1
|
Dündar Y, Schwartz CM, Lierly M, Nguyen TQ, Gilbert KK, Smith DH, Tello N, Cordero J. A Novel Surgical Landmark to Identify the Recurrent Laryngeal Nerve. Balkan Med J 2024; 41:280-285. [PMID: 38856010 DOI: 10.4274/balkanmedj.galenos.2024.2024-2-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2024] Open
Abstract
Background Although several surgical landmarks have been proposed to localize the recurrent laryngeal nerve (RLN), there is still no reliable landmark. Aims To validate the reliability of a novel reference point at the intersection of the inferior border of the cricopharyngeal muscle and the inferior cornu of thyroid cartilage for locating the RLN. Study Design Cadaver dissection study in the academic department of otolaryngology-head and neck surgery. Methods Sixty-four RLNs in cadavers were assessed, and measurements of different surgical landmarks in conjunction with the proposed surgical landmark were obtained. Descriptive statistics, Pearson’s chi-squared test, and Student’s t-test were performed to analyze the data using GraphPad Prism (version 9.4.1; Dotmatics, Boston, Massachusetts, USA). Results The average distance from the proposed landmark to the RLN was 2.3 ± 0.85 mm. The RLN was located just posterior to the reference point in 95.31% of the cadavers. The RLN passed under the inferior constrictor muscle in 90.63% of the cadavers. There was no statistically significant difference between right- and left-sided RLNs in terms of their relation with the reference point. Conclusion The proposed reference point can be used as a reliable landmark to locate the RLN. This reference point may help surgeons during difficult thyroidectomy surgeries by providing an additional anatomical landmark.
Collapse
Affiliation(s)
- Yusuf Dündar
- Department of Otolaryngology, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Cynthia M Schwartz
- Department of Otolaryngology, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Micah Lierly
- Department of Rehabilitation Sciences, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Tam Q Nguyen
- Department of Otolaryngology, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Kerry K Gilbert
- Department of Rehabilitation Sciences, Texas Tech University Health Sciences Center, Lubbock, USA
- Texas Tech University Health Sciences Center, Institute of Anatomical Sciences, Lubbock, USA
| | - Drew H Smith
- Department of Otolaryngology, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Nadia Tello
- Department of Otolaryngology, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Joehassin Cordero
- Department of Otolaryngology, Texas Tech University Health Sciences Center, Lubbock, USA
| |
Collapse
|
2
|
Matsugaki T, Yamashita A, Kikuchi K, Watanabe K. Anatomical study of the modified direct posterior gluteal splitting approach for acetabular fractures. Injury 2024; 55:111519. [PMID: 38584077 DOI: 10.1016/j.injury.2024.111519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 03/29/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND In this study, we investigated the area that can be addressed with an approach in which the skin incision is made directly above the dorsal column with Thiel cadaveric specimens. METHODS Six Thiel cadaveric specimens were prepared. A skin incision was made directly above the dorsal column. The accessible proximal end from the proximal part of the greater sciatic notch to the gluteal ridge and the accessible distal end of the ischium were marked with a flat chisel. A molded 8-hole reconstruction plate was placed from the base of the ischium toward the gluteal ridge and fixed with 3 screws proximally and 2 screws distally. The length of the skin incision and the distance from each reference point on the bone to the reachable markings were assessed after the muscles were removed. RESULTS Mean skin incision length was 9.3 ± 0.7 (range, 8.0-10.0) cm. In 3 of 6 cases, proximal screws were inserted through different spaces between muscle fibers. In all cases, we were able to reach at least the greater sciatic notch, the gluteal ridge at the level of superior border of the acetabulum, and the base of the ischial tuberosity. In all cases, an 8-hole plate could be placed from the gluteal ridge to the base of the ischium. There were no superior gluteal artery or sciatic nerve injuries in any of the cases. CONCLUSION We anatomically investigated the area that can be addressed with an approach in which the skin incision was made directly above the dorsal column. In all cases, we were able to access the areas needed to reduce the fracture and place the plates necessary to stabilize the fracture through a 9.3 ± 0.7 cm skin incision. This approach can be a useful minimally invasive posterior approach for acetabular fractures.
Collapse
Affiliation(s)
- Toru Matsugaki
- Department of Orthopaedic Surgery, Kurume University Hospital, 67 Asahimachi, Kurume city, Japan.
| | - Akihiro Yamashita
- Department of Orthopaedic Surgery, Kurume University Hospital, 67 Asahimachi, Kurume city, Japan
| | - Keishiro Kikuchi
- Department of Orthopaedic Surgery, Kurume University Hospital, 67 Asahimachi, Kurume city, Japan
| | - Koichi Watanabe
- Devision of Gross and Clinical Anatomy, Department of Anatomy, Kurume University Hospital, 67 Asahimachi, Kurume city, Japan
| |
Collapse
|
3
|
Labanca PDC, Porto M, Resende FC, Abidu-Figueiredo M, Pissinatti A. Observations on the anatomy of the funiculus spermaticus and the testis in Brachyteles sp. (SPIX, 1823) primates - Atelidae. J Med Primatol 2024; 53:e12702. [PMID: 38745344 DOI: 10.1111/jmp.12702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 04/01/2024] [Accepted: 04/25/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Analysing the literature about the reproductive anatomy on New World Primates, one can see the need of standardisation on the description methods and, more importantly, the lack of detailed information. The problem is aggravated by the difficult access to specimens of the endangered species such as Brachyteles sp. This paper's objective was to extend knowledge on the male reproductive anatomy of these primates. The testis and funiculus spermaticus of Brachyteles are described in detail. METHODS We utilised one individual of Brachyteles arachnoides, two hybrids (B. arachnoides × Brachyteles hypoxanthus) and photographs of the testis of a third fresh specimen of a hybrid individual. RESULTS The septum formed by tunica dartos adheres to the testis and separates the scrotum in two testicular cavities. Passed the spermatic cord, the external spermatic fascia continues with the tunica dartos, covering the cranial half of the testis. The fascia cremasterica divides itself in bundles of fibres and forms loops around the testicles creating a sac like structure that seems to be unique among Neotropical Primates. The appendix testis is described for the first time in platyrrhini. It is presented as a sessile structure in the extremitas capitata of the testis. Previous literature on the reproductive anatomy of platyrrhini is limited. Despite that, it can be said that the large size and volume of the testis, and complex structure of the cremaster, could consist of a heat loss reduction strategy in cold and humid forest environments. CONCLUSIONS Except for the larger size of the testicles in hybrid individuals, no other significant morphological differences were found between B. arachnoides and hybrids (B. arachnoides × B. hypoxanthus).
Collapse
Affiliation(s)
- Pedro do Carmo Labanca
- Manchester University NHS Trust (MFT), Medical Illustration and Clinical Photography, Manchester, UK
| | - Marcovan Porto
- Centro Universitário Serra dos Órgãos (Unifeso), Teresópolis, Brazil
| | | | - Marcelo Abidu-Figueiredo
- Laboratório de Ensino, Pesquisa e Extensão em Morfologia de Animais Domésticos e Selvagens, Departamento de Anatomia Animal e Humana, Instituto de Ciências Biológicas e da Saúde, Universidade Federal Rural do Rio Janeiro, Seropédica, Brazil
| | - Alcides Pissinatti
- Centro Universitário Serra dos Órgãos (Unifeso), Teresópolis, Brazil
- Centro de Primatologia do Rio de Janeiro - (CPRJ-INEA), Guapimirim, Brazil
| |
Collapse
|
4
|
Orellana F, Grassi A, Hlushchuk R, Wahl P, Nuss KM, Neels A, Zaffagnini S, Parrilli A. Revealing the complexity of meniscus microvasculature through 3D visualization and analysis. Sci Rep 2024; 14:10875. [PMID: 38740845 DOI: 10.1038/s41598-024-61497-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 05/07/2024] [Indexed: 05/16/2024] Open
Abstract
Three-dimensional information is essential for a proper understanding of the healing potential of the menisci and their overall role in the knee joint. However, to date, the study of meniscal vascularity has relied primarily on two-dimensional imaging techniques. Here we present a method to elucidate the intricate 3D meniscal vascular network, revealing its spatial arrangement, connectivity and density. A polymerizing contrast agent was injected into the femoral artery of human cadaver legs, and the meniscal microvasculature was examined using micro-computed tomography at different levels of detail and resolution. The 3D vascular network was quantitatively assessed in a zone-base analysis using parameters such as diameter, length, tortuosity, and branching patterns. The results of this study revealed distinct vascular patterns within the meniscus, with the highest vascular volume found in the outer perimeniscal zone. Variations in vascular parameters were found between the different circumferential and radial meniscal zones. Moreover, through state-of-the-art 3D visualization using micro-CT, this study highlighted the importance of spatial resolution in accurately characterizing the vascular network. These findings, both from this study and from future research using this technique, improve our understanding of microvascular distribution, which may lead to improved therapeutic strategies.
