Unusual Splitting of Medial Cord of the Right Brachial Plexus and Its Relation to the Axillary Artery and Subscapular Artery: A Case Report

BACKGROUND: Variations in human anatomy have been associated with numerous clinical correlations that may affect patient care. In this article, we present a unique variation of the medial cord of the brachial plexus about the axillary artery and subscapular artery. The precise assessment of this unique morphology was performed during a cadaveric dissection. CASE PRESENTATION: Contrary to the general course of the medial cord of the brachial plexus, this report demonstrates a rare splitting of the medial cord around the axillary artery and a second abnormal communication between the posterior and medial cords that show a “nutcracker-like” syndrome involving the subscapular artery. CONCLUSION: Such variations could make surgeries challenging. We also infer that these anatomical variations could make gliding therapy inefficient in any motor dysfunction initiating from the brachial plexus.

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Anatomical Pattern of Dorsal Metatarsal Arteries in a Black Kenyan Population

Journal of Morphological Sciences ◽

10.1055/s-0039-1691757 ◽

2019 ◽

Vol 36 (03) ◽

pp. 169-173

Author(s):

Thomas Amuti ◽

Lee Oyugi ◽

Innocent Ouko ◽

Ibsen Ongidi ◽

Julius Ogeng'o

Keyword(s):

Anatomical Variations ◽

Human Anatomy ◽

Bilateral Asymmetry ◽

Black Africans ◽

Dorsalis Pedis Artery ◽

Dorsal Interossei ◽

Arcuate Artery ◽

The Right ◽

The University ◽

Formalin Fixed

Introduction Knowledge of anatomical variations in the origin and in the course of the dorsal metatarsal arteries (DMTAs) is valuable for many procedures, including reconstructive surgeries and flap selection. However, there is a paucity of data on these arteries among black Africans. Materials and Methods The present study studied the origin and the location of DMTAs in 30 formalin-fixed cadaveric feet of adult black Kenyans at the Department of Human Anatomy of the University of Nairobi, Nairobi, Kenya. Results Dorsal metatarsal arteries were present in all of the cases. Of the right dorsalis pedis artery (DPA), in the majority of the cases, the 1st DMTA arose as the continuation of the DPA, while the 2nd to 4th DMTAs were given off as branches from the arcuate artery (AA). On the left feet, in the majority of the cases, the 1st DMTA arose as the continuation of the DPA, while the rest were given off as branches from the AA. In relation to the dorsal interossei muscles, all of the the arteries were either within the muscle fibers (53%) or beneath them (47%), on the right side. On the left side, the 1st DMTA was above the muscles in 40% of the cases; within the muscles in 53%; and beneath the muscles in 7%. The 2nd and 3rd DMTAs were above the muscles in 57% and in 53% of the cases, respectively. Conclusion These results reveal that the DMTAs show variation in their origin and position relative to the dorsal interossei muscles. These variations display bilateral asymmetry.

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Bilateral variations in the roots of origin of the phrenic nerve and absence of fibrous pericardium in an old male cadaver

Journal of Morphological Sciences ◽

10.4322/jms.092515 ◽

2016 ◽

Vol 33 (03) ◽

pp. 164-167

Author(s):

S. Ahmadpour ◽

K. Foghi

Keyword(s):

Brachial Plexus ◽

Phrenic Nerve ◽

Practical Importance ◽

Anatomical Variations ◽

Rare Variation ◽

Male Cadaver ◽

Supraclavicular Block ◽

The Right ◽

Mediastinal Pleura

AbstractPhrenic nerve provides the major motor supply to diaphragm. Various anatomical variations in the course and distribution of the phrenic nerve have reported before. Here we report a rare bilateral asymmetric variation in the roots of origin of the phrenic nerve and absence of fibrous pericardium in an old male cadaver. Specifically, the right phrenic nerve was arising from the upper trunk of the brachial plexus (C5) and the left side nerve originated from the supraclavicular nerve and a tiny branch from C5. In the same cadaver both sides phrenic nerve were buried in the mediastinal pleura. Another interesting finding was absence of the fibrous pericardium. To the best of our knowledge the presented case showed a very rare variation in the roots of origin of the phrenic nerve accompanied with pericardial anomaly which has been less reported. We think such case is of practical importance during supraclavicular block during anesthesia

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Posterior Cord of Brachial Plexus and Its Branches: Anatomical Variations and Clinical Implication

