Development and validation of a 3D laryngeal model in surgical skills training

Abstract Objective: To present and validate a new simulation model for endoscopic phonomicrosurgery training as an improved teaching method. Methods: A low-cost artificial model was assembled using 3D printing, silicone, and gelatin. The study was designed to test the model's ability to carry out training and teaching of endoscopic phonomicrosurgery. The synthetic model was built to simulate normal and pathological vocal folds such as polyps, intracordal cysts and keratoses, made of silicone and gelatin and embedded in a larynx framework made by 3D printing. Simulations of endoscopic surgical procedures were performed and documented through photographs and videos and the images were submitted to the evaluation of a group of 17 otorhinolaryngologists who used a Likert scale questionnaire. The responses were submitted to an agreement analysis using the sum of the scores obtained for the responses as an appropriate level of validation. Cronbach's alpha index was calculated to measure the degree of the questionnaire internal consistency. Result: The evaluations indicated maximum approval for the model adequacy for use in practical classes and for the teaching of the procedures, as well as in the overall satisfaction with the model in the use of surgical training. Conclusion: The present proposal for training laryngeal endoscopic surgery in a 3D synthetic model is a viable option according to the validation methodology used in the present study.

Coleção de modelos anatômicos do Museu da Pharmacia da Universidade Federal de Ouro Preto / The anatomical model collection at the Universidade Federal de Ouro Preto's Museum of Pharmacy

Resumo A Escola de Farmácia de Ouro Preto, fundada em 1839, foi a primeira da América Latina desvinculada de uma escola de medicina. No final do século XIX, contou com um acervo de modelos anatômicos franceses dos renomados Deyrolle, Dr. Auzoux e Vasseur-Tramod, muitos fabricados em cera ou papel machê. O presente trabalho teve como objetivo resgatar, identificar, higienizar, restaurar e expor os modelos. De unidades acadêmicas da Universidade Federal de Ouro Preto, 17 modelos anatômicos foram resgatados e transferidos para o Museu da Pharmacia, onde receberam o devido tratamento. Os modelos em melhores condições foram expostos no museu formando parte da coleção de ensino do curso de farmácia de Ouro Preto.

Abstract The Ouro Preto School of Pharmacy was founded in 1839 and was the first pharmacy school in Latin America independent from a medical school. At the end of the nineteenth century, it had a collection of French anatomical models made by Deyrolle, Dr. Auzoux, and Vasseur-Tramod, many produced from wax or papier-mâché. This project involved recovering, identifying, cleaning, restoring, and exhibiting seventeen models found in various facilities from Universidade Federal de Ouro Preto. The models in good condition were exhibited in the Museum of Pharmacy (where this work was carried out) as part of the teaching collection for the Ouro Preto pharmacy course.

O uso da moulage na simulação clínica: estudo de casos múltiplos / The use of moulage in clinical simulation: multiple case studies / El uso del moulage en la simulación clínica: estudio de casos múltiples

Objetivo:identificar como e porque utilizar a moulage dentro das práticas de simulação clínica. Método: trata-se de estudo de casos múltiplos, inclusivo, de caráter descritivo e exploratório com abordagem qualitativa. Os casos foram selecionados por meio de uma amostra intencional. Após aplicação dos critérios de elegibilidade, foram incluídos e analisados quatro casos de cenários simulados que utilizaram moulage. Resultados: todos os casos analisados foram desenvolvidos em atividades clínicas simuladas extracurriculares por facilitadores com experiência em práticas clínicas, na docência e na área de simulação. As moulages utilizaram técnicas diferentes, promovendo maior interação com o aprendiz pelo uso de estimulantes de diferentes órgãos do sentido, aguçando o raciocínio clínico, o desenvolvimento de habilidades, competências, entre outros. Nos quatro casos, a moulage foi realizada em paciente simulado, em cenários simulados e vídeo simulado. Os motivos descritos para moulage foram: prover realismo, fidelidade, fácil aplicação e baixo custo. Conclusão: foi possível identificar que a moulage é um recurso adequando em simulação clínica e que quando construída com rigor e método, influencia na fidelidade e no realismo do cenário simulado.

Objective:identify how and why to use moulage within clinical simulation practices. Method: it is a multiple, inclusive, descriptive and exploratory case study with a qualitative approach. The cases were selected through an intentional sample. After applying the eligibility criteria, four cases of simulated scenarios that used moulage were included and analyzed. Results: all the cases analyzed were developed in extracurricular simulated clinical activities by facilitators with experience in clinical practices, teaching and simulation. The moulages used different techniques, promoting greater interaction with the learner through the use of stimulants of different sense organs, sharpening clinical reasoning, the development of skills, competences, among others. In the four cases, the moulage was performed on a simulated patient, in simulated scenarios and simulated video. The reasons described for moulage were: to provide realism, fidelity, easy application and low cost. Conclusion: it was possible to identify that the moulage is an adequate resource in clinical simulation and that when built with rigor and method, it influences the fidelity and realism of the simulated scenario.

