Panayiotis Skandalakis

National and Kapodistrian University of Athens, Athínai, Attica, Greece

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Publications (40)49.62 Total impact

  • Th Troupis · A Michalinos · V Protogerou · A Mazarakis · P Skandalakis
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    ABSTRACT: Authors describe a case of a complex anatomic variation discovered during dissection of the humeral region. On the right side, brachial artery followed a superficial course. Musculocutaneous nerve did not pierce coracobrachialis muscle but instead passed below the muscle before continuing in the forearm. On the left side, a communication between musculocutaneous and median nerve was dissected. Those variations are analytically presented with a brief review on their anatomic and clinical implications. Considerations on their embryological origin are attempted.
    Folia morphologica 03/2015; 74(1):118-21. DOI:10.5603/FM.2015.0015 · 0.52 Impact Factor
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    ABSTRACT: In this study an unusual combination of arterial, venous and neural variations discovered during dissection of cervical, axillary and brachial area of a cadaver is described. Variations are thoroughly described and literature is briefly reviewed. Lateral cord of brachial plexus was not formed; Eight Cervical root divided into anterior and posterior division before uniting with First Thoracic root and Upper Trunk was unusually short. Axillary artery gave origin to a superficial brachial artery and then continued as deep brachial artery. Multiple variations in typical axillary artery branches were present including existence of inferior pectoral artery. Cephalic vein was absent. A variety of interventions, from relative simple as central venous catheter placement to most complicated as brachial plexus injury repair demand thorough knowledge of area's regional anatomy. Familiarity with anatomic variations allows more precise and careful interventions. Research on these variations is valuable for anatomists and embryologists but also for clinicians because it may provide useful information for non - typical cases but also helps in raising a high level of suspicion.
    Journal of Brachial Plexus and Peripheral Nerve Injury 02/2014; 9(1):2. DOI:10.1186/1749-7221-9-2
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    ABSTRACT: Description of a rare variation is provided alongside with a review of the literature with special references to anatomic, embryologic, and clinical issues it may create. This was a cadaveric dissection conducted during a pregraduate anatomy course that is accompanied by short review of the literature and critical appraisal. During dissection of the neck region of a male cadaver, the superior thyroid artery occurred from the common carotid artery bilaterally and the lingual artery occurred from the carotid bifurcation on the left side. Superior thyroid artery originating from common carotid artery or carotid bifurcation is a common variation, but the lingual artery originating from the common carotid artery or carotid bifurcation is very rare (<1%). Its existence can have a significant impact on treatment success and potentially lead to errors during interventions at the neck region. A high level of suspicion is required.
    Annals of Vascular Surgery 11/2013; 28(2). DOI:10.1016/j.avsg.2013.04.020 · 1.03 Impact Factor
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    ABSTRACT: The present study describes analytically a rare case in which a trifurcation of Femoral Artery in Superficial Femoral Artery, Deep Femoral Artery and Lateral Circumflex Femoral Artery was found during dissection of a cadaver. This variation can be considered as a subdivision of Lateral Circumflex Femoral Artery arising from Femoral Artery (frequency: 15% according to Lipper and Pabst) but diameters of the vessels (Lateral Circumflex Femoral Artery was measured at 0.4 cm, of Deep Femoral Artery at 0.55 cm, Femoral Artery at 1 cm and Superficial Femoral Artery at 0.6 cm) and small distance between origin of Deep Femoral Artery and inguinal ligament indicate instead a true trifurcation rather than a simple subdivision. The anatomic variations of the branching pattern of the femoral region arteries concerning both their origin and course are especially important due to the numerous operations performed in the femoral region that implicate various specialties such as orthopedic surgery, plastic surgery, vascular surgery, general surgery and invasive cardiology.
