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An Anatomic and morphometric study of C2 nerve root ganglion and its corresponding foramen
(Lippincott Williams & Wilkins, 2004) Bilge, O
Study Design. Exposing and measuring the dorsal root ganglion of the second cervical spinal nerve (C2 ganglion) and the second intervertebral space, which is present between posterior arch of atlas (APA) and lamina of axis (LA). Objectives. This study aims to investigate the shape, size, and relation of the C2 ganglion with the adjacent structures that limits the corresponding intervertebral space and the alterations of relation between C2 ganglion and APA and between C2 ganglion and LA with the movements of the head bilaterally. Summary of Background Data. In previous studies, the position and the heights of the C2 ganglion have been described. But the shape of the C2 ganglion and its relation to APA and LA by the movement of the head had not been considered previously. Methods. Upper cervical spines of 20 cadavers were dissected posteriorly. The muscles attaching to the atlas and axis were resected to ease the head movements. The heights of the C2 ganglion and space were measured in anatomic position and in hyperextension with opposite rotation position of the head. Originally in this study, plastic dough casts were used to obtain reliable outcomes. Results. The shape of the ganglions was defined in three types: 70% were oval, 20% were spindle-like, and 10% were spherical. The height of the C2 ganglion was 4.97 +/- 0.92 mm on the right side and 4.6 +/- 0.84 mm on the left side. The height of the intervertebral space in anatomic position and in hyperextension with rotation to the opposite position of the head were, respectively, 9.74 +/- 1.77 mm and 7.48 +/- 1.44 mm on the right side and 9.64 +/- 1.47 mm and 7.12 +/- 0.96 mm on the left side. There was no bone contact or impact to the ganglion in each position of the head. Conclusion. The C2 ganglions are confident in their place between APA and LA. No bone contact to the C2 ganglion was detected in either normal limited or in forced head motions.
The anatomic barriers in the coronary sinus: Implications for clinical procedures
(Springer, 2005) Karaca, M; Bilge, O; Dinckal, MH; Ucerler, H
Background: Coronary sinus (CS) catheterization is often used in cardiac resynchronization therapy. Failure to enter the CS is the most common reason for LV pacing lead implant failure. Methods: We evaluated the anatomic barriers, Thebesian and Vieussens valves, the CS and its tributaries in 52 adult human cadaver hearts. Results: The average diameter of CS ostiums was 9.47 mm. In 20 of the hearts heavier than 300 g, the average CS os diameter was 10.76 mm, whereas in the remaining hearts was 8.72 mm (p < 0.005). The Thebesian valves were observed in 35(67%) of the hearts. In 39(75%) of the hearts Vieussens valves were observed and noted that 6(11%) of them were qualitatively well developed and 33(63%) diminutive. Twenty cases (38%) had 3 vein branches, 19(37%) had 4 branches, 6(11%) had 5 branches, 6(11%) had 2 branches and 1(2%) had 6 branches between great and middle cardiac veins. The anatomic barriers in coronary sinus i.e., Thebesian and Vieussens valves and their branchings were evaluated and found optimal, suboptimal and worst for catheterization in 33, 15 and 4 Thebesian valves; 40, 8, 4 Vieussens valves, respectively. The coronary sinus tributaries between great and middle cardiac veins were found to be optimal, suboptimal and worst for catheterization in 88, 60 and 38 veins, respectively. Conclusions: Careful evaluation of anatomic barriers is important for treatment success. Thus, knowledge of these functional anatomic features and barriers allows for better utilization of the human coronary sinus for diagnostic and therapeutic purposes.
