The effectiveness of virtual and augmented reality in health sciences and medical anatomy

Although cadavers constitute the gold standard for teaching anatomy to medical and health science students, there are substantial financial, ethical, and supervisory constraints on their use. In addition, although anatomy remains one of the fundamental areas of medical education, universities have decreased the hours allocated to teaching gross anatomy in favor of applied clinical work. The release of virtual (VR) and augmented reality (AR) devices allows learning to occur through hands-on immersive experiences. The aim of this research was to assess whether learning structural anatomy utilizing VR or AR is as effective as tablet-based (TB) applications, and whether these modes allowed enhanced student learning, engagement and performance. Participants (n = 59) were randomly allocated to one of the three learning modes: VR, AR, or TB and completed a lesson on skull anatomy, after which they completed an anatomical knowledge assessment. Student perceptions of each learning mode and any adverse effects experienced were recorded. No significant differences were found between mean assessment scores in VR, AR, or TB. During the lessons however, VR participants were more likely to exhibit adverse effects such as headaches (25% in VR P < 0.05), dizziness (40% in VR, P < 0.001), or blurred vision (35% in VR, P < 0.01). Both VR and AR are as valuable for teaching anatomy as tablet devices, but also promote intrinsic benefits such as increased learner immersion and engagement. These outcomes show great promise for the effective use of virtual and augmented reality as means to supplement lesson content in anatomical education. Anat Sci Educ 10: 549-559. © 2017 American Association of Anatomists.

Ring-shaped variation of the coeliac trunk branches

Aberrant arterial variations in the branching pattern of the coeliac trunk are of great interest to surgeons and radiologists. We report on a rare arterial variation found in a 79-year-old cadaver during educational dissection. Specifically, the coeliac axis formed a unique incomplete trunk termed the hepato-hepatic trunk. The splenic artery arose separately from the anterior aspect of the abdominal aorta. On the right side, there was a right hepatic artery giving rise to a gastroduodenal but an absence of the left hepatic. On the left side, there was a branch coursing towards the porta hepatis; the left hepatic artery, dividing into the left gastric, an accessory left gastric, and a branch to the distal oesophagus. The hepato-hepatic trunk formed a ring-shaped vascular structure around the caudate lobe of the liver. Precise mapping and observation of the extrahepatic arteries and bile duct branches is essential in a variety of hepato-biliary laparoscopic procedures of the liver and gallbladder. Other operative procedures requiring, a comprehensive kno-wledge of the varied coeliac trunk patterns are liver transplantation and arterial embolism for hepatic tumour therapy.

Anatomical variations: How do surgical and radiology training programs teach and assess them in their training curricula?

Sound knowledge of anatomy and Anatomical variations plays an integral role in surgical and radiology specialties. This study investigated the current teaching and assessment trends on Anatomical variations in various surgical and radiology specialty training curricula in Canada and Australia. A survey was sent to 122 Program Directors and Chairs of specialty committees in Canada and Directors of Training/Education in Australia of selected surgical and radiology specialties. A total of 80.7% of respondents report that their training curricula include Anatomical variations. The highest rated classes of variations included in the curriculum are arterial (76%), venous (68%), followed by organs (64%). All trainees learn about Anatomical variations from surgeons and radiologists (100%) and via suggested textbooks of the specialty (87.1%). A total of 54.8% report that specialty training curricula do not suggest specific anatomical variation classifications for the trainees to learn, and 16.1% are uncertain if the colleges provide such kind of instruction. Trainees typically communicated findings of variations in case presentations and clinic's meetings. About 32.3% of respondents report that Anatomical variations are not assessed in their training curriculum. About 39.3% of experienced clinicians in the study report they encounter variations on a monthly basis and 25 and 21.4% on a weekly and daily basis, respectively. Surgical and radiology colleges need to investigate for hidden curriculum in their specialty training programs to ensure there are no gaps in knowledge and training related to Anatomical variations. Most educational leaders surveyed believe more teaching on Anatomical variations in the first 4 years of training would benefit resident doctors.

Supraclavicularis proprius muscle associated with supraclavicular nerve entrapment

Entrapment neuropathy of the supraclavicular nerve is rare and, when it occurs, is usually attributable to branching of the nerve into narrow bony clavicular canals. We describe another mechanism for entrapment of this nerve with the aberrant muscle; supraclavicularis being found during the routine dissection of an embalmed 82-year-old cadaver. Our report details a unique location for this rare muscular variation whereby the muscle fibres originated posteriorly on the medial aspect of the clavicle before forming a muscular arch over the supraclavicular nerve and passing laterally towards the trapezius and acromion. We recommend that in clinical instances of otherwise unexplained unilateral clavicular pain or tenderness, nerve compression from the supraclavicularis muscle must be borne in mind.

