Knowledge of the morphometry and types of pterygomaxillary junction (PMJ) during Le-Fort I osteotomy is an important consideration in the reduction of intraoperative complications. The PMJ is known to display population variations and with the recent increase in these surgical interventions in Kenya, a detailed description of the PMJ is warranted. Computed tomography scan images of PMJ obtained from 63 patients were analyzed at the level of the posterior nasal spine to assess types and the morphometry of the PMJ. A fissure type of PMJ was present in 65.9% (83/126 sides) while a synostosis type was present in 34.1% (43/126). Bilateral fissures were found in 58.73% (37/63), bilateral synostosis in 26.98% (17/63), and an asymmetric PMJ in 15.25% (9/63). The average height, width, and thickness of the PMJ were 17.45 ± 5.26 mm, 10.24 ± 1.97 mm, and 6.40 ± 1.97 mm respectively. Males had a significantly greater height (P = 0.003) and width (P = 0.000). The average width was greater in cases with a synostosis as compared with those with a fissure (P = 0.019). Average distance of greater palatine canal was 40.41 ± 2.28 mm and 7.19 ± 2.20 mm from the piriform rim and the pterygoid fossa respectively. The PMJ among Kenyans is characterized by a higher occurrence of synostosis, greater height, and thickness compared with previous findings from other populations. The results of this study can be helpful for surgeons in selecting the most appropriate techniques to achieve successful pterygomaxillary disjunction and minimize avoid attendant complications such as vascular and nerve injuries.

Background: This systematic review and meta-analysis aims to determine the prevalence of the retrorenal colon (RRC) and its implications in percutaneous nephrolithotomy with the overall objective of promoting the prevention of associated iatrogenic complications. Methods: A systematic search of literature was conducted on the electronic databases PubMed, ScienceDirect, and Hinari to identify studies eligible for inclusion. Search results were screened by title and abstract, and those potentially relevant were evaluated by full text. Studies were deemed eligible for inclusion if they reported clear extractable data regarding the prevalence of the retro-renal colon. A meta-analysis was completed using MetaX1 to calculate the pooled prevalence of the retro-renal colon. Sub-group analysis was performed based on geographical regions from which the studies originated, imaging modality, and patient position. Results: 174 records were screened and a total of 10 records included in the analysis with retrospective cohort studies being the most common study design. A male predominance was seen in most sample sizes that had reported data on gender demographics ranging from 41.5-62%. The most common imaging modality utilized was computerized tomography (CT) scan followed by ultrasound. The range of the unweighted prevalence of retro-renal colon across all studies that had absolute numbers reported was from 3.5-25%. One of the studies reported a colonic perforation rate of 0.3% in patients without CT images. Conclusion:The retro-renal colon is a relatively common finding with observed preponderance to females and left lateralization. The presence of RRC increases the likelihood of colon perforations while gaining percutaneous access to the kidney. Pre-procedural imaging can help detect its presence and choose an appropriate route of entry. USG and CT have both been found useful as a modality to pick up RRC.

Gantzer’s muscle is an accessory head of the flexor pollicis longus (FPL). Its incidence, attachments as well as relations to nervous structures have  been shown to exhibit population variations, which have important clinical bearings. Data from our setting however remains partly elucidated. To  study the muscle, the skin of the anterior forearm and fascia were removed to expose the flexor compartment of the forearm. The flexor muscles  were also identified and reflected. The Ganzter’s muscle was identified as that muscle belly originating from the flexor digitorum superficialis, the  radius, the medial humeral epicondyle or the ulna coronoid process and inserted on the flexor pollicis longus or the flexor digitorum superficialis  muscle. Its prevalence, laterality, origin, insertion, shape and relation to the anterior interosseous nerve were determined. The data obtained was  entered into SPSS and percentages calculated for the different variables. The muscle was found in 19/43 (44%) cadavers on the right and on 20/43  (46%) on the left. In 5 out the 43 cadavers (11%), the muscle was present bilaterally while in the rest, it existed solely as either on the right orleft (predominantly on the left, 46%). The Gantzer’s muscle was also noted to predominantly originate from the Flexor Digitorum Superficialis  muscle (72% on the left, 76% on the right) and insert on the Flexor pollicis longus (100%). As regards its shape, it was predominantly triangular, on  both right side (65%) as well as the left side (54%). In majority of the cases, the muscle also lay posterior to the anterior interosseous structures  (100% on the left and 89% on the right). In conclusion, the Gantzer’s muscle is relatively common in our population, exhibits marked population variations and as such should be taken into account especially during surgical approach to the anterior elbow to avoid its inadvertent injury.