Contributions of the Thiel's Method in teaching and researching anatomy.

INTRODUCTION: Knowledge of the human body is based on teaching and research. Anatomy remains an essential prerequisite for medical personnel to know the human body. The idea of Thiel's technique is to preserve the natural texture, volume, color and shape of the body. The objective of this study was to analyze a literature review of this technique from the perspective of anatomy teaching and biomechanical research. METHOD: We have taken up the process of Thiel's method from the original publication, stating the known applications of this technique in teaching and research. We have integrated into our study the specific advantages of using bodies preserved by this method in intertropical countries with a warm climate: the example of Gabon. DISCUSSION: Biomechanical research and teaching of medical and surgical sciences are regularly performed on human cadavers. Anatomical dissection therefore represents one of the main activities of anatomy laboratories. We have limited our analysis to aspects of anatomy teaching, research, and clinical and surgical practice. CONCLUSION: We have sought to popularize the Thiel body preservation technique. It offers many advantages. Teaching and research on human cadavers preserved by this method is an educational alternative. The simulation centre creates the conditions of a surgical block for the learners. We recommend this technique to anatomists and clinicians. This technique seems to be very interesting for structures with a limited number of bodies.

Arthroscopy-assisted Trillat procedure for anterior shoulder instability: Surgical technique and preliminary clinical results.

The Trillat procedure performed as open surgery to treat anterior shoulder instability has been proven effective in preventing recurrences and restoring range of motion. An arthroscopically assisted variant of the Trillat procedure is described here, together with the preliminary clinical results in 18 patients treated between 2011 and 2014. After a mean follow-up of 24.7±9.8 months, the clinical outcomes were very satisfactory, with a Walch-Duplay score of 81.5±18.0, a Rowe score of 83.6±16.0, and 94% of satisfied or very satisfied patients. Mean operative time was 55±13min. No recurrences were recorded. As an easily performed procedure that provides good clinical outcomes, the arthroscopically assisted Trillat procedure is a simple and reproducible alternative to arthroscopic Latarjet procedure, which is still reserved for highly experienced surgical teams.

Modified iliofemoral approach with osteotomy of the iliac crest, sparing the abdominal muscles, for the treatment of acetabular fracture.

Treatment of acetabular fracture is complex, requiring adapted and often extensive surgical approaches. We describe a modified iliofemoral approach, with the particularity of including iliac crest osteotomy sparing abdominal muscles to allow direct control of reduction while respecting the abdominal muscles, creating a workspace as close to the fracture as possible, without involving the inguinal canal or femoral vascular-neural bundle. In 15 complex fractures, the technique provided 13 excellent or good reductions and 13 excellent or good results according to the Matta criteria. This approach can be combined with others, such as a posterior approach, thus providing an alternative to the ilioinguinal approach in the treatment of complex acetabular fracture.

[Alfred-Louis-Dominique Richet (1816-1891): education, anatomy and surgery]. / Alfred-Louis-Dominique Richet (1816-1891) : pédagogie, anatomie et chirurgie.

Alfred-Louis-Dominique Richet was an anatomist and surgeon born in Dijon, France in 1816. He defended the teaching of clinical anatomy instead of descriptive anatomy, judged inappropriate to learn operative medicine. His name is associated with several anatomical structures that we cite in the present article.

[Current Nomina Anatomica for oral and maxillofacial surgery]. / Nomenclature anatomique utile en chirurgie orale et maxillo-faciale.

Using the international organonymy is mandatory as well for daily clinical practice as for research and teaching our students. The international organonymy, Nomina Anatomica, is in Latin. A rather unsuccessful attempt at using a French version of the international organonymy in clinical practice has been made in France. Eponyms have been systematically contraindicated; the definitions of general anatomy are applied, as well as a systematic Gallicization of the Latin terminology. Despite a stringent observance of these rules, some terms remain inappropriate because they are misleading or inaccurate. Furthermore, using this language used worldwide remains uneasy in daily clinical practice. We had for objective to focus on the main anatomical terms used routinely in oral and maxillofacial surgery, and to justify their use in clinical practice, research, and education.

[Étienne Destot (1864-1918): the first radioanatomist in Lyon, France]. / Étienne Destot (1864-1918) : l'anatomie radiographique.

