Persistent double dorsal aorta: A systematic review of the literature

Our discovery of a case of persistent double dorsal aorta prompted us to systematically review the literature of all previously reported cases of this anomaly. For our case, we present a completely separated double dorsal aorta, with the right accessory aorta arising from the abdominal aorta and ascending through the aortic hiatus to supply posterior intercostal arteries (PIAs) to the 9th-3rd spaces bilaterally. We examined and compiled data from the 10 previously reported cases, along with our observations from our cadaver, into a systematic review of all known cases of persistent double dorsal aorta. In addition to our case report and systematic review, we investigated the literature focusing on formation of the dorsal aorta in the embryo in order to postulate potential mechanisms for formation of this anomaly. Two variants of persistent double dorsal aorta have been reported in the literature. The first type is characterized by a double-lumen descending aorta with a central dividing septum, and the second features complete separation of the two dorsal aortae. The completely separated variant shows further heterogeneity in the origins of the PIAs and the iliac arteries, and the majority of the reported cases also demonstrate additional anatomical anomalies. We outline the events in embryonic dorsal aorta formation as well as discuss several potential mechanisms that could underlie persistent double dorsal aorta formation. Clin. Anat. 30:517-524, 2017. © 2017 Wiley Periodicals, Inc.

Clinical considerations of the glandular branch of the lacrimal artery

The lacrimal artery is classically described as a branch of the ophthalmic artery supplied by the internal carotid. In this study, 25 orbits were dissected to identify variations in glandular branching and to compare them to previously published accounts. The glandular branching patterns of the lacrimal artery fall into two categories, those that branch (56%) and those that do not branch (44%). We found the medial and lateral glandular branches to be equal in diameter with a divergence of 2.67-40.58 mm proximal to the gland parenchyma. The long glandular branches run alongside the superolateral aspect of the orbit. The lateral branch runs lateral to the lateral rectus muscle. The medial branch runs superomedial to the lateral rectus muscle and lateral to the superior rectus muscle. In relation to the lacrimal gland, the medial branch enters the superior aspect of the gland parenchyma and the lateral branch enters its inferior aspect. The average branch lengths were 17.88 mm (medial) and 13.51 mm (lateral) as measured with a Mitutoyo Absolute 1/100 mm caliper. We could not confirm the existence of a third branch supplying the lacrimal gland, as posited by other authors. The key finding in this study is that the lacrimal gland is predominantly supplied by two significant arterial branches, both of which must be identified during procedures involving the lateral orbit.

Self-guided clinical cases for medical students based on postmortem CT scans of cadavers

In the summer of 2009, we began full body computed tomography (CT) scanning of the pre-embalmed cadavers in the University of Michigan Medical School (UMMS) dissection lab. We theorized that implementing web-based, self-guided clinical cases based on postmortem CT (PMCT) scans would result in increased student appreciation for the clinical relevance of anatomy, increased knowledge of cross-sectional anatomy, and increased ability to identify common pathologies on CT scans. The PMCT scan of each cadaver was produced as a DICOM dataset, and then converted into a Quicktime movie file using Osirix software. Clinical cases were researched and written by the authors, and consist of at least one Quicktime movie of a PMCT scan surrounded by a novel navigation interface. To assess the value of these clinical cases we surveyed medical students at UMMS who are currently using the clinical cases in their coursework. Students felt the clinical cases increased the clinical relevance of anatomy (mean response 7.77/10), increased their confidence finding anatomical structures on CT (7.00/10), and increased their confidence recognizing common pathologies on CT (6.17/10). Students also felt these clinical cases helped them synthesize material from numerous courses into an overall picture of a given disease process (7.01/10). These results support the conclusion that our clinical cases help to show students why the anatomy they are learning is foundational to their other coursework. We would recommend the use of similar clinical cases to any medical school utilizing cadaver dissection as a primary teaching method in anatomy education.

Posterior interosseous nerve of the elbow: normal appearances simulating entrapment

OBJECTIVE

In our clinical practice, we have noted a caliber change of the posterior interosseous nerve (PIN) at the elbow as seen in the long axis on sonography simulating nerve entrapment. The objective of this study was to characterize the PIN using sonography in asymptomatic individuals.

METHODS

Our study retrospectively characterized the PIN in 50 elbows of 47 asymptomatic patients with sonography. Measurements of the PIN in a short-axis cross section using the circumferential trace technique and the anteroposterior (AP) dimension in the long axis were made proximal, at, and distal to the arcade of Frohse.

