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Average 4.2 of 15 Ratings
Which of the following describes the anatomic pathway of the ilioinguinal nerve?
Perforates the posterior part of the transversus abdominis and divides the obliquus internus abdominis branching into a lateral and an anterior cutaneous branch
Pierces the obliquus internus and then accompanies the spermatic cord or round ligament through the superficial inguinal ring
Passes under the inguinal ligament and over the sartorius muscle into the thigh, where it divides into an anterior and a posterior branch
Travels outward on the psoas major, and passes through the deep inguinal ring and descends within the spermatic cord to the scrotum
Runs along the lower border of the twelfth rib and passes under the lateral lumbocostal arch
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The ilioinguinal nerve travels with the round ligament or spermatic cord through the superficial inguinal ring. It does not pass through the deep inguinal ring, and therefore it only travels through part of the inguinal canal.
The ilioinguinal nerve provides sensation to the upper inner thigh, groin, and perineum. It is particularly at risk during the ilioinguinal approach to the acetabulum. During this approach, the nerve can be found just proximal to the inguinal ligament after penetrating the abdominal wall when releasing the muscular attachment.
Illustration A shows the pathways of the iliohypogastric, ilioinguinal, and genitofemoral nerves.
1-This describes the anatomy of the iliohypogastric nerve.
3-This describes the anatomy of the lateral femoral cutaneous nerve.
4-This describes the anatomy of the genitofemoral nerve.
5-This describes the anatomy of the subcostal nerve.
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Average 2.0 of 20 Ratings
While dissecting in the middle window of the ilioinguinal approach a nerve is encountered entering the obturator foramen. Excessive retraction on this structure would result in which of the following?
Lateral thigh numbness
Weakness in knee extension
Anterior thigh numbness
Medial thigh numbness
Weakness in hip flexion
The obturator nerve is the largest nerve from the anterior divisions of the lumbar plexus, receiving contributions from L2-4. The nerve courses through the psoas major, exiting on its medial aspect and running along the lateral wall of the lesser pelvis until it enters the obturator foramen. It then divides into an anterior and posterior division, supplying branches to the hip joint, adductor longus, adductor brevis, gracilis, adductor magnus and sensory innervation the medial thigh. While in the middle window of the ilioingunal approach, the lateral femoral cutaneous nerve (sensory innervation to lateral thigh) and femoral nerve (sensory innveration to anterior thigh and motor innervation for knee extension) will also be encountered and may be injured. Illustrations A and B demonstrate the course and sensory innervation of the aforementioned nerves, respectively.
Average 3.0 of 20 Ratings
When peforming the ilioinguinal approach, what lies between the external iliac vessels and the lateral muscle window?
Lateral femoral cutaneous nerve
The ilioinguinal approach is typically used for anterior wall and column fracture of the acetabulum. this question is essentially asking what separates the middle from the lateral windows. Mobilization of the external iliac vessels and the iliopsoas (or iliopectineal fascia) creates the 3 windows of the ilioinguinal approach: 1) Medial window: medial to external iliac artery & vein. 2) Middle window: between external iliac vessels and the iliopsoas (or iliopectineal fascia) 3) Lateral window: lateral to iliopsoas (or iliopectineal fascia). Note that some sources use the iliospoas as the structure that separates the middle from the lateral windows; other sources use the iliopectineal fascia as the structure that separates the middle from lateral windows.
The corona mortis (answer #5) is a normal variant; it is an anastomotic connection between the external iliac and obturator arteries. If damaged in this approach, massive bleeding & death can result. The lateral femoral cutaneous nerve (answer #4) crosses the inguinal crease close to the ASIS (can be slightly medial to ASIS or, more commonly, 1-2 cm lateral) and, thus, may be seen in the lateral aspect of the ilioinguinal approach. The femoral nerve (answer #3) gives branches that supply muscles in the lateral muscular compartment.
Average 4.0 of 27 Ratings
During an ilioinguinal approach to the pelvis, the lateral femoral cutaneous nerve is seen. Which nerve roots supply this nerve?
The lateral femoral cutaneous nerve (L2/3) is at risk of transection or traction injury with utilization of the ilioinguinal approach to the acetabulum/pelvis. This structure is most commonly found 10-15mm from the ASIS, passing underneath the inguinal ligament. Injury to this nerve is treated by sharply transecting the nerve and burying the nerve ends to limit the symptoms of the eventual neuroma. The ilioinguinal approach utilizes a Pfannesteil incision continuing laterally along the inguinal ligament and finally along the iliac crest. The lateral window is lateral to the iliopsoas; the middle window is between the iliopsoas and femoral vessels; the medial window is from midline to the femoral vessels.
Illustration A shows a sketch of the ilioinguinal approach, with the lateral femoral cutaneous nerve seen as it exits inferolaterally under the inguinal ligament.
Average 3.0 of 18 Ratings