Destot was born in Dijon, France, in 1864. He began his education in Burgundy, then he started his preclinical curriculum in Lyon, France, from 1884. He had to leave Lyon, and spent some times in Algeria to treat a tuberculosis. He came back in Lyon as a resident in 1886. Destot worked as an assistant in the laboratory of anatomy of Leo Testut in 1880. His thesis, in 1892, analyzed mortality in the departments of surgery of the Lyon hospitals. The polemical results he presented compromised his surgical career. He went on as prosector by Leo Testut, and then became electrician-physician in 1895 (electrotherapy and galvanotherapy). Étienne Destot of Lyon, France, developed in 1895 the first radiography room ever at the Hôtel-Dieu of Lyon, France. Wilhelm Röntgen discovered the X-rays in the same year, and Destot felt his discovery could revolutionize the approach of anatomy and traumatology. He studied wrist, ankle and calcaneus fractures, and described a new anatomy: "traumatic anatomy". For example, he focused on the posterior talar surface hollow in posterior tarsus fractures. He proposed the term of "thalamus" for this articular surface; this term is nowadays widely used by the clinicians. He introduced the term of "third malleolus" to describe the posterior part of the distal extremity of the tibia. He was the first author to analyze the normal and pathological movements of the scaphoid bone and the lunatum in wrist extension.

[Can one harvest a long bone stick in the radial forearm flap? Original radioanatomical and NanoSPECT-CT Bioscan microvascular study]. / Peut-on prélever une grande baguette osseuse radiale dans le lambeau antébrachial radial composite ? Étude radio-anatomique et microscannographique originale.

OBJECTIVES: The composite radial forearm flap is a surgical option in the reconstruction of large traumatic or oncologic orofacial defects. Nevertheless, it has been criticized for its poor bone transport faculties that would make this flap insufficient in large osseous mandibular reconstructions, or for oral prosthetic rehabilitation with dental implants. What is more, the morbidity of the donor site has often been pointed. The aim of this radioanatomic study was to revisit the vascularization of the composite radial forearm flap, focusing on the bone stick. METHODS: A radioanatomic study was performed on seven upper limbs taken from fresh cadavers. First, the vessels were washed with a 40°C solution of potassium acetate. Then an intra-arterial injection of a mixture of lead oxide and agar-agar was performed. 3D-CT-scan examinations of the anatomical pieces were performed. In a second step, the flaps were harvested and analyzed with a Microscan examination (NanoSPECT-CT Bioscan(®), voxel 220 microns). Collateral branches of the radial artery to the bone and the skin were counted and classified. RESULTS: One radial diaphyseal artery was present in all the cases. The nutrient foramen took place at the anteromedial aspect of the diaphysis, between 45 and 65 % of the length of the bone. A dense anastomotic periosteal network was highlightened, supplied by one to four musculoperiosteal branches, and one to six fascio-periosteal arteries arising from the radial artery. A total of mean five osseous branches, and 12 cutaneous branches have been observed. CONCLUSIONS: The results of the present preclinical study suggested that a 16-cm bone stick could be harvested with an optimal vascular safety, without consideration for the morbidity at the donor site. The original approach in this study, relating anatomy to the preclinical imaging, allowed a precise visualization of the microvascularization of the soft and hard tissues. It opened a field of innovative research in plastic and reconstructive surgery.

Duocentric® reversed shoulder prosthesis and Personal Fit® templates: innovative strategies to optimize prosthesis positioning and prevent scapular notching.

We describe our experience with a new system of patient-specific template called Personal Fit(®), which is unique in shoulder surgery and used in combination with Duocentric(®) prosthesis. The reverse prosthesis's concept is the invention of Paul Grammont, developed with Grammont's team of Dijon University as from 1981, which led to the first reversed total shoulder prosthesis called Trumpet in 1985. The Duocentric(®) prosthesis developed in 2001 is the third-generation prosthesis, coming from the Trumpet and the second-generation prosthesis Delta(®) (DePuy). This prosthesis provides a novel solution to the notching problem with an inferior overhang integrated onto the glenoid baseplate. Personal Fit(®) system is based on reconstructing the shoulder joint bones in three dimensions using CT scan data, placing a landmark on the scapula and locating points on the glenoid and humerus. That will be used as a reference for the patient-specific templates. We study the glenoid position planned with Personal Fit(®) software relative to native glenoid position in 30 cases. On average, the difference between the planned retroversion (or anteversion in one case) and native retroversion was 8.6°.

