Recent evidence on visual-spatial ability in surgical education: A scoping review.

BACKGROUND: Understanding the relationships between structures is critical for surgical trainees. However, the heterogeneity of the literature on visual-spatial ability (VSA) in surgery makes it challenging for educators to make informed decisions on incorporating VSA into their programs. We conducted a scoping review of the literature on VSA in surgery to provide a map of the literature and identify where gaps still exist for future research. METHODS: We searched databases until December 2019 using keywords related to VSA and surgery. The resulting articles were independently screened by two researchers for inclusion in our review. RESULTS: We included 117 articles in the final review. Fifty-nine articles reported significant correlations between VSA tests and surgical performance, and this association is supported by neuroimaging studies. However, it remains unclear whether VSA should be incorporated into trainee selection and whether there is a benefit of three-dimensional (3D) over two-dimensional (2D) training. CONCLUSIONS: It appears that VSA correlates with surgical performance in the simulated environment, particularly for novice learners. Based on our findings, we make suggestions for how surgical educators may use VSA to support novice learners. Further research should determine whether VSA remains correlated to surgical performance when trainees move into the operative environment.

CONTEXTE: Il est fondamental pour les chirurgiens en formation de comprendre les liens qui unissent les diverses structures corporelles. Étant donné l'hétérogénéité de la littérature portant sur les habiletés visuo-spatiales (HVS) nécessaires en chirurgie, les éducateurs ont de la difficulté à prendre des décisions éclairées quant à l'enseignement des HVS dans leurs programmes. On a effectué une étude exploratoire de la littérature sur les HVS en chirurgie afin de répertorier la littérature et de cerner des lacunes pouvant faire l'objet de recherches ultérieures. MÉTHODOLOGIE: On a interrogé des bases de données jusqu'à décembre 2019 à l'aide de mots-clés reliés aux HVS et à la chirurgie. Les articles trouvés ont été évalués de façon indépendante par deux chercheurs pour déterminer leur inclusion à la revue. RÉSULTATS: Au total, 117 articles ont été inclus dans la revue finale. Cinquante-neuf faisaient état d'importantes corrélations entre les tests d'évaluation des HVS et la performance chirurgicale. Cette association est étayée par les résultats d'études en neuro-imagerie. Il n'est pas clair cependant si les HVS devraient faire partie des critères de sélection des résidents et si une formation sur les techniques de visualisation en trois dimensions (3D) est préférable à une formation sur les techniques de visualisation en deux dimensions (2D). CONCLUSIONS: Il semble exister un lien entre les HVS et la performance chirurgicale en contexte de simulation, particulièrement chez les apprenants novices. À la lumière de nos résultats, nous présentons des recommandations sur la façon dont les formateurs en chirurgie pourraient se servir des HVS pour aider les apprenants novices. D'autres travaux de recherche devraient permettre de savoir si les HVS restent reliés à la performance chirurgicale lorsque les stagiaires passent à un environnement opératoire réel.

Thanatophoric dysplasia: a rare entity.

Thanatophoric dysplasia is the lethal skeletal dysplasia characterized by marked underdevelopment of the skeleton and short-limb dwarfism. The child will be having a short neck, narrow thoracic cage and protuberant abdomen. Other anatomical features include a relatively enlarged head with frontal bossing, prominent eyes, hypertelorism and the depressed nasal bridge. The diagnosis is usually made with the ultrasonography in the second trimester. In this study we report a case of this rare entity with emphasis on its anatomical features, abnormalities and clinical profile with relevant review of literature.

An anatomical study of the inferior oblique muscle with emphasis on its nerve entry.

