scholarly journals Radioanatomical examination of the dorsal tubercle and surrounding regions for intraosseous infusions

Author(s):  
Selda AKSOY ◽  
Mehmet Ali GÜNER ◽  
İnanç GÜVENÇ ◽  
Sedat BİLGE ◽  
Onur TEZEL

Objectives: The aim of the study was to determine the soft tissue thickness overlying the dorsal tubercle and the relationship with adjacent anatomical structures in the distal radius for using this area as an alternative intraosseous route. Methods: Contrast-enhanced MR images of 56 adult patients (28 females, 28 males) without any wrist pathology were evaluated. The shape of dorsal tubercle and its relations with neighboring tendons and vessels with a diameter larger than 2 mm was identified on the axial T1-weighted sections. The soft tissue thickness above the most protruding point of the dorsal tubercle, the distance of the dorsal tubercle to closest tendon on the radial and ulnar sides, as well as its distance to the bone edges on the ulnar and radial sides, and the cortical bone thickness of the radius was evaluated. Results: The dorsal tubercle had sharp edges in 40 cases (71.4%), blunt in 12 cases (21.4%), and hump in 4 (%7.1) cases. Branches of dorsal venous plexus were found on its surface in 11 cases, extensor pollicis longus tendon only was found superficial to the dorsal tubercle in 7 cases while both extensor pollicis longus and dorsal venous branches were found in 2 cases. Conclusion: Dorsal tubercle of the distal radius can be considered as an important alternative route for IO infusions since it can be easily accessed without having a risk of injury to important structures, and can provide effective flow.

1992 ◽  
Vol 71 (11) ◽  
pp. 1816-1821 ◽  
Author(s):  
C.A. Bibb ◽  
A.G. Pullinger ◽  
F. Baldioceda

Undifferentiated mesenchymal (UM) cells, the progenitor cells of the cartilage layer, have been assigned a significant role in TMJ articular tissue maintenance. This was based on reports of UM cell reduction with increased soft-tissue thickness for the condyle and temporal component. However, the strength of this inverse relationship was not presented and remained unclear. The purpose of the present study was to assess the strength of the correlation between UM cell presence and soft-tissue thickness in young adult TMJs at autopsy. Sagittal histological sections from the central thirds of 50 joints were evaluated with respect to articular soft-tissue thickness, histological character, and UM cell presence in the condyle and temporal component. The superior sector ofthe condyle and the articular eminence showed the greatest variability in soft-tissue thickness and were the only areas to show localized UM cell absence. The eminence was the only location to show an inverse relationship between soft-tissue thickness and UM cell presence, and this was consistent in both an ANOVA (p = 0.0016) and a Spearman correlation analysis. However, the strength of this correlation was only moderate (rho = -0.52), and no such relationship was observed in any other location. This study suggests that the relationship between UM cell presence and soft-tissue thickness is more complex than previously hypothesized and that the contribution of UM cells to articular tissue maintenance has been overstated, while other biological processes were overlooked.


2018 ◽  
Vol 10 (1) ◽  
pp. 1-8
Author(s):  
Daniele Gibelli ◽  
Matteo Zago ◽  
Annalisa Cappella ◽  
Claudia Dolci ◽  
Chiarella Sforza

Background: The anatomical assessment of the arrangement of facial soft tissues has important applications in different fields from orthodontics to plastic surgery. One of the issues concerns the relationship between facial soft tissue thickness and skeletal class. Literature mainly deals with adult populations, whereas very few studies have been focused on children. Objective: This study aims at investigating the relationship between midline facial soft tissue thickness and skeletal classes in Italian pre-treatment orthodontic child patients. Methods: Lateral cephalometric X-ray films were obtained from 220 healthy Caucasoid children (91 males and 129 females), aged between 6 and 18 years (Class I: 41 males and 70 females; Class II: 18 males and 25 females; Class III: 32 males and 34 females). All the films were digitized and 14 soft tissue thicknesses were measured on the midface; in addition, the skeletal class was assessed according to the corrected ANB angle (ANBc). Differences in facial soft tissue thickness according to sex and skeletal class were assessed through two-way ANOVA test (p<0.01). Results: Statistically significant differences according to sex were found for labrale superius, stomion and labrale inferius, with thicker soft tissues in males than in females (p<0.01). Only measurements at labrale superius and gnathion showed statistically significant differences according to skeletal class, with thicker soft tissues in Class III children and thinner ones in Class II children (p<0.01). Conclusion: The limited number of investigations, as well as the differences in protocols, renders the comparison of results from different studies difficult, suggesting further investigations to enlighten this complex and debated anatomical issue.


2019 ◽  
Vol 23 (3) ◽  
pp. 297-302 ◽  
Author(s):  
Julia D. Sharma ◽  
Kiran K. Seunarine ◽  
Muhammad Zubair Tahir ◽  
Martin M. Tisdall

OBJECTIVEThe aim of this study was to compare the accuracy of optical frameless neuronavigation (ON) and robot-assisted (RA) stereoelectroencephalography (SEEG) electrode placement in children, and to identify factors that might increase the risk of misplacement.METHODSThe authors undertook a retrospective review of all children who underwent SEEG at their institution. Twenty children were identified who underwent stereotactic placement of a total of 218 electrodes. Six procedures were performed using ON and 14 were placed using a robotic assistant. Placement error was calculated at cortical entry and at the target by calculating the Euclidean distance between the electrode and the planned cortical entry and target points. The Mann-Whitney U-test was used to compare the results for ON and RA placement accuracy. For each electrode placed using robotic assistance, extracranial soft-tissue thickness, bone thickness, and intracranial length were measured. Entry angle of electrode to bone was calculated using stereotactic coordinates. A stepwise linear regression model was used to test for variables that significantly influenced placement error.RESULTSBetween 8 and 17 electrodes (median 10 electrodes) were placed per patient. Median target point localization error was 4.5 mm (interquartile range [IQR] 2.8–6.1 mm) for ON and 1.07 mm (IQR 0.71–1.59) for RA placement. Median entry point localization error was 5.5 mm (IQR 4.0–6.4) for ON and 0.71 mm (IQR 0.47–1.03) for RA placement. The difference in accuracy between Stealth-guided (ON) and RA placement was highly significant for both cortical entry point and target (p < 0.0001 for both). Increased soft-tissue thickness and intracranial length reduced accuracy at the target. Increased soft-tissue thickness, bone thickness, and younger age reduced accuracy at entry. There were no complications.CONCLUSIONSRA stereotactic electrode placement is highly accurate and is significantly more accurate than ON. Larger safety margins away from vascular structures should be used when placing deep electrodes in young children and for trajectories that pass through thicker soft tissues such as the temporal region.


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