Surgical and topographic anatomy of the maxillary line: an important landmark for endoscopic nasal surgery

The maxillary line is an important surgical landmark in the lateral nasal cavity. We investigated its location, variation, and relation to other landmarks in 47 formalin fixed cadaveric half-heads dissected in steps. Measurements and observations were made to describe the topography of the maxillary line, maxillary line midpoint (M-point), and their relationship with surgically important structures. The mean curved length of the maxillary line was 15 mm (SD 3.5) and can be classified into three types. The M-point had a mean vertical distance of 0.8mm (SD 2.9) below the nasolacrimal sac-duct junction. It was found below, above, or on the same level as the nasolacrimal sac-duct junction in 57.4%, 38.3%, and 4.3% of specimens, respectively. In 51.1% the M-point was anterior to the nasolacrimal duct axis and 48.9% overlapping the lacrimal apparatus. The maxillary line and its M-point are useful surgical landmarks for localizing the nasolacrimal duct segments.

How useful is YouTube in learning heart anatomy?

Nowadays more and more modern medical degree programs focus on self-directed and problem-based learning. That requires students to search for high quality and easy to retrieve online resources. YouTube is an emerging platform for learning human anatomy due to easy access and being a free service. The purpose of this study is to make a quantitative and qualitative analysis of the available human heart anatomy videos on YouTube. Using the search engine of the platform we searched for relevant videos using various keywords. Videos with irrelevant content, animal tissue, non-English language, no sound, duplicates, and physiology focused were excluded from further elaboration. The initial search retrieved 55,525 videos, whereas only 294 qualified for further analysis. A unique scoring system was used to assess the anatomical quality and details, general quality, and the general data for each video. Our results indicate that the human heart anatomy videos available on YouTube conveyed our anatomical criteria poorly, whereas the general quality scoring found borderline. Students should be selective when looking up on public video databases as it can prove challenging, time consuming, and the anatomical information may be misleading due to absence of content review. Anatomists and institutions are encouraged to prepare and endorse good quality material and make them available online for the students. The scoring rubric used in the study comprises a valuable tool to faculty members for quality evaluation of heart anatomy videos available on social media platforms.

Internal jugular vein cannulation complications and elimination of the muscular triangle of the neck due to aberrant infrahyoid muscles

We report on a rare case of anatomical variations of the infrahyoid muscles with prominent clinical significance. The aberrant anatomy was on the right side of the neck and involved the omohyoid and sternohyoid muscles. The superior belly of the omohyoid was duplicated in width due to an aberrant belly anteriorly and merged with fibers of the inferior belly inferiorly and the sternohyoid muscle medially. An additional aberrant muscle slip extended between the inferior third of the sternohyoid muscle and united with the inferior belly of the omohyoid. The intermediate tendon between the two bellies of the omohyoid was absent, whereas the so-called muscular triangle of the neck was diminished. Due to the arrangement and fusion of myofibers the muscle could be termed as omo-sternohyoid muscle. A profound hematoma was noted in the aberrant muscle at the area overlying the internal jugular vein indicating difficulty in obtaining jugular venous access for catheter placement. Clinicians and surgeons should be aware of muscular anatomic variations when intervening in the lateral neck area as the classical anatomical landmarks might be misinterpreted and confuse.

Sesamoid ossicles within the nuchal ligament: a report of two cases and review of the literature

Sesamoid ossicles are ovoid or round nodular small bones found usually within a joint or tendon of the upper and lower limb and rarely at other regions. They are usually asymptomatic, resulting in an increased propensity to injuries. We report on two cases where sesamoid ossicles were detected within the nuchal ligament. The first one was a 55-years-old Caucasian male office employee, complaining of chronic pain in the cervical spine region accompanied by numbness of the left upper limb. During the routine lateral X-ray imaging two sesamoid ossicles were found within the nuchal ligament at the C4 and C5 spinous processes level. The second case was a 64-years-old Caucasian female store employee, complaining of chronic cervical spine pain. The routine lateral X-ray exhibited two sesamoid ossicles within the nuchal ligament at the C5 and C6 spinous processes level. Sesamoid ossicles found in the nuchal ligament in rare cases may become symptomatic and the pathogenesis mechanism should be differentially diagnosed by the physician. We discuss the precise morphology of the trait, the possible etiological mechanisms for their appearance, the histological features, as well as differential diagnosis.

Multiple aberrant coeliac trunk ramifications

This study describes a routine educational cadaveric dissection, where multiple aberrant coeliac trunk branches were noticed. Specifically, the accessory left hepatic artery emerged from the left gastric artery, while the left inferior phrenic artery originated from the coeliac trunk. The accessory left suprarenal artery was found to commence from the coeliac trunk, whereas two aberrant left suprarenal arteries branched separately from the origin of the left inferior phrenic artery. Finally, the accessory jejunal artery was observed to originate from the coeliac trunk. Anatomical variations of the coeliac trunk branches can significantly alter the surgical management of the upper abdomen; hence, clinicians and radiologists should be aware of such aberrant vascular anatomy so as to reduce the incidence of surgical complications.

