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A variation of superficial palmar arch
S51
j o u r n a l o f t h e a n a t o m i c a l s o c i e t y o f i n d i a 6 4 S ( 2 0 1 5 ) S37–S62
Objectives: The diaphragm is supplied by the superior and the inferior phrenic arteries. The superior phrenic artery is a branch from thoracic aorta and the inferior phrenic artery arises from the abdominal aorta. The left inferior phrenic artery runs posterior to the esophagus and then to the left of the esophageal opening in the diaphragm. The right inferior phrenic artery runs behind the inferior vena cava and then along the right of its opening. The inferior phrenic arteries have received increased attention in recent years because of their involvement in arterial supply and growth of hepatocellular carcinoma. The knowledge of anomalous origin of inferior artery is important in the treatment of hepatocellular carcinoma by transcatheter arterial embolization. Methods: During routine dissection for MBBS students, variant origin of the left and right inferior phrenic arteries was observed in an adult female human cadaver. Result: The right inferior phrenic artery originated from the celiac trunk. On the left side, a branch arose from celiac trunk, which divided into two. One joined the splenic artery and other was a common trunk which further divided into the left inferior phrenic artery and left suprarenal artery. Conclusion: In abdominal vascular occlusions, the inferior phrenic artery can serve as an important source of collateral circulation. Therefore, all the radiologists and surgeons managing hepatocellular carcinoma or gastro-esophageal bleeding need to be aware of this variant anatomy.
52. Pterion: A site for neurosurgical approach Shaikh Shamama Farheen ∗ , C.V. Diwan Government Medical College, Aurangabad, Maharashtra, India Abstract: The pterion is a point of sutural confluence seen in the normalateralis of the skull where frontal, parietal, temporal and sphenoid bones meet. Pterion is important in surgical interventions following surgical approaches to the anterior and middle cranial fossae, following extradural haemorrhage as well as tumours involving inferior aspects of the frontal lobe, such as olfactory meningioma and in repairing aneurysms of the middle cerebral artery. Aim of the Study: To determine the position of pterion using the midpoint of the zygoma (MPZ) and the frontozygomatic suture (FZS) as palpable points. Material and Methods: 20 dry skulls were studied irrespective of sex. Measurements were taken on both sides of the skull from the pterion to the midpoint of zygoma (MPZ) and frontozygomatic suture (FZS) using sliding vernier callipers. Result: No obvious differences between the right and left sides were observed for any of the measurements. Conclusion: In the present study, the pterion is an important landmark that could reliably be located using the FZS and MPZ according to the sexual differences. This information may be useful prior to surgery and may render pterional craniotomy safer.
53. A case report of pyramidal lobe of thyroid gland and its clinical implications S. Ralte 1,2,∗ , A. Bhattacharyya 1,2 , Y. Khonglah 1,2 1
Department of Anatomy, North Eastern Indira Gandhi Institute of Health & Medical Sciences (NEIGRIHMS), Meghalaya, India; 2 Department of Pathology, North Indira Gandhi Regional Institute of Health & Medical (NEIGRIHMS), Shillong, Meghalaya, India
Regional Shillong, Eastern Sciences
Introduction: The thyroid gland, an endocrine gland, is known to present with morphological variations. During development, the thyroid is connected to the tongue by a barrow tubular canal, the thyroglossal duct, which later disappears. Sometimes, the caudal end of the duct persists in the form of the pyramidal lobe, an accessory lobe of the thyroid gland. Material and Methods: During routine dissection of thyroid region in a 50-year-old male cadaver in the Department of Anatomy, NEIGRIHMS, a slender pyramidal lobe was found to extend upward from the right side of isthmus of the thyroid gland. A short fibromuscular band called the Levator glandulae thyroidae connected the apex of pyramidal lobe of thyroid to the body of the hyoid bone. Measurements of the lobe were taken. Small pieces of tissue were cut from both ends of the lobe. Sections were stained with Hematoxylin and Eosin, and Masson’s trichrome stains and examined under light microscope.Gross Observations: The length, width, and thickness of the pyramidal lobe were 28 mm, 2.7 mm and 1.2 mm, respectively. Light Microscopy Observations: Stained sections showed the presence of thyroid follicles with colloid in the pyramidal lobe. Striated muscle was observed in the Levator glandulae thyroidae amidst fibroglandular stroma. The pyramidal lobe is a common site of benign and malignant diseases of thyroid such as nodular goitre, Hashimoto’s thyroiditis, and papillary carcinoma. If present, the pyramidal lobe should always be examined during thyroid surgical procedures and preserved or removed accordingly in subtotal and total thyroidectomies.
