Spot(ters) the difference: Bringing traditional anatomical examinations online.

The COVID-19 pandemic caused a shift in anatomy education forcing institutions to find innovative ways to teach and assess online. This study details the development of an online spotter across multiple modules that allowed students to sit the examination at home whilst still maintaining the integrity of the assessment. The online spotter consisted of individual, Zoom calls between students and examiners whereby slides with images and questions were screen shared. To examine the viability of this spotter in non-lockdown scenarios several parameters were considered. Mean marks were compared to traditional versions and Pearson's r correlation coefficients were calculated between online and traditional spotters and between online spotters and overall performance in anatomy modules. A survey was carried out to determine the students' view of the assessment. Pearson's r was between 0.33 and 0.49 when comparing online spotters to the traditional format, and between 0.65 and 0.75 (p < 0.01) when compared to a calculated anatomy score. The survey indicated overall student satisfaction as 82.5% reported that it was a fair way to test their knowledge and 55% reported the same or lower levels of anxiety when compared to traditional spotters. However, there was nothing to indicate that the students preferred this format over laboratory-based spotters. These results indicate that this new exam format would be useful for small cohorts who are undertaking online or hybrid courses, or in circumstances when running a full spotter is too costly, and represents a fair and robust way to assess practical anatomical knowledge online.

Woodruff's plexus-arterial or venous?

PURPOSE: Woodruff's plexus is a vascular network located on the posterior lateral wall of the inferior meatus of the nasal cavity and it is generally considered to be responsible for posterior epistaxis. Despite being initially identified in 1949 as a venous plexus, discrepancies exist within literature regarding this anatomical structure, particularly its arterial or venous nature and its association with posterior epistaxis. This systematic review aims to collate information pertaining to Woodruff's plexus and evaluate our current understanding of this vascular area. METHODS: The systematic review was performed using published data in PubMed, Google Scholar, Scopus, EBSCO and Web of Science platforms using keywords such as 'Woodruff', 'posterior' and 'plexus'. Articles referring to Woodruff's plexus were collected and analysed by independent reviewers. RESULTS: The search revealed 154 papers, out of which only 40 were included in the review. Out of this number only two papers were anatomical dissection studies, both of which identify the plexus as venous in nature. Seventeen studies describe the plexus as venous by citing these two papers. The remainder of the articles (23) consider Woodruff's plexus as arterial with variability in the reported arteries that supply it. CONCLUSION: Woodruff's original description of a venous plexus is supported by modern anatomical studies. There are a multitude of reports that Woodruff's plexus is arterial in nature, despite the absence of existing anatomical studies to support this notion. This misconception has likely arisen due to clinical associations in relation to posterior epistaxis.

Endoscopic balloon dilatation of the olfactory cleft - a feasibility study of a novel technique in cadavers.

OBJECTIVE: Smell dysfunctions are common with almost 20% percent of the population affected. There are no interventional solutions for these patients. The aim of this study is to investigate the feasibility and security of the balloon dilatation technique. METHODS: This paper describes interventional steps and determines the feasibility and safety of endoscopic olfactory cleft dilatation via balloon device. We included 10 nasal cavities in the study and dilated olfactory cleft areas via balloon device. RESULTS: We could smoothly perform the procedure and did not observe any fractures on the skull base or olfactory cleft of the cadavers after dilatation. CONCLUSIONS: A combination of this intervention with medical treatments can be promising for smell dysfunctions.

A Comparison between Mygind and Kaiteki positions in administration of drops to the olfactory cleft.

OBJECTIVES: Topical nasal steroids are a common treatment intervention for olfactory dysfunction. Penetration of topical treatment to the olfactory cleft (OC), such as nasal drops, is greatly dependent on the position of the head when the treatment is administered. We aimed to examine the penetrance of nasal drops to the OC in two different head positions: the Mygind (lying head back) position and the Kaiteki position. DESIGN AND SETTING: The specimens were firstly positioned in Mygind, and thereafter in Kaiteki positions. Nasal drops mixed with blue food dye were administered into the nostrils in each of the head position. Endoscopic videos were recorded, and two blinded observers scored the extent of olfactory cleft penetration (OCP) using a 4-point scale (0 = none, 3 = heavy). PARTICIPANTS: Twelve fresh-frozen cadaver specimens. MAIN OUTCOME MEASURES: Penetration of the dye into the OC. RESULTS: The mean score of nasal drops penetrance to the OC in the Mygind position was 1.34 (standard deviation, SD = 0.92), as compared to 1.76 (SD = 0.65) in the Kaiteki position. The difference in the OCP score between the two groups was not statistically significant (P > .05). CONCLUSION: Both Mygind and Kaiteki head positions are reasonable options for patients considering topical nasal drops for olfaction impairment. The preference of one position over the other should be determined by patient's preference and comfort.

