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Roberts SO, Cardozo A. A detailed review of the spinal accessory nerve and its anatomical variations with cadaveric illustration. Anat Sci Int 2024; 99:239-253. [PMID: 38696101 PMCID: PMC11143051 DOI: 10.1007/s12565-024-00770-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 04/04/2024] [Indexed: 06/01/2024]
Abstract
The spinal accessory nerve, considered part of the eleventh cranial nerve, provides motor innervation to sternocleidomastoid and trapezius. A comprehensive literature review and two cadaveric dissections were undertaken. The spinal accessory nerve originates from the spinal accessory nucleus. Its rootlets unite and ascend between the denticulate ligament and dorsal spinal rootlets. Thereafter, it can anastomose with spinal roots, such as the McKenzie branch, and/or cranial roots. The spinal accessory nerve courses intracranially via foramen magnum and exits via jugular foramen, within which it usually lies anteriorly. Extracranially, it usually crosses anterior to the internal jugular vein and lies lateral to internal jugular vein deep to posterior belly of digastric. The spinal accessory nerve innervates sternocleidomastoid, receives numerous contributions in the posterior triangle and terminates within trapezius. Its posterior triangle course approximates a perpendicular bisection of the mastoid-mandibular angle line. The spinal accessory nerve contains sensory nociceptive fibres. Its cranial nerve classification is debated due to occasional non-fusion with the cranial root. Surgeons should familiarize themselves with the variable course of the spinal accessory nerve to minimize risk of injury. Patients with spinal accessory nerve injuries might require specialist pain management.
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Affiliation(s)
- Siôn Owain Roberts
- Department of Anatomy, Faculty of Medicine and Health, School of Medicine, University of Leeds, Leeds, Yorkshire, LS2 9JT, UK.
| | - Arun Cardozo
- Department of Otorhinolaryngology, Lancashire Teaching Hospital NHS Trust, Sharoe Green Lane North, Fulwood, Preston, Lancashire, PR2 9HT, UK
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Razzouk J, Kricfalusi M, Case T, Petersen G, Small E, Sajdak G, Nguyen K, Kagabo W, Ramos O, Danisa O, Cheng W. Surface anatomical landmarks for spine surgery: A CT-based study of the sternal notch and sternal angle in 1,035 patients. J Clin Neurosci 2023; 118:46-51. [PMID: 37866208 DOI: 10.1016/j.jocn.2023.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/08/2023] [Accepted: 08/24/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Understanding the location of surface anatomical landmarks in relation to the cervical and thoracic spine is important for a wide array of clinical applications. The objective of this study was to investigate the influence of patient demographic and anthropometric characteristics on the locations of the sternal notch and sternal angle in relation to the spine using computed tomography (CT) of a large cohort of young adult patients without spinal pathology. METHODS Vertebral levels corresponding to the sternal notch and sternal angle were analyzed using CT of 1,035 patients. Influences of patient height, weight, body mass index (BMI), sex, and ethnicity were assessed. RESULTS 567 male and 468 female patients were included in this study. Mean patient height, weight, BMI, and age were 1.68 ± 0.11 m, 81.94 ± 24.39 kg, 27.79 ± 7.9 kg/m2, and 25.9 ± 5.9 years. Of the 1,035 patients, 495 were Hispanic or Latino, 321 were Caucasian, 130 were African American, 68 were Asian, 5 were identified as "other," and 16 did not have racial or ethnic data available. The location of the sternal notch in relation to the thoracic spine demonstrated a bimodal distribution pattern clustered at the T2 and T3 vertebral bodies. The location of the sternal angle in relation to the thoracic spine demonstrated a bimodal distribution pattern clustered at the T4 and T5 vertebral bodies. Moderate, negative correlations were observed between patient weight and location of the sternal notch (r = -0.447; p <.001) and sternal angle (r = -0.499; p <.001), respectively. Zero significant correlations were observed between patient height and location of the sternal notch (r = -0.045; p =.377) or sternal angle (r = -0.080; p =.229). A weak, negative correlation was observed between patient BMI and location of the sternal notch (r = -0.378; p <.001). A moderate, negative correlation was observed between patient BMI and location of the sternal angle (r = -0.445; p <.001). The locations of the sternal landmarks did not differ based on patient sex, race or ethnicity. CONCLUSIONS The location of the sternal notch most frequently corresponds to the T2 or T3 vertebral body, while the sternal angle is most frequently located at the T4 or T5 vertebral body. Increased patient weight is associated with relatively cephalad sternal landmarks. Patient height, sex, and ethnicity are not associated with either sternal landmark.
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Affiliation(s)
- Jacob Razzouk
- Loma Linda University School of Medicine, Loma Linda, CA, USA
| | | | - Trevor Case
- California University of Science and Medicine, Colton, CA, USA
| | | | - Easton Small
- Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Grant Sajdak
- Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Kai Nguyen
- Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Whitney Kagabo
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Omar Ramos
- Department of Orthopaedic Surgery, Twin Cities Spine Center, Minneapolis, MN, USA
| | - Olumide Danisa
- Department of Orthopaedic Surgery, Loma Linda University, Loma Linda, CA, USA
| | - Wayne Cheng
- Division of Orthopaedic Surgery, Jerry L. Pettis Memorial Veterans Hospital, Loma Linda, CA, USA.
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Hankin MH, Harmon DJ, Martindale JR, Niculescu I, Aschmetat A, Mertens AN, Hanke RE, Koo AS, Kraus AE, Payne JA, Feldman MJ, Soltero Mariscal E. Needs assessment of essential anatomy: The perspective of adult primary care resident physicians. ANATOMICAL SCIENCES EDUCATION 2023; 16:504-520. [PMID: 36622764 DOI: 10.1002/ase.2252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/22/2022] [Accepted: 12/27/2022] [Indexed: 05/11/2023]
Abstract
Curricular development and modification involve first identifying a problem and then performing a needs assessment, which can guide the design of curricular components. Pedagogical changes, coupled with reductions in curricular time for gross anatomy, pose challenges and impose restrictions within medical school curricula. In order to make anatomy education effective and efficient, it is important to determine the anatomy considered essential for medical education through a targeted needs assessment. In this study, 50 adult primary care resident physicians in family medicine (FM) and internal medicine (IM) were surveyed to assess the importance of 907 anatomical structures, or groups of structures, across all anatomical regions from a curated list based on the boldface terms in four primary anatomy texts. There were no statistically significant differences in the ratings of structures between the two groups for any anatomical region. In total, 17.0% of structures, or groups of structures, were classified as essential, 58.0% as more important, 24.4% as less important, and 0.7% as not important. FM residents rated tissues classified as skeleton, nerves, fasciae, anatomical spaces, blood vessels, lymphatics, and surface anatomy (p < 0.0001) significantly higher than IM residents, but there were no differences in the rating of muscles or organs (p > 0.0056). It was notable that 100.0% of cranial nerves were classified as essential, and 94.5% of surface anatomy structures were classified as essential or more important. It is proposed that results of this study can serve to inform curricular development and revision.
