The effect on postoperative pain of pulling the rectus muscle medially during open appendectomy surgery

AIM

We investigated whether pulling the rectus muscle medially during open appendectomy surgery had any effect on postoperative pain in this study.

METHODS

This prospective study was performed on patients 6 years and older who were admitted for acute appendicitis. The patients were divided into two groups, open appendectomy was performed by pulling the rectus muscle medially in the first group and splitting the rectus muscle in the second group. Pain was evaluated in both groups at preoperative and 12 and 24 hour postoperative by using a visual analog scale graded.

RESULTS

The first group consisted of 31 and the second group of 30 patients. The preoperative and 12 and 24 hour postoperative pain evaluation results were 8.25 ± 1.03, 2.96 ± 1.40 and 1.16 ± 0.93 in the first group and 8.36 ± 0.99, 4.90 ± 1.24 and 2.03 ± 1.06 respectively in the second group. There was no statistically significant difference between the two groups for age, gender, inpatient duration and preoperative pain scores while the 12 and 24 hour postoperative pain scores were lower in the first group than the second group. This difference was statistically significant (P<0.05).

CONCLUSION

Performing the appendectomy by pulling the rectus muscle medially in clinics using open appendectomy will provide a more comfortable postoperative period for the children.

Assessment of the lateral pterygoid plate fractures during Le Fort I osteotomies regarding the angulation of the osteotome

AIM. This study aimed to clarify the relation between the angulation of the curved osteotome and fracture of the pterygoid plate during Le Fort I osteotomy. MATERIAL AND METHODS. Twenty-one specimens of hemisectioned Turkish skulls were used for the study. The maxilla was sectioned transversely on the floor of the pyriform aperture and posteriorly to the lateral pterygoid plate with a mechanical saw. The pterygomaxillary junction was separated with a curved osteotome by angulating the osteotome with, 0° and -30° to the occlusal plane. The undesired fractures of the lateral pterygoid plate were determined. Among 21 specimens, 7 pterygomaxillary junctions were separated with an angle of +30° , 7 with 0° and 7 with -30° to the occlusal plane. RESULTS. In group +30°, the undesired fracture occured in 6 of the cases. In group -30°, the undesired fracture was determines in one case. In cases where the separation was performed by placing the osteotome paralell to the occlusal plane all plates remained safe. CONCLUSION. Within the limited knowledge of the current study it can be concluded that the osteotome should be placed paralell to the occlusal plane.

The course of the marginal mandibular branch of the facial nerve in adult cadavers. An anatomic study

OBJECTIVE

To observe the course of the marginal mandibular branch of the facial nerve (MMBFN) and its relation to the inferior border of the mandible and facial vessels.

METHODS

This cadaveric study was conducted at the Department of Anatomy, Gulhane Military Medical Academy, Ankara, Turkey from April to September 2012. The 44 facial halves of 22 adult cadavers were dissected under a stereomicroscope.

RESULTS

The nerve was found to be presented by one branch (36.4%), and 2 branches (63.6%). The distance of the nerve from the inferior border of the mandible varied from 13.06-40.08 mm, with an average distance of 21.91 mm. There were communications with buccal branch only in 2 specimens (4.6%). All the branches of the marginal mandibular branch ran laterally to the facial artery in 43 (97.7%) of the 44 specimens. In one specimen, the 2 marginal mandibular branches ran between the facial artery and vein.

CONCLUSION

The MMBFN can occasionally be damaged during surgeries confined to the submandibular region due to its location and anatomical variant. The most common pattern of MMBFN was nerve with 2 branches. The maximum distance between the MMBFN and the mandible was 40.08 mm. This anatomical knowledge may be useful to surgeons of the head and neck in planning incisions and procedures in the submandibular region.

Horizontal migration of pre- and postnatal mental foramen: an anatomic study

OBJECTIVE

To evaluate the horizontal migration of the human mental foramen before and after birth.

