Disorders of the lower cranial nerves

Lesions of the lower cranial nerves (LCN) are due to numerous causes, which need to be differentiated to optimize management and outcome. This review aims at summarizing and discussing diseases affecting LCN. Review of publications dealing with disorders of the LCN in humans. Affection of multiple LCN is much more frequent than the affection of a single LCN. LCN may be affected solely or together with more proximal cranial nerves, with central nervous system disease, or with nonneurological disorders. LCN lesions have to be suspected if there are typical symptoms or signs attributable to a LCN. Causes of LCN lesions can be classified as genetic, vascular, traumatic, iatrogenic, infectious, immunologic, metabolic, nutritional, degenerative, or neoplastic. Treatment of LCN lesions depends on the underlying cause. An effective treatment is available in the majority of the cases, but a prerequisite for complete recovery is the prompt and correct diagnosis. LCN lesions need to be considered in case of disturbed speech, swallowing, coughing, deglutition, sensory functions, taste, or autonomic functions, neuralgic pain, dysphagia, head, pharyngeal, or neck pain, cardiac or gastrointestinal compromise, or weakness of the trapezius, sternocleidomastoid, or the tongue muscles. To correctly assess manifestations of LCN lesions, precise knowledge of the anatomy and physiology of the area is required.

Incomplete and accessory fissures of the lung evaluated by high-resolution computed tomography

PURPOSE

The aim of our study was to assess incomplete and accessory interlobar fissures using volumetric thin-section high-resolution computed tomography (HRCT).

MATERIALS AND METHODS

Retrospective assessment of HRCT examinations of 250 patients was performed. We assessed the localization, extension, and type of the incompleteness of fissures as well as the presence and localization of accessory fissures. We searched for possible correlation among the localization of interlobar fissures, the presence of incompleteness, and accessory fissures.

RESULTS

On the left side, an incomplete oblique fissure was found in 24%. The discontinuity was present in the parahilar region and the area of the incompleteness was most frequently between 21% and 40%. The right oblique fissure was incomplete in 35%, mostly parahilarly, with the most frequent discontinuity below 20%. An incomplete horizontal fissure was found in 74%. Accessory fissures were identified in 16% of patients, with the same frequency on both sides. The most frequent finding was accessory horizontal fissure with 8.0% on the left side, superior accessory fissure (7.2%) and inferior accessory fissure (5.2%) on the right side. No correlation was found among the localization of interlobar fissures, the presence of incompleteness, and accessory fissures.

CONCLUSION

Incomplete and accessory fissures are frequent anatomic variations of interlobar fissures.

Immune evasion activities of accessory proteins Vpu, Nef and Vif are conserved in acute and chronic HIV-1 infection

Heterosexual HIV-1 transmission has been identified as a genetic bottleneck and a single transmitted/founder (T/F) variant with reduced sensitivity to type I interferon initiates productive infection in most cases. We hypothesized that particularly active accessory protein(s) may confer T/F viruses with a selective advantage in establishing HIV infection. Thus, we tested vpu, vif and nef alleles from six T/F and six chronic (CC) viruses in assays for 9 immune evasion activities involving the counteraction of interferon-stimulated genes and modulation of ligands known to activate innate immune cells. All functions were highly conserved with no significant differences between T/F and CC viruses, suggesting that these accessory protein functions are important throughout the course of infection.

Carpal tunnel syndrome secondary to an accessory flexor digitorum superficialis muscle belly: case report and review of the literature

Anomalous muscles usually do not cause symptoms but are of academic interest mainly discovered during cadaveric dissection. An aberrant muscle belly arising from the index finger flexor digitorum superficialis tendon causing carpal tunnel syndrome is rare. The management of such an anatomical variant is dependent on whether the median nerve compression is associated with a palpable mass. A brief case highlighting important management principles along with a complete literature review is reported.