Intra-articular osteoid osteoma of the hip misdiagnosed by MRI: an unusual cause of unexplained hip pain.

Osteoid osteoma is a common benign bone tumor affecting the young adult with typical clinical and radiographic presentation in its most common locations. However, when arising in unusual intra-articular locations, diagnosis may appear confusing and lead to delayed management. We present the case of a 24-year-old man with intra-articular osteoid osteoma of the hip involving the posteroinferior quarter of the femoral head. This unusual location was at the origin of unexplained pain and delayed diagnosis made 18 months after the onset of symptoms since the initial magnetic resonance imaging (MRI) examination could not identify the lesion whereas it was detected on bone scintigraphy and thin slice CT imaging. Due to the complex location providing difficult access for radioguided techniques, an open surgical management was suggested and performed through a limited posterolateral approach with no hip dislocation, after identification of the circumflex pedicle. Following complete surgical excision of the tumor, the diagnosis could be confirmed after histopathologic analysis. No recurrence was observed.

[Joseph-Guichard Duverney (1648-1730). Doctor, teacher and researcher in the 17th and 18th centuries]. / Joseph-Guichard Duverney (1648-1730). Médecin, anatomiste et chercheur aux xviie et xviiie siècles.

Duverney was a leader in the field of research and education, because he worked as a physician, as a surgeon and he led many scientific works. To Peltier, he was the first academic professor of surgery. His wonderful career was explained by his heavy interest in knowledge. He became one of the main actors of the scientific revolution of the 17th century, especially concerning the methods of investigation in the medical science. He had so much fear for imperfect purposes, that many scientists of his century called him the Master. The only work he published about the anatomy and physiology of the ear and audition, was a world success, and is still amazing today. During about 50 years, Duverney allowed many advances in the field of osteology, otology, embryology, respiratory and circulatory physiology, but also provided competent pupils as Winslow, Sénac, Petit, Dionis, Valsalva. Duverney is still frequently cited by veterinary and dentists for many descriptions in animal anatomy. He died at the age of 82 years, and worked for the service of science until his death. His legacy consists of many works, some have been used by his pupils to highlight all the benefits he gave to the scientific community.

Cricoid cartilage and esophagus: CT scan study of the dynamic variability of their relative positions.

INTRODUCTION: Cricoid pressure occludes the esophagus (E) by compressing it between the cricoid cartilage (CC) and the body of the sixth cervical vertebra (C6). This technique is used to prevent passive regurgitation during the induction of anesthesia in patients at high risk for regurgitation. Failures of this technique had been described and a possible displacement of the E relative to the CC had been reported, but there is no study about displacement during antero-posterior movements of the head. AIM: The aim of our study was to evaluate the displacement of the CC relative to the cervical E, during flexion and extension movements of the head. MATERIALS AND METHODS: We retrospectively studied X-ray computed tomography (CT) images of 21 patients with suspected cervical trauma. Patients were in the supine position. In the first series of images, the head was positioned at maximal flexion by means of a support placed under the external occipital protuberance. In the second series of images, the head was maintained in extension by means of a support placed under the shoulders. Each position was obtained as far as possible within the limits of pain and restricted movement. In flexion and extension, we used the lowest slice from the cricoid cartilage. The variables measured were: diameters of CC (CD) and E (OD), left and right lateral displacements of E. RESULTS: A total of 13 CT were analyzed. CD and OD as well as OD/OC ratios did not vary significantly in flexion and extension. We noticed 61.5 and 92.3% (respectively in flexion and in extension) of left or right displacement: 23% of patients presented right displacement in both flexion and extension; 38.5% of patients did not present any right displacement in flexion or in extension; 61.5% of patients presented left displacement in both flexion and extension. More generally, almost 92% of patients presented displacement either in flexion or extension, or both. DISCUSSION: In our study, it can be seen that the E is clearly displaced with regard to the CC, that this displacement is favored by extension. Only 2/13 patients have an "over than 3 mm" displacement in extension whereas 5/13 in flexion. So, even if there are more displacements in extension, they are inferior to 3 mm and may not be considered as significant considering the occlusion of E. According to our results, the extension position of the head produces more displacement of the E but should preserve the containment of the cricoid pressure if we consider the thickness of the E wall.

