Assembling Facial Muscles in a Skull Model for Plastic Surgery Trainees.

ABSTRACT: The aim of this study was to report the results of a training workshop on assembling facial muscles in a skull model, with a focus on the depth and intermingling of the muscles.A commercially available model with facial and masticatory muscles was used and this has 33 muscle pieces removable and attachable by magnets. Seven participants were recruited for workshop. At first stage, they were asked to assemble 33 detached pieces. Atlases of facial anatomy and Google searches except scientific articles were available. The time required to complete the assembly was measured. At second stage, a review article on facial anatomy was provided and they were again asked to assemble the pieces and the time was also measured. They were asked to rate their satisfaction with the outcomes on a Likert scale.In the second stage, the time was significantly shortened (from 66.9 ±â€Š22.2 to 27.9 ±â€Š15.0 minutes, P  = 0.002). The reasons for this improvement we think are: first, repeating an activity itself shortens time, and second, reading a review article about the anatomy of the face, especially the depth and relationship of each muscle, provided participants with deeper anatomical knowledge. Upon finishing the 2-stage workshop, the participants' knowledge of the name (P = 0.019), origin and insertion of each muscle (P = 0.017), as well as the relationships of all neighboring muscles (including their depth) increased significantly (P = 0.002).This model would be useful for anatomy classes at the undergraduate level in medical schools or developing a station as part of the objective structured clinical examination for board certification.

Analysis of Medical Students' Book Reports on Shalamov's Kolyma Tales (1974): Would You Reveal the Truth About a Suspected Malingering Patient?

PURPOSE: The aim of this study was to investigate medical students' thought processes regarding whether to reveal the truth about a suspected malingering patient by analysing their book reports on Shalamov's Kolyma Tales (1974). METHODS: The participants were 47 medical students in their junior year. The book was provided a month before the classroom lecture. Students had discussions in groups of 7 and wrote book reports that included answers to 3 questions. RESULTS: Most students (39, 83.0%) answered that they had faked an illness previously, and abdominal pain (21, 53.8%) was the most frequently feigned illness. On the pre-reading questionnaire, 14 (29.8%) answered that they would reveal the truth by fair means or foul, whereas 15 (32.0%) would turn a blind eye to a malingering patient. On the post-reading questionnaire, however, 17 (36.2%) answered that they would reveal the truth, while 22 (46.8%) answered that they would turn a blind eye. It is notable that among the 18 students (38.2%) who replied that whether they would reveal the truth depended on the situation on the pre-reading questionnaire, 3 (6.3%) instead stated on the post-reading questionnaire that they would reveal the truth, while 7 (14.9%) answered that they would turn a blind eye. The remaining 8 (17.0%) did not change their mind and still replied that it depended on the situation. CONCLUSION: It is thought that reading and discussing this story gave the students the opportunity to think about how to manage malingering patients, as portrayed in Shalamov's Kolyma Tales (1974).

Lip Shapes Over the Last Century (1948-2012).

The aim of this study was to analyze lip shapes as represented in the British edition of Vogue over the last century (1916-2015). Photographs containing distinguishable lips were selected from a book entitled Vogue 100: A Century of Style. A total of 98 frontal pictures (20 males, 78 females) in which the lips and mouth were identifiable were included and analyzed in terms of 4 lip-related ratios (lip thickness-to-width ratio [LTW]; upper-to-lower vermillion ratio [ULR]; upper vermillion thickness-to-upper lip height ratio [VUL]; and lip-to-nose width ratio [LNW]). The LTW was 0.39 ±â€Š0.07, and did not vary significantly over time (P = 0.261 [linear regression analysis]). The LTW of women (0.41 ±â€Š0.07) was significantly greater than that of men (0.34 ±â€Š0.05) (P < 0.001 [independent 2-samples t-test]). The ULR was 0.74 ±â€Š0.16, and did not vary significantly over time (P = 0.647). There was no significant difference in the ULR between men (0.75 ±â€Š0.10) and women (0.74 ±â€Š0.17) (P = 0.769). The VUL was 0.43 ±â€Š0.09, and did not vary significantly over time (P = 0.550). The VUL of women (0.44 ±â€Š0.09) was significantly greater than that of men (0.37 ±â€Š0.06) (P = 0.001). The LNW was 1.49 ±â€Š0.19, and did not vary significantly over time (P = 0.619). There was no significant difference in the LNW between men (1.43 ±â€Š0.16) and women (1.51 ±â€Š0.19) (P = 0.082). The results of this study may be useful for planning facial rejuvenation operations, as well as for clinical practitioners dealing with brow esthetics or lip tattooing.