BACKGROUND: Anatomical studies regarding the inferior oblique muscle are scarce and the exact location of the entry of oculomotor nerve to the muscle has not been reported. In the present study, the objectives were to examine the exact location of the entry of oculomotor nerve to the inferior oblique muscle and to study the topographical anatomy of the muscle. METHODS: The study included 56 intact orbits from 28 embalmed south Indian adult cadavers. The entire course of the nerve to the inferior oblique was exposed from both anterior and posterior aspects in all specimens. The exact location of the entry of nerve supplying the inferior oblique muscle was identified and the distances of the muscle from inferior and medial orbital margins were measured. RESULTS: The oculomotor nerve entered the inferior oblique muscle through the orbital surface in 42 (75%) cases, through the ocular surface in 10 (17.9%) cases and through the posterior border in 4 (7.1%) cases. The distance of the muscle from the inferior orbital margin was 1 mm in majority (78.5%) of the cases. The distance of the muscle from the medial orbital margin was 11 mm in majority (42.8%) of the cases. CONCLUSION: The present study reports that the oculomotor nerve most often enters the inferior oblique muscle through its orbital surface. Detailed knowledge of the topographical anatomy of inferior oblique muscle and its site of nerve entry are essential for surgeons when performing ophthalmological surgery and regional anesthesia.

Morphometric analysis of the menisci of the knee joint in South Indian human fetuses / Análisis morfométrico de los meniscos de la rodilla en fetos humanos del Sur de India

The morphometrical data related to the menisci of the adults have been reported by few authors and that of the fetuses have not been reported. The aims of the present study were to analyse the external circumference thickness, the width, peripheral and inner border lengths, and the distance between anterior and posterior horns of the fetal menisci and to compare the meniscal dimensions with that of the adult meniscal parameters which are available in the literature. The menisci from 106 knee joints of the formalin fixed South Indian fetuses which were obtained from the anatomy department were analysed. The fetuses which had musculoskeletal anomalies were excluded from the study. A vernier caliper of 0.02 mm accuracy and a non elastic cotton thread were used for the morphometry. After comparing the meniscal dimensions of the present study with the adult meniscus parameters, we established that the fetal parameters of the meniscus are entirely different from the adults. These differences are may be due to the mesenchymal differentiation or variability of the vasculature early in embryonic life. We believe that our study will provide support to the fetal anatomy, concerning surgical procedures and arthroscopy of the knee joint. Since the morphometric studies of the fetal menisci are not reported, this study may be considered new and needs to be studied further with different groups of fetuses from various stages of intrauterine development. This study is important not only for orthopedic surgeons, but also for morphologists and embryologists.

Los datos morfométricos relacionados con los meniscos de los adultos han sido reportados por algunos autores, mientras que en fetos éstos aún no han sido descritos. El objetivo del estudio fue analizar, en fetos, el grosor de la circunferencia externa, ancho, y longitud de los márgenes interno y externo, asi como la distancia entre los cuernos anteriores y posteriores. Además, comparar las dimensiones del menisco fetal con los parámetros de adultos disponibles en la literatura. Fueron analizados los meniscos de 106 articulaciones de rodillas fijadas en formalina, pertenecientes a fetos del sur de la India, obtenidos desde el Departamento de Anatomía. Los fetos con anomalías musculoesqueléticas fueron excluidos del estudio. Un pie de metro de 0,02 mm de precisión junto a hilo de algodón no elástico fueron utilizados para la morfometría. Después de comparar las dimensiones del menisco del presente estudio con los parámetros de meniscos adultos se estableció que los meniscos fetales son totalmente diferentes a los adultos. Estas diferencias pueden deberse a la diferenciación mesenquimal o la variabilidad de temprana vasculatura en la vida embrionaria. Creemos que nuestro estudio prestará apoyo a la anatomía fetal, en relación con los procedimientos quirúrgicos y la artroscopía de la rodilla. Los estudios morfométricos no han informado datos en meniscos fetales, por lo que esta investigación puede ser considerada novedosa y requiere seguir siendo estudiada con diferentes grupos de fetos en las diversas etapas del desarrollo intrauterino. Además el estudio de ser importante para los cirujanos ortopédicos, también lo es para morfólogos y embriólogos.

