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Bilateral double layers of quadratus plantae muscle: A case report

June 2015

Authors:

Asaad Alshouk

University of Al-Qadisiyah

Hasan Barış Ilgaz

Hacettepe University

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BACA Meeting Abstracts

Abstracts Presented at the Joint Summer Meeting of the British Association of Clinical

Anatomists, the European Association for Clinical Anatomy and the Sociedad

Anatomica Espanola on 24th–27th June 2015 at the Medicine and Pharmacy Faculty,

Rouen, France

ASEEM, RABIYA, HASAN NAVEED, ASHRAF MESSIHA,

Department of General Surgery, Royal Albert Edward

Inﬁrmary, Wigan, United Kingdom. Anatomical vari-

ation of the marginal mandibular nerve: A liter-

ature review

The marginal mandibular nerve (MMN), important for facial symme-

try, expression and phonation, is implicated in many contemporary

jaw and neck-related surgical procedures. Operating in the vicinity of

this nerve caries a risk of permanent injury in up to 7% of cases. We

present a literature review analyzing the positional variation of the

MMN with respect to ethnicity and gender, and its implications for

head and neck surgery. The Pubmed database was used to search for

relevant articles published between 1997 and 2015. Our search terms

included a combination of the following words: geometry, morpho-

metric, anatomy, and marginal mandibular nerve. We selected ana-

tomical studies that measured the position of the marginal

mandibular nerve with respect to established landmarks. We identi-

ﬁed 12 qualifying articles that studied the position of the MMN in rela-

tion to mandibular margin, facial vessels, gonion, antegonial notch,

and masseteric tuberosity. The data from these studies was pertinent

to Caucasians, Oriental Asians, South Asians, and Middle-Eastern

peoples. There were no interethnic comparative studies conducted by

a single group. Signiﬁcant variation in the position and morphology of

the MMN were identiﬁed. This highlights the paucity of advice to pre-

cisely predict position of this nerve. Popular landmarks and geometric

relations are commonly used to predict the location of the marginal

mandibular nerve during surgery. Given the variation of anatomy,

there is a need for a gold standard measure with respect to each eth-

nicity. In light of this, we have reviewed the literature to determine

relevant landmarks and measurements speciﬁcally applicable to gen-

der and different ethnicities.

BADSHAH, MASROOR, FARHANABBAS BALOCH, QAISER

INAYAT, JAMSHAID HASNAIN, JAVED NAWAB, ROGER

SOAMES, Peshawar Institute of Medical Sciences,

Pakistan. The relationship of the origin of the

cystic artery to Calot’s triangle among the pop-

ulation of Khyber Pakhtunkhwa, Pakistan

This study investigates the origin of the cystic artery and its varia-

tions related to Calot’s triangle with the aim of reducing the chances

of injuries to blood vessels and the biliary system during various hep-

atobiliary procedures. A retrospective analysis of surgical anatomical

data of patients who underwent surgery for different lesions in the

hepatobiliary region was carried out between August 2013 and Octo-

ber 2014 at Peshawar Institute of Medical Sciences, Hayatabad,

Peshawar, Khyber Pakhtunkhwa, Pakistan. Data were retrieved from

surgical notes of the patients and was entered into Microsoft Excel.

Evaluation of the data entry was done using validity checks. After-

wards the data were exported to SPSS Version 19.0 for analysis. It

was observed that in 92.4% (n561) of the patients the origin of

cystic artery was normal i.e. from right hepatic artery and variations

were seen in the remaining 7.6% of (n55) cases. It was also noted

that in 66.5% (n544) of patients, the cystic artery entered Calot’s

triangle, while in 32% (n521) of patients the course of the cystic

artery was outside the triangle. Most of the cystic arteries that passed

through Calot’s triangle had their origin from the right hepatic artery

(95.5%, n542), while two instances were of common hepatic artery

origin (4.5%). Further research should be carried out to understand

the normal anatomy of the cystic artery to avoid injury to blood ves-

sels and the biliary system during hepatobiliary procedures.

BEZDICKOVA, MARCELA, RADKA FILIPCIKOVA, PETR

HUBACEK, STEFAN POLAK, DALIBOR PASTUCHA,

Department of Anatomy, Faculty of Medicine and

Dentistry, Palack

y University, Olomouc, Czech

Republic. Orofacial atlas with clinical anatomy

application (APP)

The orofacial system represents an anatomically and clinically rich

region with a wide variety of functions (initial part of digestive sys-

tem, respiratory system, variety of reﬂexes, etc.) This region is not

topographically complex, but disease in this system affects many

aspects of a patient’s life. The aim of establishing the interactive atlas

is to present oro-maxillo-craniofacial topographical anatomy, and

focus not only on excellent clinical-anatomical description but also on

surgical therapy and its techniques, including depiction and descrip-

tion of surgical approaches. The atlas and APP of the orofacial system

and its applied anatomy is easy to use, comprehensive and interac-

tive, and largely without time constraints. The advantage of this

medium is the possibility of continuous development and replenish-

ment as new case reports and surgical approaches are published. The

atlas covers the biomechanics of orofacial system, skull fractures,

and subsequent functional integrity of the underlying systems, with a

focus on the weak points and changes in bone thickness in the skull.

The atlas ﬁnds wide application in the ﬁelds of otorhinolaryngology,

neurosurgery, aesthetic surgery, orofacial traumatology, ortho-

gnathic surgery, and reconstructive surgery of the orofacial region. It

is planned that the atlas will be updated regularly to reﬂect develop-

ments in medicine and in surgical techniques.

BEZDICKOVA, MARCELA, STEFAN POLAK, RADKA

FILIPCIKOVA, IVAN VARGA, ZDENA BLAZKOVA,

Department of Anatomy, Faculty of Medicine and

Dentistry, Palack

y University, Olomouc, Czech

Republic. Thymol-ﬁxed specimens in plastination

procedure: Experience with focus on the cardio-

vascular system

Dissected cadavers are a principal tool for anatomists and medical

students studying gross anatomy. The most frequently used ﬁxatives

and disinfectants are formalin, ethanol, and phenol. Dissection of

embalmed cadavers exposes students, teachers, and other staff to

chemicals used in ﬁxation and preservation of cadavers. In a new

embalming solution, we use thymol instead of phenol, according to

evidence of higher safety. Thymol has antiseptic ability 253more

effective than phenol. The high antiseptic effect occurs even in the

solution of 1:3,000. What is essential, thymol is not put into the

group of carcinogens and, due to its lower solubility in water, it is less

toxic than phenol. For ﬁxation, we use a combination of formalin, thy-

mol, ethanol, and distilled water. For preservation only, thymol, etha-

nol, and distilled water is used. We also attempted to use plastination

on the anatomical specimens. First results show that during the last

step of plastination—the curing phase—it is most important to pay

attention to ﬁnd the optimal time, much shorter than using with wet

phenol-embalmed specimens. Dependent variables are size and type

of tissue. Preliminary testing was done with heart specimens and

neck complexes with a focus on vessels.

C2016 Wiley Periodicals, Inc.

DOI: 10.1002/ca.22752

Published online 4 September 2016 in Wiley Online Library (wileyonlinelibrary.com).

Clinical Anatomy 29:963–976 (2016)

BETTENCOURT-PIERES, MARIA, ANDREI YAKIMOV, JOSE

ESPERANCA-PINA, JOAO GOYRI O’NEILL, Nova Medical

School, New University of Lisbon, Portugal. Revisiting

the celiac artery

The ﬁrst accurate anatomical description of the celiac artery is usually

attributed to the Swiss humanist Albrecht Von Haller (1756). We con-

sulted the original notes of his Gottingen disciple Hermanni Boer-

haave (1741) and also some of the earlier anatomical descriptions of

the artery, by Vesalius (1543) and Virchow (1775), as both were

referred to by von Haller in the description we consulted. In addition

to this bibliographic research, we present the results of anatomical

studies carried out in Portugal using injection-corrosion casting, with

aortic injection of methacrylate (Perspex tenso/V

R) and addition of ﬂu-

orescent dye and photography in a dark room. We present the results

of our Portuguese series of 128 human arteries and 55 arteries

obtained from dogs. They are consistent with the results of more

recent studies, performed worldwide. The interest in knowledge of

the anatomical variations of the celiac artery resides in the necessity

to plan surgery on upper abdominal organs, such as segmental sple-

nectomy or hepatectomy and/or organ transplants. Modern techni-

ques of laparoscopic surgery and arterial embolization through

interventional imaging also require previous accurate knowledge of

the several anatomical variations of the aortic branches.

BURGER, ELSIE, ELSJE-MARIE GELDENHUYS, PAUL VAN

HELDEN, SANET KOTZ

E, Division of Forensic Medicine,

Department of Pathology, Faculty of Medicine and

Health Sciences, Stellenbosch University and Western

Cape Forensic Pathology Service, South Africa. The

prevalence and presentation of tuberculosis in

a cadaver population in Cape Town, South

Africa

Pulmonary tuberculosis (PTB) is not only a major health problem in

the Western Cape Province, South Africa but is also the most preva-

lent cause of death in the South African population. The aim of this

study was to determine the prevalence and anatomical distribution of

tuberculosis lesions in a cadaver cohort that originated mainly from

low socio-economic communities in the Western Cape Province.

Formalin-embalmed cadavers (n5127) consisting of 87 males and

40 females were dissected by medical students. The organs, including

the skeletal system, were examined and photographed. Standard his-

tological processing and sectioning was performed on tissue samples.

Pulmonary TB was the most common manifestation of tuberculosis

(TB) and was observed in 97/127 (76.4%) cadavers. The most fre-

quently observed forms of extra-pulmonary TB were splenic TB

(16.9%), followed by hepatic TB (11.8%), tuberculous lymphadenitis

(11.0%) and renal TB (10.2%). Gastrointestinal involvement and

pancreatic TB were both individually observed in 1.6% cadavers,

while one cadaver presented with spinal TB and one with testicular

TB. This study gives detailed information on the prevalence of pulmo-

nary and extra-pulmonary TB currently seen in cadavers from low

socio-economic communities studied by medical students. These con-

ditions will also be encountered by students in hospitals and clinics

during further training, and therefore recognition of pathology in the

dissection venue lays the groundwork for their studies. Thus, stu-

dents dissecting these cadavers are made aware of typical TB lesion

distribution and other pulmonary pathology which they will encounter

frequently as future clinical practitioners.

BURWELL, R. GEOFFREY,

EMMA M. CLARK,

PETER H.

DANGERFIELD,

ALAN MOULTON,

Centre for Spinal

Studies and Surgery, Queen’s Medical Centre,

Nottingham University Hospitals Trust, Nottingham,

Academic Rheumatology, Musculoskeletal Research

Unit, University of Bristol.

University of Liverpool and

Staffordshire University,

Department of Orthopaedic

Surgery, King’s Mill Hospital, Mansﬁeld, United

Kingdom. Adolescent idiopathic scoliosis: Cas-

cade concept of pathogenesis

Many studies have reported abnormal body composition with lower

body weight and BMI with adolescent idiopathic scoliosis (AIS).

Although several concepts attempt to explain the pathogenesis of

AIS, there is no agreed theory. Here, we suggest a novel Cascade

Concept for AIS pathogenesis initiated by the longitudinal ﬁndings of

Clark et al. (2014, J. Bone Min. Res. 8:1729–1736). These relate tis-

sue abnormalities at 10 years of age namely, low fat mass, low circu-

lating leptin, and low lean mass, to the presence of scoliosis, mostly

AIS, at 15 years of age. We speculate that the leptin body composi-

tion effect is linked to central nervous system development (Steppan

and Swick 1999, Biochem. Biophys. Res. Comm. 256:600–602) and

the asynchronous neuro-osseous growth mechanism (Chu et al.

2008, Scoliosis 3:8). The latter, in combination with human upright

posture, age, and gender-related anatomical variants of vertebral

backward tilt (dorsal shear concept of Castelein et al. 2005, Med.

Hypotheses 65:501–508; Schlosser et al. 2015, Eur. Spine J.

24:1158–1167), the Hueter-Volkmann effect in vertebrae and verte-

bral bone mass abnormality, lead to AIS, possibly both initiation and

progression of scoliosis curvatures. Numerical simulation (Drevelle

et al. 2010, Spine 35:E407–E412) may be applied to test these ideas

for components of the scoliotic spine in sagittal and transverse

planes, including the concepts of asynchronous neuro-osseous growth

and dorsal shear for AIS pathogenesis.

BURWELL, R. GEOFFREY,

EMMA M. CLARK,

PETER H.

DANGERFIELD,

ALAN MOULTON,

Centre for Spinal

Studies and Surgery, Queen’s Medical Centre,

Nottingham University Hospitals Trust, Nottingham,

Academic Rheumatology, Musculoskeletal Research

Unit, University of Bristol.

