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A Systematic Review of Anatomical Variations of the Inferior Thyroid Artery: Clinical and Surgical Considerations
(MDPI, 2025-07-23) Bruna-Mejías, Alejandro
The inferior thyroid artery (ITA) is an essential component of the thyroid gland’s vasculature, with significant clinical and surgical implications due to its anatomical variability. This systematic review aimed to describe the prevalence of ITA anatomical variants and their association with clinical conditions or surgical implications. Methods: A comprehensive search was conducted in MEDLINE, Web of Science, Google Scholar, CINAHL, Scopus, and EMBASE on 20 November 2025. Eligibility criteria included studies reporting on the presence of ITA variants and their correlation with pathologies. Two authors independently screened the literature, extracted data, and assessed methodological quality using the AQUA and JBI tools. Results: Of the 2647 articles identified, 19 studies involving 1118 subjects/cadavers were included. Variations in ITA origin, absence, and additional arteries were reported, with the most common variant being direct origin from the subclavian artery. Clinically, these variations were associated with increased risk of intraoperative hemorrhage, potential nerve damage, and challenges in preoperative planning, particularly during thyroidectomy and other neck procedures. Conclusions: Understanding the anatomical diversity of the ITA is crucial for reducing surgical risks and improving patient outcomes. The review highlighted the need for more standardized research protocols and comprehensive data reporting to enhance the quality of evidence in this domain. Preoperative imaging and thorough anatomical assessments tailored to individual patient profiles, considering ethnic and gender-related differences, are essential for safe surgical interventions in the thyroid region.
Anatomical variants of the vertebral artery and their relationship with craniocervical disorders and surgical considerations: a systematic review and meta‐analysis
(Springer Nature, 2025-05-29) Valenzuela Fuenzalida, Juan José
The vertebral artery (VA) supplies almost one-third of the blood flow to the brain, contributing mainly to its posterior circulation. This article provides a comprehensive overview of the different anatomical variations related to the origin, course, and termination of the VA and associated clinical implications. Data were compiled from numerous published studies accessed from the databases Medline, Scopus, Web of Science, Google Scholar, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Literature in Health Sciences (LILACS) as of January 2024. Methodological quality was evaluated with an assurance tool for anatomical studies (AQUA). Pooled prevalence was estimated using a random effects model, and differences in VA variant rates were assessed. VA variants were identified that could be separated into three categories: variation in origin, course, and terminal branches. A total of 16 studies met the established selection criteria for the current meta-analysis. VA variations were reported at an overall prevalence of 11% (CI: 7%–15%) and a heterogeneity of 77%. Statistically significantly higher rates were revealed in the following subgroups of the sample: imaging examinations versus cadavers (p = 0.032); right side of the body versus left (p = 0.034); and bilaterally versus unilaterally (p = 0.019). Concerns listed in included studies primarily focused on the possibility of iatrogenic damage during surgical procedures. A few studies also indicated higher rates of VA variants in patients who reported symptoms of recurrent headaches, vertigo, dizziness, and/or syncope. The presence of VA variants is high and can occur in various regions. However, the most important clinical consideration is that individuals with this variant must be constantly monitored since their posterior cerebral circulation could be affected. To avoid iatrogenic damage to the VA, clinicians should employ medical imaging to evaluate its course and branches prior to surgical interventions in the region.