Accessory Devices Frequently Used for Endoscopic Submucosal Dissection

Endoscopic submucosal dissection (ESD) is increasingly being considered an essential component of treatment for early gastrointestinal cancers and subepithelial tumors. The ESD technique owes its popularity to the development of sophisticated instruments used for ESD. With an increase in the number of ESD procedures performed, there is rapid development in the number and types of endoscopic accessory devices used for such procedures. Despite the large numbers of new devices developed and marketed, the use of ESD instruments and accessory devices is largely determined by individual preferences and experiences. Accessory devices frequently used during ESD are important tools for ESD techniques. Each instrument possesses characteristic advantages and disadvantages associated with its use, and no one instrument is superior in all respects to others. In this article, we review the characteristics of endoscopic electrical knives, cap and hood, and hemostatic devices commonly used in ESD.

Can you have multiple attentional templates? Large-scale replications of Van Moorselaar, Theeuwes, and Olivers (2014) and Hollingworth and Beck (2016)

Stimuli that resemble the content of visual working memory (VWM) capture attention. However, theories disagree on how many VWM items can bias attention simultaneously. According to some theories, there is a distinction between active and passive states in VWM, such that only items held in an active state can bias attention. The single-item-template hypothesis holds that only one item can be in an active state and thus can bias attention. In contrast, the multiple-item-template hypothesis posits that multiple VWM items can be in an activate state simultaneously, and thus can bias attention. Recently, Van Moorselaar, Theeuwes, and Olivers (Journal of Experimental Psychology: Human Perception and Performance, 40(4):1450, 2014) and Hollingworth and Beck (Journal of Experimental Psychology: Human Perception and Performance, 42(7):911–917, 2016) tested these accounts, but obtained seemingly contradictory results. Van Moorselaar et al. (2014) found that a distractor in a visual-search task captured attention more when it matched the content of VWM (memory-driven capture). Crucially, memory-driven capture disappeared when more than one item was held in VWM, in line with the single-item-template hypothesis. In contrast, Hollingworth and Beck (2016) found memory-driven capture even when multiple items were kept in VWM, in line with the multiple-item-template hypothesis. Considering these mixed results, we replicated both studies with a larger sample, and found that all key results are reliable. It is unclear to what extent these divergent results are due to paradigm differences between the studies. We conclude that is crucial to our understanding of VWM to determine the boundary conditions under which memory-driven capture occurs.

Variations in human pulmonary fissures and lobes: a study conducted in nepalese cadavers

The fissures of lungs are embryologically separating the bronchopulmonary segments, which later on persist in interlobar planes of fully developed lung. Fifty lungs (23 right side and 27 left side), obtained during routine dissection and preserved in formalin constituted the material for present study. In them, variations in fissures and lobes of lung were observed and compared with the previous studies. Seven right sided and 14 left sided lungs showed incomplete oblique fissure. Incomplete horizontal fissure of right lung was observed in eight lungs while it was completely missing in three specimens. A right lung with “lobe of the azygos vein” separated by a supernumerary fissure in medial surface was found. One of the right lung had both superior accessory fissure and inferior accessory fissure and four other right lungs and one left lung presented only with inferior accessory fissure. A vertical notch was found in middle lobe of one right lung. Eight left lungs exhibited with left minor fissure among them two lungs had lingula appearing as a separate lobe. Knowledge of variations in fissures and lobes is of interest to all medical professionals to exactly interpret radiographs, computed tomography scans, to diagnose, plan and modify a surgical procedure depending on the merit of the case and also in certain classical clinical cases pertaining to lung pathologies.

Accessory renal arteries in a Caribbean population: a computed tomography based study

INTRODUCTION

The commonest variation to the classic anatomic description of renal arterial supply is the presence of accessory renal arteries. The incidence varies widely according to ethnicity. There is no data on the prevalence of these anomalies in persons of Caribbean ethnicity.

METHODS

All CT scans done over two years from July 1, 2010 to June 30, 2012 were retrospectively evaluated. The anatomy of the renal arterial supply was reported from these studies and the anatomy of accessory renal arteries was documented.

