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  • By Author: Elton, Scott x
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R. Shane Tubbs, Scott Elton, George Salter, Jeffrey P. Blount, Paul A. Grabb and W. Jerry Oakes

Object. There is a lack of reports in the literature that contain descriptions of superficial anatomical landmarks for the identification of the internally located frontal sinus. Neurosurgeons must often enter the cranium through the frontal bone and knowledge of the frontal sinus is essential to minimize complications.

Methods. Seventy adult cadaveric frontal sinuses were evaluated. Measurements included both the lateral and superior extent of the frontal sinus in reference to a midpupillary line, and the superior extent of the frontal sinus from the nasion. Frontal sinuses were found bilaterally in all specimens. The mean height of the frontal sinus superior to the nasion was 2.8 cm. In 71.4% and 74.3% of specimens the lateral extent of the frontal sinus was found to be medial to the left and right midpupillary line, respectively. Distances superior to a plane drawn through the supraorbital ridges at a midpupillary line included a mean of 2.5 mm for the left side and 1.8 mm for the right side.

Conclusions. Of 70 sinuses, none extended more than 5 mm lateral to a midpupillary line. At this same midpupillary line and at a plane drawn through the supraorbital ridges, the frontal sinus was never higher than 12 mm. Finally, in the midline the frontal sinus never reached more than 4 cm above the nasion. These measurements will assist surgeons who must manipulate the frontal bone.

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R. Shane Tubbs, W. Jerry Oakes, Jeffrey P. Blount, Scott Elton, George Salter and Paul A. Grabb

Object. The proximal segment of the axillary nerve (ANp) is often difficult to identify without extensive dissection deep into the axilla. The present study was performed to find reliable surgical landmarks for this nerve.

Methods. Thirty dissections of human cadavers were performed to determine the relationships between the ANp and specific anatomical structures.

The authors found that the ANp is consistently located within an anatomical triangle constructed by lines passing between the coracobrachialis and pectoralis minor muscles and the axillary artery. In addition, the ANp was routinely found 4 cm distal to the coracoid process of the scapula.

Conclusions. These findings should assist the surgeon in locating the ANp during brachial plexus reconstruction.

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R. Shane Tubbs, George Salter, Scott Elton, Paul A. Grabb and W. Jerry Oakes

Object. Historically, the sagittal suture has been used as an external landmark to indicate the middle portion of the superior sagittal sinus (SSS). The goal of this study was to verify this relationship.

Methods. The authors examined 30 adult cadavers to reveal the location of the SSS with respect to the sagittal suture. Their findings demonstrated that the SSS is deviated to the right of the sagittal suture in the majority of observed specimens, although the maximum displacement to the right side was never more than 11 mm.

Conclusions. This information should be useful to the neurosurgeon who must be aware of the SSS and its relationship with superficial skull landmarks.