Cases reported "Cadaver"

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1/47. Posterior interosseous nerve palsy following placement of the compass elbow hinge for acute instability: a case report.

    We describe a case of posterior interosseous nerve palsy that developed after application of a hinged elbow external fixation device. Our hypothesis that forearm pronation during ulnar half pin insertion may have been causative is supported by anatomic findings noted during subsequent cadaveric dissection. Based on our observations we recommend that the ulnar half pins required with this device be inserted with the forearm in supination.
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2/47. Clinicopathological study of an autopsy case with sensory-dominant polyradiculoneuropathy with antiganglioside antibodies.

    A previously reported patient presenting sensory-dominant neuropathy with antiganglioside antibodies, bound preferentially to polysialogangliosides including GD1b, was autopsied. While axonal degeneration was predominant in the sural nerve, many demyelinated fibers were present in the spinal roots. Dorsal roots had undergone significant damage. These pathological findings were well correlated with the electrophysiological results showing decreased F-wave conduction velocities and conduction blocks in motor nerves and decreased or absent sensory action potentials in sensory nerves, with distribution of GD1b in nerve tissues such as dorsal root ganglia and paranodal myelin in the ventral and dorsal roots.
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3/47. Sonography and MR imaging of bifid median nerve with anatomic and histologic correlation.

    OBJECTIVE: Imaging of a bifid median nerve has not been previously described in the radiology literature. We present three cases of bifid median nerve. The first is a patient with carpal tunnel syndrome seen on sonography and confirmed at surgery. The other two were found among 10 cadaveric specimens and were imaged with sonography and MR imaging. Confirmation of bifid median nerve in these two specimens was obtained using anatomic and histologic correlation. CONCLUSION: Sonography and MR imaging can allow effective diagnosis and delineation of a bifid median nerve in the wrist. This diagnosis is important to make before carpal tunnel release or other wrist surgeries are performed to avoid nerve injury. Furthermore, the sonographic size criteria for diagnosing carpal tunnel syndrome in nonbifid median nerves may not be accurate in evaluating bifid median nerves.
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4/47. Subclavius posticus muscle: supernumerary muscle as a potential cause for thoracic outlet syndrome.

    During routine dissection a subclavius posticus muscle was found on the left side of a male cadaver. This muscle arose from the upper margin of the scapula and transverse scapular ligament, inserted in the superior side of the first rib cartilage, and was innervated by a small branch from the suprascapular nerve. The anatomical relationships of the supernumerary muscle with the brachial plexus and the subclavian artery is suggestive of a possible cause of the thoracic outlet syndrome and therefore of clinical significance.
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5/47. Flexor digitorum superficialis nerve transfer to restore pronation: two case reports and anatomic study.

    Loss of pronation affects most activities of daily living. We report 2 cases of traumatic loss of pronator teres function and successful reconstruction by transfer of a redundant motor branch to the flexor digitorum superficialis to the pronator teres branch(es). Follow-up period was 2 years and pronation strength was restored to 4/5 and 5/5 in the 2 patients. The anatomy of the median nerve in the proximal forearm was examined by dissecting 31 cadaver specimens. A branching scheme was formulated. The histomorphometric properties of the individual muscular branches were studied in 15 fresh specimens to evaluate their suitability and size match for nerve transfer.
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6/47. A trigeminal neuralgia-like paroxysmal pain condition presumably due to buccal nerve compression in the temporalis muscle.

    We encountered three patients with trigeminal neuralgia-like paroxysmal pain in the buccal nerve region. In all cases, paroxysmal pain was felt spreading to the receptive field of the ipsilateral buccal nerve, and clear tenderness was observed during intraoral palpation at the inner side of the mandibular ramus where the temporalis muscle runs and attaches. It was assumed that the paroxysmal pain might be caused by nerve compression related to temporalis muscle hyperactivity. To lend support to this hypothesis, we also studied the anatomical relationship between the buccal nerve and the masticatory muscles. In this autopsy study, the buccal nerve pierced the temporalis muscle in six (12%) of 52 specimens from 26 cadavers. These findings support the hypothesis that peripheral buccal nerve compression could be an etiology of paroxysmal neuropathic pain in the unilateral orofacial region.
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7/47. recurrent laryngeal nerve palsy and endotracheal intubation.

    voice changes developing after endotracheal intubation have been found to be due to a recurrent laryngeal nerve palsy in four patients. In none of these patients was there any obvious cause and this posed the question whether endotracheal intubation itself could result in a paralysis of the nerve. cadaver dissection has suggested a way in which which paralysis could occur and this and other possible aetiologies are discussed.
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8/47. Extraforaminal entrapment of the fifth lumbar spinal nerve by osteophytes of the lumbosacral spine: anatomic study and a report of four cases.