METHODS

54 formalin-fixed fetuses between 17 and 32 weeks of gestation, and 94 panoramic radiographs of children aged between 4 and 12 years were investigated. The distances between the mental foramen and mental symphysis, and the distances between the posterior border of the mandibular ramus and mental foramen were determined according to development periods.

RESULTS

Our results confirm that the mental foramen moves in a posterior direction during the development of the mandible.

CONCLUSION

The horizontal location of the pre- and postnatal mental foramen changes in a posterior direction as the development progresses, however, prenatal mental foramen features an irregular behavior, while the postnatal mental foramen gradually migrates posteriorly in a regular pattern.

Marginal mandibular branch of the facial nerve in human fetuses

OBJECTIVE

To observe the course of the marginal mandibular branch (MMB) and its relation to the inferior border of the mandible and facial vessels.

METHODS

This study was conducted in the Department of Anatomy, Gulhane Military Medical Academy, Etlik, Ankara, Turkey from February 2009 to April 2010. The 44 hemi-face specimens of 22 fetuses were selected for this study, and dissected under a stereomicroscope. The MMB relationship was evaluated between adjacent structures (like vessels and muscles) and the lower border of the mandible.

RESULTS

We found a number of one to 4 branches of the MMB. The MMB ran laterally to the facial vein in 42 (95.5%) of the 44 specimens. All the branches of the MMB ran laterally to the facial artery in 30 (68.2%) of the 44 specimens. In 2 specimens, it ran medially to the facial artery. In 10 specimens, the facial artery ran between 2 branches of the MMB. In 2 specimens, the 2 branches of the MMB ran between facial artery and vein. There were no statistical differences between the left and right sides, and in both genders.

CONCLUSION

The inferior border of the mandible may be an important landmark to avoid injury to the MMB of the facial nerve. It is for this reason, that surgeons who are willing to operate on this area should have a true knowledge and accurate judgement regarding the anatomy of this branch.

An Assessment of the Relationship between the Maxillary Sinus Floor and the Maxillary Posterior Teeth Root Tips Using Dental Cone-beam Computerized Tomography

OBJECTIVES

The aim of the present study was to assess the relationship between the maxillary sinus floor and the maxillary posterior teeth root tips using dental cone-beam CT.

METHODS

A total of 87 right and 89 left maxillary sinus regions from 92 patients were examined using dental cone-beam CT. Images were analyzed by a specialist in oral and maxillofacial radiology. Perpendicular lines were drawn on the cross-sectional images between the deepest point of the maxillary sinus floor and the root tips of the maxillary first and second premolars and first, second and third molars, and the distances were measured using built-in measurement tools. Means, standard deviations and minimum and maximum values were calculated for all right and left premolars and molars. T-tests were used to compare measurements between left and right sides and between female and male patients.

RESULTS

The distance between sinus floor and root tip was longest for the first premolar root tip and shortest for the second molar buccodistal root tip for both right and left sides. No statistically significant differences were found between the right and left side measurements or between female and male patients (P>.05).

CONCLUSIONS

Knowledge of the anatomical relationship between the maxillary sinus floor and the maxillary posterior teeth root tips is important for the preoperative treatment planning of maxillary posterior teeth.

Protective effects of montelukast on ischemia-reperfusion injury in rat ovaries subjected to torsion and detorsion: biochemical and histopathologic evaluation

OBJECTIVE

To reveal the effects of montelukast as an antioxidant and tissue protective agent and study the biochemical and histopathologic changes in experimental ischemia and ischemia-reperfusion (I/R) injury in rat ovaries.

DESIGN

Experimental study.

SETTING

Experimental surgery laboratory in a university department.

ANIMAL(S)

Forty-eight rats with experimentally induced ovarian torsion.