University of Liverpool and

Staffordshire University,

Department of Orthopaedic

Surgery, King’s Mill Hospital, Mansﬁeld, United

Kingdom. Adolescent idiopathic scoliosis: Embry-

onic origin of cascade concept of AIS

pathogenesis

As a complex disease, AIS should involve genetic, environmental and

lifestyle factors in development and growth (Cheng et al. Nature

Reviews Disease Primers in press; Craig 2008, Nature Educ. 1:184).

Although no speciﬁc environmental risk factors have been identiﬁed,

the Avon Longitudinal Study of Parents and Children found factors at

age 10 years associated with scoliosis deformity at 15 years (Clark

et al. 2014, J. Bone Min. Res. 8:1729–1736); these factors are low

fat mass, low lean mass, low circulating leptin, and high adiponectin

levels. To explain the association of components of body composition

identiﬁable before onset of scoliosis, Clark et al. (2014) suggested

the origin of scoliosis affects a cluster of cell types in embryonic life,

not only adipocytes and osteoblasts derived from the same progenitor

cells (mesenchymal stem cells) but also myoblasts derived from dif-

ferent progenitor cells (somitic myotome) (Gilbert 2014, Develop-

mental Biology, 10th Ed, Sinauer). Clark et al. (2014) related low

lean mass to paravertebral muscle abnormalities with scoliosis. There

is speculation that environmental factors differing in world regions,

could act in the ﬁrst year of postnatal life to initiate the expression of

AIS years later (McMaster et al. 2015, Scoliosis 10:6). More epidemi-

ological research is needed including early pregnancy.

CAXAMBU NETO, MARIO, PAULO C

ESAR DELIBERATO,

TATIANA CAXAMBU, CELIMARA GAMBA, JOS 

E RENATO

ROMERO, AUGUSTO C

ESAR GAUGLITZ, Municipal

University of S~

ao Caetano Do Sul, Sao Paulo, Brazil.

Anatomical variations of the median nerve and

its relations with carpal tunnel syndrome

This study documented anatomical variations of the median nerve

within the carpal tunnel. We dissected and analyzed the palms of 10

hands of seven adult Caucasian cadavers, one female and six males,

964 Abstracts

previously treated by injection of glycerin and 10% formalin. We

found anatomical variations in 7 of the 10 dissected hands. We ana-

lyzed the variations of the motor branch of the median nerve to the

thenar muscles in relation to the transverse carpal ligament. In three

specimens, the motor branch emerged from the distal median nerve

beyond the carpal tunnel. In two hands, the branch arose inside the

carpal tunnel. In two hands, the motor branch pierced the transverse

carpal ligament to reach the thenar muscles. The presence of acces-

sory thenar motor branches of the median nerve was recorded all 10

dissections. Doubling of the median nerve was recorded in two dis-

sections. We conclude that anatomical variations of the thenar motor

branch of the median nerve can increase the predisposition for carpal

tunnel syndrome and may require modiﬁcations in treatment.

CHAUDHRY, MOHAMMED SHIRAZ, NEIL ASHWOOD,

KARAGKEVREKIS BABIS, Queen’s Hospital, Burton-on-

Trent, United Kingdom. Avascular necrosis of the

right knee, left knee, and left talus: A unique

presentation

Avascular necrosis is deﬁned as cellular death of bone due to ischae-

mia of osseous tissue and has been well documented with many the-

ories proposed. However, there is little literature on avascular

necrosis occurring at multiple sites within a short period of time. We

present a 63-year-old woman who developed idiopathic avascular

necrosis of the right knee, left knee, and left talus with no associated

risk factors. Avascular necrosis at any site can be a debilitating dis-

ease and it is rare for it to occur at three different sites of the body

within a short time frame.

CHOUDHURY, BIPASHA, INGRID GOULDBOROUGH,

Faculty of Life Sciences, University of Manchester,

Manchester, United Kingdom. Digital histology:

Superior to light microscopy?

Students ﬁnd it challenging to examine sections using the light micro-

scope which can often be a barrier to learning the functional histology

of a structure. With the advent of newer technologies where histologi-

cal sections can be scanned and viewed digitally, new methods for

teaching this subject have evolved. The aim of this study was to eval-

uate student opinions on studying histology using digitalized slides in

comparison to traditional methods using light microscopy. Sixty-nine

ﬁrst year dental students at the University of Manchester, were asked

to view slides of the gastrointestinal system using light microscopy

(traditional method) and digitally (novel method) during a scheduled

teaching session. These students had previous experience of light

microscopy. Relevant slides had been scanned and were viewed using

Pathonet. Student opinions on each method were collected using

questionnaires. All students stated that the sections viewed were

clearer when using the digitalized slides. Students found it easier to

distinguish between different types of tissues (94%), easier to recog-

nize speciﬁc structures (86%), and felt more conﬁdent (93%) using

the imaging software when compared to light microscopy. Stated

beneﬁts of using the software included simultaneous viewing of a

slide allowing productive discussion and reassurance of correct inter-

pretation. Other beneﬁts included easier focussing and a greater abil-

ity to produce more detailed drawings. Thirty-ﬁve students

commented that the software did not allow them to develop skills in

light microscopy. This new method of histology teaching provides an

excellent way of getting students to engage with and understand

microscopic structure.

CHUNG, BEOM-SUN, MIN-SUK CHUNG, YOUNG-HWAN

AHN, JIN-SEO PARK, Department of Anatomy, Ajou

University School of Medicine, Suwon, Republic of

Korea. Ten triangular spaces around the cavern-

ous sinus, used in surgical approaches,

observed by sectioned images and 3-

dimensional models

Lesions around the cavernous sinus (CS) are difﬁcult to access surgi-

cally and triangular spaces adjacent to the sinus have been devised

by clinical anatomists and surgeons. Advances in computer tomogra-

phy and magnetic resonance imaging are enabling diagnosis of

pathology in this region. The purpose of this study is to reassess the

triangular spaces and to enhance understanding of their anatomy.

Based on papers in the literature, 10 triangular spaces (superoposte-

rior, superior, middle, inferior, anterior, middle, posterolateral, poster-

omedial, lateral, and medial) were organized into three groups

(medial, lateral, and posterior). The triangular spaces were drawn

onto a schematic diagram. The spatial relationships of the triangular

spaces and nearby structures were observed on the serially sectioned

cadaveric images. Three-dimensional models depicting the triangles

and related surgical approaches were manufactured and embedded

into a portable document format ﬁle. By comparing the schematic

diagram with the 3D models and the sectioned images, the triangles

around the cavernous sinus were recognized as being accurate. The

borders of the triangles have been revised appropriately. The nomen-

clature of the triangles has been rearranged to yield consistency. The

educational resources of this study will be provided free to aid medi-

cal students, radiologists, and surgeons requiring knowledge of the

anatomy of the cavernous sinus.

CLEMENT, HANS, KALPESH VAGHELA, DAVOUD

KHODATARS, LEE PARKER, Department of Trauma and

Orthopaedics, St Bartholomew’s Health NHS Trust,

London, United Kingdom. Syndesmosis-preserving

osteotomy of the ﬁbula for access to the lateral

talar dome

Surgical access to the posterolateral talar dome for the treatment of

osteochondral defects is challenging, often requiring a segmental

osteotomy of the ﬁbula (ﬁbula window) and division of the anterior

inferior tibioﬁbular ligament (AITFL) or, alternatively, a ﬁbular osteot-

omy with division of the AITFL and the anterior tibioﬁbular ligament

(ATFL) (ﬁbular door). These techniques require extensive surgical dis-

section. We have developed a ﬁbula osteotomy that permits access

to the lateral talar dome without disrupting the lateral ligamentous

complex or syndesmosis. A 10 cm curvilinear incision is made over

the lateral distal ﬁbula to the peroneal tubercle of the calcaneum. The

ﬁbula is then exposed subperiosteally at the level of the lateral talar

dome. A trapezoidal osteotomy is made using an oscillating saw

around the insertion of the AITFL keeping a 1 cm wide posterior col-

umn of ﬁbula behind. The ﬁbula can then be reﬂected anteriorly hing-

ing on the intact AITFL. Precise reduction and stabilization of the

osteotomy can be achieved using a single 3.5 mm lag screw. A 43-

year-old man was diagnosed with a osteochondral fracture of the

superolateral talar dome on CT scanning. A trapezoidal osteotomy

was utilized and the fracture with stabilized with two Herbert screws.

A 3.5 mm lag screw was then used to stabilize the ﬁbula osteotomy.

The ankle was immobilized in a below-knee plaster-of-Paris for 6

weeks after which radiology showed complete union of the osteotomy

and osteochondral fracture. We conclude that this novel osteotomy

conﬁguration can permit safe access to the lateral talar dome.

COEY, JAMES, SARA SULAIMAN, Department of

Anatomy, St. George’s International School of

Medicine, University of Northumbria, Newcastle,

United Kingdom. Active learning in anatomy: An

experience of introducing an ultrasound-based

research selective

Active learning in medical education is increasingly being recognized

by both educators and governing bodies for its positive inﬂuence on

students attitudes, critical analysis, and comprehension. Principles of

scientiﬁc research are taught in medical schools but rarely applied

beyond the classroom setting making them an obvious choice for

active learning. A selective course for term-2 medical students was

introduced in the St. George’s Keith B. Taylor Global Scholars pro-

gram at Northumbria University. The course was designed to intro-

duce students to the research cycle and further their anatomical

knowledge through a self-directing learning exercise. Twenty-four

students within six groups participated in the selective in which

Abstracts 965

students formulated a research question, ran a feasibility study, and

collected data before presenting their ﬁndings to the school and at an

international conference. A questionnaire-based assessment of 30

Likert-type questions evaluating students’ perception toward research

and the learning process was administered. The selective was well

received by students. Greater than 70% reported that they would like

more research opportunities and concepts incorporated into the medi-

cal curriculum. Students also thought the course to be beneﬁcial in

terms of enhancing their curriculum vitae and affecting their career

choices. Active learning in anatomy through research has proven to

not only further anatomical knowledge and practical applications of

ultrasound but also to developing skills in critical thinking, appraisal

of evidence and scientiﬁc writing. Other skills such as team work,

bed-side manner, and communication were also reinforced.

COSCIONE, ALBERTO, MICHAELIS VARNAVAS, SORAM

PATEL, RAJESH NAIR, SAMER KAKMAWI-SABBAGH,

Department of Urology, St George’s Hospital, London,

United Kingdom. A historical perspective on the

discovery and naming of the prostate

The prostate gland is an important focus of modern urology, yet

debate continues over its discovery and naming. We present a histori-

cal review of the discovery of the prostate as an organ and as a

name. A review of manuscripts analyzing anatomical treatises was

performed using databases and online resources. We found that Nic-

colo Massa (1485–1569) is widely credited with the ﬁrst description

of the prostate as: “a round, glandular structure sitting below the

bladder.” However Herophilus of Alexandria (325–255 BC) described

two “glandular assistants” found below the bladder and joined at the

midline. The use of the plural may imply the prostate was considered

part of the seminal vesicles. The term “prostate” is attributed to

Andr

e du Laurens (1558–1609) by Marx et al. (2009), but the term

prostata is found in an essay by Jacques Dubois (1478–1555) pub-

lished 50 years earlier. Herophilus’s original description Ademoideir

Paqarsases translates to “glandular assistants” and we postulate the

etymology of “prostate” may be a Latinization of “parastate.”

Although Massa may have been the ﬁrst to recognize it as an organ,

evidence exists of authors as early as Herophilus describing the ana-

tomical location and characteristics of the prostate. Moreover, the ori-

gin of term prostate is unlikely to have been coined by Du Laurens as

previously thought as it was in use several years prior to his works

and may derive from a Latinization of the Greek term “assistant”

rather than “protector.”

DAVIES, ANDREW, NATALIE PEARSE, MARTIN WEINER,

CIARAN HEALY, Department of Anatomy, University of

London, London, United Kingdom. Maximizing

venous drainage in the paramedian forehead

ﬂap

The gold standard for reconstruction of the nasal tip and alae is the

paramedian forehead ﬂap, a pedicled ﬂap raised on the supratro-

chlear vessels. Venous congestion can occur due to inadequate

venous outﬂow and may compromise ﬂap survival. It is possible to

identify superﬁcial veins in the subcutaneous fat adjacent to the ﬂap,

and include them in the ﬂap to aid venous drainage. We investigated

the incidence and drainage pattern of these superﬁcial veins. Parame-

dian forehead ﬂaps were marked on eight fresh frozen cadaveric

heads. Dissection was carried out in the subcutaneous fat adjacent to

the ﬂap. All superﬁcial veins emanating from the ﬂap and running

within 10 mm of the ﬂap margin were identiﬁed and their drainage

patterns recorded. From the eight dissections, a superﬁcial vein was

identiﬁed medial to the ﬂap in seven cases and lateral to the ﬂap in

six specimens. The mean distance of the vein from the peripheral

margin of the ﬂap was 6 mm. The point of emanation from the ﬂap

margin ranged from 10–70 mm from the radix. Nine superﬁcial veins

had multiple connecting branches to the ﬂap. The veins drained to

ipsilateral supratrochlear vessels in all but one case. We conclude

that a superﬁcial vein could be included in the forehead ﬂap in all

cases. This most commonly ran medial to the ﬂap and drained to ipsi-

lateral supratrochlear vessels. The close proximity of superﬁcial veins

allows their inclusion when raising paramedian forehead ﬂaps, and

should reduce the incidence of venous congestion.