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Affiliation(s)
- Mark H Hankin
- Anatomical Sciences Education Center, Oregon Health & Science University, Portland, Oregon, USA
| | - Derek J Harmon
- Division of Anatomy, Department of Biomedical Education and Anatomy, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - James R Martindale
- Office of Medical Education, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Iuliana Niculescu
- Department of Internal Medicine, Beaumont Health, William Beaumont Hospital, Royal Oak, Michigan, USA
| | - Adrienne Aschmetat
- Department of Internal Medicine, Oaklawn Hospital, Marshall, Michigan, USA
- Department of Pediatrics, Oaklawn Hospital, Marshall, Michigan, USA
| | - Amy N Mertens
- Michigan Heart Group at St. Joseph Mercy (Trinity Health), Ann Arbor, Michigan, USA
| | - Rachel E Hanke
- Department of Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Andrew S Koo
- Department of Obstetrics and Gynecology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Anthony E Kraus
- Department of Emergency Medicine, Signature Healthcare, Brockton Hospital, Brockton, Massachusetts, USA
| | - James A Payne
- Middle Tennessee Urology Specialists, Murfreesboro, Tennessee, USA
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Ejlersen M. The human clavicle's nutrient foramen's prevalence, number, location, and direction: A systematic review and meta-analysis. Surgeon 2023; 21:e48-e61. [PMID: 35606260 DOI: 10.1016/j.surge.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 03/08/2022] [Accepted: 04/03/2022] [Indexed: 02/01/2023]
Abstract
INTRODUCTION The clavicle's nutrient foramen is a surrogate marker for its nutrient artery. Knowing its location may be useful for interpreting fractures and to avoid iatrogenic lesions. The aim of this review was to determine the prevalence, number, location, and direction of the nutrient foramen. METHODS Embase, Medline, PubMed, Scopus, and Web of Science were searched and supplemented by Google Scholar, hand-searching major anatomical journals, and the reference list of included studies (updated March 08, 2022). Titles and abstracts were screened for eligibility, and observational studies with quantitative data were included based on full text evaluation. Internal validity was assessed using the anatomical quality assessment tool. Pooled prevalence proportions were derived using a random effects DerSimonian-Laird model using the Freeman-Tukey double arcsine transformation with Miller's inverse back-transformation. RESULTS From 18,889 unique reports, 33 studies with 3760 clavicles and 3358 foramina were included. All studies suffered from untransparent reporting. The prevalence of the nutrient foramen was 97.75%, 95% confidence interval 94.70%-99.60%. It was mainly found as a single foramen on the middle third segment's posterior surface with acromial (lateral) obliquity. Results were stable over time, robust to sensitivity analyses, albeit limited by unexplained heterogeneity and asymmetry. CONCLUSION This review may aid in interpreting fractures passing through a high-risk area (mean foraminal index range 36.31-61.03%) for lesions to the nutrient artery. Practical implications are a need to update current inaccurate textbook descriptions and further advocate evidence-based anatomy to improve conduct and reporting of anatomical research.
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Affiliation(s)
- Morten Ejlersen
- Faculty of Health Sciences, University of Southern Denmark, J.B. Winsløws Vej 19.3, Odense, 5000, Denmark.
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Abu Bakar YI, Hassan A, Yusoff MSB, Kasim F, Abdul Manan Sulong H, Hadie SNH. A Scoping Review of Effective Teaching Strategies in Surface Anatomy. ANATOMICAL SCIENCES EDUCATION 2022; 15:166-177. [PMID: 33650315 DOI: 10.1002/ase.2067] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 01/21/2021] [Accepted: 02/25/2021] [Indexed: 06/12/2023]
Abstract
To become skilled physicians, medical students must master surface anatomy. However, the study of surface anatomy is less emphasized in medical and allied health science curricula, and the time devoted to direct engagement with the human body is limited. This scoping review was designed to answer one research question: "What are the elements and strategies that are effective in teaching surface anatomy?" The review was performed using a five-stage scoping review framework, including research question identification, relevant study identification, study selection, data charting, and result collating and reporting. Three databases were searched using two search terms combined with a Boolean operator: "teaching" and "surface anatomy." The initial pool of 3,294 sources was assessed for duplication, and study eligibility was evaluated using inclusion and exclusion criteria. Data were abstracted from 26 original articles by one researcher and verified by two other researchers. A thematic analysis was performed, and several elements of effective teaching strategies for surface anatomy were identified, namely contextualized teaching, embracing experiential learning, and learning facilitation. This review revealed that a multimodal approach was most commonly used in surface anatomy instruction. Hence, future research should explore the effectiveness of multimodal teaching strategies that adopt the three aforementioned primary elements of effective teaching in an authentic learning environment. It is pertinent to clarify the effectiveness of these teaching strategies by evaluating their impact on student learning, organizational changes, and benefits to other stakeholders.