    Artery Research 06/2013; 7(2):106–108. DOI:10.1016/j.artres.2012.09.004
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    M.PIAGKOU · P.SKANDALAKIS · G. PARASKEVAS · E. REPOUSI · G.PIAGKOS · K.NATSIS
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    ABSTRACT: Background: The metopic suture is a vertical suture, occurring as a result of failure of ossification between the two halves of frontal bone. The persistence of complete metopic suture until an advanced age is named metopism and can be related to abnormal growth of the cranial bones, mechanical causes, hormonal dysfunction and genetic factors. The aim of this study is to investigate the incidence and morphological variations of the metopic sutures in relation to gender. Materials and methods: 80 Greek adult dry skulls (40 males and 40 females) from the bony collection of our institutions were examined. Results: The complete metopic suture was observed in 12.5% of the skulls (10/80), in 12.5% of males and females (5/40, respectively). The incomplete suture was found in 68.8% (55/80), with higher frequency in males, 72.5% (29/40) and in 62.5% of females (25/40). The incomplete suture showed morphological variations, the linear type being the most frequent, in 42.5% of the skulls (17/80), U-type in 12.5% (10/80), V-type in 11.25% (9/80), H-type in 10% (8/80), double type in 8.8% (7/80) and the Y-type in 3.8% of the skulls (3/80). The absence of metopic suture was seen in 20% of the skulls (16/80), 25% in female (10/40) and 15% in male skulls (6/40). Although in the majority of the skulls appeared sutural bones, no metopic sutures were associated with them. Conclusion: Comparing our findings with those of other studies, we observed a higher incidence of the presence of the complete metopic suture, probably indicates racial variations. The morphological knowledge of the metopic suture is essential for the neurosurgeons, paediatricians as far as is related to craniofacial disorders and malformations of size and shape. In addition, the radiologists may misdiagnose the metopic suture as a vertical skull fracture of the frontal bone.
    5TH INTERNATIONAL SYMPOSION OF CLINICAL AND APPLIED ANATOMY AND 1ST PANEUROPEAN MEETING OF ANATOMISTS, Graz – Austria; 05/2013
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    ABSTRACT: Background: Wormian bones are accessory bones of variable shape and size which occur from independent ossification centers within the cranial sutures and fontanelles. These bones’ formation is under the control of genetic background, epigenetic traits and environmental stressor factors. The aim of the study is to investigate the incidence and topographical distribution of wormian bones according to side and gender in a Greek modern population. Materials and methods: 80 adult dry skulls of Greek origin (40 males and 40 females) from the bony collection of our institutions were examined. Results: Wormian bones were observed in 67 skulls (83.75%), in 36 male (90%) and 31 female skulls (77.5%). The remaining 13 skulls (16.25%) did not present any sutural bone.suture in 41.25% (33 skulls), at the parietomastoid suture in 26.25% (21 skulls; 9- bilaterally; 5- right and 7- left side), at the asterion in 20% (16 skulls; 4- bilaterally; 4- right and 8- left side), at the squamosal suture in 15% (12 skulls; 2- bilaterally; 6- right and 5- left side), at the sagittal suture in 11.25% (9 skulls), at the pterion in 10% (8 skulls; 6- right and 2- left side) and at the occipitomastoid suture in 8.75% (7 skulls; 2- bilaterally; 4-right and 1- left side). Also, wormian bones were found in unusual sites, such as the anterior and posterior fontanelles, the frontonasal suture, and the sutures into the orbit, the frontal and sphenoid bones. Conclusion: The remarkable high incidence of wormian bones and their uncommonly location, compared to other reports, probably indicates racial variations. The meticulous knowledge regarding the location, incidence, number and sexual dimorphism of wormian bones may be useful to neuroanatomists, neurosurgeons, orthopedic surgeons, pediatricians, anthropologists and radiologists. Supernumerary ossicles were observed at the lambdoid suture in 50% (40 skulls), at the coronal
    5th ISCAA and 1st Paneuropean Congress, GRAZ AUSTRIA; 05/2013
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    K. NATSIS · M. PIAGKOU · K. VLASIS · G. PARASKEVAS · G.PIAGKOS · P.SKANDALAKIS
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    ABSTRACT: Background: The ossified ligaments (pterygospinous and pterygoalar) in the extracranial region of the foramen ovale are bony formations located at the lateral lamina of the pterygoid process of the sphenoid bone. The aim of this study was to investigate the incidence and morphology of the pterygospinous and pterygoalar bony bridges, the foramina resulting and their variations among Greeks and compare the findings with those available for others populations, underlying their clinical relevance. Materials and methods: In the present study, 71 Greek adult dry skulls (41 males and 30 females) investigated for the presence of pterygospinous and pterygoalar bony bridges. Results: Completely and incompletely ossified pterygospinous ligaments were found in 2.8% on the right, 4.2% on the left and in 8.4% on the right and in 7% on the left sides, respectively. Also completely and incompletely ossified pterygoalar ligaments were found in 2.8% on the right, 1.4% on the left, in 29.6% on the right and in 31% on the left sides, respectively. The pterygoalar and pterygospinous ligaments were completely ossified only in male skulls. Particularly, a completely ossified pterygospinous bar found in only one male skull, bilaterally. Conclusion: The knowledge of the detailed anatomy of these structures may increase the success of diagnostic evaluation and approaches to the region. The types of these osseous variations can cause mandibular neuralgia, impede anesthesia of the trigeminal ganglion, or cause entrapment of the lingual nerve and compression of the deep temporal, lateral pterygoid and buccal nerves, resulting in variant symptoms.