DEMIRYUREK, DENI, ALPER VATANSEVER, BURCE

OZGEN MOCAN, Department of Anatomy, Faculty of

Medicine, Hacettepe University, Ankara, Turkey. To be

or not to be: the triticeal cartilage?

The larynx is an anatomical structure in the neck region, involved in

breathing and sound production. Its skeleton is formed by hyaline

cartilages which may ossify with age, except the elastic epiglottis. Tri-

ticeal cartilages are a part of the laryngeal skeleton and, if present,

are located inside the lateral thyrohyoid ligament at the level of third

and fourth cervical vertebrae. Clinically, the triticeal cartilage has no

known function, although recently it has been suggested that it might

help reinforce the lateral thyrohyoid ligament. When calciﬁed, the tri-

ticeal cartilage can be readily seen on radiographic and CT images,

and can be misdiagnosed as calciﬁcation in the carotid artery or other

dystrophic calciﬁcations of soft tissue. As calciﬁed carotid atheroma is

a risk factor for stroke, clinicians need to differentiate between a cal-

ciﬁed triticeal cartilage and calciﬁed carotid atheroma. The objective

of this retrospective study with 100 cases was to determine the prev-

alence of calciﬁed triticeal cartilages, their age and sex distribution,

the relationship between the superior horn of the thyroid cartilage

and the greater horn of the hyoid bone on CT images, and to docu-

ment whether the shape of the triticeal cartilages differs from that of

carotid atheroma. The thickness of the lateral thyrohyoid ligament

was measured on MR images of subjects with triticeal cartilages. The

triticeal cartilage was detected in 70%. The thickness of the ligament

was increased and its length decreased in such cases. Some subjects

had both a calciﬁed triticeal cartilage and calciﬁed arterial plaque.

Further studies are required for determining the function of the triti-

ceal cartilage.

DODEVSKI, ACE, DOBRILA TOSOVSKA-LAZAROVA, MAR-

IJA PAPAZOVA, NIKI MATVEEVA, JULIJA ZHIVADINOVIK,

BILJANA ZAFIROVA, BILJANA TRPKOVSKA, Institute of

Anatomy, Medical Faculty, Ss. Cyril and Methodius

University, Skopje, Macedonia. Morphological char-

acteristics of the posterior inferior cerebellar

artery

The posterior inferior cerebellar artery (PICA) has the most complex

and variable course of the cerebellar arteries. The aim of this study

was to investigate the origin and diameter of PICA in the Macedonian

population and to emphasize their clinical signiﬁcance. We examined

radiographs of 103 patients who had undergone CT angiography for a

variety of clinical reasons at the University Clinic for Radiology in

Skopje, Macedonia. The study population was 103 patients (58 male

and 45 female), age range from 25 to 82, mean age 58.4 years. The

diameter of the left PICA was 1.24 60.42 mm, and the diameter of

the right PICA was 1.18 60.40 mm. The left PICA in 90.4% had origin

from the intracranial part of the left vertebral artery, in 4.3% from

the basilar artery and in 5.3% PICA had origin from the extracranial

part of the left vertebral artery. The right PICA had origin from the

intracranial part of the right vertebral artery in 87.2%, in 4.3% from

the extracranial part of the right vertebral artery and in 8.5% PICA

arose from the basilar artery. We conclude that, as well as being ana-

tomically interesting, an awareness of the PICA anatomy and varia-

tions is clinically important for the safe performance of diagnostic and

interventional procedures in radiology and for surgeons during the

planning and accomplishment of surgical interventions.

DURSUN, AHMET, CIHAN BEDEL, €

ONDER TOMRUK,

SONER ALBAY, Department of Anatomy, Faculty of

Medicine, Suleyman Demirel University, Turkey. Adult

malrotation: A case report

Malrotation of the midgut is an abnormality in the embryological

development of the gastrointestinal tract. The estimated incidence of

966 Abstracts

intestinal malrotation is 1 in every 500 live births. Adult malrotation

is very rare and its incidence has been reported to be between

0.0001% and 0.19%. In our case study, a 21-year-old man pre-

sented with vomiting, nausea and abdominal pain for nearly 1 week.

His physical examination was remarkable for severe right lower quad-

rant pain to palpation without guarding or rebound. The patient’s hae-

matology, biochemistry, and urine tests were within normal limits.

Abdominal ultrasonography and radiology were non-speciﬁc. In

contrast-enhanced abdominal CT, all colonic loops were located cen-

trally and in the left side of the abdomen. This appearance was inter-

preted as malrotation by the radiologist. This variation is encountered

more frequently in pediatric practice but its possibility in adult

patients should not be overlooked.

HAQUE, ABUL, NEIL ASHWOOD, Department of Trauma

and Orthopaedics, Queen’s Hospital, Burton on Trent,

United Kingdom. Pathological neck of femur frac-

ture suffered in hospital following trauma to a

left head of femur ﬁbrous dysplasia: A case

report

Fibrous dysplasia is a commonly seen developmental anomaly of

bone formation in which normal bone and marrow is replaced by

ﬁbrous-osseous tissue. The condition is benign and can affect one

bone (monostotic) or multiple bones (polyostotic). The lesion is often

asymptomatic and can be treated conservatively. However, in certain

cases, ﬁbrous dysplasia can lead to a pathological fracture and may

require surgical management. We looked at the case of a 67-year-old

man who presented to A&E following a fall ten days previously. Radi-

ology and CT showed he had a well-circumscribed lesion in the left

head of the femur which on further MRI was found to be a ﬁbrous

dysplasia. This was to be treated conservatively and the patient was

awaiting clearance from physiotherapy before being discharged. How-

ever, during his stay in hospital he sustained a traumatic knock to the

left hip which resulted in a pathological fracture at the left neck of

femur. This required surgery and the patient ended up having a left

total hip replacement.

HILAL, HAIDER, DERRICK EBOT, JAMES COEY, SARA

SULAIMAN, Department of Anatomy, St. George’s

International School of Medicine, University of

Northumbria, Newcastle, United Kingdom. The iden-

tiﬁcation of Acrel’s “ganglion” using ultrasound

Acrel’s “ganglion” is a controversial structure found toward the dor-

sum of the wrist. It is thought to be either the distal swelling of the

posterior interosseous nerve or even a cystic tumor on an extensor

tendon of the wrist named after the Swedish surgeon Olof af Acrel in

the 18th century. The function and exact location of this swelling is

poorly described within the published literature. It has been in the

past a target for anaesthetic blocks, but histological studies suggest it

to be devoid of nerve cell bodies and hence it is deemed to be a

“pseudoganglion.” This study aims to determine the possibility of

identiﬁng Acrel’s “ganglion” using ultrasound. Ten wrists were exam-

ined and compared using a GE Logiq e ultrasound system with a

12 L-RS transducer. A hypoechoic structure was found within the

fourth extensor compartment in all the wrists investigated. Our ﬁnd-

ings suggest that a structure located at the described site of Acrel’s

“ganglion” appears to be hypoechoic, contrary to the typical hypere-

choic appearance of a nerve. It is possible to visualize Acrel’s

“ganglion” using ultrasound. Our ﬁndings also support histological

studies indicating it is not the termination of the posterior interosse-

ous nerve. Documentation of the exact location of this pseudogan-

glion has clinical implications. Future studies should focus on the

beneﬁts of introducing an anaesthetic agent in a precise location

rather than the distal part of interosseous nerve as there are probably

no cell bodies at this site.

IAKIMOV, ANDREI, Department of Human Anatomy,

Ural State Medical University, Yekaterinburg, Russia.

Trabecular junctions in the fetal heart: A new

anatomical feature?

Our study aimed to investigate the trabecular morphology of the ven-

tricular septum in the normal hearts of human fetuses aged of 17–28

weeks. Myocardial structures which looked like ﬂattened tubercles or

plateau-like areas slightly elevated over the septal surface were iden-

tiﬁed in the septum in 14 of 89 hearts (15.7%) using a stereomicro-

scope. The structures seemed to be the coalescence points of the

adjacent trabeculae carneae, therefore we propose to call them tra-

becular junctions (TJs). The TJs were more evident in the inlet portion

of right side of the septum. Also the TJs were found to be in the apical

third of the left septal side. From 3 to 10 free trabeculae and ﬁne

parietal myocardial ridges ran radially and entered one TJ. The TJs

were multiangular or irregularly dentated; in some specimens they

appeared to be approximately round or ovoid. The mean dimensions

of the TJs were 1.6 32.05 mm with a range of 0.6 30.7 mm – 2.1

32.8 mm. Unlike the trabeculae and papillary muscles, there were

no signiﬁcant differences between the length and width of the same

TJ. We have never seen chordae tendineae originating from TJs;

thus, the TJs are not papillary muscle precursors.

IMRE, NURCAN, N. APAYDIN, Y. KIRICI, Department of

Anatomy, Gulhane Military Medical Academy, Etlik,

Ankara, Turkey. Location of the infraorbital fora-

men with reference to the soft-tissue

landmarks

The purpose of this study was to determine the positions of the infra-

orbital foramen based on soft-tissue landmarks to facilitate prediction

of the locations of these structures during periorbital surgery. Twenty

intact adult cadavers (40 sides; 10 male, 10 female) were obtained

from the Department of Anatomy of Gulhane Military Medical Acad-

emy. We created a triangle combining the medial and the lateral can-

thus and the ala of the nose. The location of the infraorbital foramen

was evaluated according to its relation to the borders of this triangle.

In addition, for each specimen, the number of infraorbital foramina

was noted. In all the cadavers examined, the mean distance between

the infraorbital foramen and the inferior orbital rim was 8.74 mm.

The mean distance of the infraorbital foramen from the facial midline

was 29.43 mm. The length of the line extending between the lateral

canthus and the ala of the nose was 54.79 mm. With reference to the

triangle formed by the three soft-tissue landmarks, in 11 of the 40

sides (27.5%) the infraorbital foramen was found outside of the trian-

gle. In 29 of the 40 sides (72.5%), the infraorbital foramen was on

the line extending between the lateral canthus and the ala of the

nose. Multiple ipsilateral foramina were found in only one of the 40

sides (2.5%). Such information may allow clinicians to better approxi-

mate the location of the infraorbital foramen for nerve blockade and

periorbital surgery.

IMRE, NURCAN, NECDET KOCABIYIK, Gulhane Military

Medical Academy, Department of Anatomy, Etlik,

Ankara, Turkey. Anatomical and morphometric

evaluation of the foramina transversaria of cer-

vical vertebrae

The purpose of this study is to determine the prevalence of double

foramen transversarium, a variant at the transverse processes of cer-

vical vertebrae and to document the dimensions, shape variations of

the foramen transversarium as well as clinical symptoms that may be

caused by these conditions. For this study, 82 cervical vertebrae

available at the laboratory of the G €

ulhane Military Medical Academy

Department of Anatomy were studied. The foramen transversarium

was present in all vertebrae. Double foramen transversarium were

observed in 18 of 82 cervical vertebrae. Of these, six vertebrae

exhibited unilateral and 12 vertebrae exhibited bilateral double fora-

men transversarium. Of the unilateral transversarium, one was on

the right side and ﬁve were on the left side. Foramina transversaria

observed were predominantly round in form. Anterior-posterior and

medial-lateral diameters of right foramina transversaria were 5.7 and

6.5 mm, respectively, while the anterior-posterior and medial-lateral

Abstracts 967

diameters of left foramina transversaria were 5.5 and 6.6 mm,

respectively. In this study, prevalence of double foramen transversa-

rium was found to be 24.0%. The prevalence of double foramina

transversaria was noted to be twice that of the unilateral group. Clini-

cians should be aware of this variation as it may lead to neurological

conditions due to impaired ﬂow of blood through the openings in C6

to the atlas.

JOCKOO AMIL, NEIL ASHWOOD, JOGISHA KUKADIA,

Department of Trauma and Orthopaedics, Queen’s

Hospital, Burton-on-Trent, United Kingdom. A rare,

low impact mid-foot injury: A case report

Low impact traumatic ankle and foot injuries are normally associated

with either torn or sprained ligaments or fractures. We present a case

report exploring the rare occurrence of an isolated medio-plantar sub-

luxation of the talonavicular joint. The 76-year-old woman presented

following a low impact injury to her ankle with minimal bruising but

tenderness over the medial malleolus, cuboid, cuneiforms and ante-

rior aspect of the talus, and no tenderness over the metatarsals or

the navicular. Initial radiographs of the foot and ankle demonstrated

subluxation of the talonavicular joint. Manipulation using Entonox was

undertaken and congruency restored at the joint. Further CT imaging

after manipulation conﬁrmed congruency with no discernible associ-

ated fractures.