Anatomy of vertebral artery hypoplasia and its relationship with clinical implications: a systematic review and meta-analysis of prevalence
(Springer, 2024-05-19) Valenzuela Fuenzalida, Juan José
Purpose: The vertebral artery (VA) is a vital branch of the subclavian artery, coursing through the transverse foramina of the cervical vertebrae, and playing a crucial role in irrigating the posterior region of the arterial cerebral circle, also known as the Polygon of Willis. Among the various possible alterations that can affect the VA, vertebral artery hypoplasia (HAV) emerges as a significant variant. This study aims to discern the anatomical features of HAV and its correlation with the clinical conditions of the posterior cerebral circulation. Methods: The databases Medline, Scopus, Web of Science, Google Scholar, CINAHL, and LILACS were searched until January 2024. Two authors independently performed the search, study selection, and data extraction. Methodological quality was evaluated with an assurance tool for anatomical studies (AQUA). Pooled prevalence was estimated using a random effects model. Results: A total of 24 studies met the established selection criteria, with a total of 8847 subjects. In this study, 6 articles were included for the meta-analysis with a total of subjects. The average prevalence of VAH reported in each study was 11% (95% CI 10-12%); the studies had a heterogeneity of 41% based on the funnel plot and a low risk of bias. Conclusion: The prevalence of VAH is low, but in the presence of this condition, the changes are mainly in diameter rather than morphological. If it is present, some clinical safeguards must be taken to avoid complications such as stroke.
Hepatic hilum variations and their clinical considerations in the liver: a systematic review and meta-analysis
(MDPI, 2024-05-18) Valenzuela Fuenzalida, Juan José
Background: The liver has a region called the hepatic hilum (HH) where structures enter and exit: anteriorly, the left and right hepatic ducts; posteriorly, the portal vein; and between these, the left and right hepatic arteries. The objective of this review is to know how variants in structures of the hepatic hilum are associated with clinical alterations of the liver. Methods: The databases Medline, Scopus, Web of Science, Google Scholar, CINAHL, and LILACS were researched until January 2024. The methodological quality was evaluated with an assurance tool for anatomical studies (AQUA). The pooled prevalence was estimated using a random effects model. Results: A total of six studies met the selection criteria established in this study for meta-analysis. The prevalence of hepatic hilus variants was 9% (CI = 5% to 13%), and the heterogeneity was 83%. The other studies were analyzed descriptively and with their respective clinical considerations in the presence of the variant, such as the high incidence of the Michels type III variant; among the portal vein variants, the type III variant of the Cheng classification stands out and in biliary anatomy, and the IIIa variant stands out according to the Choi classification. Conclusions: This review allowed us to know in detail the anatomical variants of HH; the structure with which the greatest care should be taken is the hepatic artery because of the probability of metastatic processes due to increased blood distribution in the hepatic lobules. Finally, we believe that new anatomical and clinical studies are needed to improve our knowledge of the relationship between HH variants and liver alterations or surgeries.
Incidence and clinical implications of anatomical variations in the pancreas and Its ductal system: A systematic review and meta-analysis
(MDPI, 2023-08-09) Orellana-Donoso, Mathias
Objetivo: Esta revisión sistemática analiza las variantes anatómicas en el páncreas y su sistema ductal para informar sobre su asociación con patologías pancreáticas. Métodos: Realizamos una búsqueda en las bases de datos MEDLINE, Scopus, Web of Science, Google Scholar, CINAHL y LILACS desde su inicio hasta julio de 2023. La calidad metodológica se evaluó con la herramienta Anatomical Quality Assessment (AQUA). Finalmente, la prevalencia agrupada se estimó mediante un modelo de efectos aleatorios. Resultados: Se encontraron 55 estudios que cumplieron con los criterios de elegibilidad. La prevalencia general de páncreas divisum (PD) fue del 18% (IC del 95% = 15-21%). La prevalencia de EP asociada con pancreatitis fue del 30% (IC 95% = 1-61%). Conclusiones: Una variante anatómica del páncreas como la EP puede ser la causa de la obstrucción de la vía biliar, dando lugar a diversas complicaciones clínicas, como la pancreatitis. De ahí que conocer esta variante sea de suma importancia para los cirujanos, especialmente para quienes tratan la región gastroduodenal.