Collapse
Affiliation(s)
- Federica Orellana
- Center for X-Ray Analytics, Empa-Swiss Federal Laboratories for Materials Science and Technology, 8600, Dübendorf, Switzerland
- Department of Chemistry, University of Fribourg, 1700, Fribourg, Switzerland
| | - Alberto Grassi
- IRCCS-Rizzoli Orthopaedic Institute, 40136, Bologna, Italy
| | - Ruslan Hlushchuk
- Faculty of Medicine, University of Bern, 3012, Bern, Switzerland
| | - Peter Wahl
- Faculty of Medicine, University of Bern, 3012, Bern, Switzerland
- Cantonal Hospital Winterthur, 8401, Winterthur, Switzerland
| | - Katja M Nuss
- Vetsuisse Faculty, University of Zurich, 8057, Zurich, Switzerland
| | - Antonia Neels
- Center for X-Ray Analytics, Empa-Swiss Federal Laboratories for Materials Science and Technology, 8600, Dübendorf, Switzerland
- Department of Chemistry, University of Fribourg, 1700, Fribourg, Switzerland
| | | | - Annapaola Parrilli
- Center for X-Ray Analytics, Empa-Swiss Federal Laboratories for Materials Science and Technology, 8600, Dübendorf, Switzerland.
| |
Collapse
|
5
|
Nakao G, Kodesho T, Yamagata K, Watanabe K, Ohsaki Y, Katayose M, Taniguchi K. Stress-strain relationship of individual hamstring muscles: A human cadaver study. J Mech Behav Biomed Mater 2024; 153:106473. [PMID: 38452573 DOI: 10.1016/j.jmbbm.2024.106473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/13/2024] [Accepted: 02/20/2024] [Indexed: 03/09/2024]
Abstract
The incidence of hamstring muscle strain varies among muscles, suggesting that the mechanical stresses associated with elongation may differ among muscles. However, the passive mechanical properties of whole human muscles have rarely been directly measured and clarified. This study aimed to clarify the stress-strain relationship of the hamstring muscles using a soft-embalmed Thiel cadaver. The long heads of the biceps femoris (BFlh), semimembranosus (SM), and semitendinosus (ST) muscles were dissected from eight cadavers. The proximal and distal hamstring tendons were affixed to the mechanical testing machine. Slack length was defined as the muscle length at the initial loading point detected upon the application of a tensile load. Muscle length was measured using a tape measure, and the anatomical cross-sectional area (ACSA) of the muscle was measured at the proximal and distal sites using B-mode ultrasonography. In the loading protocol, the muscle was elongated from its slack length to a maximum of 8% strain at an average rate of 0.83 L0/s, and the amount of displacement and tensile load were measured for each muscle. Further, the strain (%, displacement/slack muscle length) and stress (kPa, tensile load/ACSA) were calculated to evaluate the mechanical properties. Two-way repeated-measures analysis of variance (ANOVA) was used to compare stress changes with increasing muscle strain. A significant interaction between the muscle and strain factors was observed with respect to stress. Post-hoc tests revealed higher stresses in the BFlh and SM than in ST after 3% strain (P < 0.01). However, no significant differences were observed between the BFlh and SM groups. At 8% strain, the BFlh, SM, and ST exhibited stresses of 63.7 ± 12.1, 53.7 ± 23.2, and 21.0 ± 11.9 kPa, respectively. The results indicate that the stress changes associated with muscle strain differed among muscles. In particular, the stress applied to the three muscles at the same strain was found to be higher in the BFlh and SM. Thus, these findings suggest that increased mechanical stress during elongation may contribute to the frequent occurrence of muscle strain in BFlh and SM.
Collapse
Affiliation(s)
- Gakuto Nakao
- Graduate School of Health Sciences, Sapporo Medical University, Sapporo, Japan; Sapporo Medical Technology, Welfare and Dentistry Professional Training College of Nishino Gakuen School Foundation, Sapporo, Japan
| | - Taiki Kodesho
- Department of Sport Science and Research, Japan Institute of Sports Sciences (JISS), Tokyo, Japan
| | - Kazuma Yamagata
- Graduate School of Health Sciences, Sapporo Medical University, Sapporo, Japan
| | - Kota Watanabe
- Department of Physical Therapy, School of Health Sciences, Sapporo Medical University, Sapporo, Japan
| | - Yuki Ohsaki
- Department of Anatomy (I), School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Masaki Katayose
- Department of Physical Therapy, School of Health Sciences, Sapporo Medical University, Sapporo, Japan
| | - Keigo Taniguchi
- Department of Physical Therapy, School of Health Sciences, Sapporo Medical University, Sapporo, Japan.
| |
Collapse
|
6
|
Romero Corrêa R, Peres Mendes R, Darley Velasquez Piñeros D, De Lima AE, do Valle De Zoppa AL, Lopes Correia da Silva LC, de Francisco Strefezzi R, de Freitas SH. Gross, organoleptic and histologic assessment of cadaveric equine heads preserved using chemical methods for veterinary surgical teaching. J Vet Sci 2024; 25:e29. [PMID: 38568830 PMCID: PMC10990915 DOI: 10.4142/jvs.23176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/11/2023] [Accepted: 11/01/2023] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Preservation of biological tissues has been used since ancient times. Regardless of the method employed, tissue preservation is thought to be a vital step in veterinary surgery teaching and learning. OBJECTIVES This study was designed to determine the usability of chemically preserved cadaveric equine heads for surgical teaching in veterinary medicine. METHODS Six cadaveric equine heads were collected immediately after death or euthanasia and frozen until fixation. Fixation was achieved by using a hypertonic solution consisting of sodium chloride, sodium nitrite and sodium nitrate, and an alcoholic solution containing ethanol and glycerin. Chemically preserved specimens were stored at low temperatures (2°C to 6°C) in a conventional refrigerator. The specimens were submitted to gross and organoleptic assessment right after fixative solution injection (D0) and within 10, 20, and 30 days of fixation (D10, D20, and D30, respectively). Samples of tissue from skin, tongue, oral vestibule, and masseter muscle were collected for histological evaluation at the same time points. RESULTS Physical and organoleptic assessments revealed excellent specimen quality (mean scores higher than 4 on a 5-point scale) in most cases. In some specimens, lower scores (3) were assigned to the range of mouth opening, particularly on D0 and D10. A reduced the range of mouth opening may be a limiting factor in teaching activities involving structures located in the oral cavity. CONCLUSIONS The excellent physical, histologic, and organoleptic characteristics of the specimens in this sample support their usability in teaching within the time frame considered. Appropriate physical and organoleptic characteristics (color, texture, odor, and flexibility) of the specimens in this study support the use of the method described for preparation of reusable anatomical specimens.
Collapse
Affiliation(s)
- Rodrigo Romero Corrêa
- Department of Surgery, School of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, SP 05508-270, Brazil
| | - Rubens Peres Mendes
- Department of Surgery, School of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, SP 05508-270, Brazil.
| | - Diego Darley Velasquez Piñeros
- Department of Surgery, School of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, SP 05508-270, Brazil
| | - Aymara Eduarda De Lima
- Department of Surgery, School of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, SP 05508-270, Brazil
| | - André Luis do Valle De Zoppa
- Department of Surgery, School of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, SP 05508-270, Brazil
| | | | - Ricardo de Francisco Strefezzi
- Department of Veterinary Medicine, Faculty of Animal Science and Food Engineering, University of São Paulo, Pirassununga, SP 13635-900, Brazil
| | - Silvio Henrique de Freitas
- Department of Veterinary Medicine, Faculty of Animal Science and Food Engineering, University of São Paulo, Pirassununga, SP 13635-900, Brazil
| |
Collapse
|
7
|
Kehrer A, Engelmann S, Knoedler L, Klein SM, Anker AM, Heidekrueger P, Tamm E, Bleys RL, Prantl L, Ruewe M. The masseteric nerve for facial reanimation: Macroscopic and histomorphometric characteristics in 106 human cadavers and comparison of axonal ratio with recipient nerves. J Craniomaxillofac Surg 2024; 52:8-13. [PMID: 38129186 DOI: 10.1016/j.jcms.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 09/05/2023] [Indexed: 12/23/2023] Open
Abstract
Peripheral facial palsy causes severe impairments. Sufficient axonal load is critical for adequate functional outcomes in reanimation procedures. The aim of our study was to attain a better understanding of the anatomy of the masseteric nerve as a donor, in order to optimize neurotization procedures. Biopsies were obtained from 106 hemifaces of fresh frozen human cadavers. Histological cross-sections were fixed, stained with PPD, and digitized. Histomorphometry and a validated software-based axon quantification were conducted. Of the 154 evaluated branches, 74 specimens were of the main trunk (MT), 40 of the anterior branch (AB), and 38 of the descending branch (DB), while two halves of one cadaver featured an additional branch. The MT showed a diameter of 1.4 ± 0.41 mm (n = 74) with 2213 ± 957 axons (n = 55). The AB diameter was 0.9 ± 0.33 mm (n = 40) with 725 ± 714 axons (n = 30). The DB diameter was 1.15 ± 0.34 mm (n = 380) with 1562 ± 926 axons (n = 30). The DB demonstrated a high axonal capacity - valuable for nerve transfers or muscle transplants. Our findings should facilitate a balanced selection of axonal load, and are potentially helpful in achieving more predictable results while preserving masseter muscle function.