KIM, SULGINA, JONGHO BANG, HEEJUN YANG,

BYUNGGI YU, HYEYEON LEE, Department of Anatomy,

Yonsei University College of Medicine, Seoul, Republic

of Korea. The anatomy of the axillary nerve and

the branches supplying deltoid and teres minor

muscles

The axillary nerve divides into anterior and posterior divisions to

innervate the deltoid and teres minor muscles. In cases of axillary

nerve injury, nerve transfer surgery is performed to remodel the

innervation of the deltoid muscle. In this study, we investigated the

morphology, ramiﬁcation, size, and the number of axons of the axil-

lary nerve using ﬁfty upper extremities from 29 adult Korean cadav-

ers. The axillary nerve divided into the anterior and posterior

branches before passing through the quadrangular space in all speci-

mens. In 48.0% of upper limbs (Type I), the anterior branch of axil-

lary nerve innervated all three parts of the deltoid muscle (spinous,

acromial, and clavicular parts) and the posterior branch innervated

the teres minor muscle and the spinous part of the deltoid. In 38.0%

(Type II), the anterior branch innervated the deltoid muscle and the

posterior branch innervated the teres minor muscle only. In 14.0%

(Type III), the muscular parts innervated by the anterior branch were

conﬁned to the clavicular part and acromial part while the posterior

branch innervated the spinous part and teres minor. In the subjects

with Type I and III, the deltoid muscle is not expected to be fully

restored by nerve transfer only to the anterior branch because the

posterior branch also innervates the deltoid. Thus, double surgical

anastomosis of both anterior and posterior branches of the axillary

nerve to donor nerves would be helpful for the restoration of shoulder

function.

KOSALKA, ROBER, ZHE SHUN J. LI, CHEN-EN HSIEH,

JASON LATSKY, KHOI P. DANG-HO, SEAN LEVY, SARA

SULAIMAN, JAMES COEY, St. George’s International

School of Medicine, Keith B. Taylor Global Scholars

Program, Northumbria University, Newcastle, United

Kingdom. Prevalence of persistent median

artery: An ultrasound study

Typically, two arteries, the radial and ulnar, supply the hand. During

the ﬁrst eight weeks of gestation a median artery is present. This

artery can persist and may continue to contribute to the circulation of

the hand. Previous cadaveric, MRI and ultrasound studies have cited

prevalence rates ranging from 2.2 to 27.1%. This study aims to

investigate the prevalence of the persistent median artery in vivo

through the use of ultrasound and determine its contribution to the

circulation of the hand. One hundred and forty wrists from 70 individ-

uals were examined using a Sonosite Micromaxx ultrasound machine.

An L38e/10-5Mhz transducer was used to scan the wrist from proxi-

mal to distal. When present, the diameter of the artery was measured

and Allen’s Test performed to determine its contribution to the circu-

lation of the hand. The persistent median artery was present unilater-

ally in three individuals with a mean diameter of 1.3 60.5 mm.

Allen’s Test indicated that the artery is not a source of signiﬁcant cir-

culation to the hand. The prevalence rate of the persistent median

artery obtained in this study is lower than that reported in the litera-

ture. The study further reinforces the use of ultrasound as a safe and

effective tool for investigating anomalous vasculature in the general

population. Moreover surgeons can quickly identify aberrant vessels

in the wrist prior to surgery using ultrasound and avoid potential iat-

rogenic injuries.

KOTZ

E, SANET, ELSJE-M 

ARIE GELDENHUYS, ELSIE BUR-

GER, AMANDA ALBLAS, LINDA GREYLING, Division of

Forensic Medicine, Department of Pathology, Faculty

of Medicine and Health Sciences, Stellenbosch

University and Western Cape Forensic Pathology

Service, South Africa. The association between

alcoholic liver disease and healed cranio-

maxillofacial fractures suggestive of interper-

sonal violence in a South African cadaver

population

Alcoholic liver disease (ALD) and interpersonal violence (IPV) are

both major problems in South Africa, particularly in the Western Cape

Province. Chronic alcohol abuse results in varying stages of ALD,

depending on the timespan and the amount of alcohol consumed.

Cranio-maxillofacial fractures, particularly fractures to the zygoma

and maxilla, are suggestive of IPV. The aim was to ﬁnd a statistical

association between the prevalence of ALD and cranio-maxillofacial

fractures in a Western Cape cadaver population. Embalmed cadavers

(n5124) were dissected by medical students at the Division of Anat-

omy and Histology, Stellenbosch University. During dissection, the

liver of each cadaver was investigated for macroscopic pathological

lesions. Samples for histology underwent routine processing and

were sectioned at 5 lm. The cadavers were also investigated for

healed cranio-maxillofacial trauma. In this study, 37/124 (29.6%)

cadavers showed signs of healed fractures with the left nasal 16/124

(12.9%), right nasal 12/124 (9.7%), and left zygomatic 11/124

(8.9%) the most commonly affected bones. More males were

affected than females and left-sided facial fractures were statistically

more common than on the right. Morphologic features of ALD were

observed in 24/124 (19.4%) cadavers with hepatic steatosis (fatty

change) in 13/124 (10.5%) and cirrhosis in 10/124 (8.1%) cadavers.

Only 12/124 (9.6%) cadavers showed both ALD and healed cranio-

maxillofacial trauma concurrently. Although literature indicates a stat-

istically signiﬁcant relationship between alcohol abuse and cranio-

maxillofacial fractures, the present study could not conﬁrm this corre-

lation in our cadaver population.

KUKADIA, JOGISHA, KAWALJIT DHALIWAL, ANOUSKA

AYUB, JONATHON REFSON, Department of General

Surgery, University Hospitals of North Midlands NHS

Trust, Stafford, United Kingdom. Intussusception

following metastatic malignant melanoma: A

case report, review of anatomy, and evaluation

of surgical options

Intussusception is where a segment of bowel invaginates into itself,

consequently causing intestinal obstruction. The majority of intussus-

ception cases are found in paediatric patients. Adult intussuception is

rare and accounts for approximately 5% of cases and 1% of all bowel

obstruction. The mechanism is not fully understood but in some cases

a single lesion can become the focus of intestinal prolapse, known as

968 Abstracts

the lead point. In adult cases, it is possible for a malignant lesion to

be the lead point. A low threshold for suspecting intussusception

should be adopted in patients with non-speciﬁc abdominal signs and

symptoms and a history of melanoma. Surgery, wherever possible, is

the deﬁnitive treatment for these patients to alleviate bowel symp-

toms but may not prolong overall patient survival. There is great

debate on the topic of malignant lead point intussusception and its

operative management, in terms of possible post-operative meta-

static spread through seeding. We present the case of a 51-year-old

man with a history of cutaneous malignant melanoma presenting

with small bowel intussusception which was reduced and resected.

KUKADIA JOGISHA, CHRISTINA ENGLEZOU, NEIL

ASHWOOD, Department of Trauma and Orthopaedics,

Queen’s Hospital, Burton-on-Trent, United Kingdom.

Ulnar collateral ligament injury of the thumb: A

case report, review of anatomy, and surgical

options

The metacarpophalangeal joint of the thumb involves a complex

interplay of ligaments, osseous elements and muscles to produce one

of the body’s most variable ranges of joint movement. Gamekeepers’

thumb is chronic strain of the ulnar collateral ligament (UCL) of the

thumb resulting in pain and instability of the joint, as a result of long-

standing extension-abduction forces. In its acute form, it is known as

skiers’ thumb, usually resulting from a number of sporting activities

such as skiing and volleyball, where it can present as rupture or an

avulsion fracture of its attachment. It can be difﬁcult to distinguish

these injuries from sprained thumbs and detailed history and exami-

nation are essential. Early operative intervention has a better func-

tional outcome and a delay in diagnosis and thus treatment can

result in long-term weakness and progressive arthritis. Investigation

usually comprises plain radiographs and repair includes reconstruc-

tion using free or local tendon transfers. We present a case of a 44-

year-old man who sustained a penetrating injury to the base of his

left thumb. He was found to have an injury to his UCL with no bony

involvement. He underwent successful repair after prompt diagnosis

and returned to normal function.

KUKADIA, JOGISHA, MIRANVIR JASPAL, Department of

General Surgery, University Hospitals of North

Midlands NHS Trust, Stafford, United Kingdom. The

epiploic foramen: A case report of two consecu-

tive intra-abdominal hernias in the same

patient

The epiploic foramen, also known as the foramen of Winslow, is the

anatomical opening to the lesser sac. Reports of hernias through this

entity are rare. Structures reported to have herniated through this

structure include the caecum, small intestine and gallbladder. We

present a case of a normally ﬁt and well 51-year-old man with signs

and symptoms of large bowel obstruction, with a one day history of

sudden severe upper abdominal pain and vomiting on a background

of complete constipation. Computed tomography revealed a large

bowel hernia through the epiploic foramen. He underwent open

release of the hernia to ﬁnd a redundant caecum requiring a right

hemicolectomy. Post-operatively he developed a small bowel obstruc-

tion resulting from herniation of the ileum under the right colon with

a local perforation which was treated with an extended right

hemicolectomy.

KUKADIA, JOGISHA, FOUAD KALDAS, Department of

General Surgery, University Hospitals of North

Midlands NHS Trust, Stafford, United Kingdom. Obtu-

rator hernia repair with biological mesh: A case

report and review of anatomy

Obturator hernia is a rare pelvic hernia, characterized by protrusion

of intra-abdominal viscera through the obturator foramen. There are

three anatomical stages of formation: ﬁrst with preperitoneal fat

entering the foramen, formation of the sac, then eventual herniation

of the viscera. These hernias predominantly occur in elderly females

and are associated with signiﬁcant morbidity and mortality. Its pre-

sentation is often vague with non-speciﬁc signs and symptoms which

pose a diagnostic challenge. While computed tomography (CT) pro-

vides deﬁnitive diagnosis, no single method of repair has been estab-

lished to date. Here, we present an 81-year-old woman with a one

week history of symptoms of small bowel obstruction whose CT con-

ﬁrmed an obturator hernia. Biologic materials are becoming popular

in hernia mesh repairs, but there has been no report of its application

to an incarcerated obturator hernia and its integrity in the face of an

anastomotic leak. This case report is one of the ﬁrst of its kind to

report such a repair. We review the clinical anatomy including CT ﬁnd-

ings and discuss the advantages of biological mesh over traditional

synthetic mesh.

LEE, HYEYEON, SOOJUNG KIM, YOUNGCHUN GIL,

HEEJUN YANG, Department of Anatomy, Gachon

University School of Medicine, Incheon, Republic of

Korea. Associations of multiple connections

between the ulnar and median nerves

Multiple interconnections between the median and ulnar nerves may

provide detours for afferent and efferent nerve conduction. We inves-

tigated the prevalence of interconnections and the associations

between them in 90 cadaveric upper limbs. Contribution of the lateral

cord to the ulnar nerve was found in 58.9% of upper limbs. This vari-

ation was associated positively with the contribution of C8 to the lat-

eral cord which occurred in 16.7%, negatively with the contribution of

C7 to the medial cord which existed in 12.2%, and positively with

ulnar innervation of the superﬁcial head of the ﬂexor pollicis brevis

which was found in 50.0%. Ulnar innervation of this muscle was also

associated positively with Riche-Cannieu anastomosis which occurred

in 50.0%. Antebrachial ulnar-median interconnections existed in

26.7% and were negatively associated with the C8 contribution to

the lateral cord. These associations may be related to unexpected

ﬁndings about median and ulnar conduction that are contrary to tradi-

tional anatomical teaching.

LI, LILY X., CHRIS P. HUBER, Department of Trauma

and Orthopaedics, West Middlesex University Hospital,

London, United Kingdom. An unusual cause for

locking of the knee

A 22-year-old man presented to our orthopaedic clinic with a painful,

locking right knee. He complained of pain on extension of the knee

associated with a palpable “clunking” sensation and an audible snap.

This was reproducible in the clinic. The rest of his knee examination

was normal. He denied any antecedent trauma and was otherwise ﬁt

and well. Plain radiography demonstrated a large bony protuberance

over the right proximal posteromedial tibia. Magnetic resonance

imaging conﬁrmed that this mass was a benign osteochondroma, and

the patient was listed for excision of the lesion. Intra-operatively the

bony swelling was found to be 5 cm in length with a cartilaginous

cap. It was discovered that his semitendinosus tendon overlay this

protuberance such that the tendon could glide over the bone whilst

lax in knee ﬂexion, but on gradual extension of the knee, the tendon

was stretched over the protuberance, increasing tension and so creat-

ing the sensation of locking. On further extension the stretched ten-

don would eventually slip laterally and inferior to the protuberance,

creating the snapping sound and sensation. The lump was completely

excised. Intra-operative testing of the semitendinosus tendon after

excision revealed normal tendon gliding without snapping. Subse-

quent histological analysis conﬁrmed osteochondroma. Follow-up of

the patient demonstrated resolution of knee symptoms and the full

range of normal knee movements.

