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ABSTRACT: BACKGROUND: This study aimed to elucidate the anatomy of the abdominal head of the pectoralis major (AHPM) in relation to transaxillary breast augmentation (TBA). METHODS: In 20 hemithoraxes of fresh Korean cadavers, the width, thickness, and location of the origin of the AHPM were measured in relation to the seventh rib-costal cartilage junction. A force gauge was used to measure the force needed to detach the AHPM from its origin. In another four breasts, an implant pocket was made first, followed by observation of the AHPM. In 92 patients who underwent surgery, the AHPM was observed at its origin during performance of endoscopic TBA. RESULTS: The AHPM was observed in 23 (96 %) of 24 hemithoraxes dissected. The AHPM was observed in 170 (92.4 %) of 184 breasts subjected to surgery. The AHPM originated from the rectus fascia at the sixth (60 %) and seventh (35 %) costochondral junctions. The width of the AHPM was 23.5 ± 5.2 mm at its origin, 15.2 ± 3.9 mm at midbelly, and 7.3 ± 4.3 mm at insertion. The thickness of the AHPM at its origin was 1.6 ± 0.5 mm. The force needed to detach AHPM from its origin was 23.5 ± 12.0 N. In two cadavers of mock surgery, the AHPM could limit the boundary of the implant pocket after division of the costal origins. After division of the AHPM, the free inferior space was obtained. CONCLUSION: In submuscular or dual-plane breast augmentation, the AHPM should be cut to place the implant in the correct desired position. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Aesthetic Plastic Surgery 02/2013; · 1.41 Impact Factor
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ABSTRACT: We report a rare case of a left inferior epigastric artery arising from the internal iliac artery via a common trunk with the obturator artery in an 84-year-old female cadaver. A common trunk for the inferior epigastric and obturator arteries firstly originated from the left internal iliac artery, at 3.0 mm below the bifurcation of the left common iliac artery. This trunk ran straight between the left external iliac artery and left external iliac vein, and was finally divided into the left inferior epigastric and left obturator arteries just superior to the inguinal ligament.
Anatomy & cell biology 12/2012; 45(4):285-7.
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ABSTRACT: The anatomical knowledge is the most important and has a direct link with success of operation in cervical spine surgery. The authors measured various cervical parameters in cadaveric dry bones and compared with previous reported results.
We made 255 dry bones age from 19 to 72 years (mean, 42.3 years) that were obtained from 51 subjects in 100 subjects who donated their bodies. All measurements from C3-C7 levels were made using digital vernier calipers, standard goniometer, and self-made fix tool for two different cervical axes (canal and disc setting). We classified into 4 groups (uncinate process, vertebral body, lamina, and pedicle) and measured independently by two neurosurgeons for 28 parameters.
We analyzed 23970 measurements by mean value and standard deviations. In comparing with previous literatures, there are some different results. The mean values for uncinate process (UP) width ranged from 5.5 mm at C4 and 5 to 6.3 mm at C3 and C7 in men. Also, in women, the mean values for UP width ranged from 5.5 mm at C5 to 6.3 mm at C7. C7 was widest and C5 was most narrow than other levels. The antero-posterior length of UP tended to increase gradually from C3 to C6. The tip way, tip distance, and base distance of UP also showed increasing pattern from C3 to C7.
These measurements can provide the spinal surgeons with a starting point to address bony architectures surrounding targeted soft tissues for safeguard against unintended damages during cervical operation.
Journal of Korean Neurosurgical Society 05/2012; 51(5):247-52. · 0.60 Impact Factor
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ABSTRACT: The aims of this study were to investigate the sex discriminating potential of the talus in Koreans and compare this with other analyses in different populations. Statistical analyses were performed using data from nine measurements acquired from 140 tali (70 men, 70 women). The talus of Koreans is dimorphic between sexes in all measurements (p < 0.01). Discriminant function equations were generated by univariate, multivariate, and stepwise methods with a range of accuracy from 67.1 to 87.1%. Stepwise equations of other populations did not discriminate the sex of the Korean sample as accurately as each equation's own accuracies. The variables with high accuracy in this study are useful for sex determination of Koreans on the basis of confirmation of population specificity.