Objetivo:identificar cómo y por qué utilizar el moulage dentro de las prácticas de simulación clínica. Método: se trata de estudio de casos múltiples, inclusivo, de carácter descriptivo y exploratorio con abordaje cualitativo. Los casos fueron seleccionados por medio de una muestra intencional. Luego de aplicar los criterios de elegibilidad, se incluyeron y analizaron cuatro casos de escenarios simulados que utilizaron moulage. Resultados: todos los casos analizados fueron desarrollados en actividades clínicas simuladas extracurriculares por facilitadores con experiencia en prácticas clínicas, en la docencia y en el área de simulación. Los moulages utilizaron técnicas diferentes, favoreciendo una mayor interacción con el aprendiz por el uso de estimulantes de diferentes órganos del sentido, aguzando el raciocinio clínico, el desarrollo de habilidades, capacidades, entre otros. En los cuatro casos, el moulage se realizó en paciente simulado, en escenarios simulados y video simulado. Los motivos descritos para el moulage fueron: proveer realismo, fidelidad, fácil aplicación y bajo costo. Conclusión: fue posible identificar que el moulage es un recurso adecuado en simulación clínica y que cuando se construye con rigurosidad y método, influye en la fidelidad y en el realismo del escenario simulado.

Three-dimensional digitalized and printed tongue models of the cow, dog, pig, and horse for undergraduate veterinary educationh / Modelos tridimensionales digitalizados e impresos de lengua de vaca, perro, cerdo y caballo para la educación veterinaria de pregrado

SUMMARY: This study aimed to construct three-dimensional (3D) anatomical models of the tongue of domestic mammals of veterinary interest. The tongues were obtained from the didactic collection of the Laboratory of Veterinary Macroscopic Anatomy in the Surgery Department of the School of Veterinary Medicine and Animal Science, University of Sao Paulo. Tongues from a cow, dog, horse, and pig were selected for scanning and creation of the 3D-printed models. The printer used a filamentous thermoplastic material, acrylonitrile-butadiene-styrene (ABS), which was deposited together with a support resin. In addition to the printing of models, an interactive 3D PDF was generated, creating a didactic collection for students. The anatomical characteristics and peculiarity of the tongues were easily identified in the scanned and printed images. The 3D scanning and printing offered an innovative method of visualizing different anatomical structures and, together with the existing methods, can optimize anatomy teaching in an educational context.

RESUMEN: Este estudio tuvo como objetivo construir modelos anatómicos tridimensionales (3D) de la lengua de mamíferos domésticos de interés veterinario. Las lenguas se obtuvieron de la colección didáctica del Laboratorio de Anatomía Macroscópica Veterinaria del Departamento de Cirugía de la Facultad de Medicina Veterinaria y Zootecnia de la Universidad de São Paulo. Se seleccionaron lenguas de vaca, perro, caballo y cerdo para escanear y crear los modelos impresos en 3D. La impresora utilizó un material termoplástico filamentoso, acrilonitrilo-butadieno-estireno (ABS), que se depositó junto con una resina de soporte. Además de la impresión de modelos, se generó un PDF 3D interactivo, creando una colección didáctica para los estudiantes. Las características anatómicas y la peculiaridad de las lenguas se identificaron fácilmente en las imágenes escaneadas e impresas. El escaneo e impresión 3D ofrecieron un método innovador para visualizar diferentes estructuras anatómicas y, junto con los métodos existentes, puede optimizar la enseñanza de la anatomía en un contexto educativo.

Reconstrução e impressão 3D do neurocrânio de cão com o uso de tomografia computadorizada como ferramenta para auxiliar no ensino da anatomia veterinária / [Reconstruction and three-dimensional printing (3D) of the neurocranium of a dog from computed tomography used as a tool for anatomy veterinary teaching]

A impressão tridimensional (3D) vem contribuindo para o aprendizado da anatomia e para áreas aplicadas da medicina veterinária utilizando uma interface que pode valorizar o conhecimento da anatomia das espécies domésticas de maneira dinâmica. O presente trabalho objetivou utilizar imagens tridimensionais geradas por tomografias computadorizada (TC) para a obtenção de imagens digitalizadas e de modelos de ossos do crânio de cão por meio de uma impressora tridimensional. Foram gerados arquivos 3D de TC a partir de imagens que foram editadas pelo software Osirix Lite. Partes dos ossos e particularidades anatômicas do crânio foram impressas em escalas de 60% e 100%. Os resultados permitiram gerar imagens digitalizadas e impressões tridimensionais advindas das tomografias, e, assim, foi criado um acervo de imagens e modelos impressos para os estudos da anatomia do crânio da espécie canina. Além disso, a metodologia demonstrou claramente a importância para uso de planejamentos cirúrgicos nos casos de procedimentos que envolvam comprometimento de estruturas ósseas. Produziu-se um material interativo e impresso em 3D com maior durabilidade, o qual poderá ser disponibilizado para fins educacionais.(AU)

The three-dimensional printer (3D) has been contributing to the learning of anatomy and applied areas of veterinary medicine using an interface that can enhance the knowledge of the anatomy of domestic species in a dynamic way. The present study aimed to use three-dimensional images generated by computed tomography (TC) to obtain digitized images and bone models of the dog skull using a three-dimensional printer. The 3D files were generated from images that were edited in Osirix Lite software. Parts of the bones and anatomical features of the skull were printed on 60% and 100% scales. The results allowed to generate digitalized images and three -dimensional impressions from the tomographies, and in this way a collection of images and printed models was created for studies of the anatomy of the canine species. In addition, the methodology clearly demonstrated the importance of using surgical planning in cases involving procedures involving bone structure impairment. Interactive material and 3D printing with high durability that could be made available for educational purposes has been produced.(AU)

