Browsing by Author "Lazarus, Lelika."

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Anatomic study of the morphologic relationship between the proximal left and right coronary arteries.
(2016) Singh, Sadhna.; Satyapal, Kapil Sewsaran.; Lazarus, Lelika.; Ajayi, Nasirudeen Oladipupo.
Arising from the aorta, the right (RCA) and left (LCA) coronary arteries provide the arterial supply to the heart. An extensive literature review revealed that most studies have either evaluated the morphology of the RCA or the LCA independently. This study aimed to document the relationship between the morphology of the RCA and LCA using coronary angiograms and fetal dissections. In addition, variations such as split or double RCA and absence of the LCA was documented. A review of 500 coronary angiograms and a fetal dissection of 41 heart specimens was conducted. The RCA and LCA were classified according to their branching patterns and arterial dominance. The embryologic relationship between the RCA and the LCA was also documented including their lengths and diameters. The angiographic review showed that the most prevalent branching pattern of the LCA was bifurcation in 65.8%, while trifurcation and quadrifurcation occurred in 20.4% and 1.6%, respectively. The splitting of the RCA and absence of the LCA occurred in 4.2% and 11.8%, respectively. A significant correlation was found between the split RCA and absent LCA showing that the split RCA was more prevalent in the absence of the LCA. The dissection of the fetal heart specimens (age range 13.13 - 26.95 weeks) found that the RCA arose from the right aortic sinus and provided arterial dominance in all the specimens. The LCA was classified into types according to their branching pattern. The bifurcation, trifurcation and quadrifurcation of the LCA occurred in 68.3%, 29.3% and 2.4% of hearts, respectively. The mean lengths of the RCA and LCA were 0.98 ± 0.54mm and 1.83 ± 0.77mm, respectively. The mean diameters of the RCA and LCA were 0.38 ± 0.12mm and 0.49 ± 0.17mm, respectively. A significant correlation was found between the RCA and LCA length and the fetal age indicating changes in the development of the coronary vasculature with fetal development. A knowledge of the distribution of the RCA and LCA assists in providing information on the area of the myocardium supplied. With the advent of coronary angiography, a comprehensive understanding of coronary arterial anatomy and their variations is necessary.
Anatomical classification of Tessier craniofacial clefts number 3 and number 4 in a South African population.
(2019) Omodan, Abiola Olugbenga.; Madaree, Anil.; Lazarus, Lelika.; Pillay, Pamela.; Satyapal, Kapil Sewsaran.
The craniofacial clefts are rare defects of the face with an incidence of 1.43 to 4.85 per 100,000 live births. In 2016, WHO reported a death rate of 303,000 new-borns before 4 weeks of age due to congenital anomalies of which craniofacial clefts are one. Surviving the defect is associated with long term disabilities which impacts the individual, families, the healthcare system and society. How much we know about these clefts is seriously hampered by the rarity and the variations of these defects, so much so, that its treatment and communication amongst researchers is affected. The understanding of the skeletal defects occurring in the clefts has long been postulated as a key to any successive reconstruction of the face. This study aimed to reveal the extent of our understanding of these clefts, document the anatomical basis for the craniofacial cleft number 3 and number 4 and generating a sub-classification based on this and also document the clinical presentation as well as associated clefts of these craniofacial clefts in our select South African population. The methods used to achieve these included conducting a scoping review of the literature on patients with Tessier cleft number 3 and number 4 using relevant identified studies from 1976 sourced from PubMed, Medline, EBSCOhost, Google Scholar and the Cochrane libraries. The result of the study was reported using the Preferred Reporting Items for Systematic and Meta-analyses (PRISMA). Likewise, CT scans of patients who had been treated for Tessier clefts number 3 and 4 at Inkosi Albert Luthuli Central Hospital in Durban South Africa between 2003 and 2017 were analysed. Measurements of the expected defects in each cleft were taken and compared with the unaffected side as reference points. Emerging patterns of their analysis were then used to generate a sub-classification for these clefts. Lastly the records of 8 patients who had been treated for either Tessier cleft number 3 or number 4 were reviewed and compared with 9 studies sourced from the literature. In addition to the defects recorded, associated clefts and other congenital malformations were also documented, and findings were compared. The scoping review had 33 studies that met the inclusion criteria. The majority were conducted in middle income countries (54.5%) while none were recorded in low income countries. Only 12.1% of the included studies reported on anthropometry. In understanding the skeletal defects, the presence of an alveolar cleft, the emerging patterns of comparison of the measurements of the maxilla and the orbits of the cleft side and the non-cleft side as well as absence of the bone were used to arrive at a sub-classification system using (a), (b). (c), (M+ O+), (M- O-), and (0). Clinical presentation of the patients who had been treated as cases of Tessier cleft number 3 and number 4 were compared to the reviewed literature and the different parameters were documented. In addition, associated clefts were also recorded, and this study found that the association pattern noted for Tessier cleft number 4 did not conform to its traditional counterpart. In conclusion, this study found that the knowledge of Tessier clefts number 3 and number 4 exist albeit not fully documented. Also, the study proposed a sub-classification for Tessier clefts number 3 and number 4 that will allow physicians to anticipate the extent and form of skeletal defect present before even seeing the patient. Lastly, it was concluded that however variable these clefts appear; they have a similar presentation worldwide and also that associated clefts do not conform to the original Tessier classification system.
