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This study aimed to clarify the morphologic variations of the Martin-Gruber anastomosis (MGA) by tracing the anastomotic fascicles. We used 102 upper limbs, and MGA was found in 39.2%. Among 12 instances of MGA between the branches innervating the flexor digitorum profundus muscle, eight anastomotic branches solely innervated the muscle without crossover from median to ulnar nerve. The results of the present study showed three morphologic features of MGA that could not be detected by an electrodiagnostic method.

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We made a thorough observation of the morphology and course of the lingual nerve (LN) and inferior alveolar nerve (IAN) to clarify their topographical relationships in the infratemporal fossa and in the paralingual area. Thirty-two Korean hemi-sectioned heads were dissected macroscopically and microscopically from a clinical viewpoint. On the 32 tracings on the radiograph, the average distance between the retromolar portion and the LN was 7.8 mm, and no case was found where the LN ran above the alveolar crest as passing along the mandibular lingual plate. The bifurcation of the LN and IAN was located around the mandibular notch, inferior to the otic ganglion in 66% of the cases, and a plexiform branching pattern of the mandibular nerve was observed in only two cases. The bifurcation spot of the LN and IAN was located 14.3 mm inferior to the foramen ovale and 16.5 mm superior to the tip of hamulus. Collateral nerve twigs from the LN to the retromolar area were observed in 26 cases (81.2%), with an average of one nerve twig. We observed four types of variations in terms of communication pattern. In four specimens, the mylohyoid nerve passed through the mylohyoid muscle and connected with the LN. In other four specimens, the IAN communicated with the auriculotemporal nerve. We also observed another type of variational communication between the IAN and the nerve to the lateral pterygoid (LPt); this was observed in only one specimen, and it could be predicted that motor innervation from the nerve to the LPt was transmitted via the mental nerve to the depressor anguli oris. Another type was observed where the IAN divided into two branches with the posterior branch being partially entrapped by the LPt muscle fibers.

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Augmentation rhinoplasty of the Asian nose may be effectively accomplished with alloplastic materials. However, certain circumstances mandate the use of autologous grafts (e.g., dorsal augmentation that exceeds 8 mm and patient intolerance of alloplastic implants). Septal and auricular cartilages are inadequate for dorsal augmentation of the Asian nose. The use of costal cartilage for autologous augmentation in select Asian patients has proven to be a reliable method in more than 500 operative cases during a 10-year period. This study was designed to evaluate the ideal costal cartilage graft for augmentation rhinoplasty. Forty-two preserved cadavers were studied for the relationship of the individual rib cartilages to the surrounding tissue and for the length and caliber of each costal cartilage. The seventh rib was found to be the ideal rib graft by virtue of its safe location and overall size for grafting. The seventh rib is situated over the abdominal cavity, so the risk of pneumothorax is insignificant. The internal thoracic artery and vein descend in close apposition behind the first to sixth ribs but begin a course medial to the ribs inferior to this point, and therefore vascular injury during seventh-rib harvesting is unknown. The seventh rib also provides the greatest overall available length (90.7 mm, right; 89.6 mm, left) and thickness (17.6 mm, right; 17.5 mm, left). Despite the more conspicuous location of the incision required to harvest the seventh rib, the limited 3-cm incision that is used has healed favorably in almost all cases. The other major drawback for seventh-rib harvesting is the dissection required through the overlying rectus abdominis muscle, but little technical difficulty or postoperative morbidity is added with muscle dissection. The seventh rib is advocated as the ideal choice for augmentation rhinoplasty and potentially other recipient sites.

This study was designed to investigate the risk of ovarian failure and the pregnancy outcomes in women treated with intravenous cyclophosphamide (IVCYC) pulse therapy for lupus nephritis. Sixty-seven women with proliferative lupus nephritis were studied. The clinical and laboratory data, SLEDAI and damage indices at IVCYC initiation, doses and numbers of IVCYC pulses, pregnancy and fetal outcomes were evaluated. During a follow-up of 74.4+/-20.6 months, amenorrhea occurred in 25 (37.3%) and was sustained permanently in 10 patients (14.9%). Thirteen women became pregnant with a total of 19 pregnancies. Seventeen pregnancies ended without complications and all babies were born healthy without any congenital anomalies or perinatal illnesses. Two pregnancies were terminated by induced abortion but no congenital anomaly was noted in these cases. Logistic regression analysis showed that old age, high damage index at the initiation of IVCYC pulse therapy and high cumulative dosage of IVCYC were the independent risk factors of ovarian failure, and that the presence of amenorrhea, regardless of its duration, was the risk factor of pregnancy failure. Pregnancy was possible with a favorable outcome after the withdrawal of IVCYC pulse therapy, unless amenorrhea develops.