Unusual external branch of the superior laryngeal nerve: a case report.

INTRODUCTION: The knowledge of the branching pattern of external branch of the superior laryngeal nerve and its relationship with the superior thyroid artery is the key point for identifying the external branch of the superior laryngeal nerve during surgeries of the neck. CASE PRESENTATION: During routine dissection of the left head and neck region of a 50 years old female cadaver, we observed a variation of the external branch of the superior laryngeal nerve around the superior thyroid artery. The external branch of the superior laryngeal nerve has presented one medial and three lateral branches. The medial branch was running on the surface of the inferior constrictor and pierced it; where as the lateral three branches are located laterally to the superior thyroid artery. The medial two lateral branches were piercing the substance of the thyroid gland, where as the lateral most branch was communicating with the left sympathetic chain. CONCLUSION: It is very important that surgeons carefully dissect the region of the superior pole of the thyroid gland to expose the abnormal branching pattern of external branch of the superior laryngeal nerve prior to ligation of individual thyroid vessels.

Sacral hiatus in relation to low back pain in south Indian population.

OBJECTIVE: The study was designed to identify any association between the sacral hiatus of the dry sacral bones with that of patients with low back pain (LBP). The knowledge of the sacral hiatus is important in caudal epidural block (CEB). METHODS: Three hundred forty three (183 male and 160 female) complete and undamaged adult South Indian dry sacral bones and fifty two (30 male and 22 female) radiographs were included in the present study. The above radiographs were of patients with history of LBP. The osteological observation and the radiographic study were compared to find any associations of LBP with the location of the apex of the sacral hiatus. RESULTS: In dry male sacrum, in 39.3% cases the sacral hiatus was inverted U shape and in 50.6% cases the female sacrum was inverted V shape. Deficient dorsal wall of the sacrum was observed in 2.7% and 12.5% in male and female sacra, respectively. The apex of the sacral hiatus was observed the most at S4 level (81.4% in male and 61.2% in female). Deficient dorsal wall was found in 40% of male and 27.2% female patients presented with LBP. The apex of the sacral hiatus in the LBP patients observed at the S4 level was 46.6% in male and 54.5% in female respectively. CONCLUSION: The patients with LBP had a higher percentage of deficient dorsal walls in comparison to the osteological findings (Fig. 12, Tab. 7, Ref. 12). Full Text (Free, PDF) www.bmj.sk.

Unusual communication between the lingual nerve and mylohyoid nerves in a South Indian male cadaver: its clinical significance.

It is well known that variations in the branching pattern of the mandibular nerve frequently account for the failure to obtain adequate local anesthesia in routine oral and dental procedures, and also for the unexpected injury to branches of the nerves during surgery. During our routine dissection, we found the presence of a communicating branch between the mylohyoid and lingual nerves in a middle aged male cadaver. We also discussed its clinical and surgical implications in this report.

Anomalous azygos venous system in a south Indian cadaver: a case report.

INTRODUCTION: The posterior thoracic wall, an area drained by the azygos venous system, is a common site for surgical intervention. Since the venous part of the cardiovascular system is subject to most common variation, abnormalities in the azygos venous system are often reported. CASE PRESENTATION: During routine dissection classes for undergraduate medical students, we encountered a variation in the azygos venous system in a 65 years old south Indian male cadaver. We observed that there was no accessory azygos vein, and left 4th, 5th, 6th and 7th posterior intercostal veins terminated directly into azygos vein. CONCLUSION: Identifying these types of variations is important during imaging this region and surgical operations of mediastinum.

Co-existence of superficial ulnar artery and aneurysm of the deep palmar arch in the hand.