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Affiliation(s)
- Yasrul Izad Abu Bakar
- Faculty of Medicine, Medical Campus, Universiti Sultan Zainal Abidin, Terengganu, Malaysia
- Department of Medical Education, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu, Malaysia
| | - Asma' Hassan
- Faculty of Medicine, Medical Campus, Universiti Sultan Zainal Abidin, Terengganu, Malaysia
| | - Muhamad Saiful Bahri Yusoff
- Department of Medical Education, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu, Malaysia
| | - Fazlina Kasim
- Department of Anatomy, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu, Malaysia
| | - Husnaida Abdul Manan Sulong
- Integrative Medicine Cluster, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Bertam, Kepala Batas, Malaysia
| | - Siti Nurma Hanim Hadie
- Department of Anatomy, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu, Malaysia
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Farley E, Hindmarch J, Eizenberg N, Midwinter M. Surgical applied anatomy: alive and kicking. ANZ J Surg 2021; 91:832-836. [PMID: 33734548 DOI: 10.1111/ans.16680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 01/30/2021] [Accepted: 02/02/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Contention exists amongst anatomists, clinicians and surgeons about how much anatomical knowledge medical students need, although what is taught should be aligned with current surgical practice. The aim of this study was to explore the scope of recent advances in applied anatomy as highlighted in the ANZ Journal of Surgery in each of the surgical specialties. METHODS The 2018 volume of the ANZ Journal of Surgery was narrowed to 254 articles by applying the search term 'anatomy'. The main topic was extracted from each paper. The content of the paper was assessed for 'novel description' or 'novel application' of anatomical knowledge and classified accordingly. RESULTS Most papers with an anatomical focus were from general surgery, which focused on surgical techniques, outcomes and management. Vascular surgery had the highest percentage of papers with a novel description and application of anatomy. Although cardiothoracic and paediatric surgery had no papers with a novel description of anatomy, novel applications of anatomy were a focus in each speciality. CONCLUSION The trend towards novel applications of anatomical knowledge in all surgical specialties should encourage medical schools to shape their anatomy curricula in tandem with such advances as they evolve. The high proportion of novel applications and descriptions of anatomy in general surgery indicates continued growth as a benchmark of anatomical understanding. Vascular surgery's proportion of novel application and description of anatomy may change the way students will learn vascular anatomy to incorporate endovascular, radiologically based approaches.
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Affiliation(s)
- Edward Farley
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Jake Hindmarch
- Melbourne Clinical School, The University of Notre Dame, Melbourne, Victoria, Australia
| | - Norman Eizenberg
- Melbourne Clinical School, The University of Notre Dame, Melbourne, Victoria, Australia
| | - Mark Midwinter
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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8
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Goyal R, Aggarwal A, Gupta T, Gulati A, Jaggi S, Mirjalili SA, Sahni D. Reappraisal of the classical abdominal anatomical landmarks using in vivo computerized tomography imaging. Surg Radiol Anat 2019; 42:417-428. [PMID: 31511961 DOI: 10.1007/s00276-019-02326-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 08/31/2019] [Indexed: 12/13/2022]
Abstract
INTRODUCTION With expanding scope of interventions it becomes mandatory to have correct and evidence-based knowledge of surface anatomy of internal abdominal structures. Information available in text books is derived from work done on cadaveric studies. Current study was designed to provide data of key abdominal surface anatomical landmarks and their variations in living subjects using CT imaging of adult population. MATERIALS AND METHODS Cross-sectional study was conducted using 100 abdominopelvic CT scans of patients of Indian origin. RESULTS Vertebral levels of origin of celiac trunk varied from T11 to L1/2 intervertebral disc, superior mesenteric artery from T12 to L2, inferior mesenteric artery from L2 to L4 and aortic bifurcation from L3 to L5. Origin of both renal arteries varied between T12 and L2 and the formation of inferior vena cava varied from L3 to L5. Vertebral levels of upper pole of both kidneys ranged from T11 to upper L3. Spleen was related to 9th to 11th ribs in 36% and 10th to 12th ribs in 34% scans. Most common vertebral levels of subcostal plane, planum supracristale and planum intertuberculare noticed were lower L2, L4 and lower L5, respectively. CONCLUSIONS Data derived from imaging investigations of living subjects and variations from the conventional descriptions observed in the current study might be helpful for clinicians.
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Affiliation(s)
- Ruchi Goyal
- Department of Anatomy, PGIMER, #123-c Type V Flats, Sector 24 A, Chandigarh, 160023, India
| | - Anjali Aggarwal
- Department of Anatomy, PGIMER, #123-c Type V Flats, Sector 24 A, Chandigarh, 160023, India.
| | - Tulika Gupta
- Department of Anatomy, PGIMER, #123-c Type V Flats, Sector 24 A, Chandigarh, 160023, India
| | - Ajay Gulati
- Department of Radiodiagnosis and Imaging, PGIMER, Chandigarh, 160012, India
| | - Shallu Jaggi
- Department of Radiodiagnosis and Imaging, PGIMER, Chandigarh, 160012, India
| | - S Ali Mirjalili
- Anatomy and Medical Imaging Department, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Victoria Street West, Auckland, New Zealand
| | - Daisy Sahni
- Department of Anatomy, PGIMER, #123-c Type V Flats, Sector 24 A, Chandigarh, 160023, India
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Botham SJ, Fillmore EP, Grant TS, Davies H, Hutchinson C, Tunstall R. Age-related changes in inguinal region anatomy from 0 to 19 years of age. Clin Anat 2019; 32:794-802. [PMID: 31066950 DOI: 10.1002/ca.23402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 05/02/2019] [Accepted: 05/04/2019] [Indexed: 11/10/2022]
Abstract
Knowledge of the age-related changes in inguinal region anatomy is essential in pediatric urological and abdominal surgery, yet little is published. This study aimed to determine the position of inguinal region structures and growth of the surrounding pelvis and inguinal ligament in subjects from 0 to 19 years of age. Anonymized contrast-enhanced CT DICOM datasets of 103 patients (63 male: 40 female) aged from 0 to 19 years had left and right sides analyzed by three independent observers. Exclusion criteria were applied. Growth of the pelvis and inguinal ligament were determined using fixed bony reference points. The position of the deep inguinal ring and femoral vasculature were determined as ratio of inguinal ligament length, measured from the anterior superior iliac spine. Growth of the pelvis in vertical and horizontal dimensions and of the inguinal ligament followed a positive polynomial relationship with increasing age, with no observed increase in growth rate during puberty. From 0 to 19 years, the deep inguinal ring moved superolaterally with respect to the inguinal ligament (from 0.74 to 0.60 of the distance along the inguinal ligament) and the femoral artery and vein moved medially (from 0.50 to 0.58, and 0.61 to 0.65 of the distance along the inguinal ligament, respectively). The position of the femoral artery, vein, and deep inguinal ring followed a logarithmic relationship with age. No significant left:right side or male:female differences were observed. From 0 to 19 years of age the femoral vasculature and deep inguinal ring change position as the pelvis grows around them. Clin. Anat. 32:794-802, 2019. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Sean J Botham
