Anatomical Variations

Introduction: the most common surgical cause of abdominal pain is appendicitis; its diagnosis is affected by anatomical variations of the vermiform appendix, because this is the most variable abdominal organ in terms of position and organ relations.
Objective: to determine the characteristics of the normal appendix in computed tomography scans, including length, diameter, wall thickness, and the location of the base and the appendicular tip.
Methods: abdominal computed tomography scans with UroCT scan protocol images were studied to measure length, width, and diameter of the appendix, and to identify the locations of its base and tip. The appendicular tip location was categorized as anterior or posterior and subdivided into: pelvic, retrocaecal/retrocolic, postileal, paracolic, subcaecal, subhepatic or midline. The appendicular base location was defined in three planes in relation to the ileocaecal valve: anterior-posterior, medial-lateral, or superior-inferior.
Results: were included the abdominal tomography images of 83 patients in which general characteristics of the appendix were determined: a mean length of 78 mm (SD = ±23.41) and a mean diameter of 6.55 mm (SD =± 1.77) were observed. The bases were more frequently located inferior posterior, lateral and medial, to the ileocaecal valve, and the tips were more frequently located in the pelvic cavity, followed by the retrocaecal and paracaecal location.
Conclusions: the locations of the base of the appendix were correlated with overall reports. There was no correlation between the tip location and the length of the appendix, this means that, even if the appendix is long, it is not associated with a tip location further from the ileocaecal valve.

Foream and dorsum of the hand region of 13 cadavers were dissected to investigate the anatomy of the extensor tendons. In the left hand double tendon to the middle, triple tendon to the ring finger, a single tendon to the little finger or digiti minimi. The extensor digiti minimi has double tendon. In the right hand triple tendon to the middle finger, triple tendons to the ring finger, a double tendon to the little finger. The extensor digiti minimi has double tendon. The little finger receives four tendons. In the left and right hand the extensor digitorum there was a single tendon to the index. The dorsum of the left hand and right showed juncturae tendinum type 2, between the extensors tendons in the 3rd. intermetacarpal space; type 3, between the extensors tendons in the 4th intermetacarpal space. Anatomical variations may be beneficial for hand surgeons performing graft operations.

Background: Variations in the number and size of the foramina transversaria of cervical vertebrae are commonly observed during cross sectional imaging examinations.
Objective: This study while designed to investigate the magnitude and types of such diversities of the normal morphology, attempts to associate variations to anatomical and developmental criteria.
Methods: Thirty sets of dry cervical vertebrae belonging to adult subjects were selected randomly for this study. For each vertebra the foramen transversarium was examined for its number and area.
Results: There was no significant statistical difference between the area of the right and left foramina transversaria in all cervical vertebrae. C1 foramen transversarium was the largest while C7 foramen transversarium was the smallest. Accessory foramina transversaria were mostly observed in the lower cervical vertebrae (C5, C6 and C7) mostly in C6 (70% have accessory foramina). The multiplicity of the foramina was a single vertebral feature rather than a general phenomenon in the same subject.
Conclusion: It seems that many factors are involved in causing the morphological variations of the foramen transversarium including developmental factors, mechanical stress, the size, and/or the number of anatomical structures passing through.

Background: The purpose of this paper is to describe a case of duplication of unilateral femoral vein, with a complete extension of duplicated veins with similar diameters which is an
uncommon condition, noticed in fewer than 10% of lower limb. The venous anatomy is highly variable, only 1/6 patients are exempt of these anomalies. One is the duplicity of the femoral
vein. The classic anatomic venous in the lower limb is found in only 16% of subject.
Methods: Anatomical variation in the lower limb was found during routine dissection in a 75- year-old male cadaver in the Morphology Laboratory at the University of Pamplona.
Result: In the adductor canal femoral vein was divided into two veins: one medial and other lateral, which ascended in parallel until the femoral triangle, at this level 6.5 cms below the inguinal ligament the femoral vein- lateral ramus received to the lateral circumflex femoral vein, and received to the medial circumflex femoral vein, followed the femoral veins lateral ramus binds to the femoral veins medial ramus forming common femoral vein. Both Femoral Veins extend from the adductor canal to the femoral triangle had a length of 18 cms. The caliber of the femoral vein and the caliber of common femoral vein was 30 mm. The caliber of the femoral artery at the femoral triangle was 24 mm. The caliber of the femoral medial and lateral venous component was 20 mm. The common femoral vein received posterolateral to the deep femoral vein; The common femoral vein received anteromedial at the great saphenous.
Conclusion: Knowledge of the truncular venous variations is important for the investigation of the venous network. It is also important to recognize and avoid potential errors in diagnosis of deep venous thrombosis of the femoral vein, in the case of an occluded duplicated trunk.