    STUDY DESIGN: An anatomic study of the associations between the fifth lumbar spinal nerve (L5 spinal nerve) and a lumbosacral tunnel, consisting of the fifth lumbar vertebral body (L5 vertebral body), the lumbosacral ligament, and sacral ala, and clinical case reports of four patients with lumbar radiculopathy secondary to entrapment of the L5 spinal nerve in the lumbosacral tunnel. OBJECTIVES: To delineate the anatomic, clinical, and radiologic features and surgical outcome of patients with entrapment of the L5 spinal nerve in the lumbosacral tunnel. SUMMARY OF BACKGROUND DATA: Although several cadaveric studies on a lumbosacral tunnel as a possible cause of L5 radiculopathy have been reported, few studies had focused on osteophytes of the L5-S1 vertebral bodies as the major component of this compressive lesion, and clinical reports on patients with this disease have been rare. methods: Lumbosacral spines from 29 geriatric cadavers were examined with special attention to the associations between osteophytes of the L5-S1 vertebral bodies and the L5 spinal nerve. Four patients with a diagnosis of the entrapment of the L5 spinal nerve by osteophytes at the lumbosacral tunnel were treated surgically, and their clinical manifestations and surgical results were reviewed retrospectively. RESULTS: The anatomic study demonstrated osteophytes of the L5-S1 vertebral bodies in seven of the 29 cadavers. Entrapment of the L5 spinal nerve in the lumbosacral tunnel was observed in six of the seven cadavers with L5-S1 osteophytes but in only one of the 22 cadavers without such osteophytes (P < 0.05, chi2 test). All four patients had neurologic deficits in the L5 nerve root distribution. MRI and myelography showed no abnormal findings in the spinal canal, but CAT scans demonstrated prominent osteophytes on the lateral margins of L5-S1 vertebral bodies in all four. Selective L5 nerve block completely relieved all patients of pain but only temporarily. Three patients were treated via a posterior approach by resecting the sacral ala along the L5 spinal nerve, and the other patient was treated by laparoscopic anterior resection of the osteophytes. pain relief was obtained in the four patients immediately after surgery, but one patient experienced recurrence of pain 1 year after the first surgery and was successfully treated by additional posterior decompression and fusion. CONCLUSIONS: Extraforaminal entrapment of L5 spinal nerve in the lumbosacral tunnel can cause L5 radiculopathy, and osteophytes of L5-S1 vertebral bodies are a major cause of the entrapment.
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9/47. Surgical management of the facial nerve in craniofacial trauma and long-standing facial paralysis: cadaver study and clinical presentations.

    BACKGROUND AND OBJECTIVES: Examination of the extratemporal branches of the facial nerve reveals several branching patterns of the facial nerve, indicating the variability in the course of the nerve. Due to such variance, injury to this nerve often accompanies facial trauma and surgical dissection for the repair of facial bone injuries, and it may result in high morbidity. methods AND MATERIALS: A study of 12 fresh cadavers was performed to 1) review the variability in location of the extratemporal branches of the facial nerve, 2) identify the soft tissue injuries in which the facial nerve is at risk, and 3) discuss surgical options for repair. The authors identified the zygomatic and buccal and the extratemporal branches of the facial nerve. Among the five extratemporal branches, there is a significant crossover between all, except the temporal and the mandibular branches. This indicates that dissection should proceed with great caution, since injury to the temporal and marginal mandibular branches is unlikely to resolve spontaneously. The management of injuries within one year and those of longer duration is discussed. RESULTS AND/OR CONCLUSIONS: Two of the 5 major branches of the extratemporal facial nerve have a high morbidity following injury. Repair should be performed within the first 72 hours. Graft, if required, should be placed in 9 to 12 months.
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ranking = 2.4
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10/47. wrist arthroscopy through a volar radial portal.

    PURPOSE: To quantitatively describe the neurovascular relationships of a volar radial wrist arthroscopy portal and to evaluate whether volar wrist arthroscopy identified additional pathology of the dorsal capsular structures and the palmar region of the scapholunate interosseous ligament that was not seen through the dorsal portals. TYPE OF STUDY: This study was an anatomic study and retrospective chart review. methods: cadaver dissections established the neurovascular anatomy of the volar radial portal. Measurements were taken from the portal to the radial artery and its superficial palmar branch; the superficial radial nerve, the median nerve, and its palmar cutaneous branch; and the pronator quadratus. A dorsal capsulotomy was performed to assess the ligamentous interval. A chart review of 30 patients in whom a volar radial portal was used was performed. Intraoperative pathology identified through volar wrist arthroscopy that was not visible through a dorsal portal was recorded. Postoperative neurovascular complications were noted. RESULTS: There was a greater than 3 mm safe zone surrounding the portal that was free of any neurovascular structures. There were no complications from the use of the portal. Additional pathology that was not visible from a dorsal portal was identified in 10 cases. This included 1 case of hypertrophic synovitis of the dorsal capsule, 1 patient with an avulsion of the radioscapholunate ligament, 1 patient with a tear restricted to the palmar region of the scapholunate interosseous ligament, and 7 patients with tears of the dorsal radiocarpal ligament. CONCLUSIONS: This study provides a safe, standardized approach to the volar radial aspects of the radiocarpal and midcarpal joints. Volar wrist arthroscopy identified additional pathology of the palmar scapholunate interosseous ligament and dorsal capsular structures in 30% of the patients. The volar radial portal should be considered for inclusion in the arthroscopic examination of any patient with radial-sided wrist pain.
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