Journal of Forensic Sciences 01/2012; 57(1):166-71. · 1.23 Impact Factor
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ABSTRACT: The authors have observed that the ulnar nerve (UN) passes through the medial intermuscular septum (MIMS) into the posterior compartment of the upper arm in more complicated patterns than those described in anatomy textbooks. Given that these unreported patterns might be related to the idiopathic UN entrapment at the midarm, this study focused on the relationship between the MIMS and the UN.
One hundred upper arms were dissected. The site at which the UN pierced the MIMS was analyzed and measured from the medial epicondyle.
The relationship between the MIMS and the UN could be classified into 3 types according to whether the nerve pierced the MIMS and whether it ran through a fibrous tunnel within the septum. The UN pierced the MIMS in the middle third of the upper arm.
The results of this study are expected to further understanding of the relationship between the MIMS and the UN. They could also be helpful for surgeons aiming to relieve UN entrapment at the midarm, especially in nerve lesions of idiopathic origin.
Journal of Neurosurgery 02/2011; 114(6):1534-7. · 2.96 Impact Factor
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ABSTRACT: We report a rare case of a left middle thyroid artery in a 71-year-old male cadaver. The middle thyroid artery arose from the anterior surface of the left common carotid artery. This artery ran anteroinferiorly and then bifurcated as it entered the lower lateral part of the left thyroid lobe. Both the right and left superior thyroid arteries arose from the common carotid arteries below the carotid bifurcation. The presence of a middle thyroid artery may cause unexpected bleeding during thyroid or neck surgery, and this rare variation needs to be kept in mind during the surgery.
Anatomia Clinica 01/2011; 33(7):645-7. · 0.93 Impact Factor
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ABSTRACT: The maxillary artery (MA) passes over the lateral pterygoid muscle in the infratemporal fossa and enters the pterygopalatine fossa through the pterygomaxillary fissure. Refractory epistaxis is managed by ligation of the sphenopalatine artery via a transmaxillary-transantral approach; there is considerable risk of complications associated with such invasive surgical approaches. The aim of this study was to describe the gross anatomy and variations therein of the MA and its branches at the pterygopalatine fossa. One hundred hemifaces of embalmed Korean adult cadavers were dissected to establish the precise course of the MA and its branching patterns. The average thickness of the posterior wall of the maxillary sinus was 0.8 mm, but varied over a wide range from 0.2 to 3.6 mm. We classified the third part of the MA into 3 morphological categories: looped (61%), bifurcated (19%), and straight (18%). Two cases could not be classified into any of these 3 categories. The pattern of the bifurcation between the sphenopalatine and descending palatine arteries was classified into 4 types: Y (19%), intermediate (36%), M (17%), and T (28%). The posterior wall of the maxillary sinus was divided into 9 sections. The branching areas of the sphenopalatine and descending palatine arteries were most frequently (62% of cases) located at the top of the medial partition and at the middle of the medial partition (30% of cases).
The Journal of craniofacial surgery 07/2010; 21(4):1284-9. · 0.81 Impact Factor
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ABSTRACT: Pituitary adenomas can expand upward through the foramen diaphragma sellae (FDS), compress the visual pathways on the suprasellar region, and cause diverse visual defects. However, the relationship between the FDS and the visual pathway has not been thoroughly clarified. This study was thus performed to determine the topographic relationship between these two structures. One hundred heads of adult cadavers were examined in this study. The FDS was classified into five types (Ia, Ib, Ic, II, and III) according to its location relative to the four parts of suprasellar region of the visual pathways. The midpoint of the optic chiasm (OC) was located on the midline passing through the crista galli in 70% of cases, but to the left and right sides of the midline in 9 and 21% of cases, respectively. The FDS was completely covered by OC in 30% of the cases, but it was partly seen superiorly in 70%. The pituitary infundibulum passed mainly through the center middle or posterior middle part of nine partitions of the FDS. The horizontal and vertical diameters of the foramen were 7.9 +/- 2.0 and 7.6 +/- 1.9 mm, respectively. The length of the optic nerve was 9.7 +/- 1.9 mm on the left side and 9.5 +/- 1.9 mm on the right side. The angle between the optic nerve and the midline was 34.5 degrees +/- 5.7 degrees on the left side and 36.0 degrees +/- 6.3 degrees on the right side. The results of this study are expected to further the current knowledge of the topographic anatomy on suprasellar structures.