Anatomic study of the blood supply of perioral region
(Wiley, 2005) Pinar, YA; Bilge, O; Govsa, F
The use of flaps to reconstruct lip defects requires detailed knowledge of the local vasculature. New flaps for surgery around the mouth can be devised if the surgeon knows the distribution of the perioral arterial branches. Examination of the anatomy of perioral branches of the facial artery (FA) confirmed the consistent presence of septal and ajar branches in the upper lip and a labiomental branch in the lower lip. Mucosal flaps from the upper lip based on the deep septal branch or the ajar branch of the FA can be used to restore lower lip defects. A composite flap from the lower lip supplied by the labiomental branch of the FA can be used to restore combined defects of the upper lip and nose or partial defects of the lower lip. We studied the vascular anatomy of the perioral region in 25 cadaver dissections. Fixation was by 10% formaldehyde solution. Red latex was injected into the common carotid arteries before dissection. In the 50 specimens, the primary supplying vessels were identified and the size and distribution of the vessels were investigated. The FA was symmetrical in 17 (68%) of 25 heads. It terminated as an angular facial vessel in 11 (22%), as a nasal facial vessel in 30 (60%), as an ajar vessel in six (12%), and as a superior labial vessel in two (4%) facial halves. It terminated as a hypoplastic type of FA in one (2%) facial half. The average external diameter of the superior labial artery (SLA) was 1.6 mm (min-max: 0.6-2.8 mm) at its origin. The origin of the SLA was superior to the angle of the mouth in 34 of 47 specimens (72.3%), and at the angle of the mouth in 13 of 47 specimens (27.7%). In two of the remaining three specimens, the SLA was the continuation of the FA and the other was of the hypoplastic type. The SLA supplied the columellar branches in all specimens except for the hypoplastic type (49 specimens). Columellar branches were classified according to their number and their type. In five specimens (10%) the inferior labial artery (ILA) was not found. In the other specimens, the site of origin of the ILA varied between the lower margin of the mandible and the corner of the mouth. Its external diameter measured min-max: 0.5-1.5 mm. The ILA arose from the FA above the angle of mouth in 4 specimens (8%), inferior to the angle of mouth in 11 specimens (22%), and at angle of mouth in 30 specimens (60%). We observed that the labiomental arteries, which formed anastomoses between the FA, ILA, and submental artery, showed variations in their course in the labiomental region. We suggest that knowledge of the location of arteries with respect to easily identifiable landmarks will help to avoid complications at surgery. (c) 2005 Wiley-Liss, Inc.
Anatomic study of the deep plantar arch
(Wiley, 2005) Ozer, MA; Govsa, F; Bilge, O
A thorough knowledge of the topography and relations of the plantar arteries is necessary for further advances in arterial reconstruction in the foot. Such reconstruction often avoids amputation in cases of arterial trauma in industrial and automobile accidents, as well as in patients with diabetes and severe ischemia of the lower limbs. Although several studies have addressed the anatomy of the arteries of the foot, there is a shortage of recent studies on surgical vascular anatomy. The deep plantar arch was studied in 50 adult cadaveric feet. It was present in all feet and formed from the anastomosis between the deep plantar artery and the deep branch of the lateral plantar artery. The deep plantar artery was predominant in 48% of the specimens (Type I arches) and the deep branch of the lateral plantar artery in 38% (Type II) with the contribution of each being approximately equal in 14% (Type III). The location of the deep plantar arch can be estimated. The distance between the deep plantar arch and each interdigital commissure was relatively consistent between the subjects, averaging 29% of total foot length. The deep plantar arch was located in the middle third of the foot in all specimens, being in the middle 11 part of this third in 62%. The mean external diameter of the deep branch of lateral plantar artery was 1.7 mm 0.4 mm. The mean external diameter of the deep plantar artery was also 1.7 mm +/- 0.4 mm. We observed a complete superficial plantar arch in only one specimen (2%). Our findings should assist vascular surgeons in estimating the location of the deep plantar arch from the patient's foot length and in providing other data.