During routine anatomy dissection classes for undergraduate medical students, an unilateral case of superficial ulnar artery (SUA) in a 75-year-old male human cadaver arosing from the third part of the right axillary artery at the junction of the two median nerve roots was observed. In the hand, the SUA coursed over the flexor retinaculum and anastomosed with the superficial palmar branch of the radial artery to form the superficial palmar arch. After the origin of the SUA, the axillary artery continued as the brachial artery, which was divided into radial and common interosseous arteries at the neck of the radius. The normal ulnar artery was absent. In the same cadaver, a thin walled dilatation was seen on its palmar aspect at the base of the 1st metacarpal bone (Fig. 2, Ref. 11). Full Text (Free, PDF) www.bmj.sk.

Termination of the facial vein into the external jugular vein: an anatomical variation / Terminação da veia facial na veia jugular externa: uma variação anatômica

Different patterns of variations in the venous drainage have been observed in the past. During routine dissection in our Department of Anatomy, an unusual drainage pattern of the veins of the left side of the face of a middle aged cadaver was observed. The facial vein presented a normal course from its origin up to the base of mandible, and then it crossed the base of mandible posteriorly to the facial artery. Thereafter, it joined with the anterior division of retromandibular vein to form the common facial vein, which drained into the external jugular vein directly. Sound anatomic knowledge of the above variation in facial veins is essential to the success of surgical procedures in this region.

Padrões distintos de variações na drenagem venosa já foram observados. Durante a dissecção de rotina em nosso Departamento de Anatomia, observou-se um padrão incomum de drenagem das veias do lado esquerdo da face de um cadáver de meia idade. A veia facial apresentava curso normal de sua origem até a base da mandíbula, e então atravessava a base da mandíbula posteriormente à artéria facial. A seguir, juntava-se à divisão anterior da veia retromandibular para formar a veia facial comum, que drenava diretamente para a veia jugular externa. Um bom conhecimento anatômico da variação descrita acima nas veias faciais é essencial para garantir o sucesso que procedimentos cirúrgicos nessa região.

Surgical importance of variant hepatic blood vessels: a case report

This report describes a variation in blood vessels of the liver and abnormal entry of hepatic arteries into the liver found during routine dissection in an approximately 43-year-old male cadaver. An accessory hepatic artery arose from the superior mesenteric artery and entered the liver at the porta hepatis, whereas the proper hepatic artery was seen entering the left liver lobe at the fissure for ligamentum venosum. Clinical implications of such variation are discussed in the article.

Este relato descreve uma variação nos vasos hepáticos e uma entrada anormal de artérias hepáticas no fígado, encontradas durante uma dissecção de rotina em um cadáver masculino de aproximadamente 43 anos. Uma artéria hepática acessória surgiu da artéria mesentérica superior e entrou no fígado no porta hepatis, ao passo que se constatou que a artéria hepática própria entrava no lobo hepático na fissura do ligamento venoso. Implicações clínicas desta variação são discutidas neste artigo.

Accessory Head of Flexor Pollicis Longus Muscle and its Significance in Anterior Interosseous Nerve Syndrome: Case Report and Review / Cabeza Accesoria del Músculo Flexor Largo del Pulgar y su Significancia en el Síndrome del Nervio Interóseo Anterior: Reporte de Caso y Revisión

During the laboratory dissection of the fore arm, an accessory head of flexor pollicis longus muscle has been observed unilaterally in the right upper limb of a male cadaver. It took its origin from the under surface of flexor digitorum superficialis muscle just distal to the origin of this muscle from medial epicondyle. On further dissection we have noticed that, the accessory belly was running downwards to the medial aspect of the tendon of flexor pollicis longus muscle for its insertion. Its possible role in anterior interosseous syndrome is discussed in detail with a brief review.

Durante una disección en el laboratorio se encontró en el antebrazo derecho de un cadáver de sexo masculino una cabeza accesoria del músculo flexor largo del pulgar. Ésta se originaba de la superficie profunda del músculo flexor superficial de los dedos, inmediatamente distal al origen de este músculo en el epicónddilo medial. El vientre accesorio se dirigía hacia abajo medial al tendón del músculo flexor largo del pulgar hasta su inserción. Se discute detalladamente su posible rol en el síndrome interóseo anterior.