Collapse
Affiliation(s)
- Andreas Kehrer
- Department of Plastic, Hand, and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany.
| | - Simon Engelmann
- Department of Plastic, Hand, and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Leonard Knoedler
- Department of Plastic, Hand, and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Silvan M Klein
- Department of Plastic, Hand, and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Alexandra M Anker
- Department of Plastic, Hand, and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Paul Heidekrueger
- Department of Plastic, Hand, and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Ernst Tamm
- Department of Human Anatomy and Embryology, University of Regensburg, Regensburg, Germany
| | - Ronald Law Bleys
- Department of Anatomy, University Medical Center (UMC) Utrecht, Utrecht, Netherlands
| | - Lukas Prantl
- Department of Plastic, Hand, and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Marc Ruewe
- Department of Plastic, Hand, and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| |
Collapse
|
8
|
Valls-Esteve A, Tejo-Otero A, Adell-Gómez N, Lustig-Gainza P, Fenollosa-Artés F, Buj-Corral I, Rubio-Palau J, Munuera J, Krauel L. Advanced Strategies for the Fabrication of Multi-Material Anatomical Models of Complex Pediatric Oncologic Cases. Bioengineering (Basel) 2023; 11:31. [PMID: 38247908 PMCID: PMC10813349 DOI: 10.3390/bioengineering11010031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/01/2023] [Accepted: 12/06/2023] [Indexed: 01/23/2024] Open
Abstract
The printing and manufacturing of anatomical 3D models has gained popularity in complex surgical cases for surgical planning, simulation and training, the evaluation of anatomical relations, medical device testing and patient-professional communication. 3D models provide the haptic feedback that Virtual or Augmented Reality (VR/AR) cannot provide. However, there are many technologies and strategies for the production of 3D models. Therefore, the aim of the present study is to show and compare eight different strategies for the manufacture of surgical planning and training prototypes. The eight strategies for creating complex abdominal oncological anatomical models, based on eight common pediatric oncological cases, were developed using four common technologies (stereolithography (SLA), selectie laser sinterning (SLS), fused filament fabrication (FFF) and material jetting (MJ)) along with indirect and hybrid 3D printing methods. Nine materials were selected for their properties, with the final models assessed for application suitability, production time, viscoelastic mechanical properties (shore hardness and elastic modulus) and cost. The manufacturing and post-processing of each strategy is assessed, with times ranging from 12 h (FFF) to 61 h (hybridization of FFF and SLS), as labor times differ significantly. Cost per model variation is also significant, ranging from EUR 80 (FFF) to EUR 600 (MJ). The main limitation is the mimicry of physiological properties. Viscoelastic properties and the combination of materials, colors and textures are also substantially different according to the strategy and the intended use. It was concluded that MJ is the best overall option, although its use in hospitals is limited due to its cost. Consequently, indirect 3D printing could be a solid and cheaper alternative.
Collapse
Affiliation(s)
- Arnau Valls-Esteve
- Innovation Department, SJD Barcelona Children’s Hospital, Santa Rosa 39-57, 08950 Esplugues de Llobregat, Spain
- Medicina i Recerca Translacional, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, 08007 Barcelona, Spain
- 3D Unit (3D4H), SJD Barcelona Children’s Hospital, Santa Rosa 39-57, 08950 Esplugues de Llobregat, Spain
| | - Aitor Tejo-Otero
- Centre CIM, Universitat Politècnica de Catalunya (CIM UPC), Carrer de Llorens i Artigas, 12, 08028 Barcelona, Spain
| | - Núria Adell-Gómez
- Innovation Department, SJD Barcelona Children’s Hospital, Santa Rosa 39-57, 08950 Esplugues de Llobregat, Spain
- 3D Unit (3D4H), SJD Barcelona Children’s Hospital, Santa Rosa 39-57, 08950 Esplugues de Llobregat, Spain
| | - Pamela Lustig-Gainza
- Innovation Department, SJD Barcelona Children’s Hospital, Santa Rosa 39-57, 08950 Esplugues de Llobregat, Spain
- 3D Unit (3D4H), SJD Barcelona Children’s Hospital, Santa Rosa 39-57, 08950 Esplugues de Llobregat, Spain
| | - Felip Fenollosa-Artés
- Centre CIM, Universitat Politècnica de Catalunya (CIM UPC), Carrer de Llorens i Artigas, 12, 08028 Barcelona, Spain
- Department of Mechanical Engineering, Barcelona School of Industrial Engineering (ETSEIB), Universitat Politècnica de Catalunya, Av. Diagonal, 647, 08028 Barcelona, Spain
| | - Irene Buj-Corral
- Department of Mechanical Engineering, Barcelona School of Industrial Engineering (ETSEIB), Universitat Politècnica de Catalunya, Av. Diagonal, 647, 08028 Barcelona, Spain
| | - Josep Rubio-Palau
- Medicina i Recerca Translacional, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, 08007 Barcelona, Spain
- 3D Unit (3D4H), SJD Barcelona Children’s Hospital, Santa Rosa 39-57, 08950 Esplugues de Llobregat, Spain
- Pediatric Surgical Oncology, Pediatric Surgery Department, SJD Barcelona Children’s Hospital, Universitat de Barcelona, 08950 Barcelona, Spain
- Maxillofacial Unit, Department of Pediatric Surgery, Pediatric Surgical Oncology, SJD Barcelona Children’s Hospital, Universitat de Barcelona, 08950 Barcelona, Spain
| | - Josep Munuera
- Medicina i Recerca Translacional, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, 08007 Barcelona, Spain
- Diagnostic Imaging Department, Hospital de la Santa Creu i Sant Pau, 08027 Barcelona, Spain
- Advanced Medical Imaging, Artificial Intelligence, and Imaging-Guided Therapy Research Group, Institut de Recerca Sant Pau—Centre CERCA, 08041 Barcelona, Spain
| | - Lucas Krauel
- Medicina i Recerca Translacional, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, 08007 Barcelona, Spain
- 3D Unit (3D4H), SJD Barcelona Children’s Hospital, Santa Rosa 39-57, 08950 Esplugues de Llobregat, Spain
- Pediatric Surgical Oncology, Pediatric Surgery Department, SJD Barcelona Children’s Hospital, Universitat de Barcelona, 08950 Barcelona, Spain
| |
Collapse
|
9
|
Wheatley BB, Dyer OL, Tully EE, Seeley MA. Aponeurosis structure-function properties: Evidence of heterogeneity and implications for muscle function. Acta Biomater 2023; 168:298-308. [PMID: 37392931 DOI: 10.1016/j.actbio.2023.06.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/29/2023] [Accepted: 06/26/2023] [Indexed: 07/03/2023]
Abstract
Aponeurosis is a sheath-like connective tissue that aids in force transmission from muscle to tendon and can be found throughout the musculoskeletal system. The key role of aponeurosis in muscle-tendon unit mechanics is clouded by a lack of understanding of aponeurosis structure-function properties. This work aimed to determine the heterogeneous material properties of porcine triceps brachii aponeurosis tissue with materials testing and evaluate heterogeneous aponeurosis microstructure with scanning electron microscopy. We found that aponeurosis may exhibit more microstructural collagen waviness in the insertion region (near the tendon) compared to the transition region (near the muscle midbelly) (1.20 versus 1.12, p = 0.055), which and a less stiff stress-strain response in the insertion versus transition regions (p < 0.05). We also showed that different assumptions of aponeurosis heterogeneity, specifically variations in elastic modulus with location can alter the stiffness (by more than 10x) and strain (by approximately 10% muscle fiber strain) of a finite element model of muscle and aponeurosis. Collectively, these results suggest that aponeurosis heterogeneity could be due to variations in tissue microstructure and that different approaches to modeling tissue heterogeneity alters the behavior of computational models of muscle-tendon units. STATEMENT OF SIGNIFICANCE: Aponeurosis is a connective tissue found in many muscle tendon units that aids in force transmission, yet little is known about the specific material properties of aponeurosis. This work aimed to determine how the properties of aponeurosis tissue varied with location. We found that aponeurosis exhibits more microstructural waviness near the tendon compared to near the muscle midbelly, which was associated with differences in tissue stiffness. We also showed that different variations in aponeurosis modulus (stiffness) can alter the stiffness and stretch of a computer model of muscle tissue. These results show that assuming uniform aponeurosis structure and modulus, which is common, may lead to inaccurate models of the musculoskeletal system.
Collapse
Affiliation(s)
| | | | - Emily E Tully
- Department of Mechanical Engineering, Bucknell University, Lewisburg, PA
| | | |
Collapse
|
10
|
Nakao G, Kodesho T, Kato T, Yokoyama Y, Saito Y, Ohsaki Y, Watanabe K, Katayose M, Taniguchi K. Relationship between shear elastic modulus and passive muscle force in human hamstring muscles using a Thiel soft-embalmed cadaver. J Med Ultrason (2001) 2023; 50:275-283. [PMID: 37170041 PMCID: PMC10954965 DOI: 10.1007/s10396-023-01317-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/12/2023] [Indexed: 05/13/2023]
Abstract
PURPOSE Assessing muscle flexibility and architecture is important for hamstring strain injury (HSI) prevention. We investigated the relationship between shear modulus and passive force in hamstring muscles at different sites and the effect of muscle architecture on the slope of the shear modulus-passive force using shear wave elastography (SWE). METHODS The biceps femoris long head (BFlh), semitendinosus (ST), and semimembranosus (SM) muscles were dissected from nine Thiel-embalmed cadavers and fixed to a custom-made mechanical testing machine. Calibrated weights (0-1800 g) were applied gradually in 150-g increments. The shear modulus and anatomical cross-sectional area (ACSA) were measured at proximal, central, and distal points using SWE. The muscle mass and length were measured before the loading test. The shear modulus-passive load relationship of each tested muscle region was analyzed by fitting a least-squares regression line. The increase in shear modulus slope per unit load was calculated and compared between the muscles before and after normalization by the muscle mass, length, and ACSA. RESULTS The shear modulus and passive force for all hamstring muscles in each region showed a statistically significant linear correlation. Furthermore, the increase in shear modulus slope was greater for BFlh and ST than for SM (P < 0.05), but after normalization by the muscle length and ACSA, there were no significant differences among the muscles. CONCLUSION The local mechanical properties of individual hamstring muscles can be indirectly estimated using SWE, and the slope of increase in shear modulus reflects characteristics of the muscle architecture.
Collapse
Affiliation(s)
- Gakuto Nakao
- Graduate School of Health Sciences, Sapporo Medical University, Sapporo, Japan
- Professional Post-Secondary Course (Physical Therapist), Sapporo Medical Technology, Welfare and Dentistry Professional Training College of Nishino Gakuen School Foundation, Sapporo, Japan
| | - Taiki Kodesho
- Graduate School of Health Sciences, Sapporo Medical University, Sapporo, Japan
| | - Takuya Kato
- Department of Rehabilitation, Hitsujigaoka Hospital, Sapporo, Japan
| | - Yu Yokoyama
- Department of Rehabilitation, Heiseikai Hospital, Sapporo, Japan
| | - Yuhei Saito
- Graduate School of Health Sciences, Sapporo Medical University, Sapporo, Japan
| | - Yuki Ohsaki
- First Division of Anatomy, School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Kota Watanabe
- Department of Physical Therapy, School of Health Sciences, Sapporo Medical University, South-1, West-17, Chuo-Ku, Sapporo, Hokkaido, 060-8556, Japan
| | - Masaki Katayose
- Department of Physical Therapy, School of Health Sciences, Sapporo Medical University, South-1, West-17, Chuo-Ku, Sapporo, Hokkaido, 060-8556, Japan
| | - Keigo Taniguchi
- Department of Physical Therapy, School of Health Sciences, Sapporo Medical University, South-1, West-17, Chuo-Ku, Sapporo, Hokkaido, 060-8556, Japan.
| |
Collapse
|
11
|
Schmiedl A, Buchhorn A, Schönberger M. The relationship between the subclavian vessels and brachial plexus and the overlying clavicle: Anatomical study with application to plate osteosynthesis. Clin Anat 2023; 36:377-385. [PMID: 36104939 DOI: 10.1002/ca.23948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 07/12/2022] [Accepted: 08/30/2022] [Indexed: 11/05/2022]
Abstract
A subclavian artery aneurysm after clavicle fracture and plate osteosynthesis in a suspected case of a screw that was too long led us to investigate body donor cadavers. The aim was to verify clavicle variability, and the course of the neurovascular bundle in relation to the clavicle and to the osteosynthesis plate, in order to clarify safe zones for plate and screw fixation. We used one fresh frozen and 25 embalmed donors for in situ measurements: (1) length and craniocaudal thickness of the clavicle, (2) distances between the sternal end of the clavicle and the center of parts of the neurovascular bundle. The clavicle was 15.15 cm long. The mean distances from the sternal end of the clavicle were 5.62 cm to the subclavian vein, 6.75 cm to the subclavian artery and 8.42 cm to the cords of the brachial plexus. The subclavius muscle was 1 cm thick. Because of sex differences in length and distances, we recorded the distances between the sternal end and parts of the neurovascular bundle as ratios of clavicle length (at-risk area) to provide sex-independent parameters: 0.379 for the vein, 0.449 for the artery and 0.554 for the nerve. The neurovascular bundle runs below the clavicle between the medial fourth and three fifths of clavicle length. To avoid iatrogenic neurovascular injuries, special caution is necessary during drilling and screwing the osteosynthesis. We also recommend using screws shorter than 1.4 cm.
Collapse
Affiliation(s)
- Andreas Schmiedl
- Institute of Functional and Applied Anatomy, Hannover Medical School, Carl-Neuberg-Straße 1, Hannover, Germany
| | - Andreas Buchhorn
- Institute of Functional and Applied Anatomy, Hannover Medical School, Carl-Neuberg-Straße 1, Hannover, Germany
| | - Michael Schönberger
- Arbitration Board for Medical Liability Issues of the North German Medical Associations, Hannover, Germany
| |
Collapse
|
12
|
Sternocleidomastoid Muscle in Fetuses: Classification, Morphometric Analysis, and Clinical Significance. J Craniofac Surg 2023; 34:1106-1110. [PMID: 36872466 DOI: 10.1097/scs.0000000000009211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 11/14/2022] [Indexed: 03/07/2023] Open
Abstract
PURPOSE This study aimed to examine variations and morphometric properties of the sternocleidomastoid muscle (SCM) in fetuses in terms of infancy and early childhood surgeries. MATERIALS AND METHODS Neck regions of 27 fetuses (mean age: 23.30±3.40 wk, sex: 11 boys and 16 girls) fixed with 10% formalin were dissected bilaterally. Photographs of the dissected fetuses were taken in the standard position. Morphometric measurements, such as length, width, and angle, were performed on the photographs using the ImageJ software. In addition, the origin and insertion of SCM were detected. Taking into account the studies in the literature, a classification consisting of 10 types associated with the origin of SCM was carried out. RESULTS No statistically significant difference was observed in the parameters in terms of side and sex (P>0.05), except from the linear distance between the clavicle and motor point where the accessory nerve enters SCM (20.10±3.76 for male, 17.53±4.05 for female, P=0.022). Two-headed SCM (Type 1) was detected in 42 out of 54 sides. Two-headed clavicular head (Type 2a) was detected on 9 sides, and 3-headed (Type 2b) on 1 side. A 2-headed sternal head (Type 3) was detected on 1 side. A single-headed SCM (Type 5) was also detected on 1 side. CONCLUSION Knowledge related to variations of the origin and insertion of fetal SCM may be helpful in preventing complications during treatments of pathologies such as congenital muscular torticollis in early period of life. Moreover, the calculated formulas may be useful to estimate the size of SCM in newborns.
Collapse
|
13
|
West C, Norrish A, Brassett C, Pasapula C. Evaluation of the heel external rotation test in soft tissue deficiencies associated with adult acquired flatfoot deformity (AAFD). A cadaver sectioning analysis. Foot (Edinb) 2023; 55:101984. [PMID: 36867947 DOI: 10.1016/j.foot.2023.101984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 02/15/2023] [Accepted: 02/18/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND To date, evaluation of the heel external rotation test has not been taken with respect to AAFD. Traditional 'gold standard' tests do not account for the contribution of the midfoot ligaments towards instability. These tests would be flawed as any midfoot instability may produce a false positive result. AIMS To evaluate the differential contribution of the spring, deltoid and other local ligaments in external rotation generated at the heel. METHODS Serial ligament sectioning was performed on 16 cadaveric specimens, with a 40 N-external rotation force applied to the heel. These were divided into four groups with different sequences of ligament sectioning. Measurements of the total amount/range of external, tibiotalar and subtalar rotation were made. RESULTS The deep component of the deltoid ligament (DD) was the main ligament influencing heel external rotation (P < 0.05, in all cases), and acted primarily at the tibiotalar joint (87.9 %). The spring ligament (SL) influenced heel external rotation predominantly (91.2 %) at the subtalar joint (STJ). Greater than 20 degrees external rotation could only be achieved with DD sectioning. The interosseous (IO) and cervical (CL) ligaments did not significantly contribute to external rotation at either joint (P > 0.05). CONCLUSION Clinically relevant external rotation (>20 degrees) is solely attributable to DD failure in the presence of intact lateral ligaments (LL). This test may improve detection of DD instability and allow clinicians to subclassify patients with Stage 2 AAFD into those where DD may or may not be compromised.
Collapse
Affiliation(s)
- Cavan West
- School of Clinical Medicine, University of Cambridge, Cambridge, UK.
| | - Alan Norrish
- Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, King's Lynn, Norfolk, UK; Academic Orthopaedics, Trauma and Sports Medicine, School of Medicine and Health Sciences, University of Nottingham, UK
| | - Cecilia Brassett
- Human Anatomy Centre, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - Chandra Pasapula
- Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, King's Lynn, Norfolk, UK
| |
Collapse
|
14
|
Li Y, Adanty K, Vette A, Vakiel P, Ouellet S, Raboud DW, Dennison C. Review of Mechanisms and Research Methods for Blunt Ballistic Head Injury. J Biomech Eng 2022; 145:1145669. [PMID: 35993786 DOI: 10.1115/1.4055289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Indexed: 11/08/2022]
Abstract
Head injuries account for 15% to 20% of all military injuries and pose a high risk of causing functional disability and fatality. Blunt ballistic impacts are one of the threats that can lead to severe head injuries. This review aims to examine the mechanisms and injury risk assessment associated with blunt ballistic head injury (BBHI). The review further discusses research methods and instrumentation used in BBHI studies, focusing on their limitations and challenges. Studies on the mechanisms of focal and diffuse brain injuries remain largely inconclusive and require further efforts. Some studies have attempted to associate BBHIs with head mechanics, but more research is required to establish correlations between head mechanics and injury severity. Limited access to experimental models and a lack of instrumentation capable of measuring the mechanics of brain tissue in-situ are potential reasons for the lack of understanding of injury mechanisms, injury correlations and injury tolerance levels specific to this loading regime. Targeted research for understanding and assessing head injuries in blunt ballistic impacts is a necessary step in improving our ability to design protection systems to mitigate these injuries.
Collapse
Affiliation(s)
- Yizhao Li
- Biomedical Instrumentation Lab, Department of Mechanical Engineering, University of Alberta, Edmonton, AB, Canada, T6G 1H9
| | - Kevin Adanty
- Department of Mechanical Engineering, University of Alberta, Edmonton, AB, Canada, T6G 1H9
| | - Albert Vette
- Faculty of Electrical Engineering, Kempten University of Applied Sciences,Bahnhofstrasse 61, 87435 Kempten (Allgäu), Germany; Department of Mechanical Engineering, University of Alberta, Edmonton, AB, Canada, T6G 1H9
| | - Paris Vakiel
- Department of Mechanical Engineering, University of Victoria, Victoria, BC, Canada, V8P 5C2; School of Biomedical Engineering, University of British Columbia, Vancouver, BC, Canada, V5Z 1M9
| | - Simon Ouellet
- Weapons Effects and Protection Section, Defence R&D Valcartier Research Centre, Quebec, QC, Canada, G3J 1X5
| | - Don W Raboud
- Department of Mechanical Engineering, University of Alberta, Edmonton, AB, Canada, T6G 1H9
| | - Christopher Dennison
- Department of Mechanical Engineering, University of Victoria, Victoria, BC, Canada, V8P 5C2
| |
Collapse
|
15
|
Song YK, Jo DH. Current and potential use of fresh frozen cadaver in surgical training and anatomical education. ANATOMICAL SCIENCES EDUCATION 2022; 15:957-969. [PMID: 34538016 DOI: 10.1002/ase.2138] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 09/15/2021] [Accepted: 09/15/2021] [Indexed: 05/22/2023]
Abstract
As surgical procedures continue to be more complex, the need for more effective training in anatomy has increased. The study of anatomy plays a significant role in the understanding of the human body as well as in basic and advanced clinical training. Among the different cadaver models, fresh frozen cadavers (FFCs) are known for their realistic tissue quality. The purpose of this article was to review and summarize the preparation procedures for and reported cases involving FFCs. PubMed, Scopus, Medline, and Web of Science were searched for relevant studies. The preparation procedures were divided into five steps: washing, irrigation, freezing, defrosting, and arterial infusion. Not all steps were reported to be mandatory, but omitting one or more could result in a loss of quality. FFCs were reported to be used for various purposes: undergraduate education, general surgery training, vascular surgery training, minimal access surgery (laparoscopic surgery) training, and microsurgery training. In all categories, expert opinions and statistical analyses indicated successful outcomes. The reasons for high satisfaction with FFCs included realistic texture, capability of reenacting actual operations, and accuracy of anatomical locations. The results also revealed the importance and advantages of the dissection courses in surgical training. Since the direct comparison between cadaver models is insufficient, future studies regarding this topic are deemed necessary. In addition, it would be advantageous to develop methods to improve FFC quality, or ideas to optimize this model for certain purposes.
Collapse
Affiliation(s)
- Yong Keun Song
- Department of Preliminary Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Dong Hyun Jo
- Department of Anatomy and Cell Biology, Seoul National University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
16
|
Segond N, Bellier A, Duhem H, Sanchez C, Busi O, Deutsch S, Aguilera L, Truan D, Koch FX, Viglino D, Debaty G. Supraglottic airway device to improve ventilation success and reduce pulmonary aspiration during cardio-pulmonary resuscitation by basic life support rescuers: a randomised cross-over human cadaver study. PREHOSP EMERG CARE 2022:1-9. [PMID: 35543652 DOI: 10.1080/10903127.2022.2075994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objectives: Early airway management during cardiopulmonary resuscitation (CPR) prevents aspiration of gastric contents. Endotracheal intubation is the gold standard to protect airways, but supraglottic airway devices (SGA) may provide some protection with less training. Bag-mask ventilation (BMV) is the most common method used by rescuers. We hypothesized that SGA use by first rescuers during CPR could increase ventilation success rate and also decrease intragastric pressure and pulmonary aspiration.Methods: We performed a randomized cross-over experimental trial on human cadavers. Protocol A: we assessed the rate of successful ventilation (chest rise), intragastric pressure, and CPR key time metrics. Protocol B: cadaver stomachs were randomized to be filled with 300 mL of either blue or green serum saline solution through a Foley catheter. Each rescuer was randomly assigned to use SGA or BMV during a 5-minute standard CPR period. Then, in a crossover design, the stomach was filled with the second colour solution and another 5-minute CPR period was performed using the other airway method. Pulmonary aspiration, defined as the presence of coloured solution below the vocal cords, was assessed by a blinded operator using bronchoscopy. A generalized linear mixed model was used for statistical analysis.Results: Protocol A: Forty-eight rescuers performed CPR on 11 cadavers. Median ventilation success was higher with SGA than BMV: 75.0% (IQR: 59.8-87.3) vs. 34.7% (IQR: 25.0-50.0), (p = 0.003). Gastric pressure and differential (maximum minus minimum) gastric pressure were lower in the SGA group: 2.21 mmHg (IQR: 1.66; 2.68) vs. 3.02 mmHg (IQR: 2.02; 4.22) (p = 0.02) and 5.70 mmHg (IQR: 4.10; 7.60) vs. 8.05 mmHg (IQR: 5.40; 11.60) (p = 0.05). CPR key times were not different between groups. Protocol B: Ten cadavers were included with 20 CPR periods. Aspiration occurred in 2 (20%) SGA procedures and 5 (50%) BMV procedures (p = 0.44).Conclusion: Use of SGA by rescuers improved the ventilation success rate, decreased intragastric pressure, and did not affect key CPR metrics. SGA use by basic life support rescuers appears feasible and efficient.
Collapse
Affiliation(s)
- N Segond
- Emergency Department and Mobile Intensive Care Unit, University Hospital of Grenoble Alpes, Grenoble, France.,CNRS TIMC Laboratory, UMR 5525, Univ. Grenoble Alpes, Grenoble, France
| | - A Bellier
- CNRS TIMC Laboratory, UMR 5525, Univ. Grenoble Alpes, Grenoble, France.,LADAF-Laboratoire d'Anatomie Des Alpes Françaises, Univ. Grenoble Alpes, Grenoble, France
| | - H Duhem
- Emergency Department and Mobile Intensive Care Unit, University Hospital of Grenoble Alpes, Grenoble, France.,CNRS TIMC Laboratory, UMR 5525, Univ. Grenoble Alpes, Grenoble, France
| | - C Sanchez
- Emergency Department and Mobile Intensive Care Unit, University Hospital of Grenoble Alpes, Grenoble, France
| | - O Busi
- Emergency Department and Mobile Intensive Care Unit, University Hospital of Grenoble Alpes, Grenoble, France
| | - S Deutsch
- Emergency Department and Mobile Intensive Care Unit, University Hospital of Grenoble Alpes, Grenoble, France
| | - L Aguilera
- Emergency Department and Mobile Intensive Care Unit, University Hospital of Grenoble Alpes, Grenoble, France
| | - D Truan
- Emergency Department and Mobile Intensive Care Unit, University Hospital of Grenoble Alpes, Grenoble, France
| | - F X Koch
- Emergency Department and Mobile Intensive Care Unit, University Hospital of Grenoble Alpes, Grenoble, France
| | - D Viglino
- Emergency Department and Mobile Intensive Care Unit, University Hospital of Grenoble Alpes, Grenoble, France.,INSERM U1300, HP2 Laboratory, Univ. Grenoble Alpes, Grenoble, France
| | - G Debaty
- Emergency Department and Mobile Intensive Care Unit, University Hospital of Grenoble Alpes, Grenoble, France.,CNRS TIMC Laboratory, UMR 5525, Univ. Grenoble Alpes, Grenoble, France
| |
Collapse
|
17
|
Suzuki T, Suzuki-Narita M, Kubota K, Mori C. Updates on cadaver surgical training in Japan: a systematic facility at Chiba University. Anat Sci Int 2022; 97:251-263. [PMID: 35522373 PMCID: PMC9073481 DOI: 10.1007/s12565-022-00667-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 04/11/2022] [Indexed: 11/21/2022]
Abstract
Cadaver surgical training (CST), which ensures medical safety by improving the skills of surgeons, is popular overseas. However, training involves ethical issues given the use of cadavers. In 2012, the Japan Surgical Society and the Japanese Association of Anatomists compiled and opened the “Guidelines for Cadaver Dissection in Education and Research of Clinical Medicine (Guideline 2012)” to the public. This has allowed Japan to conduct CST or research under the regulations of Postmortem Examination and Corpse Preservation Act and the Body Donation Act. However, its dissemination has been sluggish. The Clinical Anatomy Lab (CAL), established in 2010 at Chiba University, is a facility for conducting CST and research. In the 11 years since its inception, 250 programs have been implemented. Orthopedics had the most implemented in the clinical field, with 120 (48%), followed by emergency and critical care medicine with 27 (10.8%), and neurological surgery with 27 (10. 8%). Based on the purpose of the training, the most common objective for the programs (approximately 83%) was education. Further, the highest number of programs was recorded in 2018 (34) and participants in 2017 (631). The implementation of CST requires more than just guiding surgeons to a dissection practice room. There are several methods of preserving cadavers to make them suitable for CST. For various surgical simulations, an operating table is more suitable than a dissection table. The current paper provides information on how to implement CST in universities that have so far only worked on anatomy education for medical students.
Collapse
Affiliation(s)
- Takane Suzuki
- Department of Bioenvironmental Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
| | - Miyako Suzuki-Narita
- Department of Bioenvironmental Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Kenji Kubota
- Department of Bioenvironmental Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Chisato Mori
- Department of Bioenvironmental Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| |
Collapse
|
18
|
Kato T, Taniguchi K, Kodesho T, Nakao G, Yokoyama Y, Saito Y, Katayose M. Adductor longus: An anatomical study to better understand groin pain. Clin Anat 2022; 35:867-872. [PMID: 35393703 DOI: 10.1002/ca.23881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION We investigated the shear modulus-passive force relationship in the hip adductor longus (AL) muscles of human cadavers and explored the effect of muscle architecture on the elastic properties of the AL muscle using shear wave elastography (SWE). MATERIALS AND METHODS Nine AL muscles were harvested from a soft, embalmed cadaver. The AL muscles were affixed to a custom-built device comprising two clamps, a pulley, and a cable to provide passive loads, which were increased from 0 to 600 g in 60-g increments. The shear modulus of the AL muscle was measured in the proximal (Pro), middle (Mid), and distal (Dis) regions. The masses and anatomical cross-sectional areas (ACSAs) of the AL muscles were measured. The shear modulus-passive load relationship of each tested muscle region was analyzed by fitting a least-squares regression line. Moreover, the rate of increase in the shear modulus per unit load (s) was calculated. RESULTS The shear modulus and passive force were linearly correlated for all AL muscles in each region (P<0.01). The mean coefficients of determination (R2 ) for Pro, Mid, and Dis were 0.989, 0.986, and 0.982, respectively. The rate of increase in the shear modulus per unit load significantly correlated with the reciprocal of the muscle mass (r=0.77, P=0.02) and ACSA (r=0.43, P=0.03). CONCLUSION Shear wave elastography can be used as an indirect measure of passive force in any region of the AL muscle. Additionally, the rate of increase in the shear modulus per unit load could be associated with muscle architectural parameters. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Takuya Kato
- Graduate School of Health Sciences, Sapporo Medical University, Sapporo, Japan.,Research Fellow of Japan Society for the Promotion of Science, Tokyo, Japan
| | - Keigo Taniguchi
- Department of Physical Therapy, School of Health Sciences, Sapporo Medical University, Sapporo, Japan
| | - Taiki Kodesho
- Graduate School of Health Sciences, Sapporo Medical University, Sapporo, Japan
| | - Gakuto Nakao
- Graduate School of Health Sciences, Sapporo Medical University, Sapporo, Japan
| | - Yu Yokoyama
- Graduate School of Health Sciences, Sapporo Medical University, Sapporo, Japan
| | - Yuhei Saito
- Graduate School of Health Sciences, Sapporo Medical University, Sapporo, Japan
| | - Masaki Katayose
- Department of Physical Therapy, School of Health Sciences, Sapporo Medical University, Sapporo, Japan
| |
Collapse
|
19
|
Efficacy of urea solution reperfusion to a formalin-embalmed cadaver for surgical skills training. Anat Sci Int 2022; 97:264-272. [PMID: 35239164 DOI: 10.1007/s12565-022-00653-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/08/2022] [Indexed: 11/01/2022]
Abstract
Formaldehyde has been traditionally used for embalming human cadavers for gross anatomy education and surgical skills training. However, exposure to formaldehyde negatively affects human health. This study aimed to assess the efficacy of reperfusing urea solution to a formalin-embalmed cadaver for surgical skills training and then investigate the cadaver's tissue elasticity alteration after being soaked into the urea solution. Twelve surgeons evaluated the similarity of tissue characteristics between the cadaver (embalmed by formalin solution and reperfused by urea solution) and a living human body. Furthermore, the tissue formaldehyde content and mechanical properties of the formalin-fixated femoral skin and artery specimens with or without soaking into urea solution were measured. Results showed that the tactile assessment, skin incision, vessel ligation and suture, and decollement were better and more useful in the cadaver reperfused by urea solution than in the cadaver merely fixated by formalin solution. In the urea-reperfused cadaver, the volatilized, or tissue formaldehyde levels declined. The stiffness and Young's modulus of the femoral skin and artery were also lower in the specimen than in the mere formalin-fixated specimen. In conclusion, reperfusion of urea solution to the formalin-fixated cadaver makes anatomical education and surgical skills training more efficient with fewer requirements for cadaver management.
Collapse
|
20
|
Porschke F, Nolte PC, Knye C, Weiss C, Studier-Fischer S, Gruetzner PA, Guehring T, Schnetzke M. Does the Interval Slide Procedure Reduce Supraspinatus Tendon Repair Tension?: A Biomechanical Cadaveric Study. Orthop J Sports Med 2022; 10:23259671211066887. [PMID: 35047647 PMCID: PMC8761884 DOI: 10.1177/23259671211066887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 09/20/2021] [Indexed: 11/17/2022] Open
Abstract
Background The benefits of the interval slide (IS) procedure in retracted rotator cuff tears remain controversial. Purpose The purpose was to evaluate the effect of the IS procedure on repair tension (RT). It was hypothesized that the IS procedure (anterior IS [AIS], posterior IS [PIS], and intra-articular capsular release [CR]) would reduce the RT of a supraspinatus tendon. Study Design Controlled laboratory study. Methods A total of 31 Thiel-embalmed human cadaveric shoulders (mean age, 74 years; range, 68-84 years) were tested. Full-thickness supraspinatus tendon tears were created, and 1 cm of tendon was resected to simulate a retracted defect. Shoulders were randomized into intervention (n = 16) and control (n = 15) groups. In all shoulders, the load during tendon reduction to footprint was measured, an endpoint was defined as maximum tendon lateralization before 50 N was reached, and the RT (load during lateralization to endpoint) of the native tendon (t1) was evaluated. In the intervention group, AIS (t2), PIS (t3), and CR (t4) were performed in order, with RT measurement after each step. In the control group, RT was assessed at the same time points without the intervention. Results A complete reduction of the tendon was not achieved in any of the shoulders. Mean maximum lateralization was 6.7 ± 1.30 mm, with no significant differences between groups. In the intervention group, the overall IS procedure reduced RT about 47.0% (t1 vs t4: 38.7 ± 3.9 vs 20.5 ± 12.3 N; P < .001). AIS reduced RT significantly (t1 vs t2: 38.7 ± 3.9 vs 27.4 ± 10.5 N; P < .001), whereas subsequent PIS (t2 vs t3: 27.4 ± 10.5 vs 23.2 ± 12.4 N; P = .27) and CR (t3 vs t4: 23.2 ± 12.4 vs 20.5 ± 12.3 N; P = .655) did not additionally reduce tension. Comparison between groups at t4 revealed a reduction of RT of about 47.8% (control vs intervention: 39.3 ± 4.0 vs 20.5 ± 12.3 N; P < .001). Conclusion The IS procedure reduces RT of the supraspinatus tendon in human cadaveric shoulders. However, performing PIS and CR subsequent to AIS does not reduce tension additionally. Clinical Relevance These findings provide surgeons with a biomechanical rationale regarding the efficacy of the IS procedure.
Collapse
Affiliation(s)
- Felix Porschke
- BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwigshafen, Germany
| | | | - Christian Knye
- BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwigshafen, Germany
| | - Christel Weiss
- Department of Medical Statistics, University Medicine Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | | | - Paul Alfred Gruetzner
- BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwigshafen, Germany
| | - Thorsten Guehring
- Department of Orthopedic Surgery, Paulinenhilfe, Diakonieklinikum Stuttgart, Stuttgart, Germany
| | | |
Collapse
|
21
|
Asai T, Sakuma E, Mizutani T, Ishizaka Y, Ori K, Ueki T. Sex- and Age-related Differences in Spinal Degeneration: An Anatomical and Magnetic Resonance Imaging Study of the Human Spine. Prog Rehabil Med 2022; 7:20220011. [PMID: 35342836 PMCID: PMC8894105 DOI: 10.2490/prm.20220011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/27/2022] [Indexed: 11/22/2022] Open
Abstract
Objectives: A precise anatomical understanding of the morphology of the spine is indispensable for neck and low back pain therapy including rehabilitation. However, few studies have directly addressed spinal morphology with a focus on the height of the vertebral body and discs. The aim of the current study was to analyze sex- and age-related changes in the spine by measuring the distance between adjacent centers of the intervertebral disc spaces from the posterior aspect in cadavers and by using magnetic resonance imaging (MRI) measurements at the cervical and lumbar vertebral levels. Methods: In the cadaveric study, the posterior distance between the adjacent centers of the disc spaces was measured for 58 spinal canals. The equivalent distances were examined using MRI in 370 and 660 subjects who presented with neck pain and back pain, respectively. Results: The distance between the adjacent centers of the intervertebral disc spaces in male cadavers was larger than that in female cadavers from C3 to L5/S1. The MRI results showed that the distance between the adjacent centers of the intervertebral disc spaces decreased with age in all spinal areas in men and women. Cadaveric values were significantly lower than the MRI values in men, whereas in women, no significant differences were observed. Conclusions: These results suggest that age-related changes in the cervical and lumbar spine are associated with differences between men and women in the degrees of progressive vertebral body and disc degeneration.
Collapse
Affiliation(s)
| | | | | | | | - Koji Ori
- Kouyu Clinic, Ichinomiya, Aichi, Japan
| | - Takatoshi Ueki
- Department of Integrative Anatomy, Graduate School of Medical Sciences, Nagoya-City University, Nagoya, Aichi, Japan
| |
Collapse
|
22
|
Microanatomy of the Frontal Branch of the Facial Nerve: The Role of Nerve Caliber and Axonal Capacity. Plast Reconstr Surg 2021; 148:1357-1365. [PMID: 34705806 DOI: 10.1097/prs.0000000000008586] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND A commonly seen issue in facial palsy patients is brow ptosis caused by paralysis of the frontalis muscle powered by the frontal branch of the facial nerve. Predominantly, static methods are used for correction. Functional restoration concepts include the transfer of the deep temporal branch of the trigeminal nerve and cross-facial nerve grafts. Both techniques can neurotize the original mimic muscles in early cases or power muscle transplants in late cases. Because axonal capacity is particularly important in cross-facial nerve graft procedures, the authors investigated the microanatomical features of the frontal branch to provide the basis for its potential use and to ease intraoperative donor nerve selection. METHODS Nerve biopsy specimens from 106 fresh-frozen cadaver facial halves were obtained. Histologic processing and digitalization were followed by nerve morphometric analysis and semiautomated axon quantification. RESULTS The frontal branch showed a median of three fascicles (n = 100; range, one to nine fascicles). A mean axonal capacity of 1191 ± 668 axons (range, 186 to 3539 axons; n = 88) and an average cross-sectional diameter of 1.01 ± 0.26 mm (range, 0.43 to 1.74 mm; n = 67) were noted. In the linear regression model, diameter and axonal capacity demonstrated a positive relation (n = 57; r2 = 0.32; p < 0.001). Based on that equation, a nerve measuring 1 mm is expected to carry 1339 axons. CONCLUSION The authors' analysis on the microanatomy of the frontal branch could promote clinical use of cross-facial nerve graft procedures in frontalis muscle neurotization and free muscle transplantations.
Collapse
|
23
|
Natale G, Stouthandel MEJ, Van Hoof T, Bocci G. The Lymphatic System in Breast Cancer: Anatomical and Molecular Approaches. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:1272. [PMID: 34833492 PMCID: PMC8624129 DOI: 10.3390/medicina57111272] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 12/30/2022]
Abstract
Breast cancer is one of the most important causes of premature mortality among women and it is one of the most frequently diagnosed tumours worldwide. For this reason, routine screening for prevention and early diagnosis is important for the quality of life of patients. Breast cancer cells can enter blood and lymphatic capillaries, then metastasizing to the regional lymph nodes in the axilla and to both visceral and non-visceral sites. Rather than at the primary site, they seem to enter the systemic circulation mainly through the sentinel lymph node and the biopsy of this indicator can influence the axillary dissection during the surgical approach to the pathology. Furthermore, secondary lymphoedema is another important issue for women following breast cancer surgical treatment or radiotherapy. Considering these fundamental aspects, the present article aims to describe new methodological approaches to assess the anatomy of the lymphatic network in the axillary region, as well as the molecular and physiological control of lymphatic vessel function, in order to understand how the lymphatic system contributes to breast cancer disease. Due to their clinical implications, the understanding of the molecular mechanisms governing lymph node metastasis in breast cancer are also examined. Beyond the investigation of breast lymphatic networks and lymphatic molecular mechanisms, the discovery of new effective anti-lymphangiogenic drugs for future clinical settings appears essential to support any future development in the treatment of breast cancer.
Collapse
Affiliation(s)
- Gianfranco Natale
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
- Museum of Human Anatomy “Filippo Civinini”, University of Pisa, 56126 Pisa, Italy
| | - Michael E. J. Stouthandel
- Department of Human Structure and Repair, Ghent University, 9000 Ghent, Belgium; (M.E.J.S.); (T.V.H.)
| | - Tom Van Hoof
- Department of Human Structure and Repair, Ghent University, 9000 Ghent, Belgium; (M.E.J.S.); (T.V.H.)
| | - Guido Bocci
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy;
| |
Collapse
|
24
|
Guaraná JB, Müller AF, Strefezzi RDF, Oliveira FS, Machado LC, Ambrósio CE, Dória RGS, Freitas SHD. Swine viscera preservation in hypersaturated salt solution after alcohol fixation as a preparation method for educational purposes. Anat Histol Embryol 2021; 50:996-1006. [PMID: 34585765 DOI: 10.1111/ahe.12739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 08/03/2021] [Accepted: 09/08/2021] [Indexed: 11/28/2022]
Abstract
The use of live animals for educational purposes is an old practice that is still employed in teaching and research institutions. However, there are several objections to this practice, whether for ethical or humanitarian reasons. Surgical techniques teaching using anatomical pieces and/or preserved cadavers promotes greater learning efficiency, provides exercise repetition and increases the confidence and satisfaction of the students when compared to the use of live animals. The current work aimed to analyse the feasibility of using fresh swine urinary bladder and small intestines (jejunum), obtained from slaughterhouses, fixed in 99.8% ethyl alcohol (EA) and preserved in sodium chloride hypersaturated solution (SCHS) at 30%, for 7, 14 and 21 days, as an alternative method for surgical skills training (SST). Swine viscera, fixed in EA and preserved in SCHS, presented a realistic appearance, absence of odour and maintained the viable morphological characteristics during the performance of the operative techniques. Preservation solutions had low cost, were easy to acquire and did not offers risks to human health. Therefore, urinary bladders and small intestines fixed in 99.8% EA for 30 days and maintained in 30% SCHS at different periods were demonstrated as a good viable option as a preservation method for surgical skills training.
Collapse
Affiliation(s)
- Julia Belotto Guaraná
- Faculty of Animal Science and Food Engineering, Department of Veterinary Medicine, University of São Paulo (USP), Pirassununga, Brazil
| | - Alois Foltran Müller
- Faculty of Animal Science and Food Engineering, Department of Veterinary Medicine, University of São Paulo (USP), Pirassununga, Brazil
| | - Ricardo de Francisco Strefezzi
- Faculty of Animal Science and Food Engineering, Department of Veterinary Medicine, University of São Paulo (USP), Pirassununga, Brazil
| | - Fabrício Singaretti Oliveira
- Department of Animal Morphology and Physiology, School of Agrarian and Veterinary Sciences, São Paulo State University (Unesp), Jaboticabal, Brazil
| | - Luciana Cristina Machado
- Faculty of Animal Science and Food Engineering, Department of Veterinary Medicine, University of São Paulo (USP), Pirassununga, Brazil
| | - Carlos Eduardo Ambrósio
- Faculty of Animal Science and Food Engineering, Department of Veterinary Medicine, University of São Paulo (USP), Pirassununga, Brazil
| | - Renata Gebara Sampaio Dória
- Faculty of Animal Science and Food Engineering, Department of Veterinary Medicine, University of São Paulo (USP), Pirassununga, Brazil
| | - Silvio Henrique de Freitas
- Faculty of Animal Science and Food Engineering, Department of Veterinary Medicine, University of São Paulo (USP), Pirassununga, Brazil
| |
Collapse
|
25
|
Abstract
OBJECTIVE This study was aimed to obtain data on the dimensions of the optic foramen in human fetuses for early childhood surgeries. METHODS Twenty-five formalin-fixed fetuses (16 boys and 9 girls) with average age 21.68 ± 3.12 gestational weeks (range, 16-28 weeks) in the inventory of Anatomy Department, Faculty of Medicine were included in the study. The surface area, width, and height of the optic foramen were bilaterally measured using a digital image analysis software. RESULTS The forms of the optic foramen were described as oval shaped (72%, 36 foramina) and round shaped (28%, 14 foramina). The surface area, width, and height of the optic foramen were found as 2.40 ± 1.02 mm, 1.83 ± 0.59 mm, and 1.58 ± 0.36 mm, respectively. The measurements of the parameters related to the optic foramen were not statistically different in terms of sides and sexes (P > 0.05). Linear functions for the height, width and surface area of the optic foramen were calculated as: y = 0.711 + 0.040 × weeks, y = -0.019 + 0.086 × weeks, and y = -0.400 + 0.129 × weeks, respectively. CONCLUSION The linear functions in this study can be used to estimate the dimensions of the optic foramen. The calculated regression equations, representing the growth dynamic of the optic foramen showed that the surface area, width, and height were increasing according to gestational ages between 16 and 28 weeks. Microanatomical knowledge related to the optic foramen may be beneficial for surgeons to avoid iatrogenic injury in infants and for anatomists to understand the development of the fetal skull base.
Collapse
|
26
|
Beger O, Vayisoğlu Y, Örs AB, Özdemir DL, Müdüroğlu F, Taghipour P, Dağtekin O, Talas DÜ. Comparison of fetal and adult tympanic membrane sizes: a cadaveric study. Surg Radiol Anat 2021; 43:161-167. [PMID: 33048245 DOI: 10.1007/s00276-020-02593-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 10/03/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The work aimed to compare fetal and adult tympanic membrane (TM) sizes for understanding dimensional development from intrauterine life to adulthood. METHODS Fifty-six temporal bones (18 fetuses, 10 elderly adults, half male and half female in each group) were included in this study. Using a digital image software, the TM height, width and area were measured. RESULTS The mean area, height and width of the TM in adults were found as 58.84 ± 22.01 mm2, 9.06 ± 1.33 mm, and 8.10 ± 1.43 mm, respectively. Moreover, the mean area, height and width of the TM in fetuses were measured as 47.62 ± 12.57 mm2, 8.22 ± 1.12 mm, and 7.25 ± 1.15 mm, respectively. The TM dimensions were increasing in fetuses between 20-32 weeks of gestation. However, the TM dimension was statistically similar at the 7th month, the 8th month and adult periods. The TM height was greater than its width in fetuses and adults. CONCLUSION The calculated regression equations of the TM parameters in fetuses may be used to estimate its size. The TM size did not change from the 7th gestational month, and thus the membrane reached adult diameter in fetal life. The TM height and width showed a very wide range; therefore, we thought that the 12 mm (the height) × 10 mm (the width) graft might be ideal dimension during the repair of the TM perforations.
Collapse
Affiliation(s)
- Orhan Beger
- Department of Anatomy, Faculty of Medicine, Mersin University, Ciftlikkoy Campus, 33343, Mersin, Turkey.
| | - Yusuf Vayisoğlu
- Department of Otorhinolaryngology, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Alev Bobuş Örs
- Department of Anatomy, Faculty of Medicine, Mersin University, Ciftlikkoy Campus, 33343, Mersin, Turkey
| | | | - Fatma Müdüroğlu
- Faculty of Medicine, İstanbul University-Cerrahpaşa, İstanbul, Turkey
| | | | - Oykut Dağtekin
- Department of Histology and Embryology, Mersin City Hospital, Mersin, Turkey
| | - Derya Ümit Talas
- Department of Otorhinolaryngology, Faculty of Medicine, Mersin University, Mersin, Turkey
| |
Collapse
|
27
|
Microsurgical anatomy of the stapedius muscle in adult cadavers. Anat Sci Int 2020; 95:540-547. [PMID: 32476102 DOI: 10.1007/s12565-020-00551-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 05/26/2020] [Indexed: 02/07/2023]
Abstract
This study aimed to establish an extended morphometric dataset regarding the stapedius muscle for anatomists and otologists. The tympanic cavity of ten cadavers (five females, five males) aged with 75.70 ± 13.75 years was bilaterally dissected. Morphometric properties of the stapedius muscle (i.e., its muscular belly and tendon) and its relationship with the neighborhood structures including the facial nerve was evaluated. The length of the entire stapedius muscle was found as 4.80 ± 1.13 mm. The depth between the entrance of the external auditory canal and stapedius muscle was measured as 18.23 ± 2.30 mm. The incudostapedial joint and stapedial tendon were found to be 1.66 ± 0.25 mm and 1.18 ± 0.19 mm away from the facial nerve, respectively. The stapedial tendon length was standardized as five types: Type 1, extremely short tendon (under 0.5 mm), 5% of cases; Type 2, short tendon (between 0.5 and 1 mm), 30% of cases; Type 3, normal tendon (between 1 and 2 mm), 55% of cases; Type 4, long tendon (between 2 and 2.5 mm), 10% of cases; and Type 5, extremely long tendon (above 2.5 mm), no cases. Our findings showed that the stapedius tendon size in adults was quite similar to fetuses. Therefore, probably entire muscle dimension does not alter after birth. Considering the concordance between direct anatomic (our findings) and radiologic measurements (literature findings) of the stapedius muscle, preoperative radiological evaluation may be important for otologists in terms of the choice of surgical tools such as diamond burr sizes. Due to the lack of standardization regarding the evaluation of the stapedius tendon size (i.e., extremely short or extremely long), we defined the tendons below 0.5 mm as extremely short (Type 1) and above 2.5 mm as extremely long (Type 5).
Collapse
|