Neurogenic thoracic outlet syndrome (NTOS) is the most common type of TOS. Typically it results from impingement of the neurovasculature as it passes between the anterior and middle scalene muscles; this classic anatomical relationship being the foundation of clinical diagnosis. Positional testing relies on vascular compromise occurring when the subclavian artery is compressed in this space. This study describes several anatomical variations observed in this relationship. Sixty-five cadavers (35m/30f) were assessed to determine the frequency and extent of brachial plexus branching variants. A total of thirty-one variations from " classic " anatomy were observed (47.7%). In two specimens (3.1%), the entire superior trunk coursed completely anterior to the anterior scalene in a position of relative vulnerability. In 27 instances, a portion of or the entire superior trunk pierced the anterior scalene muscle, and in two, the middle trunk also pierced the muscle belly. Interestingly, while two bilateral branching variations were observed, the majority occurred unilaterally, and almost exclusively on the left side. There were no sex differences in frequency. The high frequency of these variations and their potential to predispose patients to neurogenic TOS suggest that current diagnostic methods may be insufficient in clinical diagnosis. Due to lack of vascu-lar compromise, patients with the piercing variant would not display positive signs on the traditional positional tests. The use of ultrasound to determine the route of the brachial plexus could determine whether this variation is present in patients who suffer from TOS symptoms but lack a diagnosis based on traditional positional testing.

Awareness of the variation and renal vascular abnormality at retroperitoneal space surgeries such as kidney surgery and transplantation is very important and necessary. Complexity in the veins development of the kidney area of fetus leads to a series of changes in the production of these veins, including the extra kidney vein, and the posterior aorta vein. In this case report, we present a case report of a 36-year-old male with a rare renal variation which has been identified with a simple abdominal Computed Tomography (CT) scan (16-slice). In this case report, there is a single renal vein which becomes two branches before drainage into Inferior Vena Cava (IVC) in which one of these branches passes anterior to aorta and the other posterior to aorta which suggests the type of circumaortic left renal vein.

The aim of this study was to verify the presence, spatial location, and calibre of the accessory canals (AC) of the canalis sinuosus by cone beam computed tomography, and their relationship to the anterior maxilla. This retrospective analysis included the scans of 1000 subjects. Parameters registered were sex, age, number of AC, presence or absence of AC with a diameter <1.0 mm, AC diameter (only for AC with a diameter >1.0 mm), and AC location in relation to the adjacent teeth. Males showed a statistically higher frequency of AC than females. The difference in age distribution was not statistically significant. Twenty percent of all AC presented a diameter of a least 1.0 mm. The end of the AC trajectory was most frequently located palatal to the anterior maxillary teeth. All relationships analyzed here were very weak (age vs. number of AC, age vs. AC diameter, number of AC vs. sex). Overall, the results of this study showed that AC of the canalis sinuosus are a common anatomical structure in the anterior maxilla, regardless of age and sex.

The major blood supply of extrahepatic biliary ductal system is by
cystic artery, which supplies to cystic duct, common hepatic duct
and the upper part of the common bile duct. The lower part of bile
duct  is  supplied  by  gastroduodenal  artery.  The  present  study  is
aimed at determining the anatomical variations of blood supply of
extrahepatic biliary ductal system and its clinicalimplications. The
present  study  of  the  blood  supply  of  extrahepatic  biliary  ductal
system  has  been  conducted  on  30  cadavers.  After  exposing  the
abdominal cavity and removing peritoneal fat, extrahepatic biliary
system and its blood supply was carefully dissectedand relevant
photographs  were  taken.  Special  attention  was  given to  the
relationship of the cystic artery to the Calot’s triangle. Along with
the arteries, the variations in the venous drainagewere also noted.
Major  importance  of  knowledge  of  blood  supply  of  extrahepatic
biliary  ductal  system  may  well  lie  in  the  understanding  of  the
etiology  of  postoperative  bile  duct  strictures  and  in  their
prevention. A clear understanding of the major arterial supply to
the  extrahepatic  bile  ducts  should  be  of  assistance in  biliary
reconstruction and treating hemobilia.

Bones of four individuals were discovered in three features at the site. In feature 5, there was a man (aged 24–30 years, his average body height was 169.8 cm, muscle insertions in general were well developed on all bones, anatomical varieties: incisura supratrochlearis, ossiculum suturae lambdoideae, interruption groove, fovea articularis superior atlantis bipartita, foramen processus transversi partitum, foramen olecrani, crista solei, facies articularis talaris anterior et media communis, pathologies: caries, tartar, healed rib fracture with a bone neoplasm – false joint). In feature 8, there was found just a fragment of the body of a femur, most probably belonging to an adult woman. In feature 9/11, two adult individuals were found – non-anatomically placed skeleton 2 (adult man, average body height of 177.0 cm, muscle insertions in general well developed on all bones, anatomical varieties: crista solei) and under it, there was anatomically placed skeleton 3 (woman, aged 40-50, body height more than 157.5 cm, muscle insertions in general well developed on all bones, anatomical varieties: sulcus frontalis, incisura supratrochlearis, foramen frontale, foramen supratrochleare, bifucated
canal for the nervus hypoglossus, patologies: caries, mild tartar, arthrosis corresponding to the given age).

A rare case of median artery with unusually high origin and superficial course, also termed superficial brachiomedian artery, was observed during routine anatomical dissection of the right upper extremity of a 63-year-old Caucasian female cadaver.
The aberrant artery arose from the initial part of the brachial artery. In the arm region it followed a superficial course and at
the elbow passed beneath the bicipital aponeurosis. In the upper third of the forearm, the variant artery passed under the
muscular belly of the palmaris longus and flexor digitorum superficialis muscle. Accompanying the median nerve, the unusual median artery passed through the carpal tunnel and participated in the formation of the superficial palmar arch. Due to its variant course and location, the superficial brachiomedian artery may cause compression on the nerve within the carpal tunnel or nerve ischemia may result from an accidental arterial injury.