54. A variation of superficial palmar arch M. Paul ∗ , K.L. Talukdar, H. Bayan, J.D. Sarma, G. Rabha Department Of Anatomy, Gauhati Medical College, Guwahati, India Objective: The superficial palmar arch is an anastomosis fed mainly by the ulnar artery. The latter enters the palm with the ulnar nerve, anterior to the flexor retinaculum and lateral to the pisiform. It passes medial to the hook of the hamate, then curves laterally to form an arch that is convex distally and level with a transverse line through the distal border of the fully extended pollicial base. Methods: Routine dissection of the upper limb was performed in the Department of Anatomy, Gauhati Medical College, Guwahati. Results: The superficial palmar arch was found with a variation in the course and its branches.
S52
j o u r n a l o f t h e a n a t o m i c a l s o c i e t y o f i n d i a 6 4 S ( 2 0 1 5 ) S37–S62
Conclusion: During surgery of the palm, unexpected bleeding may arise from unusual patterns of the superficial palmar arch. An appreciation of the course and branches of the arch is, therefore, important for the surgeons during surgery of the palm and hand.
57. An unusual variation of the anterior communicating artery in the Circle of Willis of the human brain – A case report F.A. Karim ∗ Gauhati Medical College and Hospital, Guwahati, India
55. Abnormally long umbilical cord – A case report B. Rabha ∗ , J. Sarma, G. Rabha Gauhati Medical College, Guwahati, India Objective: To present a case of long umbilical cord. Long umbilical cord is one of the common complications of umbilical cord. It may lead to intrauterine death of the fetus. The present study will highlight the clinical importance of long umbilical cord. Method: The dead fetus was collected from the Department of Obstetrics And Gynaecology, Gauhati Medical College and Hospital and the study was conducted in the Department of Anatomy, Gauhati Medical College, Guwahati. The specimen was preserved under standard methods and the length of the umbilical cord was measured and recorded. Results: The length of the umbilical cord was found to be 130 cm. Conclusion: Though umbilical cord length is variable, majority of the cases have normal length cord. The cases with long cord have higher incidence of cord complications, intrapartum complications, and more chances of birth asphyxia.
56. Communication between the musculocutaneous nerve and the median nerve – A case report M. Aditya ∗ , M. Pari Plavi Department of Anatomy, Osmania Medical College, India Introduction: Inter-communications between peripheral nerves deserve special attention in view of their clinical significance. The nerves of the extremities are especially vulnerable to injury because of their long course and superficial distribution. Case Report: During routine undergraduate dissection, it was observed in the left upper limb of a male cadaver, the musculocutaneous nerve after its origin from lateral cord gave a branch to corachobrachialis muscle and then gave a communicating branch to the median nerve along with a branch to the biceps brachii. Applied Importance: A lack of awareness of variations with different patterns might not only complicate surgical repair but may also cause ineffective nerve blockade. This variation of the median nerve and the musculocutaneous nerve may prove valuable in the trauma of the shoulder joint and also entrapment syndrome. Details will be discussed in the poster presentation.
