Ponticulus posticus: Another variant present in a recently published case

D’Antoni, Anthony V.

doi:10.1002/ca.20922

Cited by 3 publications

(2 citation statements)

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“…Segment V3, found in the suboccipital triangle, courses posteromedially around the lateral mass and lies in a groove on the posterior arch of the atlas, eventually traveling beneath the posterior atlanto-occipital membrane (Standring, 2008). Occasionally, this part of the vertebral artery may traverse an arcuate foramen (Tubbs et al, 2007a) formed by a bony bridge called the ponticulus posticus (D'Antoni, 2010;Kimmerle, 1930). Intracranially, segment V4 courses from its entrance into the dura mater to its union with the opposing vertebral artery to form the basilar artery (Standring, 2008;Tubbs et al, 2007b).…”

Section: Introductionmentioning

confidence: 98%

Anatomic study of the suboccipital artery of Salmon with surgical significance

D’Antoni¹,

Battaglia²,

DiLandro³

et al. 2010

Clinical Anatomy

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The anatomy of the muscular branches of the vertebral arteries has clinical relevance during surgical procedures, suboccipital injections, and manual therapies. Each vertebral artery is divided into four segments. Segment V3, found in the suboccipital triangle, courses posteromedially around the lateral mass to lie in a groove on the posterior arch of the atlas, ultimately coursing beneath the posterior atlanto-occipital membrane to enter the skull. Although not always present, any muscular branch that emanates from this segment to supply the suboccipital muscles is called the suboccipital artery of Salmon. There is a paucity of literature on this artery despite its clinical relevancy. We found the suboccipital artery of Salmon in 10 (67%) of 15 embalmed adult cadavers. This frequency is considerably higher than that in previous reports. Two (20%) of the 10 cadavers demonstrated bilateral and symmetrical suboccipital arteries of Salmon (one artery on each side). Four (40%) of the 10 cadavers had an arrangement of two parallel suboccipital arteries of Salmon on one side, and one on the contralateral side. Three (30%) of the 10 cadavers displayed an asymmetrical unilateral arrangement (only one artery). One (10%) of the 10 cadavers displayed the unique arrangement of three arteries of Salmon on one side and one artery on the contralateral side. This study adds to a limited, but growing, body of knowledge by providing photographic evidence of the course and arrangement of these arteries and, therefore, can be of value to surgeons and other clinicians whose procedures focus on the suboccipital region.

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Section: Introductionmentioning

confidence: 98%

Anatomic study of the suboccipital artery of Salmon with surgical significance

D’Antoni¹,

Battaglia²,

DiLandro³

et al. 2010

Clinical Anatomy

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“…From the anatomical point of view, there is an interesting correlation between the presence of elongated styloid process and a congenital anomaly of the first vertebra (atlas) known as ponticulus posticus [ 28 ]. Ponticulus posticus (or Kimmerle anomaly) is defined as an abnormal small bony bridge formed between the posterior portion of the superior articular process and the posterolateral portion of the superior margin of the posterior arch of the atlas, which encircles the vertebral artery [ 29 ]. The existence of these two congenital anomalies in one patient may be a mere coincidence or the result of simultaneous ossification of the stylohyoid ligament and posterior atlanto-occipital membrane during development [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

The Syndrome of Elongated Styloid Process, the Eagle’s Syndrome—From Anatomical, Evolutionary and Embryological Backgrounds to 3D Printing and Personalized Surgery Planning. Report of Five Cases

et al. 2020

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Background and Objectives: The symptoms of Eagle’s syndrome are associated with the elongated styloid process of the temporal bone or calcification of the stylohyoid ligament. The first mention of pain syndrome associated with the elongated styloid process dates back to 1937, when it was described by Watt Weems Eagle. Over the last decade, experts in the field have shown a lively interest in the issue of the relationship between the elongated styloid process and various symptoms. This article presents the correlation between the clinical signs of Eagle’s syndrome and alterations in surrounding anatomical structures. It includes a brief review of the evolutionary, embryological and clinical anatomical background of the elongated styloid process. Materials and Methods: Between 2018 and 2019, five patients were admitted to our workplace with 1–3-year history of bilateral or unilateral throat pain, otalgia and pharyngeal foreign body sensation. As a therapeutic novelty in the surgical approach to this condition, we used individual 3D printed models to measure and identify the exact location of the resection of the styloid process without damaging the surrounding anatomical structures, such as the facial, accessory, hypoglossal, and vagal nerves; the internal jugular vein; and the internal carotid artery. Results: Compared to traditional surgical methods without 3D models, 3D models helped to better identify cutting edges and major landmarks used in surgical treatment of Eagle’s syndrome. Printed models provided assistance with the exact location of the styloid process resection position without damaging the surrounding anatomical structures such as the facial, accessory, hypoglossal, and vagal nerves; the internal jugular vein; and the internal carotid artery. Conclusion: In our clinical report, we used 3D printed models for navigation and planning during surgical procedures involving resections of the elongated styloid process. Additionally, we can formulate a new hypothesis: the elongated styloid process is a form of atavism of the bony hyoid apparatus in our evolutionary ancestors that is evolutionarily encoded or arises from disrupted degeneration of the middle portion of embryonal Reichert´s cartilage of the second pharyngeal arch. Under normal conditions, this portion does not ossify but degenerates and transforms into a connective tissue band, the future stylohyoid ligament.

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