During routine anatomical dissection of the left upper limb of a 73-year-old female cadaver, a unique coexistence of variant muscles was found. In the forearm region, a largely developed reversed palmaris longus was discovered. Its short distal tendon was in close relation to the median nerve. In the neighboring hypothenar region, an unusual abductor digiti minimi was also observed. Its muscular body was composed of two portions - medial and lateral one, arising from the reversed palmaris longus tendon. The lateral portion passed over the ulnar nerve and artery in the canal of Guyon. In the literature, there are descriptions of entrapment neuropathies caused by either reversed palmaris longus or variant abductor digiti minimi. Here, for the first time we describe a coexistence of these variant muscles and suggest it as a possible, even rare, cause of both the median and ulnar nerves entrapment and ulnar artery thrombosis.

During the routine anatomical dissection in the hypothenar region of the left hand of a 67-year-old female cadaver, a number of variant structures were observed. The most prominent finding in our case was a supernumerary muscle hitherto unknown in the anatomical literature. This variant muscle had a muscular body formed by the connection of two deeply situated muscular bellies - medial and lateral. The lateral belly originated from the flexor retinaculum, the medial one - from the hamate bone. The common muscular body inserted to the antero-lateral surface of the base of the fifth proximal phalanx. Due to its location and possible function, we named the variant muscle as “deep abductor-flexor” of the little finger. The flexor digiti minimi brevis muscle showed two proximal tendons – the medial tendon was attached to the hamulus of the hamate bone while the aberrant lateral tendon originated from the lateral part of the flexor retinaculum. Both, the aberrant lateral tendon of the flexor digiti minimi brevis and the lateral belly of the “deep abductor-flexor”, passed over the palmar branch of the ulnar nerve, which define their possible clinical significance in ulnar nerve compression. Therefore, the variations of the hypothenar muscles are reviewed and their relation to the compression of the ulnar nerve is discussed.

Background: The purpose of this paper is to describe an anatomical variation of the hand extensor on the little finger of the right hand which receives four tendons, condition unknown, as it is the first case reported so far in the literature. The human extensor tendons of hand often display an array of variations. Awareness of the anatomy and variations of the extensor tendons on the dorsum of the hand is necessary not only for the anatomist but also for surgeons when considering tendons for hand surgery, tendon rerouting or transplants. Materials and Methods: Bilateral anatomical variation in the upper limb was found during routine dissection in a 75-year-old male cadaver in the Morphology Laboratory at the University of Pamplona. The variations were recorded and photographed. Result: In the left hand the extensor digitorum there was a single tendon to the index, double tendon to the middle, triple tendon to the ring finger, a single tendon to the little finger or digiti minimi. T...

Background: The veins of the head and neck have a complex developmental pattern which predisposes them to variations in formation and drainage. Superficial veins of the head and neck are utilized for central venous cannulation, oral reconstruction and parenteral nutrition in debilitated patients. Clinical and sonological examinations of these veins may provide clues toward underlying cardiac pathology. Aims: The aim of the present study was to describe anatomical variation and determined the position of the facial vein in relation to neighboring structures. Methods and Findings: Head and neck region were carefully dissected as per standard dissection procedure, studied serially during the years 2013-2017 in 16 males and 2 females, i.e. 36 sides, embalmed adults cadavers with different age group, in the laboratory of Morphology of the University of Pamplona. In 34 sides (94.5 %) of the cases the facial vein (FV) terminated into the internal jugular vein via the common facial vein (CFV) as per standard anatomic description. The facial vein on two sides (5.5 %) was found to drain into the external jugular vein with different degree of angulations and variable distance from the angle of the mandible. On the right side, the facial vein was draining into external jugular vein (EJV), 63.6 mm below the angle of the mandible. On the left side, the facial vein was draining into EJV, 42.4 mm below the angle of the mandible. The length of the neck was 137.8 mm.  The mean distance of the superior and inferior labial veins, deep facial vein, and angular vein from the inferior orbital margin was 41.89 ± 3.01, 52.31 ± 3.72, 26.85 ± 3.55 and 6.25 ± 0.65 mm, respectively Conclusion: A sound knowledge on variation of the course and termination of facial vein is very useful for oral and maxillofacial surgeons, plastic surgeons, otorrhinologists and radiologists, is essentially important in the clinical examination and surgical procedures of the head and neck region.

In order to study the incidence of the axillary arch in the Bulgarian population, we examined the axillary regions of 56 formol–carbol fixed human cadavers and observed two cases with a unilateral axillary arch. In the first case, the variant structure was situated on the right side of a 58-year-old female
cadaver. The axillary arch extended from the lateral border of the latissimus dorsi to the posterior layer of the pectoralis major tendon. In the second case, the axillary arch was found on the left side of a 63-year-old male cadaver and had the same attachment points as in the first case. The innervation and blood supply of the arches are discussed. We have also reviewed extensive information concerning the clinical importance of the axillary arch, and for the first time, it was summarized clearly for clinicians. The summary consists of three
parts: ‘‘diagnosis’’ of the axillary arch by physical investigation or imaging techniques; the axillary arch and surgical interventions in the region of the axilla; the axillary arch as an entrapment site for the axillary vessels and nerves.