LIGHTFOOT, REBECCA, PAUL REA, Laboratory of

Human Anatomy, School of Life Sciences, College of

Medical, Veterinary and Life Sciences, University of

Glasgow, Glasgow, United Kingdom.

Abstracts 969

Neurovasculature of the temporalis muscle for

orbital reanimation

Lagophthalmos is a major problem associated with facial nerve palsy

and can lead to blindness. Facial reanimation procedures for the orbit

are limited. The regional transfer of the temporalis muscle is a

dynamic surgical technique used to correct lagophthalmos and

restore orbital animation. To ensure a successful muscle transposi-

tion, a detailed knowledge of the intramuscular neurovasculature of

the temporalis is essential, but there is limited literature on this ﬁeld.

This study aimed to investigate the neurovasculature of the tempora-

lis for transposition to the outer canthus in eyelid reanimation. Cadav-

eric dissection of a single male cadaver was carried out, from which

two temporalis muscles and one deep temporal fascia were obtained

and divided into 28 segments in total. Ten sections from each tempo-

ralis and fascia segment were stained with haematoxylin and eosin to

identify the neurovascular pattern of the temporalis. A pattern of neu-

rovasculature was identiﬁed in which an abundance of arteries, veins

and nerves was observed in the temporalis muscles and fascia, espe-

cially in the segments of the inferior regions of the muscle tendon. It

can be concluded that the temporalis is an ideal candidate for orbital

reanimation due to its densely populated nature and proximity to the

surgical ﬁeld. An enhanced understanding of the intramuscular neuro-

vasculature is essential for selection of the optimum window of tem-

poralis for transposition to the outer canthus. Increased knowledge of

the anatomy of the temporalis muscle would aid the facial surgeon to

ensure the success of this procedure.

MCCLEARY, PAIGE, ADAM MANN, NINA NOGHREHKAR,

AQUIB NOORANI, SARA SULAIMAN, JAMES COEY, St

George’s International School of Medicine, Keith B.

Taylor Global Scholars Program, Northumbria

University, Newcstle, United Kingdom. The relation-

ship between knee menisci neovascularization

and self-assessment of knee functions

Inﬂammatory responses are initiated in both acute and degenerative

knee meniscal tears, inducing angiogenesis and bringing about repair.

Diagnosis of these lesions, however, is heavily dependent on clinical

examination and patient history, as routine imaging techniques are

resource-dependent. Our study proposes the use of ultrasound

assessment of neovascularization as an early clinical diagnostic

addendum for impaired knee functioning. Twenty-ﬁve asymptomatic

participants were selected at random to take part in this study. Partic-

ipants’ perception about their knee and associated problems was

assessed by Knee Injury and Osteoarthritis Outcome Score (KOOS).

With the knee ﬂexed at a 458angle, the lateral and medial menisci of

each participant were examined using a Sonosite Turbo ultrasound

machine, with a L38e 10-5MHZ transducer. Vascularization, if pres-

ent, was identiﬁed and conﬁrmed with Color Doppler imaging. Menis-

cal neovascularization was found in at least one side of each knee in

19/25 (76%) participants. Presence of vascularization signiﬁcantly

correlated with the subtotal scores obtained from the KOOS related

to pain, r520.513 [20.70 to 20.299], function, sports and recrea-

tional activities, r520.353 [20.580 to 20.118], and quality of life,

r520.435 [20.639 to 0.188]. The overall KOOS was also found to

be signiﬁcantly related to neovascularization, r520.352 [20.535 to

20.150] (all P<0.05). Knee meniscal neovascularization was found

to correlate with impaired daily functioning and pain experienced by

individuals. The results displayed a graded relationship, in which the

extent of neovascularization followed a decline in subjective knee

outcomes.

MATVEEVA, NIKI, DOBRILA LAZAROVA, MERI

PAPAZOVA, JULIJA ZHIVADINOVIK, BILJANA ZAFIROVA,

Institute of Anatomy, Faculty of Medicine, University

Ss. Cyril and Methodius, Skopje, Republic of

Macedonia. Relation of lumbosacral transitional

vertebra and degenerative spinal stenosis

The association of lumbosacral transitional vertebra (LSTV) pseu-

doarthrosis and degenerative spinal stenotic changes has been spor-

adically reported. The aim of the study was to examine the relation

between LSTV pseudoarthrosis and degenerative stenotic changes of

the nerve root canals. Thirty-ﬁve patients with low back pain and S1

nerve root radiculopathy who underwent MRI examination of the lum-

bosacral spine and were classiﬁed as positive for LSTV pseudoarthro-

ses were included in the study. Coronal (T1W1) and oblique MRI

sequences were added to the MRI investigation of the lumbar spine.

We found that the MRIs of the lumbar spine of all patients demon-

strated degenerative stenotic changes of the S1 nerve root canals at

the transitional level, and in seven patients at the adjacent proximal

level as well. Patients with unilateral LSTV pseudoarthrosis demon-

strated more severe degenerative stenotic changes. In conclusion,

we emphasize the relation of LSTV pseudoarthrosis and degenerative

stenotic changes of the nerve roots canals at the transitional level

and symptoms of S1 radiculopathy.

MATVEEVA, NIKI, NATASHA NAKEVA, MERI PAPAZOVA,

ACE DODEVSKI, BILJANA BOJADZIEVA, BILJANA

TRPKOVSKA, Institute of Anatomy, Faculty of Medicine,

University Ss. Cyril and Methodius, Skopje, Republic of

Macedonia. Morphologic alterations of sacra

associated with transitory lumbosacral state-

sacralization

Sacralization is the most frequent transitional state that may reﬂect

the biomechanics of load transmission and the range of movement at

the lumbosacral junction. The aims of the study were to identify mor-

phostructural characteristics of sacra that showed bony fusion to the

last lumbar vertebra (sacralization), to compare them with the normal

sacra and to analyze their biomechanical impact. Seventy-one dried

human adult sacra were divided into three groups: normal sacra with

ﬁve segments (35 specimens), sacra with ﬁve segments and acces-

sory articulating facets on their ala (17), and sacra with six segments

(19), with complete osseous fusion with the last lumbar vertebra. Lin-

ear dimensions and surface areas on their articular surfaces were

measured with the help of digital sliding caliper, medical tape (Micro-

pore), and a digital planimeter. In sacra with accessory articulations,

mid-ventral straight lengths were less, with more pronounced con-

cavity of the sacral curvature. The divergence of the superior arms

and the convergence of the inferior arms of their auricular surfaces

were less pronounced. The superior articulating facets were smaller,

coronally oriented and mostly ﬂat. In sacra showing bony fusion with

the L5 vertebra, the mid-ventral straight and curved lengths were

greater than in normal ones, and the superior articular facets were

placed closer to the sagittal plane and further from the sacral verte-

bral body.

MAYORDOMO, RAQUEL, ANA PEREZ PICO, FELIX

MARCOS TEJEDOR, JOS

E IGLESIAS SANCHEZ,

Department of Anatomy and Cellular Biology,

University Centre of Plasencia, Extremadura

University, Plasencia, C

aceres, Spain. Deformities of

forefoot are predominant in institutionalized

psychiatric patients

Forefoot deformities can affect walking and cause immobility in

elderly patients. In a population with special features such psychiatric

disorders and learning disabilities, forefoot deformities are more limit-

ing because there is the added difﬁculty of patients not being able to

describe their situation, ailments, and needs to healthcare professio-

nals. Few studies have addressed deformities and pathologies on the

feet of a population with psychiatric disorders, even though it has

been demonstrated that this population has a high level of postural

instability. This study shows the prevalence of deformities of the fore-

foot in two very different populations, a control population and

another population consisting of patients conﬁned in a psychiatric

institution. A study of the forefoot of 298 patients shows that in gen-

eral, deformities of this part of the foot are more frequent in psychiat-

ric patients. The most frequent deformity is hallux valgus in both

populations, followed by claw toes.

970 Abstracts

MITROUSIAS, VASILEIOS, ARISTEIDIS ZIBIS, KYRIAKI

BAXEVANIDOY, DIMITRIOS ARVANITIS, Department of

Anatomy, Medical School of Larissa, University of

Thessaly, Greece. Anatomical variations of the

foramen transversarium in cervical vertebrae:

Findings, embryological basis and clinical

signiﬁcance

This study aims to describe certain anatomical variations of the fora-

men transversarium of cervical vertebrae, and to determine their pos-

sible etiology and to explore their clinical importance. We examined

102 cervical vertebrae (C2–C7) from 17 different skeletons from the

collection of the Department of Anatomy. All foramina were measured

with digital callipers. The average size of the normal foramina was:

6.49 mm 35.74 mm on the right side and 6.65 mm 35.76 mm on

the left side. Regarding the variations, we found two cervical verte-

brae (1.96%), one C3 and one C6, in which the right foramen trans-

versarium was clearly smaller than that on the left. The exact

dimensions of these foramina were: 2.3 mm 32.5 mm on the right

side and 6.54 mm 38.0 mm on the left side in the ﬁrst vertebra and

2.8 mm 33.74 mm on the right side and 6.0 mm 37.5 mm on the

left side in the second one. We also observed double foramina in 14

vertebrae (13.72%). In seven vertebrae, the duplication was bilateral

(6.86%). Finally, we found one vertebra (0.98%) with triplication of

the foramen transversarium on the left side. Summarizing, ten out of

our 17 skeletons (58.82%) showed variations (extremely narrow –

11.76% or multiple foramina – 47.06%). The ﬁnding of hypoplastic,

duplicated, and triplicated foramina transversaria in unexpectedly

high rates raises questions about the integrity of the contained struc-

tures, the possibility of a different path for them, as well as the clini-

cal impact that the above may have.

MUSBAHI, AYA, Medical Student, University of

Glasgow, Glasgow, United Kingdom. Novel way of

teaching embryology to second year medical

students: Using analogies and mnemonics

Traditional teaching of embryology has been reduced in undergradu-

ate medical curricula or replaced by more clinically relevant teaching

of the subject. Students often ﬁnd this subject matter difﬁcult to

comprehend and learn for examinations. This study aimed to intro-

duce a novel way of teaching the subject. An embryology revision lec-

ture was delivered to 49 second year medical students approaching

end of term exams. The lecture was delivered using novel, humorous

analogies and new, easy to remember mnemonics describing the var-

ious stages of embryo development. Ten new analogies and mne-

monics were created for this lecture. Questionnaire-based data were

collected covering overall rating, knowledge covered, visual material,

enthusiasm, interactivity, communication, and structure. Students

were asked to rate the tutor on the above categories from 1 to 5 (5

being the best and 1 being poorest). Mean scores were calculated for

each session. The mean overall rating for student satisfaction was

4.65. Students made positive comments on the feedback forms

regarding the mnemonics and analogies used. It is concluded that

students were highly satisﬁed with the teaching techniques used and

that teaching embryology can be facilitated by novel analogies and

mnemonics without compromising student satisfaction.

NAKEVA-JANEVSKA, NATASHA, NIKI MATVEEVA,

BILJANA ZAFIROVA, BILJANA BOJADGIEVA, BILJANA

TRPKOVSKA, Department of Anatomy, Faculty of

Medicine, UKIM, Skopje, Macedonia. The structural

components of the body in Macedonian

teenagers

Establishing the structural components of the body (bone, muscle

and fat) is of great signiﬁcance in sport orientation and selection and

in studying the biophysical development in young people. On the

basis of manifested anthropometrical variables, structural compo-

nents of the body were deﬁned in Macedonian children at the age of

16 years who lived in the Skopje area in approximately equal socio-

economical conditions. The material comprised personal ﬁles of 200

Macedonian examinees 16-years old, 100 males and 100 females.

For quantitative determination of the absolute values of: bone (O kg),

muscle (M kg), fat tissue (D kg), the dynamic anthropometric method

of J. Mateigka has been applied. At the age of 16 years the absolute

values of bone mass (O kg) was 10.88 (16.98%) in males and 8.09

(14.38%) in females. The sex difference was highly signiﬁcant

(P<0.001) and was in high correlation with the diameter of the knee

joint in both sexes. The muscle mass (M kg) was 36.86 (56.82%) in

males and 30.46 (53.78%) in females. The sex difference was again

highly signiﬁcant (P<0.001) and was in high correlation with the

upper arm circumference in males (0.92) and with the forearm cir-

cumference in females (0.92). The fat structural components (D kg)

was 7.60 (10.72%) in males and 7.73 (13.32%) in females. There

were no signiﬁcant differences between males and females, and there

was no correlation with measured anthropometric parameters.

PAPAZOVA, MARIJA, DOBRILA LAZAROVA, JULIJA

ZHIVADINOVIK, NIKI MATVEEVA, ACE DODEVSKI,

BILJANA TRPKOVSKA, Institute of Anatomy, Medical

Faculty, Skopje, Macedonia. Anterior communicat-

ing artery: Anatomy and clinical signiﬁcance

The anterior communicating artery (ACoA) is an essential component

of the cerebrovascular system with great morphologic and clinical sig-

niﬁcance resulting from the importance of the structures which it sup-

plies as well as from the polymorphism of the pathological processes

which affects this artery. The investigation of the anatomical charac-

teristics of the ACoA were made on 133 human brains with no frank

cerebrovascular pathology, from both sexes at age 23 to 68 years.