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Erin P Fillmore
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Thomas S Grant
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Harvey Davies
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Charles Hutchinson
- Warwick Medical School, University of Warwick, Coventry, United Kingdom.,University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
| | - Richard Tunstall
- Warwick Medical School, University of Warwick, Coventry, United Kingdom.,University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
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Nadesan T, Keough N, Suleman FE, Lockhat Z, van Schoor AN. Apprasial of the surface anatomy of the Thorax in an adolescent population. Clin Anat 2019; 32:762-769. [PMID: 30758865 DOI: 10.1002/ca.23351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 02/07/2019] [Accepted: 02/08/2019] [Indexed: 11/06/2022]
Abstract
Surface anatomy is considered a fundamental part of anatomy curricula and clinical practice. Recent studies have reappraised surface anatomy using CT, but the adolescent age group has yet to be appraised. Sixty adolescent thoracoabdominal CT scans (aged 12-18 years) were examined. The surface anatomy of the central veins, cardiac apex, diaphragmatic openings, and structures in relation to the sternal angle plane were analyzed. The results showed that the brachiocephalic vein (left and right) formed mostly posterior to the sternoclavicular joint. The superior vena cava formed close to the second costal cartilage, ±16.3 mm to the right of the midline. The apex of the heart was located in relation to the fifth intercostal space; ±78.6 mm to the left of the midline. The caval hiatus was in relation to T9 and T10; the esophageal hiatus was at T10; whereas the aortic hiatus was at T11. The sternal angle plane was in relation to the upper half of T5, which was also where the bifurcations of the trachea and pulmonary trunk were observed. The SVC/azygos vein junction and the concavity of the aortic arch were observed to be more than 10 mm superior to this plane. The results of this study further highlight the substantial variability of the surface anatomy between age groups. It also emphasizes the notion that surface anatomy is a dynamic variable and cannot be treated as a static observation. Clin. Anat. 32:762-769, 2019. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Thiasha Nadesan
- Department of Anatomy, Faculty of Health Sciences, School of Medicine, University of Pretoria, Pretoria, South Africa
| | - Natalie Keough
- Department of Anatomy, Faculty of Health Sciences, School of Medicine, University of Pretoria, Pretoria, South Africa
| | - Farhana E Suleman
- Department of Radiology, Faculty of Health Sciences, School of Medicine, University of Pretoria, Pretoria, South Africa
| | - Zarina Lockhat
- Department of Radiology, Faculty of Health Sciences, School of Medicine, University of Pretoria, Pretoria, South Africa
| | - Albert N van Schoor
- Department of Anatomy, Faculty of Health Sciences, School of Medicine, University of Pretoria, Pretoria, South Africa
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Ko TS, Siu Hei Tse M, Wong KK, Wong WC. The Inaccuracy of Surface Landmarks for the Anterior Approach to the Cervical Spine in Southern Chinese Patients. Asian Spine J 2018; 12:1123-1126. [PMID: 30322240 PMCID: PMC6284114 DOI: 10.31616/asj.2018.12.6.1123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 04/29/2018] [Indexed: 11/23/2022] Open
Abstract
Study Design Observational study. Purpose To assess the correlational accuracy between the traditional anatomic landmarks of the neck and their corresponding vertebral levels in Southern Chinese patients. Overview of Literature Recent studies have demonstrated discrepancies between traditional anatomic landmarks of the neck and their corresponding cervical vertebra. Methods The center of the body of the hyoid bone, the upper limit of the lamina of the thyroid cartilage, and the lower limit of the cricoid cartilage were selected as representative surface landmarks for this investigation. The corresponding vertebral levels in 78 patients were assessed using computed tomography. Results In both male and female patients, almost none of the anatomical landmarks demonstrated greater than 50% correlation with any vertebral level. The most commonly corresponding vertebra of the hyoid bone, the lamina of the thyroid cartilage, and the cricoid cartilage were the C4 (47.5%), C5 (35.9%), and C7 (42.3%), respectively, which were all different from the classic descriptions in textbooks. The vertebral levels corresponding with the thyroid and cricoid cartilage were significantly different between genders. Conclusions The surface landmarks of the neck were not accurate enough to be used as the sole determinant of vertebral levels or incision sites. Intra-operative fluoroscopy is necessary to accurately locate each of the cervical vertebral levels.
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Affiliation(s)
- Tin Sui Ko
- Corresponding author: Tin Sui Ko Department of Orthopaedics and Traumatology, Kwong Wah Hospital, 25 Waterloo Road, Hong Kong Tel: +852-23322311, Fax: +852-35175168, E-mail:
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12
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Badshah M, Soames R, Ibrahim M, Khan MJ, Khan A. Surface anatomy of major anatomical landmarks of the neck in an adult population: A Ct Evaluation of Vertebral Level. Clin Anat 2017; 30:781-787. [PMID: 28514499 DOI: 10.1002/ca.22907] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 04/20/2017] [Accepted: 04/26/2017] [Indexed: 11/10/2022]
Abstract
To compare the projectional surface anatomy of healthy individuals in an adult population with those with a thyroid mass, using computed tomography (CT). Sixteen slice CT images of 101 individuals were analyzed using a 32-bit Radiant DICOM viewer to establish the relationships among major anatomical landmarks in the neck and their vertebral levels. The structures investigated included: hard palate (HP), hyoid bone (HB) including body and lesser horns, soft palate (SP), thyroid gland (TG) (both superior and inferior poles), thyroid gland anteroposterior (APD) and superoinferior (SID) diameters, thyroid isthmus (TI) superoinferior dimension, epiglottis, vertebral arteries (right and left), and both right and left parotid glands (superior and inferior extents). The vertebral levels noted most frequently were: body of hyoid bone (C4, 42.71%); lesser horns of hyoid bone (C3, 36.46%); thyroid gland superior pole (C6, 31.25%); and thyroid gland inferior pole (T2, 30.2%). TG-ID, TG-APD, and TG-SID were not significantly different between males and females in the healthy group; however, there was a significant gender difference in thyroid gland inferior diameter in the pathology group [males 2.16(±1.16) vs. females 3.37(±1.30), P = 0.01, paired sample t-test]. Further studies are needed to determine whether neck pathology in those with a thyroid mass affects the dimensions of the thyroid gland. Moreover, the surface anatomy of the neck should be revisited using modern imaging techniques to address inconsistencies in anatomy and clinical reference texts. Clin. Anat. 30:781-787, 2017. © 2017Wiley Periodicals, Inc.
