The effectiveness of three-dimensional printing in undergraduate and postgraduate anatomy education: A review of reviews.

PURPOSE: Several reviews and meta-analyses about the value of three-dimensional (3D) printing in anatomy education have been published in the last years, with variable-and sometimes confusing- outcomes. We performed a review of those reviews, in order to shed light on the results concerning the effectiveness of 3D printing in anatomy education, compared to specific traditional methods and other technologies. METHODS: The electronic databases PubMed, ERIC and Cochrane library were searched for reviews or meta-analyses with purpose to investigate the effectiveness of 3D printing in undergraduate and postgraduate anatomy education. RESULTS: Seven papers were included: four systematic reviews with meta-analysis, one narrative, one scoping and one systematic review. Overall, it has been shown that 3D printing is more effective than two-dimensional (2D) images for undergraduate health science students, but not for medical residents. Also, it seems to be more effective than 2D methods for teaching anatomy of some relatively complex structures, such as the nervous system. However, there is generally lack of evidence about the effectiveness of 3D printing in comparison with other 3D visualization methods. CONCLUSIONS: For students, the effectiveness of 3D printing in anatomy education is higher than 2D methods. There is need for studies to investigate the effectiveness of 3D printing in comparison with other 3D visualization methods, such as cadaveric dissection, prosection and virtual reality. There is also need for research to explore if 3D printing is effective as a supplementary tool in a blended anatomy learning approach.

Methods and outcomes of teaching functional anatomy of the musculoskeletal system: A scoping review.

PURPOSE: Although musculoskeletal anatomy is inherently related to motion, there is a lack of evidence review about the best teaching practices for the locomotor apparatus functional anatomy. We aimed to detect the strategies that have been implemented for functional musculoskeletal anatomy education, and their outcomes, with the ultimate purpose of suggesting the most effective teaching methods. METHODS: The databases PubMed, Scopus, ERIC, and Cochrane Library were searched for papers with the purpose of exploring the outcomes (participants' perceptions and/or examination performance) of teaching functional musculoskeletal anatomy. From each study, the following information was extracted: author(s), number of participants, implementation method, participants' perceptions and/or examination performance after the educational intervention, and classification of the outcomes according to the Kirkpatrick hierarchy. RESULTS: Seven papers were included. Six of them involved active learning strategies (other than seeing, listening, and taking notes). Several specific teaching methods were implemented, including physical activities, lectures, textbooks, atlases, prosected specimens, near-peer teaching, and digital and physical models. Overall, methods that involved active learning, especially some form of physical activity, had the best educational outcomes, while passive learning was not found to be significantly more effective in any case. The role of modern anatomy education technologies has been inadequately explored. CONCLUSIONS: It appears that teaching functional musculoskeletal anatomy is more successful when using active learning methods, especially involving some form of physical activity. More research is necessary to determine the best environment for these methods and investigate the role of modern technologies in functional musculoskeletal anatomy education.

Gestures-enhanced anatomy teaching: A literature review of an educational strategy with promising outcomes.

PURPOSE: The educational use of gestures has resulted in positive outcomes in several fields. We performed a literature review to investigate the outcomes of the use of gestures to enhance the existing anatomy education methods. METHODS: PubMed, SCOPUS, ERIC and Cochrane databases were searched for papers with purpose to investigate the outcomes of the use of gestures (either seeing or performing them or both) as adjuncts to existing anatomy education methods. RESULTS: Six articles were included. Three studies comprised both seeing and performing gestures by the students, while the remaining three studies only comprised either seeing or performing gestures by the students. Most studies evaluated the acquisition of anatomical knowledge after the educational intervention and demonstrated that the addition of gestures resulted in significant benefit compared to control groups, while positive students' perceptions were recorded. It was not clarified whether seeing or performing gestures by the students leads to better educational outcomes. CONCLUSION: Gestures-enhanced anatomy education seems to be a promising teaching strategy, given that it has led to significantly increased acquisition of anatomical knowledge compared to no gestures-enhanced modalities. The addition of gestures to existing anatomy education modalities seems able to increase their potential without increasing their cost. Further research is needed to determine if seeing or performing gestures by the students is more effective.

Do virtual dissection tables add benefit to cadaver-based anatomy education? An evaluation.

