Indian Journal of Anatomy

Anatomical variations and aberrations represent an ever-present challenge to clinicians in general and surgeons in particular. This is particularly true if the variation is rare and the clinical context doesn’t permit a thorough investigation, such as would happen intraoperatively. The unfamiliarity with abnormal anatomy and contextual time constraints may preclude their timely recognition, which may result, subsequently in significant morbidity. The shifting paradigms in anatomy education in both undergraduate and residency medical programs may be linked to an increasingly cited “abnormal anatomy “as a cause for morbidity and mortality in litigious literature. Therefore, Continuous, and self-directed learning, in the face of diminished formal anatomy curricula, is essential to achieving this end. In this case report we describe an incident of iatrogenic excision of a leaf of a bifid xiphisternum mistaken for a migrated ingested bone and the clinical lessons imparted from it. We also provide a relevant literature review.

 

Stiff finger is a common condition found among the elder population due to various types of arthritis. In the younger age group, it occurs usually as a sequel of trauma. It is a difficult condition to treat and follow up. Patient cooperation and strict adherence to exercise routines are paramount for the success of the treatment of stiff fingers. The ideal treatment includes the release of the adhesions and active physiotherapy. However, because of the covid 19 crisis, the usual treatments for the various disease have been compromised due to lack of travel, transport, the need to maintain social distancing, etc. We devised our own splint management for stiff fingers and found it too useful.
 

Anatomical variations of the pen process (PS) and ossification of the pen-hyoid ligament constitute Eagle syndrome. This is a rare syndrome, often bilateral, that summarizes the clinical manifestations due to an excessive length of the pen process that is greater than 25mm. Other important morphometric and topographical variations are associated with this anomaly.

Taking these anatomical data into account is essential for the etiopathogenic analysis and surgical treatment of Eagle syndrome. The purpose of this work was to investigate anatomical variations of the pen process during Eagle syndrome.

Material and method:  This was a retrospective study over a period of 07 months from December 2020 to June 2021 inclusive. It concerned 32 patients, received in the radiology and medical imaging department of the National Pikine Hospital for suspicion of Eagle syndrome confirmed by scanner without and with injection. Patients who had a normal scanner were not included in the study. We used SPSS 24.0 and Excel 2016 to analyze the data.

Results:  24 women (75%) and 8 men (25%), a sex ratio of 0.33. The average age of patients was 39 years, with a standard deviation of 12 years, and extremes of 21 to 71 years. The age range of 30-40 was 34% and 41-50 was 33%. Examination found pharyngeal foreign body sensation in 65% of cases, dysphagia in 67% of cases, headache in 71% of cases, and cervical neuralgia. Brachial in 95% of cases. At CT, the average length of all pen processes was 39.2 mm (extremes: 21-76 mm). The elongation of the pen process was bilateral in 68%, unilateral right in 7% of cases, and unilateral left in 25% of cases. Morphologically, the PS consisted of a single long fragment in 78% of cases (Langlais types 1), or two fragments articulated either by fibrous tissue or by a pseudo articulation with an angular shape in 19% of cases (Langlais types 2), or several fragments (3% Langlais types 3).

Conclusion: Eagle syndrome is a radio anatomical entity with several variants whose knowledge is essential to its management.

Objectives: The aim of this study is to determine the prevalence of thyroid ima artery (TIA) and branching pattern variations of aortic arch among 2000 patients who underwent
CECT imaging.
Materials and methods: This retrospective cross-sectional observational study included 2000 patients who underwent CECT of aortic arch and branches during a two years period in a tertiary care center in South India. The presence of the thyroid ima artery with its origin was identified and the branching patterns of the aortic arch were assessed.
Results: TIA was identified in 23 patients, showing a prevalence of 1.15%. The normal branching pattern of the aortic arch was observed in 1493 patients, and variations in the branching pattern were seen in 507 patients. The variations included 342 cases of the bovine-type arch, 162 left vertebral arteries originating from the arch, 16 aberrant right subclavian arteries, 10 right-sided aortic arch, and 1 double aortic arch.
Conclusion: The identification of TIA and variations in aortic arch branching are crucial, as they can cause complications during neck and thoracic surgeries and endovascular interventions. CECT is a reliable tool to assess vascular anatomy. Considering the prevalence demonstrated in our study, imaging should be included prior to procedures in order to prevent
complications.