Limb Muscle Reinnervation with the Nerve-Muscle-Endplate Grafting Technique: An Anatomical Feasibility Study

Background. Peroneal nerve injuries results in tibialis anterior (TA) muscle paralysis. TA paralysis could cause “foot drop,” a disabling condition that can make walking difficult. As current treatment methods result in poor functional recovery, novel treatment approaches need to be studied. The aim of this study was to explore anatomical feasibility of limb reinnervation with our recently developed nerve-muscle-endplate grafting (NMEG) in the native motor zone (NMZ). Methods. As the NMEG-NMZ technique involves in nerves and motor endplates (MEPs), the nerve supply patterns and locations of the MEP bands within the gastrocnemius (GM) and TA muscles of rats were investigated using Sihler’s stain and whole-mount acetylcholinesterase (AChE) staining, respectively. Five adult rats underwent TA nerve transaction. The denervated TA was reinnervated by transferring an NMEG pedicle from the ipsilateral lateral GM. At the end of a 3-month recovery period, maximal muscle force was measured to document functional recovery. Results. The results showed that the TA was innervated by the deep peroneal nerve. A single MEP band was located obliquely in the middle of the TA. The GM was composed of two neuromuscular compartments, lateral (GM-l) and medial (GM-m), each of which was innervated by a separate nerve branch derived from the tibial nerve and had a vertically positioned MEP band. The locations of MEP bands in the GM and TA muscles and nerve supply patterns demonstrated that an NMEG pedicle can be harvested from the GM-l and implanted into the NMZ within the TA muscle. The NMEG-NMZ pilot study showed that this technique resulted in optimal muscle force recovery. Conclusion. NMEG-NMZ surgery is feasible for limb reinnervation. Specifically, the denervated TA caused by peroneal nerve injuries can be reinnervated with a NMEG from the GM-l.

Surgical anatomy of the breast

The anatomy of the breast is integral knowledge for the surgeon undertaking oncoplastic, aesthetic, or reconstructive breast surgery. This chapter reviews the current literature on applied breast anatomy. Arterial and nerve supply, venous and lymphatic drainage, and ligamentous framework as well as the nipple–areolar complex are discussed. Relevant gross anatomy and histology are covered along with current concepts of breast aesthetics. This chapter emphasizes surgical anatomy with both historical and practical references for the plastic surgeon

Variations in the Biceps Brachii in North Bengal - An Observational Study

BACKGROUND Supernumerary heads of the biceps brachii are a common anatomical variation, with an incidence of 3.7 % to 20.5 % in various studies carried out around the world. They can occur in various forms, and produce a range of clinical symptoms, such as impingement syndromes at the shoulder joint, and nerve-compression syndromes in the arm. An awareness of these variations is helpful when assessing patients with pain symptoms in the region of the shoulder and arm. The purpose of this study was to examine the morphology, nerve supply, and variations in morphology, of the biceps brachii in a population in Eastern India. METHODS This observational study was carried out on 20 (17 males, 3 females) formalinembalmed cadavers during routine gross anatomy dissection of the upper limb, using standard dissection methods. We examined the morphology, nerve supply, and variations in morphology, of the biceps brachii in a population in Eastern India. RESULTS Three upper limbs (7.5 % out of 40 limbs) showed supernumerary heads. In one male, a third humeral head of origin, from the anteromedial surface of the shaft of the humerus was observed in the left upper limb. In another male cadaver, we found a unique case with bilateral third heads with an aponeurotic origin from the capsule of the shoulder joint, with the third head comparable in size and bulk to the long and short heads. The remaining upper limbs showed the usual morphology, with the long head originating intracapsularly from the supraglenoid tubercle of the humerus and the glenoid labrum, and the short head from the tip of the coracoid process of the scapula. Insertions were usual. CONCLUSIONS Our study found an incidence of 7.5 % in a population sample from Eastern India, North Bengal. Supernumerary heads can occur in various forms, and can result in varied clinical symptoms. KEYWORDS Biceps Brachii, Biceps Brachii Variations, Supernumerary Head, Third Head, Humeral Head, Long Head of Biceps

Architecture of the Musculus Uvulae- A Review

The architecture of the musculus uvulae is subject to controversy, especially with regard to its crucial role in maintaining the morphology of the cleft palate, and its involvement in surgical procedures of palate repair. Its functional role in the closure of the velum and elevation of the same leading to voice changes are also an element of debate. The fate and orientation of its muscle fibres and its reinforcement with other related muscles of the palate raise concerns with regard to its functional role. Its positioning in the soft palate would give us an insight on the exact role played by this muscle in velopharyngeal closure. Its nerve supply also remains shrouded by various theories without conclusive evidence. Hence, this review aims to highlight its morphological role for the same.

