Achieving Complete Nasal Lining Closure at Primary Cleft Palate Repair When the Lesser Segments Have Collapsed

Obtaining a tension-free 2-layer anatomic closure at cleft palate repair reduces risks of fistula and facilitates later alveolar bone grafting. Anterior nasal lining closure can be one of the most challenging aspects of repair but is rarely discussed. We present our approach to palatoplasty for BCLP and additional technical maneuvers for closure in the unfavorable configuration when the lesser segments are collapsed against the vomer: “inside-out” approach along the cleft margin provides access for accurate incision; elevation of medial pterygoid mucoperiosteum provides access further anteriorly to separate nasal lining from palatal shelf; mobilization of lining off of bone when 2 structures are in apposition opens a space for access; nasal lining can be drawn into view with a hook; and the nasal lining closure can be passed back through the space to heal in an anatomic relationship, cephalic to the bony shelves.

The Hallux Metatarsophalangeal Capsule: An Anatomic Study With Respect to Percutaneous Hallux Valgus Correction

Background: Minimally invasive surgery for the treatment of hallux valgus deformities has become increasingly popular. Knowledge of the location of the hallux metatarsophalangeal (MTP) proximal capsular origin on the metatarsal neck is essential for surgeons in planning and executing extracapsular corrective osteotomies. A cadaveric study was undertaken to further study this anatomic relationship. Methods: Ten nonpaired fresh-frozen frozen cadaveric specimens were used for this study. Careful dissection was performed, and the capsular origin of the hallux MTP joint was measured from the central portion of the metatarsal head in the medial, lateral, dorsal, plantarmedial, and plantarlateral dimensions. Results: The ten specimens had a mean age of 77 years, with 5 female and 5 male. The mean distances from the central hallux metatarsal head to the MTP capsular origin were 15.2 mm dorsally, 8.4 mm medially, 9.6 mm laterally, 19.3 mm plantarmedially, and 21.0 mm plantarlaterally. Conclusion: The MTP capsular origin at the hallux metatarsal varies at different anatomic positions. Knowledge of this capsular anatomy is critical for orthopedic surgeons when planning and performing minimally invasive distal metatarsal osteotomies for the correction of hallux valgus. Type of Study: Cadaveric Study.

Microsurgical Anatomy of the Inferior Petroclival Vein and its Relation to Surrounding Structures: A Cadaveric and Radiological Study

BACKGROUND The inferior petroclival vein (IPV) courses along the extracranial surface of the petroclival fissure. It is occasionally involved in vascular diseases and has recently been used for vascular access to the cavernous sinus. However, detailed descriptions of its anatomy are currently lacking. OBJECTIVE To define the anatomic relationship between the IPV and its surrounding structures based on cadaveric dissection and radiological analysis. METHODS A dry skull and an injected cadaver head were examined to reveal the relationships between the IPV and its surrounding structures. The existence of the IPV and its relationships with other venous structures were also examined by contrast-enhanced, fat-suppressed T1-weighted magnetic resonance imaging in 26 patients (51 sides). RESULTS The entire course of the IPV was shown via stepwise cadaver dissection from below. Its relationships with surrounding structures, such as the jugular bulb, sigmoid sinus, inferior petrosal sinus, petrosal venous confluence, and the posterior, lateral, and anterior condylar veins, were also shown. In the radiological analysis, the IPV was identified on all sides. The rostral end of the vein was connected to the venous plexus around the carotid artery on all sides. The vein drained into the caudal end of the inferior petrosal sinus (49/51 sides, 96.1%) or into the anterior condylar vein (2/51 sides, 3.9%). CONCLUSION A precise understanding of the anatomy of the IPV will enable endovascular and skull base surgeons to achieve diagnoses and gain safe access to lesions involving the IPV.

Relationship of natural occlusal plane with different anatomical landmarks

Objectives: To evaluate the parallelism of natural maxillary occlusal plane with inter-pupillary line and ala-tragus line among dentate subjects. To evaluate anatomic relationship of natural mandibular occlusal plane with retromolar pad among dentate subjects Methodology: Front and profile photographs of 109 students of Fatima Jinnah Dental College with age ranging from 20 to 28 years were taken while holding the camper’s plane against the maxillary occlusal plane. The study was completed in six months. Photographs were imported in software AutoCAD(2017). An interpupillary line was drawn and angle with Camper’s plane was measured. On both profile pictures, line were drawn from base of the ala to the three different points on tragus (superior, middle and inferior). The angle between ala-tragus line and camper’s plane were measured. Intra-orally, height of the mandibular occlusal plane in relation to the retromolar pad was evaluated using a stainless steel scale. Data was analyzed using SPSS Version 23. Student’s paired sample t test and Pearson’s correlation coefficient were applied. Results: Horizontal parallelism of occlusal plane with inter-pupillary line was observed (mean angle 1.17 ±1.27). The angle between the occlusal plane and the inferior ala-tragus line was 4.25 and 4.50 degrees on right and left side, respectively. Intraorally, mandibular occlusal plane coincided with inferior (44%) and middle third (44%) of the retromolar pad. Conclusions: Inter-pupillary line and retromolar pad area (middle & inferior third) should be used as a guide in determination of plane of occlusion. Continuous...