During routine anatomical dissection a rare case of chondroepitrochlearis muscle was observed. The variant muscle originated from the fifth and sixth costal cartilages, then ascended to the axillary fossa, where received a musculotendinous slip extending from the posterior surface of the lateral part of the pectoralis major. After that the chondroepitrochlearis arched under the axilla, and descended to blend with the medial intermuscular septum of the deep brachial fascia. Because the variant muscle crossed the axilla and has some relation to its neurovascular bundle it could be of interest for clinicians. The possible clinical implications, such as cosmetic defects, functional disability, and to entrap the ulnar nerve due to its presence are reviewed.

Fifty dry Caucasoid adult skulls with full eruption of the molar teeth were examined to assess the location of the greater palatine foramen (GPF), and variations of the foramen and nearby area of the hard palate. The centre of the GPF was found to be 1.57 cm from the midline and 0.48 cm from the most lateral point of the posterior border of the hard palate. A regression equation was calculated to predict the distance of GPF from the midline according to palatine width. The GPF was found to be related to the upper 3rd molar tooth in most of the skulls (55%), 2nd molar in (12%), between the 2nd & 3rd molar in (19%) and retromolar in (14%). An average position rank of (2.702) was calculated, this was compared with calculated ranks from other studies. 60% of the foramina were found to be directed anteromedially, (36%) anteriorly and only (4%) were directed vertically (inferiorly) into the oral cavity. 55% of the sides of the skulls had multiple lesser palatine foramina and 4% showed absence of lesser palatine foramina. An unusually large lesser palatine foramen was reported. Palatine spines were observed in 67% of the sides of the skulls, they were bilateral in 64% of the sides. The shape of the foramen was elongated antero-posteriorly in 97% of the cases and an unusually crescent shaped foramen was observed in 2% of the sides. Our results did not support any bilaterality in the criteria studied. Comparison with other studies revealed no ethnic variation regarding the location the GPF. The significance of the results in relation to surgical procedures associated with the GPF was discussed.

The majority of medical students may not have witnessed the absence of the suprascapular notch throughout their dissection period in their medical schools due to its rarity. This absence is very important to the physicians and to the surgeons, as it can cause suprascapular nerve entrapment neu-ropathy. The aim of this paper is to report the incidence of the total absence of suprascapular notch amongst the past and the presently dissected ca-davers in the department. The Anatomy Department had procured averagely 90 human cadavers within thirty years of its establishment. Each forma-lin-embalmed cadaver was fully dissected by either 200 or 300 level medical or para-medical students. Since the inception of the department, any morphological anomalies of the soft or hard tissues and variations in terms of shape, size, position, or absence were always recorded and published. The human scapulae from those previously dissected cadavers were always examined just like any other bone in the human body to determine any variations or anomalies. Our previous records did not indicate any absence of the suprascapular notch except in one cadaver that was recently dissected and macerated in early 2017. Thus, it can be said that the incidence of absence of the suprascapular notch in Nigeria is 2:180 (90 cadavers: 90 left side, 90 right side scapulae), which is 1.1%. In summary, the absence of the suprascapular notch in our environment is also rare. Notwithstanding, physicians and surgeons should bear in mind the rare absence of the suprascapular notch and its possible involvement in the development of neuropathy due to the entrapment of the suprascapular nerve.

Background: Blood supply of kidney and gonads is characterized by
the presence of variations, which are usually silent and unnoticed until
they are found by retroperitoneal surgery, radiologic examination or
necropsy. Multiple renal vessels are no longer relative contraindication
for laparoscopic donor nephrectomy, however of their presence may
help avoid possible complication on a patient with these variations.
The purpose of this morphological study was to analyze the frequency
of supernumerary renal and testicular vessels and describe an unusual
combination of vascular variations in the retroperitoneal region.
Methods and Findings: A total of 18 cadavers with different age
group and 10 visceral blocks were used for the study in the Morphology
Laboratory of the University of Pamplona. Multiple bilateral
anatomical variations of testicular and renal vessels were found during
routine dissection in a 65-year-old male cadaver. The variations found
were: bilateral presence of three renal arteries and three renal veins.
The three left renal arteries are divided and gave rise to seven branches:
the left main renal artery originates two branches; the upper
branch originates four branches and the lower branch originates one
branch. Retro-aortic left renal vein. Three left testicular artery and double
right testicular artery all originating from accessory renal arteries.
Conclusions: Awareness of renal and testicular vessels anomalies
is essential for decreasing the rate of accidental injuries in surgical
procedures in the retroperitoneal region as well as aid in diagnosis of
diseases associated with vascular variation in the posterior abdomen.
An understanding of the morphology of renal and testicular vessels
is necessary in uroradiology, doppler imaging and computed tomography
studies.

