The ethmoidal foramens are located on the medial wall of the orbit and are key reference points for intraoperative orientation. Detailed knowledge of the anatomy, bony landmarks and morphometric ...characteristics of the medial wall of the orbit is essential for various surgical procedures. The aim of this study was to determine the morphometric variations in the medial wall of the orbit and establish significant variations regarding age and gender. A total of 110 orbits were analyzed and subdivided by age (over or under 40 years) and gender. The distances of the medial wall of the orbit between the anterior lacrimal crest, the ethmoidal foramen, the optic canal and the interforamina were determined. Safe surgical areas were sought. Statistical tests were used to determine the differences between groups. In men, there is a safe surgical area proximal to the anterior and posterior ethmoidal foramen. In women, this area is in the posterior third of the medial wall of the orbit between the posterior ethmoidal foramen and the optic canal. Regarding variation according to age, the results of this study suggested that the anteroposterior diameter of the medial wall increases with age. This study showed that the anteroposterior total length of the medial orbit wall is similar between genders of similar age, increases with age, and has significant variations in the distances between the various structures that make up the medial orbit wall with regard to gender and age.
To describe the safety areas for placement of 5 anterolateral portals (anterior, anterior lateral, posterior lateral, proximal anterior medial and distal anterior medial portals) and 3 recently ...described medial portals (anterior medial, posterior medial and distal posterior medial portals) to provide topographical description of the safety of each. A descriptive, observational and cross-sectional study in which femoral triangle dissection was performed in 12 hips. 5 lateral portals and the 3 medial portals were placed. Clinically relevant neurovascular structures associated with each portal, were identified measured and documented. The lateral portal with the highest risk of injury to a nearby neurovascular structure was the anterior portal, the most adjacent to the femoral cutaneous nerve, 1.42 cm (±0.85) lateral to the portal. In the medial portals, the anterior medial portal has the narrowest margin in relation to the femoral artery, 2.14 cm (±0.35) lateral to the portal and medial to the obturator nerve by 0.87 cm (±0.62). The lateral portals have a higher safety margin; the portal with the most proximity to a neurovascular structure is the anterior portal, associated laterally with the femoral cutaneous nerve, presenting a higher risk of injury. Medial portals have a higher risk of injuring the femoral neurovascular bundle as well as the obturator nerve.
The abundant vascular structures that surround the shoulder joint are complex and variable, complicating arthroscopy approaches. The aim of this study is to determine safe and risky areas around ...standard posterior and standard anterior portals, and accounting for the distribution of neurovascular structures of small and medium diameters that can lead to intra-articular bleeding during surgery. The standard posterior portal, and standard anterior portal were placed as described in the literature, and punch dissection was performed 2.5 cm around the trocar in situ. The arrangement of each identified structure was photographically documented and digitalized for each anatomic plane; the distance to the trocar and the diameter of each structure were measured. Based on each digitalized anatomic plane, safe and risky tissue areas were determined, and a clock face coordinate system was used to represent these areas. The safe area around the standard posterior portal was located between 11 and 1 o´clock for the left shoulder and 11 and 2 o´clock for the right shoulder. For the standard anterior portal, the safe area was located between 2 and 3 o´clock for the left shoulder and between 9 and 12 o´clock for the right shoulder. However, we did document a risk of injuring the cephalic vein 5 times, the axillary artery 3 times and the deltoid branch of the thoracoacromial artery once. This study reports quantitatively the total number of small diameter structures present in the two shoulder arthroscopic portals evaluated. The safe areas proposed in this study must be evaluated to propose new access points for performing arthroscopic procedures on the shoulder.