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Affiliation(s)
- Masroor Badshah
- Centre for Anatomy and Human Identification, University of Dundee, Scotland, DD1 4HN, United Kingdom.,North West School of Medicine, Sector A 3 Phase 5, Hayatabad Peshawar KP 25000, Pakistan
| | - Roger Soames
- Centre for Anatomy and Human Identification, University of Dundee, Scotland, DD1 4HN, United Kingdom
| | - Muhammad Ibrahim
- Department of Surgery, Khyber Teaching Hospital, Peshawar KP 25000, Pakistan
| | - Muhammad Jaffar Khan
- Department of Biochemistry, Khyber Medical University, Peshawar KP 25000, Pakistan
| | - Adnan Khan
- Department of Radiology, As Suwaidi Hospital, Shar-e- Hamza bin mutalib, Az zahra, Riyadh, Saudi Arabia
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Fischer NJ, Morreau J, Sugunesegran R, Taghavi K, Mirjalili SA. A reappraisal of pediatric thoracic surface anatomy. Clin Anat 2017; 30:788-794. [PMID: 28514496 DOI: 10.1002/ca.22913] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 05/12/2017] [Indexed: 11/05/2022]
Abstract
Accurate knowledge of surface anatomy is fundamental to safe clinical practice. A paucity of evidence in the literature regarding thoracic surface anatomy in children was identified. The associations between surface landmarks and internal structures were meticulously analyzed by reviewing high quality computed tomography (CT) images of 77 children aged from four days to 12 years. The results confirmed that the sternal angle is an accurate surface landmark for the azygos-superior vena cava junction in a plane through to the level of upper T4 from birth to age four, and to lower T4 in older children. The concavity of the aortic arch was slightly below this plane and the tracheal and pulmonary artery bifurcations were even lower. The cardiac apex was typically at the 5th intercostal space (ICS) from birth to age four, at the 4th ICS and 5th rib in 4-12 year olds, and close to the midclavicular line at all ages. The lower border of the diaphragm was at the level of the 6th or 7th rib at the midclavicular line, the 7th ICS and 8th rib at the midaxillary line, and the 11th thoracic vertebra posteriorly. The domes of the diaphragm were generally flatter and lower in children, typically only one rib level higher than its anterior level at the midclavicular line. Diaphragm apertures were most commonly around the level of T9, T10, and T11 for the IVC, esophagus and aorta, respectively. This is the first study to provide an evidence-base for thoracic surface anatomy in children. Clin. Anat. 30:788-794, 2017. © 2017Wiley Periodicals, Inc.
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Affiliation(s)
| | - Jonty Morreau
- Department of Anatomy and Medical Imaging, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | | | - Kiarash Taghavi
- Department of Paediatric Surgery and Urology, Starship Children's Hospital, Auckland, New Zealand.,Department of Surgery, University of Auckland, New Zealand
| | - S Ali Mirjalili
- Department of Anatomy and Medical Imaging, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Badshah M, Soames R, Khan MJ, Ibrahim M, Khan A. Revisiting thoracic surface anatomy in an adult population: A computed tomography evaluation of vertebral level. Clin Anat 2017; 30:227-236. [PMID: 27935171 DOI: 10.1002/ca.22817] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 11/29/2016] [Accepted: 12/01/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Masroor Badshah
- Centre for Anatomy and Human Identification; University of Dundee; Scotland United Kingdom
- North West School of Medicine; Hayatabad Peshawar Khyber Pakhtunkhwa 25000 Pakistan
| | - Roger Soames
- Centre for Anatomy and Human Identification; University of Dundee; Scotland United Kingdom
| | - Muhammad Jaffar Khan
- Department of Biochemistry; Khyber Medical University; Peshawar Khyber Pakhtunkhwa 25000 Pakistan
| | - Muhammad Ibrahim
- Department of Surgery; Khyber Teaching Hospital; Peshawar Khyber Pakhtunkhwa 25000 Pakistan
| | - Adnan Khan
- Department of Radiology; As Suwaidi Hospital; Shar-e-Hamza bin mutalib Az zahra Riyadh Saudi Arabia
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Keough N, Mirjalili S, Suleman F, Lockhat Z, van Schoor A. The thoracic surface anatomy of adult black South Africans: A reappraisal from CT scans. Clin Anat 2016; 29:1018-1024. [DOI: 10.1002/ca.22776] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 08/26/2016] [Accepted: 08/26/2016] [Indexed: 11/09/2022]
Affiliation(s)
- N. Keough
- Department of Anatomy, Faculty of Health Sciences, School of Medicine; University of Pretoria; Pretoria South Africa
| | - S.A. Mirjalili
- Department of Anatomy and Medical Imaging; University of Auckland; Auckland New Zealand
| | - F.E. Suleman
- Department of Radiology, Faculty of Health Sciences School of Medicine; University of Pretoria; Pretoria South Africa
| | - Z.I. Lockhat
- Department of Radiology, Faculty of Health Sciences School of Medicine; University of Pretoria; Pretoria South Africa
| | - A. van Schoor
- Department of Anatomy, Faculty of Health Sciences, School of Medicine; University of Pretoria; Pretoria South Africa
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Affiliation(s)
- Norman Eizenberg
- Department of Anatomy & Developmental Biology, Monash University, Melbourne, VIC, Australia
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Pak N, Patel SG, Hashemi Taheri AP, Hashemi F, Eftekhari Vaghefi R, Naybandi Atashi S, Mirjalili SA. A reappraisal of adult thoracic and abdominal surface anatomy in Iranians in vivo using computed tomography. Clin Anat 2015; 29:191-6. [DOI: 10.1002/ca.22669] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 10/07/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Neda Pak
- Department of Radiology; Shariati Hospital, Tehran University of Medical Sciences; Tehran Iran
| | - Shilpan G. Patel
- Department of Anatomy with Radiology, Faculty of Medical and Health Sciences; University of Auckland; Auckland New Zealand
| | - Amir P. Hashemi Taheri
- Department of Radiology; Shariati Hospital, Tehran University of Medical Sciences; Tehran Iran
| | - Fariba Hashemi
- Department of Radiology; Shariati Hospital, Tehran University of Medical Sciences; Tehran Iran
| | - Raana Eftekhari Vaghefi
- Department of Radiology; Shariati Hospital, Tehran University of Medical Sciences; Tehran Iran
| | - Sara Naybandi Atashi
- Department of Radiology; Shariati Hospital, Tehran University of Medical Sciences; Tehran Iran
| | - S. Ali Mirjalili
- Department of Anatomy with Radiology, Faculty of Medical and Health Sciences; University of Auckland; Auckland New Zealand