Vascular variations of the head and neck are common, but oft en go unnoticed because they generally do not present clear clinical symptoms. Lack of awareness of the presence and location of such variations may result in iatrogenic complications or even fatalities. Physicians and surgeons should be cognizant of such variations given their potential clinical significance.
Vertebral artery variations are prevalent in both number and origin, but documented infrequently in the literature. Each of the five case studies described here: a White 65-year-old male (Case 1), a White 89-year-old female (Case 2), a White 80-year-old female (Case 3), a White 96-year-old female (Case 4), and a White 95-year-old female (Case 5), presented with an accessory left vertebral artery originating from the aortic arch, between the left common carotid artery and the left subclavian artery. This is the most common place for variations of this type cited in the literature. All five cases in this report, however, also presented with a left vertebral artery branching from the left subclavian artery. For Cases 1 and 3, the accessory left vertebral artery coursed cranially and entered the foramen transversarium at the C5 level. For Case 2, it entered at the C3 level. For Cases 4 and 5, it entered at the C4 level. With a prevalence of 7.81%, among a population of 64 specimens randomly selected and undergoing cadaveric review, this anatomical variant illustrates the potential frequency, and thus, the clinical importance of extensive anatomical understanding of head and neck vascular variations.

Keywords: Accessory Left Vertebral Artery; Duplicate Origin of the Left Vertebral Artery; Vertebral Artery Variation; Head and Neck
Vascular Variations

Abstract
Background: Anatomical knowledge of the facial vasculature is crucial
not only for anatomists but also for oral and maxillofacial surgery,
plastic surgeon, otorhinolaryngologists. Access pathways, pedicled
and free flap transfer, and explantation and transplantation of total
faces are based on the proper assessment and use of the facial veins
and arteries. The anatomical variations reported in the present study
confirms the need for preoperative vascular imaging for sure good
venous outflow for the free flap survival.
Aims: The aim of the present study was to describe a rare anatomical
variation of the common facial vein which not been previously
described.
Methods and Findings: Head and neck region were carefully
dissected as per standard dissection procedure, studied serially during
the years 2013-2017 in 15 males and 2 females, i.e. 34 sides, embalmed
adults cadavers with different age group, in the laboratory of
Morphology of the University of Pamplona. In 33 sides (97 %) of the
cases the anterior facial vein (FV) terminated into the internal jugular
vein via the common facial vein (CFV) as per standard anatomic description.
The right common facial vein in one side (3%) was found
to drain into the contralateral internal thoracic vein and contralateral
pericardiophrenic vein. Remarkable communications with the external
jugular vein, the internal jugular vein, the anterior jugular vein, and
left brachiocephalic vein. The length of the right common facial vein
from the level of its formation till its termination in the contralateral
pericardiophrenic and internal thoracic vein was about 22.75 cm. The
venous drainage pattern on the left side of the face was found to
be normal.
Conclusion: The existence of this anatomical variation among others
supposes a double edge sword in the medical practice with its own
opportunities and risks, especially in the surgical treatment; therefore,
we need to study with more strictness these possibilities with the aim
of facilitate this practices, and improve the life quality of our patients.

During routine anatomical dissection of the right upper extremity of a 53-year-old woman cadaver, an unusual high-origin of the pronator teres muscle was discovered. The fibers of the aberrant muscle arose from two bone origins--the medial epicondyle and a small supracondylar process of the humerus, and from a tendinous arch (Struthers&#39; ligament) extending between them. In addition, there was a variation of the musculocutaneous nerve--in the axilary fossa the musculocutaneous was fused to the median nerve and its usual branches arose consecutively from the median nerve stem. The last of these branches--the lateral antebrachial cutaneous arose in the lower part of the arm from the median nerve and companion to it and to the brachial artery passed under the Struthers&#39; ligament. Our findings indicate that in some rare cases of combined muscular-nerve variations, the lateral antebrachial cutaneous nerve can be added to the neurovascular structures possibly entrapped by the Strut...

In this report we describe an unusual combination of anatomical variations in the left upper extremity. A rare case of a variant palmaris longus muscle, an unknown variation of the flexor carpi ulnaris muscle and a persistent median artery were discovered
during routine anatomical dissection. The anatomical aspects of these variations have been discussed in detail. We also review the clinical literature and presented their possible clinical implications.

During routine anatomical dissections two cases of variant fibrous bands in the costoclavicular interval were observed. In the first case unusual fibrous bands were found bilaterally. In the second case a variant fibrous band was observed on the right side. In both cases the fibrous bands started from the coracoid region and lateral part of the clavicle, passed obliquely downwards crossing in front of the subclavian vessels and nerves of the brachial plexus and, at the end, they attached to the medial end of the first rib. Because the variant findings, reported here, might compress the vessels and nerves passing through the costoclavicular space, they could be regarded as a possible cause of thoracic outlet syndrome.

During routine dissection, was found bilateral arterial y nervous variations in a 60 years old male embalmed cadaver. First part of axillary artery did not give any branch, the second part of axillary artery gave off only three branches: Lateral Thoracic artery, thoracoacromial artery and large common trunk which later gave off thoracodorsal, circumflex scapular artery, subscapular, Posterior circumflex humeral artery. The third part of axillary artery gave off only anterior circumflex humeral artery. In both right and left arm the musculocutaneous nerve fused with the median nerve almost 5 cm proximal to elbow joint after the emergence of lateral cutaneous branch for forearm. It is important to be aware of this variations while planning a surgery in the region of axilla o arm, as these arteries and nerves are more liable to be injured during operations.

Fifty mandibles of adult Caucasoid cadavers of both sexes were used in this study. The results were discussed in view of the clinical significance of the anatomical features observed: These included position, number, and direction of the mental foramen; lingual fenestration of lower molar teeth region; condylar defects and the retromolar foramen.
The most frequent position (63%) of the mental foramen was in line with the longitudinal axis of the 2nd premolar tooth. The position of the mental foramen was discussed and compared with the results of other investigators on racial basis. It was concluded that the position of the 2nd premolar tooth is the most frequent position regardless of the race. The discrepancy in the frequency of other positions may be attributed to the details of the criteria employed by different observers. Double, triple, and quadruple mental foramina were observed in 17% of the sides. Only (4%) of the mandibles showed bilateral multiple mental foramina. The majority of the multiple foramina were unequal in size comprised of a single large foramen while the others were small (satellite) foramina except for one side of a double mental foramen of equal sizes. An incisive mental foramen was observed in 1% of the sides. Its presence was reported neither in Caucasoid nor in Mongoloid races thus a racial predilection for this type of foramen in blacks couldn’t be supported.
In 87% of sides the long axis of the mental foramen was directed downward and foreword, transversely forwards (11%), and downward and backwards (2%). Lingual fenestrations of lower molar teeth region were detected on one side only of a single mandible. 8% of the mandibles showed condylar defects. 48% of the mandibles showed the presence of retromolar foramina of these 62.5% were bilateral. These data are clearly of direct relevance in dental teaching and practice and were discussed in view of their clinical significance.

Background: The purpose of this paper is to describe a case of duplication of unilateral femoral vein, with a complete extension of duplicated veins with similar diameters which is an uncommon condition, noticed in fewer than 10% of lower limb. The venous anatomy is highly variable, only 1/6 patients are exempt of these anomalies. One is the duplicity of the femoral vein. The classic anatomic venous in the lower limb is found in only 16% of subject. Methods: Anatomical variation in the lower limb was found during routine dissection in a 75- year-old male cadaver in the Morphology Laboratory at the University of Pamplona. Result: In the adductor canal femoral vein was divided into two veins: one medial and other lateral, which ascended in parallel until the femoral triangle, at this level 6.5 cms below the inguinal ligament the femoral vein- lateral ramus received to the lateral circumflex femoral vein, and received to the medial circumflex femoral vein, followed the femoral veins la...

During routine dissection classes for undergraduate medical students, arterial anomalies were noted at the base of the brain, in an approximately 65-yearold male cadaver. The left internal carotid artery was slightly larger compared to the right internal carotid artery. It terminated by dividing into anterior cerebral and middle cerebral arteries. It gave a large posterior communicating artery, which was almost same in size as that of the middle cerebral artery (Figures 1, 2). The basilar artery terminated at the upper border of the pons by dividing into right and left posterior cerebral arteries. The left posterior cerebral artery was smaller than that of the right. The left posterior cerebral artery merged with the left posterior communicating artery and thereafter, the posterior communicating artery continued as the posterior cerebral artery. The two anterior cerebral arteries were connected to one another by two anterior communicating arteries, out of which the proximal one was ...

Either from congenital or ischemic problems, difficulties in aortic bypass surgery are usually caused by the unrecognized variation of aortic arch anatomy.
Objective: To investigate the frequency and anatomical basis of the aortic arch branching pattern from the world largest hospital.
Materials and Methods: Thirty eight adult human preserved cadavers, and one thousand fifty three aortic arches analyzed from images of computerized tomography and aortic angiography were used.  Occurrence among gender, branching pattern of the aortic arch was studied; number of branches and distance from their origin to the mid-vertebrae line were measured.
Results: In 81.3% of the cases, the main most common brachiocephalic trunk, left common carotid and left subclavian artery originate independently. From the remaining variants of the aortic arch: 13.2% have two branches, an independent left subclavian artery and a common trunk for the brachiocephalic trunk and left common carotid. 4.8% has four branches with the left vertebral artery; 0.4% having the left common carotid artery originating from a common trunk. Any other variation
falls within 0.1%. However, a strong significant positive correlation was found between the diameters of left common carotid artery and left subclavian artery.
Conclusion: The results in this study provide accurate information on aortic arch variations considered vital for academic purpose, and clinical vascular surgery and a primary data among the Chinese.

High division of the median nerve proximal to the carpal tunnel, also known as a bifid median nerve, is a rare anatomical variant
with an incidence between 1 and 3%. In order to study the incidence of this anatomical variation in the Bulgarian population,
we examined the upper limbs of 51 formol-carbol fixed human cadavers and also 154 upper limbs undergoing carpal tunnel
decompression. We detected one case of bifid median nerve during anatomical dissections and two cases in patients with carpal
tunnel syndrome. In one of the clinical cases, the anatomical variation was detected preoperatively by MRI. We discuss different variations of this nerve and emphasize their potential clinical implications.

Classically renal arteries are a pair of lateral branches from the abdominal aorta. Each kidney is supplied by single renal artery and a single renal vein However, current literature report great variability in renal blood supply, the number of renal arteries and the arrangement of hilar structures on the left side. In the present paper is described a case of origin of three renal artery found in the both sides; on the right side the main renal artery and the upper branch took their origin from a common trunk coming out of the lateral aspect of the abdominal aorta, the lower branch took origin from the anterior aspect of the abdominal aorta. On the left side the three renal arteries had separate origins of the abdominal aorta, three renal arteries gives rise to 7 branches. Both found three kidney renal vein, but In the left kidney was found three renal veins, which formed a common trunk that ran obliquely passing behind the abdominal aorta (retro – aortic) and draining into the inferior vena cava, further at the hilum was found embracing the main renal artery and the upper arterial branch. Proper knowledge of variations of the arteries supplying the kidney is essential not only to the anatomists but also to surgeons.

Background: Blood supply of kidney and gonads is characterized by the presence of variations, which are usually silent and unnoticed until they are found by retroperitoneal surgery, radiologic examination or necropsy. Multiple renal vessels are no longer relative contraindication for laparoscopic donor nephrectomy, however of their presence may help avoid possible complication on a patient with these variations. The purpose of this morphological study was to analyze the frequency of supernumerary renal and testicular vessels and describe an unusual combination of vascular variations in the retroperitoneal region. Methods and Findings: A total of 18 cadavers with different age group and 10 visceral blocks were used for the study in the Morphology Laboratory of the University of Pamplona. Multiple anatomical variations bilateral of testicular vessels and renal were found during routine dissection in a 65-year-old male cadaver. The variations found were: bilateral presence of three ren...

Background: Anatomical knowledge of the facial vasculature is crucial not only for anatomists but also for oral and maxillofacial surgery, plastic surgeon, otorhinolaryngologists. Access pathways, pedicled and free flap transfer, and explantation and transplantation of total faces are based on the proper assessment and use of the facial veins and arteries. The anatomical variations reported in the present study confirms the need for preoperative vascular imaging for sure good venous outflow for the free flap survival. Aims: The aim of the present study was to describe a rare anatomical variation of the common facial vein which not been previously described. Methods and Findings: Head and neck region were carefully dissected as per standard dissection procedure, studied serially during the years 2013-2017 in 15 males and 2 females, i.e. 34 sides, embalmed adults cadavers with different age group, in the laboratory of Morphology of the University of Pamplona. In 33 sides (97 %) of the...

Introduction: The frontal sinus is the most variable part of the paranasal sinuses in terms of symmetry, anatomical features and degree of development. The aim of this study was to assess the morphometric changes of the frontal sinus in cone-beam computed tomography (CBCT) images. Materials & Methods: In this cross-sectional study, 200 CBCT images were examined for anatomical variations such as the presence of frontal sinus, sinus symmetry, lateral frontal sinus extension (LFSE) to orbital roof, scalloping, septum and type of septum. Moreover, Crista Galli (CG) was divided into three equal segments of anterior, middle and posterior in order to have a precise criterion for determining the location of the frontal recess in coronal plane. The data were analyzed using ANOVA with T-test and Chi-square at significant level of P&lt;0.05. Results: Of 200 cases, 113 and 87 ones were male and female with the mean age of 18‒88 years. The results showed that frontal sinus was bilateral in all c...

Although the variability of the upper limb arteries is a clinically important problem, the prevalence is varying across the existing studies and classification is rather complicated, not well established and sometimes even unclear for simple and direct understanding and usage. Multiple case reports appearing in the last years apply incorrect, inappropriate, and sometimes misleading terminology. We performed an anatomical cadaveric study of the variability of the arteries of the upper limb, namely, the axilla, arm, and forearm, in 423 upper limbs embalmed with classical formaldehyde method (Central European population). We proposed to apply the Equality system based on the common trunks for denomination of the axillary artery branches principal variations: Truncus subscapulocircumflexus (22.9%), truncus profundocircumflexus (13.75%), and truncus bicircumflexus (13.95%). Further, we proposed the terminology system developed by Rodríguez-Niedenführ et al. for the free upper limb principal arterial trunk variations based on the origin, location (in the arm only, or in the arm and forearm), and course (related to the forearm flexor muscles) of the involved artery: Arteria brachialis superficialis (9.5%), arteria brachioradialis superficialis (6.4%), arteria brachioulnaris superficialis (1.9%), arteria brachiomediana superficialis (0.5%), and arteria comitans nervi mediani manus (3.3%). Extensive development of the catheterization methods via the arteria radialis et ulnaris as well as surgical procedures using flaps based on perforating branches of these arteries (including arteria brachioradialis superficialis et brachioulnaris superficialis) necessitate thorough data on prevalence of the variant vessels for safe performance of these procedures to prevent any unexpected situations or to react adequately in such.

