As total mesorectal excision (TME) for rectal cancer is widely carried out in China, lateral ligament of rectum, as an important anatomical structure of the lateral rectum with certain anatomical value and clinical significance, has been the focus of attention. In this paper, by comparing and analyzing the characteristics about ligaments of the abdomen and pelvis, reviewing the membrane anatomy and the theory of primitive gut rotation, and combining clinical observations and histological studies, the author came to a conclusion that lateral ligament of rectum does not exist, but is only a relatively dense space on the rectal side accompanied by numerous tiny nerve plexuses and small blood vessels penetrating through it.
Humans ; Rectum/anatomy & histology* ; Pelvis/anatomy & histology* ; Rectal Neoplasms/surgery* ; Peritoneum ; Collateral Ligaments ; Cognition

OBJECTIVE: To observe and verify the key anatomies of DeLancey's three levels of vaginal support theory through laparoscopic surgery by space dissection technique. METHODS: The features and stress performance of related anatomies were observed and analyzed in laparoscopic type C hysterectomy and pelvic lymphadenectomy for cervical cancer by natural space exposures. RESULTS: The main ligament-like structure at level Ⅰ was the uterosacral ligament, which acted as the main apical fixation in the sacral direction, while the cardinal ligament was mainly composed of vascular system, lymph-vessels and loose connective tissue around them, lacking the tough connective tissue structures, which was connected to the internal iliac vascular system. There were no strong ligaments connected to the tendinous arch of pelvic fascia (ATFP) at the lateral side of vaginal wall at level Ⅱ. ATFP was the edge of the superior fascia of pelvic diaphragm, which was bounded by the fascia of the obturator. Its surface was smooth and close to the levator ani muscle and fuses with the vaginal fascia in about one thirds of middle lower segments of the vagina. When the ureter tunnel is separated, dense connective structures can be found in both anterior and posterior walls near the intersection of the ureter across uterine artery, fixing the bilateral angle of the bladder triangle, starting from the cervix and vagina and ending in the tunica muscularis vesicae urinariae. CONCLUSIONS Based on the laparoscopic anatomy, the pelvic floor fascia ligament support above the levator ani muscle can be considered mainly around the vagina, and fascial ligament above the levator ani muscle can be simply considered as two parallel planes forming a "double hammock" structure, which may provide more anatomic data for pelvic floor reconstruction.
Female ; Humans ; Laparoscopy ; Ligaments ; anatomy & histology ; Pelvic Floor ; Urinary Bladder ; Vagina ; anatomy & histology ; surgery

INTRODUCTIONKnowledge of morphological variations of the suprascapular region is important in the management of entrapment neuropathy and interventional procedures. The objective of this study was to collect data on the morphological features and dimensions of ossified ligaments and unusual bony tunnels of scapulae from a North Indian population.

METHODSA total of 268 adult human scapulae of unknown gender were obtained from the bone bank of the Department of Anatomy, Dayanand Medical College and Hospital, Ludhiana, Punjab, India. The scapulae were evaluated for the incidence of ossified superior transverse scapular ligaments (STSLs), ossified inferior transverse scapular ligaments (ITSLs) and bony tunnels (i.e. the bony canal between the suprascapular notch and spinoglenoid notch), found along the course of the suprascapular nerve (SSN). The dimensions of these structures were measured and noted down. Ossified STSLs were classified based on their shape (i.e. fan- or band-shaped) and the dimensions of the ossified suprascapular openings (SSOs) were measured.

RESULTSOssified STSLs were present in 26 (9.7%) scapulae. Among the 26 scapulae, 16 (61.5%) were fan-shaped (mean area of SSO 16.6 mm(2)) and 10 (38.5%) were band-shaped (mean area of SSO 34.2 mm(2)). Bony tunnels were observed in 2 (0.75%) specimens, while an ossified ITSL was observed in 1 (0.37%) specimen.

CONCLUSIONThe data obtained in the present study augments the reference literature for SSN decompression and the existing anatomical databases, especially those on Indian populations. This data is useful to clinicians, radiologists and orthopaedic surgeons.

Adult ; Cadaver ; Humans ; Ligaments, Articular ; anatomy & histology ; Nerve Compression Syndromes ; diagnosis ; epidemiology ; Ossification, Heterotopic ; diagnosis ; epidemiology ; Scapula ; anatomy & histology

OBJECTIVETo investigate the curative effect of penile elongation with four differentoperative approaches.

METHODSThrough four different operative approaches (the coronary sulcus ringincision, Y or Z shaped incision or Z shaped incision combined with coronary sulcus ring incision), thepenile skin and fascia were degloved until the penile root. Then the superficial and deep dorsal penilesuspensory ligament were cut off. After electric coagulation of the residue ends, the two-side tissue at thefront of the pubic symphysis was sutured. Then the penile skin and fascia were repositioned and the incisionat the inner and outer plate was closed.

RESULTSThe increased penile static length was (2.9 ± 0.2) cmwith abdominal wall Y incision (12 cases); (3.1 ± 0.3) cm with transabdominal modified Z incision (260 cases); (3.9 ± 0.7) cm with coronary sulcus ring incision (363 cases); (3.4 ± 0.8) cm with combined incision (39 cases). The lengthening effect was significantly different between the coronary ring incision and abdominal wall Y/Z incision (P < 0.05). The postoperative follow-up period was 6 months to 5.5 years without serious complications. Only 3 cases of subcutaneous hematoma occurred with treatment of debridement and drainage. 4 cases with ischemic necrosis at distal penile skin, were treated with debridement, dressing and physiotherapy, leaving no scar.

CONCLUSIONSPenile lengthening surgery are safe and effective through different approaches. The coronal ring incision has the best therapeutic effect.

Bandages ; Debridement ; Drainage ; Electrocoagulation ; Fasciotomy ; Follow-Up Studies ; Humans ; Ligaments ; surgery ; Male ; Necrosis ; surgery ; Organ Size ; Penis ; anatomy & histology ; pathology ; surgery ; Postoperative Period ; Reconstructive Surgical Procedures ; methods ; Skin ; Time Factors

The purpose of this review was to demonstrate magnetic resonance (MR) arthrography findings of anatomy, variants, and pathologic conditions of the superior glenohumeral ligament (SGHL). This review also demonstrates the applicability of a new MR arthrography sequence in the anterosuperior portion of the glenohumeral joint. The SGHL is a very important anatomical structure in the rotator interval that is responsible for stabilizing the long head of the biceps tendon. Therefore, a torn SGHL can result in pain and instability. Observation of the SGHL is difficult when using conventional MR imaging, because the ligament may be poorly visualized. Shoulder MR arthrography is the most accurately established imaging technique for identifying pathologies of the SGHL and associated structures. The use of three dimensional (3D) volumetric interpolated breath-hold examination (VIBE) sequences produces thinner image slices and enables a higher in-plane resolution than conventional MR arthrography sequences. Therefore, shoulder MR arthrography using 3D VIBE sequences may contribute to evaluating of the smaller intraarticular structures such as the SGHL.
Adult ; *Breath Holding ; Female ; Humans ; Imaging, Three-Dimensional/*methods ; Ligaments, Articular/*anatomy & histology/pathology ; Magnetic Resonance Imaging/*methods ; Male ; Middle Aged ; Shoulder Impingement Syndrome/*diagnosis ; *Shoulder Joint/injuries ; Tendon Injuries/diagnosis

OBJECTIVETo observe the origins and insertions of Pitanguy ligament,in order to find the anatomically theoretical basis for the treatment of nasal deformity such as drooping nose, short columella, gingival show.

METHODS15 cadaveric heads fixed by 10% formalin were used. 12 specimens underwent nasal anatomic study. The skin was incised, along the nasal midline to expose the Pitanguy ligament. The origin of Pitanguy ligament and its relationship with surrounding tissue were studied. Then the Pitanguy ligament was taken out for HE staining. Longitudinal section along the ligament was observed. 3 specimens underwent harvesting of full-thickness nasal tissue from skin to periosteal membrane. Then the samples were used for HE staining to show histologic study of ligament at horizontal section.

RESULTSPitanguy ligament originates in the midline of lower third of the nasal superficial musculoaponeurotic system, extends down to the tip along the midline of the nasal dorsum and then turns backwards at the nasal tip, and runs between the medial crura of the lower lateral cartilages, inserts into the base of columella. Its muscle is connected with the orbicularis oris muscle and the depressor septi nasi muscle. HE staining showed the ligament consists of fibrous connective tissue, muscle tissue and other ingredients, but without cartilage.

CONCLUSIONSPitanguy ligament exists with complex histological composition, so its name is still controversial. Because it has multiple connection with the orbicularis oris muscle and the depressor septi nasi muscle, so cutting or shortened the Pitanguy ligament can treat deformity of nose and lip by adjustment of nasolabial angles and the nasal length.

Cadaver ; Cartilage ; anatomy & histology ; Facial Muscles ; anatomy & histology ; Humans ; Ligaments ; anatomy & histology ; Lip ; anatomy & histology ; Nasal Septum ; anatomy & histology ; Nose ; anatomy & histology ; Nose Deformities, Acquired ; pathology ; surgery ; Subcutaneous Tissue ; anatomy & histology

OBJECTIVE: To explore the imaging characteristics of the transverse ligament in healthy adolescents, and further understand the imaging characteristics of the ligament injury. METHODS: We used 3.0T-MR to scan the transverse ligament with proton-weighted sequence in 32 young volunteers, scanned coronally, horizontally and sagittally, and then observed the morphology, thickness, running and signal characteristics of the ligament. RESULTS: The anatomy and signal characteristics of the transverse cervical ligament were clearly displayed by high resolution proton density weighted imaging (PDWI). The whole picture of the transverse ligament was effectively displayed by coronal combined with horizontal image. The transverse ligament was located in the rear of the odontoid, and connected to the inside of both sides of the block like half-arc. The length was (20.4±3.3) mm, the ligament center was the thickest, and both sides gradually became thinner. The middle width of the ligament was (7.3±0.6) mm, the ligament ends narrowed down, and the middle was (2.1±0.4) mm thick; 75% of the transverse ligament showed homogeneous low signal in PDWI, while 25% of the local transverse ligament had high signal. CONCLUSION High resolution PDWI with 3.0T-MR is a effective method to evaluate the structure of the transverse cervical ligament. Local high signal may not necessarily be the sign of ligament injure. There may also be some high signal in the normal adolescent ligament, so we must pay much attention to clinical diagnosis and treatment.
Adolescent ; Diagnostic Imaging ; Humans ; Ligaments ; anatomy & histology ; Magnetic Resonance Imaging ; Protons

OBJECTIVETo discuss the midface aging mechanism through anatomic study of malar fat pad.

METHODS10 fresh adult cadaveric heads (20 sides) fixed by vascular perfusion of formalin were used for anatomic study with microsurgery technique under microscope. The midfacial ligament and connective tissue between skin and subcutaneous fat were observed carefully in different parts of midface. The location, shape and extent of malar fat pad was also recorded and photographed.

RESULTSThe malar fat pad has a triangle shape. The bottom is a curve along the orbicularis retaining ligament at the lower eyelid. The fat pad is extended internally to the nasolabial fold and labiomandibular fold, externally from the major zygomatic muscle end point at the malar surface to the angulus oris and submandibular edge. (2) The malar fat pad is composed of meshed fibrous tissue, with big fat particles in it. It becomes tight when being stretched in horizontal direction along nasolabial fold and loosen when being stretched in vertical direction. (3) There is tight connection between skin and fat pad, which is divided into four areas as I, II, III, IV. The areas I, II, III are strip-shaped parelled to the nasolabial fold. The area IV is a irregular quadrilateral. (4) There are six fixation ligaments between malar fat pad and deep tissue: orbicularis retaining ligament upper layer of lower eyelid, orbicularis retaining ligament substratum of lower eyelid, zygomaticus ligament, zygomatic cutaneous ligament, zygomatic cutaneous ligament substratum, platysma There are four closely connected areas cutaneous forward ligament, cheek maxilla ligament.

CONCLUSIONSbetween the facial skin and malar fat pad which makes malar fat pad and skin keep relatively consistent. The malar fat pad moving down mainly resulted from slack of ligaments support which is one of the reasons for aging face.