RESULTS

There were 302 CT scans evaluated and accessory renal arteries were present in 109/302 (36.1%) CT scans, 95% confidence interval 30.6%, 41.4%. There were 71/309 (23.5%) patients with accessory arteries on the left and 54/309 (17.9%) had them on the right (p 0.087). Of these, 16 (14.7%) patients had bilateral accessory renal arteries present. The most common origin for the accessory arteries was the abdominal aorta in 108 (99.1%) cases and in 1 case the accessory artery arose from the coeliac trunk. There were 80 left sided accessory renal arteries: 17 (21.3%) upper polar and 27 (33.8%) lower polar arteries. Of 62 right sided accessory arteries, 14 (22.6%) were upper polar and 26 (42%) were lower polar arteries.

CONCLUSION

This is the first population-based report of anatomic anomalies in renal arterial supply in a Caribbean population. These are important findings that may affect vascular and urologic procedures on persons of Caribbean ethnicity.

Variations in the Origin and Course of Right Hepatic Artery and its Surgical Significance

INTRODUCTION

Variations in the Right Hepatic Artery (RHA) are exceedingly common and these variations are of great importance to surgeons and interventional radiologists. A thorough knowledge of the right hepatic arterial anatomy is mandatory while performing hepatic surgery and hepatic arteriography.

AIM

To find out the variations in the origin and course of the RHA and its surgical significance.

MATERIALS AND METHODS

This study was conducted in 60 embalmed adult cadavers of both sexes of age group between 50 to 80 years. Abdomen was opened by a linear midline incision extending from the xiphoid process to the pubic symphysis. The origin of RHA from the proper hepatic artery was traced. The presence of aberrant right hepatic arteries -replaced and accessory were noted. The source of origin of accessory or replaced RHA arising from the superior mesenteric artery (SMA), right renal artery and inferior mesenteric artery was traced. The course of normal and aberrant RHA from its origin to the entrance into the right lobe of the liver was followed and structures related to it were noted.

RESULTS

The RHA mostly originated from the main trunk of the proper hepatic artery in 52 specimens (86.6%). Presence of aberrant RHA was found in 8 specimens (13.3%). Among 8 specimens of aberrant RHA, replaced RHA arising from SMA was found in 5 specimens (8.3%) and accessory RHA arising from SMA was observed in 3 specimens (5%). In 86.6% of specimens, the RHA coursed dorsal to the duct system to enter the Calot's triangle. In 8.3% of specimens, the RHA coursed ventral to duct system to reach the Calot's triangle. The caterpillar like loop of the RHA was found in two specimens (3%). The replaced and accessory RHA (13.3%) arising from the SMA had a course dorsal to duct system to reach the Calot's triangle.

CONCLUSION

Right hepatic artery is subject to anatomical variation in its origin and course. Our study identified the variations in the origin and course of right hepatic artery. Adequate knowledge of these variations would be of incredible help to the hepatobiliary surgeon and interventional radiologist.

Accessory middle cerebral artery associated with an unruptured aneurysm at its origin

BACKGROUND

An aneurysm originating from the junction of the A1 segment of the anterior cerebral artery and accessory middle cerebral artery (Acc-MCA) is markedly rare. We report a rare case of an Acc-MCA aneurysm, and discuss the clinical course and management of this rare condition.

CASE DESCRIPTION

A 64-year-old man with a past history of cerebral infarction was revealed to have a left Acc-MCA and an aneurysm at its origin. The aneurysm was clipped via a transsylvian approach. Due to its location and projectile direction, the neck of the aneurysm was left partially unclipped.

CONCLUSION

Although an Acc-MCA aneurysm is very rare, it has a potential risk of rupture. Therefore, radical treatment is necessary for such aneurysms.

Extra middle turbinate lamellas: a suggested new classification

PURPOSE

Proper knowledge of sinonasal configurations and anatomical structural variations is essential to perform safe endoscopic sinus surgery. Although common middle turbinate variations have been well described in literature, rare variations have not. The aims of this study are to revise the nomenclature of extra middle turbinate lamellas variations and suggest an easy classification system of these lamellas.