Digital revolution in veterinary anatomy: confection of anatomical models of canine stomach by scanning and three-dimensional printing (3D) / Revolución digital en anatomía veterinaria: confección de modelos anatómicos del estómago canino mediante escaneo e impresión tridimensional (3D)

Three-dimensional (3D) scanning and printing can contribute to the area of Veterinary Anatomy, producing anatomical models that can be used in teaching. The objective of this project was to apply the 3D digitalization and printing to produce models of the canine stomach, and make these models available as an alternative tool of study in the practical classes of veterinary anatomy. The stomachs of dogs were digitized and printed in 3D models. Anatomical aspects were easily identifies in the models as compared with stomach original. The results of this project clearly demonstrated that the digitalization and 3D printing from the dog stomach come to strongly contribute to the teaching of veterinary anatomy, currently playing an important role by producing replicas which present desirable anatomical characteristics from organ.

El escaneo e impresión tridimensional (3D) puede contribuir al área de Anatomía Veterinaria, produciendo modelos anatómicos que pueden usarse en la enseñanza. El objetivo de este proyecto fue aplicar la digitalización e impresión 3D para producir modelos del estómago canino y hacer que estos modelos estén disponibles como una herramienta alternativa de estudio en las clases prácticas de anatomía veterinaria. Los estómagos del perro fueron digitalizados e impresos en modelos 3D. Los aspectos anatómicos se identificaron fácilmente en los modelos en comparación con el estómago original. Los resultados de este proyecto demostraron claramente que la digitalización y la impresión en 3D del estómago del perro contribuyen en gran medida a la enseñanza de la anatomía veterinaria y que actualmente desempeña un papel importante, al producir réplicas que presentan características anatómicas deseables a partir de órganos.

Técnica de plastinación de la Universidad de Antioquia: una adaptación del método estándar alemán / Plastination technique Antioquia University: an adaptation of the german standard method

RESUMEN Introducción: la plastinación es una técnica de conservación de componentes anatómicos que consiste en reemplazar las moléculas de agua por un polímero. Esto se logra en cuatro etapas (fijación, deshidratación, impregnación forzada y curado). Con base en ello nuestro objetivo fue adaptar el método estándar alemán, a las condiciones propias del Laboratorio de Plastinación de la Facultad de Medicina de la Universidad de Antioquia (UDEA). Materiales y métodos: se adaptó el método estándar alemán al reemplazar el agente deshidratante original, la acetona, por alcohol isopropílico. Fue necesario modificar la temperatura de la etapa de impregnación forzada en la técnica estándar alemana, realizada en su totalidad en frío. Esto hace que la técnica adaptada requiera realizar una segunda impregnación a temperatura ambiente. Resultados: se han obtenido 343 piezas plastinadas, de estas, 150 mediante el protocolo de plastinación UDEA, con las características descritas en el método estándar alemán: secas, inodoras, de aspecto natural y duradero. Discusión: aunque la técnica de plastinación de la UDEA aumenta el consumo de polímeros, es favorable en la relación costo/beneficio, pues disminuye los costos respecto a la aplicación de la técnica estándar alemana en nuestro medio. Emplear piezas plastinadas para la enseñanza tiene distintas ventajas. Permite reemplazar el uso de la conservación de piezas a base de formaldehído, evitando la exposición al mismo y sus efectos nocivos para la salud; por lo cual el uso de la misma ha ayudado a fortalecer diversos programas académicos en nuestra facultad.

SUMMARY Introduction: Plastination is a preservation method of anatomical components; which consists of replacing the water molecules with a polymer, this is achieved in four stages (fixation, dehydration, forced impregnation and curing), based on this our objective was to adapt the plastination technique known as the German standard technique, to the conditions of the Laboratory of Plastination of the UDEA. Materials and methods: We adapted the standard German plastination method by replacing the original dehydrating agent, acetone, with isopropyl alcohol; it was necessary to modify the temperature of the forced impregnation step in the standard German technique completely done in cold; requiring in our technique to perform a second impregnation at room temperature. Results: A total of 343 plastinated pieces were obtained, 150 with the plastination protocol UDEA, with the characteristics described in the standard German method: dry, odorless, natural looking and durable. Discussion: The plastination technique of the UDEA, although it increases the consumption of polymers, the cost / benefit ratio is still favorable, since it reduces the costs with respect to the application of standard German techniques in our environment. Employing plastinated pieces for teaching have different advantages, in turn it allows to replace the use of the conservation of pieces with base of formaldehyde, avoiding the exposure to the same and their harmful effects for the health; so the use of it has helped to strengthen various academic programs in our faculty.