Aim: The aim of the study is to report an unusual variation of anterior communicating artery of the Circle of Willis. Materials and Method: The brain was dissected out from the skull in routine dissection, it being without any signs of decomposition or pathological changes. The Circle of Wilis at the base of the brain was dissected and variations studied. Result: Two Anterior Communicating arteries with a short vertical segment joining them. Conclusion: The result may be helpful to neurosurgeons and vascular surgeons to plan the treatment if any anomaly exists in the Circle of Willis and the blood supply of the brain.
58. Variation in the insertion pattern of the flexor carpi ulnaris – A case report Jitendra Singh Yadav ∗ , Antony Sylvan D’Souza, Anne D’Souza, R. Kotian Sushma, Mamatha Hosapatna, Vrinda Hari Ankolekar Department of Anatomy, Kasturba Medical College, Manipal University, Manipal, India Objective: To report a rare variation of flexor carpi ulnaris muscle presenting an extra muscle belly with its tendon inserting into the deep fascia of distal forearm and the palm. Case Report: During routine dissection of the left forearm of a 50-year-old male cadaverin the Department of Anatomy, Kasturba Medical College, Manipal, we observed an extra belly of the flexor carpi ulnaris with a variant insertion pattern. The accessory belly appeared to have a common origin along with the main muscle from the medial epicondyle and then split from the latter at a variable distance. The tendon of this additional belly showed an unusual insertion into the deep fascia of the distal forearm about 2 cm proximal to the flexor retinaculum and the palm. The length of the main muscle, the additional muscle belly, and its tendon were measured and recorded. Conclusion: This is a rare variation of the insertion of the flexor carpi ulnaris and is seldom reported in the literature. Therefore, the knowledge of these variations is important for surgeons in procedures like tendon transfers, grafts, etc.
59. Morphometric study of the optic strut and the anterior clinoid process Nivedita Nayak ∗ , Antony Sylvan D’Souza, Anne D’Souza, Vrinda Hari Ankolekar, Mamatha Hosapatna Department of Anatomy, Kasturba Medical College, Manipal University, Manipal, India Objectives: The optic strut (OS) and the anterior clinoid process (ACP) represent bony structures that are closely related
j o u r n a l o f t h e a n a t o m i c a l s o c i e t y o f i n d i a 6 4 S ( 2 0 1 5 ) S37–S62
Objectives: The diaphragm is supplied by the superior and the inferior phrenic arteries. The superior phrenic artery is a branch from thoracic aorta and the inferior phrenic artery arises from the abdominal aorta. The left inferior phrenic artery runs posterior to the esophagus and then to the left of the esophageal opening in the diaphragm. The right inferior phrenic artery runs behind the inferior vena cava and then along the right of its opening. The inferior phrenic arteries have received increased attention in recent years because of their involvement in arterial supply and growth of hepatocellular carcinoma. The knowledge of anomalous origin of inferior artery is important in the treatment of hepatocellular carcinoma by transcatheter arterial embolization. Methods: During routine dissection for MBBS students, variant origin of the left and right inferior phrenic arteries was observed in an adult female human cadaver. Result: The right inferior phrenic artery originated from the celiac trunk. On the left side, a branch arose from celiac trunk, which divided into two. One joined the splenic artery and other was a common trunk which further divided into the left inferior phrenic artery and left suprarenal artery. Conclusion: In abdominal vascular occlusions, the inferior phrenic artery can serve as an important source of collateral circulation. Therefore, all the radiologists and surgeons managing hepatocellular carcinoma or gastro-esophageal bleeding need to be aware of this variant anatomy.
52. Pterion: A site for neurosurgical approach Shaikh Shamama Farheen ∗ , C.V. Diwan Government Medical College, Aurangabad, Maharashtra, India Abstract: The pterion is a point of sutural confluence seen in the normalateralis of the skull where frontal, parietal, temporal and sphenoid bones meet. Pterion is important in surgical interventions following surgical approaches to the anterior and middle cranial fossae, following extradural haemorrhage as well as tumours involving inferior aspects of the frontal lobe, such as olfactory meningioma and in repairing aneurysms of the middle cerebral artery. Aim of the Study: To determine the position of pterion using the midpoint of the zygoma (MPZ) and the frontozygomatic suture (FZS) as palpable points. Material and Methods: 20 dry skulls were studied irrespective of sex. Measurements were taken on both sides of the skull from the pterion to the midpoint of zygoma (MPZ) and frontozygomatic suture (FZS) using sliding vernier callipers. Result: No obvious differences between the right and left sides were observed for any of the measurements. Conclusion: In the present study, the pterion is an important landmark that could reliably be located using the FZS and MPZ according to the sexual differences. This information may be useful prior to surgery and may render pterional craniotomy safer.
53. A case report of pyramidal lobe of thyroid gland and its clinical implications S. Ralte 1,2,∗ , A. Bhattacharyya 1,2 , Y. Khonglah 1,2 1
Department of Anatomy, North Eastern Indira Gandhi Institute of Health & Medical Sciences (NEIGRIHMS), Meghalaya, India; 2 Department of Pathology, North Indira Gandhi Regional Institute of Health & Medical (NEIGRIHMS), Shillong, Meghalaya, India
Regional Shillong, Eastern Sciences
Introduction: The thyroid gland, an endocrine gland, is known to present with morphological variations. During development, the thyroid is connected to the tongue by a barrow tubular canal, the thyroglossal duct, which later disappears. Sometimes, the caudal end of the duct persists in the form of the pyramidal lobe, an accessory lobe of the thyroid gland. Material and Methods: During routine dissection of thyroid region in a 50-year-old male cadaver in the Department of Anatomy, NEIGRIHMS, a slender pyramidal lobe was found to extend upward from the right side of isthmus of the thyroid gland. A short fibromuscular band called the Levator glandulae thyroidae connected the apex of pyramidal lobe of thyroid to the body of the hyoid bone. Measurements of the lobe were taken. Small pieces of tissue were cut from both ends of the lobe. Sections were stained with Hematoxylin and Eosin, and Masson’s trichrome stains and examined under light microscope.Gross Observations: The length, width, and thickness of the pyramidal lobe were 28 mm, 2.7 mm and 1.2 mm, respectively. Light Microscopy Observations: Stained sections showed the presence of thyroid follicles with colloid in the pyramidal lobe. Striated muscle was observed in the Levator glandulae thyroidae amidst fibroglandular stroma. The pyramidal lobe is a common site of benign and malignant diseases of thyroid such as nodular goitre, Hashimoto’s thyroiditis, and papillary carcinoma. If present, the pyramidal lobe should always be examined during thyroid surgical procedures and preserved or removed accordingly in subtotal and total thyroidectomies.
54. A variation of superficial palmar arch M. Paul ∗ , K.L. Talukdar, H. Bayan, J.D. Sarma, G. Rabha Department Of Anatomy, Gauhati Medical College, Guwahati, India Objective: The superficial palmar arch is an anastomosis fed mainly by the ulnar artery. The latter enters the palm with the ulnar nerve, anterior to the flexor retinaculum and lateral to the pisiform. It passes medial to the hook of the hamate, then curves laterally to form an arch that is convex distally and level with a transverse line through the distal border of the fully extended pollicial base. Methods: Routine dissection of the upper limb was performed in the Department of Anatomy, Gauhati Medical College, Guwahati. Results: The superficial palmar arch was found with a variation in the course and its branches.
S52
j o u r n a l o f t h e a n a t o m i c a l s o c i e t y o f i n d i a 6 4 S ( 2 0 1 5 ) S37–S62
Conclusion: During surgery of the palm, unexpected bleeding may arise from unusual patterns of the superficial palmar arch. An appreciation of the course and branches of the arch is, therefore, important for the surgeons during surgery of the palm and hand.
