Öz
Plexus brachialis’in fasciculus lateralis’inden ayrılan bir dal olan n. musculocutaneus’un oluşumu çeşitli varyasyonlar göstermektedir. Çalışmamızda n. musculocutaneus’un kök varyasyonlarının tespit edilmesi ve sınıflandırılması amaçlanmıştır. Çalışmamız yaşları 17-40 gebelik haftası yaşı arasında değişen, eksternal patolojisi ve anomalisi olmayan, 51 adet insan fetusu (25 erkek, 26 dişi)’na ait 102 üst ekstremite üzerinde gerçekleştirildi. Plexus brachialis, anatomik diseksiyon yöntemi ile ortaya çıkarıldı. Daha sonra, n. musculocutaneus’un varyasyonları belirlenerek sınıflandırıldı. Yaptığımız sınıflandırmada Tip 1 normal anatomik yapıyı ifade ederken tip 2A ve tip 2B’de n. musculocutaneus ile n. medianus arasında sırasıyla bir ve iki adet bağlantı dalı vardır. Tip 3’te radix lateralis nervi mediani ve radix medialis nervi mediani’nin birleşmesiyle ortak kök şeklinde oluşan n. musculocutaneus ve n. medianus belli bir mesafeden sonra ayrılmaktadır. Örneklerin %91,1’i (n=93) tip 1, %6,9’u (n=7) tip2A, %1’i (n=1) tip 2B ve %1’i (n=1) tip 3 olarak bulundu. Nervus musculocutaneus’un varyasyonlarının bilinmesi ve toplumsal prevalansın ortaya çıkarılması doğumsal plexus brachialis paralizisi, ateşli silah yaralanmaları, laserasyonlar, sinirin nörotizasyon amaçlı kullanımları ve post operatif komplikasyonların önlenmesi açısından önemlidir.
Anahtar Kelimeler
Nervus Musculocutaneus Oluşum Varyasyonları Plexus Brachialis
Etik Beyan
Onaylayan Kurul: Süleyman Demirel Üniversitesi Tıp Fakültesi Bilimsel Araştırmalar Etik Kurulu Onay Tarihi: 25.09.2020 Karar No: 277
Destekleyen Kurum
yok
Proje Numarası
yok
Teşekkür
yok
Kaynakça
- 1. Pandey SK, Shukla VK. Anatomical variations of the cords of brachial plexus and the median nerve. Clinical Anatomy, 2007; 20(2): 150–6. doi: 10.1002/ca.20365, indexed in Pubmed: 16795062.
- 2.Macchi V, Tiengo C, Porzionato A, et al. Musculocutaneous nerve: histotopographic study and clinical implications. Clinical Anatomy,F 2007; 20(4): 400–6. doi: 10.1002/ca.20402, indexedin Pubmed: 17022027.
- 3.Standring S, Ellis H, Healy J, Johnson D, Williams A, CollinsP, Wigley C. Gray's anatomy: the anatomical basis of clinical practice. American Journal of Neuroradiology, 2005; 26(10), 2703.
- 4.Hunter D D, Zdilla M J. The absent musculocutaneous nerve: A systematic review. Translational Research in Anatomy,2021;22, 100092.
- 5. Le Minor, J. M. A rare variation of the median andmusculocutaneous nerves in man. Archives d'anatomie, d'histologie et d'embryologie normales et experimentales,1990;73, 33-42.
- 6.Davidson J. J, Bassett F. H, Nunley J. A. Musculocutaneous nerve entrapment revisited. Journal of shoulder and elbowsurgery, 1998;7(3), 250-5.
- 7.Sunderland S. Nerves and nerve in juries. Edinburgh, E& SLivingstone Ltd, 1968.
- 8.Gorbunov N. S, Kober K. V, Kasparov E. V. Anatomicalaspects of the use of the thoracodorsal nerve as a donor inmusculocutaneous nerve injury. Kazan medical journal, 2020;101(6), 820-4.
- 9.Socolovsky M, Malessy M, Bonilla G, Di Masi G, Conti M. E, Lovaglio A. Phrenic to musculocutaneous nerve transfer for traumatic brachial plexus injuries: analyzing respiratory effectson elbow flexion control. Journal of neurosurgery,2018; 131(1), 165-174.
- 10. De Mendonça Cardoso M, Gepp R, Lima F. L, Gushiken A.Intercostal to musculocutaneous nerve transfer in patients withcomplete traumatic brachial plexus injuries: case series. Acta Neurochirurgica, 2020;162, 1907-12.