The anatomical features and surgical usage of the submental artery
(Springer France, 2005) Pinar, YA; Govsa, F; Bilge, O
The skin characteristics make the submental region an available flap site for facial and intraoral reconstructions. For this reason, the anatomy of the submental region and the submental artery (SA) has gained in importance recently. The SA branches out from the facial artery at the level of superior edge of the submandibular gland. The SA runs anteromedially below the mandible and superficial to the mylohyoid muscle. It gives off some perforating branches to the overlying platysma and underlying mylohyoid muscle during its course. The terminal branches continue toward the midline, crossing the anterior belly of digastric muscle either superficially or deep, and end at the mental region in general. Some perforating arteries from the terminal branches supply the anterior belly of digastric muscle. This study aimed to describe the anatomical features of the SA and its branches to help in the preparation of submental arterial flaps.
Anatomical study of the communicating branches between the medial and lateral plantar nerves
(Springer, 2005) Govsa, F; Bilge, O; Ozer, MA
The plantar areas of the foot have specific biomechanical characteristics and play a distinct role in balance and standing. For the forefoot surgeon, knowledge of the variations in the anatomy of communicating branches is important for plantar reconstruction, local injection therapy and an excision of interdigital neuroma. The anatomy of the communicating branches of the plantar nerves between the fourth and third common plantar digital nerves in the foot were studied in 50 adult men cadaveric feet. A communicating branch was present between the third and fourth intermetatarsal spaces nerves in all eight left feet and in six right feet (overall, 28%), and absent in 36 (72%). A communicating branch was found in 14 ft. Ten of the 14 communications were from the lateral to the medial plantar nerve. The length of the communicating branch ranged from 8 to 56 mm (average 16.4 mm) and its diameter was 0.2-0.6 times of the fourth common plantar digital nerve. The angle of the communicating branch with the common plantar digital nerve from which it originated was less than 30 degrees in 11 ft, 30-59 degrees in 27 ft, 60-80 degrees in 8 ft, and more than 80 degrees in 4 ft. Classification of the branch is based on the branching pattern of the communicating branch and explains variations in plantar sensory innervations. We think that the perpendicular coursing communicating branch is at higher risk to be severed during surgery.
Arterial anatomy of the auricle: its importance for reconstructive surgery
(Springer-Verlag, 2003) Pinar, YA; Ikiz, ZAA; Bilge, O
Because the auricle is an organ that is both used as a flap in reconstructive surgery and is often exposed to trauma, the arterial distribution of the auricle is of great importance. The aims of this study were to investigate the auricular branches of the posterior auricular artery (PAA) and superficial temporal artery (STA), to determine the vascular territory of various auricular flaps for flap design. Fifteen human male cadaver auricles were used for this study. A branch of the STA to the ear lobe (lower branch) was present in only five auricles (33%). Branches distributing the tragus were small and short arterioles (middle branch of the STA) which were present in 14 auricles (93%). The upper branch of the STA ascends the ascending helix, giving off sub-branches. Some of these sub-branches traverse to the posterior surfaces of the ear and communicate with branches of the PAA. The upper branch was present in all auricles. In 10 auricles (67%), the PAA terminated on the posterior auricular surface, whereas in five auricles (33%) it continued and distributed to the parietotemporal area. The arterial network which was obvious in the middle region of the posterior auricular surface was formed from the middle branch and some sub-branches of the upper branch of the PAA, which was found in 10 auricles (67%). We are convinced that the PAA is the dominant artery for the auricle and the arterial network of posterior auricular surface is better developed in the middle region than the other regions.
