (TE 17) so as to provide anatomical basis for clinical treatment.

METHODSFifteen fresh adult corpse samples, 10 males and 5 females, were randomly taken for investigating the anatomical structures and nerve-blood vessel relationship at the acupoint area of Yifeng (TE 17) with layer anatomical method layer by layer.

RESULTSAnterior of Yifeng (TE 17) is posterior border of condylion, the part backward is the aponeurosis of sternocleidomastoid muscle and anterior border of papillary. Structures of this point are skin, subcutaneous fascia, the posterior border of parotid, venous plexus of infratemporal fossa in turn. And the superficial layer of the point are the branches of great auricular nerve and external jugular vein. The structures of the deep layer are occipital artery, branches of upper jaw's artery and vein, pterygoid venous plexus and facial nerve, mandibular nerve. The average dangerous depth is (35.52 +/- 6.31) mm.

CONCLUSIONThere are important nerves and blood vessels around Yifeng (TE 17), which should be noted in acupuncture.

Facial Nerve ; anatomy & histology ; Humans ; Neck Muscles

OBJECTIVETo find a procedure for facial rejuvenation which is simple, safe with lasting aesthetic results based on facial anatomic study.

METHODSAnatomy study was performed on 12 sides from 6 head specimens. Observe the range and thickness of fat lateral to the nasolabial grooves. Observed the location of the skin retaining ligaments and reappraised their functions combining with clinical observations.

RESULTSSkin and subcutis and SMAS (including mimic muscles) become slackening with aging, but the loosening degrees are different, especially in the region lateral to the nasolabial groove. So they should be handled respectively. The fat lateral to the nasolabial groove is thick and is mobile with aging . So the subcutaneous detachment need not beyond the anterior border of the masseter. In the past two years, we performed rhytidectomy on 100 patients by limited subcutaneous detachment and SMAS double-plication. Satisfactory results were obtained. There are no serious complications observed.

CONCLUSIONSRhytidectomy by limited subcutaneous detachment and SMAS double-plication is a simple and safe procedure with lasting aesthetic results.

Face ; anatomy & histology ; Head ; anatomy & histology ; Humans ; Male ; Middle Aged ; Neck ; anatomy & histology ; Rhytidoplasty ; methods

OBJECTIVEThe aim of this investigation was to examine the anatomic basis of palatopharyngeus and clinical implications for sphincter pharyngoplasty.

METHODSDetailed dissections were performed on 17 sides of adult human head and neck specimens. The eight sides newborns' head and neck cadavers were also used in the study (4 normal and 4 cleft lip and palate). The observations of histologic serial sections were undertaken in six fetus head and neck specimens on coronal, transverse and sagittal direction.

RESULTSThe palatopharyngeus with three components of pharyngeal origins and two heads of velar insertions contributes the continuity between the velum and lateral pharyngeal wall and the bulk of muscle fibers were extended to the posterior tonsilar pillars with (27.58 +/- 6.73) mm length and (34.1 +/- 10.50) mm2 section area. The muscles were supplied dominantly from the branches of ascending pharyngeal artery and tonsilar artery and partly from the branches of ascending palatine artery and dorsal lingual artery. The muscles were innervated by the branches of pharyngeal plexus which focus on the level 10 mm to 25 mm below the hard palate and at the level of 15 mm below the hard palate there was at least one of the nerve branch entered the muscle.

CONCLUSIONThe palatopharyngeus muscle is not only a major musculature of lateral pharyngeal wall but also an important portion of the soft palate, participating the middle and posterior velum, which means that the muscle may play a significant effect in the velar function and pharyngeal wall movements. It is also a good donor site for palatopharyngeus flap. The sphincter pharyngoplasty has some influence to the blood supply and innervation of the muscles, which may result to blood reversion and denervation for the distal component of palatopharyngeal flap.

Adult ; Cadaver ; Head ; anatomy & histology ; Humans ; Infant, Newborn ; Neck ; anatomy & histology ; Palatal Muscles ; anatomy & histology ; Pharyngeal Muscles ; anatomy & histology

INTRODUCTIONThe lingual, inferior alveolar and auriculotemporal nerves, being branches of the posterior division of the mandibular nerve, mainly innervate the mandibular teeth and all the major salivary glands. Anomalous communications among these branches are widely reported due to their significance to various treatment procedures undertaken in the region. This study was performed as detailed exploration of the functional perspectives of such communicating branches would further enhance the scope of these procedures.

METHODSA total of 36 specimens were dissected to examine the infratemporal region. The branches from the posterior division of the mandibular nerve--namely the lingual, inferior alveolar and auriculotemporal nerves--were carefully dissected, and their branches were studied and analysed for abnormal course.

RESULTSCommunication between branches of the posterior division of the mandibular nerve was observed in four specimens. In two of the four specimens, communication between the mylohyoid and lingual nerves was observed. A rare and seldom reported type of communication between the auriculotemporal and inferior alveolar nerves is described in this study. This communicating nerve split into two to form a buttonhole for the passage of the mylohyoid nerve.

CONCLUSIONSuch communicating branches between nerves found in this study are developmental in origin and thought to maintain functional integrity through an alternative route.