    5TH INTERNATIONAL SYMPOSION OF CLINICAL AND APPLIED ANATOMY AND 1ST PANEUROPEAN MEETING OF ANATOMISTS, Graz – Austria; 05/2013
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    M.PIAGKOU · P. SKANDALAKIS · G. PARASKEVAS · E. REPOUSI · G. PIAGKOS · K. NATSIS
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    ABSTRACT: Background: The metopic suture is a vertical suture, occurring as a result of failure of ossification between the two halves of frontal bone. The persistence of complete metopic suture until an advanced age is named metopism and can be related to abnormal growth of the cranial bones, mechanical causes, hormonal dysfunction and genetic factors. The aim of this study is to investigate the incidence and morphological variations of the metopic sutures in relation to gender. Materials and methods: 80 Greek adult dry skulls (40 males and 40 females) from the bony collection of our institutions were examined. Results: The complete metopic suture was observed in 12.5% of the skulls (10/80), in 12.5% of males and females (5/40, respectively). The incomplete suture was found in 68.8% (55/80), with higher frequency in males, 72.5% (29/40) and in 62.5% of females (25/40). The incomplete suture showed morphological variations, the linear type being the most frequent, in 42.5% of the skulls (17/80), U-type in 12.5% (10/80), V-type in 11.25% (9/80), H-type in 10% (8/80), double type in 8.8% (7/80) and the Y-type in 3.8% of the skulls (3/80). The absence of metopic suture was seen in 20% of the skulls (16/80), 25% in female (10/40) and 15% in male skulls (6/40). Although in the majority of the skulls appeared sutural bones, no metopic sutures were associated with them. Conclusion: Comparing our findings with those of other studies, we observed a higher incidence of the presence of the complete metopic suture, probably indicates racial variations. The morphological knowledge of the metopic suture is essential for the neurosurgeons, paediatricians as far as is related to craniofacial disorders and malformations of size and shape. In addition, the radiologists may misdiagnose the metopic suture as a vertical skull fracture of the frontal bone
    5TH INTERNATIONAL SYMPOSION OF CLINICAL AND APPLIED ANATOMY AND 1ST PANEUROPEAN MEETING OF ANATOMISTS, GRAZ, AUSTRIA; 05/2013
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    K Natsis · M Piagkou · G Skotsimara · G Piagkos · P Skandalakis
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    ABSTRACT: BACKGROUND: The foramen magnum (FM), a complex area in craniocervical surgery, poses a challenge for neurosurgeons. The knowledge of the detailed anatomy of the FM, occipital condyles (OC) and variations of the region is crucial for the safety of vital structures. This study focuses on the FM and OC morphometry, highlights anatomical variability and investigates correlations between the parameters studied. MATERIALS AND METHODS: One hundred and forty-three Greek adult dry skulls were examined using a digital sliding calliper (accuracy, 0.01 mm). RESULTS: Mean FM width and length were found 30.31 ± 2.79 and 35.53 ± 3.06 mm, respectively. The commonest FM shape was two semicircles (25.9 %), whereas the most unusual was irregular (0.7 %). The OC minimum width, maximum width and length were 5.71 ± 1.61, 13.09 ± 1.99 and 25.60 ± 2.91 mm on the right, and 6.25 ± 1.76, 13.01 ± 1.98 and 25.60 ± 2.70 mm on the left side. The commonest OC shape was S-like and the most unusual was ring, bilaterally. The mean anterior and posterior intercondylar distances were 19.30 ± 3.25 and 51.61 ± 5.01 mm, respectively. The OC protruded into the FM in 86.7 % of the skulls. Variations such as a third OC existed in 5.6 % and basilar processes in 2.8 %. Posterior condylar foramina were present in 75.5 %. The gender was correlated with FM width and length, OC length, bilaterally, anterior intercondylar distance (AID) and posterior intercondylar distance (PID). The OC protrusion and existence of posterior condylar foramina were correlated. Bilateral asymmetry for OC shape was statistically significant. CONCLUSION: Our results provide useful information that will enable effective and reliable surgical intervention in the FM region with the maximum safety and widest possible exposure.