[Isolated mandibular B-cell lymphoma revealed by inferior alveolar nerve anesthesia]. / Lymphome B mandibulaire isolé révélé par une anesthésie du nerf alvéolaire inférieur.

INTRODUCTION: Mandibular lymphomas are rare and most often revealed by painless swelling. The authors report the case of a mandibular lymphoma revealed by an isolated lesion of the inferior alveolar nerve evolving for eight months. CASE REPORT: A 41-year-old male patient was followed for left mandibular pain, with progressive hypoesthesia of the left inferior alveolar nerve. The radiological assessments remained normal during eight months. Then a vestibular tumor developed in front of tooth 34. The biopsy revealed a B-cell lymphoma. No other localization was found. The patient was in complete remission two years after polychemotherapy. DISCUSSION: Our observation is unusual in its clinical presentation. Mandibular lymphomas most often present as a painless swelling, sometimes ulcerated in the mouth. They are very rarely diagnosed after an isolated hypoesthesia of V3. Lymphomas are the second most frequent head and neck lymphomas after epidermoid carcinomas, but the frequency seems to be increasing. In almost all the cases, they present as B-cell tumours of the DLBCL subtype in the WHO classification. Mandibular localizations account for only 0.6% of the cases. They are often misdiagnosed as a dental problem. The complete remission rate after chemotherapy ranges from 60 to 80% at one year. Nevertheless, the prognosis remains bad with a survival rate of only 50% at five years.

[Open chest cardiopulmonary resuscitation: is there an interest in France?]. / Intérêts des manoeuvres de réanimation à thorax ouvert en France ?

OBJECTIVE: To expose and clarify indications, techniques, results, complications and cost for open chest cardiopulmonary resuscitation manoeuvres (OCCRM) in traumatic or nontraumatic cardiac arrest. DATA SOURCES: References were obtained from Pubmed data bank using the following keywords: "emergency thoracotomy", "resuscitative thoracotomy". STUDY SELECTION: We focused on publications in English language, from 2000 to 2007. DATA SYNTHESIS: OCCRM are useful especially in case of traumatic cardiac arrest, penetrating trauma, but also in blunt trauma. Time between cardiac arrest and realisation of the thoracotomy seems to be the most important factor for the prognosis. CONCLUSION: According to the French "physician in ambulance" prehospital system, OCCRM might be promising in France, because this system favours the fastness of care and therefore would minimize the time factor.

[Contribution of the posterior auricular artery in the vascularization of the facial nerve in prestylian space: anatomical study and surgical applications]. / Contribution de l'artère auriculaire postérieure à la vascularisation du nerf facial dans l'espace préstylien : étude anatomique et conséquences chirurgicales.

INTRODUCTION: The aim of our study was to establish a systematization of collateral branches originating from posterior auricular artery to facial nerve in prestylian space. MATERIALS AND METHODS: Thirty posterior auricular arteries were studied on 15 fresh cadavers after selective patent blue injection. We observed subsequent colouration of facial nerve. Number and topography of collateral branches were highlighted. RESULTS: Posterior auricular artery supplied facial nerve in 67%. Collateral branches dedicated to facial nerve could be classified into three types: type 1 corresponded to one artery in prestylian space, type 2 to several branches in prestylian space; finally type 3 featured several branches originating from posterior auricular artery in prestylian space on the one hand, in superficial retroauricular area on the other hand. CONCLUSION: Posterior auricular artery is the main blood supply to facial nerve in prestylian space. In most of the cases, branches to facial nerve originate deeply in parotid space. Nevertheless nervous branches may originate from superficial retroauricular segment of posterior auricular artery. Their damage during surgical procedures as bat ear surgery can cause definitive facial nerve palsy.

[François Chaussier (1746-1828). A vision of the anatomic nomenclature based on education]. / François Chaussier (1746-1828). Une vision de la nomenclature anatomique fondée sur la pédagogie.

François Chaussier (1746-1828) developed an original point of view concerning the anatomic nomenclature teaching and learning. The myology nomenclature proposed by Chaussier was based on a very simple concept: the name of a muscle is composed by its two attachment points. He wanted to make science learning easier for the students; that we can see in his myology nomenclature, his publications and anatomical drawings. His experience is still interesting nowadays.

[Trapezio second metacarpal joint: anatomical study and clinical matters]. / Articulation du trapèze avec le second métacarpien: étude anatomique et intérêts cliniques.