Anatomia Clinica 04/2010; 32(7):653-7. · 0.93 Impact Factor
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ABSTRACT: In anterior interosseous nerve syndrome and ulnar neuropathy, paralysis or weakness of the flexor digitorum profundus (FDP) muscles has been shown to vary according to the degree of involvement of the median and ulnar nerves, respectively. We traced these nerves in 50 cadaveric specimens in which each FDP was completely separated. The specimens were classified into six anatomic and another six presumptive electromyography (EMG) types according to the innervation patterns of the entire and the proximal one-third of the FDP muscles, respectively. The diverse anatomic and presumptive EMG types in this study suggest that the FDP muscles of the 2nd to the 5th digits should be examined by functional tests and EMG in lesions of the median or ulnar nerve.
Muscle & Nerve 05/2009; 39(4):498-502. · 2.37 Impact Factor
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ABSTRACT: We observed a variation of the median nerve that split into two divisions in the proximal forearm and conjoined into a single cord in the distal forearm before entering the carpal tunnel. The medial division was larger than the lateral division. An aberrant muscular slip from the flexor digitorum superficialis ran over the medial division of the split median nerve. The muscular slip over the medial division might have caused an entrapment syndrome of this nerve due to several muscular and cutaneous branches originating from the medial division. This variation of the median nerve has not been reported to our knowledge and may affect diagnosis and treatment of any neuropathy of the median nerve.
Anatomical science international. 05/2009; 85(2):115-7.
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ABSTRACT: The brachialis muscle is dually innervated by the musculocutaneous nerve running via the anterior division of the brachial plexus and the radial nerve running via the posterior division of the plexus. There have been inconsistent descriptions of the pathway of the radial nerve branch at the brachial plexus. This study investigated the route of the radial nerve branch innervating the brachialis muscle at the brachial plexus. In 20 samples, the radial nerve branch innervating the brachialis muscle was separated and traced up to the cervical nerve under a surgical microscope. All the radial nerve branches innervating the muscle ran via the posterior cord, the posterior division, and the superior or middle trunk at the brachial plexus. The radial nerve branches arose from C5 in 5 cases, C6 in 11 cases, C5 and C6 in 3 cases, and C6 and C7 in 1 case.
Clinical Anatomy 04/2009; 22(4):495-9. · 1.29 Impact Factor
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ABSTRACT: Anatomical variations of the prostatic utricle (PU) have rarely been reported despite an understanding of them being required for diagnosing and treating PU anomalies. This study was performed on 57 prostates to clarify the variations of this structure. Fifty prostates were dissected under a surgical microscope, five prostates were used for ultrasonography and dissection, and two others were processed for light microscopy and reconstructed into 3D models. The PU was classified into three types based on the location of its pouch. The most common type was one in which the PU projected out from between the two ejaculatory ducts. The site and shape of the utricular orifice were also diverse on the seminal colliculus, which was most commonly located on the distal three-fourths of the prostatic urethra. The results of this study clarified the variations in the anatomy of the PU and may help improve diagnosis and treatment of PU diseases.
Clinical Anatomy 02/2009; 22(3):358-64. · 1.29 Impact Factor
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ABSTRACT: The varied morphology of the umbilical ring and its surrounding structures, such as the ligamentum teres hepatis, and the median and medial umbilical ligaments, has not been thoroughly investigated. Hence, this study was undertaken to clarify the morphologic variations of these structures.
The anterior abdominal walls were removed en bloc from 57 adult cadavers and dissected under a surgical microscope.
One case of umbilical hernia was observed, and the remaining 56 umbilical rings were classified into 3 types: oval or round in 33 cases (Type A, 59.0%), obliterated or slitted in 12 cases (Type B, 21.4%), and completely covered by a connecting band between the ligamentum teres hepatis and umbilical ligaments in 11 cases (Type C, 19.6%). The median and medial umbilical ligaments were classified into four types based on their interrelationships. The most common type was the median umbilical ligament terminated by joining one or both medial umbilical ligaments (Type II, 41.1%). The ligamentum teres hepatis frequently ended by dividing into several branches in the area cranial to the umbilical ring, some of which crossed the umbilical ring. The umbilical fascia covered the umbilical ring in 50.0% of cases, and the rest either not covering the ring or not existing.