Adjunctive techniques to improve access of the endoscopic prelacrimal recess approach.

OBJECTIVES: To determine whether adjunctive surgical techniques could improve access of instruments provided by the endoscopic prelacrimal recess approach to the anatomical boundaries of the maxillary sinus, and pterygopalatine and infratemporal fossa. METHODS: Ten fresh-frozen adult cadaver heads were utilized. The anatomical areas of interest were fixed, bony boundaries of the maxillary sinus, infratemporal fossa, and pterygopalatine fossa: alveolar recess (AR), zygomatic recess (ZR), perpendicular plate of the palatine bone (PB), ascending ramus of mandible (RM), floor of the orbit medial and lateral to infraorbital nerve (M-ION and L-ION, respectively). Access to the areas were compared using standard sinus surgery instruments (straight and 45° forceps) introduced via the prelacrimal recess approach, trans-septal window and canine fossa puncture. RESULTS: The prelacrimal recess approach successfully provided access to the PB and M-ION in >90% of dissections when using both the straight and 45° forceps. With the straight forceps, the ability to successfully access to the AR and ZR was the lowest at 50% and 35% respectively, although improving to 75% and 60% respectively with the 45° forceps. Access to the AR, ZR, and L-ION improved significantly when the 45° forceps was introduced through the trans-septal window. Frequency of access to the RM when either instruments when introduced through the canine fossa puncture was no greater than 60% of the dissections. CONCLUSIONS: The addition of a small trans-septal window for instruments significantly improved access of the prelacrimal recess approach especially to the orbital floor, lateral margins of the maxillary sinus, and retromaxillary space. LEVEL OF EVIDENCE: 4 Laryngoscope, 130: 1857-1863, 2020.

The marine-derived, multi-mineral formula, Aquamin, enhances mineralisation of osteoblast cells in vitro.

Osteoporosis is a global health problem characterized by low bone mass and an increase in bone fragility. It is now well accepted that dietary factors play a central role in bone development and health. Diet that lacks adequate minerals is considered to be a risk factor for osteoporosis. The food supplement, Aquamin, is a natural, multi-mineral derived from the red algae Lithothamnion corallioides, rich in calcium, magnesium and 72 other trace minerals. The aim of this study was to evaluate the effect of Aquamin on osteoblastic behaviour and mineralisation in a pre-osteoblastic cell line. Cell number and metabolic activity were assessed using Hoescht DNA and AlamarBlue assays respectively. Osteogenic differentiation was measured using an alkaline phosphatase assay while mineralisation was determined using von Kossa and alizarin red staining. It is reported here that Aquamin promotes increased mineralisation in osteoblast cell culture. These data suggest that the nutritional supplement Aquamin plays an important role in promoting bone formation and may be useful in treating bone diseases such as osteoporosis.

The effects of collagen concentration and crosslink density on the biological, structural and mechanical properties of collagen-GAG scaffolds for bone tissue engineering.

In this study, we examined the effects of varying collagen concentration and crosslink density on the biological, structural and mechanical properties of collagen-GAG scaffolds for bone tissue engineering. Three different collagen contents (0.25%, 0.5% and 1% collagen) and two different dehydrothermal (DHT) crosslinking processes [1] 105 degrees C for 24 h and [2] 150 degrees C for 48 h were investigated. These scaffolds were assessed for (1) pore size, (2) permeability (3) compressive strength and (4) cell viability. The largest pore size, permeability rate, compressive modulus, cell number and cell metabolic activity was all found to occur on the 1% collagen scaffold due to its increased collagen composition and the DHT treatment at 150 degrees C was found to significantly improve the mechanical properties and not to affect cellular number or metabolic activity. These results indicate that doubling the collagen content to 1% and dehydrothermally crosslinking the scaffold at 150 degrees C for 48 h has enhanced mechanical and biological properties of the scaffold making it highly attractive for use in bone tissue engineering.

Osteoblast activity on collagen-GAG scaffolds is affected by collagen and GAG concentrations.

Optimization of a tissue engineering scaffold for use in bone tissue engineering requires control of many factors such as pore size, porosity, permeability and, as this study shows, the composition of the matrix. The collagen-glycosaminoglycan (GAG) scaffold variants were fabricated by varying the collagen and GAG content of the scaffold. Scaffolds were seeded with MC3T3 osteoblasts and cultured for up to 7 days. During the culture period, osteoblastic activity was evaluated by measuring metabolic activity, cell number, and spatial distribution. Collagen and GAG concentrations both affected osteoblast viability, proliferation, and spatial distribution within the scaffold. Scaffolds containing 1% collagen (w/v) and 0.088% GAG (w/v) were found to have a porosity of approximately 99%, high cell metabolic activity and cell number, and good cell infiltration over the 7 days in culture. Taken together, these results indicate the need to tailor the parameters of a biological substrate for use in a specific tissue application, in this case bone tissue engineering.