A systematic review of facial plastic surgery simulation training models.

OBJECTIVES: The coronavirus disease 2019 pandemic has led to a need for alternative teaching methods in facial plastics. This systematic review aimed to identify facial plastics simulation models, and assess their validity and efficacy as training tools. METHODS: Literature searches were performed. The Beckman scale was used for validity. The McGaghie Modified Translational Outcomes of Simulation-Based Mastery Learning score was used to evaluate effectiveness. RESULTS: Overall, 29 studies were selected. These simulated local skin flaps (n = 9), microtia frameworks (n = 5), pinnaplasty (n = 1), facial nerve anastomosis (n = 1), oculoplastic procedures (n = 5), and endoscopic septoplasty and septorhinoplasty simulators (n = 10). Of these models, 14 were deemed to be high-fidelity, 13 low-fidelity and 2 mixed-fidelity. None of the studies published common outcome measures. CONCLUSION: Simulators in facial plastic surgical training are important. These models may have some training benefits, but most could benefit from further assessment of validity.

Planning considerations prior to laryngectomy for a patient infected with severe acute respiratory syndrome coronavirus-2 pre-operatively.

BACKGROUND: Coronavirus disease 2019 was declared a pandemic on 11th March 2020. All non-urgent surgical procedures have been postponed indefinitely. The British Association of Head and Neck Oncology state that only those with treatable head and neck cancer unsuitable for alternative treatment should undergo surgery. This paper details our management of a patient who tested positive for severe acute respiratory syndrome coronavirus-2 days before curative surgery for laryngeal cancer. CASE REPORT: By following British Association of Head and Neck Oncology guidance, a 49-year-old male scheduled for total laryngectomy and bilateral neck dissection for a T3 transglottic squamous cell cancer was pre-operatively identified as an asymptomatic carrier of severe acute respiratory syndrome coronavirus-2. Following 14-day isolation and laboratory proven viral clearance, he underwent successful major surgery. He was managed throughout the peri- and post-operative phases without complications or adverse effects on staff. CONCLUSION: With careful planning, previous coronavirus disease 2019 positive status should not prevent an individual from undergoing successful total laryngectomy and bilateral neck dissection in a safe and timely manner during the pandemic.

Validation study of an ex vivo porcine auricular model for simulation training in otoplasty.

OBJECTIVE: To perform a validation assessment of a novel porcine ex vivo model for otoplasty training. METHODS: A total of nine otolaryngology trainees performed a standard approach otoplasty on a porcine ear. They completed a series of tasks including posterior skin incision, anterior scoring, Mustardé suture placement and concha-mastoid suture placement. Trainees completed a post-task questionnaire assessing face validity, global content validity and task-specific content validity. RESULTS: Trainees' median scores for the porcine model were: 4 for face validity (interquartile range, 3-4), 5 for global content validity (interquartile range, 4-5) and 4 for task-specific content validity (interquartile range, 4-4). CONCLUSION: This study is the first to formally validate the ex vivo porcine auricular model as a useful tool for training in otoplasty. The model should be incorporated into simulation training for otoplasty in order to improve learning, enable acquisition of specific surgical skills and improve operative outcomes.

Feasibility of ovine and synthetic temporal bone models for simulation training in endoscopic ear surgery.

OBJECTIVE: Comparing the feasibility of ovine and synthetic temporal bones for simulating endoscopic ear surgery against the 'gold standard' of human cadaveric tissue. METHODS: A total of 10 candidates (5 trainees and 5 experts) performed endoscopic tympanoplasty on 3 models: Pettigrew temporal bones, ovine temporal bones and cadaveric temporal bones. Candidates completed a questionnaire assessing the face validity, global content validity and task-specific content validity of each model. RESULTS: Regarding ovine temporal bone validity, the median values were 4 (interquartile range = 4-4) for face validity, 4 (interquartile range = 4-4) for global content validity and 4 (interquartile range = 4-4) for task-specific content validity. For the Pettigrew temporal bone, the median values were 3.5 (interquartile range = 2.25-4) for face validity, 3 (interquartile range = 2.75-3) for global content validity and 3 (interquartile range = 2.5-3) for task-specific content validity. The ovine temporal bone was considered significantly superior to the Pettigrew temporal bone for the majority of validity categories assessed. CONCLUSION: Tympanoplasty is feasible in both the ovine temporal bone and the Pettigrew temporal bone. However, the ovine model was a significantly more realistic simulation tool.