METHOD

A retrospective charts and medical records review was performed for consecutive cases that were diagnosed with extra lamella middle turbinate based on endoscopic and stander three-dimensional reconstruction computer tomography scan at a tertiary academic center. After extensive literature review, these lamellas were classified into four types depending on the presence or absence of uncinate process and their morphological configuration.

RESULT

Twenty-two subjects (mean age 35 years; 8 men and 14 women) were identified who had thirty extra middle turbinate lamellas. Nasal obstruction and discharge were the most common presenting symptoms. Accessory middle turbinate was the most common extra lamella been observed and bifid inferior turbinate was the least common. Ten patients (45 %) had an accompanied middle turbinate anatomical variations, 9 (41 %) had nasal septum deviation, 11 (50 %) had associated maxillary or ethmoid sinusitis and 5 (23 %) had hypoplastic maxillary sinus.

CONCLUSION

Extra middle turbinate lamella is a rare type of middle turbinate anatomical variation that can be diagnosed by careful endoscopic examination and a precise computer tomography scan review. These lamellas may have a significant association with mucosa pathologies and are commonly seen with other common middle turbinate variations. Correct description and the use of common terminology can help to further evaluate the incidence of lamellas, their pathophysiological role, and to avoid any intraoperative landmark confusion.

Morphometric analysis and anatomical variations of infraorbital foramen: a study in adult North Indian population

PURPOSE

Various studies have been conducted on morphometric variations of infraorbital foramen to provide data to surgeons for nerve block in infraorbital region. This study aims to analyse the anatomical variations by comparing various morphometric measurements of infraorbital foramen in dry skulls of adult North Indian population. This study becomes relevant in the present study group as very scant data is available about the variations and morphometric measurements in Indian population. The data thus collected can be standardized and become useful for the surgeons working in this area of face.

MATERIALS AND METHODS

The study was conducted on 75 dry adult human skulls, which were a part of Department of Anatomy, used for teaching purposes in medical colleges. Straight distance of the Infraorbital foramen from the infraorbital rim, supraorbital foramen and sagittal plane was measured. The position of the infraorbital foramen was determined in relation to maxillary teeth and supraorbital foramen. The data thus obtained was analysed.

RESULTS

The distance of infraorbital foramen from infraorbital rim, supraorbital foramen, sagittal plane in the present study was found to be 6.71 ± 1.11 mm, 42.02 ± 4.31 mm and 31.94 ± 4.88 mm respectively. The position of infraorbital foramen was lateral in relation to supraorbital foramen (in 88% of cases). Infraorbital foramen was above the 1st premolar tooth in most of the cases. Accessory infraorbital foramen was found in 11.2% cases (double foramen).

CONCLUSION

The data thus obtained will perhaps be helpful to the surgeons in identifying the extent of the operative field thereby reducing procedural risks.

Comparison of outcomes following polidocanol microfoam and radiofrequency ablation of incompetent thigh great and accessory saphenous veins

BACKGROUND

Microfoam ablation (MFA) and radiofrequency ablation (RFA) are both approved by the Food and Drug Administration for treatment of proximal saphenous truncal veins. The objective of our study was to compare early postoperative outcomes between MFA and RFA following treatment of incompetent thigh saphenous veins.

METHODS

A retrospective review of a prospectively maintained database was conducted of patients who underwent treatment of incompetent great saphenous veins (GSVs) or anterior accessory saphenous veins (AASVs) in the thigh. All the patients underwent duplex ultrasound of the treated leg at 48 to 72 hours postoperatively. Patients were excluded from analysis if concomitant stab phlebectomy was performed. Demographic data, CEAP (clinical, etiologic, anatomic, pathophysiologic) class, venous clinical severity score (VCSS), and adverse events were recorded.

