Yıl: 2011 Cilt: 19 Sayı: 1 Sayfa Aralığı: 72 - 76 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

Cadaver analysis of thoracic outlet anomalies

Öz:
Amaç: Bu çalışmada kadavra analizi ile torasik outlet anomalilerinin oranını belirlemeye çalıştık.Çalışma planı: Yirmi kadavrada (7 kadın, 13 erkek; ort. yaş 46) torakoservikoaksiller bölgede, her iki ekstremiteye (n=40) iki anatomi uzmanı ve iki göğüs cerrahı tarafından supraklaviküler kesi uygulandı. Fibröz bant formasyonu ve tipi, servikal kosta ve C7 uzun transvers çıkıntı varlığı, klavikula, skalenus anterior ve skalenus medius kası, brakiyal pleksus, subklavian arter ve subklavian ven anomalileri değerlendirildi. Fibröz bant formasyonu ve tipi Roos sınıflamasına göre adlandırıldı.Bulgular: Otuz dört (%85) extremitede anomaliye rastlandı. Tip 3 bant en sık oranda (%15) gözlendi ve tümü sağ ekstremitede idi. Tip 4 bant ise en az oranda (%2.5) görüldü. Aynı ekstremitedeki iki bantın (tip 9 ve tip 11) varlığına ise bir kadavrada (%2.5) rastlandı. Servikal kot oluşma oranı ve C7 uzun transvers çıkıntısı %10 idi. Skalenus medius kasının bazı lifleri bir ekstremitede (%2.5) servikal kostadan başlıyordu. Anteriyor subklavyan arter üç ekstremitede (%7.5) skalen kasın içinden geçiyor idi. Yüzde on ekstremitede ise C5 trunkusun anteriyor skalen kası perfore ederek içinden geçtiği ve %7.5 oranında ise brakiyal pleksusun üst trunkusunun anteriyor skalen kası perfore ederek geçtiği gözlendi.Sonuç: Toplumumuzda brakiyal pleksus ve subklaviyan arter varyasyonları sıklıkla gözlenmektedir. Bu nedenle kasların bölünmesi ya da blokaj uygulamaları sırasında morbidite ve komplikasyonların önlenmesi açısından bu tip anomaliler dikkate alınmalıdır.
Anahtar Kelime:

Konular: Kalp ve Kalp Damar Sistemi Cerrahi

Torasik çıkıştaki anomalilerin kadavra analizi

Öz:
Background: This study aims to determinate the rate of thoracic outlet anomalies by means of analysis of cadavers.Methods: Supraclavicular incisions were applied by two anatomists and two thoracic surgeons in the thoracocervicoaxillary region of both extremities (n=40) in twenty cadavers (7 females, 13 males; mean age 46). The formation and type of fibrous bands, cervical ribs, C7 long transverse processes and anomalies of the clavicles, scalenus anterior and scalenus medius muscles, brachial plexus, subclavian arteries and veins were evaluated. The type and formation of fibrous bands were classified using Roos' classification.Results: Anomalies were found in 34 (85%) of extremities. The type 3-band was most frequently (15%) observed and all of them were on the right extremity. The type 4-band was rarely seen (2.5%). Two bands (type 9 and type 11) in the same extremity were notified in one cadaver. (2.5%). The occurrence rate of cervical rib and C7 long transverse process was 10%. Some fibers of m. scalenus medius emerged from a cervical rib in one extremity (2.5%). The arteria subclavia anterior passed through the scalene muscle in three extremities (7.5%). In 10% of extremities the C5 truncus passing through the anterior scalene muscle and upper truncus of brachial plexus passing anterior scalene muscle via perforation was found in 7.5% of patients.Conclusion: In our population, brachial plexus and subclavian artery variations are frequently observed. Therefore these types of anomalies should be taken into consideration to prevent morbidity and complications when muscle division or blockage applications are performed.
Anahtar Kelime:

Konular: Kalp ve Kalp Damar Sistemi Cerrahi
Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
  • 1) Yavuzer S, Atinkaya C, Tokat O. Clinical predictors of surgical outcome in patients with thoracic outlet syndrome operated on via transaxillary approach. Eur J Cardiothorac Surg 2004;25:173-8.
  • 2) Davidovic LB, Kostic DM, Jakovljevic NS, Kuzmanovic IL, Simic TM. Vascular thoracic outlet syndrome. World J Surg 2003;27:545-50.
  • 3) Sobey AV, Grewal RP, Hutchison KJ, Urschel JD. Investigation of nonspecific neurogenic thoracic outlet syndrome. J Cardiovasc Surg (Torino) 1993;34:343-5.
  • 4) Roos DB. Transaxillary approach for first rib resection to relieve thoracic outlet syndrome. Ann Surg 1966;163:354-8.
  • 5) Roos DB. The place for scalenectomy and first-rib resection in thoracic outlet syndrome. Surgery 1982;92:1077-85.
  • 6) Roos DB. Congenital anomalies associated with thoracic outlet syndrome. Anatomy, symptoms, diagnosis, and treatment. Am J Surg 1976;132:771-8.
  • 7) Adson AW. Surgical treatment for symptoms produced by cervical ribs and the scalenus anticus muscle. Surg Gynecol Obstet 1947;85:687-700.
  • 8) Urschel HC Jr, Razzuk MA. Neurovascular compression in the thoracic outlet: changing management over 50 years. Ann Surg 1998;228:609-17.
  • 9) Tubbs RS, Tyler-Kabara EC, Salter EG, Sheetz J, Zehren SJ, Oakes WJ. Additional vascular compression of the brachial plexus in a cadaver with a cervical rib: case illustration. Surg Radiol Anat 2006;28:112-3.
  • 10) Juvonen T, Satta J, Laitala P, Luukkonen K, Nissinen J. Anomalies at the thoracic outlet are frequent in the general population. Am J Surg 1995;170:33-7.
  • 11) Pollack EW. Surgical anatomy of the thoracic outlet syndrome. Surg Gynecol Obstet 1980;150:97-103.
  • 12) Machleder HI, Moll F, Verity MA. The anterior scalene muscle in thoracic outlet compression syndrome. Histochemical and morphometric studies. Arch Surg 1986;121:1141-4.
  • 13) Harry WG, Bennett JD, Guha SC. Scalene muscles and the brachial plexus: anatomical variations and their clinical significance. Clin Anat 1997;10:250-2.
  • 14) Natsis K, Totlis T, Tsikaras P, Anastasopoulos N, Skandalakis P, Koebke J. Variations of the course of the upper trunk of the brachial plexus and their clinical significance for the thoracic outlet syndrome: a study on 93 cadavers. Am Surg 2006;72:188-92.
  • 15) Abe M, Ichinohe K, Nishida J. Diagnosis, treatment, and complications of thoracic outlet syndrome. J Orthop Sci 1999;4:66-9.
  • 16) Nathan H, Seidel MR. The association of a retroesophageal right subclavian artery, a right-sided terminating thoracic duct, and a left vertebral artery of aortic origin: anatomical and clinical considerations. Acta Anat (Basel) 1983;117:362-73.
  • 17) Sealy WC. A report of two cases of the anomalous origin of the right subclavian artery from the descending aorta. J Thorac Surg 1951;21:319-24.
  • 18) Konuşkan B, Bozkurt MC, Tağil SM, Ozçakar L. Cadaveric observation of an aberrant left subclavian artery: a possible cause of thoracic outlet syndrome. Clin Anat 2005;18:215-6.
APA TOKAT A, ALTINKAYA C, Esmer A, APAYDIN N, TEKDEMİR İ, GÜNGÖR A (2011). Cadaver analysis of thoracic outlet anomalies. , 72 - 76.
Chicago TOKAT Arif Osman,ALTINKAYA Cansel,Esmer Ali Firat,APAYDIN Nihal,TEKDEMİR İbrahim,GÜNGÖR Adem Cadaver analysis of thoracic outlet anomalies. (2011): 72 - 76.
MLA TOKAT Arif Osman,ALTINKAYA Cansel,Esmer Ali Firat,APAYDIN Nihal,TEKDEMİR İbrahim,GÜNGÖR Adem Cadaver analysis of thoracic outlet anomalies. , 2011, ss.72 - 76.
AMA TOKAT A,ALTINKAYA C,Esmer A,APAYDIN N,TEKDEMİR İ,GÜNGÖR A Cadaver analysis of thoracic outlet anomalies. . 2011; 72 - 76.
Vancouver TOKAT A,ALTINKAYA C,Esmer A,APAYDIN N,TEKDEMİR İ,GÜNGÖR A Cadaver analysis of thoracic outlet anomalies. . 2011; 72 - 76.
IEEE TOKAT A,ALTINKAYA C,Esmer A,APAYDIN N,TEKDEMİR İ,GÜNGÖR A "Cadaver analysis of thoracic outlet anomalies." , ss.72 - 76, 2011.
ISNAD TOKAT, Arif Osman vd. "Cadaver analysis of thoracic outlet anomalies". (2011), 72-76.
APA TOKAT A, ALTINKAYA C, Esmer A, APAYDIN N, TEKDEMİR İ, GÜNGÖR A (2011). Cadaver analysis of thoracic outlet anomalies. Türk Göğüs Kalp Damar Cerrahisi Dergisi, 19(1), 72 - 76.
Chicago TOKAT Arif Osman,ALTINKAYA Cansel,Esmer Ali Firat,APAYDIN Nihal,TEKDEMİR İbrahim,GÜNGÖR Adem Cadaver analysis of thoracic outlet anomalies. Türk Göğüs Kalp Damar Cerrahisi Dergisi 19, no.1 (2011): 72 - 76.
MLA TOKAT Arif Osman,ALTINKAYA Cansel,Esmer Ali Firat,APAYDIN Nihal,TEKDEMİR İbrahim,GÜNGÖR Adem Cadaver analysis of thoracic outlet anomalies. Türk Göğüs Kalp Damar Cerrahisi Dergisi, vol.19, no.1, 2011, ss.72 - 76.
AMA TOKAT A,ALTINKAYA C,Esmer A,APAYDIN N,TEKDEMİR İ,GÜNGÖR A Cadaver analysis of thoracic outlet anomalies. Türk Göğüs Kalp Damar Cerrahisi Dergisi. 2011; 19(1): 72 - 76.
Vancouver TOKAT A,ALTINKAYA C,Esmer A,APAYDIN N,TEKDEMİR İ,GÜNGÖR A Cadaver analysis of thoracic outlet anomalies. Türk Göğüs Kalp Damar Cerrahisi Dergisi. 2011; 19(1): 72 - 76.
IEEE TOKAT A,ALTINKAYA C,Esmer A,APAYDIN N,TEKDEMİR İ,GÜNGÖR A "Cadaver analysis of thoracic outlet anomalies." Türk Göğüs Kalp Damar Cerrahisi Dergisi, 19, ss.72 - 76, 2011.
ISNAD TOKAT, Arif Osman vd. "Cadaver analysis of thoracic outlet anomalies". Türk Göğüs Kalp Damar Cerrahisi Dergisi 19/1 (2011), 72-76.