RESULTS

There was reduction of the AP dimension of the PIN distal to the arcade of Frohse when compared with the measurements at the arcade of Frohse and proximal to the arcade (P < .0001); however, there was no significant difference between the cross-sectional area of the PIN at all 3 levels (P = .59).

CONCLUSIONS

The PIN normally flattens as it enters into the supinator muscle without a notable change in the cross-sectional area. This appearance should not be misinterpreted as nerve entrapment when imaged in the long axis.

Spectrum of normal and pathologic findings in the region of the first extensor compartment of the wrist: sonographic findings and correlations with dissections

OBJECTIVE

The purpose of this presentation is to review pathologic conditions that lead to pain at the radial aspect of the distal radius and to address anatomic variations of the first extensor compartment that exist and may have diagnostic and therapeutic implications.

METHODS

Our presentation is based on a review of cases from teaching files and observations made in anatomic specimens.

RESULTS

The discussed conditions include de Quervain tenosynovitis, intersection syndrome, and Wartenberg syndrome. Sonographic diagnosis of these conditions is addressed, and correlations are provided with anatomic specimens.

CONCLUSIONS

Sonography is able to depict and differentiate between these conditions.

Sonography of Inguinal Region Hernias

OBJECTIVE

The purpose of this article is to describe the anatomy of the inguinal region in a way that is useful for sonographic diagnosis of inguinal region hernias, and to illustrate the sonographic appearance of this anatomy. We show sonographic techniques for evaluating inguinal, femoral, and spigelian hernias and include surgically proven examples.

CONCLUSION

Understanding healthy inguinal anatomy is essential for diagnosing inguinal region hernias. Sonography can diagnose and differentiate between various inguinal region hernias.

Nasal capsule shape changes following septopremaxillary ligament resection in a chimpanzee animal model

Recent human data suggest a relationship between the disruption of the septopremaxillary ligament (SPL) attachment and lack of anterior midfacial growth in cleft lip and palate (CLP) individuals. Early SPL resection in chimpanzees resulted in premaxillary growth deficits through 1200 days. Since the SPL is also continuous with the nasal bones, the present study was undertaken to investigate compensatory nasal capsule shape changes following SPL resection in a chimpanzee animal model. The study used 17 chimpanzees (Pan troglodytes): seven unoperated controls, five sham surgical controls, and five animals with early (average 144 days) SPL resection. Lateral head x-ray films and dental study models were collected quarterly and landmarks representing boundaries of the nasal capsule were identified. Mean nasal capsule polyhedrons were constructed from linear measurements at 200, 600, and 1000 days. In animals with SPL resection, the nasal capsule appeared truncated, shortened anteroposteriorly, and nasion was displaced posteriorly compared to controls by 600 days. Tensor biometric analysis of the growth/shape changes of the nasal capsule triangles revealed no significant differences across age in SPL resection animals while significant (p less than .05) age-related changes were noted in both control groups. Results showed that early SPL resection resulted in maintaining the neonatal nasal capsule morphology in the chimpanzee and suggested that such early growth mechanisms may be operating in complete CLP individuals as well. These data support the concept of early re-establishment of the SPL in primary nasolabial cleft repair to facilitate midfacial and nasal capsule growth.

Septopremaxillary ligament resection and midfacial growth in a chimpanzee animal model

Data collected from human studies suggests a relationship between a disruption of the septopremaxillary ligament (SPL) attachment and midfacial hypoplasia in complete cleft individuals. The present study investigates the SPL-traction mechanism and midfacial growth in a chimpanzee animal model. Seventeen chimps (7 unoperated controls, 5 shams, and 5 animals with early SPL reaction) were used in the present study. Lateral head x-rays and dental study models were collected quarterly through 1200 days of age. Growth rates (slopes of the linear growth components) were statistically compared across groups. Premaxillary growth rates were significantly (p less than 0.001) reduced in SPL resected animals compared to the other groups. Maxillary growth rates were significantly reduced in both SPL and sham animals compared to unoperated controls. No significant differences were noted for midfacial height. We conclude that SPL resection produced a significant effect on anterior midfacial growth independent of surgical trauma. These data support the concept of early reestablishment of the SPL in primary nasolabial cleft repair.