 Good day everybody, welcome to a dissection demonstration of the neurovascular structures in the gluteal region. And Dr. Sanjo Sanyal, Professor and Department Chair, if you take a look, this is the greater sciatic foramen. And the greater sciatic foramen has been divided by this muscle here, pyriformis muscle, into a suprapyriformis compartment and an infrapyriformis compartment. So therefore let's take a look at the neurovascular structures in the suprapyriform compartment. We can see these vessels here and this nerve here. So this is the superior gluteal vessels, the superior gluteal artery in the vein. The superior gluteal artery is a branch of the posterior division of the internal iliac and it comes out through the suprapyriformis compartment and it supplies superficial group of muscles namely the gluteus medius and the gluteus minimus and you can see on the cut surface the cut sections of the arteries which have been cut from here. So this is about the superior gluteal artery. The superior gluteal nerve, L5S1 posterior ramas. Superior gluteal nerve also supplies the gluteus medius and the gluteus minimus and the tensor facial eta. And here we can see the cut section of the nerve here. It is supplying the gluteus medius and the gluteus minimus. And here there is a very important clinical correlation in a stab injury or penetrating injury of the upper part of the buttock. If the superior gluteal nerve is injured then the person gets paralysis of the gluteus medius and this produces the condition known as trendlenberg sign and a gluteal gait. So this is an important clinical correlation putting into the superior gluteal nerve. Now let us come to the infrapyriformis compartment. The infrapyriformis compartment has got several neurovascular structures but first let us focus on the counterpart of the superior gluteal, namely the inferior gluteal. Straight away you can see that the inferior gluteal, the cut portions of the inferior gluteal artery are all visible here. The inferior gluteal artery is bigger than the superior gluteal. The inferior gluteal artery is a branch of the anterior division of the internal iliac. And the inferior gluteal has got many other branches. Apart from supplying the gluteus maximus and you can see the cut portions of them here. It also gives a branch to the sciatic itself and this artery is called the artery to the sciatic nerve. In Latin it is called arteria comitans nervei ischia dici. Apart from that the inferior gluteal artery also participates in the cruciate anastomosis around the greater trochanter. Let us come to the inferior gluteal nerve. This is the cut portion, one end of the cut portion of the inferior gluteal nerve and this is the other end of the inferior gluteal nerve. The inferior gluteal nerve is S1S2 from the posterior ramus and it supplies the gluteus maximus. If the inferior gluteal nerve is injured then the person is unable to extend and laterally rotate his hip because the gluteus maximus gets paralyzed. In this connection I can mention something related to neurology. There is a condition called epiconus syndrome which involves the S1S2 segments and of the spinal cord just above the conus medullaris and then also the person has same features. He is unable to extend and laterally rotate his hip joint. That is about the inferior gluteal vessels and nerve. What are the other structures which are coming out from the intra pyriformis compartment? We can see this big nerve coming out here. This is the largest nerve in the human body and this is the sciatic nerve which I am going to mention in my next video. What is the third group of structures which come out from the intra pyriformis compartment and if you look very closely and for that I have to reflect all the other structures and you can see these structures coming out. These are the pudendal vessels and the pudendal nerve. The unique thing about the pudendal vessels and the pudendal nerve is the pudendal artery is also branched from the anterior division of the internal iliac. The pudendal artery and the pudendal nerve has got a root value. It is a separate nerve all by itself with a root value of S234. Both of them come out through the greater sciatic foramen through the intra pyriformis compartment and immediately after that they wind around the ischial spine. The ischial spine is located where my probe is going. They wind around the ischial spine under the sacro tuberous ligament and they enter the ischial fossa and if you look closely here this is the lateral wall of the ischial fossa and you can see the pudendal vessels and the pudendal nerve are coming here. Right pull here you can see it is moving here and if I put my probe inside you can see my probe is come there. So therefore this is the passage through which the pudendal nerve and the internal pudendal artery they pass out and enter the through the lesser sciatic foramen and there is a small canal here. This canal is called the pudendal canal or the alcox canal and it runs in the pudendal or the alcox canal and it supplies the structures in the perineum. Incidentally this is the ischial fossa from where the fat has been removed and we can see a branch coming out from the pudendal artery called the inferior rectal artery and this supplies the radial canal. So this is about the pudendal nerve and the pudendal internal pudendal artery. Just to bring you up to speed this is the operator internus muscle. We can see the operator internus muscle here much more clearly and this is the superior gemulus this is the inferior gemulus. The operator internus started from the inside the ischial fossa and we can see the muscle here and the fascia over the operator internus is the one which forms the pudendal canal or the alcox canal which gives passage to these pudendal vessels and you can see it in the ischial fossa. So that is about the next structure. That's all for now thank you very much for watching ladies and gentlemen Dr. Sanjay Sanyal signing out have a nice day. If you have any questions or comments put them in the comment section below. Don't forget to like the video and click the subscribe button.