Anomalous formation of the portal vein: a case report

The knowledge about the formation and relations of the portal vein is important for surgeons and radiologists. The variations in the level of formation and the pattern of formation of portal vein might lead to confusions during radiological and surgical procedures. Here we present a rare variation in the formation of the portal vein as found during the cadaveric dissections. The portal vein was formed by the union of splenic vein, superior mesenteric vein and inferior mesenteric veins. The abnormal termination of left gastric vein into superior mesenteric vein before the formation of portal vein was also seen in the same cadaver. Identification of these variations is useful in managing traumatic rupture of the mesentery.

O conhecimento sobre a formação e as relações da veia porta é importante para cirurgiões e radiologistas. As variações no nível de formação e o padrão de formação da veia porta podem causar confusões durante procedimentos cirúrgicos e radiológicos. Neste relato, apresentamos uma variação na formação da veia porta encontrada durante as dissecções cadavéricas. A veia porta foi formada pela união da veia esplênica, veia mesentérica superior e veias mesentéricas inferiores. A terminação anormal da veia gástrica esquerda na veia mesentérica superior antes da formação da veia porta também foi observada no mesmo cadáver. A identificação dessas variações é útil para tratar a ruptura traumática do mesentério.

The origin of the inferior phrenic artery: a study in 32 South Indian cadavers with a review of the literature

BACKGROUND: Considering the paucity of information presently available concerning inferior phrenic arteries, a more definitive study seemed appropriate and necessary, both for its potential clinical applications and to provide additional data to contemporary anatomical literature. OBJECTIVE: Most anatomical textbooks of gross anatomy offer very little information concerning the anatomy and distribution of the inferior phrenic artery (IPA). For that reason, the origin of the IPA has been studied and the available literature has been reviewed. METHODS: Thirty-two human adult cadavers preserved in formalin obtained from the departments of Anatomy, Kasturba Medical College, Manipal and Mangalore were dissected and the origin of the IPA was studied. RESULTS: The IPA had its usual origin from the abdominal aorta in 28 cases but in the remaining four cases, two were arising from the celiac trunk, one from the left gastric artery and one from the right renal artery. CONCLUSION: The IPA usually originates from the aorta or celiac artery, and less frequently from the renal, hepatic or left gastric arteries. The IPA is a major source of collateral or parasitized arterial supply to hepatocellular carcinoma, second only to the hepatic artery. Literature on the IPA origin and clinical implications of variation in its origin have been reviewed in this article.

CONTEXTO: Considerando a escassez de informações atualmente disponíveis sobre artérias frênicas inferiores, umestudo mais definitivo nos pareceu apropriado e necessário, tanto por suas potenciais aplicações clínicas quanto para fornecer dados adicionais à literatura anatômica contemporânea. OBJETIVO: A maioria dos livros-texto de anatomia oferece muito poucas informações referentes à anatomia e distribuição da artéria frênica inferior (AFI). Por este motivo, a origem da AFI foi investigada e a literatura disponível foi revisada. MÉTODOS: Trinta e dois cadáveres humanos adultos preservados em formol e obtidos dos departamentos de anatomia do Kasturba Medical College, Manipal and Mangalore foram dissecados, e a origem da AFI foi investigada. RESULTADOS: A AFI teve sua origem habitual na aorta abdominal em 28 casos; no entanto, nos quatro casos restantes, duas originavam-se do tronco celíaco, uma da artéria gástrica esquerda e uma da artéria renal direita. CONCLUSÃO: A AFI geralmente origina-se da aorta ou artéria celíaca, e menos freqüentemente das artérias renal, hepática ou gástrica esquerda. A AFI é a maior fonte de fornecimento arterial colateral ou parasitado para carcinoma hepatocelular, ficando atrás somente da artéria hepática. A literatura sobre a origem da AFI e as implicações clínicas de variação em sua origem foram revisadas neste artigo.