RESULTS

Between June 2018 and September 2022, 784 consecutive limbs (RFA, n = 560; MFA, n = 224) underwent venous closure for symptomatic reflux. A total of 200 consecutive thigh GSVs and ASVs treated within the study period using either MFA (n = 100) or RFA (n = 100) were identified. The patients were predominantly women (69%) with a mean age of 64 years. The preoperative CEAP classification was similar between the MFA and RFA groups. The mean preoperative VCSS was 9.4 ± 2.6 for the RFA patients and 9.9 ± 3.3 for the MFA patients. Among the RFA patients, the GSV was treated in 98% and the AASV in 2% compared with the GSV in 83% and the AASV in 17% in the MFA group (P < .001). The mean operative time was 42.4 ± 15.4 minutes in the RFA group and 33.8 ±16.9 minutes in the MFA group (P < .001). The median follow-up was 64 days for the study cohort. The mean postoperative VCSS declined to 7.3 ± 2.1 in the RFA group and 7.8 ± 2.9 in the MFA group. Complete closure occurred in 100% of the limbs after RFA and 90% after MFA (P = .005). Eight veins were partially closed and two remained patent following MFA. The incidence of superficial phlebitis was 6% and 15% (P = .06) after RFA and MFA, respectively. Overall, symptomatic relief was 90% following RFA and 89.5% following MFA. The complete ulcer healing rate for the entire cohort was 77.8%. Deep venous proximal thrombus extension (RFA, 1%; vs MFA, 4%; P = .37) and remote deep vein thrombosis (RFA, 0%; vs MFA, 2%; P = .5) showed a trend toward being higher following MFA but the difference did not reach statistical significance. All were asymptomatic and resolved with short-term anticoagulation therapy.

CONCLUSIONS

MFA and RFA are both safe and effective for treating incompetent thigh saphenous veins, with excellent symptomatic relief and a low incidence of postprocedure adverse thrombotic events. RFA resulted in improved complete closure rates following initial treatment compared with MFA. The operative times were shorter with MFA. Both modalities can be used for patients with active venous ulcers with good healing rates. Longer term studies are required to characterize the durability of MFA closure for above knee truncal veins.

Eradication of the nidus in arteriovenous malformations with a dominant outflow vein in the lower extremities using coils and absolute ethanol

OBJECTIVE

In the present study, we summarize our experience in locating the nidus of arteriovenous malformations (AVMs) with a dominant outflow vein (DOV) in the lower extremities and eradicating the nidus with ethanol and coils.

METHODS

Twelve patients with lower extremity AVMs who underwent ethanol embolization combined with DOV occlusion from January 2017 to May 2018 were enrolled in the present study. Selective angiography was used to locate the nidus of the AVMs, which was eradicated using ethanol and coils via the direct puncture pathway. All treated patients underwent postoperative follow-up (mean, 25.5 months; range, 14-37 months).

RESULTS

The 12 patients underwent a total of 29 procedures (mean, 2.4; range, 1-4) with 27 detachable coils and 169 Nester coils (Cook Medical Inc, Bloomington, IN). Of the 12 patients, 7 (58.3%) had a complete response and 5 (41.7%) a partial response. Three patients (25%) had minor complications such as blister and superficial skin ulcers during follow-up. However, they recovered spontaneously and completely. No major complications were recorded.

CONCLUSIONS

Ethanol embolization combined with coil-assisted DOV occlusion has the potential to eradicate the nidus of lower extremity AVMs with acceptable complication rates.

Frequency of Acccessory Renal Arteries Diagnosed by Computerized Tomography

INTRODUCTION

Accessory renal arteries play a significant role in kidney and abdominal aorta surgery, and renovascular hypertension. In the published literature, the frequency varies considerably, depending on the size of the sample, the method of examination and the ethnic group.

MATERIALS AND METHODS

The aim of this study is to determine the general frequency of accessory renal arteries, their frequency in relation to gender, the origin and the vascularization area, and to determine the differences in left-right and bilateral distribution.

RESULTS AND DISCUSSION

CT scans of 1357 patients were retrospectively analyzed. Accessory renal arteries were recorded in 35.5% of patients, with a statistically significant difference in male and female incidence (p<0.05) with a ratio of 1.4 : 1. Accessory arteries occur more commonly unilaterally (p<0.05) than bilaterally with a ratio of 4 : 1. Unilateral accessory renal arteries occur at approximately the same frequency at right and left side 1.1 : 1, without statistically significant differences in frequencies (p>0.05). Of the total number of noticed accessory renal arteries 76.7% was originated from abdominal aorta (AA), 23% from renal artery and 0.3% from CIA, with a ratio of 3.3: 1 : 0.0005.