Some of the specimens were fresh and some were ﬁxed. The length

of the ACoA varied from 0.6 to 7.6 mm, with mean value 2.6 mm.

The diameter of the ACoA ranged from 0.5 to 5.1 mm, with mean

value 2.0 mm. The classical ACoA as a single transverse anastomotic

channel was found in 54% of the cases. The following morphological

variations were found on the ACoA: hypoplasia in 1%, double ACoA

in 4%, the ACoA with conﬁgurations like the letters Y, X, H, and O

were observed in 29% of the subjects. In 4%, a fusion was observed

between the two anterior cerebral arteries instead of an ACoA. We

conclude that each ACoA is unique, and knowledge of anatomical

characteristics of the ACoA is useful in teaching anatomy, but also for

clinicians in ensuring safe surgery and interventional radiology.

PAPAZOVA, MARIJA, SUNCIC PETROVSKA, NIKI

MATVEEVA, JULIJA ZHIVADINOVIK, ACE DODEVSKI,

BILJANA ZAFIROVA, Institute of Anatomy, Medical

Faculty, Skopje, Macedonia. Morphological charac-

teristics of the middle cerebral artery

Cerebral circulation, especially arterial, in recent decades has

attracted the interest of anatomists and clinicians. The aim of this

study was to determine the morphological and topographic character-

istics of the middle cerebral artery (MCA). Investigations of morpho-

logical and topographic characteristics of the MCA were performed in

the Institute of Anatomy. The examination was made on 50 speci-

mens of the human brain, ﬁxed in 10% formalin. The average diame-

ter of the proximal segment M1 ranged from 2.4 to 4 mm, and the

average length was 15 mm. The average diameter of the distal seg-

ment M2 ranged from 2.2 to 3.9 mm. The ending of the distal seg-

ment M2 was singular in 15% of cases. In 52% of cases, it divided

into two terminal branches, dorsal, and ventral, and in 24% of cases

in three terminal branches (dorsal, ventral, and medial). There were

four terminal branches (dorsal, ventral, and two medial) in 9% of

cases. A duplication of the MCA was registered in 0.7–2.7% of cases.

An accessory MCA brain artery was present in 0.3–2.7% of cases.

PARK, JIN SEO, Department of Anatomy, Dongguk

University School of Medicine, Gyeongju, Republic of

Korea. Advanced sectioned images of whole

female body and its surface models

Abstracts 971

The aim of this research was to present high-quality sectioned images

of a whole female body which would be helpful in creating an atlas,

virtual dissection, and various applications for medical education and

clinical trials. In addition, the authors sought to demonstrate the

applicabilities of sectioned images. A female cadaver was sectioned

serially using the cryomacrotome and photographed to make the sec-

tioned images. Structures in the images were segmented to produce

segmented images in Photoshop. The sectioned and segmented

images were stored in self-developed browsing software. Based on

the segmented images, surface models were created on commercial

software and saved as PDF ﬁles. High-quality sectioned images of the

female body were taken (intervals, 0.2 mm or 1 mm; pixel size,

0.1 mm; color depth, 48 bit color). In the images obtained, very

small and complicated structures could be identiﬁed in the color of

the living body. To ascertain the applicability of the images, the

browsing software including sectioned and segmented images and

the PDF ﬁle containing the surface models. The sectioned images and

surface models produced during this research will prove to be a useful

source for medical software. All data generated are available free of

charge.

PARMAR, ANAMIKA, GLENN WAKLEY, Centre for

Comparative and Clinical Anatomy, University of

Bristol, Bristol, United Kingdom. Standing in practi-

cal anatomy teaching increases student

interaction

Student interaction with cadaveric specimens enhances the educa-

tional value of didactic anatomical teaching. Anatomy teachers

noticed students were more proactive during anatomy practical

classes when standing rather than when sitting: we aimed to quantify

the effects that sitting and standing have on student behavior and

learning. Ethics approval was granted to observe 68 dental under-

graduates (split into six teaching groups) over two practical anatomy

classes at the University of Bristol. Student behavior was observed in

a crossover study where three groups were seated and three groups

were standing during practical anatomy classes. After each practical

class, students completed a survey to evaluate their opinions regard-

ing their own learning. This study revealed that students were more

interactive when standing during practical anatomy classes compared

to those seated. Results from observations showed that standing stu-

dents positioned themselves signiﬁcantly closer to cadaveric speci-

mens (P50.003) and handled specimens 11 times more than those

seated (although this was not statistically signiﬁcant). In contrast,

seated students made notes more frequently compared to standing

students (P50.006). The survey did not show signiﬁcant differences

in the seated and standing students’ perceived difﬁculty of the practi-

cal or perceived improvement in understanding the anatomical topic.

This may be due to compensatory activities of the teacher for stu-

dents who were further away and appeared less engaged. Our results

highlight the wider impact that room layout of practical anatomy

classes has on student behaviors. Furthermore, educational institu-

tions may be obliged to consider environmental factors more seri-

ously when designing practical anatomy classes.

PATRON, VINCENT, CL

EMENT ESCALARD, JULIE

BERKAOUI, ANNE-LISE ROUSSEL, MARTIN HITIER,

Department of Anatomy, Chu De Caen, France. Ana-

tomical and radiological study of the anterior

olfactory cleft

The olfactory cleft has garnered interest as the advent of endoscopic

skull base surgery. Its precise anatomy, however, is still partially

unknown. According to Rouvie`re, an “ethmoidal foramen” is located

in its anteromedial part and contains a process of the dura mater. In

a more lateral and anterior location, a second foramen, the

“cribroethmoidal foramen,” contains the anterior ethmoidal nerve.

The aim of this study was to verify the existence of these elements

and to establish landmarks for surgery. We carried out an anatomical

and histological study of eight olfactory clefts in four cadavers using

both endonasal endoscopic and endocranial dissection. Six more

cadavers were studied radiologically by CT-scan. An ethmoidal and a

cribroethmoidal foramen were found in, respectively, 100% and 75%

of subjects. Their mean lengths were, respectively, 4.1 mm and

1.8 mm. They were located respectively at a mean of 5.3 and

5.8 mm from the anterior ethmoidal artery. The radiological study

allowed the identiﬁcation of the ethmoidal foramen in all subjects and

to establish landmarks to allow its radiological identiﬁcation. CT-scan

did not allow clear identiﬁcation of the cribroethmoidal foramen. Our

anatomical study demonstrates the existence of both foramina. The

ethmoidal foramen clearly represents an area of least resistance in

the anterior part of the olfactory cleft, readily identiﬁable on routine

CT-scan. The ethmoidal foramen could predispose to anterior skull

base cerebrospinal ﬂuid leaks and meningoceles.

PORZIONATO, ANDREA, MARIA MARTINA SFRISO,

VERONICA MACCHI, LUCIA PETRELLI, ALEX PONTINI,

VINCENZO VINDIGNI, RAFFAELE DE CARO, Section of

Human Anatomy, Department of Molecular Medicine,

University of Padova, Italy. Development of biologi-

cal scaffolds through decellularization of

human arteries and veins

The objects of this study were to develop a new type of biological

scaffold through decellularization of human arteries/veins and to eval-

uate its integration capability in a rabbit model. Human blood vessels

were sampled from donated bodies and amputated limbs. Artery/vein

scaffolds were obtained through a detergent-enzymatic decellulariza-

tion protocol. Morphological and ultrastructural analyses, together

with DNA quantiﬁcation, were performed. Human artery and vein

scaffolds were then implanted at femoral vessels in four rabbits, and

were maintained for 2 weeks. Perfusion analyses of the implanted

scaffolds were tested during the above period to verify the occurrence

of possible thrombogenic events. After sacriﬁce, structure and ultra-

structure of implants were analyzed. The decellularization process

was effective, resulting in biologic scaffolds free from cell materials

and mechanically suitable for surgical sutures. The collagenic compo-

nents of the arteries and veins were not altered by the use of deter-

gents and enzymatic solutions, preserving the native three-

dimensional organization around the vascular channels, as also dem-

onstrated by TEM analyses. The preservation of the elastic ﬁbers was

also conﬁrmed. After implant in rabbits, the human artery and vein

scaffolds were completely biointegrated and partly recellularized by

host cells after two weeks. No rejection or inﬂammation were

observed. Blood perfusion appeared to be satisfactory in in vivo anal-

yses and microscopical study conﬁrmed the absence of thrombotic

events. New biological vascular scaffolds derived from artery/vein

decellularization could be useful for regenerative medicine when small

vessels are needed and autologous vessels are not sufﬁcient.

ROMANI, MICHAEL, GEORGIOS MIHALOPULOS,

ANDREW SHLIMUN, JAINESH PATEL, MICHAEL TOMANI,

MAXIMILIAN SOLOW, RYAN TOEWS, SARA SULAIMAN,

JAMES COEY, St. George’s International School of

Medicine, Keith B. Taylor Global Scholars Program at

Northumbria University, Newcastle, United Kingdom.

Ultrasound assessment of patellar ligament

length in athletes and non-athletes

Determining the length of the patellar ligament is important both clin-

ically and in research where it has been linked to various knee pathol-

ogies including patellar dislocation and instability. Within the

published literature, plain ﬁlm radiography, magnetic resonance

imaging and computerized tomography have been used to study/

assess the patellar ligament. Ultrasound has been proposed as a non-

invasive, low-cost alternative but there is currently no consensus as

to the techniques used and questions remain about inter-operator

variability. This study aims to evaluate variations in patellar ligament

length (PLL) between athletes and non-athletes and address inter-

operator variability through the use of ultrasound. Each ligament was

measured following a modiﬁed form of a recently published technique

by two investigators, blinded to each other’s results and using a GE

LOGIQ e system with a 12 L-RS transducer. Once the technique was

clearly deﬁned, there was no statistically signiﬁcant difference

between the measurements obtained from the two investigators.

972 Abstracts

Average PLL was found to be 47.1 67.8 mm and 45.164.0 mm in

athletes and non-athletes respectively with no signiﬁcant difference

in means between the two groups regardless of limb dominance, sex

or height. The difference in the PLL between the two limbs was signif-

icantly affected by body mass index value (H(2) 59.577, P50.008),

speciﬁcally between the normal and overweight groups (P50.007).

Previous work has related patellar ligament length to force output

rather than age but our ﬁndings show no signiﬁcant correlation

between the two. This study validates a pre-existing ultrasound tech-

nique with speciﬁc modiﬁcations to control inter-operator variability.

SAGA, TSUYOSHI, YOKO TABIRA, KOICHI WATANABE,

JOE IWANAGA, AYANO SAKURAGI, KOH-ICHI YAMAKI,

Department of Anatomy, Kurume University School of

Medicine, Asahi-Machi, Kurume, Fukuoka, Japan.

Rediscovery of the musculus cricotrachealis

The musculus cricotrachealis is a small muscle on the front of the lar-

ynx. In 1871, Macalister reported in the publication titled Additional

Observations on Muscular Anomalies in Human Anatomy of the Trans-

actions of the Royal Irish Academy that he had once found the mus-

culus cricotrachealis passing from the lower border of the anterior

part of the cricoid cartilage, below the origin of the cricothyroid mus-

cle, and inserting into the ﬁfth ring of the trachea; it passed behind

the isthmus of the thyroid. In 1959, Manjome studied many different

laryngeal muscles in Japanese individuals but found no musculus cri-

cotrachealis. To the best of our knowledge, no reports about this

muscle were published thereafter. In 2014, we found several musculi

cricotrachealis in Japanese cadavers donated to the student gross

anatomical course. A typical musculus cricotrachealis was identiﬁed

in 6 of 15 cadavers; the origin in all cases was the lower border of

the anterior part of the cricoid cartilage, and the muscle inserted into

the second or third ring of the trachea. The width of this muscle

ranged from 1.4 to 4.1 mm, and the length ranged from 8.2 to

20.8 mm. A small musculus cricotrachealis was observed in front of

the ceratocricoid ligament in 2 of 15 cadavers; the origin of this mus-

cle was the same as that described above but the muscle inserted

into the ﬁrst ring of the trachea. The musculus cricotrachealis may

not have an important function but may be an important muscle with

respect to phylogeny.