Multiple software based 3D modeling protocol for printing anatomical structures / Protocolo de impresión 3D de estructuras anatómicas basados en la utilización de software múltiple

With the increasing number of medical programs, research for new teaching methods has also emerged. Computer software and diagnostic images have been used for anatomy teaching as an alternative to cadaver dissection, which means students cannot develop a mental image of the human body without compromising spatial reasoning. Also the cadavers present flaws such as color, texture and smell. This paper explains in details the protocol used to reconstruct 3D models for rapid prototyping as an overcome to these difficulties. Online Computerized Tomography scans were obtained in DICOM format from OsiriX and InVesalius. Reconstruction of 3D models from aortic and superior tracheobronchial tract structures were created, InVesalius and Rhinoceros software were used. 3D models of a heart with its aorta, superior tracheobronchial tract and an aneurysm at the aortic bifurcation were obtained for rapid prototyping. The superior tracheobronchial tract model was printed. It is possible to produce printed models from CT scans using different softwares for 3D modeling and rapid prototyping. These models could allow the student to develop a three dimensional mental image of the human body according to literature.

Con el incremento en el número de programas médicos, la búsqueda por nuevos métodos de enseñanza también ha emergido. Software computarizado e imágenes diagnósticas han sido utilizados en la enseñanza de anatomía como una alternativa a la disección cadavérica, lo que conlleva a que los estudiantes no puedan desarrollar una imagen mental del cuerpo humano sin comprometer el raciocinio espacial. También los cadáveres presentan desventajas como color, textura y olor. Este artículo explica en detalle el protocolo usado para la reconstrucción de modelos 3D para prototipado rápido como un recurso para superar estas dificultades. Tomografías computarizadas online fueron obtenidas en formato DICOM de OsiriX e InVesalius. La reconstrucción en 3D de modelos de estructuras aórticas y del ducto traqueobronquial fueron creadas con los software InVesalius y Rhinoceros. Modelos 3D de corazón y aorta, el ducto traqueobronquial y un aneurisma aórtico abdominal en su bifurcación fueron obtenidos para la prototipado rápido. El modelo de ducto traqueobronquial fue impreso. Es posible producir modelos de TC usando diferentes programas de modelado 3D. Estos modelos podrían permitir a los estudiantes desarrollar una imagen metal tridimensional del cuerpo humano según la literatura.

Impresiones 3D, nueva tecnología que apoya la docencia anatómica / 3D impressions, new technology that supports anatomical teaching

La dificultades de acceso al material cadavérico han forzado a los anatomistas a reemplazar la disección por el uso de preparaciones tratadas con diversos métodos de conservación y la utilización cada vez más frecuente de modelos anatómicos, elementos de alto costo que pretenden imitar, no siempre con éxito, a las preparaciones cadavéricas. En el último tiempo se han desarrollado métodos de impresión 3D de modelos de segmentos corporales utilizando imágenes de Tomografía Computadorizada o escáner de superficie, de modo que existe la tecnología para poder realizar réplicas de secciones corporales o de disecciones humanas para aplicarlas con fines docentes. En este trabajo presentamos nuestra experiencia en la tecnología de impresión 3D aplicada a la creación de réplicas de secciones corporales humanas, lo que nos ha permitido generar un símil de la sección corporal, real y tangible, que conserva exactamente las proporciones, las relaciones topográficas, la veracidad morfológica y el color, sin posibilidad de descomposición ni contaminación.

The difficulties of access to cadavers have forced anatomists to replace dissections with the use of preparations treated with various methods of conservation and/or anatomical models; high-cost items that intended to imitate - not always successfully - the cadaveric preparations. Recently, new methods have been developed for 3D printing of models of body segments using computed tomography images or scanner surface, so that the technology exists to create replicas of body sections or cadaver dissections to apply for teaching purposes. We present our experience in 3D printing technology applied to create replicas of human body sections, allowing us to generate an accurate reproduction, with real and tangible sections which retain the proportions exactly as well as topographic relations, morphological and color accuracy, without the possibility of decomposition or contamination.

Avaliação da acurácia e confiabilidade de modelos digitais por escaneamento do modelo de gesso / Evaluation of the accuracy and reliability of digital models by scanning the plaster cast

Introdução: o objetivo deste estudo foi avaliar a acurácia e a confiabilidade de medições feitas em modelos digitais obtidos com um scanner a laser de superfície (R700; 3Shape, Copenhagen, Dinamarca). Material e métodos: foram selecionados 30 modelos ortodônticos de gesso de dentições permanentes. As medições foram realizadas por três examinadores com um paquímetro digital, diretamente sobre os modelos de gesso, e digitalmente, através do programa Ortho Analyser (3Shape, Copenhagen, Dinamarca), nos modelos digitais. Foram determinadas 62 medidas, incluindo diâmetro e altura dentária, overjet, overbite, distâncias intercanino e intermolar, e relação sagital bilateral. Utilizou-se o teste t pareado para avaliar o erro intraexaminador e a acurácia das medições nos modelos digitais. Avaliou-se a reprodutibilidade entre os examinadores por meio do coeficiente de correlação intraclasse e a confiabilidade pelo teste de Bland e Altman. Resultados: apesar de existirem diferenças estatisticamente significantes entre as medições realizadas entre os modelos de gesso e os digitais, as discrepâncias foram consideradas clinicamente não significantes. Tanto os modelos de gesso quanto os modelos digitais apresentaram altos valores no coeficiente de correlação intraclasse entre os examinadores. Conclusão: os modelos digitais por escaneamento do modelo de gesso, utilizando o scanner R700 e o programa Ortho Analyser, podem ser utilizados com acurácia clinicamente aceitável e uma excelente confiabilidade e reprodutibilidade. Os modelos digitais podem substituir os modelos de gesso com segurança.