ISRN Anatomy ◽

10.5402/2013/501813 ◽

2013 ◽

Vol 2013 ◽

pp. 1-3 ◽

Cited By ~ 2

Author(s):

Rakhi Rastogi ◽

Virendra Budhiraja ◽

Kshitij Bansal

Keyword(s):

Brachial Plexus ◽

Clinical Implication ◽

Axillary Artery ◽

Anatomical Variations ◽

Axillary Nerve ◽

Upper Extremities ◽

Surgical Approaches ◽

Lower Trunk ◽

Medical Undergraduate ◽

Posterior Division

Background. Knowledge of anatomical variations of posterior cord and its branches is important not only for the administration of anaesthetic blocks but also for surgical approaches to the neck, axilla, and upper arm. The present study aimed to record the prevalence of such variations with embryological explanation and clinical implication. Material and Method. 37 formalin-preserved cadavers, that is, 74 upper extremities from the Indian population, constituted the material for the study. Cadavers were dissected during routine anatomy classes for medical undergraduate. Dissection includes surgical incision in the axilla, followed by retraction of various muscles, to observe and record the formation and branching pattern of posterior cord of brachial plexus. Results. Posterior cord was formed by union of posterior division of C5 and C6 roots with posterior division of middle and lower trunk (there was no upper trunk) in 16.2% of upper extremities. Posterior cord of brachial plexus was present lateral to the second part of axillary artery in 18.9% of upper extremities. Axillary nerve was taking origin from posterior division of upper trunk in 10.8% upper extremities and thoracodorsal nerve arising from axillary nerve in 22.9% upper extremities. Conclusion. It is important to be aware of such variations while planning a surgery in the region of axilla as these nerves are more liable to be injured during surgical procedures.

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Paramastoid apophysis: case report

Journal of Morphological Sciences ◽

10.4322/jms.069914 ◽

2015 ◽

Vol 32 (01) ◽

pp. 060-061

Author(s):

C. Lins ◽

A. Amorin Júnior ◽

F. Villarouco ◽

M. Gatis ◽

R. Tavares

Keyword(s):

Facet Joint ◽

Practical Interest ◽

Transverse Process ◽

Anatomical Variations ◽

Health Sciences ◽

Human Anatomy ◽

Human Skull ◽

Metopic Suture ◽

The Right ◽

Constituent Elements

AbstractThe aim of this study was to report a case of a paramastoid apophysis of a human skull, identified during routine lessons at the Laboratory of Human Anatomy, Federal University of Pernambuco and Recife-PE, Brazil. The skull used in this study showed a morphological variation present only on the right side of the occipital bone, which had a height of 18.10 mm and had a facet joint with the transverse process of the atlas, being identified as paramastoid apophysis. Other anatomical variations in skull were found as: presence of sutural bone along the lambdoidal suture and persistent metopic suture. Thus, this study will be important for the health sciences and those who keep interest in pathologies associated with atlanto-occipital joint, because the description of the structures that deviate from the normal organogenesis resulting from disorders: hereditary basis or not, has a practical interest that prints the modification to the arrangement of the constituent elements of the region and possible functional alterations resulting therefrom.

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Brachial plexus variations in its formation and main branches

Acta Cirurgica Brasileira ◽

10.1590/s0102-86502003001200006 ◽

2003 ◽

Vol 18 (suppl 5) ◽

pp. 14-18 ◽

Cited By ~ 30

Author(s):

Valéria Paula Sassoli Fazan ◽

André de Souza Amadeu ◽

Adilson L. Caleffi ◽

Omar Andrade Rodrigues Filho

Keyword(s):

Brachial Plexus ◽

Phrenic Nerve ◽

Anatomical Variations ◽

Anatomical Structure ◽

The Body ◽

Long Thoracic Nerve ◽

Thoracic Nerve ◽

Close Relationship ◽

Axillary Region ◽

The Right

PURPOSE: The brachial plexus has a complex anatomical structure since its origin in the neck throughout its course in the axillary region. It also has close relationship to important anatomic structures what makes it an easy target of a sort of variations and provides its clinical and surgical importance. The aims of the present study were to describe the brachial plexus anatomical variations in origin and respective branches, and to correlate these variations with sex, color of the subjects and side of the body. METHODS: Twenty-seven adult cadavers separated into sex and color had their brachial plexuses evaluated on the right and left sides. RESULTS: Our results are extensive and describe a large number of variations, including some that have not been reported in the literature. Our results showed that the phrenic nerve had a complete origin from the plexus in 20% of the cases. In this way, a lesion of the brachial plexus roots could result in diaphragm palsy. It is not usual that the long thoracic nerve pierces the scalenus medius muscle but it occurred in 63% of our cases. Another observation was that the posterior cord was formed by the posterior divisions of the superior and middle trunks in 9%. In these cases, the axillary and the radial nerves may not receive fibers from C7 and C8, as usually described. CONCLUSION: Finally, the plexuses studied did not show that sex, color or side of the body had much if any influence upon the presence of variations.