An anatomical exploration of the extracranial (V1-V3) and intracranial (V4) components of the vertebral arteries in a select KwaZulu-Natal population.
(2021) Omotoso, Bukola Rukayat.; Lazarus, Lelika.; Satyapal, Kapil Sewsaran.; Harrichandparsad, Rohen.
The risk of injury to the vertebral artery is a significant complication of surgery. The presence of anatomical variation in the course of the vertebral artery increases the likelihood of injury. Due to inadequate understanding of the presence and location of anatomical variations in the morphology and morphometry, the vertebral artery can be injured during surgical intervention. Apart from the vascular injury that can occur during surgical intervention, anatomical variations have implications for some pathologies in the posterior circulation territory. These include aneurysm formation, cerebrovascular disorders, posterior circulatory stroke, and some neurovascular problems. In this retrospective observational study, we investigated the anatomical features of the extracranial (V1-V3) and intracranial (V4) components of the vertebral arteries in a South African population. The study is an observational, retrospective chart review of 554 consecutive South African patients (Black, Indian, and White) who had undergone computed tomography angiography (CTA) at Lenmed Ethekwini Hospital and Heart Centre, Durban, South Africa, from January 2009 to September 2019. The vertebral artery exhibited various morphological variations in its course. We report the incidence of variant origin of the left vertebral artery (6.9%). The level of entry into the transverse foramen ranged between C7-C3. We report the incidence of vertebral artery tortuosity at V1, V2: 76.6%, and 32.1%, respectively. We observed fenestration at V3 (0.18%) and V4 (0.4%) segments. We registered the incidence of the persistent first intersegmental artery (1.1%), extradural PICA origin (2.8%), atresia (6.7%), and hypoplastic terminal vertebral artery (13.2%). Average length and diameter at each vertebral artery segment were registered; we also report on hypoplasia of the vertebral artery. Anatomical variations of the vertebral artery are common in the South African population studied in the present study. Imaging of the complete segments of the vertebral artery from the origin to the point of convergence to form the basilar artery may be necessary to decide a treatment strategy for interventions in the vicinity of the vertebral artery. Understanding the patterns of anatomical variations of the vertebral arteries will contribute significantly to the diagnosis of various diseases in the posterior circulatory territory. The average diameter was significantly larger on the left in all the racial groups, but there were no significant gender differences. We registered a left dominance pattern in all the segments (V1-V4). Iqoqa Ingozi yokulimala emithanjeni yomgogodla iyinkinga enzima kakhulu yokuhlinzwa. Ukuba khona kokwehlukahlukana kokwakheka komzimba ekuhambeni komthambo womgogodla kwandisa amathuba okulimala. Ngenxa yokuqonda okunganele kokukhona kanye nendawo yokwehlukahlukana kwesakhikwo somzimba ekwakhekeni nokulinganisa umumo, umthambo womgogodla ungalimala ngesikhathi sokuhlinzwa. Ngaphandle kokulimala kwemithambo yegazi okungenzeka ngesikhathi sokuhlinzwa, ukuhlukahlukana kwemithamdo yomgogodla kunomthelela ngezinye izimbangela ngokuthola umsuka wesifo ngokuhamba kwegazi emigudwini. Lokhu kubandakanya ukwakheka kokuvuvukala komthambo, ukuphazamiseka kokuhamba kwegazi engqondweni, ukushaywa yisifo sohlangothi, nezinye izinkinga ngezinzwa nemithambo. Kulolu cwaningo lokubheka ngokuqhathanisa abanesifo nabangenaso, sibheke ukwakheka komzimba kwamathambo ekhanda ngaphandle (V1-V3) kanye nokwakheka kwawo ngaphakathi (V4) nezingxenye zemithambo yomgogodla emphakathini waseNingizimu Afrikha. Ucwaningo lungukuzibonela ngqo, ukuqhathanisa ngokubuyekeza amashadi eziguli zaseNingizimu Afrikha angama-554 ngokulandelana (abaNsundu, amaNdiya, nabaMhlophe) abafakwe emshinini bahlolwa wonke umzimba ngekhompuyutha ukubona okusemithanjeni (isibonathambomzimba) (CTA) esibhedlela i-Lenmed Ethekwini neSikhungo seNhliziyo, eThekwini, eNingizimu Afrikha, kusukela kuMasingana wowezi-2009 kuya kuMandulo wowezi-2019. Umthambo womgogodla ukhombisa ukwehlukahluka kwesakhiwo