Catgut and its Use in Plastic Surgery.

The aim of this paper is to review the origin, physical properties, advantages, and usage of catgut in plastic surgery and oral surgery.In PubMed search, the search terms ("catgut" AND ["plastic surgery" OR "facelift"]) and ("catgut" AND "oral surgery") were used, resulting in 28 and 30 papers, respectively. Of those 58 papers, 31 papers were excluded. Eight other papers were added; therefore, 35 papers were analyzed.Catgut has been used in cleft palate surgery since 1938. In 1976, it was used in a superficial wound with anti-tension taping. In the 1970s, 1980s, and 1990s, catgut was used in otoplasty, scrotoplasty, hemostasis of neurofibroma, blepharoplasty, ptosis surgery, and rhytidectomy. From the 2000s until the present day, it has been preferred in many fields of plastic surgery, including pediatric lacerations and conjunctiva sutures. In oral wound repairs and tonsillectomy, catgut has been used from the 1970s to the present. Many studies have compared catgut with other suture materials in terms of wound healing, inflammatory reaction, and longevity, and their respective advantages and disadvantages continue to be discussed.The advantages of catgut as a suture material are as follows: 1, The fundamental advantage of catgut is its absorbability. 2, Catgut has excellent tensile strength. 3, Sterility, when catgut is taken from a sealed tube, is assured. 4, Hardened, or 'chromed,' catgut is preferable to the 'plain' variety. 5, The finest possible size should be used in preference to thicker sizes.Catgut sutures are still widely used in plastic surgery and oral surgery.

Usage of Epinephrine Mixed With Lidocaine in Plastic Surgery.

Plastic surgeons commonly administer subcutaneous epinephrine to reduce intraoperative blood loss. The authors hypothesized that there are safe and effective concentration of epinephrine for vasoconstriction and their durations. The aim of this study is to summarize the existing literatures for the usage of epinephrine mixed with lidocaine in plastic surgical field.In 1903, Braun reported that adrenaline prolonged the local anesthetic effects of cocaine. The Parke-Davis Company began selling cocaine with adrenaline, as well as combining adrenaline with new synthetic local anesthetics.Based on a review of the literature, concentrations between 1:50,000 and 1:400,000 are equally effective and provide superior vasoconstriction compared with more dilute solutions. If epinephrine is further diluted, its onset and time to peak serum concentration are delayed, and its duration of action is shortened. When lidocaine is used without epinephrine, duration of anesthesia is shortened reverse proportionally to the lidocaine concentration. When lidocaine is used with epinephrine, duration of anesthesia is prolonged proportionally to the lidocaine concentration. With slow injection rate in the soft tissue, the maximum safe dose of lidocaine is approximately 3 mg/kg plain and 7 mg/kg when mixed with epinephrine. Lidocaine may protect the myocardium because of its antiarrhythmic activity, which is the rationale for infiltrating lidocaine mixed with epinephrine in general anesthesia.In plastic surgery, subcutaneous infiltration of epinephrine-lidocaine solution is performed to reduce intraoperative blood loss. Even in general anesthesia, infiltrating lidocaine mixed with epinephrine may protect the myocardium because of its antiarrhythmic activity.