Introduction: the aim of this study was to evaluate the accuracy and reliability of measurements made on digital models obtained with a laser scanner surface (R700; 3Shape, Copenhagen, Denmark). Material and methods: thirty orthodontic plaster models of permanent dentition were selected. The measurements were performed by three examiners with a digital caliper directly on the plaster casts and digitally, through Ortho Analyser software (3Shape, Copenhagen, Denmark), in digital models. It was determined sixty two measures, including diameter and tooth height, overjet, overbite, intercanino and intermolar distances and bilateral sagittal relationship. It was used paired t test to assess intra-examiner error and the accuracy of measurements in digital models. It was evaluated the reproducibility between examiners using the intraclass correlation coefficient and reliability by Bland and Altman test. Results: although there were significant differences between the plaster casts and the digital models measurements, the discrepancies were considered clinically insignificant. Plaster casts and digital models showed high values of intraclass correlation coefficient among examiners. Conclusion: digital models by scanning plaster cast using the R700 scanner and Ortho Analyser software can be used with clinically acceptable accuracy and excellent reliability and reproducibility. Digital models can replace the plaster models safely.

Modelo anatômico de ventriculomegalia para treinamento neuroendoscópico / Ventriculomegaly anatomical models for neuroendoscopy training

OBJETIVO: Desenvolver peças anatômicas que simulem uma condição real de ventriculomegalia para serem utilizadas como uma ferramenta no treinamento dos neurocirurgiões nas técnicas de neuroendoscopia e viabilizar estudo anatômico dos ventrículos. MÉTODO: Foram utilizadas vinte peças anatômicas de encéfalo de cadáveres de indigentes, com a aprovação do Comitê de Ética em pesquisa da FMUSP sob o número 046/10. As peças foram retiradas da base do crânio com a persistência da superfície óssea (parte da calvária) para serem submetidas aos seguintes procedimentos: canulação do IV ventrículo por meio da abertura mediana do IV ventrículo (forame de Magendie); tomografias pré-experimento e injeção de água destilada no sistema ventricular. A água injetada estava à temperatura ambiente e os cérebros foram resfriados até 4º C e, após 12 horas, foram congelados a uma temperatura de 0º C (no estado sólido) por 24 horas. Esses procedimentos foram realizados na frequência de três vezes. Após o experimento, foram realizadas tomografias pós-experimento e procedimentos neuroendoscópicos ventriculares. Foram excluídos encéfalos com lesões traumáticas ou antecedentes de enfermidades transmissíveis. Não foram critérios de exclusão o sexo e a idade. Foram avaliadas, nas imagens tomográficas, a variação pré e pós-experimento dos seguintes parâmetros: coeficiente corno frontal/diâmetro interno; índice de Evan; e tamanho do corno temporal. As análises estatísticas foram realizadas no programa SPSS (Statistical Package for the Social Sciences) versão 13, para ambos os grupos. RESULTADOS: A avaliação da relação Corno frontal/Diâmetro interno, antes e pós-experimento apresentou média de 11,98% e 19,46%, respectivamente. Estudo estatístico (t Student) mostrou diferença estatística (t= -5142, gl =19; p < 0,01). O Índice de Evan também apresentou diferença significativa (t = -5,172, gl = 9; p < 0,01) entre os resultados antes (média de 10,86%) e após experimento (média de 18,35%). A análise...

PURPOSE: To develop anatomical models which simulate real conditions of ventriculomegaly and to use them as tools to train neuroendoscopic techniques and allow the study of the ventricles. METHODS: A total of twenty brains, with the approval of the Ethics in Research Committee from FMUSP (046/10) were used to perform this research. The brains were separated from the skull base, but keeping part of the calvaria, and then underwent the following procedures: cannulation of the fourth ventricle through the median open of the fourth ventricle (foramen of Magendie); CT scans performed before the experiment; and then injection of distilled water into the ventricular system. The water was injected at room temperature, and then the brains were cooled to 4ºC. After 12 hours, they were then frozen at 0ºC for 24 hours.These procedures were repeated three times. After the experiment,CT scans were performed after the injections and neuroendoscopic procedures. Brains, which had traumatic injuries or history of infectious diseases, were excluded. Gender and age were not exclusion criteria. The statistical analysis was performed with the SPSS program (Statistical Package for the Social Sciences) version 13, for both groups. To assess the variation of the frontal horn (FH)/internal diameter (ID) coefficient, such as Evan's index's variation, and to analyze the temporal horn (TH) size, thet-Student test was used. RESULTS: The results of the t-Student test showed that the FH/ID, with an average of 11.98% before the experiment, had significant difference (t = -5.142, gl = 19; p < 0.01) after the experiment, with an average of19.46%. The Evan's index also showed a significant difference (t = -5.172, gl = 9; p < 0,01) with an initial average of 10.86% and a final average of 18.35%. The analysis of the temporal horn size showed a significant difference between the size before and after the experiment (t = -2.297, gl = 9; p < 0.01), indicating the significant increase of the temporal...