ekuthubelezeni kwawo. Sibika isehlakalo semvelaphi esehlukile somthambo womgogodla kwesokunxele (6.9%). Izinga lokungena esikhaleni esiphakathi komthambo womgogodla laliphakathi kwe-C7 ne-C3. Sibika isehlakalo esihambisana nokuguga komthambo womgogodla nomfutho wegazi okulinganiselwa phakathi kuka-V1, V2: 76.6% no-32.1%, ngokulandelana. Sibone ukuhlinzwa kwesakhiwo sendlebe ngaphakathi kwezingxenye ezingu-V3 (0.18%) nezingu-V4 (0.4%). Sabhalisa izehlakalo zomthambo wokuqala ngezingxenye ezilokhu zikhona ngo-1.1%, imvelaphi ye-PICA yamathambo ekhanda (2.8%), isicubu esingenayo embotsheni ngokwemvelo (6.7%), nokungakhuli kwesitho ngokuphelele (13.2%). Isilinganiso sobude nobubanzi engxenyeni ngayinye yomthambo womgogodla yabhaliswa; siphinde sibike ngokungasebenzi ngokwejwayelekile komthambo womgogoda. Ukwehlukahlukana kokwakheka komthambo womgogodla kuvamile kubantu baseNingizimu Afrikha ocwaningweni lwamanje. Ukufanekisa kwezingxenye eziphelele zomthambo womgogodla lapho zihlangana khona ukwenza umthambo ophakathi nendawo ekhanda kungadingakala ukunquma ngamasu okwelapha ngokungenelela endaweni eseduze nomthambo womgogodla. Ukuqonda ukuphiceka kwesakhiwo esahlukahlukene semithambo yomgogodla kuzodlala indima ebalulekile ekuhlonzeni izifo ezahlukahlukene ekuhlinzekweni kokuhamba kwegazi. Isilinganiso sobubanzi besisikhulu kakhulu kwesokunxele kuwo wonke amaqembu ezinhlanga, kodwa kwakungekho mehluko obalulekile phakathi kobulili. Sibhalise indlelakwenza ebihamba phambili kuzo zonke izingxenye ebe ngu-V1-V4.
An anatomical investigation of intracranial meningiomas.
(2021) Anirudh, Ezra Earl.; Lazarus, Lelika.; Harrichandparsad, Rohen.
Meningiomas are generally benign, highly vascularised, slow-growing tumours arising from the arachnoid cap cells of the arachnoid villi. The clinical presentation of these tumours is usually location dependant due to the vast expanse covered by the meninges. Resection of a meningioma is generally performed after preoperative embolisation. A feeder vessel is selected and embolised in an attempt to reduce excessive blood loss and postoperative complications. However, embolisation requires a sound knowledge of the vasculature of the meninges since these vessels supply portions of the cranial nerves. Literature consulted have investigated anatomical features of meningioma’s; however, there is a scarcity of studies investigating patients specifically referred for preoperative embolisation. Therefore, this study aimed to investigate the anatomical features, namely the location, histology, volume and vascularity of intracranial meningiomas referred for preoperative embolisation. This entailed using Magnetic resonance imaging (MRI), Digital subtraction angiography (DSA), and the histological reports obtained from the data bank at the central regional hospital in Durban, South Africa. A retrospective chart review yielded 103 patients that met the inclusion criteria, of which 98 patients (subset 1) presented with a single meningioma and 5 patients (subset 2) presented with multiple meningiomas. The average age of patients (at the time of diagnosis) was reported within the 40–49-year group and primarily within the female population (subset 1: 67.3%; subset 2: 80%). The benign grade of meningiomas was reported as the most common (70.4%), of which the meningothelial subtype (48%) was predominant. Meningiomas were mostly observed within the supratentorial region (subset 1: 57.2%; subset 2: 91.7%) with almost equal incidences in subset 1 and a majority on the right side in subset 2. Regarding tumour volume, subset 1 revealed the largest meningiomas within the supratentorial region (90.9 cm3), and subset 2 revealed an average tumour volume of 43.9 cm3. In terms of meningioma vascularity, within the supratentorial region, the external carotid arteries were noted to be a common primary feeder vessel, for the skull base region the primary arterial supply is the internal carotid artery. This study provides insight into the anatomical basis of intracranial meningiomas within a select South African population as it has introduced a novel methodology of meningioma vascularity. This may assist endovascular surgeons in assessing the feeder vessel contributions of meningiomas and understand the prevalence of these anatomical parameters in this population.