STOKHOLM, CAMILLA, JIM PRICE, CLAIRE F. SMITH,

Brighton and Sussex Medical School, Brighton, United

Kingdom. Understanding medical students’

approaches to learning anatomy

In recent years there has been international debate concerning how

students learn anatomy. The rapid increase in scientiﬁc knowledge

has put pressure on the place of anatomy within the medical curricu-

lum, as well as on the design and structure of anatomy courses. In

this regard, relatively little is known about what medical students

want from an anatomy course or how they learn it. To assess stu-

dents’ learning approach and perceptions of anatomy, we adminis-

tered a Likert-style questionnaire to 82 ﬁrst year medical students on

a bachelor 5-year programme in the United Kingdom. Analysis of the

Anatomy Learning Experience questionnaire revealed a predomi-

nantly positive attitude toward anatomy and the dissection room,

most not seeing the latter as a daunting environment and also valu-

ing cadaveric dissection. Additionally a majority of students felt that

reading textbooks was a useful way of learning. Further to this, anal-

ysis of the Approaches to Studying Inventory for Students (ASSIST)

revealed a striking preference for the deep and strategic approaches

with 46.3 and 51.2% of students preferring them respectively. Con-

versely, only 2.4% were found to prefer a predominantly surface

approach. We conclude that traditional ways of learning anatomy

remain important for students, including textbooks and cadaveric dis-

section. Furthermore, any curriculum reform should take into account

that there is a strong preference for deep and strategic approaches

from an early stage in the course. This has implications for curriculum

reform to support these learning approaches, such as the implemen-

tation of the “ﬂipped classroom” model.

STONELAKE, STEPHEN, DOMINIC POWER, JOANNE

WILTON, Department of Anatomy, University of

Birmingham, United Kingdom. Transfer of triceps

nerves to a vascularized sensory conduit for re-

innervation of intrinsic hand muscles for

patients with lower cervical cord injury: A

cadaveric feasibility study

Re-innervation distances to intrinsic hand muscles in lower cervical

cord injury remains a challenge. Unlike recently described nerve

transfers to hand extrinsics, direct suturing to motor nerves at the

mid-arm leaves insufﬁcient time to recover denervated intrinsic

muscles of the hand. We explored whether the sensory fascicles of

the ulnar nerve could be used as a vascularized conduit for triceps

motor axons that are still under voluntary control. The dorsal and

superﬁcial sensory branches of the ulnar nerve could then be anasto-

mosed to the deep motor branch. Re-innervation to intrinsic hand

muscle end-plates, still attached to the spinal cord below the level of

cord injury (therefore not having undergone Wallerian degeneration),

might potentially be achieved. Using a single male cadaver, triceps

nerves were dissected posteriorly. The triangular interval was dis-

sected medially and triceps nerves assumed to be transferred through

this space onto the ulnar nerve. The distance from this point to the

intrinsic hand muscles was then measured. We found that nerve

lengths from their origin to the muscle bellies of the long, medial and

lateral heads of triceps were 77, 85, and 60 mm, respectively. The

distance between the point of anastomosis on the ulnar nerve and

hand intrinsic muscles was between 490 and 510 mm, giving an

innervation time of 16–17 months. In conclusion, this study conﬁrms

the anatomical feasibility of transferring triceps nerves through the

triangular interval to the ulnar nerve. Re-innervation times, in theory,

are not unreasonably longer compared with transfer procedures for

extrinsic hand muscle restoration.

SULAIMAN, SARA, JAMES COEY, Department of Applied

Sciences, Faculty of Health and Life Sciences,

Northumbria University, Newcastle, United Kingdom.

Effect of peer-teaching in learning and teaching

anatomy: Pilot study of the effect of introducing

tutor training sessions

The use of peer-teaching has been well recognized as an effective

tool within medical school curricula. Published literature provides

some evidence of its advantages for both the tutor and the tutee.

Often, in practice the planning and implementation of the peer-

teaching sessions are left to the tutors with little or no guidance. This

study aims to (i) investigate the effect of participation in peer-

teaching on tutors’ anatomical knowledge with the application of a

training program, (ii) evaluate the perceptions of peer-tutors and

tutees of the effectiveness of the peer-teaching program. Ten term-2

medical students took part in three training sessions focusing on the

clinical applications of the anatomy of the upper limb, thorax and

abdomen prior to their peer-teaching sessions, which included 23

tutees. The questionnaire-based assessment included: tutors’ appre-

ciation of the relative anatomy assessed by 30 clinical vignettes,

tutors’ and tutees’ perception of the peer-teaching experience meas-

ured by 23 and 12 questions, Likert-type-scale questionnaires

respectively. Tutors’ perception correlated favorably with respect to

improving their teaching abilities (mean scores of 3.5/5.0). The peer-

teaching sessions were well received by the tutees, providing them

with a student-perception and an alternative explanation of anatomi-

cal concepts (mean score of 3.7/5.0 and 3.8/5.0 respectively). Peer-

teaching provides students with not only an opportunity to reinforce

their anatomical knowledge, but also allows them to develop essential

teaching skills and further develop various competencies. Creating a

peer-teaching program allows for a clear learning strategy which can

be implemented, evaluated, and improved.

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URK, ESRA KOYUNCU,

MEHMET ALI MALAS, Department of Anatomy, Faculty

Abstracts 973

of Medicine, Suleyman Demirel University, Turkey.

Development of fontanelles during the fetal

period

A newborn baby has six fontanelles: the anterior and posterior, two

mastoid, and two sphenoid. The anterior and posterior fontanelles

close by 24 and 3 months of age, respectively. According to our liter-

ature search, there is no study about the shape and closing time of

the mastoid and sphenoid fontanelles. A large fontanelle or delayed

fontanelle closure may be caused by achondroplasia, congenital

hypothyroidism, Down syndrome, or rickets. Craniosynostosis and

abnormal brain development are associated with a small fontanelle or

early fontanelle closure. The present study aims to describe the nor-

mal development and classiﬁcation of the fontanelles and their

shapes during gestation. We examined 40 fetuses between 9 and 40

weeks of gestation with no external or internal pathology or anomaly.

Signed informed consent to use the fetuses for research purposes

was obtained from the families. Anatomical dissection exposed the

fontanelle. Fontanelles were classiﬁed by their shape, then photo-

graphed and their areas measured with the Netcad 5.1 program. Dur-

ing the fetal period, all of the anterior fontanelles were observed to

be open. However, the posterior, mastoid and sphenoid fontanelles

were closed in 30%, 42.5%, and 27.5%, respectively. We observed

that the anterior fontanelles were rhomboid-shaped in 90%, the pos-

terior fontanelles were triangular-shaped in 86%, the mastoid fonta-

nelles were triangular-shaped in 73%, and the sphenoid fontanelles

were irregularly shaped in 34%. The ﬁndings of this study will be of

interest to clinicians in pediatrics, pediatric neurosurgery, and

obstetrics.

SWAMY, MEENAKSI, ROGER SEARLE, School of

Medicine, Pharmacy and Health, University of

Newcastle, Newcastle, United Kingdom. Evaluation

of body painting as a learning gap in anatomy

and clinical examination session

Body painting is reported as a fun learning activity and a useful tool for

learning anatomy. The aim was to introduce body painting in the anat-

omy and clinical examination of the shoulder session at Newcastle Uni-

versity for enabling students to better relate anatomy learned to

clinical skill examination and to obtain students’ feedback. Thirty medi-

cal students on the graduate entry MBBS programme participated. Stu-

dents body painted skeletal landmarks around the shoulder joint on

their peers in groups of two for ﬁfteen minutes. Body painting was used

as ﬁller interspersed between anatomy and clinical examination of the

shoulder joint. Students completed a feedback questionnaire with

questions rated using ﬁve point Likert scale (strongly disagree to

strongly agree). The majority (83%) found the experience interesting

and would like to have similar sessions for future teaching; 69% found

it helped their understanding of anatomy; 90% felt that sufﬁcient time

was allowed and none of them felt that the technique was difﬁcult;

90% did not ﬁnd the session embarrassing. Some of the comments

were that it is “really helpful as a memory aid,” “more bright vivid col-

ors,” “doing the muscles could also be useful,” “someone to check after

they have painted.” We conclude that body painting can be used to ﬁll a

learning gap which could facilitate experiential learning of surface anat-

omy and aid in visualizing structures during clinical examination of the

shoulder joint. It is useful as a visual aid and an interesting tool to reit-

erate clinical anatomy knowledge.

TABIRA, YOKO, TSUYOSHI SAGA, KOICHI WATANABE,

JOE IWANAGA, KEIKO KAJI, KOH-ICHI YAMAKI,

Department of Anatomy, Kurume University School of

Medicine, Fukuoka, Japan. Muscle ﬁber types of

triceps surae muscle demonstrated by immuno-

histochemical staining in formalin-ﬁxed

cadavers

We studied types of muscle ﬁber and muscle structure of the triceps

surae muscle (TSM) in formalin-ﬁxed cadavers to clarify the charac-

teristics of the TSM by gross anatomical and histological examina-

tions. Five right lower limbs of male cadavers from the anatomy

course of our laboratory were included in this study. The TSM com-

prises the medial gastrocnemius (MG), lateral gastrocnemius (LG),

and soleus (SOL) muscles. The SOL has a unique architectural feature

characterized by a bipennate (BP) muscular portion on its anterior

surface. Therefore, we divided the SOL into the medial BP portion and

lateral BP portion, and analyzed each portion. The muscle ﬁbers were

categorized into slow and fast ﬁbers by immunohistochemical stain-

ing. The MG and SOL were unipennate muscles. The LG and BP were

bipennate muscles, which contained an intramuscular tendon as

shown by gross anatomical observation. In these ﬁve portions, the

MG had a higher number of the fast-type than the slow-type of mus-

cle ﬁbers. The LG had the same ratio of slow to fast types of muscle

ﬁber. The SOL and BP had a higher number of the slow type than fast

type of muscle ﬁber by histological examination. We note that previ-

ous studies of fresh cadavers and/or biopsies have shown that the

MG and LG have a higher proportion of fast ﬁbers than the SOL mus-

cle, which is similar to our results. However, our results suggest that

the MG and LG are dissimilar in the arrangement of muscle ﬁbers and

types of muscle ﬁber.

THOMPSON, KRISDTJAN, HENRY YOUNG, Mercer

University School of Medicine, Savannah, Georgia,

United States of America. Student performance in

and perception of gross anatomy in varied cur-

ricular material organization

The ﬁrst and second year curriculum at Mercer University School of

Medicine provides students with an opportunity to learn the subject

material in a problem-based learning (PBL) case format. The muscu-

loskeletal phase provides students with their ﬁrst gross anatomy lab-

oratory dissection experience. This study looks at student

performance when one group of students followed a case order that

paralleled the laboratory dissection sequence (Dissection) compared

to that of one which did not (Traditional). This study also evaluated

student perception of their learning experiences in the anatomy labo-

ratory. Students in the Dissection group (n559) scored a gross anat-

omy average of 77.82 and an overall phase average of 78.40.

Students in the Traditional group (n546) had a gross anatomy aver-

age of 79.63 and an overall Phase average of 79.74. The results indi-

cate that the case order presentation does not signiﬁcantly alter the

overall student performance within the discipline (P50.371) or the

phase (P50.368). Seventy-one out of the 105 students participated

in the survey assessing their perception of the learning experience

within the phase. Students felt the laboratory was helpful in learning

the phase material and that they would prefer to dissect in the same

order as the PBL cases were presented. Those students within the

Dissection group felt more prepared for laboratory experiences com-

pared to their Traditional order counterparts. We conclude that the

order of case presentation does not have an effect on student per-

formance in the discipline or examination as a whole.

TRPKOVSKA, BILJANA, DOBRILA LAZAROVA, MARIJA

PAPAZOVA, NATASA NAKEVA, NIKI MATVEEVA, BILJANA

ZAFIROVA, ACE DODEVSKI, Department of Anatomy,

Faculty of Medicine, UKIM, Skopje, Macedonia.

Anthropometrical characteristics in 3-year-old

children

Growth and development are essential biological characteristics of

each individual and can be described by certain anthropological

parameters that can be used as indicators of growth and assessment

of obesity in preschool children. We analyzed two groups of healthy

preschool children from kindergarten aged 3 years. The ﬁrst group

was 90 boys and the second was 80 girls. The study included ten var-

iables: body weight and height, length of arm, leg length, head cir-

cumference, chest circumference, abdomen circumference, diameters

of knee and elbow and BMI. The research was conducted according to

International Biological Program methods. The research showed that

there are sex-differences in some parameters, slightly higher in boys

but they were not signiﬁcant. Three-year old boys had body weights

of 18.7 62.8 kg, heights of 101.1 65.2 cm, and BMI of 18.3 6

2.5 kg/m

. These parameters in girls were body weight 18.4 64.4 kg,

height 103.3 66.6 cm, and BMI 17.3 63.3 kg/m

. The results

974 Abstracts

obtained can be used to monitor levels and trends of obesity and to

detect deviations in growth in preschool children.

VAGHELA,KALPESH,LEEPARKER,DAVOUDKHODATARS,

STEPHAN GRECHENIG, WOLFGANG GRECHENIG,

Department of Trauma and Orthopaedics, St

Bartholomew’s Health NHS Trust, London, United

Kingdom. Is it possible, or wise, to undertake

minimally-invasive plate osteosynthesis of the

medial distal femur?