INTERVENTION(S)

Group 1: sham; Group 2: ovarian ischemia; Group 3: a 30-hour period of ischemia followed by a 3-hour reperfusion. Groups 4 and 5: rats administered 10 and 20 mg/kg doses of montelukast before a half-hour of ischemia, then ovarian ischemia applied; after a 3-hour period of ischemia, the bilateral ovaries removed. Groups 6 and 7: 3-hour period of ovarian ischemia applied, then 2.5 hours after the ischemia induction, rats given montelukast. Group 8: sham operation and 20 mg/kg of montelukast; at the end of a 3-hour period of ischemia, 3-hours of reperfusion continued.

MAIN OUTCOME MEASURE(S)

Measurement of ovarian tissue concentrations of superoxide dismutase (SOD), glutathione (GSH), lipid peroxidation (LPO) and myeloperoxidase (MPO) activity; and histopathologic examination of all ovarian rat tissue.

RESULT(S)

Montelukast treatment normalized changes of LPO and MPO and stimulated an overproduction of endogenous SOD and GSH. The results of the histologic parameters showed that treatment with montelukast in the I/R group of rats ameliorated the development of ischemia and reperfusion tissue injury.

CONCLUSION(S)

Montelukast at different doses attenuates ovarian I/R-induced ovary tissue injury in rats.

Double facial nerve trunk emerged from the stylomastoid foramen and petrotympanic fissure: a case report

There are several studies concerning branches of the facial nerve, but we encountered less information about the trunk of the facial nerve in the literature. During the routine dissection of a 65-yr-old Caucasian male cadaver, double facial nerve trunk emerged from the stylomastoid foramen and petrotympanic fissure were encountered. Because of an extremely rare variation, we presented this case report. In addition this cadaver had two buccal plexuses. These plexuses and other branches were formed to structures like to polygon. These anatomic peculiarities were described, photographed and illustrated. Finally, magnetic resonance imaging was performed by using 1.5T scanner to this cadaver. The facial nerve trunk can be damaged during surgical procedures of the parotid gland tumours and submandibular region. Surgeons who are willing to operate on this area should be aware of the possible anatomical variations of the facial nerve trunk.

A Morphometric Study of the Maxillary Artery and Lingula in Relation to Mandibular Ramus Osteotomies and TMJ Surgery

OBJECTIVES

Mandibular osteotomies and resection of the temporomandibular joint (TMJ) ankylosis are the mostly performed surgical procedures in the infratemporal fossa, which is in close proximity with the main trunk of the maxillary artery (MA). It is imperative to avoid the trunk or branches of the maxillary artery, otherwise, massive intraoperative or postoperative hemorrhage may develop. The goal of the study was to investigate the position of the maxillary artery in the infratemporal fossa and the lingula of the mandible.

METHODS

Significant landmarks were selected on the mandibles of formalin fixed cadavers, and the distances were measured between the maxillary artery and the bony landmarks with a digital caliper.

RESULTS

The average distances between the MA and the articular eminence, the medial cortex of the mandibular ramus, the inferior border of the pterygoid fovea and the mandibular notch were 1.67+/-0.48 mm, 5.38+/-2.47 mm, 16.84+/-1.74 mm, 2.94+/-0.52 mm, respectively. Course pattern of the MA at the subcondylar level was also mapped. In order to determine the position of the lingula, the average distances between the tip of the lingula and the mandibular notch, the inferior border of the ramus, the anterior margin of the ramus and posterior margin of the ramus were measured and found as 15.4+/-2.1 mm, 49.5+/-4.3 mm, 18.1+/-2.7 mm, 16.6+/-2.5 mm, respectively. No significant differences were found between the right and left sides, for all parameters.

CONCLUSIONS

The studied parameters will assist and navigate clinicians to determine the anatomic proximity to the maxillary artery, and, minimize the risk of damaging the vessel.

The analysis of the factors affecting lumbar spinal stenosis in adult patients

BACKGROUND

In this study 67 lumbar spinal stenosis in adult patients operated in our clinic in 3 years are aimed to be analysed in terms of clinical and surgical techniques.

METHODS

Diagnoses were made on the basis of patients' histories and their clinical examinations.