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Uzun C, Atman ED, Ustuner E, Mirjalili SA, Oztuna D, Esmer TS. Surface anatomy and anatomical planes in the adult turkish population. Clin Anat 2015; 29:183-90. [PMID: 26403267 DOI: 10.1002/ca.22634] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 09/16/2015] [Accepted: 09/18/2015] [Indexed: 11/10/2022]
Abstract
Surface anatomy and anatomical planes are widely used in education and clinical practice. The planes are largely derived from cadaveric studies and their projections on the skin show discrepancies between and within anatomical reference textbooks. In this study, we reassessed the accuracy of common thoracic and abdominopelvic anatomical planes using computed tomography (CT) imaging in the live adult Turkish population. After patients with distorting pathologies had been excluded, CT images of 150 supine patients at the end tidal inspiration were analyzed. Sternal angle, transpyloric, subcostal, supracristal and pubic crest planes and their relationships to anatomical structures were established by dual consensus. The tracheal bifurcation, azygos vein/superior vena cava (SVC) junction and pulmonary bifurcation were usually below the sternal angle while the concavity of the aortic arch was generally within the plane. The tip of the tenth rib, the superior mesenteric artery and the portal vein were usually within the transpyloric plane while the renal hila and the fundus of the gallbladder were below it. The inferior mesenteric artery was below the subcostal plane and the aortic bifurcation was below the supracristal plane in most adults. Projectional surface anatomy is fundamental to medical education and clinical practice. Modern cross-sectional imaging techniques allow large groups of live patients to be examined. Classic textbook information regarding anatomy needs to be reviewed and updated using the data gathered from these recent studies, taking ethnic differences into consideration.
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Affiliation(s)
- C Uzun
- Department of Radiology, Ankara University School of Medicine, Ankara, Turkey
| | - E D Atman
- Department of Radiology, Ankara University School of Medicine, Ankara, Turkey
| | - E Ustuner
- Department of Radiology, Ankara University School of Medicine, Ankara, Turkey
| | - S A Mirjalili
- Department of Anatomy with Radiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - D Oztuna
- Department of Biostatistic, Ankara University School of Medicine, Ankara, Turkey
| | - T S Esmer
- Department of Anatomy, Ankara University School of Medicine, Ankara, Turkey
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Taghavi K, Geneta VP, Mirjalili SA. The pediatric inguinal canal: Systematic review of the embryology and surface anatomy. Clin Anat 2015; 29:204-10. [PMID: 26400820 DOI: 10.1002/ca.22633] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 09/15/2015] [Accepted: 09/16/2015] [Indexed: 11/06/2022]
Abstract
The inguinoscrotal region is one of the most common areas operated on in pediatric surgery. Despite this, the surface anatomy of the pediatric inguinal canal is variably defined. The aim of the current systematic review is to evaluate the development and surface anatomy of the pediatric inguinal canal. A systematic review of inguinal canal anatomy in children was conducted using the electronic databases: Medline, PubMed, Scopus, and Google Scholar. Relevant anatomical measurements and relationships were reviewed. The anatomical structures forming the walls of the inguinal canal were identified in fetuses as early as 8-10 weeks gestation. No studies addressed the developmental basis of this early defect in the lower anterior abdominal. Later gonadal development and descent has a defined role. In vivo measurements of children carried out during open surgery are inconsistent. Some studies showed rapid growth velocity of the length of the inguinal canal up to 2 years of age (with height and growth of the bony pelvis) before plateauing, while others suggested no increase in canal length prior to 10 years of age. The position of the deep inguinal ring was equally unclear; some studies suggested this was medial to the midpoint of the inguinal ligament. No studies described the position of the superficial ring, challenging the assumption that the rings are superimposed in the neonate. The dearth of studies analyzing pediatric inguinal anatomy means that changes in the position of the rings with respect to the lengthening of the canal remain unclear.
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Affiliation(s)
- Kiarash Taghavi
- Department of Pediatric Surgery, Wellington Hospital, Wellington, New Zealand
| | - von Paolo Geneta
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - S Ali Mirjalili
- Department of Anatomy with Radiology, University of Auckland, Auckland, New Zealand
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Selkirk GD, Mclaughlin AC, Mirjalili SA. Revisiting the surface anatomy of the sciatic nerve in the gluteal region in children using computed tomography. Clin Anat 2015; 29:211-6. [PMID: 26379096 DOI: 10.1002/ca.22628] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 09/06/2015] [Accepted: 09/11/2015] [Indexed: 12/25/2022]
Abstract
No anatomy text specifically describes the course of the sciatic nerve (SN) in the gluteal region in children. Anatomical information is largely derived from cadaveric studies of adults, so accurate anatomical information about the location of the SN in children is required. The aim of this study is to assess the surface anatomy of the SN in children using computed tomography (CT). After excluding studies with pelvic pathology, 75 CT scans were analyzed. Three groups were selected for analysis (0-2, 4-6, and 8-10 years). The position of the SN was measured between the posterior superior iliac spine (PSIS) and the ischial tuberosity (IT) and between the IT and the greater trochanter (GT) using 3-dimensional images. In the 0-2 age group, the SN crossed the middle third of a line between the PSIS and the IT in 94% and the GT and the IT in 80% of cases. In the 4-6 age group, the SN crossed the middle third of a line between the PSIS and the IT in 96% and the GT and the IT in 87%. In the 8-10 age group, the SN crossed the middle third of a line between the PSIS and the IT in 100% and the GT and the IT in 71%. The findings indicate that the SN in children is most accurately located in the middle third along a line drawn from the PSIS to the IT and the GT to the IT. Our study is the first to provide anatomical CT data from living children to guide interventions in the gluteal region.