A utilização dos modelos digitais em ortodontia / The use of digital orthodontic models

O modelo digital pode se tornar em breve uma realidade na clínica ortodôntica, pois apresenta grandes vantagens e facilita o planejamento dos casos clínicos, com a possibilidade de inter-relação com outros arquivos digitais. Os trabalhos publicados na literatura demonstraram que os modelos digitais apresentam precisão e confiabilidade aceitáveis para serem aplicados como método de diagnóstico, além de auxiliar no planejamento ortodôntico. No entanto, este recurso ainda é pouco explorado no Brasil. Este trabalho objetiva apresentar o panorama atual da utilização dos modelos digitais em Ortodontia.

The digital model may soon become a reality in clinical orthodontics because it presents great advantages and facilitates treatment planning, with the possibility of interrelation with other digital files. The published papers have shown that digital models exhibit acceptable accuracy and reliability to be applied as a method to assist the diagnosis and orthodontic planning. However, this resource is still little explored in Brazil. This paper aims to present a current overview of the use of digital models in orthodontics.

Quality and language of learning objects used in the teaching of human anatomy / Calidad y lenguaje de los objetos de aprendizaje utilizados en la enseñanza de la anatomía humana

The traditional method of teaching Human Anatomy is based on the use of cadavers, text books and the use of images from an atlas. Learning anatomy by means of a cadaver contributes to the understanding of the shape, location and relationship of various organs and structures of the human body. However, the use of cadaverous material presents difficulties in terms of acquisition, conservation, quality and quantity. Thus, to improve the teaching of anatomy other learning objects such as anatomical models, videos and software, have been used. Each of these objects has its qualities as facilitators of knowledge, a fact represented by the impact that they have on the learning of anatomy translated into an improvement in student grades. However, such learning objects should not replace the use of cadavers, rather all of these methods should be integrated in order to improve the performance of students. This article presents a review of the literature on the quality and the language of learning objects used to enhance the teaching of Human Anatomy, in addition to analyzing the influences of computers on changes to the learning objects in content of the discipline of anatomy.

El método tradicional de enseñanza de la Anatomía Humana se basa en el uso de cadáveres, libros de texto y en la utilización de imágenes de atlas. Aprender anatomía por medio del empleo de cadáveres contribuye a la comprensión de la forma, localización y relación de los órganos y estructuras del cuerpo humano. Sin embargo, las dificultades que se observan en la utilización de material cadavérico están relacionadas a su obtención, conservación, calidad y cantidad. En ese sentido, para mejorar la enseñanza de la anatomía se utilizan otros objetos de aprendizaje como modelos anatómicos, videos y softwares. Cada uno de esos objetos tiene cualidades como facilitadores del conocimiento, este hecho se plasma en la obtención de mejores calificaciones por parte de los alumnos. No obstante, estos materiales no deben sustituir al material cadavérico, por el contrario, debe existir una integración de todos los métodos, con el objetivo de mejorar el desempeño del alumno. Este artículo presenta una revisión de la literatura sobre la calidad y el lenguaje de los objetos de aprendizaje utilizados para mejorar la enseñanza de la Anatomía Humana, además de analizar la influencia que los computadores ejercen para que los objetivos y contenidos del aprendizaje de la disciplina de Anatomía sean cumplidos.

The use of anatomical models for learning anesthesia techniques in oral surgery.

Aim: The objective of this work is to present a new collaborative method for teaching administration of anesthetic block in dentistry, with three-dimensional anatomical models used to improve learning and thereby increase safety, reduce anxiety, and improve the performance of students during the administration of anesthesia in the patients. Materials and Methods: Three-dimensional (3D) models of skulls were made that reproduced all innervations of the V th cranial nerve (trigeminal nerve), as well as some blood vessels, glands, and muscles of mastication. For teaching the local anesthetic techniques we prepared pictures and videos of the administration of anesthesia in the models , which were presented to 130 students in two universities in Brazil. With the help of the models the students could follow the path of the nerves to be anesthetized and identify the anatomical points of reference for the correct positioning of the needle in the tissues. After the presentation the students answered a questionnaire aiming to assess the effect of the 3D models on learning. Results: Eighty-eight percent of students rated the material as excellent, 12% as good, 0% as regular, and 0% as bad (unnecessary materials). After the presentation, 70% of the students felt confident about being able to achieve the nerve block in patients. Conclusion: When exposed to an appropriate method, students recognized the importance of knowledge of anatomy for learning local anesthetic techniques. This method improved the quality of education and increased patient safety during the first injection.

Form-Stable Highly Cohesive gel Breast Implants

Highly cohesive, form-stable cohesive gel implants were introduced in 1993. This resulted in a paradigm shift in breast augmentation surgery. With the introduction of shaped textured implants, surgeon started to think in terms of shape and dimensions rather than volume and cup size. Basically most aspects of such breast augmentations are different. The way of selecting implants is different. Patient preoperative markings, surgical techniques, postoperative recommendations and results also differ. These are not mere new types of implant, but they represent a new concept in breast augmentation surgery. Surgeons who believe that form stable implants behave in the same way as non-form stable implants will tend to plan, select implants and perform surgery in traditional ways. Unfortunately, they are bound to encounter significantly more complications and problems. These implants are recently available in Korea since 2012 and will provide patients and surgeons with the ability of enhanced outcome and results if used properly; however there needs to be a transition from round cohesive gel implant thought process to a more comprehensive approach for the typical Korean plastic surgeon.