CONCLUSIONS

The study showed a relatively high frequency of accessory arteries and described their anatomy in detail, which can be of great importance in surgical interventions on abdominal aorta, kidneys, and in case of kidney transplantation.

An Extremely Rare Case of Accessory Auricle, Polyotia and its Surgical Correction

Certain malformations may occur during the embryonic development of the ear. Accessory auricle has a wide range from a small elevation of skin to a large size to resemble an additional auricle, where the latter is called polyotia. This condition is defined as an accessory auricle that is large enough to closely resemble an additional pinna rather than a skin remnant and cartilage. Polyotia, also known as mirror ear or accessory ear, is a type of ear anomaly in the tragus area, but this term refers to substantial anomalies which resemble an accessory ear, unlike a pre-auricular tag. Here, we present a case of an accessory auricle in a young female adult. The occurrence was unilateral; the subject did not have any audiological disorder. A simple surgical procedure is also mentioned for excision of accessory without any complications. We compared our findings with different cases of accessory auricle in the literature. The clinical importance and genetic association are also discussed.

Future Development of Endoscopic Accessories for Endoscopic Submucosal Dissection

Endoscopic submucosal dissection (ESD) has recently been accepted as a standard treatment for patients with early gastric cancer (EGC), without lymph node metastases. Given the rise in the number of ESDs being performed, new endoscopic accessories are being developed and existing accessories modified to facilitate the execution of ESD and reduce complication rates. This paper examines the history underlying the development of these new endoscopic accessories and indicates future directions for the development of these accessories.

Abnormal Origin and Course of the Accessory Phrenic Nerve: Case Report

In the current cadaveric study an unusual sizeable accessory phrenic nerve (APN) was encountered emerging from the trunk of the supraclavicular nerves and forming a triangular loop that was anastomosing with the phrenic nerve. That neural loop surrounded the superficial cervical artery which displayed a spiral course. The form of a triangular loop of APN involving the aforementioned artery and originating from the supraclavicular nerve to the best of our knowledge has not been documented previously in the literature. The variable morphological features of the APN along with its clinical applications are briefly discussed.

Rupture of the peroneus quartus tendon in a professional rugby player

The peroneus quartus is one of a variety of described accessory peroneal muscles, most commonly an incidental finding on MRI or ultrasound of the ankle. We present the only described case in the literature of a peroneus quartus tendon rupture in a professional rugby player as well as the MRI findings.

Accessory Extensor Pollicis Longus Tendon Incidentally Discovered During Dorsal Distal Radius Plating

Anatomical variations of the extensor pollicis longus (EPL) tendon are rare. Variations are typically asymptomatic, yet knowledge of these variations poses significance in the setting of dorsal approaches to wrist surgery. We present a case of an accessory EPL tendon that was discovered intraoperatively in the fourth dorsal compartment during open repair of a distal radius fracture with a dorsal spanning plate. If not correctly identified, the accessory EPL could have been entrapped beneath the plate, resulting in limited thumb extension and potentially tendon rupture.

Multidetector computed tomography angiography study of the renal arterial vasculature anatomy and its variations in a Bulgarian adult population

PURPOSE

Renal arterial anatomy has a great clinical importance during surgical and endovascular procedures. However, comprehensive data on renal arterial variations in the Bulgarian population has not yet been provided. The aim of this study was to conduct a detailed research about the normal anatomy and variations of the renal arteries in the Bulgarian population.

METHODS

Five hundred sixty-one patients underwent contrast-enhanced multidetector computed tomography scans for the period 2016-2021. The images were retrospectively reviewed. Number, branching pattern, origin level and course of the renal arteries were noted. Data were categorized on the basis of laterality, gender and symmetry.