RESULTS

Average age was 52.16 +/- 8.9 (33-64). 70.1% (47) of patients were females and 29.9% (20) were males. The most frequent neurological symptoms were 71.1% lasque (+) and 56.7% sensory loss. The anterior-posterior diameter was below 11.5 mm in 56.7% of the cases. Partial recovery was observed in the early term of 71.6% the cases. 56.7% of the cases were applied total laminectomy.

CONCLUSION

Decompressive laminectomy can be performed safely and effectively in patients of with lumbar stenosis.

Length of the styloid process and anatomical implications for Eagle's syndrome

The styloid process is a bony projection, located just anterior to the stylomastoid foramen, the normal length of which is approximately 20-25 mm. Elongation of the process may cause various clinical symptoms such as neck and cervicofacial pain, described as Eagle's syndrome. The present study aimed to determine the mean length of the styloid process on cadavers, panoramic radiographs, and dry skulls, and to investigate the incidence of the elongated styloid process, while assessing the elongation in relation to Eagle's syndrome. When the measurements from the panoramic radiographs were assessed, the mean length of the styloid processes in males and females on the right and left sides were found to be the following: 25.78 + or - 5.68 mm; 22.69 + or - 3.68 mm, 25.80 + or - 5.75 mm; and 22.75 + or - 3.65 mm, respectively. The males had greater styloid process lengths than the females, and the differences in length on both the right and left sides were statistically significant. Descriptive statistics and comparison results according to age groups were determined. There was no statistically significant difference between right or left styloid process lengths according to age groups. The mean length of the styloid process of the cadavers and dry bones was 22.54 + or - 4.24, and there was no significant difference between the right and left sides of the cadavers and dry bones. The incidence of the elongated styloid process was determined as 3.3%, and the elongations revealed a female dominance. The average length of the elongated styloid process was 36.06 + or - 6.12 mm, while the mean length of the styloid processes of the subjects reporting Eagle's syndrome was 40 + or - 4.72 mm. The results of this morphological study will assist clinicians in the diagnosis of Eagle's syndrome.

Radiological evidence of double inferior vena cava in a young adult male

The development of the inferior vena cava IVC is a complex process comprising the formation and regression of some anastomoses, so various anomalies may occur during embryogenesis. These variations can increase the difficulty of aneurysm resection as well as the risk of venous injury and subsequent excessive bleeding during retroperitoneal and thoracic surgical interventions. Here, we report a patient with double inferior vena cava by radiographically during his investigation for the etiology of pancytopenia.

Imaging problems and clinical findings in adolescent lumbar disc herniation: a retrospective study

OBJECTIVES

Disc degeneration probably begins in childhood although low back pain and radicular leg pain is not as common a complaint as in adults. However as yet no explanation exists for the appearance of advanced degenerative changes seen occasionally in patients in their twenties.

PATIENTS AND METHODS

We report 12 adolescents between the ages of 15 and 20 among a total of 1068 cases with radiologically demonstrated lumbar disc herniations treated between March 1991 and March 1996.

RESULTS

Most of their findings were in good agreement with earlier and more recent reports. The only different findings worth commenting upon were the common presence of multiple level disc herniations, and the occasional presence of a so called "fractured epiphysial plate".

CONCLUSION

Depending on magnetic resonance imaging findings coupled with computed tomographic images; we suppose that the so called "fractured bone fragments of the vertebral epiphysial rim impinging on the spinal canal at multiple levels" and "wedges of bone attached to the disc end plate and associated bony defects in the margins of the posterior vertebral bodies" reported to be demonstrated on computed tomographic (CT) images may in fact be false images. Inappropriately angled CT scan slices may cut partly through the epiphysial ring which has totally been distracted backwards together with the firmly attached avulsed disc annuli, designated as an "epiphysial avulsion"; giving rise to the mistaken interpretation as a "fractured epiphysial ring" appearance. Such a mechanism may also involve the posterior longitudinal ligament, which is firmly attached to the neighboring annuli, accounting for the common multilevel involvement.