- 11.Hansasuta A, Tubbs R. S, Grabb P. A. Surgical relationship of the medial pectoral nerve to the musculocutaneous nerve: acadaveric study. Neurosurgery, 2001;48(1), 203-7.
- 12.Wellons J. C, Tubbs R. S, Pugh J. A, Bradley N. J, Law C. R,Grabb P. A. Medial pectoral nerve to musculocutaneous nerve neurotization for the treatment of persistent birth-related brachial plexus palsy: an 11-year institutional experience. Journal of Neurosurgery: Pediatrics, 2009;3(5), 348-353.
- 13.Venieratos D, Anagnostopoulou S. Classification of communications between the musculocutaneous and mediannerves. Clinical Anatomy: The Official Journal of the American Association of Clinical Anatomists and the British Association of Clinical Anatomists, 1998;11(5), 327-31.
- 14.Loukas M, Aqueelah H. Musculocutaneous and median nerve connections within, proximal and distal to the coracobrachialis muscle. Folia morphologica,2005; 64(2), 101-8.
- 15.Kupsamy K, Ishwarkumar S, De Gama, B. Z, Pillay P.Classification of the Musculocutaneous NerveFetuses. International Journal of Morphology, 2021;39(2).Anat Res, 2018; 6(4.2), 5853-60.
- 16.Fazlıoğulları Z, Ulusoy M, Doğan N. Ü, Yılmaz M. T,Karabulut A. K. A formation variation of the median nerve inthe arm. Fırat Tıp Dergisi, 2011;16(4), 199-201.
- 17.Beheiry EE. Anatomical variations of the median nerve distribution and communication in the arm. Folia Morphol 2004; 63: 313–8.
- 18.Jain I. Variations of the Musculocutaneous Nerve: A Cadaveric Study. Acta Scientific Anatomy, 2022;1(1).
- 19.Kırık A, Mut S. E, Daneyemez M. K, Seçer H. İ. Anatomical variations of brachial plexus in fetal cadavers. Turk Neurosurg, 2018;28(5), 783-91.
- 20.Hayashi M, Shionoya K, Hayashi S, Hatayama N, Kawata S, Qu N, Itoh M. A novel classification of musculocutaneous nerve variations: The relationship between the communicating branch and transposed innervation of the brachial flexors to the median nerve. Annals of Anatomy-Anatomischer Anzeiger, 2017;209, 45-50.
- 21.Leng L, Liu H, Wang, T, Liu, L, Si D. Classifying musculocutaneous nerve variations depending on the origin. Journal of Neurological Disorders. 2016
- 22.Ballesteros L. E, Forero P. L, Buitrago E. R. Communication between the musculocutaneous and median nerves in the arm: an anatomical study and clinical implications. Revista Brasileira de Ortopedia, 2015;50, 567-72.
- 23.Kervancioglu P, Orhan M, Kılınç, N. Patterns of motor branching of the musculocutaneous nerve in human fetuses andclinical significance. Clinical Anatomy, 2011;24(2), 168-78.
- 24.Guerri‐Guttenberg R. A, Ingolotti M. Classifying musculocutaneous nerve variations. Clinical Anatomy,2009;22(6), 671-83.
- 25.Uysal I. I, Karabulut A. K, Büyükmumcu M, Dogan N. U, Salbacak A. The course and variations of the branches of the musculocutaneous nerve in human fetuses. Clinical Anatomy: The Official Journal of the American Association of Clinical Anatomists and the British Association of Clinical Anatomists,2009; 22(3), 337-45.
- 26.Bhattarai C, Poudel P. P. Unusual variation in musculocutaneous nerves in Nepalese. Kathmandu University Medical Journal (KUMJ), 2009;7(28), 408-10.
- 27.Krishnamurthy A, Nayak S. R, Prabhu L. V, Hegde R. P,Surendran S, Kumar M, Pai, M. M. The branching pattern andcommunications of the musculocutaneous nerve. Journal of Hand Surgery (European Volume), 2007;32(5), 560-2.
- 28.Chitra R. Various types of intercommunications betweenmusculocutaneous and median nerves: An analytical study. Annals of Indian Academy of Neurology,2007; 10(2), 100-4.
- 29.Choi D, Rodríguez‐Niedenführ M, Vázquez T, Parkin I, Sañudo J. R. Patterns of connections between the musculocutaneous and median nerves in the axilla and arm. Clinical Anatomy, 2002;15(1), 11-17.