Infraorbital canal variants and its clinical and surgical implications: A systematic review
(Springer Nature, 2024-04-29) Orellana-Donoso, Mathias
Background: Recent literature highlights anomalous cranial nerves in the sinonasal region, notably in the sphenoid and maxillary sinuses, linked to anatomical factors. However, data on the suspended infraorbital canal (IOC) variant is scarce in cross-sectional imaging. Anatomical variations in the sphenoid sinuses, including optic, maxillary, and vidian nerves, raise interest among specialists involved in advanced sinonasal procedures. The infraorbital nerve's (ION) course along the orbital floor and its abnormal positioning within the orbital and maxillary sinus region pose risks of iatrogenic complications. A comprehensive radiological assessment is crucial before sinonasal surgeries. Cone-beam computed tomography (CBCT) is preferred for its spatial resolution and reduced radiation exposure. Objective: The aim of this study was to describe the prevalence of anatomical variants of the infraorbital canal (IOC) and report its association with clinical condition or surgical implication. Methods: We searched Medline, Scopus, Web of Science, Google Scholar, CINAHL, and LILACS databases from their inception up to June 2023. Two authors independently performed the search, study selection, data extraction, and assessed the methodological quality with assurance tool for anatomical studies (AQUA). Finally, the pooled prevalence was estimated using a random effects model. Results: Preliminary results show that three types are prevalent, type 1: the IOC does not bulge into the maxillary sinus (MS); therefore, the infraorbital foramen through the anterior wall of MS could be used for identification of the ION. Type 2: the IOC divided the orbital floor into medial and lateral aspects. Type 3: the IOC hangs in the MS and the entire orbital floor lying above the IOC. From which the clinical implications where mainly surgical, in type 1 the infraorbital foramen through the anterior wall of MS could be used for identification of the ION, while in type 2, since the lateral orbital floor could not be directly accessed an inferiorly transposition of ION is helpful to expose the lateral orbital wall directly with a 0 scope; or using angled endoscopes and instruments, however, the authors opinion is that direct exposure potentially facilitates the visualization and management in complex situations such as residual or recurrent mass, foreign body, and fracture located at the lateral aspect of the canal. Lastly, in type 3, the ION it's easily exposed with a 0° scope. Conclusions: This systematic review identified four IOC variants: Type 1, within or below the MS roof; Type 2, partially protruding into the sinus; Type 3, fully protruding into the sinus or suspended from the roof; and Type 4, in the orbital floor. Clinical recommendations aim to prevent nerve injuries and enhance preoperative assessments. However, the lack of consistent statistical methods limits robust associations between IOC variants and clinical outcomes. Data heterogeneity and the absence of standardized reporting impede meta-analysis. Future research should prioritize detailed reporting, objective measurements, and statistical approaches for a comprehensive understanding of IOC variants and their clinical implications. Open Science Framework (OSF): https://doi.org/10.17605/OSF.IO/UGYFZ .
Morphological Characteristics of the Double Mental Foramen and Its Relevance in Clinical Practice: An Observational Study
(MDPI, 2024-04-25) Bruna-Mejías, Alejandro
The mental foramen (MF) is an opening found bilaterally on the anterolateral aspect of the mandible; it can be round or oval and have different diameters. One of the anatomical variants of the jaw is the presence of an accessory mental foramen (AMF). These are usually smaller than the MF and can be located above, below, or to the sides of the main MF. The objective of this study was to recognize the presence of AMF in dry jaws of the Chilean population and collect information about its clinical relevance reported in the literature. In this descriptive observational study, we have collected dried jaws obtained from three higher education institutions in Santiago de Chile, from the Department of Morphology of the Andrés Bello University, the Normal Human Anatomy Unit of the University of Santiago, and the Human Anatomy pavilion from the Faculty of Medicine of the Finis Terrae University. The samples for this research were obtained by convenience, and the observation of the jaws was carried out in the human anatomy laboratories of each institution by three evaluators independently, and a fourth evaluator was included to validate that each evaluation was correct. The sample for this research came from 260 dry jaws, showing the following findings from the total jaws studied, and to classify as an accessory MF, it will be examined and measured so that it complies with what is declared in the literature as the presence of AMF, which is between 0.74 mm. and 0.89 mm. There were 17 studies included with a sample that fluctuated between 1 and 4000, with a cumulative total of 7946 and an average number of jaws analyzed from the studies of 467.4, showing statistically significant differences between the means with the sample analyzed in this study; p = 0.095. For the cumulative prevalence of the presence of AMF, this was 3.07 in this study, and in the compared studies, the average of AMF was 8.01%, which did not present a statistically significant difference; p = 0.158. Regarding the presence of variants of unilateral AMF, this occurred in five jaws, which is equivalent to 1.84% in the sample of this study, while in previous studies, it was 7.5%, being higher on the left side than on the right. The presence of AMF is a variant with high prevalence if we compare it with other variants of the jaw. Knowledge of the anatomy and position of the AMF is crucial to analyze different scenarios in the face of surgical procedures or conservative treatments of the lower anterior dental region.