Arterial anatomy of the auricle: its importance for reconstructive surgery
(Springer-Verlag, 2003) Pinar, YA; Ikiz, ZAA; Bilge, O
Because the auricle is an organ that is both used as a flap in reconstructive surgery and is often exposed to trauma, the arterial distribution of the auricle is of great importance. The aims of this study were to investigate the auricular branches of the posterior auricular artery (PAA) and superficial temporal artery (STA), to determine the vascular territory of various auricular flaps for flap design. Fifteen human male cadaver auricles were used for this study. A branch of the STA to the ear lobe (lower branch) was present in only five auricles (33%). Branches distributing the tragus were small and short arterioles (middle branch of the STA) which were present in 14 auricles (93%). The upper branch of the STA ascends the ascending helix, giving off sub-branches. Some of these sub-branches traverse to the posterior surfaces of the ear and communicate with branches of the PAA. The upper branch was present in all auricles. In 10 auricles (67%), the PAA terminated on the posterior auricular surface, whereas in five auricles (33%) it continued and distributed to the parietotemporal area. The arterial network which was obvious in the middle region of the posterior auricular surface was formed from the middle branch and some sub-branches of the upper branch of the PAA, which was found in 10 auricles (67%). We are convinced that the PAA is the dominant artery for the auricle and the arterial network of posterior auricular surface is better developed in the middle region than the other regions.
Duplication of the parotid duct: a previously unreported anomaly
(Springer-Verlag, 2001) Aktan, ZA; Bilge, O; Pinar, YA; Ikiz, AO
A hitherto unreported duplication of the parotid duct in a 63-year-old man is reported. The ducts were found in the right cheek during cadaver dissection. The surrounding connective tissue of the ducts was removed and a photograph was taken. These two parotid ducts were then removed and fixed in a 10% formalin solution, embedded in paraffin blocks and the sections stained with hematoxylin eosin. The histologic findings showed that both had the normal ductal columnar epithelium. There was only one parotid duct in the left cheek.
Multiple variations of abdominal vessels in a single cadaver
(Wiley-Liss, 2003) Bilge, O; Aktan, AA
Variations of abdominal vessels are common and there are many reports about this subject. We report numerous variations of the superior part of the abdominal aorta and renal vessels which were determined in a single cadaver. (C) 2002 Wiley-Liss, Inc.
Multiple variations of abdominal vessels in a single cadaver
(Wiley-Liss, 2003) Bilge, O; Aktan, AA
Variations of abdominal vessels are common and there are many reports about this subject. We report numerous variations of the superior part of the abdominal aorta and renal vessels which were determined in a single cadaver. (C) 2002 Wiley-Liss, Inc.
Variations in the origin of the medial and inferior calcaneal nerves
(Springer, 2006) Govsa, F; Bilge, O; Ozer, MA
Introduction: Entrapment of the medial heel region nerves is often mentioned as a possible cause of heel pain. Some authors have suggested that the medial and inferior calcaneal nerves may be involved in such heel pain, including plantar fasciitis, heel pain syndrome and fat pad disorders. The aim of this study was to give a detailed description of the medial heel that would determine the variability and pattern of the medial and inferior calcaneal nerves, as well as to relate these findings to the currently used incision line for tarsal tunnel, fixations of fractures with external nailing, medial displacement osteotomy and nerve blocks in podiatric medicine. Materials and methods: The origin, relationship, distribution, variability and innervation of medial and inferior calcaneal nerves were studied with the use of a 3.5 power loupe magnification for dissection of 25 adult male feet of formalin-fixed cadavers. The medial heel was found to be innervated by just one medial calcaneal nerve in 38% of the feet, by two medial calcaneal nerves in 46%, by three medial calcaneal nerves in 12% and by four medial calcaneal nerves in 4%. An origin for a medial calcaneal nerve from the medial plantar nerve was found in 46% of the feet. This nerve most often innervates the skin of the posteromedial arch. Results: In our dissection, the rate of occurrence of the medial and inferior calcaneal nerves in medial heel region was 100%. When compared with the inferior calcaneal nerve, the medial calcaneal nerve was posterior, superior and thicker. The inferior calcaneal nerve supplies deeper structures. In the majority of the cases, inferior calcaneal nerve aroused from the lateral plantar nerve, but it may also arise from the tibial nerve, sometimes in a common origin with the medial calcaneal nerve. Conclusions: Knowledge of fine anatomy of the calcaneal nerves is necessary to ensure safe surgical intervention in the medial heel region.

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