Adipose Tissue ; anatomy & histology ; physiology ; Cadaver ; Cheek ; Eyelids ; anatomy & histology ; physiology ; Face ; anatomy & histology ; physiology ; Facial Muscles ; anatomy & histology ; physiology ; Head ; Humans ; Ligaments ; anatomy & histology ; physiology ; Lip ; anatomy & histology ; physiology ; Skin ; anatomy & histology ; Skin Aging ; pathology ; physiology

OBJECTIVETo investigate the effect of autologous dermal-fat strip grafting in penile augmentation and elongation.

METHODSFrom May 2004 to December 2010, 24 patients underwent penile enhancement with free dermal-fat strip grafting. Through suprapubic incision, the superior suspensory ligament and part deep suspensory ligament are cutted off to lengthen the penis. The resulted dead space is filled with the autologous dermal-fat strip (6.0-9.5 cm in length, 1.2-1.5 cm in width and 0.6-0.8 cm in depth) to enhance the penis.

RESULTSPrimary healing was achieved in 23 cases. Incisional fat liquefaction happened in one case which healed after dressing change. The penile appearance was satisfactory both at rest or erection. The penile length and circumference increased by 2.5-4.8 cm (average, 3.2 cm) and 1.8-3.0 cm (average, 2.4 cm), respectively. 18 patients were followed up for 3 months to 5 years. All the patients were satisfactory on the cosmetic and functional results. No complication happened.

CONCLUSIONSIt is safe and effective for penile augmention and elongation with autologous dermal-fat strip grafting and disconnection of penile suspensory ligament.

Adipose Tissue ; transplantation ; Humans ; Ligaments ; surgery ; Male ; Organ Size ; Penile Erection ; Penis ; anatomy & histology ; surgery ; Reconstructive Surgical Procedures ; methods

The aim of this review is to familiarize the reader with the critical lower eyelid anatomy as is related to lower blepharoplasty or a midface lift. The contents include 1) the lacrimal canaliculus in the lower eyelid: the depth and width (diameter) of the vertical portion were 2.58+/-0.24 mm and 0.44+/-0.07 mm, respectively. A vertical portion of the canaliculus was about 1 mm (1.11+/-0.16 mm) deep, and the horizontal portion was about 2~3 mm (2.08+/-2.74 mm) long 2 mm below the mucocutaneous junction, which is where an incision may be made when performing epicanthoplasty. 2) Motor innervation to the lower orbiculis oculi muscle: the pretarsal and preseptal OOMs were innervated by five to seven terminal twigs of the zygomatic branches of the facial nerve that approached the muscle at a right angle. The mean horizontal distance between the lateral canthus and the zygomatic branch was 2.31+/-0.29 cm (range: 1.7~2.7 cm) and the vertical distance was 1.20+/-0.20 cm (range: 0.8~1.5 cm). 3) Sensory innervation of the lower eyelid skin: the majority of the terminal branches (93.8%) of the ION were distributed to the medial to the lateral canthus. Most (99.4%) of the terminal branches of the ZFN were distributed to lateral to the lateral canthus. 4) Retractor of the lower eyelid; capsulopalpebral fascia (CPF): the orbital septum blended with the CPF most closely at 3.7~5.4 mm beneath the lower tarsal border and differently at 3.7+/-0.7 mm on the medial limbus line, 4.3+/-0.8 mm on the midpupillary line and 5.4+/-1.0 mm on the lateral limbus line. 5) Arcuate expansion (AE): The AE was a fibrous band expanding from the inferolateral orbital rim to the medial canthal ligament. A sector (fan-shaped) of the AE originated in the angle of 5 to 80 degrees at the circumference of the inferolateral orbital rim circle, falling within the range of 3 to 5.5 o'clock, and then it tapered and attached to the inferior border of the medial canthal ligament. 6) Suborbicularis oculi fat (SOOF) in the lower eyelid: the SOOF was located in the inferolateral side of the orbit within a range between medial +15 and lateral -89 degrees to a vertical midpupillary line. Histologically, the SOOF was situated deep to the Orbicularis oculi muscle and superficial to the orbital septum and periosteum. The SOOF consisted more of fibrofatty tissue rather than being the pure fatty nature like orbital fat. I hope surgeons can achieve desirable outcomes with the knowledge reviewed in this article.
Anatomy, Regional ; Blepharoplasty ; Eyelids ; Facial Nerve ; Fascia ; Ligaments ; Muscles ; Orbit ; Periosteum