RESULTS

Only 46.3% of the patients exhibited normal renal arterial anatomy. Variations were observed in 301 patients (53.7%). The most common variant was the presence of accessory renal arteries (ARA), discovered in 41.2% of the subjects. There was no significant difference based on gender and laterality (p > 0.05). Hilar ARA (72.6%) were significantly more common than polar ARA (p < 0.001). The most common origin location of the main renal arteries and ARA was the aorta, followed by the common iliac arteries. Early division was observed in 21.7% of the patients, significantly more common on the right. Precaval course was found in 0.5% of the right main renal arteries and in 30% of ARA and the difference was significant (p < 0.001).

CONCLUSION

These results show novel insight into the prevalence of renal arterial variations in the Bulgarian population. Anatomic renal vasculature variants are common therefore awareness is crucial for the success of surgical and interventional procedures.

Congenital Peritoneal Encapsulation in A Pregnant Woman: A Case Report

Congenital peritoneal encapsulation (CPE) is a very rare congenital malformation of the gastro-intestinal tract which is characterised by the presence of an accessory peritoneal membrane in which the small bowel is contained and communicates with the rest of the peritoneal cavity by means of a small opening. We report a 26-year-old primigravida who presented with an acute onset abdominal pain and was found at laparotomy to have complications resulting from CPE. The embryological basis, clinical and pathological features of the disease are also considered. Knowledge of this condition will help guide the surgeon in making prompt decision when confronted with it.

Stoma care in the community

There are over 100 000 people in the UK with a stoma. For nurses working within the community and dealing with a variety of conditions, making a decision regarding the most appropriate stoma appliance to use on ostomates can be a challenge. This article gives a general overview of stomas and stoma appliances. It then discusses the various stoma accessories and gives recommendations for when and how they should be used.

An Anomalous Origin of the Accessory Splenic Artery and its Significance in Surgical and Radiological Contexts: A Case Report

Abstract

During the routine dissection classes for undergraduate medical students, we encountered a rare anatomical variation concerning the aberrant origin and course of the accessory splenic artery. The splenic artery is one of the direct branches of the coeliac trunk. During its tortuous course, it supplies the pancreas with greater curvature of the stomach and spleen. The accessory splenic artery originating from the main trunk of splenic artery, too, follows the same tortuous course while running through the lesser sac and supplies the posterior part of the spleen via the splenophrenic ligament. The accessory splenic artery is gaining clinical importance during various GI surgeries and some radiological procedures. The unnoticed accessory splenic artery damage may result in tremendous bleeding while performing GI-based surgery or radiological investigation like angiography. In our case report, the accessory splenic artery is an aberrant origin from the initial part of the actual splenic artery. Knowledge regarding the origin, course and termination is of utmost importance to GI surgeons, radiologists, and anatomists.

Tendon variations of the fibularis brevis and extensor muscles in leg: a case report and a brief review of the literature

The present case report aims to present tendon variations of the extensor hallucis longus, extensor digitorum longus, fibularis brevis and fibularis tertius. During routine dissection classes for anatomy training, accessory tendon variations were observed in both feet of a 76-year-old male Caucasian cadaver. The accessory tendons were made visible by excising the surrounding tissues. A single bilateral accessory tendon arising from the fibularis brevis, passing through the canal within the fibularis tertius tendons and ending in the dorsal aponeurosis of the fifth toe, was observed as well as a bilateral single accessory tendon originating from the extensor hallucis longus and ending on the dorsomedial side of the first metatarsophalangeal joint capsule. We came across a unilateral (right side) double accessory tendon arising from the extensor digitorum longus and ending on the body of the fifth metatarsal bone. Additionally, we detected bilateral double tendon at the insertion of the fibularis tertius on the base of the fifth metatarsal bone. These four muscles are of clinical importance because the extensor hallucis longus is used in the correction of hallux varus deformity, the fibularis brevis is used for tendon transfer in Achilles tendon ruptures, and the fibularis tertius and the extensor digitorum longus tendons are used to correct drop foot deformity. Therefore, knowing the variations of these muscles will be beneficial to clinicians.