An anatomical investigation of the sympathetic and parasympathetic contributions to the cardiac plexus.
(2011) De Gama, Brenda Zola.; Satyapal, Kapil Sewsaran.; Partab, Pravesh.; Lazarus, Lelika.
The cardiac plexus is “formed by mixed autonomic nerves” that are “described in terms of superficial and deep components, with the superficial located below the aortic arch and anterior to the right pulmonary artery, and the deep located anterior to the tracheal bifurcation (above the division of the pulmonary trunk) and posterior to the aortic arch” (Standring et al., 2008). This investigation aims to review and update the medial cardiac contributions of the cervical and thoracic sympathetic chains to the cardiac plexus and also the contributions from the vagus nerve and its counterpart, the recurrent laryngeal nerve. This study involved the macro and micro-dissection of 100 cadaveric sides of adult and fetal material. The number of ganglia in a cervical sympathetic chain varied from 2 to 5 in this study. This study confirms previous reports on the location of the two components of the cardiac plexus. The origin of the sympathetic contributions to the cardiac plexus in this study were either ganglionic, interganglionic or from both the ganglion and interganglionic chain of the respective ganglia. The superior cervical cardiac nerve had an incidence of 92% while the middle cervical cardiac nerve had an incidence of 65% in the specimens studied. This study also records a vertebral cardiac nerve that arose from the vertebral ganglion in 39% of the cases. The inferior cervical and cervicothoracic cardiac nerves had incidences of 21%, respectively. This investigation records the thoracic caudal limit of the sympathetic contributions to the cardiac plexus as the T₅ ganglion. The findings in this study indicate the importance of understanding the medial sympathetic contributions and their variations to the cardiac plexus as this may assist surgeons during minimal surgical procedures, sympathectomies, pericardiectomies and in the management of diseases like Reynaud’s Phenomenon and angina pectoris (Kalsey et al., 2000; Zhang et al., 2009).
Anterior synostotic plagiocephaly: a quantitative analysis of craniofacial features using computed tomography.
(2021) Mohan, Nivana.; Lazarus, Lelika.; Madaree, Anil.; Harrichandparsad, Rohen.
Anterior synostotic plagiocephaly (ASP) is caused by the premature fusion of one coronal suture, which results in severe craniofacial asymmetry that can be challenging to correct. The various methods of the surgical procedures, as well as the distinctive facial characteristics of ASP, have been well documented. However, there is a paucity of literature pertaining to the quantitative analysis of the craniofacial features that are affected in ASP. This study used preoperative computed tomography (CT) scans to document and compare the morphometry of the anterior cranial fossa (ACF), orbit, and ear on the ipsilateral (synostotic) and contralateral (non-synostotic) sides in a select South African population of patients diagnosed with ASP. The dimensions of the ACF, orbit and the position of the ear on the ipsilateral and contralateral sides were measured using a set of anatomical landmarks on two-dimensional (2D) CT scans of 18 consecutive patients diagnosed with non-syndromic ASP. The differences between the ipsilateral and contralateral sides were computed and expressed as a percentage of the contralateral side. The findings of this study revealed that there was side-to-side asymmetry in the ACF, orbit, and ear. All ACF parameters decreased significantly (t-test; p<0.001) on the ipsilateral side when compared to the contralateral side, resulting in the volume of the ACF being the most affected (-27.7%). In terms of the orbit, on the ipsilateral side, the length-infraorbital rim (IOR), height, and surface area parameters increased significantly (t-test; p<0.001), with the height being the most affected (24.6%). The remaining orbital parameters (length-supraorbital rim (SOR), breadth and volume) decreased significantly (t-test; p<0.001), with the length-SOR parameter being the most affected (-10.8%). Furthermore, the ipsilateral SOR was noted to be displaced more cranially by an average of 3.89mm from the contralateral SOR. With regards to the position of the ipsilateral ear, it was found to be displaced anteriorly (9.33mm) and caudally (5.87mm) from the contralateral ear. This study augments the existing literature by providing actual values to corroborate the hallmark characteristics of ASP. These measures may help surgeons plan the technique and extent of surgical correction of the affected craniofacial structures during corrective surgery as it will provide them with an indication of the extent of the deformity on the ipsilateral side as compared to the contralateral side. The results of this study have the potential to propose a grading system in ASP patients according to severity of the condition if the sample size is increased.
An anthropometric evaluation of the glenohumeral joint in a South African population.
(2018) Khan, Raeesa.; Satyapal, Kapil Sewsaran.; Lazarus, Lelika.; Naidoo, N.