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Affiliation(s)
| | - Andrew C Mclaughlin
- Department of Radiology, Starship Children's Hospital, Auckland, New Zealand
| | - S Ali Mirjalili
- Department of Anatomy with Radiology, University of Auckland, New Zealand
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Attwell L, Rosen S, Upadhyay B, Gogalniceanu P. The umbilicus: a reliable surface landmark for the aortic bifurcation? Surg Radiol Anat 2015; 37:1239-42. [PMID: 26044782 DOI: 10.1007/s00276-015-1500-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Accepted: 05/29/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE Anatomical surface landmarks are frequently used by clinicians to guide both diagnosis and treatment. Few studies have examined the reliability of vascular anatomical landmarks in living subjects. The umbilicus has traditionally been described as a surface landmark for the bifurcation of the abdominal aorta. This study examined the factors affecting the position of the umbilicus relative to that of the aortic bifurcation in 95 patients. METHODS 106 consecutive abdominal CT scans were analysed by a surgeon and radiologist. Following exclusion of CT scans with relevant significant intra-abdominal pathology, 95 patients were included in the study. Measurements were taken of the craniocaudal distance between the aortic bifurcation and umbilicus, as well as maximum subcutaneous fat thickness at the level of the umbilicus. Patient age and gender were also documented. RESULTS The umbilicus was found to lie -6.3 ± 26.5 mm from the aortic bifurcation. Increasing subcutaneous fat thickness was associated with a more caudal position of the umbilicus relative to the aortic bifurcation. This result was highly statistically significant in males over 65 years old. CONCLUSIONS This study suggests that the umbilicus is a reliable clinical surface landmark for the bifurcation of the abdominal aorta. Whilst some variation in craniocaudal distance exists between patients, in the majority of cases, the bifurcation of the abdominal aorta lies within a clinically narrow range of distances from the umbilicus.
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Affiliation(s)
- Lukas Attwell
- Basildon and Thurrock University Hospitals, Basildon, Essex, SS16 5NL, UK.
| | - Sarah Rosen
- Royal Free Hospital, Pond Street, London, NW3 2QG, UK
| | - Bhavin Upadhyay
- Basildon and Thurrock University Hospitals, Basildon, Essex, SS16 5NL, UK
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Shen XH, Su BY, Liu JJ, Zhang GM, Xue HD, Jin ZY, Mirjalili SA, Ma C. A reappraisal of adult thoracic and abdominal surface anatomy via CT scan in Chinese population. Clin Anat 2015; 29:165-74. [PMID: 26032163 DOI: 10.1002/ca.22556] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 04/06/2015] [Indexed: 11/07/2022]
Affiliation(s)
- Xin-Hua Shen
- Department of Anatomy; Histology and Embryology, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College; Beijing China
| | - Bai-Yan Su
- Department of Radiology; Peking Union Medical College Hospital; Beijing China
| | - Jing-Juan Liu
- Department of Radiology; Peking Union Medical College Hospital; Beijing China
| | - Gu-Muyang Zhang
- Department of Radiology; Peking Union Medical College Hospital; Beijing China
| | - Hua-Dan Xue
- Department of Radiology; Peking Union Medical College Hospital; Beijing China
| | - Zheng-Yu Jin
- Department of Radiology; Peking Union Medical College Hospital; Beijing China
| | - S. Ali Mirjalili
- Department of Anatomy with Radiology; Faculty of Medical and Health Sciences, University of Auckland; Auckland New Zealand
| | - Chao Ma
- Department of Anatomy; Histology and Embryology, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College; Beijing China
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Van Schoor A, Bosman MC, Bosenberg AT. Descriptive study of the differences in the level of the conus medullaris in four different age groups. Clin Anat 2015; 28:638-44. [DOI: 10.1002/ca.22505] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 12/12/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Albert‐Neels Van Schoor
- Faculty of Health Sciences, Department of Anatomy, School of MedicineUniversity of PretoriaPretoria South Africa
| | - Marius C. Bosman
- Faculty of Health Sciences, Department of Anatomy, School of MedicineUniversity of PretoriaPretoria South Africa
| | - Adrian T. Bosenberg
- Director Regional Anesthesia, Department Anesthesiology and Pain ManagementSeattle Children's HospitalSeattle Washington
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Bowness J, Kilgour PM, Whiten S, Parkin I, Mooney J, Driscoll P. Guidelines for chest drain insertion may not prevent damage to abdominal viscera. Emerg Med J 2014; 32:620-5. [DOI: 10.1136/emermed-2014-203689] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 11/08/2014] [Indexed: 11/04/2022]
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Currin SS, Mirjalili SA, Meikle G, Stringer MD. Revisiting the surface anatomy of the sciatic nerve in the gluteal region. Clin Anat 2014; 28:144-9. [DOI: 10.1002/ca.22449] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 07/09/2014] [Indexed: 11/07/2022]
Affiliation(s)
| | - S. Ali Mirjalili
- Department of Anatomy with Radiology; University of Auckland; Auckland New Zealand
| | - Grant Meikle
- Department of Radiology; Dunedin Hospital; Dunedin New Zealand
| | - Mark D. Stringer
- Department of Paediatric Surgery; Christchurch Hospital; Christchurch New Zealand
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Kotzé SH, Driescher ND, Mole CG. The translucent cadaver: a follow-up study to gauge the efficacy of implementing changes suggested by students. ANATOMICAL SCIENCES EDUCATION 2013; 6:433-439. [PMID: 23533087 DOI: 10.1002/ase.1365] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Revised: 02/18/2013] [Accepted: 02/23/2013] [Indexed: 06/02/2023]
Abstract
In a study conducted in 2011, the use of full body digital X-ray images (Lodox(®) Statscan(®)) and drawings were described for surface anatomy education during which suggestions were made by students on how to improve the method. Educational innovations should continuously be adjusted and improved to provide the best possible scenario for student learning. This study, therefore, reports on the efficacy of implementing some of these suggestions. Suggestions incorporated into the follow-up study included: (1) The inclusion of eight strategically placed labeled digital X-ray images to the dissection halls, (2) The placement of both labeled and unlabeled digital X-ray images online, (3) The inclusion of informal oral questions on surface anatomy during dissection, (4) The requirement of students to submit individual drawings in addition to group drawings into their portfolios, and (5) Integrating information on how to recognize anatomical structures on X-rays into gross anatomy lectures given prior to dissection. Students were requested to complete an anonymous questionnaire. The results of the drawings, tests and questionnaires were compared to the results from the 2011 cohort. During 2012, an increased usage of the digital X-rays and an increase in practical test marks in three out of the four modules (statistically significant only in the cardiovascular module) were reported. More students from the 2012 cohort believed the images enhanced their experience of learning surface anatomy and that its use should be continued in future. The suggested changes, therefore, had a positive effect on surface anatomy education.