    Anatomia Clinica 04/2013; 35(10). DOI:10.1007/s00276-013-1119-z · 1.33 Impact Factor
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    ABSTRACT: Joseph Gensoul is considered an important figure of the 19th century Lyonnais Medical School. His contribution to maxillofacial surgery and his legendary abilities secured him a place in the history of Medicine.
    Journal of B.U.ON.: official journal of the Balkan Union of Oncology 10/2012; 17(4):801-803. · 0.71 Impact Factor
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    ABSTRACT: The purpose of this project is to study and analyse the anatomical variations of the infrapopliteal vessels concerning their branching pattern. A reliable sample of one hundred formalin-fixed adult cadavers was dissected by the Anatomical Laboratory of Athens University. The variations can be classified in the following way: the normal branching of the popliteal artery was present in 90%. The remainder revealed variant branching patterns: hypoplastic or aplastic posterior tibial artery and the pedis arteries arising from the peroneal (3%); hypoplastic or aplastic anterior tibial artery (1.5%); and the dorsalis pedis formed by two equal branches, arising from the peroneal and the anterior tibial artery (2%). The variations were more frequent in females and in short-height individuals. Knowledge of these variations is rather important for any invasive technic concerning lower extremities.
    Folia morphologica 08/2012; 71(3):164-7. · 0.52 Impact Factor
  • T Troupis · A Michalinos · P Skandalakis
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    ABSTRACT: Intramammary lymph nodes have not received for a long time enough attention from the medical literature and thus many of their characteristics are not sufficiently explored. Their incidence at various studies ranges between 0, 7 and 48%. They may be found in all breast quadrants but usually at the Upper Outer Quadrant (UOQ). Their radiological image at mammography is that of a well circumscribed density with an area of lower density at centre representing the hilum and at ultrasonography of a hypoechoic, circumscribed mass with an echogenic hilum. Their role in lymphatic drainage of breast regions is important although it is not known if they represent true sentinel nodes or if lymphatic drainage to them comes from ectopic, independently developed pathways. Intramammary Lymph Nodes are involved in a variety of clinical situations including benign situations, tumor metastasis, breast lymphoma and breast cancer. Their importance over breast cancer is not fully defined but there is evidence that they worsen prognosis and they may change therapeutic decisions. Breast cancer and Breast lymphoma can coexist and interfere.
    Breast (Edinburgh, Scotland) 06/2012; 21(5):615-20. DOI:10.1016/j.breast.2012.06.006 · 2.58 Impact Factor
  • Eleni Panagouli · Theodore Troupis · Panayiotis Skandalakis · Dionysios Venieratos
    The American surgeon 02/2012; 78(2):266-7. · 0.92 Impact Factor
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    Piagkou M · Demesticha T · Piagkos G · Skandalakis P · Johnson EO
    Maxillofacial Surgery, 01/2012; , ISBN: 979-953-307-166-3
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    ABSTRACT: The purpose of this historical review is to add new elements to the international literature in relation to the birth and progress of the science of anatomy in modern Greece. Step by step, it outlines the efforts of prominent Greek anatomists to establish the course of the basic science of anatomy in the newly founded Medical School, the laborious effort to collect cadaveric material to compile museum anatomical collections and to gradually build the foundations of modern anatomy science at the Medical School of the Athenian University.
    Italian journal of anatomy and embryology = Archivio italiano di anatomia ed embriologia 01/2012; 117(1):8-12.
  • The American surgeon 12/2011; 77(12):1717-9. · 0.92 Impact Factor
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    ABSTRACT: Objective To investigate the anatomical variability of the palatine structures in Greek population.Material and methods71 Greek adult dry human skulls were examined to detect the position of the greater palatine (GPF) and lesser palatine foramina (LPF) related to adjacent anatomical landmarks.ResultsThe perpendicular distance of the GPF to the midline sagittal suture was 1.53 cm and 0.3 cm from the inner border of the alveolar ridge. The mean distance from the posterior palatal border was consistent 0.46 cm on the right and 0.47 cm on the left side of the skulls. In the greater majority of the skulls (76.2%), the GPF were between proximal–distal surfaces of the 3rd maxillary molar. A single LPF was observed in 53.45% of the skulls, two LPF were observed in 31% of the skulls bilaterally and five LPF were rare (2.1%). The commonest position of LPF was at the junction of the palatine bone and the inner lamella of the pterygoid plate (71.9%).Conclusion Our results can help clinicians localize the palatine foramina in patients with and without maxillary molars and to predict the depth of a needle to anaesthetise the maxillary nerve with greater success when performing surgical procedures in the hard and soft palate.