Simulation training in laser safety education: the use of technical and non-technical skills simulation in a comprehensive laser safety course.

OBJECTIVE: The completion of a laser safety course remains a core surgical curriculum requirement for otolaryngologists training in the UK. This project aimed to develop a comprehensive laser safety course utilising both technical and non-technical skills simulation. METHODS: Otolaryngology trainees and consultants from the West of Scotland Deanery attended a 1-day course comprising lectures, two high-fidelity simulation scenarios and a technical simulation of safe laser use in practice. RESULTS: The course, and in particular the use of simulation training, received excellent feedback from otolaryngology trainees and consultants who participated. Both simulation scenarios were validated for future use in laser simulation. CONCLUSION: The course has been recognised as a laser safety course sufficient for the otolaryngology Certificate of Completion of Training. To the authors' knowledge, this article represents the first description of using in situ non-technical skills simulation training for teaching laser use in otolaryngology.

The occurrence of root rot and crown rot of rice in Gilan and Zanjan provinces, Iran.

Root rot and crown rot of rice is one of the important fungal diseases of rice in Gilan and Zanjan provinces, Iran. During 1999--2002, samples of plant and soil around the roots of infected rice plants were collected and used to identify the causal agent. Root and crown parts were surface sterilized with sodium hypochlorite and then cultured on PDA (potato dextrose agar), PPA (pepton pentacholoritobenzene agar) and CLA (carnation leaf agar) media. Soil samples prepared in water agar were used to isolate the pathogen. The causal agent was identified as Fusarium moniliforme. Colonies were initially white but turned violet to grey late. Microconidia were arranged in chain and macroconidia were cylindrical and long with 3-5 septa. The disease was severe in Zanjan province particularly along Ghezel Ozan river where the infection ranged from 70-80%. Root and crown rot was more prevalent in areas where Champa and Gerdeh were being cultivated continuously. On the other hand, Sadri cultivars had relatively less infection. Persistent cultivation of rice and seed sowing method intensified disease development and caused significant economic losses.

Identification of physiological races of Blumeria graminis f. sp. tritici and evaluation of powdery mildew resistance in wheat cultivars in Sistan province, Iran.

Powdery mildew of wheat caused by Blumeria graminis f. sp. tritici (Bgt) is one of the most important fungal diseases in Iran. During the years 1998-2001, wheat fields in Sistan province were surveyed and powdery mildew infected samples were collected from various areas and transferred to the laboratory. In the greenhouse, fungal spores were purified and inoculated onto susceptible wheat cultivars using single pustule and single spore procedures. Selected pure isolates were inoculated onto the first leaves of eight differential wheat varieties for identifying physiological races. The results showed the existence of Bgt races 5, 11, 14, 19, 21, 24, 27, 28, 31, 32, 44, 50, 53, 58, 66, 73 and 84 in Sistan. These races were new to Sistan province and Iran as a whole. Among 17 races studied, races 11, 53 and 73 were important dominant races thus constituting 40% of total population. Race 53 constituted 16% of all isolates and was the dominant race in the area with 62.5% pathogenicity. Therefore, this race was introduced as the most virulent race during the period of this study. This study showed that Bgt isolates were compatible with host plant genes pm8, pm3 and pm3b but incompatible with gene pm4b. Powdery mildew resistance was evaluated using race 11 on 70 wheat cultivars during seedling stage as well as adult plant under both greenhouse and field conditions between 1999 and 2001. Among wheat lines tested for resistance against powdery mildew, cultivar Hirmand resembled the differential line Weihenst M1 in that both may possess gene pm4b and showed no symptoms under the greenhouse and field conditions. Cultivar Chamran was found to be highly resistant whereas Sorkhtokhm was susceptible. Other cutivars showed partial and gradual resistance against the powdery mildew disease.