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Lower Limb Muscles
Published in Eve K. Boyle, Vondel S. E. Mahon, Rui Diogo, Handbook of Muscle Variations and Anomalies in Humans, 2022
Eve K. Boyle, Vondel S. E. Mahon, Rui Diogo, Malynda Williams
Obturator internus originates from bony surfaces that surround the obturator foramen including the inferior pubic ramus, the ischial ramus, the pelvic surface of the ilium, and the greater sciatic foramen (Standring 2016). It also originates from the obturator membrane and the obturator fascia (Standring 2016). Its fibers converge into four or five tendinous bands that pass through the lesser sciatic foramen to insert as a single tendon onto the greater trochanter (Standring 2016). The superior gemellus and inferior gemellus fuse with this tendon prior to insertion (Standring 2016).
Bladder exstrophy and epispadias
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
To mobilize the corpora, their neurovascular supply (the pudendal artery, veins, and nerve) must be freed along their course from behind the spine of the ischium from where they run forward in Alcock's canal. This is a fascial channel that runs forward on the surface of the internal obturator fascia, lateral to the ischiorectal fossa, below the pelvic floor (Figure 79.19a). A retroperitoneal plane lateral to the bladder is developed by forefinger dissection behind the lower rectus toward the pelvic floor. Medial retraction of the bladder and rectum behind it reveals the pelvic floor muscles and a muscle stimulator helps to define their attachment to the obturator fascia (the so-called “white line”) (Figure 79.19b). The muscle fibers are divided about 0.5 cm medial to the white line with bipolar diathermy. This exposes the ischiorectal fat, which can be pushed downward and medially to expose the fascia over the internal obturator muscle (Figure 79.19c).
Diseases of the Peripheral Nerve and Mononeuropathies
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Diana Mnatsakanova, Charles K. Abrams
Courses anteriorly along the intrapelvic wall within a tunnel in the dense obturator fascia and divides into three branches: The inferior rectal nerve supplies the external anal sphincter, the perianal skin, and the mucosa of the lower anal canal.The perineal nerve innervates the muscles of the perineum, the erectile tissue of the penis, the external urethral sphincter, the distal part of the mucous membrane of the urethra, and the skin of the perineum and labia/scrotum.The dorsal nerve of the clitoris/penis supplies the corpus cavernosum then courses forward on the dorsum of the clitoris/penis to innervate the skin, prepuce, and glans.
Ten-Step Surgical Approach to Management of Pathology of the Ischiorectal Fossa—A Review of the Literature and Application in a Rare Pelvic Schwannoma
Published in Journal of Investigative Surgery, 2022
Sarah Louise Smyth, Sunanda Dhar, Miss Lucy Cogswell, Hooman Soleymani majd
The transichiorectal approach provides direct access to Alcock’s canal with minimal pelvic muscle and ligament disruption [5, 7]. The procedure requires an in-depth knowledge of the pelvic anatomical spaces [4]. The pudendal nerve arises from the S2-4 sacral nerve and travels forward laterally in the pelvis within the obturator internus fascial sheath [8]. It has both motor and sensory functions. The ischiorectal fossa is a pyramidal space lateral to the anal canal and below the pelvic diaphragm with the apex at the anal canal and obturator fascia boundary, and the base at the perineal surface. It is bound medially by the levator ani, external anal sphincter and anal fascia, laterally by the ischial tuberosity and obturator internus muscle, anteriorly by the urogenital diaphragm fascia and Colles’ transverse perineal muscle fascia and posteriorly by the gluteus maximus and sacrotuberous ligament [2, 9]. It contains the internal pudendal, posterior labial and inferior rectal vessels and nerve, the perineal S4 branch, the perforating cutaneous nerve and lymphatic tissue [1, 3].