INTRODUCTION: An unusual dislocation of the column of the thumb associated with a fracture of the base of the second metacarpal inspired an anatomical study of the trapeziosecond metacarpal joint. MATERIALS AND METHODS: Forty-five dissections of the palmar aspect of trapeziometacarpal joint aimed at focusing on palmar ligaments and tendons reinforcing the joints. RESULTS: Trapeziosecond metacarpal joint is a constant little diarthrosis reinforced by a palmar ligament stressed between the crest of the trapezium and the base of the second metacarpal. The tendon of flexor radialis carpi muscle is an active link due to strong vinculae to trapezium bone and distal attachment to the bases of both second and third metacarpals. CONCLUSION: The connections between the trapezium and the base of the second metacarpal bone play a role in the treatment of thumb instability and their mechanical importance is illustrated in our original clinical observation.

[Third molar surgery under general anesthesia: a review of 180 patients]. / Extraction des dents de sagesse sous anesthésie générale : à propos de 180 patients.

BACKGROUND: Third molar surgery is an important part of the activity in a maxillofacial surgery department. This common activity is often under-evaluated by patients who forget its surgical aspect. The aim of this study was to evaluate our practice, and especially complications, with special consideration given to medicolegal aspects. MATERIALS AND METHODS: All the patients operated between September 2004 and July 2006 were enrolled in a retrospective study. This population is described, with the indications, follow-up, and complications. RESULTS: One hundred and eighty patients were reviewed (sex-ratio 1, mean age 27 years). The most frequent indications were impaction and pain. The mean duration of hospitalization was 1.7 days and temporary disability, one week. Local infection occurred in 8%; there was neurological complication in 2% for the inferior alveolar nerve, and 1% for the lingual nerve. These were all transient cases. DISCUSSION: Third molar surgery is an important and profitable part of the activity in a maxillofacial surgery department. Standardized information is necessary even if the rate of complications remains low.

[Peri-implantitis or squamous cell carcinoma?]. / Péri-implantite ou carcinome épidermoïde?

INTRODUCTION: Squamous cell carcinoma developed around dental implants has seldom been described. It simulates peri-implantitis. The authors present two cases and a literature review. CASE REPORTS: A 70 year-old woman presented with an exophytic tumor developed around dental implants placed in the anterior part of the mandible. Panoramic X-rays showed major osteolysis, especially around the distal abutment implants. A 72 year-old patient, smoker, presented with chronic lichen planus; he was carrying two implants supporting an overdenture with ball-attachments, placed 15 years before. He presented with an ulcerated symphyseal tumor, bone loss around implant in position 43. The implant had been spontaneously pushed out. In both cases the diagnosis was squamous cell carcinoma. DISCUSSION: Few cases of squamous cell carcinoma developed around dental implants have been reported. They initially mimic peri-implantitis. The carcinogenic role of the implant has never been established. Another hypothesis is the migration of malignant cells, originating from a mucosal tumor, through the sulcus. Risk factors for squamous cell carcinoma (smoking or alcohol consumption, precancerous lesions) are an indication for a permanent follow-up. Biopsies will prove the diagnosis.

[Lymph node clearance: is surgical practice homogenous?]. / La pratique des curages ganglionnaires est-elle harmonieuse? Analyse rétrospective de 330 cas.

AIM: The aim of our study was to make evident the huge variability in lymph node dissection practice. MATERIAL AND METHODS: Therefore a retrospective study was conducted on 330 patients assessed for cervical, axillary or groin dissections. In each case the authors collected the primary diagnosis and clinical stage indicating lymph node clearance, identity of the surgeon and the pathologist, surgical technique including skin incision and landmarks of tissue removal, size of the clearance, and number of lymph nodes removed. Correlations between diagnosis, surgeon's or pathologist's identity, size of the clearance and number of nodes were analyzed using non-parametric tests. RESULTS: Standardized procedures as axillary dissections occurred few differences between surgeons. In groin or cervical dissections statistical differences were made evident with great technical variability. There was a positive correlation between size of the piece of lymphadenectomy and number of lymph nodes removed. CONCLUSION: Standardized procedures as axillary dissections provide few variations. Cervical and especially groin dissections should be harmonized, published and taught harmoniously in schools of surgery. So the expression "regional lymph node clearance" would mean.