These results are expected to improve our understanding of the anatomy of the umbilical area, and further improve treatments of the umbilical hernia.
Yonsei Medical Journal 01/2009; 49(6):1004-7. · 1.14 Impact Factor
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ABSTRACT: During anatomic dissection, a 59-year-old man presented with an arteria peronea magna that replaced all the branches of the posterior tibial artery as well as the dorsalis pedis artery. Thus, the right popliteal artery terminated into the anterior tibial artery and the enlarged peroneal artery. The right anterior tibial artery ended before it reached the ankle. The right dorsalis pedis artery arose from the peroneal artery through its perforating branch. The left popliteal artery gave rise to a common stem that subdivided into two individual branches replacing the proximal part of the anterior tibial artery, and then divided into the posterior tibial artery and the peroneal artery. As on the right side, the left dorsalis pedis artery also arose from the peroneal artery through its perforating branch. A possible embryologic explanation of these variations is proposed.
Surgical and Radiologic Anatomy 08/2008; 30(5):449-52. · 1.06 Impact Factor
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ABSTRACT: The aim of this study is to elucidate the cutaneous distribution of the zygomaticofacial nerve (ZFN). Twenty hemifaces of 10 adult Korean cadavers were dissected. ZFN-innervated limits were rectangular and each side was 18.8 +/- 4 mm and 15.8 +/- 3.4 mm. The center of the rectangle was located laterally at 17.3 +/- 5.5 mm from the lateral canthus and then inferiorly at 18.1 +/- 3.1 mm. The cutaneous area innervated by the ZFN was rectangular shaped having a horizontal side that was 9.3 +/- 4% to 27.3 +/- 7.5%of the line from the lateral canthus to the root of helix and a vertical side that was 13.9 +/- 5.8% to 35.7 +/- 5.4% of the line from the lateral canthus to the oral commissure level. Knowledge of ZFN innervation is available with an intraoral approach in maloplasty or midface lift.
Journal of Craniofacial Surgery 06/2007; 18(3):575-7. · 0.82 Impact Factor
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ABSTRACT: The aim of this study is to elucidate the detailed anatomical relation of mental nerve with marginal mandibular branch of the facial nerve. Twenty-three hemi-faces of adult Korean cadavers (11 Male and 7 female) were dissected. All locations of crossing (C) of marginal mandibular branch of the facial nerve and mental nerve were measured below the inferior verge of the lower vermillion (V): a vertical distance (V-Gn) between V and gnathion (Gn) and horizontal distance (V-OC) between V and oral commissure (OC). The mental foramen located at 19.8 +/- 4.4 mm below the inferior verge of the lower vermillion (V) and 34.3 +/- 5.2 mm laterally from the midline. In all specimens there were found interconnections between marginal mandibular branch of the facial nerve and mental nerve. The number of connecting site was 8.26 +/- 2.49. Microscopically, both of the nerve branches had a common epineurium, but the perineurium separated. V-Gn and the vertical distance between V and the connecting point (C) was in the ratio of approximately 2:1, and V-OC and the horizontal distance from V:C was an equal ratio. The proximity of the mental nerve and marginal mandibular branch of the facial nerve to each other draws an attention as operating the mental area.
Journal of Craniofacial Surgery 02/2007; 18(1):165-8. · 0.82 Impact Factor
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ABSTRACT: To retrospectively determine the accuracy of coronal contrast material-enhanced fat-suppressed three-dimensional (3D) fast spoiled gradient-recalled acquisition in the steady state (SPGR) magnetic resonance (MR) imaging, as compared with that of routine transverse MR imaging, in the assessment of distal tibiofibular syndesmosis injury, with arthroscopy as the reference standard.
The review board of the College of Medicine in Yonsei University approved this study; informed consent was waived. The study group comprised 45 patients (26 men, 19 women; mean age, 32.1 years; range, 18-58 years) with a chronic ankle injury who had undergone MR imaging and arthroscopic surgery. Three independent readers retrospectively reviewed the two sets of MR images (one set of gadolinium-enhanced 3D fast SPGR images and one set of routine T1-, T2-, and intermediate-weighted images). Scores from 1 to 5 in increasing order of the probability of injury were assigned to both sets. Arthroscopy was the reference standard. Syndesmotic recess height was measured on contrast-enhanced images. The two sets of images were compared for diagnostic performance with receiver operating characteristic (ROC) analysis. Dissection and histologic examination of six cadaveric ankles was performed to assess the syndesmotic area and ascertain the enhancing structure at MR imaging.