Background: Anatomical structures of head are essential to carry out almost all of dental procedures.In this regard to study the variation of mental and mandibular foramens are prerequisite for the intervention of clinical dentistry. The study was undertaken to determine the anatomical position of the mental foramen (mF) and mandibular foramen (MF) and their relationship. Methods and Methods: Eighty-seven selected Malay patients were examined at Universiti Kebangsaan Malaysia Dental Clinics in which 34 were male and 53 were female. The size and position of the mF in relation to tooth position were recorded. The size and position of the MF were recorded based on the horizontal and vertical dimensions consisting of reference point’s namely anterior and posterior border of ascending border of ramus as well as mandibular notch and lower border of mandibular ramus, respectively. Results: The mF was found to be most in line with second premolar (49%) on both sides in both sexes. The size of mF was larger on the right side and in male (p<0.05). The size of MF on the right and left side for both male and female did not differ significantly (p>0.05). The mean distance between the MF to occlusal plane was 10mm (SD ±1.56) for both sides. There was no significant difference between mF and MF position (p>0.05). Conclusion: In the Malay population, anatomical relationship and variation between mental and mandibular foramen were not found to be significant. The information would be useful in dental intervention of the clinicians. © 2016, Ibn Sina Trust. All rights reserved.

Median arcuate ligament syndrome (MALS) is a rarely diagnosed condition resulting from compression of the celiac trunk (CT) by the median arcuate ligament (MAL) of the diaphragm. Ischemia due to reduced blood flow through the CT and/or neuropathic pain resulting from celiac ganglion compression may result in a range of gastrointestinal symptoms, including nausea, postprandial discomfort, and weight loss. However, the mechanism of compression and its anatomical correlates have been incompletely delineated. It has been hypothesized that CT angle of origination may be more acute in individuals with MALS. Here, frequency of anatomical variation in the MAL and CT were assessed in 35 cadaveric subjects (17M/18F), including the vertebral level of origin of CT and superior mesenteric artery (SMA), the distance between CT and MAL and SMA, the angles of origination of CT and SMA, the diameter at the CT base, and MAL/CT overlap. Females exhibited significantly higher rates of inferred MAL/CT overlap than males. Significant correlations were revealed between MAL/CT overlap and angles of origination of the CT and SMA. Vertebral level of origin of the CT in individuals with MAL/CT overlap was not significantly more superior than in those without. This study also revealed a significant relationship between MAL/CT overlap and angle of origination of the CT, which has clinical implications for understanding the anatomy associated with MALS.

Background: The purpose of this paper is to describe an anatomical variation of the hand extensor on the little finger of the right hand which receives four tendons, condition unknown, as it is the first case reported so far in the literature. The human extensor tendons of hand often display an array of variations. Awareness of the anatomy and variations of the extensor tendons on the dorsum of the hand is necessary not only for the anatomist but also for surgeons when considering tendons for hand surgery, tendon rerouting or transplants. Materials and Methods: Bilateral anatomical variation in the upper limb was found during routine dissection in a 75-year-old male cadaver in the Morphology Laboratory at the University of Pamplona. The variations were recorded and photographed. Result: In the left hand the extensor digitorum there was a single tendon to the index, double tendon to the middle, triple tendon to the ring finger, a single tendon to the little finger or digiti minimi. The extensor digiti minimi has double tendon. In the right hand the extensor digitorum there was a single tendon to the index, triple tendon to the middle finger, triple tendons to the ring finger, a double tendon to the little finger. The extensor digiti minimi has double tendon. The little finger receives four tendons, 2 of extensor digitorum and 2 of extensor digiti minimi. The dorsum of the left hand and right showed juncturae tendinum type 2, between the extensors tendons in the 3rd intermetacarpal space; type 3, between the extensors tendons in the 4th inter metacarpal space. Conclusion: The presence of multiple tendons may alter the kinematics around the site of attachment to the phalanx. Knowledge of anatomical variations and normal anatomy of the extensor tendons, may be helpful while performing graft and tendon transfer operations.

Variations in arterial anatomy are less frequent, contrary to the venous system, and most
of these variations affect visceral arteries. Variations in the brachial artery are the most
frequently reported and so far a minimum of six different patterns have been described. The
most common of these patterns is the superficial brachial artery, which lies superficially to
the median nerve. Much less prevalent is the high origin of the radial artery (brachioradial
artery) or the existence of a doubled brachial artery (accessory brachial artery). The current
study presents a pattern of brachial artery variation which was previously undescribed.
During dissection of the right upper limb of a 50 year-old male embalmed cadaver, the
bifurcation of the brachial artery in the proximal portion of the middle third of the arm was
observed. In this case, the medial branch reaches the medial aspect of the arm, posterior to
the median nerve. Afterwards, this medial branch redirects laterally and crosses the median
nerve again, this time lying anterior to the nerve till it reaches the lateral aspect of the arm.
At the elbow level, the medial branch originates from the radial artery. The lateral branch
of the brachial artery remains lateral to the median nerve and continues as ulnar artery and
originates from the interosseous artery. It was also observed that the left brachial artery was
smaller in size, and bifurcated high in the arm into the superficial radial and ulnar arteries.
It was also interesting to note that the common interosseous artery was originated from the
left radial artery in the cubital fossa, which descended deep to pronator teres where it was
divided into the anterior and posterior interosseous arteries. These variations are discussed
comprehensively and compared with the previous reports. Also, it is asserted how clinically
the findings are significant.