The glenohumeral joint (GHJ), the most mobile yet unstable joint in the body, is comprised of a large humeral head which fits into the relatively smaller socket formed by the glenoid fossa. While this articulation allows for a wide range of motion, it predisposes the shoulder to injury. There is a paucity of literature on the biomechanics of the GHJ in the South African population. The aim of the study was to evaluate the anthropometric parameters of the GHJ, with emphasis on the coracoid process, glenoid fossa, bicipital groove (BG), long head of the biceps brachii tendon (LHBBT) and the transverse humeral ligament (THL). This study comprised of two subsets (n = 404), viz. (i) anthropometric evaluation of the scapula and proximal humerus [n=324: Scapula – Right (R): 80, Left (L): 84; Male (M): 68, Female (F): 96; Humerii – (R): 80, (L): 80; (M): 68, (F): 96] and (ii) cadaveric dissection of the LHBBT and THL [n=80: (R): 40, (L): 40; (M): 44, (F): 36], both of which focused on morphological and morphometric parameters. Results (i) (a) Shape of glenoid fossa = Type 1 (inverted comma): (R): 16.47%, (L): 10.98%; (M): 20.12%, (F): 7.32%; Type 2 (pear): (R): 14.02%, (L): 15.24%; (M): 18.29%, (F): 10.98%; Type 3 (oval) : (R): 18.29%, (L): 25.00%; (M): 27.44%, (F): 15.85%. (b) Notch type of glenoid fossa: Type 1 (without a notch): (R): 1.83%, (L): 7.32%; (M): 6.71%, (F): 2.44%; Type 2 (with one notch): (R): 46.95%, (L): 43.90%; (M): 59.15%, (F): 31.70%. (c) Mean parameters of coracoid process (mm): Length (CL): (R): 41.74±4.74, (L): 41.50±4.87; (M): 42.07±4.73, (F): 40.74±4.84; Width (CW): (R): 13.27±1.89, (L): 14.18±11.90; (M): 13.05±1.90, (F): 15.07±14.49. (d) Mean parameters of glenoid fossa (mm): Horizontal diameter 1 (HD1): (R): 18.40±3.27, (L): 17.51±2.87; (M): 18.23±3.29, (F): 17.38±2.60; Horizontal diameter 2 (HD2): (R): 24.45±2.88, (L): 23.64±2.63; (M): 24.22±2.74, (F): 23.68±2.83; Vertical diameter (VD): (R): 35.23±3.10, (L): 34.88±3.03; (M): 35.26±3.18, (F): 34.64±2.79. (e) Mean coracoglenoid distance (CGD) (mm): (R): 27.40±8.34, (L): 28.15±3.53; (M): 28.19±7.41, (F): 27.00±3.38 .(f) Mean dimensions of BG (mm): Length: (R): 66.64±9.06, (L): 68.31±11.52; (M): 67.44±9.12, (F): 67.53±12.25; Width: (R): 8.98±1.49, (L): 9.27±1.30; (M): 9.18±1.45, (F): 9.05±1.31; Depth: (R): 7.73±1.31, (L): 7.20±1.18; (M): 7.43±1.29, (F): 7.53±1.24. (ii) (a) Mean parameters of the LHBBT (mm): Length: (R): 81.99±21.28, (L): 79.73±17.27; (M): 79.82±19.66, (F): 82.14±19.03; Width: (R): 4.28±1.31, (L): 4.67±1.43; (M): 4.35±1.17, (F): 4.63±1.60. (b) Mean parameters of the THL (mm): Length: (R): 20.91±5.24, (L): 21.19±6.36; (M): 21.52±5.71, (F): 20.48±5.92; Width: (R): 16.65±6.92, (L): 16.63±7.49; (M): 16.83±6.65, (F): 16.40±7.84. In this study, Type 3 (oval) was observed to be most prevalent shape of the glenoid fossa, which corroborated the findings of previous studies. Type 2 (with one notch) was found to be the predominant notch type, differing from the literature reviewed. The mean VD, HD1, HD2, CL and CGD were larger in male individuals, while female individuals presented with larger means of CW. Both BG length and depth were increased on the right side; with the latter yielding a statistically significant difference thus suggesting that an increased depth is a common finding in the right side of individuals. Although the BG length and depth were noted to be greater in female individuals, male individuals presented with larger widths. The mean length and width of the THL were markedly smaller than those reported in previous studies. Any variation from the normal musculoskeletal composition of the GHJ is fundamental to understand rotator cuff disease, tendinitis and shoulder dislocation. This study may provide clinicians and biomechanical engineers with reliable anthropometric reference parameters of the GHJ for the design of prosthesis and may also act as diagnostic tools of degenerative pathology.