Cadaver ; Female ; Humans ; Lingual Nerve ; anatomy & histology ; Male ; Mandibular Nerve ; anatomy & histology ; Neck Muscles ; innervation ; Tongue

OBJECTIVE: To provide anantomical basis for the endoscope-assisted partial superficial parotidectomy via retroauricular hairline approach (EASPRHA) and assess its feasibility and safety. METHOD: The surgical anatomy of retroauricular hairline region and parotid gland region were observed in 15 fresh human cadavers (30 halves). The EASPRHA was performed on 5 human cadavers (10 halves). After the procedure, the related vascular and neural structures were evaluated. RESULT: The retroauricular hairline region extends between superficial musculoaponeurotic system and superficial cervical fascia. On the superficial surface of the upper sternocleidomastoid lie the lesser occipital nerve, the great auricular nerve and the external jugular vein. The bifurcation of great auricular nerve is(22.85 ± 2.01) mm from the bottom of earlobe. The parotid gland region extends between parotidomassteric fascia and parotid gland parenchyma. The facial nerve emerging from the stylomastoid foramen runs across the superficial surface of base of styloid process, passes through the interspace between cartilage of external acoustic meatus and posterior belly of digastric muscle, and enters the parotid gland. The bifurcation of facial nerve trunk is (19.10 ± 3.10)mm from the mastoidale and (39.49 ± 5.78) mm from the mandibular angle. Above the posterior belly of digastric muscle, the posterior auricular artery arises from the posterior wall of the external carotid artery with its main stem running over the superficial surface of facial nerve trunk. In all endoscope-assisted operations, the partial superficial parotidectomy was successful without the need for an additional incision. No major neurovascular damage wasobserved. CONCLUSION A thorough knowledge of the surgical anatomy of retroauricular hairline region and parotid gland region is an essential requirement in performing the safe and feasible EASPRHA.
Cranial Nerves ; anatomy & histology ; Endoscopes ; Endoscopy ; methods ; Facial Nerve ; anatomy & histology ; Fascia ; Feasibility Studies ; Humans ; Male ; Neck Muscles ; anatomy & histology ; Parotid Gland ; anatomy & histology ; surgery

Hip fractures have high morbidity and mortality rate for the people as a complication of osteoporosis and is generally seen in old age. It is known that femoral geometric measurements are important in the assessment of hip fracture risks. This study aimed to examine the association between hip geometry and hip fracture in post-menopausal elderly females. In the present study, 232 hip X-rays were taken from women with no hip fractures (Group 1) and 29 post-menopausal women with hip fractures (Group 2) after a minor trauma. After standard anterior-posterior plain pelvic X-ray radiographs were obtained, various radiographic measurements were performed in all cases, including the hip axis length (HAL), femoral neck axis length (FAL), acetabular width (AW), femoral head width (HW), femoral neck width (FW), femoral shaft width (FSW), intertrochanteric width (TW), lateral and medial cortical thickness of the femoral shaft (LCT, SMCT), femoral neck cortical thickness (NMCT) and femoral neck-shaft angle (Q-angle). In group 1, the mean age, weight and height were 62.5 +/-7.4 years, 70.8 +/-12.5 kg, and 157.5 +/-6.7 cm, respectively. In group 2, these values were 70.17 +/-6.8 years, 64.7 +/-11.5 kg, and 158.3 +/-2.7 cm, respectively. There were no statistically significant differences in the measurements of HAL, FAL, AW and HW between the two groups. In group 2, the mean FW value was significantly higher than in group 1 (p= 0.01). The mean values for FSW, TW, NMCT, SMCT, LCT were statistically lower in group 2 than those in group 1 (p= 0.01, p=0.038, p=0.001, p< 0.001, p< 0.001, respectively). Q-angle was also significantly higher in cases with hip fracture than in cases with no hip fracture (p=0.01). The values of FW, FSW, TW, NMCT, SMCT, LCT and Q-angle seem to be important parameters in the evaluation of hip fracture risks. However, further studies are needed to clarify this conclusion.
Aged ; Body Mass Index ; Female ; Femur/*anatomy & histology ; Femur Neck/anatomy & histology ; Hip Fractures/*pathology ; Humans ; Middle Aged

OBJECTIVETo analyze the risk factors for difficult airway in laryngoscopy and mask ventilation.

METHODSA total of 300 patients receiving general anesthesia with tracheal intubation were examined preoperatively for height, thyromental and sternomental distance (TMD), range of neck movement, inter-incisor distance, and modified Mallampati class. Intubation Difficult Score was used to identify a difficult laryngoscopy. Difficult airway was defined as either difficult laryngoscopy or difficult mask ventilation. The association between the airway characteristics and difficult airway was analyzed by logistic regression analysis, and the cut-off values for the height-to-TMD ratio was determined by the ROC curve.

RESULTS AND CONCLUSIONEight airway characteristics were identified to contribute to a difficult airway, including (OR [95%CI]) the height-to-TMD ratio (3.58[1.95-8.46]), modified Mallampati class (3.34 [1.82-7.14]), BMI (3.07 [1.64-6.69]), history of a previous difficult airway (2.79 [1.28-5.25]), a thick neck (2.15 [1.04-4.37]), range of neck movement (1.98 [0.96-3.89]), sternomental and angulus mandibulae distance (1.46 [0.67-3.04]), and inter-incisor distance (1.01 [0.49-2.54]). The optimal cut-off value for the height-to-TMD ratio was 22.8 for predicting a difficult airway.

Anesthesia, General ; Body Height ; Humans ; Intubation, Intratracheal ; Laryngoscopy ; Logistic Models ; Neck ; anatomy & histology ; ROC Curve ; Risk Factors ; Trachea ; anatomy & histology

OBJECTIVE: To measure the anatomic data of the proximal femur and to design an internal fixation instrument aiming at subtrochanteric fracture. METHODS: We measured the anatomic data of 56 pairs of the matching proximal femur specimens: the diameter of femoral head (HD), the axis length of femoral head (HAL), 135 degree femoral head-neck axis length (HNAL), 135 degree femoral head-neck axis upper length (HNAUL), 135 degree femoral head-neck axis underside length (HNADL), the anterior-posterior axis diameter of femoral neck (NAPD), the upper-underside diameter of femoral neck (NUUD), femoral neck-shaft angle (NFA), femoral shaft lateral cortex-greater trochanter angle (SLGA), the medial-lateral diameter of lesser trochanter level's femoral shaft (LSMLD), the anterior-posterior diameter of lesser trochanter level's femoral shaft (LSAPD), the medial-lateral diameter of 5 cm below lesser trochanter femoral shaft (5 cm MLD), and the anterior-posterior diameter of 5 cm below lesser trochanter femoral shaft (5 cm APD). Part of the data was analyzed and compared. RESULTS: HD was (46.69+/-3.73) mm, HAL was (39.22+/-4.17) mm, HNAL was (95.45+/-8.16) mm, HNAUL was (84.02+/-7.11) mm, HNADL was (99.95+/-9.34) mm, NAPD was (26.27+/-3.15) mm, NUUD was (32.24+/-3.31) mm, NFA was 126.21 degree+/-7.13 degree, SLGA was 16.38 degree+/-4.04 degree, LSMLD was (31.05+/-3.57) mm, LSAPD was (27.63+/-2.96) mm, 5 cm MLD was (26.36+/-3.22) mm, and 5 cm APD was (25.59+/-2.75) mm. NFA was positively correlated with SLGA (r=0.396, P=0.003). CONCLUSION It is necessary to design internal fixator to fit the anatomical feature of Chinese femur for the treatment of subtrochanteric fracture, and we should thoroughly consider the angle of the SLGA.
Anthropometry ; Cadaver ; Equipment Design ; Femur Head ; anatomy & histology ; Femur Neck ; anatomy & histology ; Fracture Fixation, Internal ; instrumentation ; Hip Fractures ; surgery ; Humans

OBJECTIVETo study the influences of head/neck ratio and femoral antetorsion on the safe-zone of operative acetabular orientations, which meets the criteria for desired range of motion (ROM) for activities of daily living in total hip arthroplasty (THA).

METHODSA three-dimensional generic, parametric and kinematic simulation module of THA was developed to analyze the cup safe-zone and the optimum combination of cup and neck antetorsion. A ROM of flexion > or =120 degree internal rotation > or = 45 degree at 90 degree flexion, extension > or = 30 degree and external rotation > or =40 degree was defined as the criteria for desired ROM for activities of daily living. The cup safe-zone was defined as the area that fulfills all the criteria of desired ROM before the neck impinged on the liner of the cup. For a fixed stem-neck (CCD)-angle of 130 degree theoretical safe-zones fulfilling the desired ROM were investigated at different general head-neck ratios (GR=2, 2.17, 2.37, 2.61 and 2.92) and femoral anteversions (FA equal to 0 degree,10 degree,20 degree and 30 degree).

RESULTSLarge GRs greatly increased the size of safe-zones and when the CCD-angle was 130 degree, a GR larger than 2.37 could further increase the size of safe-zones. There was a complex interplay between the orientation angles of the femoral and acetabular components. When the CCD-angle was 130 degree the optimum relationship between operative acetabular anteversion (OA) and femoral antetorsion (FA) could be estimated by the formula: OA equal to -0.80 multiply FA+47.06, and the minimum allowable operative acetabular inclination (OI(min)) would be more than 210.5 multiply GR(-2.255).

CONCLUSIONSLarge GRs greatly increase the size of safe-zones and it is recommended that the GR be more than 2.37 so as to extend the acceptable range of error that surgeons cannot avoid completely during operation. As to the optimum operative acetabular inclination (OI), surgeons need to make a decision combining with other factors, including stress distribution, soft tissue and cup wear conditions, as well as patients'individual situations and demands. The data obtained from this study and the module of THA can be used to assist surgeons to choose and implant appropriate implants.

Acetabulum ; anatomy & histology ; Arthroplasty, Replacement, Hip ; methods ; Computer Simulation ; Femur Head ; anatomy & histology ; physiology ; Femur Neck ; anatomy & histology ; physiology ; Humans ; Range of Motion, Articular