Topographic anatomy of the internal laryngeal nerve: surgical considerations

BACKGROUND

This study is focused on the topographic features of the internal branch of the superior laryngeal nerve (ibSLN) at the thyrohyoid membrane area using as anatomic landmarks the posterior border of the thyrohyoid muscle and the superior border of the thyroid cartilage.

METHODS

Thirty-six fresh adult cadavers were dissected to determine the topography and branching pattern of the ibSLN and the superior laryngeal artery.

RESULTS

The ibSLN prior to thyrohyoid membrane's penetration was divided into 3 or 2 branches, in 72.22% and 27.78% of cases. The trifurcated ibSLN was more common than the bifurcated in both sexes and in both sides of the neck. In over 80% of cases the ibSLN penetrated the thyrohyoid membrane 0.1 to 0.9 cm far from the posterior border of the thyrohyoid muscle and 0.1 to 1.2 cm far from the superior border of the thyroid cartilage.

CONCLUSIONS

We provide a schematic overview of the ibSLN penetration zone at the thyrohyoid membrane, the so-called danger zone, to avoid ibSLN damage.

Superior thyroid artery origin in Caucasian Greeks: A new classification proposal and review of the literature

Studies on the origin of the superior thyroid artery, define that it could originate either from the external carotid artery, (at the level of common carotid bifurcation), or from the common carotid artery. However, there is a classical anatomic knowledge that the superior thyroid artery is a branch of the external carotid artery. Variability in the anatomy of the superior thyroid artery was studied on 100 carotids. Moreover, a review about the origin of superior thyroid artery between recent and previous cadaveric, autopsy, and angiographic studies, on adults and fetuses, was carried out. The superior thyroid artery originated from the external carotid artery in 39% and at the level of carotid bifurcation and common carotid artery in 61% of cases. The anterior branches of the external carotid artery were separate in 76% of cases, while common trunks between the arteries were found in 24% of the specimens. A new classification proposal on the origin of the superior thyroid artery is also suggested. In this study, the origin of superior thyroid artery is considered at the level of the carotid bifurcation and not from the external carotid artery as stated in many classical anatomy textbooks. This has a great impact on the terminology when referring to the anterior branches of the external carotid artery, which could be termed as anterior branches of the cervical carotid artery. Head and neck surgeons must be familiar with anatomical variations of the superior thyroid artery in order to achieve a better surgical outcome.

High origin of a testicular artery: a case report and review of the literature

Introduction

Although variations in the origin of the testicular artery are not uncommon, few reports about a high origin from the abdominal aorta exist in the literature. We discuss the case of a high origin of the testicular artery, its embryology, classification systems, and its clinical significance.

Case presentation

We report a very rare case of high origin of the left testicular artery in a 68-year-old Caucasian male cadaver. The artery originated from the anterolateral aspect of the abdominal aorta, 2 cm cranially to the ipsilateral renal artery. Approximately 1 cm after its origin, it branched off into the inferior suprarenal artery. During its course, the artery crossed anterior to the left renal artery.

Conclusions

A knowledge of the variant origin of the testicular artery is important during renal and testicular surgery. The origin and course must be carefully identified in order to preserve normal blood circulation and prevent testicular atrophy. A reduction in gonadal blood flow may lead to varicocele under circumstances. A knowledge of this variant anatomy may be of interest to radiologists and helpful in avoiding diagnostic errors.

Variable anatomical relationship of phrenic nerve and subclavian vein: clinical implication for subclavian vein catheterization

BACKGROUND

During subclavian vein catheterization, a potential, but rare, hazard is the phrenic nerve injury, which compromises respiratory function. We conducted a cadaver study focused on the possible anatomical relationships between the subclavian vein and the phrenic nerve.

METHODS

Forty-two adult cadavers (84 heminecks) were dissected. Special attention was given to the topography of the phrenic nerve and subclavian vein.

RESULTS

In all but three cases (81 of 84), normal topography was present, that is, the nerve was posterior to the vein. In two cases, the phrenic nerve crossed anterior to the subclavian vein and in one case traversed the anterior wall of the subclavian vein.

CONCLUSIONS

Variants of the relationship of the subclavian vein and the phrenic nerve should be familiar to anaesthesiologists during subclavian vein cannulation in order to achieve successful vein approach without causing phrenic nerve palsy.