The nerve supply of the mammary gland

Proper development and functioning of the mammary gland depends not only on hormones, but also on the nervous system. The aim of this paper was to summarize the existing knowledge on the innervation of the mammary gland in various mammalian species, including domestic animals. In general, the pattern of innervation of this gland is similar in all studied species, i.e. large farm animals, rodents, dogs and beavers, as well as humans. Using the pan-neuronal marker of neural structures PGP-9.5, it was found that the mammary gland is well supplied with nerve fibres. Very rich innervation was discovered in the nipple, and less numerous nerve endings were found in the parenchyma. Nerve fibres supply the skin, especially the nipple, and many nerve terminals are associated with blood vessels and smooth muscles throughout the organ. Immunohistochemical investigations have made it possible to distinguish two major subpopulations of nerve fibres supplying the mammary gland. One of them consists of putative sensory fibres expressing CGRP, SP, GAL and/or PACAP, and the other is presumably composed of adrenergic axons containing TH, DBH, SOM and/or VIP. Studies on the sources of innervation of the mammary gland have confirmed assumptions about the nature of the nerve fibres and have revealed that they derive from the spinal ganglia (DRG) and sympathetic trunk ganglia (SChG). In the rat, mammary gland-projecting (MGP) neurons were also found in the nodose ganglion. So far, the rat and the pig have been tested most comprehensively for the sources of the mammary gland innervation. The MGP sensory neurons were observed ipsilaterally in several consecutive DRG, suggesting that the same neurons supply several successive glands. In the case of the SChG, it was found that MGP neurons are located, among others, in the L1-L4 ganglia, which constitute a specific „mammary gland nerve centre”. Previous studies on the sources of nerve supply to female reproductive organs have revealed that the SChG L1-L4 ganglia also contain nerve cells that project to the ovary, fallopian tube and uterus. Some clinical implications of the mammary gland innervation are also discussed.

Benign thyroid swelling presenting as Horner’s syndrome

Horner’s syndrome is a rare neurological condition seen in association with the disruption in the sympathetic nerve supply. Thyroid swelling is a common condition but rarely causes cervical sympathetic chain compression. We describe a case of a 54-year-old man who presented with Horner’s syndrome secondary to a benign thyroid nodule with pressure effect on the sympathetic chain. An association between thyroid pathologies and Horner’s syndrome has been mentioned previously, however, to our knowledge, this is the first case of Horner’s syndrome being the initial presentation for an underlying benign thyroid swelling.

A STUDY OF THE MORPHOLOGICAL FEATURES OF THE HUMAN THORACO-ABDOMINAL DIAPHRAGM IN FOETUSES

Background: An incidence of 1 in 4000 of diaphragmatic hernias certainly warrants a thorough study especially in the light of possible noninvasive diagnostic techniques and treatment in utero. Aim: Study of the diaphragm in various gestational stages. Objectives: In-depth study of the thraco-abdominal diaphragm in fetuses was done as there is a paucity of literature. Morphometry of various aspects like attachments, foramina, blood supply and nerve supply. The major openings of the diaphragm were observed and as many structures as discernable were elucidated. The findings are compared with those of adult cadavers. Methods: 50 Fetuses of both sexes were procured from ANITS and KGH, Visakhapatnam and 10 adult cadavers were acquired from the Department of Anatomy from NRIIMS, Visakhapatnam for the study. Results: Variation of origin of inferior phrenic arteries were found. The accessory phrenic nerve was found arising from the nerve to subclavius. The eventration of the left dome of the diaphragm and oesophageal hiatus hernia with atretic lung were observed. Conclusion: Such a comprehensive study is of immense value for the detection of relevant hernias of the diaphragm in early intrauterine life by the clinicians and for alleviation of such disorders by surgical measures.