Primary Breast Augmentation with Anatomical Form-stable Implant

The Natrelle(TM) 410 (Allergan Inc., Irvine, CA, USA) shaped, form-stable silicone gel implant was introduced in Europe in 1993. Its "form stability" relates to increased cohesiveness or stiffness of the gel filler, allowing the implant to maintain its shape in the upright position. The anatomical form-stable implant is helpful for reducing ripples and provides more natural looking due to less upper pole fullness, so it has some benefits for the thin patients. And it provides more expansion to the lower pole, it has also benefits for the ptotic breasts or constricted breasts. I have experienced 69 cases with anatomical form-stable implants (52 Polytech Replicon(R) (POLYTECH Health & Aesthetics, Dieburg, Germany) implants, 85 Natrelle(TM) 410 implants) from February to December of 2012. The most common used implants are MF295 g of Natrelle(TM) 410 and high profile 315 g of Polytech Replicon(R). I did reoperations for 2 breasts of 2 patients. One was due to hematoma and the other was due to displacement. Both cases are my early experiences of shaped implants. There is no other complication yet. I need longer follow-up period for the appropriate evaluation. In my early experiences, the results of anatomical form-stable implants seem to make less fullness of upper pole, less ripples, more tightness, and similar recovery periods in contrast with the results of round textured implants.

Role of Anatomical Implant in Augmentation of Glandular Ptotic Breast

Breast augmentation of ptotic micromastia is relatively difficult procedure than simple augmentation. Surgeon must make into account many variables, ptosis degree, chest wall size, shape, asymmetry, nipple and inframammary fold level, soft tissue characteristic etc. One-stage mastopexy augmentation procedure has higher patient acceptance because this limits the number of sick days and the need for hospital care, and it is also less expensive. Because of two procedures that has opposite effect to soft tissue be done in the same time, there can be high incidence of unfavorable outcomes and complications. Some well known doctors recommend that 2-step procedure of mastopexy folllowed by augmentation can be much better option. It can make more predictable result and it is also safe in soft tissue problem and vascularity. In one stage augmentation mastopexy, high and extrahigh projection implants have often been promoted for augmenting glandular ptotic breast, emphasizing the role of implant projection to the sagging parenchyma and skin of lower pole of breast anteriorly to "lift" the breast and "correct" the ptosis. High and extra high profile implants may contribute projection, but they are not the best choice for correction of glandular ptosis. It has several negatives, additional parenchymal atrophy, lower pole skin stretch and thinning and visible and palpable rippling. All of these tissue consequences are irreversible and uncorrectable. Optimal implant design for augmentation of glandular ptotic breast is full height, moderate profile, shaped, textured, form stable implant.

O uso de simuladores no aprendizado para cirurgia otológica / The use of simulators in the learning for otologic surgery

INTRODUÇÃO: A doutrina do "aprender fazendo" foi criada por Halsted e col. no início do século 20 criando o primeiro modelo de residência médica do mundo. Esse aprendizado se desenvolve em 3 fases: cognitiva, associativa e autônoma, por meio de uma curva ascendente. Os simuladores surgiram nos últimos anos como complementação à fase cognitiva, somando esforços para o treinamento, antes realizado apenas em modelos animais e em cadáveres, cada vez mais dificultado por dilemas médico-legais. OBJETIVO: Descrever e comparar os diversos tipos de simuladores disponíveis para o aprendizado de cirurgia otológica. SÍNTESE DOS DADOS: Os modelos de simuladores se dividem principalmente em modelos reais e virtuais, cada um contendo suas particularidades com pontos positivos e negativos. O ponto principal de cada um deles é o feedback sensitivo conferido por cada um deles, o que chamamos de realidade háptica: coloração da estrutura dissecada; audição de sons correspondentes, como o da broca ou do aspirador; presença de pedal para acionamento da broca; possibilidade de aspiração do conteúdo dissecado; presença de joystick que simule a caneta do motor; utilização de óculos ou mesmo microscópio para visualização tridimensional; utilização de instrumental cirúrgico otológico real. O custo dos diferentes tipos de simuladores é também um ponto crucial para a implementação dos mesmos na realidade diária dos centros de treinamento. É importante citar que alguns desses simuladores permitem que os alunos em treinamento possam ser avaliados objetivamente pelo próprio simulador. CONCLUSÃO: Simuladores são vistos como ferramenta complementar para treinamento e aprimoramento de cirurgiões otológicos.