Occipitalization of the atlas: prevalence, functional and anatomical considerations. A systematic review and meta-analysis
(Elsevier, 2026) Bruna-Mejias, Alejandro
Background: Occipitalization of the atlas, defined as a congenital fusion between the first cervical vertebra (C1) and the occipital bone, is an uncommon anatomical variant of the craniovertebral junction. Reported prevalence in the general population varies widely, and the condition is often identified incidentally during imaging or anatomical assessment. Objective: To synthesize available evidence on the prevalence of atlas occipitalization and to describe its anatomical characteristics across different populations and study designs. Methods: A comprehensive literature search was conducted in MEDLINE, Scopus, Web of Science, Google Scholar, CINAHL, and LILACS from inception to January 2025. Study selection and data extraction were performed independently by four reviewers. Methodological quality was assessed using the Anatomical Quality Assessment (AQUA) tool. A random-effects meta-analysis was applied to estimate pooled prevalence values and explore predefined subgroups. Results: Twenty-five studies met the inclusion criteria for qualitative synthesis, of which eleven were included in the meta-analysis, encompassing a total of 4219 subjects. The pooled prevalence of atlas occipitalization was 0.64% (95% confidence interval: 0.00–1.00%). Variability in prevalence estimates was observed across populations and assessment methods. Conclusion: Atlas occipitalization is a rare congenital anatomical variant of the craniovertebral junction. Although often asymptomatic, its identification is anatomically relevant due to potential associations with other craniovertebral anomalies. Awareness of this variant is important for accurate anatomical interpretation and for planning procedures involving the craniovertebral junction.
Partial agenesis of the pectoralis major and minor muscle: A cadaveric case report
(Wolters Kluwer Health, Inc., 2024-09-13) Bruna-Mejías, Alejandro
Rationale: The pectoralis major and minor muscles, located in the anterior chest wall, are crucial for upper limb movements. Patient concerns: Their nonsyndromic absence is rare but significant for surgical procedures involving the axillary and pectoral regions. Diagnoses: Ultrasound can confirm the diagnosis and delimit the extent of the muscular abnormality, detect abnormalities of the costal cartilages, among others. Interventions: This descriptive, cadaveric case report involves a formalin-fixed 57-year-old North American male, with no clinical or family history of similar conditions. The study was conducted at the Human Anatomy Laboratory of the School of Medicine of the universidad Finis Terrae in Santiago, Chile, in August 2022. Outcomes: We present a cadaveric case of bilateral partial agenesis of the pectoralis muscles discovered during routine dissection. The pectoralis major muscle exhibited only the clavicular portion, with the sternocostal and abdominal portions absent and replaced by a thin layer of connective tissue bilaterally. The pectoralis minor muscle showed partial muscle fibers only in the most distal and inferior portions bilaterally. Lessons: This case report is significant due to the rarity of this condition without accompanying anatomical variations. Understanding this variant is valuable for clinical situations involving the shoulder and thorax region, such as trauma to the proximal third of the humerus, clavicular region, suprascapular region, and anterior chest wall. It may complicate conservative and/or surgical treatments due to different functional and irrigation patterns in the area and is also important for educating future professionals.