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Unilateral high bifurcation of brachial artery: a case report

Anatomy Journal of Africa ◽

10.4314/aja.v6i2.160458 ◽

1970 ◽

Vol 6 (2) ◽

pp. 916-918

Author(s):

Ahmed M. Auwal ◽

Adaudu D. Zagga ◽

Samuel A. Asala

Keyword(s):

Brachial Artery ◽

Axillary Artery ◽

Anatomical Variation ◽

Anatomical Variations ◽

Proximal Half ◽

Collateral Arteries ◽

Arterial Trunk ◽

Teres Major ◽

Inferior Border ◽

The Right

The Brachial artery usually begins as the continuation of the Axillary Artery at the inferior border of the Teres Major muscle and terminates by bifurcating into radial and ulnar arteries in the cubital fossa. A case of unilateral bifurcation of the artery 7.5 cm distal to the inferior border of the Teres Major muscle in the proximal half of the right arm was identified in a northern Nigerian cadaver that was dissected by medical students of Usmanu Danfodiyo University, Sokoto. The Profunda Brachii, Superior Ulnar Collateral and Inferior Ulnar Collateral arteries arose from the relatively short brachial arterial trunk. Although the documented incidence of this anatomical variation is low in Nigeria, its concomitant widespread documentation in other parts of the world makes it a sufficiently important anatomical variation of the Brachial Artery, to warrant its being taught to students of Anatomy and Medicine. The knowledge of anatomical variations of the brachial artery and its branches is also important in radiological and clinical practice.Keywords: Anatomical variation, brachial, artery, Nigeria

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An Anatomical Variation of Terminal Branches of the Thoracoacromial Artery – Case Report

Journal of Interdisciplinary Medicine ◽

10.2478/jim-2020-0018 ◽

2020 ◽

Vol 5 (3) ◽

pp. 110-113

Author(s):

Loránd Kocsis ◽

Mihai-Iuliu Harșa ◽

Lóránd Dénes ◽

Zsuzsánna Pap

Keyword(s):

Axillary Artery ◽

Anatomical Variation ◽

Practical Importance ◽

Anatomical Variations ◽

Common Trunk ◽

Anatomical Variant ◽

Case Presentation ◽

Thoracoacromial Artery ◽

Lateral Thoracic Artery ◽

Shoulder Region

AbstractIntroduction: Mapping the branching patterns of the thoracoacromial artery has a particular practical importance. Familiarity with the different anatomical variations is essential for successful surgical procedures in the anterior shoulder region.Case presentation: We present an unusual anatomical variant observed during the dissection of a cadaver at the Department of Anatomy and Embryology of the “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureş, Romania. According to the classical description, the thoracoacromial artery originates from the second part of the axillary artery, but we observed an unusual branching variation: the thoracoacromial artery provided a subscapular branch right after its origin, then it split into a pectoral branch, the lateral thoracic artery, and a common trunk that gave a second pectoral branch and a deltoid-acromial branch. The clavicular branch was missing.Conclusions: The case we presented demonstrates that there are anatomical variations of the axillary artery system that are partially or entirely different from the classical descriptions. Our study describes a variation of the thoracoacromial artery that has not been reported so far.

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Anterior Cervical Discectomy and Fusion combined with thyroid gland surgery, a tailored case and literature review

BMC Musculoskeletal Disorders ◽

10.1186/s12891-019-2997-y ◽

2019 ◽

Vol 20 (1) ◽

Author(s):

Konstantinos M. Themistoklis ◽

Stefanos I. Korfias ◽

Themistoklis I. Papasilekas ◽

Konstantinos A. Boviatsis ◽

Agis G. Kokkoros ◽

...