- 30.Arıncı K, Elhan A. Anatomi. 2. cilt, 4. baskı. Ankara, Türkiye,Güneş Kitabevi, 2006;166-7.
Öz
Musculocutaneous nerve, which arises from the lateral cord of the brachial plexus, undergoes a number of changes during its development. The goal of our study was to identify and classify the variations that occur during the formation of the musculocutaneous nerve. Our study was carried out on 102 upper extremities of 51 human fetuses (25 males, 26 females) aged between 17-40 weeks of gestation, without external pathology and anomalies. Brachial plexus was revealed by the anatomical dissection method, and the formation variations of the musculocutaneous nerve were determined and these variations were typed. Type 1 refers to the normal anatomical structure in typing, whereas types 2A and type 2B have respectively one and two connecting branches between the musculocutaneous nerve and median nerve. In type 3, the musculocutaneous and median nerve formed as a common root by the junction of the lateral root of median nerve and medial root of median nerve are separated after a certain distance. In our study, 91.1% (n=93) of the samples were type 1, 6.9% (n=7) type 2A, 1% (n=1) type 2B and 1% (n=1) of the samples was found as type 3. Knowing the variations during the formation of the musculocutaneous nerve and revealing the population prevalence are important in terms of congenital brachial plexus paralysis, gunshot injuries, lacerations, use of the nerve for neurotization, and prevention of postoperative complications.
Anahtar Kelimeler
Proje Numarası
yok
Kaynakça
- 1. Pandey SK, Shukla VK. Anatomical variations of the cords of brachial plexus and the median nerve. Clinical Anatomy, 2007; 20(2): 150–6. doi: 10.1002/ca.20365, indexed in Pubmed: 16795062.
- 2.Macchi V, Tiengo C, Porzionato A, et al. Musculocutaneous nerve: histotopographic study and clinical implications. Clinical Anatomy,F 2007; 20(4): 400–6. doi: 10.1002/ca.20402, indexedin Pubmed: 17022027.
- 3.Standring S, Ellis H, Healy J, Johnson D, Williams A, CollinsP, Wigley C. Gray's anatomy: the anatomical basis of clinical practice. American Journal of Neuroradiology, 2005; 26(10), 2703.
- 4.Hunter D D, Zdilla M J. The absent musculocutaneous nerve: A systematic review. Translational Research in Anatomy,2021;22, 100092.
- 5. Le Minor, J. M. A rare variation of the median andmusculocutaneous nerves in man. Archives d'anatomie, d'histologie et d'embryologie normales et experimentales,1990;73, 33-42.
- 6.Davidson J. J, Bassett F. H, Nunley J. A. Musculocutaneous nerve entrapment revisited. Journal of shoulder and elbowsurgery, 1998;7(3), 250-5.
- 7.Sunderland S. Nerves and nerve in juries. Edinburgh, E& SLivingstone Ltd, 1968.
- 8.Gorbunov N. S, Kober K. V, Kasparov E. V. Anatomicalaspects of the use of the thoracodorsal nerve as a donor inmusculocutaneous nerve injury. Kazan medical journal, 2020;101(6), 820-4.
- 9.Socolovsky M, Malessy M, Bonilla G, Di Masi G, Conti M. E, Lovaglio A. Phrenic to musculocutaneous nerve transfer for traumatic brachial plexus injuries: analyzing respiratory effectson elbow flexion control. Journal of neurosurgery,2018; 131(1), 165-174.
- 10. De Mendonça Cardoso M, Gepp R, Lima F. L, Gushiken A.Intercostal to musculocutaneous nerve transfer in patients withcomplete traumatic brachial plexus injuries: case series. Acta Neurochirurgica, 2020;162, 1907-12.
- 11.Hansasuta A, Tubbs R. S, Grabb P. A. Surgical relationship of the medial pectoral nerve to the musculocutaneous nerve: acadaveric study. Neurosurgery, 2001;48(1), 203-7.
- 12.Wellons J. C, Tubbs R. S, Pugh J. A, Bradley N. J, Law C. R,Grabb P. A. Medial pectoral nerve to musculocutaneous nerve neurotization for the treatment of persistent birth-related brachial plexus palsy: an 11-year institutional experience. Journal of Neurosurgery: Pediatrics, 2009;3(5), 348-353.