To describe the safety areas for placement of 5 anterolateral portals (anterior, anterior lateral, posterior lateral, proximal anterior medial and distal anterior medial portals) and 3 recently ...described medial portals (anterior medial, posterior medial and distal posterior medial portals) to provide topographical description of the safety of each. A descriptive, observational and cross=sectional study in which femoral triangle dissection was performed in 12 hips. 5 lateral portals and the 3 medial portals were placed. Clinically relevant neurovascular structures associated with each portal, were identified measured and documented. The lateral portal with the highest risk of injury to a nearby neurovascular structure was the anterior portal, the most adjacent to the femoral cutaneous nerve, 1.42 cm (+ or - 0.85) lateral to the portal. In the medial portals, the anterior medial portal has the narrowest margin in relation to the femoral artery, 2.14 cm ( + or - 0.35) lateral to the portal and medial to the obturator nerve by 0.87 cm ( + or - 0.62). The lateral portals have a higher safety margin; the portal with the most proximity to a neurovascular structure is the anterior portal, associated laterally with the femoral cutaneous nerve, presenting a higher risk of injury. Medial portals have a higher risk of injuring the femoral neurovascular bundle as well as the obturator nerve. KEY WORDS: Anatomy; Arthroscopy; Hip; Portal. El objetivo fue describir las areas de seguridad para la colocacion de 5 portales estandar (portal anterior, anterolateral, posterolateral, portal anterior proximal medial y portal anterior distal medial) y 3 portales mediales emergentes (antero medial, portal posteromedial y posteromedial distal) para proporcionar una descripcion topografica de la seguridad de cada portal. Se realizo un estudio descriptivo, observacional y transversal, en la que se diseco el triangulo femoral de 12 caderas. Se colocaron los 5 portales laterales y los 3 portales mediales. Se documento la medicion de cada estructura neurovascular de relevancia clinica en relacion a cada uno de los portales evaluados. En cuanto al portal de mayor riesgo entre los laterales, se encontro el portal anterior con mayor cercania al nervio cutaneo femoral lateral (1,42 + or - 0,85 cm), ubicado lateral al portal. En los portales mediales el portal anterior medial tiene el margen mas estrecho respecto a la arteria femoral (2,14 + or - 0,35 cm) lateral al portal, y medial el nervio obturador (0,87 + or - 0,62 cm). Los portales laterales tienen un amplio margen de seguridad, el portal con el margen mas reducido es el portal anterior en relacion al nervio cutaneo femoral lateral, presentando un elevado riesgo de lesionarlo, los portales mediales tienen un alto riesgo de lesionar las estructuras neurovasculares femorales y el nervio obturador. PALABRAS CLAVE: Anatomia; Artroscopia; Cadera; Portal.
To describe the safety areas for placement of 5 anterolateral portals (anterior, anterior lateral, posterior lateral, proximal anterior medial and distal anterior medial portals) and 3 recently ...described medial portals (anterior medial, posterior medial and distal posterior medial portals) to provide topographical description of the safety of each. A descriptive, observational and cross=sectional study in which femoral triangle dissection was performed in 12 hips. 5 lateral portals and the 3 medial portals were placed. Clinically relevant neurovascular structures associated with each portal, were identified measured and documented. The lateral portal with the highest risk of injury to a nearby neurovascular structure was the anterior portal, the most adjacent to the femoral cutaneous nerve, 1.42 cm (+ or - 0.85) lateral to the portal. In the medial portals, the anterior medial portal has the narrowest margin in relation to the femoral artery, 2.14 cm ( + or - 0.35) lateral to the portal and medial to the obturator nerve by 0.87 cm ( + or - 0.62). The lateral portals have a higher safety margin; the portal with the most proximity to a neurovascular structure is the anterior portal, associated laterally with the femoral cutaneous nerve, presenting a higher risk of injury. Medial portals have a higher risk of injuring the femoral neurovascular bundle as well as the obturator nerve.