At arthroscopy, syndesmotic injury was found in 24 ankles but not in 21 ankles. Areas under the ROC curve were significantly higher for the contrast-enhanced images (P<.05). The contrast-enhanced set showed higher accuracy, sensitivity, and specificity compared with the routine set for the assessment of syndesmosis injury. Mean syndesmotic recess height was significantly greater (P<.05) in patients with syndesmotic injury. Dissection and histologic examination revealed a highly vascular synovial fold in the syndesmotic area that is expected to enhance at MR imaging.
In the assessment of chronic syndesmosis injury, coronal gadolinium-enhanced fat-suppressed 3D fast SPGR MR images were more sensitive, specific, and accurate than routine MR images.
Radiology 02/2007; 242(1):225-35. · 5.73 Impact Factor
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ABSTRACT: The aim of this study is to elucidate the innervation of upper orbicularis oris muscle. The upper lips of 17 hemifaces of Korean adult cadavers were dissected. The number of nerve branches crossing and entering the outer margin of pars peripheralis and pars marginalis were counted, respectively. The location of ramifying point of the buccal branch was measured. The nerve branches crossing the outer margin of pars peripheralis were about 4 (3.71 +/- 1.05) on each side of the face and branches crossing the outer margin of pars marginalis was 4.65 +/- 1.46. About four (4.06 +/- 0.83) branches entering the pars marginalis were found. Most ramifying points (14/17, 82%) located within a circle of 5 mm in radius diameter and the center was at 12 mm lateral and 26 mm superior to the mouth corner. An anatomical knowledge might be contributive to understand a wrinkle depletion of the upper lip and function of the orbicularis oris muscle.
Journal of Craniofacial Surgery 12/2006; 17(6):1116-7. · 0.82 Impact Factor
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ABSTRACT: The aim of this study is to elucidate each insertion of the capsulopalpebral fascia (CPF) and orbital septum (OS) in the lower eyelid. Fifteen eyelid specimens were obtained from 15 Korean male adult cadavers for the study. Three parasagittal sections were made apart at medial limbus, midpupillary line and lateral limbus. The specimens were cut in 10-mum sections, stained with Masson-trichrome and observed under light microscopy. The head of the CPF split open superiorly and inferiorly wrapping around the inferior oblique muscle and met anteriorly. CPF inserted to the inferior border of the tarsus, merging the anterior border of the inferior tarsal muscles. OS blended with 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. The blending level is closer to the tarsus at the medial side than the lateral side. The closest distance between the lower tarsal border and the first identifiable smooth muscle nuclei of the inferior tarsal muscle was 2.1-2.7 mm, and differently 2.7 +/- 0.7 mm on the medial limbus line, 2.7 +/- 0.7 mm on the midpupillary line and 2.1 +/- 0.9 mm on the lateral limbus line. Precise anatomical understanding of OS and CPF may be conducive to the lower eyelid surgery.
Journal of Craniofacial Surgery 12/2006; 17(6):1118-20. · 0.82 Impact Factor
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ABSTRACT: The aim of this study is to elucidate innervation of the procerus muscle, which is attributed mainly to transverse lines on the radix nasi and indirectly to glabella frown line. Twenty-three hemifaces of Korean adult cadavers were dissected. In all specimens, the procerus muscle was supplied by the buccal branch of the facial nerve, which coursed infraorbitally. The number of the buccal branches varied: three in 47.8%, two in 47.8%, and one in 4.4% of the specimens. The buccal branch crosses the intercanthal line (nasion to the medial canthus) at approximately lateral one third. The nerve entrance was within a circle with a diameter of 5 mm and its center located 9 mm lateral and 10 mm superior from nasion. It was about a midpoint of lateral half of intercanthal line and lower one third between the intercanthal line and tangential line of the supraorbital rim. The anatomical knowledge might be contributive to depletion of transverse lines on the nasal bridge and function of the procerus muscle.
Journal of Craniofacial Surgery 06/2006; 17(3):484-6. · 0.82 Impact Factor