- 13.Venieratos D, Anagnostopoulou S. Classification of communications between the musculocutaneous and mediannerves. Clinical Anatomy: The Official Journal of the American Association of Clinical Anatomists and the British Association of Clinical Anatomists, 1998;11(5), 327-31.
- 14.Loukas M, Aqueelah H. Musculocutaneous and median nerve connections within, proximal and distal to the coracobrachialis muscle. Folia morphologica,2005; 64(2), 101-8.
- 15.Kupsamy K, Ishwarkumar S, De Gama, B. Z, Pillay P.Classification of the Musculocutaneous NerveFetuses. International Journal of Morphology, 2021;39(2).Anat Res, 2018; 6(4.2), 5853-60.
- 16.Fazlıoğulları Z, Ulusoy M, Doğan N. Ü, Yılmaz M. T,Karabulut A. K. A formation variation of the median nerve inthe arm. Fırat Tıp Dergisi, 2011;16(4), 199-201.
- 17.Beheiry EE. Anatomical variations of the median nerve distribution and communication in the arm. Folia Morphol 2004; 63: 313–8.
- 18.Jain I. Variations of the Musculocutaneous Nerve: A Cadaveric Study. Acta Scientific Anatomy, 2022;1(1).
- 19.Kırık A, Mut S. E, Daneyemez M. K, Seçer H. İ. Anatomical variations of brachial plexus in fetal cadavers. Turk Neurosurg, 2018;28(5), 783-91.
- 20.Hayashi M, Shionoya K, Hayashi S, Hatayama N, Kawata S, Qu N, Itoh M. A novel classification of musculocutaneous nerve variations: The relationship between the communicating branch and transposed innervation of the brachial flexors to the median nerve. Annals of Anatomy-Anatomischer Anzeiger, 2017;209, 45-50.
- 21.Leng L, Liu H, Wang, T, Liu, L, Si D. Classifying musculocutaneous nerve variations depending on the origin. Journal of Neurological Disorders. 2016
- 22.Ballesteros L. E, Forero P. L, Buitrago E. R. Communication between the musculocutaneous and median nerves in the arm: an anatomical study and clinical implications. Revista Brasileira de Ortopedia, 2015;50, 567-72.
- 23.Kervancioglu P, Orhan M, Kılınç, N. Patterns of motor branching of the musculocutaneous nerve in human fetuses andclinical significance. Clinical Anatomy, 2011;24(2), 168-78.
- 24.Guerri‐Guttenberg R. A, Ingolotti M. Classifying musculocutaneous nerve variations. Clinical Anatomy,2009;22(6), 671-83.
- 25.Uysal I. I, Karabulut A. K, Büyükmumcu M, Dogan N. U, Salbacak A. The course and variations of the branches of the musculocutaneous nerve in human fetuses. Clinical Anatomy: The Official Journal of the American Association of Clinical Anatomists and the British Association of Clinical Anatomists,2009; 22(3), 337-45.
- 26.Bhattarai C, Poudel P. P. Unusual variation in musculocutaneous nerves in Nepalese. Kathmandu University Medical Journal (KUMJ), 2009;7(28), 408-10.
- 27.Krishnamurthy A, Nayak S. R, Prabhu L. V, Hegde R. P,Surendran S, Kumar M, Pai, M. M. The branching pattern andcommunications of the musculocutaneous nerve. Journal of Hand Surgery (European Volume), 2007;32(5), 560-2.
- 28.Chitra R. Various types of intercommunications betweenmusculocutaneous and median nerves: An analytical study. Annals of Indian Academy of Neurology,2007; 10(2), 100-4.
- 29.Choi D, Rodríguez‐Niedenführ M, Vázquez T, Parkin I, Sañudo J. R. Patterns of connections between the musculocutaneous and median nerves in the axilla and arm. Clinical Anatomy, 2002;15(1), 11-17.
- 30.Arıncı K, Elhan A. Anatomi. 2. cilt, 4. baskı. Ankara, Türkiye,Güneş Kitabevi, 2006;166-7.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Anatomi |
| Bölüm | Özgün Araştırma Makaleleri |
| Yazarlar | |
| Proje Numarası | yok |
| Yayımlanma Tarihi | 31 Aralık 2023 |
| Kabul Tarihi | 1 Aralık 2023 |
| Yayımlandığı Sayı | Yıl 2023 Cilt: 49 Sayı: 3 |
Kaynak Göster
Journal of Uludag University Medical Faculty is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.