In situations where there is extensive comminution of a distal femoral

fracture, it may be desirable to offer both stable lateral and medial

buttresses to enable fracture healing. In this situation minimally-

invasive plate osteosynthesis (MIPO) techniques can minimize soft

tissue stripping thus preserving blood supply and aiding fracture heal-

ing. We undertook a cadaveric anatomical study to investigate the

safe positioning of a submuscular locking plate (AO/Synthes 9-hole

LCP) using a MIPO technique on the medial distal femur of ten

randomized cadaveric femora, noting the proximity of the plate and

its locking holes to the neurovascular bundle on the medial side of

the thigh. We found that the safest location for plate positioning was

on the anteromedial distal femur in the 1–3 o’clock position, staying

anterior to the adductor longus tendon. The average distance of the

perforator branching off into the vastus medialis oblique muscle was

13 cm from the joint line where the perforator was seen to cross the

plate after the overlying soft tissues were dissected. In addition, we

found it was safe to use plates that were <25 cm in length to be well

distal to the site where the femoral neurovascular bundle crosses the

femur from anterolateral to medial toward the groin. We conclude

that MIPO plate position in the distal medial femur is safe in the 1–3

o’clock position anterior to the adductor longus tendon. Moreover,

using plates <25 cm long avoids the femoral neurovascular bundle.

VATANSEVER, ALPER, NESE CETIN, ASAAD ALSHOUK,

HASAN ILGAZ, MUSTAFA SARGON, Department of

Anatomy, Faculty of Medicine, Hacettepe University,

Ankara, Turkey. Bilateral double layers of quadra-

tus plantae muscle: A case report

The quadratus plantae (ﬂexor accessorius) muscle originates by two

heads and inserts into the tendons of the ﬂexor digitorum longus

muscle. Variations of the muscle are very common, especially of the

medial head. In this case report of a cadaveric dissection, we describe

the right and left quadratus plantae muscles having double layers:

superﬁcial and deep. The subject was a formalin-ﬁxed 45-year-old

male with no surgical interventions on the feet. After removal of the

skin and superﬁcial fascia of the sole and the plantar aponeurosis, we

reﬂected the ﬂexor digitorum brevis muscle from proximal to distal to

demonstrate the quadratus plantae muscle more clearly. We found

that the superﬁcial layer of the quadratus plantae inserted into the

superﬁcial aspect of the ﬂexor digitorum longus tendon and the deep

layer of the muscle inserted into the deep side of this tendon. Exami-

nation of studies reported in the literature showed that the insertion

of the muscle to different aspects of the ﬂexor digitorum longus ten-

don was common. We found no previous reports, however, demon-

strating bilateral quadratus plantae muscles having double layers.

VATANSEVER, ALPER, SEDA UYGUN, BURCE OZGEN,

DENIZ DEMIRYUREK, Department of Anatomy, Faculty

of Medicine, Hacettepe University, Ankara, Turkey.

Relationships between nasal septal deviation

and volume of paranasal sinuses: A retrospec-

tive study

Many people have a nasal septal deviation and its detection is impor-

tant in surgical planning. Surgeons have to plan the operative meth-

ods for each patient and also need to be aware of septal deviation.

Many factors may lead to nasal septum deviation. We aim to deter-

mine whether nasal septal deviation is correlated with the volume of

the paranasal sinuses using CT images. In this study, we examined a

total of 30 patients: 15 male, 15 female. We quantiﬁed CT images

and evaluated total paranasal sinus volume using Osirix software.

The volume of right paranasal sinuses was 34.20 69.96 cm

for

women and 44.969.20 cm

for men. The volume of left paranasal

sinuses was 34.17 69.45 cm

for women and 46.48 67.03 cm

for

men.

VERGARA, MARIA ELENA, SEBASTI

A LAZA, MARIE

POUMAIRAC, ALEJANDRA NEIRREITER, MARCOS

TAZANO, PABLO CABRAL, JAUN PABLO GAMBINI,

ALEJANDRA CASTILLO, Departamento De Anatom

ıa,

Facultad De Medicina, Universidad De La Rep

ublica,

Montevideo, Uruguay. Cadaver preservation using

gamma rays

Based on experience in the food industry with radiopreservation using

gamma rays, methods of sterilization by ionizing radiation for pre-

serving cadavers were explored. A cobalt gamma ray source was

used. Twelve kidneys from fresh adult cadavers were harvested

within 12 hr of death. They were placed in plastic bags with double

heat sealing. A Gamma Chamber 4000 A was used to irradiate the

material in a consistent manner. Once ionized, the tissue was

removed from the ionizing source and stored in the dark and below

308C. After a month, a sample was analyzed for microbial ﬂora. The

result was negative. This study was conducted between 10 Septem-

ber and 14 October 2014. No deterioration was observed in the mate-

rial with respect to the macroscopic appearance and the presence of

microbial ﬂora. We conclude that the appropriate use of gamma rays

is suitable for the preservation of small cadaveric samples for at least

1month.

VISAGAN, RAVINDRAN, Department of Anatomy,

University of London, London, United Kingdom.

Uncovering the neuroanatomical secrets of the

sistine chapel

Between 1508 and 1512, Michelangelo Buonarroti, architect, painter,

anatomist and engineer, was commissioned to paint the inspiring

frescoes on the ceilings of the Sistine Chapel in Rome. Greater than

500 years after this feat, a stirring among anatomists and art schol-

ars has surfaced. Was Michelangelo concealing what he believed to

be the gift of cerebral intellect he had received from his creator?

Often neglected is that Michelangelo, among other things, was an

exceptional student of anatomy. He performed detailed cadaveric and

animal studies, performing his own public dissections aged 18 and

producing a text on medical anatomy. This review, considers two fres-

cos The Creation of Adam and the Separation of Light From Darkness

in the Sistine Chapel. In the former, an anatomically accurate image

of the human brain is concealed in the ﬁnal four panels. Neuroana-

tomical structures including the sulci, brain stem, basilar artery, pitui-

tary gland and optic chiasm have been mapped onto the fresco.

Some emotions conveyed in the piece are even argued to represent

neuroanatomical correlates of functional imaging. The anatomy of

pituitary, pons, and medulla overlaid on this piece are a recurring

theme in another fresco. In the Separation of Light From Darkness,

God’s neck is anatomically distorted and this has been proposed to

represent a ventral view of the brainstem, perisellar, and chiasmal

areas concealed within the anterior neck. This fresco is of iconic

importance, signifying the beginning of creation. The concealed neu-

roanatomy reported in the literature, its accuracy and controversies

are explored and reviewed.

VISAGAN, RAVINDRAN, JAMES BATES, Department of

Anatomy, University of London, London, United

Kingdom. Submandibular tiger country: Revisit-

ing variations of the course of the marginal

mandibular nerve in adult cadavers

Abstracts 975

The objective of this cadaveric study was to evaluate the surgical

anatomy of the marginal mandibular branch (MMB) of the facial

nerve. Due to its location, the nerve is susceptible to damage during

a variety of surgical procedures resulting in salivary incontinence and

aesthetic impairment. Such damage may be sustained, for example,

in cervical surgery, parotidectomy, open reduction of mandibular

angle fractures, rhytidoplasties, and other interventions in the sub-

mandibular triangle. The authors dissected 12 hemifaces and param-

eters of the MMB including its source, branchings, and relationship to

the lower border of the mandible (LBM) and to the facial artery and

vein were recorded. All 12 nerves dissected originated from the infe-

rior border of the parotid gland and 100% had a single branch at ori-

gin. Along the course, 25% further divided into two branches. A

quarter of the nerves lay directly along the LBM but the remaining

75% were all inferior to the LBM with none in this series coursing

superior to the LBM. When the MMB or, the inferior division of the

MMB, was inferior to the LBM, the mean distance from the LBM was

3.9 62.03 mm. All of the MMB divisions in this series were superﬁcial

to the facial artery and vein. Our ﬁndings add to the literature and

debate about variation in the course of the MMB. Traditionally, a 2 cm

infra-mandibular incision is advised in most surgical texts.

ZAFIROVA BILJANA, NIKI MATVEEVA, DOBRILA LAZAROVA,

NATASA NAKEVA, MARIA PAPAZOVA, BILJANA TRPKOVSKA,

ACE DODEVSKI, Department of Anatomy, Faculty of

Medicine, UKIM, Skopje, Macedonia. The meaning of

some anthropometrical indices in a child

population

Anthropometrical measurements are sensitive, non-invasive and reli-

able and have a special place in the child population. This study

aimed to determine the meaning of some anthropometrical indices in

a population of children for assessment on nutritional status and

growth. We examined 220 Macedonian children (110 boys, 110 girls)

at the age of 6 years. We selected ﬁve anthropometrical parameters

to measure and the following indices were calculated: weight-for-age,

height-for-age, BMI-for-age, mid-upper arm circumference-for-age,

skin-folds: scapula and triceps-for-age and weight-for-height, respec-

tively. Results showed sex-speciﬁc differences for all parameters, but

BMI, weight, height were signiﬁcantly higher in boys. Conversely,

mid-upper arm circumference (MUAC), and skinfolds were signiﬁ-

cantly higher in girls. The values of the indices for the 50th percentile

for the boys were: 23 kg (weight), 119.1 cm (height), 16.18 kg/m

(BMI), 16.7 cm (MUAC), and for skinfolds: 5 mm (scapula) and

8.1 mm (triceps). Corresponding values for the girls were: 21 kg,

117.2 cm, 15.41 kg/m

, 17.2 cm, 5.5 mm, and 8.8 mm, respectively.

These results could be used as criteria for assessment on the nutri-

tional status and growth in the child population.

ZAMFIR GEORGIANA, CHRISTINA ENGLEZOU, NEVAN

MEGHANI, NEIL ASHWOOD, Department of Trauma and

Orthopaedics, Queen’s Hospital, Burton on Trent,

United Kingdom. Cauda equina syndrome as the

presentation of primary multiple sclerosis

Multiple sclerosis (MS) is an autoimmune inﬂammatory demyelinating

disorder of the central nervous system (CNS). It is the commonest

cause of non-traumatic neurological disability, especially in ages of

20–40 years. Diagnosis is made based on the clinical presentation

supported by the McDonald Criteria for MS. Clinical presentation

varies, resulting in different clinical pictures of the same entity. We

present the case of a 24-year-old woman who presented with a two-

day history of back and thigh pain. There was no history of trauma,

and no signiﬁcant past medical history. Normal sensation and power

of all four limbs was noted. Sphincter function was also normal; per

rectum examination was performed with normal sphincter tone and

perianal sensation. The patient was sent home with analgesia. Two

days later she returned with evolving numbness in her lower limbs

and the ﬁnger tips, constipation for four days and no urge to pass

urine. Cauda equina syndrome was suspected and MRI of the brain

and whole spine was performed. The imaging report satisﬁed the

McDonald criteria and a diagnosis of primary MS was made. It has

been said that MS is the “modern great imitator.” Common clinical

signs include optic neuritis, diplopia, ophthalmoplegia, and limb

numbness but non-speciﬁc symptoms, such as fatigue, pain, and

depression, can also occur in MS attacks. Unusual presentations,

such as cauda equina syndrome, can mislead the specialist and cre-

ate a diagnostic challenge.

ZAMFIR, GEORGIANA, NEVAN MEGHANI, CHRISTINA

ENGELZOU, NEIL ASHWOOD, Department of Trauma

and Orthopaedics, Queen’s Hospital, Burton-on-Trent,

United Kingdom. Aggressive osteochondroma in a

patient with Tatton–Brown–Rahman syndrome:

A unique case report and literature review

Tatton–Brown–Rahman syndrome is a rare overgrowth disorder

caused by a mutation in DNMT3A, a gene which is responsible for

growth control during embryonic development. Characteristic fea-

tures include tall stature, a round face with heavy horizontal eye-

brows and narrow palpebral ﬁssures, as well as intellectual disability.

The authors describe a unique case report of osteochondroma of the

proximal humerus associated with this uncommon overgrowth syn-

drome. The 13-year-old female presented with an 8-week history of

noticing a lump in her left upper arm causing occasional discomfort

but not impacting on the function of the arm. Physical examination

revealed a lump in the left axilla with a full range of shoulder move-

ments and no neurological functional loss. The patient underwent

radiology of the left shoulder which revealed an osteochondroma aris-

ing from the proximal third of the left humerus, measuring 10 cm 3

6 cm, with no radiographic features of malignancy. The patient was

managed conservatively and subsequent radiographs over the follow-

ing 6 years showed no change in the size of the lesion and no fea-

tures of malignant transformation. We were unable to ﬁnd any other

recorded case of osteochondroma in a patient with Tatton–Brown–

Rahman syndrome. Following diagnosis, the management of this con-

dition has remained conservative as surgical options are complex. If

required, debulking of the lesion with or without a tibial autograft has

been described in the literature but the signiﬁcant risk of neurovascu-

lar damage associated with this procedure was deemed unacceptable

for our patient.

976 Abstracts

ResearchGate has not been able to resolve any citations for this publication.

ResearchGate has not been able to resolve any references for this publication.

Bilateral double layers of quadratus plantae muscle: A case report

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