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Affiliation(s)
- Sanet Henriët Kotzé
- Division of Anatomy and Histology, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, University of Stellenbosch, Tygerberg, South Africa
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Mirjalili SA, Hale SJ, Stringer MD, Wilson B. The surface anatomy of the central sulcus. J Clin Neurosci 2012; 19:1467. [DOI: 10.1016/j.jocn.2012.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 03/07/2012] [Indexed: 11/30/2022]
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Ali Mirjalili S, Stringer MD. The need for an evidence-based reappraisal of surface anatomy. Clin Anat 2012; 25:816-8. [DOI: 10.1002/ca.22142] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Revised: 06/28/2012] [Accepted: 07/05/2012] [Indexed: 11/08/2022]
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Standring S. Evidence-based surface anatomy. Clin Anat 2012; 25:813-5. [DOI: 10.1002/ca.22133] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Accepted: 06/27/2012] [Indexed: 11/07/2022]
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Mirjalili SA, McFadden SL, Buckenham T, Stringer MD. Vertebral levels of key landmarks in the neck. Clin Anat 2012; 25:851-7. [PMID: 22836507 DOI: 10.1002/ca.22124] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 06/02/2012] [Accepted: 06/14/2012] [Indexed: 11/12/2022]
Abstract
Vertebral levels of key landmarks in the neck are well documented in anatomy texts but are they accurate? This study aimed to investigate the vertebral levels of the hard palate, hyoid bone, thyroid cartilage, cricoid cartilage, and bifurcation of the common carotid artery (CCA) using computed tomography (CT). After excluding patients with distorting pathology, 52 CT scans of the neck from supine adults with a standardized head position (mean age 63 ± 17 years, range 30-94 years; 21 female) were available for analysis by dual consensus reporting. Only the vertebral level of the hard palate (C1) was consistent with contemporary descriptions. Other landmarks were located most frequently at the following vertebral levels: the center of the body of the hyoid bone at C4 (54% of cases); the superior limit of the laminae of the thyroid cartilage at C4 in women (60%) and C5 in men (52%) (P = 0.02); the inferior border of the cricoid cartilage in the midline anteriorly at C6 in women (37%) and C7 in men (47%) (P = 0.008); and the bifurcation of the left and right common carotid arteries at C3 (left 56%, right 62%). The bifurcation of the CCA was a mean of 1.6 ± 1.2 cm above the superior border of the thyroid laminae. Vertebral levels of key bony/cartilaginous structures in the neck differ from standard descriptions but in the absence of a standardized cervical axial plane have limited value and clinical utility.
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Affiliation(s)
- S Ali Mirjalili
- Department of Anatomy, Otago School of Medical Sciences, University of Otago, Dunedin, New Zealand
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Mirjalili SA, McFadden SL, Buckenham T, Stringer MD. A reappraisal of adult abdominal surface anatomy. Clin Anat 2012; 25:844-50. [PMID: 22744875 DOI: 10.1002/ca.22119] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Revised: 05/14/2012] [Accepted: 05/26/2012] [Indexed: 12/21/2022]
Affiliation(s)
- S Ali Mirjalili
- Department of Anatomy, Otago School of Medical Sciences, University of Otago, Dunedin, New Zealand
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Mirjalili SA, McFadden SL, Buckenham T, Wilson B, Stringer MD. Anatomical planes: Are we teaching accurate surface anatomy? Clin Anat 2012; 25:819-26. [PMID: 22674662 DOI: 10.1002/ca.22104] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 04/13/2012] [Accepted: 05/07/2012] [Indexed: 11/07/2022]
Affiliation(s)
- S Ali Mirjalili
- Department of Anatomy, Otago School of Medical Sciences, University of Otago, Dunedin, New Zealand
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Mirjalili SA, Hale SJM, Buckenham T, Wilson B, Stringer MD. A reappraisal of adult thoracic surface anatomy. Clin Anat 2012; 25:827-34. [PMID: 22576938 DOI: 10.1002/ca.22091] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Revised: 03/22/2012] [Accepted: 03/31/2012] [Indexed: 12/11/2022]
Abstract
Accurate surface anatomy is essential for safe clinical practice. Numerous inconsistencies in clinically important surface markings exist between and within anatomical reference texts. The aim of this study was to investigate key thoracic surface anatomical landmarks in vivo using computed tomographic (CT) imaging. High-resolution thoracic CT scans from 153 supine adults (mean age 63, range 19-89 years; 53% female) taken at end tidal inspiration were analyzed by dual consensus reporting to determine the surface anatomy of the sternal angle, central veins, heart, lungs, and diaphragm. Patients with kyphosis/scoliosis, distorting space-occupying lesions, or visceromegaly were excluded. The position of the cardiac apex, formation of the brachiocephalic veins, and vertebral levels of the sternal angle, xiphisternal joint, and aortic hiatus were consistent with commonly accepted surface markings although there was a wide range of normal variation. In contrast, common surface markings were markedly inaccurate for the following: the position of the tracheal bifurcation, aortic arch, and azygos vein termination (below the plane of the sternal angle at T5-T6 vertebral level in most individuals); the superior vena cava/right atrial junction (most often behind the fourth costal cartilage); the lower border of the lung (adjacent to T12 vertebra posteriorly); and the level at which the inferior vena cava and esophagus traverse the diaphragm (T11 in most). Surface anatomy must be reappraised using modern imaging in vivo if it is to be evidence based and fit for purpose. The effects of gender, age, posture, respiration, build, and ethnicity also deserve greater emphasis.
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Affiliation(s)
- S Ali Mirjalili
- Department of Anatomy, Otago School of Medical Sciences, University of Otago, Dunedin, New Zealand
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