Medical Terminology Daily (MTD) is a blog sponsored by Clinical Anatomy Associates, Inc. as a service to the medical community. We post anatomical, medical or surgical terms, their meaning and usage, as well as biographical notes on anatomists, surgeons, and researchers through the ages. Be warned that some of the images used depict human anatomical specimens.
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William S. Halsted, MD
(1852 – 1922)
American anatomist, teacher, and surgeon, William Stewart Halsted was born in New York City, USA to a wealthy family of English origin. His father was involved in charitable work and Governor and trustee to a city hospital. Not a brilliant student initially, Halsted took an undergraduate in Liberal Arts in Yale, CT., after which he entered the Medical College of Physicians at the Columbia College, where he excelled.
As a second-year medical student Halsted applied and obtained a position in surgery at a local hospital. In here he learned about Lister’s antiseptic technique and became an adamant proponent of it to reduce infection. In 1877 Halsted obtained his MD. After a short time as House Physician at the New York Hospital, Halsted traveled to Europe to further his education studying for two years at the Universities of Vienna, Leipzig, and W?rzburg.
Besides being at the forefront of surgical and antiseptic techniques (introducing the use of rubber gloves in surgery), Halsted was extremely concerned with the way medical students were taught in the US. He pioneered bedside clinical round discussions with the medical students after two years of basic sciences studies. Halsted developed the idea of a patient chart; he also developed the residency program for medical students in use today.
Halsted is probably the most influential researcher and surgeon at the turn of the century. He dedicated time to the study of intestinal anastomoses and the use of silk as a suture material. His experimental work in 1887 proved that the inclusion of the submucosa layer in an anastomosis was mandatory, as well that a single layered anastomosis was enough to attain closure. Perhaps Halsted’s most important contribution was the application and use of the scientific method to surgical questions. Halsted’s principles set the standards used today in surgical suturing and surgical stapling.
He also pioneered the development and surgical techniques for radical mastectomy as a treatment for breast cancer.
As a side effect of this studied in anesthesia and the use of cocaine for anesthesia, Halsted became addicted to this substance, a problem that followed him through the years. Without impairing his capacity as a researcher and a surgeon, Halsted eventually recovered. He died in Baltimore in 1922 as a complication to surgery.
Sources:
1. Dubay, A. D., & Franz, G. M. (2003). Acute Wound Healing: The Biology of Acute Wound Failure. Surg Clin NA, 83, 463-481.
2. Halsted, W. S. (1887). Circular Suture of the Intestine - An Experimental Study. Am J Med Sci, 436-461.
3. “William Stewart Halsted: his life and contributions to surgery” Osborne, P. Lancet Oncol 2007; 8: 256–65
4. “William Stewart Halsted: Surgical pioneer” Burress, P Endoc Today (2010), 8: (2) 22
5. “William Stewart Halsted (1852–1922) Neurological stamp” Haas, LF J Neurol Neurosurg Psych 2000;69:641
Original image courtesy of "Images from the History of Medicine" at www.nih.gov
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The temporal muscle (Lat:Temporalis) is a bilateral muscle located on the side of the head. It belongs to a subgroup of head muscles called Masticatory Muscles, named after their function elevating the mandible to produce the mandible movements (1,2). Masticatory muscles are four per side: Temporalis, Masseter, Pterygoideus medialis and Pterygoideus lateralis (1,2).
The temporalis muscle is a fan-shaped muscle which occupies the temporal fossa from which its fascicles (fibers) converge to the coronoid process of the mandible. Classic description for this muscle recognizes three main muscular bodies (anterior, midle, and posterior) originated from the temporal fossa up to the lower temporalis line and the temporalis fascia, fascicles which descend through the inner part de the zygomatic arch converging to be inserted on the coronoid process of the mandible, its temporalis crest and anterior margin of the mandibular branch through thick tendons (1,2).
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In 1996 Dunn et al. (3) reported the discovery of a so far unknown masticatory muscle called the “sphenomandibularis”, originated from the greater wing of the sphenoid bone medial to the temporalis muscle and descends on an oblique (lateral and slightly posterior) fashion reaching distally the coronoid process of the mandible. This muscular portion has been recognized as the “deep belly of the temporalis muscle” and has been described by several authors since then (4,5,6,8). The importance that has been given to this particular bundle lies on the fact that its medial insertion can reach a close relationship to the foramen rotundum, place of emergency from the cranium of the maxillary nerve, which has been hypothesized, could lead to eventual alteration of this nerve if it got trapped by this part of the muscle (6, 7).
The temporalis muscle receives innervation fundamentally from branches of the mandibular nerve: Deep temporal nerve (N. temporalis profundus)through its anterior middle and posterior branches.
The temporalis muscle is covered by a thick fascia layer: the temporalis fascia.
Article written by: Maria F. Cortés, DDS, MSc.
Images from:
Fig 1. Public domain, by Henry Vandyke Carter, MD - Gray's Anatomy, 1918
Fig 2. Geers C, Nyssen-Behets C, Cosnard G, Lengelé B. The deep belly of the temporalis muscle: an anatomical, histological and MRI study. Surg Radiol Anat. 2005 Aug;27(3):184-91. Epub 2005 Apr 9
Sources:
1. “Anatomía humana” V.2. Latarjet- Ruiz Liard, 4ª ed. 6ª reimp. 2008 Médica Panamericana, Buenos Aires, Argentina.
2. “Anatomía humana: descriptiva, topográfica y funcional. Tomo 1. Cabeza y Cuello, Rouviere H – Delmas A, 11° ed. 2005 MASSON, S.A., Barcelona, Spain.
3. Dunn GF, Hack GD, Robinson WL, Koritzer RT. Anatomical observation of a craniomandibular muscle originating from the skull base: the sphenomandibularis. Cranio. 1996 Apr;14(2):97-103; discussion 104-5.
4. Shimokawa T, Akita K, Soma K, Sato T. Innervation analysis of the small muscle bundles attached to the temporalis: truly new muscles or merely derivatives of the temporalis? Surg Radiol Anat. 1998;20(5):329-34.
5. Akita K, Shimokawa T, Sato T. Aberrant muscle between the temporalis and the lateral pterygoid muscles: M. pterygoideus proprius (Henle). Clin Anat. 2001 Jul;14(4):288-91.
6. Schön Ybarra MA, Bauer B. Medial portion of M. Temporalis and its potential involvement in facial pain. Clin Anat. 2001;14(1):25-30.
7. Fuentes E, Llanos S, Gómez R, Llanos P, Llanos F, Cortés-Sylvester MF, Solaria P, Melian A, Asfura J, Santos M, Zamorano E. Discovery of deep temporalis muscle belly close to maxillary nerve in a patient with trigeminal neuralgia: hypothesis of muscular compression and case report treated by Botox® Onabotulinum toxin tipe-A. Chirurgia 2016 June;29(3):99-102
8. Geers C, Nyssen-Behets C, Cosnard G, Lengelé B. The deep belly of the temporalis muscle: an anatomical, histological and MRI study. Surg Radiol Anat. 2005 Aug;27(3):184-91. Epub 2005 Apr 9.
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We would like to welcome María Fernanda Cortés DDS, MSc. as a contributor to Medical Terminology Daily.
Dr. Cortés has a degree in Dentistry and is a Specialist in Dentomaxilofacial Radiology. She also has a Master’s degree in Temporomandibular disorders and orofacial pain.
Currently she is a lecturer of Human Anatomy at the Faculty of Dentistry of the Finis Terrae University. She also collaborates as a Postgraduate teacher for students of the “Anatomical Bases of Normal Imaging” diploma program at the Medical school of the same university.
Dr. Cortés has her own private practice in Santiago, Chile.
Clinical Anatomy Associates, Inc is proud to have Dr. Cortés as a contributor to "Medical Terminology Daily" and as a consultant to our team.
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Today I received the bust of Andreas Vesalius which will be displayed in my office in a place of honor.
This bust is a small version of a bronze bust made by the Belgian artist Pascale Pollier, who is a contributor to "Medical Terminology Daily". Copies of this original bronze bust can be found is different libraries and museums around the world. Pascale, along with Theo Dirix, Dr. Sylviane Déderix, and others are on a quest to find the cemetery where Andreas Vesalius was buried in the island of Zakynthos in Greece. Eventually, the final quest is to find the body of this illustrius anatomists.
To fund this private research Pascale and other artists have donated their work to a GoFundMe page whose objective is to raise €9,900, roughly US$10,800. You can reach the GoFundMe page here.
This bust that sits in my office today is the sixth in a run of twelve copies. If you go to the GoFundMe page you can opt to aquire other artistic works or one of the last copies of this bust. To acquire the bust there is a minumum required donation of US$350.
As of this publication, the research is 51% funded. We need your help to achieve our goal!!
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The [buccinator] muscle is a flat, thin quadrilateral muscle, that closes the space between the maxillary bone superiorly and the mandible inferiorly. It forms the side of the face and is the main muscular component of the “cheeks”. Etymologically [buccinator] means "trumpeter".
The superior and inferior boundaries of the muscle are the external surfaces of the alveolar processes of the maxilla and mandible on its posterior region, related to the posterior three molars. The posterior boundary is the anterior border of the pterygomandibular raphe, where posteriorly the middle pharyngeal constrictor also attaches. Anteriorly, its fibers appear to continue with the orbicularis oris muscle, but this is not so, as these two muscles (orbicularis oris and buccinator) are separate.
The fibers of the buccinator muscle are divided into three groups: the horizontal group continues anteriorly horizontally. The superior fibers have an anteroinferior direction and converge toward the angle of the mouth. The inferior fibers have an anterosuperior direction. These fibers appear to be continuous with the orbicularis oris, although they terminate in the mucosa, skin and some intermix with the muscular fibers of the orbicularis oris.
The buccinator muscle is covered by the buccopharyngeal fascia, and is in relation by its superficial surface and posteriorly, with a mass of fat (Bichat’s fat pad or suctorial pad), which separates it from the ramus of the mandible, the masseter, and a small portion of the temporalis muscle.
The parotid duct (Stensen’s duct) pierces the buccinator muscle opposite the second molar tooth of the maxilla.
The buccinator muscle receives innervation from the temporofacial and cervicofacial branches of the facial nerve (7th cranial nerve)
Sources:
1. “Gray’s Anatomy” Henry Gray, 1918
2. "Tratado de Anatomia Humana" Testut et Latarjet 8th Ed. 1931 Salvat Editores, Spain
3. "Gray's Anatomy" 38th British Ed. Churchill Livingstone 1995
Image in Public Domain, by Henry Vandyke Carter, MD - Gray's Anatomy, 1918
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The anatomical, term [buccinator] refers to a quadrilateral muscle that forms the side of the mouth and the face, vernacularly known as “mouth cheeks”.
Its origin is from the Latin word [bucca] meaning mouth (in Spanish the term meaning mouth is "boca"). Further evolution of the word leads to the Latin term [buccina] meaning “trumpet” or “horn”, and [buccinator] which means “trumpeter”
The term takes real meaning when you look at a trumpet player distending the buccinator muscle to obtain longer note, such as the well-known Louis Armstrong or Dizzy Gillespie. (see image).
For the anatomical description of this muscle, click here
Image source: By Roland Godefroy - Own work, CC BY 3.0, https://commons.wikimedia.org/w/index.php?curid=4612877
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While working on my library catalog, I made a very nice discovery!
I found a set of 22 medical brochures circa 1950, from MedExport, an USSR government-sponsored company. These brochures depict instruments that are not in use now, or have been modernized.
The brochures were inside one of the books that Dr. Mark Ravitch's family donated to my library.
Some of these are surgical staplers which I have mentioned in my series of articles "History of Surgical Stapling" which includes a video on the topic.
What is interesting is that some of these instruments where discarded and thought of as non-practical, but they are coming back in modern versions such as the coronary artery bypass graft (CABG) vascular devices manufactured by Cardica, a division of Dextera Surgical.
An example of this is shown in the image attached to this article (you can click on the image for a larger view).
This is the YAN-30, used to close the ductus arteriosus, also known as the Duct of Botallus, named after Leonardo Botallus.
This duct has a function in the fetus, and it closed shortly after birth. Patency of the ductus arteriosus causes deoxygenated blood to mix with the oxygenated blood in the thoracic aorta giving rise to a condition known as PDA or Patent Ductus Arteriosus.
Needless to say, I am not selling or trading these priceless collector's items!!