Keyword(s):

Anatomical Variations ◽

Anterior Cervical Discectomy ◽

Anterior Neck ◽

Case Presentation ◽

Cervical Discectomy ◽

Surgical Field ◽

Thyroid Gland Surgery ◽

The Right ◽

Preoperative Work Up ◽

Work Up

Abstract Background Nowadays, Anterior Cervical Discectomy and Fusion (ACDF) is considered a routine procedure. However, unexpected difficulties do occasionally arise, especially when anterior neck pathologies or anatomical variations are encountered. In such cases, proactive thinking will allow surgeons to tailor appropriately their approach and eliminate surgical risks. Case presentation We present the case of a 50-year-old male patient suffering from left upper limb radiculopathy that underwent a C7-T1 ACDF combined with a hemithyroidectomy. Excision of the right thyroid lobe was offered to the patient because of a goiter found during the preoperative work-up. Furthermore, the hemithyroidectomy provided a wide surgical field so the ACDF performed without excreting excessive traction to the adjacent neck structures. Conclusions The patient had an uncomplicated post-operative. To our knowledge this is the first report of a planned hemithyroidectomy being carried out as the first step towards an ACDF procedure.

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Conventional and variant origin of the transverse cervical artery in a select kenyan population

Anatomy Journal of Africa ◽

10.4314/aja.v9i1.11 ◽

2020 ◽

Vol 9 (1) ◽

pp. 1727-1731

Author(s):

Jeremiah Munguti ◽

Fiona Nyaanga ◽

Vincent Kipkorir ◽

Shane Bhupendra ◽

Onyango Marita ◽

...

Keyword(s):

Brachial Plexus ◽

Human Anatomy ◽

Type I ◽

Musculocutaneous Flaps ◽

Cervical Artery ◽

Posterior Neck ◽

Key Words Anatomy ◽

The Right ◽

Type V ◽

Transverse Cervical Artery

Data from previous studies have highlighted on the use of transverse cervical artery (TCA) flaps as posterior neck musculocutaneous flaps in reconstructive surgeries. General preference of flap selection relies heavily on the neurovascular supply of the flap in question and even though known, the transverse cervical artery has been shown to vary among populations, therefore affecting its use as a potential flap. Additionally, variant points of origin of the trans-cervical artery have been shown to predispose to brachial plexus compression. Our data on the same, however, remains partly elucidated and therefore a study aimed at describing the conventional and variant origin of the TCA in a Kenyan population would aid in deciding on its use as musculocutaneous flaps and determining the possible prevalence of brachial plexus compression because of its variant origin. The origin of the transverse cervical artery was studied bilaterally in 26 adult Kenyan cadavers in the Department of Human Anatomy, University of Nairobi. As regards their origin, the different types were photographed and grouped into five: Types I to V relative to its origin. The data collected was then analysed using SPSS version 21 and findings presented as percentages. The findings were presented in a bar graph and pie chart. The TCA was present in all the 26 cadavers studied. Type I origin of the TCA was the most common (71.15%) while type V was the least (1.92%). While type I origin occurred mostly on the left limbs, the other types were more prevalent on the right side. The significant variant origin of the TCA and its resultant aberrant course should be important considerations during the planning of posterior neck musculocutaneous flaps as well as in understanding brachial plexus compression associated with its variant origin. Key Words: Anatomy, Transverse cervical artery.

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Fenestrated Vertebral Artery in A Routine Cadaveric Dissection

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2019.563 ◽

2019 ◽

Vol 7 (13) ◽

pp. 2154-2156

Author(s):

Adegbenro Omotuyi John Fakoya ◽

Erica Barnes ◽

Faviola Laureano-Torres ◽

Adrian Felciano Muniz ◽

Emmanuel Morales Monsanto ◽

...

Keyword(s):

Vertebral Artery ◽

Neck Dissection ◽

Clinical Significance ◽

Vascular Malformations ◽

Case Presentation ◽

Iatrogenic Injuries ◽

Vertebral Arteries ◽

Pass Through ◽

The Right ◽

Unique Variation

BACKGROUND: Anomalies associated with the vertebral arteries are relatively rare. The vertebral arteries arise from the first part of the Subclavian artery and pass through the transverse foramina of C6 through C1. CASE PRESENTATION: However, in this article, we describe a unique variation in the anatomical orientation of the right vertebral artery during a routine cadaveric neck dissection where the right vertebral artery gives an oblique branch from the extradural segment (C2) forming a fenestrated Vertebral artery. CONCLUSION: Despite the lack of established clinical significance, multiple co-morbid vascular malformations are yet associated with the Vertebral artery fenestration with a possibility of iatrogenic injuries if not taking into cognisance.

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