Developmental changes of the facial skeleton from birth to 18 years within a South African cohort: a computed tomography study.
(2021) Niemann, Kristen.; Rennie, Carmen Olivia.; Lazarus, Lelika.
Introduction: The facial skeleton or viscerocranium has been recently noted as a method for age estimation as its development is influenced not only by the developing paranasal air sinuses and tooth eruption, but also the individual’s ancestry particularly population specific normative data. This study aimed to investigate the developmental changes of the facial skeleton in males and females from birth to 18 years within the South African population with African ancestry to estimate age. The facial skeleton was assessed according to five regions viz: - orbital, nasal, midfacial, maxillary and mandibular. Methods and materials: A retrospective study which consisted of 239 computed tomography (CT) scans of subadult individuals (0–18 years of age) of African ancestry (128 males; 111 females) was conducted. The scans were obtained from an online server utilised by a private medical facility in the eThekwini Muncipality. The DICOM images were viewed from an online Picture Archiving and Communication Systems server using Infinitt software (version 5.0.1.1) which is the standard software used by the practitioners. Linear parameters in the horizontal, sagittal, and vertical planes assessed the development of the viscerocranial regions. Results: a) Development: Most of the viscerocranial regions experienced a rapid increase in growth between 0–5 years of age viz: orbital (orbital height and width: 0–5 years; lateral orbital wall distance: 0–3.75 years), midfacial (zygomatic arch distance: 0–3.75 years), nasal (aperture height and width: 0–5 years); maxilla (length: 0–3.75 years), mandibular (mandible width: 0–5 years). Thereafter growth continued to increase at a slower rate in the orbital width (0.61–0.8 mm/year in females; 0.56–0.76 mm/year in males), lateral orbital wall distance (1.1 mm/year in females; 1 mm/year in males), zygomatic arch distance (1.6 mm/year in females; 1.8 mm/year in males), nasal aperture width (0.45 mm/year in females; 0.4 mm/year in males) and height (0.63 mm/year in females; 0.77 mm/year in males), maxillary length (0.7 mm/year in females; 0.81 mm/year in males), mandible width (1.1 mm/year in females; 1.5 mm/year in males) and mandible head widths (right: 0.42 mm/year in females, 0.49 mm/year in males; left: 0.52 mm/year in females, 0.68 mm/year in males). Additionally, in the orbital region, the orbital width underwent two periods of rapid growth i.e., 0–5 and 10–18 years of age, whilst the anterior interorbital distance noted no significant increase after 7.5 years of age. xiv b) Sexual dimorphism: Males displayed overall larger measurements than females in all the parameters, except for the anterior interorbital distance and the zygomatic arch lengths (ZAL) on the right and left, as females displayed larger measurements. Although these differences were not statistically significant (p>0.05). The only measurements which displayed statistically significant differences between males and females were the left orbital height (p = 0.048), nasal aperture height (p = 0.048) and the mandible width (p = 0.05), in which males displayed larger measurements than females. c) Age estimation: The measurements which displayed the strongest correlation to age were the ZAD (r = 0.8842, p<0.001), ZAL (right: r = 0.8929, p<0.001; left: r = 0.8656, p<0.001) and the mandible width (r = 0.8444, p<0.001). Formulas were derived for the measurements which could be used to estimate age. Discussion and conclusion: The findings from this study have outlined the development of the viscerocranium in subadult individuals with African ancestry. This study discussed the correlation between the development patterns of each viscerocranial region with age. The data from this study can be a useful addition to the existing data on the skeletal developments of subadult South African individuals. Forensically the development of formulas for subadult individuals could be utilised in the age estimation of skeletal remains.
The praxis and research of human anatomy through autoethnography.
(2016) Lazarus, Lelika.; Satyapal, Kapil Sewsaran.; Sookrajh, Reshma.