INTRODUCTION: The teaching method of "learn by doing it'' was created by Halsted e col. In the beginning of 20th century creating the first model of medical residence in the world. This learning develops in three phases: cognitive, associative and autonomous, through an ascending curve. The simulators appeared in the last years as a complement to the cognitive phase, adding efforts to the training, performed before only in animals and cadavers, ever more hampered by medical and legal dilemmas. OBJECTIVE: Describe and compare the various types of simulators available for the learning of otological surgery. DATA SYNTHESIS: The model of simulators are divided mainly in real and virtual models, each having its peculiarities with positive and negative points. The main point of each one of them is the sensory feedback granted by each one of them, what we call it haptic reality: coloring of the structure dissected; listening to the corresponding sounds; as the drill or vacuum; presence of a joystick that simulates the pen motor; use of glasses or even a microscope for three dimensional view; use of a real otologic surgical instrument. The cost of the differents types of simulators is also a key point for the implementation of them in the daily reality of the training centers. Is important to mention that some of these simulators allow the training students and can be objectively evaluated by the simulator itself. CONCLUSION: Simulators are seen as a complementary tool for training and improvement of the otological surgeons.

Evaluaciones Prácticas Objetivadas en Anatomía: Diferencias de Rendimiento en Preguntas Realizadas en Modelos, Preparaciones Anatómicas y Cadáveres / Objetive Structured Practical Test in Anatomy: Differences in the Score of Questions Realized in Models, Anatomical Preparations and Cadavers

En la mayoría de los cursos de anatomía de nuestros país los temidos exámenes prácticos se realizan ahora en el formato de pruebas prácticas objetivadas; actividades no menos temidas pero que si ofrecen una similitud de condiciones a todos los examinados. En nuestro caso y atendida la escasez de material cadavérico, una parte de las estaciones de evaluación ocupan preparaciones anatómicas parafinadas o plastinadas y modelos anatómicos de serie que existen en el mercado; material que por sus características no siempre reflejan, en forma fidedigna, la realidad anatómica. En este estudio se compara el rendimiento de los alumnos de nuestros cursos de anatomía en a) disecciones cadavéricas b) preparaciones anatómicas plastinadas; y, c) distintos tipos de modelos anatómicos fabricados especialmente para la docencia en anatomía. Los resultados obtenidos muestran distinto grado de dificultad según el elemento sobre el cual se realiza la evaluación. Así, las peguntas sobre modelos son respondidas con mayor facilidad (?=3,219; escala de 0 a 4 puntos) que aquellas realizadas sobre preparaciones (?=3,193) o cadáveres (?=2,537). Además, hemos detectado que algunos modelos ofrecen mayor dificultad que otros -sobre una misma región anatómica- en el reconocimiento de estructuras anatómicas vasculares. Considerando estos datos, parece necesario extremar los cuidados al planificar estos tipos de evaluaciones prácticas que mezclan modelos, preparaciones anatómicas y cadáveres, a fin de minimizar los factores que inducen algún grado de disparidad en la evaluación.

In most anatomy courses in our country practical tests are now performed in objectified format, activities that provide similar conditions for all examinees. In our case and attending the shortage of cadaveric material, part of the evaluation stations use plastinated or paraffined anatomical preparations and serial anatomical models; material which by its nature, does not always reflect real anatomy in a trustworthy manner. This study compares the performance of students in our courses of anatomy in a) cadaveric dissections b) plastinated anatomical preparations, and c) different types of anatomical models made specifically for teaching anatomy. The results show varying degrees of difficulty depending on the element on which the assessment is realized. Questions made in models are more easily answered (? = 3.219; scale of 0 to 4 points) than those performed on anatomical preparations (? = 3.193) or cadaver (?= 2.537). In addition, we found that some models offer greater difficulty than others of the same anatomical region. Considering these facts it seems necessary to be particularly careful during the planning of this type of practical test, which includes models, anatomical preparations and cadavers, in order to avoid those factors which induce some grade of disparity.

Valoración de la Actividad de Modelos Anatómicos en el Desarrollo de Competencias en Alumnos Universitarios y su Relación con Estilos de Aprendizaje, Carrera y Sexo / Assessment of Anatomical Models Activity in the Competence Development in Undergraduate Students and their Relationship to Learning Style, Career and Sex

La actividad de modelos anatómicos se realiza en algunas universidades chilenas con el objeto de facilitar el aprendizaje en anatomía considerando la dificultad para obtener cadáveres humanos. Se diseñó una encuesta que evaluó la opinión de los alumnos de kinesiología y fonoaudiología que realizaron la actividad de modelos anatómicos en primer año de su carrera en la Universidad de Talca. La encuesta se refirió a si esta actividad es favorable como actividad de aprendizaje y si es posible desarrollar competencias cognitivas, procedimentales y actitudinales. Los resultados obtenidos mostraron que es bien valorada por los alumnos como actividad de aprendizaje y que competencias, valores y actitudes como trabajo en equipo, responsabilidad, respeto y creatividad se fomentan a través de ella. No se encontró diferencia estadísticamente entre el desarrollo de competencias y las variables de carrera, sexo o estilo de aprendizaje.

Considering the difficulty in obtaining human cadavers, the use of anatomical models is carried out in some Chilean universities in order to facilitate learning in anatomy, A survey was designed to assess the opinion of kinesiology and phonology students who realized activities and use of anatomical models in the fist year of their careers at the Universidad de Talca. The survey referred to whether this activity is favorable as a learning tool and whether it was possible to develop cognitive, procedural and attitudinal abilities. The results obtained show that the activity was valued positively by students as a learning activity, and that competences, attitudes and values such as teamwork, responsibility, respect and creativity are encouraged. No significant statistical difference was found between competence development and career, sex, or learning style variables.