Prevalence and clinical consideration of anatomical variants of the splenic artery: a systematic review and meta-analysis
(MDPI, 2023-03-09) Valenzuela Fuenzalida, Juan José
Background: The spleen is the largest secondary immune organ in the body. Knowledge regarding the normal splenic vascular anatomy and its anatomical variants is crucial in the medical practice of surgeons and radiologists and is useful for diagnostic evaluations and the guidance of various surgical procedures. Hence, in this research, we aim to characterize the behavior of the lineal or splenic artery in humans from an anatomoclinical point of view. Methods: A systematic search was carried out in electronic databases to compile the available literature on the research subject. Searches were undertaken in the following databases: Medline, Scielo, Wos, Cinahl, Scopus, and Google Scholar. The search terms were “Splenic artery”, “Splenic vascularization”, “Anatomical variations’’, “Splenic organ”, and “Clinical anatomy”. Results: From the 35 studies included in this review, clinical correlations of anatomical variations in the splenic artery with surgical procedures in the abdominal region were reported in 8 studies. These correlations are mainly associated with surgical procedures for the pancreas, liver, stomach, and bile ducts through imaging of the spleen. To verify our conclusions, the risk of bias of the anatomical studies was measured using the AQUA checklist. Conclusions: Recognition of the usual anatomy and anatomical variants of the splenic artery is crucial for both morphology professionals and clinicians addressing the abdominal region and its vascular components. In this review, we determined that the splenic artery could present a variation in its origin or entry into the splenic hilum, which could mean that in any abdominal intervention there may be complications if the splenic artery variation is overlooked. More anatomic clinical studies considering this variation in both diagnostic and surgical processes are suggested for further investigations.
Prevalence of radial artery variants and their relationship with clinical considerations of the antebrachial region: Systematic revier and meta-analysis
(MDPI, 2025-11-24) Sanchis Gimeno, Juan
Background: The radial artery (RA) is one of the terminal branches of the brachial artery, extending along the lateral forearm, crossing the anatomical snuffbox, and contributing to the palmar arches. Anatomical variations in the RA are of great clinical relevance due to their implications in procedures such as transradial catheterization, arterial cannulation, and bypass grafting. These variants may alter the course, branching pattern, or origin of the vessel, potentially increasing procedural complexity and the risk of iatrogenic injury. In critically ill patients and in surgical or interventional settings, accurate identification of RA anatomy is essential. The objective of this study was to systematically identify and describe RA variants reported in the scientific literature and to analyze their clinical relevance. Methods: A systematic search was conducted across six electronic databases: Medline, Scopus, Web of Science, Google Scholar, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Latin American and Caribbean Literature in Health Sciences (LILACS), covering publications up to July 2025. Eligible studies included anatomical, radiological, and surgical investigations reporting RA variants. Study quality was evaluated using the Assessment of Quality in Anatomical Studies (AQUA) tool. Quantitative synthesis was performed using a random-effects model to estimate the pooled prevalence of RA variants and subgroup differences. Twenty-three studies met the inclusion criteria, and eleven were included in the meta-analysis, encompassing a total of 6320 participants. Results: Radial artery variants were categorized into three main types: variations in origin, course, and branching pattern. The pooled global prevalence of RA variants was 12% (95% CI: 6-18%), with substantial heterogeneity (I2 = 97.7%). Higher prevalence was found in imaging-based studies (14%) compared with donor-based studies (12%). Sex-based subgroup analysis revealed a higher prevalence in females (18%; CI: 9-28%) compared with males (3%; CI: 3-4%), with moderate heterogeneity (I2 = 61.3%). Regionally, European populations demonstrated a higher prevalence (20%) than Asian populations (11%), both showing high heterogeneity (I2 > 98%). Notably, only one study from the Americas and none from Africa or Oceania were identified, representing a major geographical limitation in the available data. The findings of this study highlight the considerable variability in RA anatomy across populations. Such variations hold significant clinical importance, particularly in the context of transradial interventions, arterial cannulation, and reconstructive procedures where vascular integrity is critical. The high degree of heterogeneity observed may reflect differences in population genetics, sample size, and imaging or dissection methodologies. The limited representation of certain regions underscores the need for further anatomical and radiological studies to obtain a more comprehensive understanding of global RA variability. Preoperative or pre-procedural imaging using Doppler ultrasonography or computed tomography angiography is recommended to identify anomalous patterns and minimize iatrogenic complications. Conclusions: Radial artery variants are frequent and diverse. Their recognition is fundamental for the safety and success of invasive and surgical procedures in the upper limb. A standardized approach to vascular evaluation, particularly through preoperative imaging, is essential to improve procedural outcomes and reduce the risk of arterial injury in clinical practice.