This thesis is in manuscript format, as per the guidelines of the College of Health Sciences of the University of KwaZulu Natal. It comprises five manuscripts that have been submitted to accredited journals for publication (one manuscript is currently in press and the others are awaiting final status after revisions were completed). The use of autoethnography as an approach is an emerging transformative field of study within the Health Sciences at Higher Education institutions and is a move away from the key traditional positivist models of research in the domain of anatomical education. This study with praxis and research at the nucleus, aimed to investigate the following: (i) challenges experienced in the teaching and learning of human anatomy; (ii) the views and perceptions of fellow colleagues regarding research in the domain of clinically applied anatomy and how this has impacted on their teaching practices; (iii) the opinions of senior anatomy instructors regarding the state of anatomical knowledge at their respective institutions; (iv) student attitudes and experiences regarding human cadaveric dissection through an analysis of their journal-reflective writings; and (v) the use of mobile devices by learners at a selected medical school. Each of these aims stated above were achieved through the articles which comprised the manuscript of this study. In the first manuscript, Bits, bytes and bones: An Autoethnographic Account of Challenges in Anatomy Education: Perceptions Emanating from a Selected South African University I describe the methodological approach of autoethnography, specifically as it applies to reflection and memory work, and describe how this style enabled me to interrogate the current challenges and dilemmas underpinning the research, teaching and learning practices within this discipline. This was done through the use of an exclusive autoethnographic approach which is a qualitative method of research that seeks to describe and examine personal experience to comprehend cultural practice. The autoethnographic study highlighted challenges experienced, and these included the shortage of cadaveric material for teaching and research, the subsequent implementation of medical software applications, deficiencies in the curriculum and the teaching of anatomy by scientist anatomists. The second manuscript was entitled Communities of Practice: a new methodology in anatomical research and teaching. In this the notion of collaborative autoethnography as a research method is introduced. In this approach, researchers worked in tandem with me to gather autobiographical material to analyse and understand their data collectively with each contributing to an understanding of the sociocultural phenomena. This type of research allowed for in-depth learning about the self and others and fostered collaboration among researchers in this field of applied anatomy. The use of semi-structured interviews with coauthors (n=10) on co-written papers formed the essential method used in generating this article. The collaborative autoethnographic study revealed four important themes namely: the value of research collaboration; the impact of human anatomical variations; the association with medical and non-medical collaborators; and teaching practice emanating from collaborative research. In manuscript 3, Views of South African Academic Instructors regarding the Scholarship of Teaching and Learning in Anatomy Education, a reflective design is presented and it is understood that reflecting on teaching is commonly referred to as an essential practice for personal and professional development. Open-ended questionnaires were distributed to senior anatomy faculty based at the eight national medical schools in South Africa. The emerging argument in this paper is that educational research into the scholarship of teaching and learning anatomy includes engaging in discipline-specific literature on teaching, reflecting on individual pedagogical methods and communicating these findings to peers. In medical education, reflection has been considered to be a core skill in professional ability. Faculty teaching anatomy highlighted several challenges such as time constraints within the medical curriculum, the lack of cadavers to reinforce knowledge and lack of appropriately qualified staff in the delivery of the subject. The anatomy laboratory is an ideal setting for faculty/student interaction and provides important occasions to investigate active learning and reflection on anatomical knowledge. This forms the basis of the Manuscript 4, Reflective Journals: Unmasking student perceptions of anatomical education, in which seventy-five journals from medical and allied Health Science students were collected and analysed. Through the use of journal-reflective writing as a technique, student attitudes and experiences of human cadaveric dissection of anatomy were analysed. Student reflective journals highlighted the following themes which included (a) Dissecting room stressors, (b) Educational value of dissection , (c) Appreciation, Gratitude, Respect & Curiosity for the cadaver , (d) Positive and negative sentiments expressed in the dissecting room , (e) Benefit of alternate teaching modalities, (f) Spirituality/Religious Beliefs, (g) Shared humanity and emotional bonds, (h) Acknowledgement of human anatomical variations, (i) Beauty and complexity of the human body, and (j) Psychological detachment . For the final manuscript which forms this compilation, Anytime, Anywhere’: Tablet technology in Medical education, a questionnaire comprising both open and closed- ended questions was analysed from 179 (60 male; 119 female) second year medical students registered for the Anatomy course to establish the use of mobile devices by learners at a selected medical school. The themes that emerged from m-learning included students’ ideas on mobile device engagement, and propositions related to the advantages and challenges affecting use of mobile devices. The use of autoethnography as a research approach can be considered dissident, and an ‘anatomical turn’ in the praxis and research in the domain of anatomical education. This study highlights relevant contributions to the research, praxis (teaching and learning) of human anatomy through views of all significant role players – students, researchers and educators. The conceptual framework which was abstracted from the articles and the thesis in its entirety, offers significant understandings regarding the praxis and research of human anatomy within the context of educational theory.
Scaphocephaly in a select South African population: a morphometric analysis of the cranial fossae and ventricular access points.
(2021) Bisetty, Vensuya.; Lazarus, Lelika.; Madaree, Anil.; Harrichandparsad, Rohen.
