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Retromolar foramen and canal: a comprehensive review on its anatomy and clinical applications

Kumar Potu B, Jagadeesan S, Bhat KM, Rao Sirasanagandla S

Morphologie, 2013 Jun;97(317):31-7.
PMID: 23806306 DOI: 10.1016/j.morpho.2013.04.004

The retromolar foramen (RMF) and retromolar canal (RMC) are the anatomical structures of the mandible located in retromolar fossa behind the third molar tooth. This foramen and canal contain neurovascular structures which provide accessory/additional innervation to the mandibular molars and the buccal area. These neurovascular contents of the canal gain more importance in medical and dental practice, because these elements are vulnerable to damage during placement of osteointegrated implants, endodontic treatment and sagittal split osteotomy surgeries and a detailed knowledge of this anatomical variation would be vital in understanding failed inferior alveolar nerve blockage, spread of infection and also metastasis. Although few studies have been conducted in the past showing the incidence and types in different population groups, a lacunae in comprehensive review of this structure is lacking. Though this variation posed challenging situations for the practicing surgeons, it has been quite neglected and the incidence of it is not well presented in all the textbooks. Hence, we made an attempt to provide a consolidated review regarding variations and clinical applications of the RMF and RMC.
The axillary arch - morphological and histological study with clinical importance

Omar N, Abidin FZ, Das S, Abd Ghafar N, Haji Suhaimi F, Abd Latiff A, et al.

Morphologie, 2010 May;94(305):36-9.
PMID: 20359930 DOI: 10.1016/j.morpho.2010.03.001

The latissimus dorsi is a muscle of the back which forms the posterior fold of the axilla and its tendon twists to insert into the floor of the intertubercular sulcus of the humerus. Occasionally, the muscle has a muscular slip which crosses the axilla to insert into the pectoralis major. This muscular slip is often termed as "axillary arch." In the present study, we report bilateral axillary arch detected in a 45-year-old male cadaver. The average vertical length of the axillary arch measured 7 cm. The average maximum width of the uppermost, middle and lower part of the arch measured 2, 3.5 and 3.2 cm, respectively. The presence of the axillary arch is an uncommon finding in humans, considering the fact that it is solely found in the animals who prefer to hang on the trees. A histological study of the axillary arch was also performed and it showed skeletal muscle fibres which was uniformly arranged. The presence of the axillary arch may assist in the adduction of the shoulder. It may also compress the axillary vessels and nerves thereby causing resultant symptoms. Prior anatomical knowledge of the presence of axillary arch may be helpful for surgeons performing radical dissection of the axillary lymph nodes and ligation of axillary vessels, clinicians diagnosing abduction syndromes and interventional radiologists interpreting axillary mass in day to day clinical practice.
Innervation of the scrotum by the anterior division of the obturator nerve - a rare variation

Nayak SB, Vasudeva SK

Morphologie, 2021 Apr 16.
PMID: 33875370 DOI: 10.1016/j.morpho.2021.03.005

The scrotum is supplied by ilioinguinal, genital branch of genitofemoral, perineal branch of the posterior cutaneous nerve of the thigh and the posterior scrotal branches of the pudendal nerve. We report an extremely rare innervation of the anterior part of the scrotum by the anterior division of the right obturator nerve. The genital branch of genitofemoral nerve did not reach the scrotum. The ilioinguinal nerve did not supply the scrotum. The anterior division of the obturator nerve gave a branch which ascended superomedially in the thigh, crossed superficial to the spermatic cord and communicated with the right ilioinguinal nerve. As it crossed the spermatic cord, it gave a scrotal branch which descended over the spermatic cord and ramified to supply the anterior part of the scrotum. Knowledge of this variation could be important to anaesthesiologists, urologists and surgeons in general.
Unusual contribution of the first jejunal vein in the formation of the portal vein

Nayak SB, Shetty SD, Packirisamy V, Vasudeva SK

Morphologie, 2021 May 05.
PMID: 33965324 DOI: 10.1016/j.morpho.2021.04.003

Jejunum is drained into superior mesenteric vein through a series of jejunal veins. The way in which the first jejunal vein terminates is of great importance in upper abdominal surgery and radiological procedures. Knowledge of its variations is particularly important in surgical procedures like orthotropic hepatic transplantation, hepatic vein reconstruction, pancreatic surgery and surgical procedures of duodenojejunal junction. We saw a first jejunal vein opening directly into the portal vein. Further, the inferior mesenteric vein drained into the first jejunal vein. This case could be useful to gastroenterologists, general surgeons and radiologists.
Complete enclosure of gall bladder inside the lesser omentum - a rare anomaly

Nayak SB, Shetty SD, Vasudeva SK

Morphologie, 2021 Jun 16.
PMID: 34147369 DOI: 10.1016/j.morpho.2021.06.001

Gall bladder is known for many congenital anomalies such as duplication, intrahepatic position, floating position etc. Most of its anomalies can be detected in ultrasound examination and radiography. We report an extremely rare congenital anomaly of gall bladder as observed in a male cadaver during dissection classes. The gall bladder was totally enclosed in the right free margin of the lesser omentum, in front of the usual contents of the right free margin of lesser omentum. The size, shape and blood supply of the gall bladder were normal. Though this anomaly might not cause any functional disturbances, it might result in complications during laparoscopic cholecystectomy.
Variant formation of left common iliac vein by the confluence of four veins

Nayak SB, Vasudeva SK

Morphologie, 2021 Jun 16.
PMID: 34147368 DOI: 10.1016/j.morpho.2021.05.116

Common iliac vein variations are relatively rare compared to the variations of external and internal iliac veins. A rare pattern of formation of common iliac vein by the confluence of four veins is being reported here. The left common iliac vein was formed by the union of left external iliac vein, internal iliac vein, iliolumbar vein and a common trunk formed by the obturator and vesical veins. External iliac vein and obturator veins were connected by a communicating vein. Both external and common iliac veins were respectively medial to the external and common iliac arteries. Knowledge of this variant formation of common iliac vein could be useful to radiologists, gynecologists and orthopedic surgeons.
Accessory slip of flexor digitorum accessorius (Quadratus plantae) muscle surrounding the lateral plantar nerve and vessels

Nayak SB, Vasudeva SK

Morphologie, 2021 Jul 08.
PMID: 34247922 DOI: 10.1016/j.morpho.2021.06.004

Flexor digitorum accessorius (quadratus plantae) is a muscle of second layer of the sole of the foot. Though it is not a very important muscle in terms of movements or stability of foot, it could pose problems when it presents variations. We observed a novel, accessory slip of flexor digitorum accessorius. The slip arose from the fascia covering abductor digiti minimi muscle and got inserted into the tendon of the flexor digitorum longus muscle. It was supplied by a branch from lateral plantar nerve. The proximal part of this accessory slip surrounded the lateral plantar nerve and vessels. Compression of lateral plantar nerve by this accessory slip might produce symptoms similar to that of tarsal tunnel syndrome and lead to misdiagnosis. The case could be of importance to foot and ankle surgeons and radiologists.
Morphometric analysis of foramen magnum and occipital condyle using CT images for sex determination in a Saudi Arabian population

Aljarrah K, Packirisamy V, Al Anazi N, Nayak SB

Morphologie, 2022 Dec;106(355):260-270.
PMID: 34391659 DOI: 10.1016/j.morpho.2021.07.006

OBJECTIVE OF THE STUDY: The objective of this study was to evaluate FM and occipital condyles measurements morphometrically for sex determination by using discriminant function analysis and to note visually the variation in the shape of the foramen magnum in a Saudi Arabian population by using CT scan images.
MATERIAL AND METHODS: This study included 472 CT scans (236 males and 236 females; age range, 18-72 years). The foramen magnum shapes were classified into 8 types: oval, egg, round, hexagonal, pentagonal, tetragonal, irregular (A) and irregular (B). The intraobserver and interobserver test was done to calculate the reliability of the measurement. Eight dimensions of the FM and occipital condyle were evaluated to determine the sexual dimorphism using an independent t-test. Sex determination was estimated using discriminate function analysis.
RESULTS: The commonest shape of FM was hexagonal and the tetragonal shape was the least common type. Coefficient of reliability (R) was high, ranging between 0.89 and 0.99, which indicates the measurements are reliable and sufficiently precise. All the eight measurements, the FM length and width, FM index, FM area, the width and length of right and left occipital condyles were significantly greater in males than the female. Univariate discriminant function showed an accuracy rate varying from 61% to 66.6% based on FM or occipital condyles measurements. The multivariate analysis of FM and occipital condyle measurements increased the overall accuracy rate of sex determination to 71.6%.
CONCLUSION: The univariate analysis of FM and occipital condyle measurements indicates, that the FM area (66.1%), FML (62.5%), FMW (62.5%) and ROCL (62.1%) could be reliable individual variables in sex determination. The multivariate analysis including all the eight variables of FM and occipital condyle increased the accuracy rate of sex determination to 71.6% in determining the sex as male (73.3%) or female (69.9%). The shape of the FM is not useful in sex estimation. The results obtained showed a low degree of sexual dimorphism in the basicranium, the use of this method in forensic anthropology could be helpful for assessment on highly fragmented skull bases.
The morphological and microscopical characteristics of posterior layer of human thoracolumbar fascia; A potential source of low back pain

Marpalli S, Mohandas Rao KG, Venkatesan P, George BM

Morphologie, 2021 Feb 09.
PMID: 33579637 DOI: 10.1016/j.morpho.2021.01.001

BACKGROUND: Posterior layer of thoracolumbar fascia (PTLF) is the deep fascia of back of the trunk, which connects the trunk, upper limb and lower limb muscles. Very few cadaveric studies of posterior layer of thoracolumbar fascia (PTLF) are found in the literature, which mention the presence of nerve receptors in it but, quantification of the nerve receptors where not found. Providing the morphological and morphometrical data of PTLF may help the exercise physiologists, sports physicians, occupational health assistants and, physiotherapists to modify or invent new protocol of treatment to help the society.
METHODS: In this study, twenty formalin embalmed human cadavers were used and we have documented the orientation of the PTLF and quantified the number of peripheral nerve endings at the different vertebral levels.
RESULTS: Mean distance of PTLF from vertebral spines to the musculofascial junction was at thoracic region 3.38cm and 3.34cm; at lumbar region, it was 7.4cm and 7.36cm and at sacral region it was 2.98cm and 2.96cm on right and left side, respectively. The angulation of PTLF varies from 18-110 degrees at different vertebral levels. The microscopic data shows the thickness of PTLF and number of nerve endings in the sacral level is increased compared to that of thoracic vertebral levels.
CONCLUSIONS: We have contributed the novel morphological and microscopical details to the limited existing data on PTLF. We also have provided the quantitative data of nerve fibers, which are possible nociceptors of PTLF.