Duplicated gallbladder: surgical application and review of the literature

Duplicated gallbladder is a rare congenital anomaly, usually asymptomatic and occurring as incidental radiographic or surgical finding during upper abdomen, liver and extrahepatic biliary tract surgery. We report on a case of two separate gallbladders, one main and one accessory, each one with its own cystic duct. The main cystic duct drained into the common bile duct while the accessory bile duct extruded into the left side of common bile duct just inferior to the main cystic duct termination. Imaging advances such as computerized tomography, intraoperative endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiopancreatography may aid in the establishment of accurate diagnosis. The anomaly is of great importance because the surgeon may miss the main or the accessory gallbladder and the patient may need to be re-operated in case of cholelithiasis.

Bilateral pectoral musculature malformations with concomitant vascular anomaly

We report on a unique combination of multiple variations concerning the pectoral muscles and the left external jugular vein. Specifically, a bilateral hypoplasia of the medial clavicular portion of the pectoralis major muscle was noticed along with the coexistence of total right pectoralis minor aplasia, substituted by loose connective and fatty tissue. Simultaneously, a supernumerary anterior-placed external jugular vein was found, which, after its supraclavicular course, pierced the interval between the left clavicular and the sternocostal head, and drained into the left jugular junction. The combination of the above anomalies constitutes an atypical pattern of Poland syndrome. We discuss the related embryological development and the relative literature. Attention was paid to the clinical importance for plastic surgeons, general surgeons, and radiologists, facilitating them with accurate interpretation of anterior thoracic wall findings.

Multiple variations in the branching pattern of the abdominal aorta

We report on a unique clinically and surgically significant case of multiple abdominal aorta variations. Specifically, the left inferior phrenic, left gastric and splenic artery arose in common from the left aspect of the aorta constituting a common phrenogastrosplenic trunk, while the common hepatic artery originated separately from the midline of the anterior aspect of the aorta just inferiorly to the trunk. An accessory right hepatic artery arises from the right-anterior aspect of the abdominal aorta adjacent to superior mesenteric artery origin. On the left side, two renal arteries were observed. Moreover, the left gonadal artery exhibited a high origin, arising inferiorly to the upper left renal artery. We discuss about the embryological development of abdominal aorta arterial abnormalities and we attempt to sort the noticed variations according to existing classification in the literature. It is highlighted that the thorough knowledge of these arterial variations is important for the success of upper abdomen surgical operations such as liver and kidney transplantation, kidney preservation, abdominal aorta related vascular surgery, treatment of hepatocellular carcinoma by transcatheter arterial chemoembolizations as well as imaging interpretation of the region. Preoperative selective angiography or other abdominal aorta imaging studies are helpful for arterial variation demonstration and a precious tool for appropriate surgery planning.

Unilateral elongated styloid process: a case report

An unusual case of a unilaterally elongated styloid process with a length of 5.8 cm was found on a dry skull of a male cadaver. During his life the subject was complaining for reported ipsilateral otalgia presumably due to nerve compression from the elongated styloid process. The symptomatology appeared by such an anatomical variant as well as relative literature is discussed in this paper.

Osteopoikilosis: a case report of a symptomatic patient

Osteopoikilosis (OP) is a very rare benign sclerosing bony dysplasia with an autosomal dominant inheritance. We describe the morphology of an osteopoikilosis male patient, associated with severe pain on wrist and hand joints, report on the relative literature and focus on clinical significance, due to mimicking capability of other more severe conditions such as bone metastases.

Excavated-type of rhomboid fossa of the clavicle: a radiological study

The excavated type of rhomboid fossa of the clavicle is a relatively neglected anatomical structure that can potentially cause diagnostic problems. Its unilateral occurrence may be confused by the physician as avascular necrosis, osteomyelitis, or even a tumour. We studied 80 routine chest radiographs and identified the clavicles with excavated type of rhomboid fossa. The sex, sidedness, and handedness were recorded. An excavated type of rhomboid fossa was present in 43 clavicles (26.88%), appearing more frequently in males than in females. In addition, the incidence of the excavated type of rhomboid fossa was greater on the right side than on the left. That type of fossa was also present more frequently on the right side in right-handed specimens and on the left side in left-handed specimens. The high incidence of the excavated type of rhomboid fossa on the dominant hand supports the mechanical theory of fossa formation. Radiologists and physicians should be aware of this fossa, as it may resemble a pathological condition.

Co-existence of os acromiale with suprascapular osseous bridge: a case report and review of the literature

We report on a very rare case of co-existence of os acromiale with suprascapular osseous bridge in a dry scapula. The frequency of os acromiale alone ranges from 1.3 to 15%, while the frequency of suprascapular osseous bridge varies between 0.036% and 12.5%. We review the relative literature and emphasize the fact that such knowledge is important for a physician in order to avoid misdiagnosis of an acromion fracture and lytic lesion of the scapula.