Scaphocephaly is a cranial deformity that results from premature fusion of the sagittal suture and is characterized by an elongated and narrowed skull. Patients with this condition present with varying clinical features including frontal bossing and occipital protrusion. This study comprised two subsets, analysing different aspects related to this cranial deformity. Most morphological and morphometrical studies in patients with scaphocephaly focus on the cranial vault. Literature on the morphometry of the cranial base and its fossae in these patients is sparse. Therefore, the first subset aimed to analyse and compare the morphometry of the cranial fossae in patients with scaphocephaly. Due to varying cranial morphology among patients with these deformities, ventricular access using conventional techniques is often a challenge. Although ventricular access may not be frequently required in paediatric scaphocephalic patients, it is vital that an ideal location of the access points be established for safe ventricular catheterization. Accordingly, the second subset aimed to document the morphometry of Kocher’s and Frazier’s points in scaphocephalic patients using known craniometric and surface anatomical landmarks. Dimensions of the anterior, middle and posterior cranial fossae (ACF, MCF and PCF) were measured using select anatomical landmarks on computed tomography (CT) scans of 24 consecutive patients diagnosed with scaphocephaly between 2014 and 2020, and 14 non-affected/ normal paediatric patients selected as controls. Parameters of Kocher’s and Frazier’s points were measured in relation to known cranial surface anatomical landmarks on scans of the scaphocephalic patients utilized in subset 1. The study found that ACF and PCF are most affected in scaphocephalic patients, with elongation along the anteroposterior (AP) plane (lengths) (ACF, p=0.041 and PCF, p=0.018). Minimal changes were observed in the transverse plane (widths) in scaphocephaly versus non-affected/normal controls. Regarding subset 2, Kocher’s point was located between 91.6mm and 140mm posterior to the nasion, and between 20.5mm and 34.6mm lateral to the midline in patients with scaphocephaly. Frazier’s point was located between 60.9mm and 82.8mm superior to the inion, and 25.9mm and 41.4mm lateral to the midline. Parameters measured in the AP plane were found to be more affected than those measured lateral from the midline. This study contributes to the literature by providing novel morphometric data based on a select South African population. Data obtained could aid craniofacial surgeons in understanding which cranial fossa is most affected in scaphocephaly and to what extent, to decide on the most appropriate method of treatment. Additionally, the study concluded that the traditional landmarks used for ventricular access are relatively unreliable in scaphocephalic patients. This study provides data for neurosurgical consideration regarding ventricular catheterization procedures in patients with scaphocephaly.
Trigonocephaly in a select South African population: A morphometric analysis utilising specific anatomical cranial landmarks.
(2024) Barnes, Courtney; Lazarus, Lelika.; Madaree, Anil.
Trigonocephaly is a congenital abnormality that is caused by the premature fusion of the metopic suture. A triangular shaped forehead, shortening of the anterior cranial fossa (ACF), hypotelorism, narrowing of the bitemporal region, and widening of the occipitoparietal region are some of the cranial and facial deformities that patients with trigonocephaly present with. Literature on the morphometry of the ACF and cranial base is scarce in patients with trigonocephaly; most studies focus on the morphometric changes that occur to the entire cranium rather than the cranial base. Therefore, this study aimed to investigate the morphometric changes that occurred to the ACF and orbits in trigonocephaly patients and to determine whether compensatory growth of the middle and posterior cranial fossae (MCF and PCF) was evident via volumetric assessment. Additionally, the identification of various cranial parameters in order to assess the severity of patients with trigonocephaly remains controversial. Thus, this study also aimed to describe an improved grading system in the assessment of trigonocephaly within a select South African population. Dimensions of the ACF and of the orbits, and volumetric assessment of all three cranial fossae were measured using specific anatomical cranial landmarks on preoperative computed tomography (CT) scans of 15 patients with a radiographic confirmed diagnosis of non-syndromic, isolated trigonocephaly between 2012 and 2023, and eight non-affected age-matched pediatric patients were selected as the control group. ACF dimensions in younger and trigonocephaly patients who were classified as severe, were observed to be larger compared to control patients, whilst in older and trigonocephaly patients who were classified as severe, ACF dimensions were observed to be smaller compared to control patients. MCF volume showed significance (p=0.050), whilst ACF and PCF volumes, respectively showed no significance (p=0.170 and p=0.821) when trigonocephaly patients were compared to controls. Additionally, maximum compensatory growth occurred in the PCF compared to the MCF in trigonocephaly patients. The overall dimensions of the orbit showed no significance between trigonocephaly and control patients. However, significant findings were observed in the correlation analysis between the interorbital distance and other orbital parameters and ACF angles when trigonocephaly patients were compared to control patients. Furthermore, more complex orbital morphologies were observed in trigonocephaly patients in younger age groups, compared to less complex orbital morphologies which were observed in older age groups. This study provides novel morphometric and morphological data within a specific South African population. The data obtained could further assist craniofacial surgeons by providing a relationship between the degree of severity and choice of surgical intervention. Additionally, the orbital data obtained could indicate to surgeons the morphological changes that occur in the orbits, and provide an insight into the evolution of the deformity in pediatric patients with trigonocephaly in order to obtain as near to normal orbital features.