The abundant vascular structures that surround the shoulder joint are complex and variable, complicating arthroscopy approaches. The aim of this study is to determine safe and risky areas around ...standard posterior and standard anterior portals, and accounting for the distribution of neurovascular structures of small and medium diameters that can lead to intra-articular bleeding during surgery. The standard posterior portal, and standard anterior portal were placed as described in the literature, and punch dissection was performed 2.5 cm around the trocar in situ. The arrangement of each identified structure was photographically documented and digitalized for each anatomic plane; the distance to the trocar and the diameter of each structure were measured. Based on each digitalized anatomic plane, safe and risky tissue areas were determined, and a clock face coordinate system was used to represent these areas. The safe area around the standard posterior portal was located between 11 and 1 o'clock for the left shoulder and 11 and 2 o'clock for the right shoulder. For the standard anterior portal, the safe area was located between 2 and 3 o'clock for the left shoulder and between 9 and 12 o'clock for the right shoulder. However, we did document a risk of injuring the cephalic vein 5 times, the axillary artery 3 times and the deltoid branch of the thoracoacromial artery once. This study reports quantitatively the total number of small diameter structures present in the two shoulder arthroscopic portals evaluated. The safe areas proposed in this study must be evaluated to propose new access points for performing arthroscopic procedures on the shoulder. KEY WORDS: Anatomy; Arthroscopy; Portals; Safe Areas; Shoulder. Las abundantes estructuras vasculares que rodean la articulacion del hombro son complejas y variables, y dificultan los abordajes artroscopicos. El objetivo del estudio fue determinar areas seguras y en riesgo en relacion al portal posterior estandar y el portal anterior estandar y cuantificar la distribucion de estructuras de diametro pequeno e intermedio que puedan conducir a sangrado intraarticular durante la cirugia. El portal posterior estandar y el portal anterior estandar fueron colocados segun su descripcion en la literatura y fueron realizadas disecciones en sacabocado de 2,5 cm alrededor del trocar in situ. La disposicion de cada estructura identificada fue documentada fotograficamente y digitalizada para cada plano anatomico. La distancia hacia el trocar y el diametro de cada estructura fueron medidos. Basado en cada plano anatomico digitalizado, areas de seguridad y riesgo tisular fueron determinadas y un sistema de coordenadas de manecillas de reloj fue utilizado para representar estas areas. El area segura alrededor del portal posterior estandar fue localizada entre las 11 y las 1 en el sistema de las manecillas del reloj para hombros izquierdos y entre las 11 y las 2 para hombros derechos. Para el portal anterior estandar, el area segura fue localizada entre las 2 y 3 horas para hombros izquierdos y entre las 9 y 12 horas para hombros derechos. Aun asi, se documento el riesgo de lesionar la vena cefalica en 5 ocasiones, la arteria axilar en 3 ocasiones y la rama deltoidea de la arteria toracroacromial en una ocasion. Este estudio reporta cuantitativamente el numero total de estructuras de pequeno diametro presentes en los dos portales artroscopicos evaluados. Las areas seguras propuestas en este estudio deben ser evaluadas para proponer nuevos puntos de acceso para la realizacion de procedimientos artroscopicos en el hombro. PALABRAS CLAVE: Anatomia; Artroscopia; Portales; Areas Seguras; Hombro.
The abundant vascular structures that surround the shoulder joint are complex and variable, complicating arthroscopy approaches. The aim of this study is to determine safe and risky areas around ...standard posterior and standard anterior portals, and accounting for the distribution of neurovascular structures of small and medium diameters that can lead to intra-articular bleeding during surgery. The standard posterior portal, and standard anterior portal were placed as described in the literature, and punch dissection was performed 2.5 cm around the trocar in situ. The arrangement of each identified structure was photographically documented and digitalized for each anatomic plane; the distance to the trocar and the diameter of each structure were measured. Based on each digitalized anatomic plane, safe and risky tissue areas were determined, and a clock face coordinate system was used to represent these areas. The safe area around the standard posterior portal was located between 11 and 1 o'clock for the left shoulder and 11 and 2 o'clock for the right shoulder. For the standard anterior portal, the safe area was located between 2 and 3 o'clock for the left shoulder and between 9 and 12 o'clock for the right shoulder. However, we did document a risk of injuring the cephalic vein 5 times, the axillary artery 3 times and the deltoid branch of the thoracoacromial artery once. This study reports quantitatively the total number of small diameter structures present in the two shoulder arthroscopic portals evaluated. The safe areas proposed in this study must be evaluated to propose new access points for performing arthroscopic procedures on the shoulder.
PDF