57. An unusual variation of the anterior communicating artery in the Circle of Willis of the human brain – A case report F.A. Karim ∗ Gauhati Medical College and Hospital, Guwahati, India
55. Abnormally long umbilical cord – A case report B. Rabha ∗ , J. Sarma, G. Rabha Gauhati Medical College, Guwahati, India Objective: To present a case of long umbilical cord. Long umbilical cord is one of the common complications of umbilical cord. It may lead to intrauterine death of the fetus. The present study will highlight the clinical importance of long umbilical cord. Method: The dead fetus was collected from the Department of Obstetrics And Gynaecology, Gauhati Medical College and Hospital and the study was conducted in the Department of Anatomy, Gauhati Medical College, Guwahati. The specimen was preserved under standard methods and the length of the umbilical cord was measured and recorded. Results: The length of the umbilical cord was found to be 130 cm. Conclusion: Though umbilical cord length is variable, majority of the cases have normal length cord. The cases with long cord have higher incidence of cord complications, intrapartum complications, and more chances of birth asphyxia.
56. Communication between the musculocutaneous nerve and the median nerve – A case report M. Aditya ∗ , M. Pari Plavi Department of Anatomy, Osmania Medical College, India Introduction: Inter-communications between peripheral nerves deserve special attention in view of their clinical significance. The nerves of the extremities are especially vulnerable to injury because of their long course and superficial distribution. Case Report: During routine undergraduate dissection, it was observed in the left upper limb of a male cadaver, the musculocutaneous nerve after its origin from lateral cord gave a branch to corachobrachialis muscle and then gave a communicating branch to the median nerve along with a branch to the biceps brachii. Applied Importance: A lack of awareness of variations with different patterns might not only complicate surgical repair but may also cause ineffective nerve blockade. This variation of the median nerve and the musculocutaneous nerve may prove valuable in the trauma of the shoulder joint and also entrapment syndrome. Details will be discussed in the poster presentation.
Aim: The aim of the study is to report an unusual variation of anterior communicating artery of the Circle of Willis. Materials and Method: The brain was dissected out from the skull in routine dissection, it being without any signs of decomposition or pathological changes. The Circle of Wilis at the base of the brain was dissected and variations studied. Result: Two Anterior Communicating arteries with a short vertical segment joining them. Conclusion: The result may be helpful to neurosurgeons and vascular surgeons to plan the treatment if any anomaly exists in the Circle of Willis and the blood supply of the brain.
58. Variation in the insertion pattern of the flexor carpi ulnaris – A case report Jitendra Singh Yadav ∗ , Antony Sylvan D’Souza, Anne D’Souza, R. Kotian Sushma, Mamatha Hosapatna, Vrinda Hari Ankolekar Department of Anatomy, Kasturba Medical College, Manipal University, Manipal, India Objective: To report a rare variation of flexor carpi ulnaris muscle presenting an extra muscle belly with its tendon inserting into the deep fascia of distal forearm and the palm. Case Report: During routine dissection of the left forearm of a 50-year-old male cadaverin the Department of Anatomy, Kasturba Medical College, Manipal, we observed an extra belly of the flexor carpi ulnaris with a variant insertion pattern. The accessory belly appeared to have a common origin along with the main muscle from the medial epicondyle and then split from the latter at a variable distance. The tendon of this additional belly showed an unusual insertion into the deep fascia of the distal forearm about 2 cm proximal to the flexor retinaculum and the palm. The length of the main muscle, the additional muscle belly, and its tendon were measured and recorded. Conclusion: This is a rare variation of the insertion of the flexor carpi ulnaris and is seldom reported in the literature. Therefore, the knowledge of these variations is important for surgeons in procedures like tendon transfers, grafts, etc.
59. Morphometric study of the optic strut and the anterior clinoid process Nivedita Nayak ∗ , Antony Sylvan D’Souza, Anne D’Souza, Vrinda Hari Ankolekar, Mamatha Hosapatna Department of Anatomy, Kasturba Medical College, Manipal University, Manipal, India Objectives: The optic strut (OS) and the anterior clinoid process (ACP) represent bony structures that are closely related