The organization of the human hypothalamus was studied in 33 brains aged from 9 weeks of gestation (w.g.) to newborn, using immunohistochemistry for parvalbumin, calbindin, calretinin, neuropeptide Y, neurophysin, growth-associated protein (GAP)-43, synaptophysin, and the glycoconjugate 3-fucosyl- N-acetyl-lactosamine. Developmental stages are described in relation to obstetric trimesters. The first trimester (morphogenetic periods 9-10 w.g. and 11-14 w.g.) is characterized by differentiating structures of the lateral hypothalamic zone, which give rise to the lateral hypothalamus (LH) and posterior hypothalamus. The PeF differentiates at 18 w.g. from LH neurons, which remain anchored in the perifornical position, whereas most of the LH cells are displaced laterally. A transient supramamillary nucleus was apparent at 14 w.g. but not after 16 w.g. As the ventromedial nucleus differentiated at 13-16 w.g., three principal parts, the ventrolateral part, the dorsomedial part, and the shell, were revealed by distribution of calbindin, calretinin, and GAP43 immunoreactivity. The second trimester (morphogenetic periods 15-17 w.g., 18-23 w.g., and 24-33 w.g.) is characterized by differentiation of the hypothalamic core, in which calbindin- positive neurons revealed the medial preoptic nucleus at 16 w.g. abutted laterally by the intermediate nucleus. The dorsomedial nucleus was clearly defined at 10 w.g. and consisted of compact and diffuse parts, an organization that was lost after 15 w.g. Differentiation of the medial mamillary body into lateral and medial was seen at 13-16 w.g. Late second trimester was marked by differentiation of periventricular zone structures, including suprachiasmatic, arcuate, and paraventricular nuclei. The subnuclear differentiation of these nuclei extends into the third trimester. The use of chemoarchitecture in the human fetus permitted the identification of interspecies nuclei homologies, which otherwise remain concealed in the cytoarchitecture.

PurposeRetrograde parotidectomy is employed in situations where tumors or scar tissue obscure the facial nerve trunk, making anterograde parotidectomy hazardous. Hence, the reliability of anatomical landmarks in retrograde parotidectomy is of equal practical importance.MethodsDistances from soft tissue and osseous landmarks to the corresponding peripheral branches of the facial nerve were measured in 41 half-head specimens. The distances were from: i) the zygomatic arch (Z) to the buccal branch (B); ii) the retromandibular vein (RMV) to the marginal mandibular branch (MM); and iii) the angle of the mandible (A) to MM. These distances were compared in left vs, right sides, male vs. female groups, occlusal vs. nonocclusal sides.ResultsNo statistically significant differences were found in any of the three distances between all groups compared, amongst which, the mean distances from A to MM were the shortest and least variable (Male = 8.9 ± 3.0 mm vs. Female = 6.8 ± 3.5 mm; Left = 7.3 ± 2.8 mm vs. Right = 8.8 ± 3.9 mm; Occlusal = 8.6 ± 3.5 mm vs. Nonocclusal = 7.8 ± 3.4 mm).ConclusionThe findings indicate that all three landmarks are useful for surgeons to locate the facial nerve branches during retrograde parotidectomy. Since all three landmarks were consistent indicators for the corresponding facial nerve branches, the surgeon has more than one option should one landmark be obscured by tumors. The optimal landmark is the distance from A to MM because it is shortest and most reliable, followed by RMV to MM, and Z to B.

Purpose: : Anterograde identification of facial nerve trunk (FNT) identification is paramount, because FNT injury causes substantial morbidity. This study reexamines controversial landmarks and considers the importance of gender and dentition in landmark choice. Methods: Distances from key landmarks to FNT were measured and compared by side, gender and dentition (92 specimens). Landmarks included posterior belly of digastric muscle (PBM), tragal pointer (TP), mastoid process (MP), external acoustic meatus (EAM) and transverse process of axis (TPA). Results: Two-sample T tests showing longer distances from: MP/TPA to FNT in men than in women (14.8 ± 2.2 mm vs. 13.5 ± 1.6 mm, P = 0.004; 37.6 ± 4.4 mm vs. 32.7 ± 4.2 mm, P = 0.001); EAM to FNT on occlusal sides than on the counterparts (14.2 ± 1.8 mm vs. 16.0 ± 3.8 mm, P = 0.020). One-sample T tests showing longer distances from: TP to FNT on right than on left side (21.4 ± 2.7 vs. 19.9 ± 2.9, P = 0.006); MP to FNT on the less dentulous maxillae than on the counterpart (14.4 ± 2.1 vs. 13.0 ± 1.6, P = 0.027); PBM/EAM to FNT on the less dentulous mandible than on the counterpart (9.8 ± 1.6 vs. 7.8 ± 2.5, P = 0.039; 16.4 ± 3.0 vs. 14.1 ± 1.5, P = 0.020). Conclusion: Surgeons should be aware that distances of MP, PBM and EAM, to FNT, are lengthened in less dentulous patients, especially when maxilla and mandibles are non-occlusive. Overall, soft landmarks are less reliable than osseous landmarks. Highlights: