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Möhlhenrich SC, Kniha K, Peters F, Heitzer M, Szalma J, Prescher A, Danesh G, Hölzle F, Modabber A. Evaluation of bone contact area and intercondylar distance changes in orthognathic surgery - a comparison between BSSO and HSSO technique depending on mandibular displacement extent. Clin Oral Investig 2024; 28:182. [PMID: 38424318 PMCID: PMC10904418 DOI: 10.1007/s00784-024-05584-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 02/25/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVES The present study aims to assess the impact of bilateral and high oblique sagittal split osteotomy (BSSO/HSSO), as well as displacement distances and directions on the expected and achievable bone contact area (BCA) and changes in the intercondylar distance (ICD). The primary question addressed is whether mandibular splitting through BSSO results in a greater BCA and/or ICD when compared to splitting through HSSO. MATERIALS AND METHODS Totally 80 mandibular displacements were performed on 20 fresh cadavers, for each subject, four splints were produces to facilitate mandibular advancement as well as setbacks of 4 and 8 mm. Pre- and postoperative CBCT scans were performed to plan the surgical procedures and to analyze the expected and achieved BCA and ICD. RESULTS Regarding the maximum mandibular displacement, the expected BCA for HSSO/BSSO were 352.58 ± 96.55mm2 and 1164.00 ± 295.50mm2, respectively, after advancement and 349.11 ± 98.42mm2 and 1344.70 ± 287.23mm2, respectively, after setback. The achieved BCA for HSSO/BSSO were 229.37 ± 75.90mm2 and 391.38 ± 189.01mm2, respectively, after advancement and 278.03 ± 97.65mm2 and 413.52 ± 169.52 mm2, respectively after setback. The expected ICD for HSSO/BSSO were 4.51 ± 0.73 mm and 3.25 ± 1.17 mm after advancement and - 5.76 ± 1.07 mm and - 4.28 ± 1.58 mm after setback. The achieved ICD for HSSO/BSSO were 2.07 ± 2.9 mm and 1.7 ± 0.60 mm after advancement and - 2.57 ± 2.78 mm and - 1.28 ± 0.84 mm after setback. Significant differences between the BCA after HSSO and BSSO were at each displacement (p < 0.001), except for the achieved BCA after 8-mm setback and advancement (p ≥ 0.266). No significant differences were observed regarding ICD, except for the expected ICD after 8-mm setback and advancement (p ≤ 0.037). CONCLUSIONS Compared to the virtual planning, the predictability regarding BCA and ICD was limited. ICD showed smaller clinical changes, BCA decreased significantly in the BSSO group. CLINICAL RELEVANCE BCA and ICD might have been less important in choosing the suitable split technique. in orthognathic surgery.
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Affiliation(s)
- Stephan Christian Möhlhenrich
- Department of Orthodontics, University of Witten/Herdecke, Alfred-Herrhausen Str. 45, 58455, Witten, Germany.
- Department of Oral and Maxillofacial Surgery, University Hospital of Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Kristian Kniha
- Department of Oral and Maxillofacial Surgery, University Hospital of Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Florian Peters
- Department of Oral and Maxillofacial Surgery, University Hospital of Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Marius Heitzer
- Department of Oral and Maxillofacial Surgery, University Hospital of Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Josef Szalma
- Department Oral and Maxillofacial Surgery, Medical School, University of Pécs, 1. Tüzér St., Pécs, 7623, Hungary
| | - Andreas Prescher
- Institute of Molecular and Cellular Anatomy, Medical Faculty of RWTH-Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Gholamreza Danesh
- Department of Orthodontics, University of Witten/Herdecke, Alfred-Herrhausen Str. 45, 58455, Witten, Germany
| | - Frank Hölzle
- Department of Oral and Maxillofacial Surgery, University Hospital of Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Ali Modabber
- Department of Oral and Maxillofacial Surgery, University Hospital of Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
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Antipova V, Niedermair JF, Siwetz M, Fellner FA, Löffler S, Manhal S, Ondruschka B, Pietras SM, Poilliot AJ, Pretterklieber ML, Wree A, Hammer N. Undergraduate medical student perceptions and learning outcomes related to anatomy training using Thiel- and ethanol-glycerin-embalmed tissues. ANATOMICAL SCIENCES EDUCATION 2023; 16:1144-1157. [PMID: 37337999 DOI: 10.1002/ase.2306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 05/11/2023] [Accepted: 05/18/2023] [Indexed: 06/21/2023]
Abstract
Anatomical dissection is known to serve as an integral tool in teaching gross anatomy, including postgraduate training. A variety of embalming techniques exist, resulting in different haptic and optical tissue properties. This study aimed to objectify learning outcomes and medical student perceptions related to the use of two widely used embalming techniques, namely Thiel and ethanol-glycerin embalming. Between 2020 and 2022, first- and second-year medical students enrolled in the course on topographic anatomy participated in this study. Objective structured practical examinations were carried out for the head, neck, thorax, abdomen, pelvis, and extremity regions following regional dissection just before the oral examinations began. Six to ten numbered tags were marked in prosections of each region in Thiel- and ethanol-glycerin-embalmed specimens. Following the examinations, the students were surveyed regarding the suitability of the two embalming techniques with respect to preservation, colorfastness, tissue pliability, and the suitability in preparing for their anatomy examinations. Consistently higher scores were achieved for the thoracic and abdominal regions in ethanol-glycerin-embalmed specimens when compared to Thiel. No benefit was found for Thiel-embalmed upper or lower extremities. Tissues embalmed with ethanol-glycerin were rated higher for preservation and suitability to achieve the learning objectives, tissue pliability was rated higher for Thiel-embalmed tissues. Ethanol-glycerin embalming appears to offer certain advantages for undergraduate students in recognizing visceral structures, which may align with students' ideas on tissue suitability for their learning. Consequently, the benefits reported for Thiel embalming for postgraduate study unlikely reflect its suitability for novices.
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Affiliation(s)
- Veronica Antipova
- Division of Macroscopic and Clinical Anatomy, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
| | - Julian F Niedermair
- Central Radiology Institute, Johannes Kepler University Hospital, Linz, Austria
| | - Martin Siwetz
- Division of Macroscopic and Clinical Anatomy, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
| | - Franz A Fellner
- Central Radiology Institute, Johannes Kepler University Hospital, Linz, Austria
- Division of Virtual Morphology, Institute of Anatomy and Cell Biology, Johannes Kepler University, Linz, Austria
| | - Sabine Löffler
- Department of Anatomy, University of Leipzig, Leipzig, Germany
| | - Simone Manhal
- Office of the Vice-Rector for Studies and Teaching, Medical University of Graz, Graz, Austria
| | - Benjamin Ondruschka
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sandra M Pietras
- Division of Macroscopic and Clinical Anatomy, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
| | | | - Michael L Pretterklieber
- Division of Macroscopic and Clinical Anatomy, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
| | - Andreas Wree
- Institute of Anatomy, Rostock University Medical Center, Rostock, Germany
| | - Niels Hammer
- Division of Macroscopic and Clinical Anatomy, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
- Department of Orthopedic and Trauma Surgery, University of Leipzig, Leipzig, Germany
- Division of Biomechatronics, Fraunhofer Institute for Machine Tools and Forming Technology Dresden, Dresden, Germany
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Wyatt TB, Bagian LK, Balta JY. Human body donors at academic institutions in the United States of America: An investigative study. Clin Anat 2023; 36:993-1000. [PMID: 37199183 DOI: 10.1002/ca.24060] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 03/12/2023] [Accepted: 05/02/2023] [Indexed: 05/19/2023]
Abstract
Work with deceased human bodies to enhance anatomical education was first documented in the 3rd century BCE. However, the development of body donation programs provided many new opportunities for medical education. The aim of this study was to investigate the work supported by human body donors at academic institutions in the United States and to evaluate the ethical oversight process and the preparation methods used. A questionnaire was developed using Qualtrics and sent to 125 body donation programs in the United States. Representatives from a total of 69 institutions completed the questionnaire. The data showed that human body donations across the United States are used in teaching, clinical skills training, research, and educational outreach. Most institutions worked with hard-fixed donors for teaching and some with soft-preserved and unembalmed donors for clinical skills training. Among the participating programs, only 33 representatives reported an ethical approval process for conducting research involving human body donors. These findings raise ethical concerns related to the operation of body donation programs due to the lack of oversight. Furthermore, some institutions allowed faculty and staff to take photographs of donated bodies for educational purposes, which is often not disclosed on the consent form. The data also showed the need for more discussion on anatomical legacy collections housed at these institutions in the United States.
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Affiliation(s)
- Taylor B Wyatt
- Division of Anatomy, Department of Biomedical Education and Anatomy, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Lauren K Bagian
- Division of Anatomy, Department of Biomedical Education and Anatomy, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Joy Y Balta
- Anatomy Learning Institute, College of Health Sciences, Point Loma Nazarene University, San Diego, California, USA
- Division of Anatomy, Department of Surgery, School of Medicine, University of California, San Diego, California, USA
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Heitzer M, Kniha K, Katz MS, Winnand P, Peters F, Möhlhenrich SC, Hölzle F, Modabber A. The primary stability of two dental implant systems in low-density bone. Int J Oral Maxillofac Surg 2022; 51:1093-1100. [PMID: 35339332 DOI: 10.1016/j.ijom.2022.02.012] [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: 04/06/2021] [Revised: 02/18/2022] [Accepted: 02/23/2022] [Indexed: 11/19/2022]
Abstract
Primary stability in low-density bone is crucial for the long-term success of implants. Tapered implants have shown particularly favourable properties under such conditions. The aim of this study was to compare the primary stability of tapered titanium and novel cylindrical zirconia dental implant systems in low-density bone. Fifty implants (25 tapered, 25 cylindrical) were placed in the anterior maxillary bone of cadavers meeting the criteria of low-density bone. The maximum insertion (ITV) and removal (RTV) torque values were recorded, and the implant stability quotients (ISQ) determined. To establish the isolated influence of cancellous bone on primary stability, the implantation procedure was performed in standardized low-density polyurethane foam bone blocks (cancellous bone model) using the same procedure. The primary stability parameters of both implant types showed significant positive correlations with bone density (Hounsfield units) and cortical thickness. In the cadaver, the cylindrical zirconia implants showed a significantly higher mean ISQ when compared to the tapered titanium implants (50.58 vs 37.26; P < 0.001). Pearson analysis showed significant positive correlations between ITV and ISQ (P = 0.016) and between RTV and ISQ (P = 0.035) for the cylindrical zirconia implants; no such correlations were observed for the tapered titanium implants. Within the limitations of this study, the results indicate that cylindrical zirconia implants represent a comparable viable treatment option to tapered titanium implants in terms of primary implant stability in low-density human bone.
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Affiliation(s)
- M Heitzer
- Department of Oral and Craniomaxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany.
| | - K Kniha
- Department of Oral and Craniomaxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - M S Katz
- Department of Oral and Craniomaxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - P Winnand
- Department of Oral and Craniomaxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - F Peters
- Department of Oral and Craniomaxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - S C Möhlhenrich
- Department of Orthodontics, University of Witten/Herdecke, Witten, Germany
| | - F Hölzle
- Department of Oral and Craniomaxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - A Modabber
- Department of Oral and Craniomaxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany
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5
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Humbert M, Micault E, Moreau S, Patron V, Bois J, Hitier M. The advantages of modified Thiel technique in head and neck surgical anatomy teaching. Surg Radiol Anat 2022; 44:345-352. [DOI: 10.1007/s00276-022-02895-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 01/24/2022] [Indexed: 11/28/2022]
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Thiel embalming in neonates: methodology and benefits in medical training. Anat Sci Int 2022; 97:290-296. [PMID: 35137346 PMCID: PMC9167811 DOI: 10.1007/s12565-022-00650-1] [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: 12/28/2021] [Accepted: 01/18/2022] [Indexed: 12/04/2022]
Abstract
Current teaching and training methods for surgical techniques in the pediatric population involve artificial models (manikins), animals or adult human cadavers embalmed using various techniques. We found no references in the literature concerning the use of the Thiel method in the pediatric population. The aim of this study, therefore, was to assess the viability of using pediatric human cadavers embalmed through Thiel’s technique and to compare them with standard pediatric manikins. After donation of a 24-week stillborn, the Thiel technique was carried out for fixation following the usual protocol. A video recording with eye-tracking glasses was used to perform an examination, and techniques. The same procedures were conducted on a pediatric manikin. Medical students, medical residents and physicians were asked to respond to questions in an online survey after being shown the video. A total of 92 responses were obtained. The Thiel-embalmed stillborn was assessed as superior to the manikin in all items. Our study confirmed that this technique is feasible even with extremely small donors. The value of this form of preservation for medical training is not widely known though it is receiving increasing interest. Our results show that Thiel fixation in pediatrics is clearly more highly valued than a manikin and offers great potential. This innovative application of the Thiel method in the pediatric population is technically possible. It poses no additional difficulties and is very positively assessed for undergraduate and postgraduate teaching.
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Pekedis M, Yoruk MD, Binboga E, Yildiz H, Bilge O, Celik S. Characterization of the mechanical properties of human parietal bones preserved in modified larssen solution, formalin and as fresh frozen. Surg Radiol Anat 2021; 43:1933-1943. [PMID: 33954823 DOI: 10.1007/s00276-021-02762-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/27/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE Although the fresh frozen (FF) cadaver is preferred for surgical applications, it is limited due to short usage time, unsuitable for reuse and the risk of infection. Due to its limited use, FF cadavers, which are covered by import in countries with insufficient body donation cause low-cost effectiveness. With the increase of real human tissue specimen necessities for surgical training, long-term preservation of the cadavers is crucial due to changes in mechanical properties. Therefore, studies on embalming solutions have increased in recent years. METHODS We quantify the biomechanical properties of human parietal bones preserved via modified larssen solution (MLS) and compare the results with the specimens preserved as FF and fixed with 10% formalin-based solution (F10). The rectangular samples of 24 parietal bones of male individuals were resected from MLS-embalmed, F10-embalmed and FF cadavers to form three groups each containing eight samples. These specimens were tested longitudinally to identify mechanical properties. RESULTS The tensile test results showed that there is not a significant difference between the groups in terms of stiffness, elastic modulus, strain at ultimate stress, failure strain and effective plastic strain. However, the yield stress, ultimate stress, yield strain, failure stress and total energy and post-yield properties are significantly lower in F10 than MLS and FF groups. CONCLUSION It is observed that the mechanical properties of MLS preserved and FF parietal bones have almost similar properties. Thus, it can be concluded that MLS is a suitable fixative solution for bone studies and bone-related surgical anatomy training applications.
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Affiliation(s)
- Mahmut Pekedis
- Faculty of Engineering Department of Mechanical Engineering, Ege University, 35100, Bornova, Izmir, Turkey
| | - Mustafa Deniz Yoruk
- Faculty of Medicine Department of Anatomy, Mugla Sitki Kocman University, Kotekli quarter, Marmaris road boulevard, No:50, 48000, Mentese-Mugla, Turkey
| | - Erdal Binboga
- Faculty of Medicine Department of Biophysics, Ege University, 35100, Bornova-Izmir, Turkey
| | - Hasan Yildiz
- Faculty of Engineering Department of Mechanical Engineering, Ege University, 35100, Bornova, Izmir, Turkey
| | - Okan Bilge
- Faculty of Medicine Department of Anatomy, Ege University, 35100, Bornova-Izmir, Turkey
| | - Servet Celik
- Faculty of Medicine Department of Anatomy, Ege University, 35100, Bornova-Izmir, Turkey.
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Comparison of Thiel preserved, fresh human, and animal liver tissue in terms of mechanical properties. Ann Anat 2021; 236:151717. [PMID: 33689839 DOI: 10.1016/j.aanat.2021.151717] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 01/26/2021] [Accepted: 02/09/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND In medical training and research fresh human tissue is often replaced by preserved human or fresh animal tissue, due to availability and ethical reasons. Newer preservation approaches, such as the Thiel method, promise more realistic mechanical properties than conventional formaldehyde fixation. Concerning animal substitute material, porcine and bovine tissue is often chosen, as it is easily obtainable and certain similarity to human tissue is assumed. However, it has not been thoroughly investigated how Thiel preservation changes non-linear and viscoelastic behaviour of soft organ tissues. Furthermore, differences in these properties between animal tissue and human tissue have not been previously corroborated. METHODS We conducted ramp and relaxation tensile tests on fresh human and Thiel preserved hepatic tissue, extracting strain-specific elastic moduli, and viscoelastic properties. The results for fresh human liver were then compared to corresponding results for Thiel preserved liver, as well as previously published results for porcine and bovine liver. RESULTS Our results showed that Thiel preservation seems to be associated with increased stiffness as well as decreased viscoelastic damping behaviour. Porcine liver was stiffer than human liver with similar viscoelastic properties. Bovine liver exhibited similar stiffness as human liver, however lower viscoelastic damping. CONCLUSIONS The differences between human and animal liver tissue, concerning their mechanical properties, can be explained by their characteristic histology. Changes in mechanical properties due to Thiel preservation might stem from altered protein cross-linking and dehydration. The results illustrate that appropriate materials for medical training systems must be selected based on which mechanical properties are relevant for the respective application.
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Mckeage JW, Loch C, Zwirner J, Hammer N, White DE, Ruddy BP, Brunton PA, Taberner AJ. Controllable Jet Injection of Dental Local Anaesthetic. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE 2021. [DOI: 10.1109/jtehm.2021.3090748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- James W. Mckeage
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Carolina Loch
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Johann Zwirner
- Department of Anatomy, University of Otago, Dunedin, New Zealand
| | - Niels Hammer
- Department of Anatomy, University of Otago, Dunedin, New Zealand
| | - David E. White
- School of Engineering, Computer and Mathematical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Bryan P. Ruddy
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Paul A. Brunton
- Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Andrew J. Taberner
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
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Möhlhenrich SC, Ernst K, Peters F, Kniha K, Chhatwani S, Prescher A, Danesh G, Hölzle F, Modabber A. Immediate dental and skeletal influence of distractor position on surgically assisted rapid palatal expansion with or without pterygomaxillary disjunction. Int J Oral Maxillofac Surg 2020; 50:649-656. [PMID: 33131988 DOI: 10.1016/j.ijom.2020.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/18/2020] [Accepted: 10/08/2020] [Indexed: 10/23/2022]
Abstract
The outcome of surgically assisted rapid palatal expansion (SARPE) can be affected by pterygomaxillary disjunction (PMD) and the distractor position. In this study, SARPE was performed, with or without PMD, in 20 fresh cadaver heads. Transverse expansion was conducted twice using a bone-borne distractor in the anterior and posterior positions, resulting in four groups (n=10). Cone beam computed tomography scans were completed before and after SARPE to evaluate maxillary changes. A comparative anterior decrease and posterior increase in midpalatal opening resulted from SARPE with PMD combined with a posteriorly placed distractor. Significant differences in the internal transverse changes were found between the two SARPE techniques combined with an anterior distractor at the level of the premolars and molars for alveolar ridge width (P=0.040, P=0.024), and at the level of the molars for the dental crown width (P=0.017) and corresponding tooth cusp width (P=0.018). In contrast, using a posteriorly placed distractor led to a significant difference for tooth cusp width only (P=0.050). No statistically significant differences were found between external transverse changes or between distractor positions. PMD is more important in achieving a more uniform and parallel transverse expansion pattern than the distractor position. However, a posterior distractor seems to intensify the effects of PMD.
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Affiliation(s)
- S C Möhlhenrich
- Department of Orthodontics, University of Witten/Herdecke, Witten, Germany; Department of Oral and Maxillofacial Surgery, University Hospital of Aachen, Aachen, Germany.
| | - K Ernst
- Department of Oral and Maxillofacial Surgery, University Hospital of Aachen, Aachen, Germany
| | - F Peters
- Department of Oral and Maxillofacial Surgery, University Hospital of Aachen, Aachen, Germany
| | - K Kniha
- Department of Oral and Maxillofacial Surgery, University Hospital of Aachen, Aachen, Germany
| | - S Chhatwani
- Department of Orthodontics, University of Witten/Herdecke, Witten, Germany
| | - A Prescher
- Institute of Molecular and Cellular Anatomy, Medical Faculty of RWTH-Aachen, Aachen, Germany
| | - G Danesh
- Department of Orthodontics, University of Witten/Herdecke, Witten, Germany
| | - F Hölzle
- Department of Oral and Maxillofacial Surgery, University Hospital of Aachen, Aachen, Germany
| | - A Modabber
- Department of Oral and Maxillofacial Surgery, University Hospital of Aachen, Aachen, Germany
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Watanabe M, Yoneyama Y, Hamada H, Kohno M, Hasegawa O, Takahashi H, Kawase-Koga Y, Matsuo A, Chikazu D, Kawata S, Itoh M. The Usefulness of Saturated Salt Solution Embalming Method for Oral Surgical Skills Training: A New Cadaveric Training Model for Bone Harvesting. ANATOMICAL SCIENCES EDUCATION 2020; 13:628-635. [PMID: 31608585 DOI: 10.1002/ase.1925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 07/24/2019] [Accepted: 10/09/2019] [Indexed: 06/10/2023]
Abstract
The purpose of this study was to assess the usefulness of saturated salt solution-embalmed cadavers for oral surgical skills training related to bone graft harvesting. Two half-day surgical skills training workshops were held at the Tokyo Medical University utilizing eight cadavers embalmed with the saturated salt solution. A total of 22 participants including oral surgeons, residents, and dentists attended the workshop. Surgical training consisted of six procedures related to intraoral and extraoral bone harvesting. The participants were surveyed to assess self-confidence levels for each surgical procedure before and after completion of each workshop. The Wilcoxon signed-rank test was used to compare the differences between each median score before and after the workshop. There were statistically significant increases in the self-assessed confidence scores in bone harvesting procedures for the zygomatic bone (P = 0.003), maxillary tuberosity (P = 0.002), and other sites (P < 0.001). The anatomical features of saturated salt solution-embalmed cadavers were also examined. The textures of the oral mucosa and skin were similar to those of living individuals. The structure of bone tissues was well-preserved and the hardness was realistic. Consequently, all procedures were performed with sufficient realism. The saturated salt solution method has a relatively low cost of preparation and storage, and almost no odor. The authors suggest that saturated salt solution-embalmed cadavers could provide a new model for oral surgical skills training in bone harvesting.
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Affiliation(s)
- Masato Watanabe
- Department of Oral and Maxillofacial Surgery, Tokyo Medical University Hospital, Tokyo, Japan
| | - Yuya Yoneyama
- Department of Oral and Maxillofacial Surgery, Tokyo Medical University Hospital, Tokyo, Japan
| | - Hayato Hamada
- Department of Oral and Maxillofacial Surgery, Tokyo Medical University Ibaraki Medical Center, Ibaraki, Japan
| | - Michihide Kohno
- Department of Oral and Maxillofacial Surgery, Tokyo Medical University Hospital, Tokyo, Japan
| | - On Hasegawa
- Department of Oral and Maxillofacial Surgery, Tokyo Medical University Hospital, Tokyo, Japan
| | - Hidetoshi Takahashi
- Department of Oral and Maxillofacial Surgery, Tokyo Medical University Hospital, Tokyo, Japan
| | - Yoko Kawase-Koga
- Department of Oral and Maxillofacial Surgery, Tokyo Medical University Hospital, Tokyo, Japan
| | - Akira Matsuo
- Department of Oral and Maxillofacial Surgery, Tokyo Medical University Ibaraki Medical Center, Ibaraki, Japan
| | - Daichi Chikazu
- Department of Oral and Maxillofacial Surgery, Tokyo Medical University Hospital, Tokyo, Japan
| | - Shinichi Kawata
- Department of Anatomy, Tokyo Medical University, Tokyo, Japan
| | - Masahiro Itoh
- Department of Anatomy, Tokyo Medical University, Tokyo, Japan
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Vascular survey of the maxillary vestibule and gingiva-clinical impact on incision and flap design in periodontal and implant surgeries. Clin Oral Investig 2020. [PMID: 32638127 DOI: 10.1007/s00784‐020‐03419‐w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
OBJECTIVES Currently, empirical clinical findings on the blood supply of the maxillary vestibule are not backed up with sufficient literature. The purpose of this study was to investigate the mucosal and periosteal vascular supply in the maxillary vestibule macroscopically and radiographically to improve surgical strategies and flap designs. MATERIALS AND METHODS Thirty head corpses were selected (9 dentate, 11 partially edentulous, 10 edentulous). Twenty-six corpses were injected by red latex milk and embalmed with Thiel solution. Four cadavers were prepared for corrosion casting. Arterial path and anastomoses in the maxillary vestibule of dentate, partially edentulous and edentulous ridges, were analyzed macroscopically and by computed tomography (CT). RESULTS Transverse periosteomucosal anastomoses were detected in the posterior and esthetic zones of the maxillary vestibule. The buccal branches penetrated the interdental septum toward the palate. In the esthetic zone, superior labial artery (SLA) supplied the mucosa and the infraorbital artery (IOA) supplied the periosteum. Corrosion casting showed anastomoses between IOA and nasal septal branches. CT analysis revealed ipsilateral and contralateral anastomoses between SLA and IOA. In dentate ridges, mucosal star-shaped terminal branches were detected. CONCLUSIONS The macroscopic and radiographic vascular survey analysis revealed the anatomical background behind several clinically documented phenomena related to oral and periodontal surgeries. CLINICAL RELEVANCE This study permits clinicians to design less invasive flaps when releasing incisions in the maxillary vestibule during periodontal and implant surgeries. Our observations strongly point to the significance of an undamaged periosteum to prevent compromised flap revascularization and wound healing disturbances.
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Vascular survey of the maxillary vestibule and gingiva-clinical impact on incision and flap design in periodontal and implant surgeries. Clin Oral Investig 2020; 25:539-546. [PMID: 32638127 PMCID: PMC7819931 DOI: 10.1007/s00784-020-03419-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 06/16/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Currently, empirical clinical findings on the blood supply of the maxillary vestibule are not backed up with sufficient literature. The purpose of this study was to investigate the mucosal and periosteal vascular supply in the maxillary vestibule macroscopically and radiographically to improve surgical strategies and flap designs. MATERIALS AND METHODS Thirty head corpses were selected (9 dentate, 11 partially edentulous, 10 edentulous). Twenty-six corpses were injected by red latex milk and embalmed with Thiel solution. Four cadavers were prepared for corrosion casting. Arterial path and anastomoses in the maxillary vestibule of dentate, partially edentulous and edentulous ridges, were analyzed macroscopically and by computed tomography (CT). RESULTS Transverse periosteomucosal anastomoses were detected in the posterior and esthetic zones of the maxillary vestibule. The buccal branches penetrated the interdental septum toward the palate. In the esthetic zone, superior labial artery (SLA) supplied the mucosa and the infraorbital artery (IOA) supplied the periosteum. Corrosion casting showed anastomoses between IOA and nasal septal branches. CT analysis revealed ipsilateral and contralateral anastomoses between SLA and IOA. In dentate ridges, mucosal star-shaped terminal branches were detected. CONCLUSIONS The macroscopic and radiographic vascular survey analysis revealed the anatomical background behind several clinically documented phenomena related to oral and periodontal surgeries. CLINICAL RELEVANCE This study permits clinicians to design less invasive flaps when releasing incisions in the maxillary vestibule during periodontal and implant surgeries. Our observations strongly point to the significance of an undamaged periosteum to prevent compromised flap revascularization and wound healing disturbances.
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Accuracy of fully guided orthodontic mini-implant placement evaluated by cone-beam computed tomography: a study involving human cadaver heads. Clin Oral Investig 2020; 25:1299-1306. [PMID: 32613434 PMCID: PMC7878209 DOI: 10.1007/s00784-020-03436-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 06/24/2020] [Indexed: 10/27/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the accuracy of fully guided orthodontic mini-implant (OMI) placements supported by tooth- (TBGs) or gingiva-borne silicone guides (GBGs) based on virtually superimposed lateral cephalograms on virtual plaster models. MATERIALS AND METHODS Lateral cephalograms and corresponding plaster models were virtually superimposed for the planning of OMI positions; fully guided TBGs and GBGs were fabricated (each, n = 10). A total of 40 OMIs were inserted in a paramedian position into the palate of 20 human cadavers. Postoperative cone-beam computer tomographies (CBCTs) were carried out, and an accuracy evaluation was performed by comparing preoperative planning models and postoperative CBCTs. Deviations of the axis, tip, centre of the shoulder and vertical position of each of the implants were evaluated. Furthermore, the transfer accuracy measured by postoperative CBCT scans were compared with the accuracy determined using an intraoral scanner. RESULTS A significant deviation between TBGs (2.81° SD 2.69) and GBGs (6.22° SD 4.26) regarding implant angulation was evaluated (p = 0.005). Implant tip and implant shoulder deviations revealed no statistical differences between the guides. Accuracy values of oral scans regarding vertical deviations were significantly more inaccurate when compared with CBCTs (p < 0.001). CONCLUSIONS The accuracy of an OMI position can be significantly increased by using a guide extension over the teeth. Vertical implant positions presented the lowest deviations. Postoperative oral scans and CBCTs represent diverging accuracy measurements when compared with virtual planning. CLINICAL RELEVANCE Users must keep in mind that despite virtual planning deviations, inaccuracies of a few millimetres may occur.
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Hohenberger GM, Schwarz AM, Grechenig P, Grechenig C, Krassnig R, Weiglein AH, Feigl GC. Success Rate in Puncture of the Temporomandibular Joint. Clin Anat 2019; 33:683-688. [PMID: 31581305 DOI: 10.1002/ca.23489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 09/14/2019] [Accepted: 09/20/2019] [Indexed: 11/08/2022]
Abstract
Puncture of the temporomandibular joint (TMJ) is a minimally invasive treatment for various jaw disorders. This study used a cadaveric model to evaluate the procedure from two entrance points with respect to hit ratio and possible complications, such as extraarticular extrusion of injection fluid. Ten heads, embalmed with Thiel's method, were investigated. A straight line drawn with a colored pen connected the center of the tragus and the lateral canthus. The first portal "A" was located at a distance of 1 cm anterior and 2 mm caudal from the center of the tragus. Portal "B" was located 2 cm anterior and 1 cm caudal starting from the same reference point. Punctures "A" and "B" were performed alternately on the right and left sides. Specimens were dissected and the local distribution of the injected latex was recorded. With Approach A, four punctures (40%; 4/10) reached the TMJ, whereas with Approach B, six injections (60%; 6/10) entered the TMJ. There were no statistically significant differences between the tested puncture methods (P = 0.0317) and body sides (P = 1). With each method, for example, 35% (7/20) each, the injected latex was either periarticular or retromandibular. In a further 20% (4/20), it was located subperiosteally alongside the ramus of mandible. The latex was injected into the infratemporal fossa and the external acoustic meatus in one case each (each 5%). There was no statistically significant difference between the techniques. The adjacent anatomy has to be kept in mind during TMJ puncture as the complication rate was remarkably high, suggesting that ultrasound guided intraarticular injection could improve the hit rate. Clin. Anat., 33:683-688, 2020. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Gloria Maria Hohenberger
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | | | - Peter Grechenig
- Division of Macroscopic and Clinical Anatomy, Medical University of Graz, Harrachgasse 21, 8010, Graz, Austria
| | - Christoph Grechenig
- Department of Ophthalmology and Optometry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Renate Krassnig
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Andreas Heinrich Weiglein
- Division of Macroscopic and Clinical Anatomy, Medical University of Graz, Harrachgasse 21, 8010, Graz, Austria
| | - Georg Christoph Feigl
- Division of Macroscopic and Clinical Anatomy, Medical University of Graz, Harrachgasse 21, 8010, Graz, Austria
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Möhlhenrich SC, Heussen N, Winterhalder P, Prescher A, Hölzle F, Modabber A, Wolf M, Kniha K. Predicting primary stability of orthodontic mini‐implants, according to position, screw‐size, and bone quality, in the maxilla of aged patients: a cadaveric study. Eur J Oral Sci 2019; 127:462-471. [DOI: 10.1111/eos.12651] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2019] [Indexed: 11/29/2022]
Affiliation(s)
| | - Nicole Heussen
- Department of Medical Statistics University Hospital of the RWTH Aachen Aachen Germany
- Center of Biostatistics and Epidemiology Medical School Sigmund Freud University Vienna Vienna Austria
| | - Philipp Winterhalder
- Department of Oral and Maxillofacial Surgery University Hospital of the RWTH Aachen AachenGermany
| | - Andreas Prescher
- Institute of Molecular and Cellular Anatomy Medical Faculty of RWTH‐Aachen Aachen Germany
| | - Frank Hölzle
- Department of Oral and Maxillofacial Surgery University Hospital of the RWTH Aachen AachenGermany
| | - Ali Modabber
- Department of Oral and Maxillofacial Surgery University Hospital of the RWTH Aachen AachenGermany
| | - Michael Wolf
- Department of Orthodontics University Hospital of the RWTH Aachen AachenGermany
| | - Kristian Kniha
- Department of Oral and Maxillofacial Surgery University Hospital of the RWTH Aachen AachenGermany
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Zwirner J, Scholze M, Ondruschka B, Hammer N. Tissue biomechanics of the human head are altered by Thiel embalming, restricting its use for biomechanical validation. Clin Anat 2019; 32:903-913. [DOI: 10.1002/ca.23409] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 05/13/2019] [Accepted: 05/16/2019] [Indexed: 01/10/2023]
Affiliation(s)
- Johann Zwirner
- Department of Anatomy University of Otago Dunedin New Zealand
| | - Mario Scholze
- Institute of Materials Science and Engineering Chemnitz University of Technology Chemnitz Germany
| | | | - Niels Hammer
- Department of Anatomy University of Otago Dunedin New Zealand
- Department of Orthopedic and Trauma Surgery University of Leipzig Germany
- Fraunhofer IWU Dresden Germany
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Trainotti S, Hoffmann TK, Rotter N, Greve J, Veit JA, Schuler P, Scheithauer M. Pectoralis Major Muscle Free Flap: Anatomical Studies on Pedicle Length and Vessel Diameter. EAR, NOSE & THROAT JOURNAL 2019; 98:431-434. [PMID: 31018692 DOI: 10.1177/0145561319840821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Large and deep defects resulting from lateral skull base surgery represent a challenge to the head and neck surgeon. Different microvascular free flaps have specific advantages and disadvantages. While the pedicled pectoralis major flap is considered a "work horse," it comes with a rather short pedicle. The aim of this study was to analyze the vascular anatomy of the pectoralis major flap and assess its suitability for microvascular transfer. Anatomical studies have been performed on 6 Thiel-fixed cadavers allowing a harvest of 12 flaps by the same surgeon. Measurements of the pedicle's length and vessel diameters have been taken with a ruler and caliper. The mean pedicle length and mean diameters (Ø) of the thoracoacromial artery and concomitant vein were found to be 9.8 cm, Ø 4.2 mm, and Ø 4.9 mm, respectively. These results suggest the potential utility of a free pectoralis major flap with microvascular anastomosis.
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Affiliation(s)
- Susanne Trainotti
- 1 Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ulm University Medical Center, Universitätsklinikum Ulm, Ulm, Germany
| | - Thomas K Hoffmann
- 1 Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ulm University Medical Center, Universitätsklinikum Ulm, Ulm, Germany
| | - Nicole Rotter
- 2 Department of Oto-Rhino-Laryngology, University Medical Center Mannheim, Mannheim, Germany
| | - Jens Greve
- 1 Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ulm University Medical Center, Universitätsklinikum Ulm, Ulm, Germany
| | - Johannes A Veit
- 2 Department of Oto-Rhino-Laryngology, University Medical Center Mannheim, Mannheim, Germany
| | - Patrick Schuler
- 1 Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ulm University Medical Center, Universitätsklinikum Ulm, Ulm, Germany
| | - Marc Scheithauer
- 1 Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ulm University Medical Center, Universitätsklinikum Ulm, Ulm, Germany
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Liao P, Wang Z. Thiel-embalming technique: investigation of possible modification in embalming tissue as evaluation model for radiofrequency ablation. J Biomed Res 2019; 33:280. [PMID: 30956232 PMCID: PMC6813523 DOI: 10.7555/jbr.32.20160148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 01/20/2017] [Indexed: 11/03/2022] Open
Abstract
Contrary to freezing preservation and formalin embalming, Thiel embalmed cadaver presents soft texture and color very close to that of living organism, and many applications based on Thiel embalmed cadavers have been reported. However, Thiel embalmed cadavers cannot be used as reliable evaluation model for radiofrequency ablation (RFA) due to dramatic changes of electrical conductivity in the embalmed tissue. To address this issue, we investigated various modifications of the original Thiel embalming solution. By altering the chemicals' species and concentration we figured out a formula that can greatly reduce the embalming fluid's electrical conductivity without significantly compromising the 18-day embalmed kidney samples' suppleness and color. We also investigated a two-stage embalming technique by first submerging the kidney sample into original Thiel's tank fluid for 28 days, then the sample was withdrawn from the tank fluid and placed into modified dilution fluids for additional two weeks. Stiffening and discoloration occurred in these diluted samples implying the reversibility of Thiel-embalmed tissues' suppleness and color with the removal of the strong electrolytes. This study presents a modified embalming method which could be used for RFA evaluation and also helps our understanding of the mechanism of embalmment process.
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Affiliation(s)
- Peiyu Liao
- Institute for Medical Science and Technology, University of Dundee, Dundee, Scotland DD2 1FD, United Kingdom
- School of Engineering, Physics and Mathematics, University of Dundee, Dundee, Scotland DD1 4HN, United Kingdom
- College of Chemistry and Chemical Engineering, Hunan University, Changsha, Hunan 410000, China
- College of Engineering, Peking University, Beijing 100671, China
| | - Zhigang Wang
- Institute for Medical Science and Technology, University of Dundee, Dundee, Scotland DD2 1FD, United Kingdom
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Gatt A, Schembri-Wismayer P, Chockalingam N, Formosa C. Kinematic and Kinetic Comparison of Fresh Frozen and Thiel-Embalmed Human Feet for Suitability for Biomechanical Educational and Research Settings. J Am Podiatr Med Assoc 2019; 109:113-121. [PMID: 31135207 DOI: 10.7547/16-130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND In vitro biomechanical testing of the human foot often involves the use of fresh frozen cadaveric specimens to investigate interventions that would be detrimental to human subjects. The Thiel method is an alternative embalming technique that maintains soft-tissue consistency similar to that of living tissue. However, its suitability for biomechanical testing is unknown. Thus, the aim of this study was to determine whether Thiel-embalmed foot specimens exhibit kinematic and kinetic biomechanical properties similar to those of fresh frozen specimens. METHODS An observational study design was conducted at a university biomechanics laboratory. Three cadavers had both limbs amputated, with one being fresh frozen and the other preserved by Thiel's embalming. Each foot was tested while undergoing plantarflexion and dorsiflexion in three states: unloaded and under loads of 10 and 20 kg. Their segment kinematics and foot pressure mapping were assessed simultaneously. RESULTS No statistically significant differences were detected between fresh frozen and Thiel-embalmed sample pairs regarding kinematics and kinetics. CONCLUSIONS These findings highlight similar kinematic and kinetic properties between fresh frozen and Thiel-embalmed foot specimens, thus possibly enabling these specimens to be interchanged due to the latter specimens' advantage of delayed decomposition. This can open innovative opportunities for the use of these specimens in applications related to the investigation of dynamic foot function in research and education.
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Affiliation(s)
- Alfred Gatt
- Department of Podiatry, Faculty of Health Sciences, University of Malta, Msida, Malta
- Faculty of Health, Staffordshire University, Stoke on Trent, United Kingdom
| | | | - Nachiappan Chockalingam
- Department of Podiatry, Faculty of Health Sciences, University of Malta, Msida, Malta
- Faculty of Health, Staffordshire University, Stoke on Trent, United Kingdom
| | - Cynthia Formosa
- Department of Podiatry, Faculty of Health Sciences, University of Malta, Msida, Malta
- Faculty of Health, Staffordshire University, Stoke on Trent, United Kingdom
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Kinugasa R, Taniguchi K, Yamamura N, Fujimiya M, Katayose M, Takagi S, Edgerton VR, Sinha S. A Multi-modality Approach Towards Elucidation of the Mechanism for Human Achilles Tendon Bending During Passive Ankle Rotation. Sci Rep 2018. [PMID: 29531268 PMCID: PMC5847516 DOI: 10.1038/s41598-018-22661-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The in vitro unconstrained Achilles tendon is nearly straight, while in vivo experiments reveal that the proximal region of the Achilles tendon, adjacent to Kager’s fat pad, bends ventrally during plantarflexion but remains nearly straight during dorsiflexion. Tendon bending is an important factor in determining the displacement of the foot compared to the shortening of the muscle fibers. The objective of this study was to elucidate the various mechanisms that could cause tendon bending, which currently remain unknown. Examination of Thiel-embalmed cadavers, with preservation of native articular joint mobility, revealed that the Achilles tendon still bent ventrally even when its surrounding tissues, including the skin surface, Kager’s fat pad, and distal portions of the soleus muscle were removed. Shear modulus and collagen fiber orientation were distributed homogeneously with respect to the longitudinal line of the tendon, minimizing their causative contributions to the bending. Given that tendon bending is not caused by either the nature of the deformations of the tissues surrounding the Achilles tendon or its physical properties, we conclude that it results from the geometric architecture of the Achilles tendon and its configuration with respect to the surrounding tissues.
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Affiliation(s)
- Ryuta Kinugasa
- Department of Human Sciences, Kanagawa University, Yokohama, Japan. .,Computational Engineering Applications Unit, Advanced Center for Computing and Communication, RIKEN, Wako, Japan. .,Department of Physical Therapy, Sapporo Medical University, Sapporo, Japan.
| | - Keigo Taniguchi
- Department of Physical Therapy, Sapporo Medical University, Sapporo, Japan
| | - Naoto Yamamura
- Department of Mechanical Engineering, The University of Tokyo, Tokyo, Japan
| | - Mineko Fujimiya
- Department of Anatomy, Sapporo Medical University, Sapporo, Japan
| | - Masaki Katayose
- Department of Physical Therapy, Sapporo Medical University, Sapporo, Japan
| | - Shu Takagi
- Department of Mechanical Engineering, The University of Tokyo, Tokyo, Japan
| | - V Reggie Edgerton
- Department of Integrative Biology and Physiology, University of California Los Angeles, Los Angeles, USA.,Department of Neurobiology, University of California Los Angeles, Los Angeles, USA.,Department of Neurosurgery, University of California Los Angeles, Los Angeles, USA.,Brain Research Institute, University of California Los Angeles, Los Angeles, USA
| | - Shantanu Sinha
- Department of Radiology, University of California San Diego, San Diego, USA
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Kennel L, Martin DMA, Shaw H, Wilkinson T. Learning anatomy through Thiel- vs. formalin-embalmed cadavers: Student perceptions of embalming methods and effect on functional anatomy knowledge. ANATOMICAL SCIENCES EDUCATION 2018; 11:166-174. [PMID: 28719722 DOI: 10.1002/ase.1715] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 05/01/2017] [Accepted: 06/18/2017] [Indexed: 06/07/2023]
Abstract
Thiel-embalmed cadavers, which have been adopted for use in anatomy teaching in relatively few universities, show greater flexibility and color retention compared to formalin-embalmed cadavers, properties which might be considered advantageous for anatomy teaching. This study aimed to investigate student attitudes toward the dissection experience with Thiel- compared to formalin/ethanol-embalmed cadavers. It also aimed to determine if one embalming method is more advantageous in terms of learning functional anatomy through the comparison of student anterior forearm functional anatomy knowledge. Student opinions and functional anatomy knowledge were obtained through use of a questionnaire from students at two medical schools, one using Thiel-, and one using more traditional formalin/ethanol-embalmed cadavers. Both the Thiel group and the formalin group of students were surveyed shortly after completing an anterior forearm dissection session. Significant differences (P-values <0.01) in some attitudes were found toward the dissection experience between cohorts using Thiel- vs. formalin-embalmed cadavers. The Thiel group of students felt more confident about recognizing anatomy in the living individual, found it easier to identify and dissect anatomical structures, and indicated more active exploration of functional anatomy due to the retained flexibility of the cadaver. However, on testing, no significant difference in functional anatomy knowledge was found between the two cohorts. Overall, although Thiel embalming may provide an advantageous learning experience in some investigated areas, more research needs to be carried out, especially to establish whether student perception is based on reality, at least in terms of structure identification. Anat Sci Educ 11: 166-174. © 2017 American Association of Anatomists.
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Affiliation(s)
- Larissa Kennel
- Centre for Anatomy and Human Identification, School of Science and Engineering, University of Dundee, Dundee, Scotland, United Kingdom
| | - David M A Martin
- School of Life Sciences, University of Dundee, Dundee, Scotland, United Kingdom
| | - Hannah Shaw
- School of Biosciences, Cardiff University, Cardiff, Wales, United Kingdom
| | - Tracey Wilkinson
- Centre for Anatomy and Human Identification, School of Science and Engineering, University of Dundee, Dundee, Scotland, United Kingdom
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Hanson C, Wilkinson T, Macluskey M. Do dental undergraduates think that Thiel-embalmed cadavers are a more realistic model for teaching exodontia? EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2018; 22:e14-e18. [PMID: 27995728 DOI: 10.1111/eje.12250] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/15/2016] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Teaching exodontia to novice undergraduates requires a realistic model. Thiel-embalmed cadavers retain the flexibility of the soft tissues and could be used to teach exodontia. OBJECTIVE The objective was to determine whether Thiel-embalmed cadavers were perceived to be a more realistic model by undergraduates in comparison with mannequins. MATERIALS AND METHODS Over a period of 4 years (2011-2014), students were randomly assigned into two groups: those taught exodontia on mannequins only (NT) and those who also experienced cadaveric teaching (T). This was followed by an assessment. RESULTS There were 174 students in the T group and 108 in the NT group. Sixty-five per cent of the T group and 69% of the NT group provided feedback. Ninety-eight per cent (98%) felt that they had been advantaged by being included in the group compared with 95% in the NT who felt disadvantaged. The majority (98%) thought that using the cadavers was advantageous and gave a realistic feel for soft tissue management (89%) and that it was similar to managing a patient (81%). Self-reported confidence in undertaking an extraction was not different between the two groups (P=.078), and performance in the extraction assessment was not significantly different between the two groups over the 4 years (P=.8). CONCLUSION The Thiel-embalmed cadavers were well received by the students who found it a more realistic model for exodontia than a mannequin, even though this did not impact on their performance in a following assessment. Future work on these cadavers may be expanded to include surgical procedures.
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Affiliation(s)
- C Hanson
- Unit of Oral Surgery and Medicine, University of Dundee Dental School, Dundee, Scotland, UK
| | - T Wilkinson
- Centre for Anatomy and Human Identification (CAHID), University of Dundee, Dundee, Scotland, UK
| | - M Macluskey
- Unit of Oral Surgery and Medicine, University of Dundee Dental School, Dundee, Scotland, UK
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Abstract
Background Changes in UK legislation allow for surgical procedures to be performed on cadavers. The aim of this study was to assess Thiel cadavers as high-fidelity simulators and to examine their suitability for surgical training. Methods Surgeons from various specialties were invited to attend a 1 day dissection workshop using Thiel cadavers. The surgeons completed a baseline questionnaire on cadaveric simulation. At the end of the workshop, they completed a similar questionnaire based on their experience with Thiel cadavers. Comparing the answers in the pre- and post-workshop questionnaires assessed whether using Thiel cadavers had changed the surgeons’ opinions of cadaveric simulation. Results According to the 27 participants, simulation is important for surgical training and a full-procedure model is beneficial for all levels of training. Currently, there is dissatisfaction with existing models and a need for high-fidelity alternatives. After the workshop, surgeons concluded that Thiel cadavers are suitable for surgical simulation (p = 0.015). Thiel were found to be realistic (p < 0.001) to have reduced odour (p = 0.002) and be more cost-effective (p = 0.003). Ethical constraints were considered to be small. Conclusion Thiel cadavers are suitable for training in most surgical specialties.
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Bilge O, Celik S. Cadaver embalming fluid for surgical training courses: modified Larssen solution. Surg Radiol Anat 2017; 39:1263-1272. [DOI: 10.1007/s00276-017-1865-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 05/04/2017] [Indexed: 11/30/2022]
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Zarb F, McNulty J, Gatt A, Formosa C, Chockalingam N, Evanoff M, Rainford L. Comparison of in vivo vs. frozen vs. Thiel cadaver specimens in visualisation of anatomical structures of the ankle on proton density Magnetic Resonance Imaging (MRI) through a visual grading analysis (VGA) study. Radiography (Lond) 2017; 23:117-124. [DOI: 10.1016/j.radi.2016.12.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 11/28/2016] [Accepted: 12/08/2016] [Indexed: 12/01/2022]
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Lone M, McKenna JP, Balta JY, O'Mahony SM, Cryan JF, Downer EJ, Toulouse A. Assessment of Thiel-Embalmed Cadavers as a Teaching Tool for Oral Anatomy and Local Anesthesia. J Dent Educ 2017; 81:420-426. [PMID: 28365606 DOI: 10.21815/jde.016.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 10/19/2016] [Indexed: 12/12/2022]
Abstract
The aim of this study was to determine whether Thiel-embalmed cadavers would provide a useful anatomy teaching tool for topics that cannot be approached using formalin-fixed cadavers such as oral cavity examination and maxillary anesthesia. The suitability of Thiel-embalmed bodies for performing oral examinations was assessed by asking first-year dental and dental hygiene students at a dental school in Ireland to identify oral structures on a classmate and on a Thiel-embalmed body. The study was conducted in 2016. The ease of location was compared in the two settings, and their quality was assessed on the cadavers. The suitability of Thiel-embalmed cadavers to teach maxillary anesthesia was assessed by students' performing mock injections at five adjacent sites daily for five consecutive days, followed by inspection of the gingival surface by experienced anatomists and dentists. Data were obtained from 57 students, but only the 54 forms that were fully completed were analyzed, for an overall response rate of 85.7%. The results showed that most oral structures were more difficult to locate on cadavers. The texture and appearance of features in the cadavers were rated at a midpoint between realistic and unrealistic. The relative inexperience of the participants, the accumulation of fixative in the oral cavity, and discoloration were mentioned as potential confounding factors. Visual analysis of images obtained following repeated injections revealed no deterioration of the tissue. Importantly, the puncture marks appeared to reduce over time, suggesting that the gingival tissue maintains some elasticity following Thiel fixation. These findings suggest that Thiel-embalmed cadavers may be a useful tool to provide students more time to localize and study aspects of the oral cavity. Likewise, the recoiling capacity of gingival tissue suggests that Thiel-embalmed cadavers may provide an ideal tool for teaching injection technique of local anesthetics.
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Affiliation(s)
- Mutahira Lone
- Dr. Lone is with the Department of Anatomy and Neuroscience, University College Cork, Ireland; Dr. McKenna is with the Cork University Dental School and Hospital, University College Cork, Ireland; Dr. Balta is with the Department of Anatomy and Neuroscience, University College Cork, Ireland; Dr. O'Mahony is with the Department of Anatomy and Neuroscience, University College Cork, Ireland; Dr. Cryan is with the Department of Anatomy and Neuroscience, University College Cork, Ireland; Dr. Downer is with the School of Medicine, Discipline of Physiology, Trinity College Dublin, Ireland; and Dr. Toulouse is with the Department of Anatomy and Neuroscience, University College Cork, Ireland
| | - Joseph P McKenna
- Dr. Lone is with the Department of Anatomy and Neuroscience, University College Cork, Ireland; Dr. McKenna is with the Cork University Dental School and Hospital, University College Cork, Ireland; Dr. Balta is with the Department of Anatomy and Neuroscience, University College Cork, Ireland; Dr. O'Mahony is with the Department of Anatomy and Neuroscience, University College Cork, Ireland; Dr. Cryan is with the Department of Anatomy and Neuroscience, University College Cork, Ireland; Dr. Downer is with the School of Medicine, Discipline of Physiology, Trinity College Dublin, Ireland; and Dr. Toulouse is with the Department of Anatomy and Neuroscience, University College Cork, Ireland
| | - Joy Y Balta
- Dr. Lone is with the Department of Anatomy and Neuroscience, University College Cork, Ireland; Dr. McKenna is with the Cork University Dental School and Hospital, University College Cork, Ireland; Dr. Balta is with the Department of Anatomy and Neuroscience, University College Cork, Ireland; Dr. O'Mahony is with the Department of Anatomy and Neuroscience, University College Cork, Ireland; Dr. Cryan is with the Department of Anatomy and Neuroscience, University College Cork, Ireland; Dr. Downer is with the School of Medicine, Discipline of Physiology, Trinity College Dublin, Ireland; and Dr. Toulouse is with the Department of Anatomy and Neuroscience, University College Cork, Ireland
| | - Siobhain M O'Mahony
- Dr. Lone is with the Department of Anatomy and Neuroscience, University College Cork, Ireland; Dr. McKenna is with the Cork University Dental School and Hospital, University College Cork, Ireland; Dr. Balta is with the Department of Anatomy and Neuroscience, University College Cork, Ireland; Dr. O'Mahony is with the Department of Anatomy and Neuroscience, University College Cork, Ireland; Dr. Cryan is with the Department of Anatomy and Neuroscience, University College Cork, Ireland; Dr. Downer is with the School of Medicine, Discipline of Physiology, Trinity College Dublin, Ireland; and Dr. Toulouse is with the Department of Anatomy and Neuroscience, University College Cork, Ireland
| | - John F Cryan
- Dr. Lone is with the Department of Anatomy and Neuroscience, University College Cork, Ireland; Dr. McKenna is with the Cork University Dental School and Hospital, University College Cork, Ireland; Dr. Balta is with the Department of Anatomy and Neuroscience, University College Cork, Ireland; Dr. O'Mahony is with the Department of Anatomy and Neuroscience, University College Cork, Ireland; Dr. Cryan is with the Department of Anatomy and Neuroscience, University College Cork, Ireland; Dr. Downer is with the School of Medicine, Discipline of Physiology, Trinity College Dublin, Ireland; and Dr. Toulouse is with the Department of Anatomy and Neuroscience, University College Cork, Ireland
| | - Eric J Downer
- Dr. Lone is with the Department of Anatomy and Neuroscience, University College Cork, Ireland; Dr. McKenna is with the Cork University Dental School and Hospital, University College Cork, Ireland; Dr. Balta is with the Department of Anatomy and Neuroscience, University College Cork, Ireland; Dr. O'Mahony is with the Department of Anatomy and Neuroscience, University College Cork, Ireland; Dr. Cryan is with the Department of Anatomy and Neuroscience, University College Cork, Ireland; Dr. Downer is with the School of Medicine, Discipline of Physiology, Trinity College Dublin, Ireland; and Dr. Toulouse is with the Department of Anatomy and Neuroscience, University College Cork, Ireland
| | - André Toulouse
- Dr. Lone is with the Department of Anatomy and Neuroscience, University College Cork, Ireland; Dr. McKenna is with the Cork University Dental School and Hospital, University College Cork, Ireland; Dr. Balta is with the Department of Anatomy and Neuroscience, University College Cork, Ireland; Dr. O'Mahony is with the Department of Anatomy and Neuroscience, University College Cork, Ireland; Dr. Cryan is with the Department of Anatomy and Neuroscience, University College Cork, Ireland; Dr. Downer is with the School of Medicine, Discipline of Physiology, Trinity College Dublin, Ireland; and Dr. Toulouse is with the Department of Anatomy and Neuroscience, University College Cork, Ireland.
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Völlner F, Pilsl U, Craiovan B, Zeman F, Schneider M, Wörner M, Grifka J, Weber M. Stability of knee ligament complex of Thiel-embalmed cadaver compared to in vivo knee. J Mech Behav Biomed Mater 2017; 71:392-396. [PMID: 28411549 DOI: 10.1016/j.jmbbm.2017.04.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 03/29/2017] [Accepted: 04/06/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND The first biomechanical evaluation of new implants is usually carried out with cadavers. Fixation of Thiel-embalmed cadavers is supposed to preserve the histological structure, colour and consistency of the tissue and has a low risk of infection and toxicity. However, the biomechanical properties of Thiel-fixated tissue are still unknown. The aim of this study was to quantify the effect of the Thiel-embalming method on the elastic properties of the ligament complex of the knee compared to in vivo knees during total knee arthroplasty. METHODS The results of biomechanical tensile tests with 10 Thiel-embalmed knees were compared with the findings of 10 patients who underwent total knee arthroplasty with a standardised knee balancer at our department. We reconstructed the force-elongation curves of the medial and lateral ligament complex and calculated the stiffness in direct correlation with overall soft tissue stability in full extension and in 90° of flexion. RESULTS All curves consisted of a non-linear part at the beginning and a linear part from about 80N onwards. In full extension, median stiffness in the cadavers was 26.6N/mm for the medial compartment and 31.6N/mm for the lateral compartment. The values for in vivo were 25.7N/mm for the medial compartment and 25.3N/mm for the lateral compartment (p=0.684 for the medial compartment and p=0.247 for the lateral compartment). In 90° of flexion, median stiffness in the cadaver group was 24.7N/mm for the medial compartment and 22.2N/mm for the lateral compartment. In vivo, median stiffness was 30.3N/mm for the medial compartment and 29.2N/mm for the lateral compartment (p=0.009 for the medial compartment and p=0.143 for the lateral compartment). CONCLUSION Stiffness of the medial and lateral ligament complex in the knee was comparable between Thiel-embalmed cadavers and in vivo patients during total knee arthroplasty. Thiel fixation seems to preserve the soft tissue properties similar to those in vivo.
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Affiliation(s)
- Florian Völlner
- Department of Orthopaedic Surgery, University Medical Centre Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V-Allee 3, 93077 Bad Abbach, Germany.
| | - Ulrike Pilsl
- Institute of Macroscopic and Clinical Anatomy, Medical University of Graz, Harrachgasse 21, 8010 Graz, Austria
| | - Benjamin Craiovan
- Department of Orthopaedic Surgery, University Medical Centre Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V-Allee 3, 93077 Bad Abbach, Germany
| | - Florian Zeman
- Center of Clinical Studies, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Michael Schneider
- Department of Orthopaedic Surgery, University Medical Centre Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V-Allee 3, 93077 Bad Abbach, Germany
| | - Michael Wörner
- Department of Orthopaedic Surgery, University Medical Centre Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V-Allee 3, 93077 Bad Abbach, Germany
| | - Joachim Grifka
- Department of Orthopaedic Surgery, University Medical Centre Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V-Allee 3, 93077 Bad Abbach, Germany
| | - Markus Weber
- Department of Orthopaedic Surgery, University Medical Centre Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V-Allee 3, 93077 Bad Abbach, Germany
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Sawhney C, Lalwani S, Ray BR, Sinha S, Kumar A. Benefits and Pitfalls of Cadavers as Learning Tool for Ultrasound-guided Regional Anesthesia. Anesth Essays Res 2017; 11:3-6. [PMID: 28298747 PMCID: PMC5341665 DOI: 10.4103/0259-1162.186607] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Ultrasound-guided regional anesthesia (UGRA), like other basic skills, should be learnt in a simulation laboratory before performing on the patient. Cadavers provide an ideal tool for learning sonoanatomy and skills required for performing UGRA. On the basis of preservation technique used, the cadavers can be formalin embalmed cadavers, Thiel cadavers (soft cadavers), and fresh frozen cadavers. We compared three types of cadavers for performing ultrasound-guided upper and lower limb blocks. We observed that fresh frozen and Thiel cadavers were less smelling and had more realistic appearance as compared to formalin embalmed cadavers. It was seen that Thiel cadavers were more flexible and hence, rotation of neck, shoulder and knee was easier. Although images seen in most cadavers were comparable with live subjects but, Thiel cadavers provided more realistic model.
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Affiliation(s)
- Chhavi Sawhney
- Department of Anesthesia, Pain Medicine and Critical Care, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Lalwani
- Department of Forensic Medicine, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Bikash Ranjan Ray
- Department of Anesthesia, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Sumit Sinha
- Department of Neurosugery, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Abhyuday Kumar
- Department of Anesthesia, Pain Medicine and Critical Care, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
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Möhlhenrich SC, Ayoub N, Fritz U, Prescher A, Hölzle F, Modabber A. Evaluation of ultrasonic and conventional surgical techniques for genioplasty combined with two different osteosynthesis plates: a cadaveric study. Clin Oral Investig 2016; 21:2437-2444. [PMID: 28032198 DOI: 10.1007/s00784-016-2040-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 12/21/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The aim of this study was to compare genioplasties performed using traditional saw or piezosurgery combined with different osteosynthesis plates. MATERIALS AND METHODS Thirty-two genioplasties were first performed on fresh human cadavers using a saw or piezosurgery, followed by chin osteosynthesis with bending or pre-shaped plates. The time required for osteotomy and plate fixation was measured, and the suprahyoid pedicle was inspected. RESULTS The mean time required was 204 s (SD 43) with the saw and 52 s (SD 67) with piezosurgery. Osteosynthesis fixation time was 100 s (SD 31) for pre-shaped plates and 124 s (SD 24) for individual plates. Statistical differences were found between both osteotomy techniques (p < 0.001) and osteosynthesis plates (p = 0.025). Injuries of the suprahyoid muscle pedicle were found in 10/16 saw cases and 3/16 piezosurgery cases (p = 0.012). CONCLUSIONS Although piezosurgery is more time consuming compared with saw osteotomy, it is still adequate in time and allows a reduction of the suprahyoid pedicle injuries. Therefore, piezosurgery seems to be a viable alternative technique for genioplasty. From a clinical point of view, the time difference for osteosynthesis fixation has no significance. CLINICAL RELEVANCE The time taken for ultrasonic surgery is suitable for clinical use and leads additional to less damage to the suprahyoid pedicle.
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Affiliation(s)
- Stephan Christian Möhlhenrich
- Department of Orthodontics, University Hospital of RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany. .,Department of Oral and Maxillofacial Surgery, University Hospital of RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Nassim Ayoub
- Department of Oral and Maxillofacial Surgery, University Hospital of RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Ulrike Fritz
- Department of Orthodontics, University Hospital of RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Andreas Prescher
- Institute of Molecular and Cellular Anatomy, Medical Faculty of RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Frank Hölzle
- Department of Oral and Maxillofacial Surgery, University Hospital of RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Ali Modabber
- Department of Oral and Maxillofacial Surgery, University Hospital of RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
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Upper and Lower Urinary Tract Endoscopy Training on Thiel-embalmed Cadavers. Urology 2016; 93:27-32. [DOI: 10.1016/j.urology.2016.01.040] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 12/22/2015] [Accepted: 01/19/2016] [Indexed: 11/18/2022]
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32
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Shepherd S, Macluskey M, Napier A, Jackson R. Oral surgery simulated teaching; 3D model printing. ACTA ACUST UNITED AC 2016. [DOI: 10.1111/ors.12228] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- S. Shepherd
- Oral and Maxillofacial Clinical Sciences; University of Dundee; Dundee UK
| | - M. Macluskey
- Oral and Maxillofacial Clinical Sciences; University of Dundee; Dundee UK
| | - A. Napier
- DJCAD Make; Duncan of Jordanstone College of Art and Design; University of Dundee; Dundee UK
| | - R. Jackson
- DJCAD Make; Duncan of Jordanstone College of Art and Design; University of Dundee; Dundee UK
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Yoshitake Y, Miyamoto N, Taniguchi K, Katayose M, Kanehisa H. The Skin Acts to Maintain Muscle Shear Modulus. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:674-682. [PMID: 26738629 DOI: 10.1016/j.ultrasmedbio.2015.11.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 11/19/2015] [Accepted: 11/23/2015] [Indexed: 06/05/2023]
Abstract
It is not clear how the tissues covering the skeletal muscles affect the muscles' mechanical properties. The main purpose of this study was to examine changes in muscle shear modulus as a representative mechanical property of muscle with and without the covering tissues of skin and epimysium (fascia). Shear modulus of the medial gastrocnemius (MG) muscle was determined using ultrasound shear-wave elastography in the Thiel's embalmed cadavers under three different conditions: original (intact cadavers), removal of the skin on the MG and subsequent removal of the epimysium. Muscle shear modulus significantly decreased by 50% after removal of the skin, whereas no additional changes in shear modulus were observed after subsequent removal of the epimysium. This study suggests that the skin is a main contributor for maintaining the muscle mechanical properties among tissues covering the skeletal muscle.
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Affiliation(s)
- Yasuhide Yoshitake
- Department of Sports and Life Sciences, National Institute of Fitness and Sports in Kanoya, Kanoya, Japan.
| | - Naokazu Miyamoto
- Department of Sports and Life Sciences, National Institute of Fitness and Sports in Kanoya, Kanoya, Japan
| | - Keigo Taniguchi
- School of Health Sciences, Sapporo Medical University, Sapporo, Japan
| | - Masaki Katayose
- School of Health Sciences, Sapporo Medical University, Sapporo, Japan
| | - Hiroaki Kanehisa
- Department of Sports and Life Sciences, National Institute of Fitness and Sports in Kanoya, Kanoya, Japan
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Joy J, McLeod G, Lee N, Munirama S, Corner G, Eisma R, Cochran S. Quantitative assessment of Thiel soft-embalmed human cadavers using shear wave elastography. Ann Anat 2015; 202:52-6. [DOI: 10.1016/j.aanat.2015.06.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 06/08/2015] [Accepted: 06/30/2015] [Indexed: 10/23/2022]
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Hayashi S, Naito M, Kawata S, Qu N, Hatayama N, Hirai S, Itoh M. History and future of human cadaver preservation for surgical training: from formalin to saturated salt solution method. Anat Sci Int 2015; 91:1-7. [PMID: 26670696 DOI: 10.1007/s12565-015-0299-5] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Accepted: 08/18/2015] [Indexed: 01/07/2023]
Abstract
Traditionally, surgical training meant on-the-job training with live patients in an operating room. However, due to advancing surgical techniques, such as minimally invasive surgery, and increasing safety demands during procedures, human cadavers have been used for surgical training. When considering the use of human cadavers for surgical training, one of the most important factors is their preservation. In this review, we summarize four preservation methods: fresh-frozen cadaver, formalin, Thiel's, and saturated salt solution methods. Fresh-frozen cadaver is currently the model that is closest to reality, but it also presents myriad problems, including the requirement of freezers for storage, limited work time because of rapid putrefaction, and risk of infection. Formalin is still used ubiquitously due to its low cost and wide availability, but it is not ideal because formaldehyde has an adverse health effect and formalin-embalmed cadavers do not exhibit many of the qualities of living organs. Thiel's method results in soft and flexible cadavers with almost natural colors, and Thiel-embalmed cadavers have been appraised widely in various medical disciplines. However, Thiel's method is relatively expensive and technically complicated. In addition, Thiel-embalmed cadavers have a limited dissection time. The saturated salt solution method is simple, carries a low risk of infection, and is relatively low cost. Although more research is needed, this method seems to be sufficiently useful for surgical training and has noteworthy features that expand the capability of clinical training. The saturated salt solution method will contribute to a wider use of cadavers for surgical training.
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Affiliation(s)
- Shogo Hayashi
- Department of Anatomy, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-Ku, Tokyo, 160-8402, Japan.
| | - Munekazu Naito
- Department of Anatomy, School of Medicine, Aichi Medical University, Aichi, Japan
| | - Shinichi Kawata
- Department of Anatomy, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-Ku, Tokyo, 160-8402, Japan
| | - Ning Qu
- Department of Anatomy, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-Ku, Tokyo, 160-8402, Japan
| | - Naoyuki Hatayama
- Department of Anatomy, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-Ku, Tokyo, 160-8402, Japan
| | - Shuichi Hirai
- Department of Anatomy, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-Ku, Tokyo, 160-8402, Japan
| | - Masahiro Itoh
- Department of Anatomy, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-Ku, Tokyo, 160-8402, Japan
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Willaert W, De Vos M, Van Hoof T, Delrue L, Pattyn P, D’Herde K. Understanding Thiel embalming in pig kidneys to develop a new circulation model. PLoS One 2015; 10:e0120114. [PMID: 25806527 PMCID: PMC4373718 DOI: 10.1371/journal.pone.0120114] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 01/24/2015] [Indexed: 11/18/2022] Open
Abstract
The quality of tissue preservation in Thiel embalmed bodies
varies. Research on the administered embalming volume and its vascular distribution may elucidate one of the mechanisms of tissue preservation and allow for new applications of Thiel embalming. Vascular embalming with (group 1, n = 15) or without (group 2, n = 20) contrast agent was initiated in pig kidneys. The distribution of Thiel embalming solution in group 1 was visualized using computed tomography. The kidneys in both groups were then immersed in concentrated salt solutions to reduce their weight and volume. Afterwards, to mimic a lifelike circulation in the vessels, group 2 underwent pump-driven reperfusion for 120 minutes with either paraffinum perliquidum or diluted polyethylene glycol. The circulation was imaged with computed tomography. All of the kidneys were adequately preserved. The embalming solution spread diffusely in the kidney, but fluid accumulation was present. Subsequent immersion in concentrated salt solutions reduced weight (P < 0.01) and volume (P < 0.01). Reperfusion for 120 minutes was established in group 2. Paraffinum perliquidum filled both major vessels and renal tissue, whereas diluted polyethylene glycol spread widely in the kidney. There were no increases in weight (P = 0.26) and volume (P = 0.79); and pressure further decreased (P = 0.032) after more than 60 minutes of reperfusion with paraffinum perliquidum, whereas there were increases in weight (P = 0.005), volume (P = 0.032) and pressure (P < 0.0001) after reperfusion with diluted polyethylene glycol. Arterial embalming of kidneys results in successful preservation due to complete parenchymatous spreading. More research is needed to determine whether other factors affect embalming quality. Dehydration is an effective method to regain the organs’ initial status. Prolonged vascular reperfusion with paraffinum perliquidum can be established in this model without increases in weight, volume and pressure.
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Affiliation(s)
- Wouter Willaert
- Department of Gastrointestinal Surgery, Ghent University Hospital, Ghent, Belgium
- * E-mail:
| | - Marie De Vos
- Department of Gastrointestinal Surgery, Ghent University Hospital, Ghent, Belgium
| | - Tom Van Hoof
- Department of Basic Medical Sciences, Ghent University Hospital, Ghent, Belgium
| | - Louke Delrue
- Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium
| | - Piet Pattyn
- Department of Gastrointestinal Surgery, Ghent University Hospital, Ghent, Belgium
| | - Katharina D’Herde
- Department of Basic Medical Sciences, Ghent University Hospital, Ghent, Belgium
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Healy SE, Rai BP, Biyani CS, Eisma R, Soames RW, Nabi G. Thiel Embalming Method for Cadaver Preservation: A Review of New Training Model for Urologic Skills Training. Urology 2015; 85:499-504. [DOI: 10.1016/j.urology.2014.11.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 11/06/2014] [Accepted: 11/13/2014] [Indexed: 12/01/2022]
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38
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Liao X, Kemp S, Corner G, Eisma R, Huang Z. Elastic properties of Thiel-embalmed human ankle tendon and ligament. Clin Anat 2015; 28:917-24. [DOI: 10.1002/ca.22512] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 12/24/2014] [Accepted: 01/06/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Xiaochun Liao
- School of Engineering, Physics and Mathematics, University of Dundee; Dundee DD1 4HN United Kingdom
| | - Sandy Kemp
- School of Engineering, Physics and Mathematics, University of Dundee; Dundee DD1 4HN United Kingdom
| | - George Corner
- Department of Medical Physics; Ninewells Hospital and Medical School; Dundee DD1 9SY United Kingdom
| | - Roos Eisma
- Centre for Anatomy and Human Identification, College of Art, Science and Engineering, University of Dundee; Dundee DD1 4HN United Kingdom
| | - Zhihong Huang
- School of Engineering, Physics and Mathematics, University of Dundee; Dundee DD1 4HN United Kingdom
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Kühl S, Kirmeier R, Platzer S, Bianco N, Jakse N, Payer M. Transcrestal maxillary sinus augmentation: Summers' versus a piezoelectric technique--an experimental cadaver study. Clin Oral Implants Res 2015; 27:126-9. [PMID: 25682786 DOI: 10.1111/clr.12546] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Sinus floor augmentation using transalveolar techniques is a successful and predictable procedure. The aim of the study was to compare the performance of conventional hand instruments using mallets and osteotomes with that of piezoelectric-hydrodynamic devices for maxillary sinus floor elevation. MATERIAL AND METHODS In 17 undamaged cadaver heads on randomly allocated sites, Schneiderian membrane elevation was carried out transcrestally using piezosurgery and a hydrodynamic device or by conventional hand instrumentation. After simulation of sinus augmentation by the use of a radiopaque impression material, a post-operative CT scan was carried out and volumes were determined. Statistic significant differences between the two methods were evaluated by nonparametric Mann-Whitney U-test with P < 0.05. RESULTS A mean graft volume of 0.29 ± 0.18 cm(3) (0.07-0.60 cm(3)) was measured for the Summers' technique compared to 0.39 ± 0.32 cm(3) (0.05-1.04 cm(3)) for the Sinus Physiolift(®) technique. There is no statistically significant difference with regard to trauma to the Schneiderian membrane or augmented volume. CONCLUSIONS Both techniques generate expedient augmentation volume in the posterior atrophic maxilla. The piezoelectric technique can be recommended as an alternative tool to graft the floor of human maxillary sinuses.
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Affiliation(s)
- S Kühl
- Department of Oral Surgery, Oral Radiology and Oral Medicine, School of Dental Medicine, University of Basel, Basel, Switzerland
| | - R Kirmeier
- Department of Oral Surgery and Radiology, School of Dentistry, Medical University of Graz, Graz, Austria
| | - S Platzer
- Department of Prosthodontics, School of Dentistry, Medical University of Graz, Graz, Austria
| | - N Bianco
- Department of Oral Surgery and Radiology, School of Dentistry, Medical University of Graz, Graz, Austria
| | - N Jakse
- Department of Oral Surgery, Oral Radiology and Oral Medicine, School of Dental Medicine, University of Basel, Basel, Switzerland
| | - M Payer
- Department of Oral Surgery, Oral Radiology and Oral Medicine, School of Dental Medicine, University of Basel, Basel, Switzerland
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Hammer N, Löffler S, Bechmann I, Steinke H, Hädrich C, Feja C. Comparison of modified Thiel embalming and ethanol-glycerin fixation in an anatomy environment: Potentials and limitations of two complementary techniques. ANATOMICAL SCIENCES EDUCATION 2015; 8:74-85. [PMID: 24706536 DOI: 10.1002/ase.1450] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 01/29/2014] [Accepted: 03/11/2014] [Indexed: 06/03/2023]
Abstract
Thiel-fixed specimens have outstandingly lifelike visual and haptic properties. However, the original Thiel method is expensive and requires an elaborate setup. It is therefore of principal interest to modify the Thiel method in order to make it available to a broader user group. A modified Thiel embalming method will be described in detail and compared to ethanol-glycerin fixation with the help of illustrative examples. The visual properties, haptic properties, the usability for performing histological investigations, costs and potential health aspects will be considered. Tissues fixed with the modified Thiel technique gave results similar to the original method, providing more realistic visual and haptic properties than ethanol-glycerin embalming. However, Thiel fixation is significantly more expensive and requires more precautions to minimize potential health hazards than ethanol-glycerin-fixed tissues. In contrast to ethanol-glycerin-fixed specimens, the Thiel-fixed specimens are not suitable for histological investigations. Both modes of fixation are inappropriate for biomechanical testing. Modified Thiel embalming simplifies the availability of body donors with lifelike properties and has cost-saving advantages to the original technique. Thiel-embalmed body donors are ideally suited for clinical workshops but have restrictions for student dissection courses in facilities with limited storage space, air circulation or technical staff. Vice versa, ethanol-glycerin-fixed body donors are well suited for student dissection courses in such an environment but are limited in their use for clinical workshops. Modified Thiel embalming therefore ideally complements ethanol-glycerin fixation in order to provide customized solutions for clinical workshops and student dissection courses in a wide range of applications.
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Affiliation(s)
- Niels Hammer
- Institute of Anatomy, University of Leipzig, Faculty of Medicine, Leipzig, Germany
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Balta JY, Lamb C, Soames RW. A pilot study comparing the use of Thiel- and formalin-embalmed cadavers in the teaching of human anatomy. ANATOMICAL SCIENCES EDUCATION 2015; 8:86-91. [PMID: 24996059 DOI: 10.1002/ase.1470] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 03/27/2014] [Accepted: 05/25/2014] [Indexed: 06/03/2023]
Abstract
Formalin had traditionally been used to preserve human material to teach gross anatomy. In 2008 the Centre for Anatomy and Human Identification (CAHID) at the University of Dundee embarked on the use of the Thiel method of embalming. The aim of this pilot study was to assess the difference between formalin-embalmed cadavers (FEC) and Thiel-embalmed cadavers (TEC) used for teaching and surgical training. Three different questionnaires were prepared for data collection from undergraduate and postgraduate students and clinical staff. All undergraduate and postgraduate students as well as clinical staff commented on the appearance of the TEC. There was no overall consensus concerning the use of TEC, some respondents preferred TEC for the entire dissection, some only for certain areas such as the musculoskeletal system. On a technical level TEC were considered less hazardous then FEC by one-third of participants with fewer than 10% regarding TEC as more irritating than FEC. Psychologically, 32.7% of undergraduate students expressed the view that TEC made them feel more uncomfortable compared with FEC because of their life-like appearance. However, 57.1% of undergraduate students encountered the same uncomfortable feelings when viewing both TEC and FEC. The use of Thiel-embalmed cadavers to teach anatomy has an added value, though further research is required over longer periods of time to identify its best usage.
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Affiliation(s)
- Joy Y Balta
- Department of Anatomy and Neuroscience, College of Medicine and Health, University College Cork, Cork, Ireland; Centre for Anatomy and Human Identification, College of Art, Science and Engineering, University of Dundee, Dundee, Scotland, United Kingdom
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Abstract
In this essay Roos Eisma and Tracey Wilkinson describe how the Thiel technique has expanded the range of applications in which embalmed human cadavers can be used. For decades, embalmed cadavers have played an important role in teaching anatomy to the scientists and doctors of the future. Most anatomy departments use a traditional formaldehyde-based embalming method, but formalin embalming makes the bodies very rigid, which limits their usefulness for procedures other than dissection. A more recent embalming method developed by W. Thiel has allowed these “silent teachers” to take on a further role in applied anatomy research and teaching: to act as models for surgical training and medical research.
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Affiliation(s)
- Roos Eisma
- Centre for Anatomy and Human Identification, University of Dundee, Dundee, Scotland, United Kingdom
- * E-mail:
| | - Tracey Wilkinson
- Centre for Anatomy and Human Identification, University of Dundee, Dundee, Scotland, United Kingdom
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Eljamel S, Volovick A, Saliev T, Eisma R, Melzer A. Evaluation of Thiel cadaveric model for MRI-guided stereotactic procedures in neurosurgery. Surg Neurol Int 2014; 5:S404-9. [PMID: 25289170 PMCID: PMC4173306 DOI: 10.4103/2152-7806.140199] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 03/10/2014] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Magnetic resonance imaging (MRI)-guided deep brain stimulation (DBS) and high frequency focused ultrasound (FUS) is an emerging modality to treat several neurological disorders of the brain. Developing reliable models to train and assess future neurosurgeons is paramount to ensure safety and adequate training of neurosurgeons of the future. METHODS We evaluated the use of Thiel cadaveric model to practice MRI-guided DBS implantation and high frequency MRI-guided FUS in the human brain. We performed three training sessions for DBS and five sonications using high frequency MRI-guided FUS in five consecutive cadavers to assess the suitability of this model to use in training for stereotactic functional procedures. RESULTS We found the brains of these cadavers preserved in an excellent anatomical condition up to 15 months after embalmment and they were excellent model to use, MRI-guided DBS implantation and FUS produced the desired lesions accurately and precisely in these cadaveric brains. CONCLUSION Thiel cadavers provided a very good model to perform these procedures and a potential model to train and assess neurosurgeons of the future.
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Affiliation(s)
- Sam Eljamel
- Centre for Neurosciences, College of Medicine, Dentistry and Nursing, Ninewells Hospital and Medical School, Dundee, UK
| | - Alexander Volovick
- Centre for Neurosciences, College of Medicine, Dentistry and Nursing, Ninewells Hospital and Medical School, Dundee, UK ; Department of Anatomy and Human Identification, Institute for Medical Science and Technology, University of Dundee, UK
| | - Timur Saliev
- Centre for Neurosciences, College of Medicine, Dentistry and Nursing, Ninewells Hospital and Medical School, Dundee, UK
| | - Roos Eisma
- Department of Imaging at IMSAT and R and D, Department at Insightic, InSightec Ltd., Tirat Carmel, Israel
| | - Andreas Melzer
- Centre for Neurosciences, College of Medicine, Dentistry and Nursing, Ninewells Hospital and Medical School, Dundee, UK
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Karakitsios I, Dogadkin O, Le N, Melzer A. Measurement of proton resonance frequency shift coefficient during MR-guided focused ultrasound on Thiel embalmed tissue. Magn Reson Med 2014; 74:260-265. [DOI: 10.1002/mrm.25378] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 06/30/2014] [Accepted: 06/30/2014] [Indexed: 01/23/2023]
Affiliation(s)
- Ioannis Karakitsios
- Institute for Medical Science and Technology, University of Dundee; Dundee United Kingdom
| | - Osnat Dogadkin
- Institute for Medical Science and Technology, University of Dundee; Dundee United Kingdom
| | - Nhan Le
- Institute for Medical Science and Technology, University of Dundee; Dundee United Kingdom
| | - Andreas Melzer
- Institute for Medical Science and Technology, University of Dundee; Dundee United Kingdom
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Karakitsios I, Bobeica M, Saliev T, Rube M, Melzer A. Thermometry during MR-guided focused ultrasound in a preclinical model based on Thiel embalmed tissue. MINIM INVASIV THER 2013; 23:120-6. [DOI: 10.3109/13645706.2013.839950] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Gueorguieva MJ, Yeo DTB, Eisma R, Melzer A. MRI of Thiel-embalmed human cadavers. J Magn Reson Imaging 2013; 39:576-83. [PMID: 23818428 DOI: 10.1002/jmri.24210] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 04/12/2013] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To explain the observed considerable loss of signal and contrast when Thiel-embalmed human cadavers are imaged using clinical magnetic resonance imaging (MRI) sequences, especially those based on spin-echo MRI. MATERIALS AND METHODS All cadavers were imaged with a medical 1.5T scanner using standard MRI sequences. Dual angle B1+ magnitude mapping and electromagnetic (EM) simulations that characterize the radiofrequency (RF) penetration in a male human body model (HBM) were carried out for a range of tissue conductivities. RESULTS The EM simulations show that RF penetration issues begin to affect the image quality for values of electrical conductivity as low as 2.6 S/m. The electrical conductivity values of the embalming fluids were found to be within the range of 5-10.6 S/m, thus strongly suggesting that the observed loss in signal and contrast is due to diminished RF penetration inside the cadavers. Furthermore, it was demonstrated that gradient-echo (GRE)-based MRI sequences perform better than spin-echo (SE)-based sequences, as they are less susceptible to imperfections in the flip angle that are inevitably present when imaging Thiel cadavers. CONCLUSION The diminished signal and contrast observed when imaging Thiel-embalmed human cadavers may be attributed to the high conductivity of the embalming liquids.
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Affiliation(s)
- Mariana J Gueorguieva
- Institute for Medical Science and Technology, University of Dundee, Dundee, Scotland, UK
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Eisma R, Gueorguieva M, Immel E, Toomey R, Mcleod G, Soames R, Melzer A. Liver displacement during ventilation in Thiel embalmed human cadavers – a possible model for research and training in minimally invasive therapies. MINIM INVASIV THER 2013; 22:291-6. [DOI: 10.3109/13645706.2013.769451] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Eisma R, Lamb C, Soames RW. From formalin to Thiel embalming: What changes? One anatomy department's experiences. Clin Anat 2013; 26:564-71. [PMID: 23408386 DOI: 10.1002/ca.22222] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Revised: 05/15/2012] [Accepted: 12/16/2012] [Indexed: 11/10/2022]
Abstract
In 2009, the Centre for Anatomy and Human Identification started Thiel embalming on a small scale to assess (i) the suitability for our current teaching in which long-lasting dissection courses are key, (ii) the potential for new collaborations and activities, and (iii) the practical implications of changing our embalming method from formalin to Thiel. Twenty six Thiel-embalmed cadavers have been used for dissection by staff and students on a taught MSc course, as a model for clinical and surgical training, and increasingly as a model for evaluation of new medical devices and procedures. Our experiences with dissection were mostly positive especially for teaching the musculoskeletal system. Internal organs handle differently from formalin-fixed organs and dissection manuals need to be adjusted to reflect this. Durability of the cadavers was not an issue, though changes are seen over time due to gradual fluid loss. We have started new collaborations related to postgraduate anatomy teaching and advanced training in surgical and clinical skills. In general, feedback is very positive and demand for cadavers outstrips our current limited supply. Thiel-embalmed cadavers were found to provide a unique opportunity for evaluation of medical products especially in areas where no suitable alternative model is available, and without the complications associated with clinical testing. This has resulted in new collaborations and research projects. As a result Thiel-embalmed cadavers are used for longer and for more activities than formalin cadavers: this requires changes in our procedures and staff roles.
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Affiliation(s)
- R Eisma
- Centre for Anatomy and Human Identification, College of Life Sciences, University of Dundee, United Kingdom
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Prasad Rai B, Tang B, Eisma R, Soames RW, Wen H, Nabi G. A qualitative assessment of human cadavers embalmed by Thiel's method used in laparoscopic training for renal resection. ANATOMICAL SCIENCES EDUCATION 2012; 5:182-186. [PMID: 22362548 DOI: 10.1002/ase.1267] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Revised: 01/12/2012] [Accepted: 01/23/2012] [Indexed: 05/31/2023]
Abstract
Human cadaveric tissue is the fundamental substrate for basic anatomic and surgical skills training. A qualitative assessment of the use of human cadavers preserved by Thiel's method for a British Association of Urological Surgeons-approved, advanced laparoscopic renal resection skills training course is described in the present study. Four trainees and four experienced laparoscopic surgeons participated in the course. All participants completed a five-point Likert scale satisfaction questionnaire after their training sessions. The quality of cadaveric tissue and the training session were assessed with particular emphasis placed on the ease of patient positioning, the ease of trocar placement, the preservation of tissue planes, the ease of renal pedicle dissection, and the quality of tissue preservation. All of the participants highly rated the quality of the cadaveric tissue embalmed by Thiel's method (mean scores for quality on the five-point Likert scale were 4.5 and 4.3 by the trainees and experienced laparoscopic surgeons, respectively). All of the steps of laparoscopic renal resection were rated 4.0 or more on the Likert scale by both trainees and faculty members. The initial response rates for using a human cadaver embalmed by Thiel's method as a training tool for laparoscopic nephrectomy showed encouraging results. The performance of a laparoscopic nephrectomy on a human cadaver embalmed by Thiel's method bears close resemblance to real laparoscopic nephrectomy procedures, and thus demonstrates added advantages to the previously reported models.
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Affiliation(s)
- Bhavan Prasad Rai
- Department of Urology, Medical Research Institute, Ninewells Hospital and Medical School, University of Dundee, Dundee, Scotland, United Kingdom
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Evaluation of a new optical measuring system for experiments on fractured human mandibles. Clin Oral Investig 2011; 16:1535-42. [DOI: 10.1007/s00784-011-0659-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2011] [Accepted: 12/08/2011] [Indexed: 11/26/2022]
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