Sexual dimorphism in the Atlas Vertebra of normal and overweight patients with its possible surgical implications
(Elsevier, 2025-10-04) Tuncel, Nilgün Çini
Background: We aimed to detect the sexual dimorphism in the width and external anteroposterior length (EAPL) values of the atlas vertebra, and to detect significant correlations between the width and EAPL with height, weight, and body mass index (BMI) in normal weight and in overweighted patients. Methods: The width and EAPL were measured in 63 (32 female, 31 male) normal weight individuals and in 61 (30 female, 31 male) overweighted individuals who underwent a cervical spine computed tomography scan. Data was first compared between all female patients and male patients, and secondly was compared between normal and overweight individuals. Spearman's correlation analysis was used to evaluate correlations between width and EAPL with height, weight, and BMI. Results: Atlas width and EAPL were significantly higher in normal and overweight males (P < 0.001). No correlations were found between height, weight, and BMI and the width and EAPL in normal and overweight individuals. The only significant correlation found was between width and EAPL in both normal and overweight individuals (P < 0.001). Conclusions: There is sexual dimorphism in atlas width and EAPL, with male patients presenting significantly higher values, but there are no correlations between height, weight, and BMI and the width and EAPL in both normal and overweight individuals. In addition, being overweight does not affect the correlation between width and EAPL.
Systematic review and meta-analysis of right subclavian artery variants and their correlation with cervical-thoracic clinical conditions
(Wolkers Kluwer Health, 2024-12-13) Valenzuela Fuenzalida, Juan José
Background: A high incidence of anatomical variations in the origin of the branches of the aortic arch has been reported, Nowadays, this variation is considered the most frequent in the aortic arch, its prevalence being estimated between 0.5% and 2.5% of the population. To understand its origin, knowledge of embryonic development is necessary. Methods: We searched the MEDLINE, Scopus, Web of Science, Google Scholar, Cumulative Index to Nursing and Allied Health Literature, and Latin-American literature and caribean of health sciences databases with dates ranging from their inception to June 2023. Study selection, data extraction, and methodological quality were assessed with the guaranteed tool for anatomical studies (Anatomical Quality Assurance). Finally, the pooled prevalence was estimated using a random effects model. Results: Thirty-nine studies were found that met the eligibility criteria. Twenty studies with a total of 41,178 subjects were included in the analysis. The overall prevalence of an ARSA variant was 1% (95% confidence interval = 1%–2%), the clinical findings found are that if ARSA is symptomatic it could produce changes in the hemodynamic function of the thoracocervical region in addition to other associated symptomatic complications in surrounding structures. Conclusions: ARSA can cause several types of alterations in the cervical or thoracic region, resulting in various clinical complications, such as lusory dysphagia. Hence, knowing this variant is extremely important for surgeons, especially those who treat the cervico-thoracic region. The low prevalence of ARSA means that many professionals are completely unaware of its existence and possible course and origin. Therefore, this study provides detailed knowledge of ARSA so that professionals can make better diagnoses and treatment of ARSA.

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