    Journal of Cranio-Maxillofacial Surgery 11/2011; DOI:10.1016/j.jcms.2011.10.011 · 2.60 Impact Factor
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    ABSTRACT: The postsynaptic fibers of the pterygopalatine or sphenopalatine ganglion (PPG or SPG) supply the lacrimal and nasal glands. The PPG appears to play an important role in various pain syndromes including headaches, trigeminal and sphenopalatine neuralgia, atypical facial pain, muscle pain, vasomotor rhinitis, eye disorders, and herpes infection. Clinical trials have shown that these pain disorders can be managed effectively with sphenopalatine ganglion blockade (SPGB). In addition, regional anesthesia of the distribution area of the SPG sensory fibers for nasal and dental surgery can be provided by SPGB via a transnasal, transoral, or lateral infratemporal approach. To arouse the interest of the modern-day clinicians in the use of the SPGB, the advantages, disadvantages, and modifications of the available methods for blockade are discussed.▪
    Pain Practice 09/2011; 12(5):399-412. DOI:10.1111/j.1533-2500.2011.00507.x · 2.18 Impact Factor
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    ABSTRACT: The posterior trunk of the mandibular nerve (V(3)) comprises of three main branches. Various anatomic structures may entrap and potentially compress the mandibular nerve branches. A usual position of mandibular nerve (MN) compression is the infratemporal fossa (ITF) which is one of the most difficult regions of the skull base to access surgically. The anatomical positions of compression are: the incomplete or complete ossified pterygospinous (LPs) or pterygoalar (LPa) ligament, the large lamina of the lateral plate of the pterygoid process and the medial fibres of the lower belly of the lateral pterygoid (LPt). A contraction of the LPt, due to the connection between nerve and anatomic structures (soft and hard tissues), might lead to MN compression. Any variations of the course of the MN branches can be of practical significance to surgeons and neurologists who are dealing with this region, because of possibly significant complications. The entrapment of the MN motor branches can lead to paresis or weakness in the innervated muscle. Compression of the sensory branches can provoke neuralgia or paraesthesia. Lingual nerve (LN) compression causes numbness, hypoesthesia or even anaesthesia of the mucous of the tongue, anaesthesia and loss of taste in the anterior two-thirds of the tongue, anaesthesia of the lingual gums, as well as pain related to speech articulation disorders. Dentists should be very suspicious of possible signs of neurovascular compression in the region of the ITF.
    Anatomia Clinica 05/2011; 33(4):291-9. DOI:10.1007/s00276-010-0706-5 · 1.33 Impact Factor
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    Maria Piagkou · Theano Demesticha · Panayiotis Skandalakis · Elizabeth O Johnson
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    ABSTRACT: Various anatomic structures including bone, muscle, or fibrous bands may entrap and potentially compress branches of the mandibular nerve (MN). The infratemporal fossa is a common location for MN compression and one of the most difficult regions of the skull to access surgically. Other potential sites for entrapment of the MN and its branches include, a totally or partially ossified pterygospinous or pterygoalar ligament, a large lamina of the lateral plate of the pterygoid process, the medial fibers of the lower belly of the lateral pterygoid muscle and the inner fibers of the medial pterygoid muscle. The clinical consequences of MN entrapment are dependent upon which branches are compressed. Compression of the MN motor branches can lead to paresis or weakness in the innervated muscles, whereas compression of the sensory branches can provoke neuralgia or paresthesia. Compression of one of the major branches of the MN, the lingual nerve (LN), is associated with numbness, hypoesthesia, or even anesthesia of the tongue, loss of taste in the anterior two thirds of the tongue, anesthesia of the lingual gums, pain, and speech articulation disorders. The aim of this article is to review, the anatomy of the MN and its major branches with relation to their vulnerability to entrapment. Because the LN expresses an increased vulnerability to entrapment neuropathies as a result of its anatomical location, frequent variations, as well as from irregular osseous, fibrous, or muscular irregularities in the region of the infratemporal fossa, particular emphasis is placed on the LN.
    Clinical Anatomy 03/2011; 24(2):143-50. DOI:10.1002/ca.21089 · 1.16 Impact Factor