PURPOSE: The anatomy education literature suggests blended-learning approaches as more effective. We performed a literature review to answer the question if virtual dissection tables can play a significant role as supplements to traditional cadaver-based anatomy education methods. METHODS: PubMed, SCOPUS, ERIC and Cochrane databases were searched for articles with purpose to explore the outcomes of the use of virtual dissection tables in conjunction with cadaver-based anatomy education. RESULTS: Six articles were included. Three articles were comparative and comprised evaluation of participants' anatomy examinations results. Three articles were non-comparative and comprised only evaluation of participants' opinions about the educational intervention. In all studies, the participants expressed satisfaction about the educational value of this intervention, while the data about anatomy examinations' results suggest that virtual dissection tables may also enhance students' academic performance, when they are used in conjunction with cadavers. CONCLUSION: Virtual dissection tables seem to do have a role in modern blended-learning anatomy curricula and could essentially supplement the educational power of cadaver-based methods. Our findings may stimulate further implementation of virtual dissection tables as supplementary tools to cadaver-based anatomy education.

Incorporation of team-based learning in the cadaveric anatomy laboratory: An overview.

PURPOSE: Team-based learning is a strategy which has resulted in positive outcomes concerning health professions education. We aimed to shed light on the role of this strategy when it is incorporated in the cadaveric anatomy laboratory. METHODS: We explored PubMed, SCOPUS, ERIC and Cochrane databases for articles with purpose to investigate the educational outcomes of the integration of team-based learning in the cadaveric anatomy laboratory. RESULTS: Six articles were eligible for inclusion. One of them assessed only participants' opinions about the educational intervention and five papers evaluated students' knowledge. Overall, the research showed significant improvement in students' examinations performance and significant superiority to control groups, as well as positive perceptions. There are limited data regarding the factors which may contribute to this success, but it seems that particularly the degree of teacher's involvement and competency needs to be further investigated. CONCLUSION: Anatomy educators may consider further adopting team-based learning to facilitate the achievement of the learning objectives of the cadaveric anatomy laboratory and increase the teaching potential of cadavers.

Evaluation of the use of cadaveric computed tomography in anatomy education: An overview.

OBJECTIVE: We aimed to explore to what extent the literature supports that the use of cadaveric computed tomography can play an important role in anatomy education. MATERIALS AND METHODS: PubMed, SCOPUS, Education Resources Information Center and Cochrane Databases were searched for papers with purpose to explore the outcomes of the use of cadaveric computed tomography scans in anatomy education. The following data were obtained from each paper: authors, number of participants, type of study (comparative or not), level of outcome according to Kirkpatrick hierarchy, possible evaluation of statistical significance, acquisition of anatomical knowledge after the educational intervention and perceptions about the effectiveness of this intervention in anatomy learning. RESULTS: Seven articles were included. Four of them evaluated students' knowledge after the use of cadaveric computed tomography scans in anatomy education and three papers evaluated only students' perceptions. Generally, the outcomes, which mainly concerned students' perceptions, were positive, while it was showed that students' academic performance may also be improved. CONCLUSIONS: The outcomes of the use of cadaveric computed tomography scans in anatomy education encourage the implementation of this teaching modality in anatomy curricula. Further research, including comparative studies with evaluation of acquisition of students' knowledge, is needed to show if cadaveric computed tomography will be proved a remarkable supportive tool in anatomy educators' hands.

Accessory muscles of the anterior thoracic wall and axilla. Cadaveric, surgical and radiological incidence and clinical significance during breast and axillary surgery.

BACKGROUND: The present study aims to summarise the accessory muscles of the anterior thoracic wall and axilla that can be encountered during breast and axillary surgery and record their incidence and clinical significance. Moreover, the laterality of the atypical muscles is highlighted and possible gender dimorphism is referred. Accessory anterior thoracic wall muscles include: Langer's axillary arch, sternalis muscle, chondrocoracoideus, chondroepitrochlearis, chondrofascialis, pectoralis minimus, pectoralis quartus and pectoralis intermedius. MATERIALS AND METHODS: The anatomical, surgical and radiological literature has been reviewed and an anatomical study on 48 Greek adult cadavers was performed. RESULTS: Literature review revealed the existence of accessory muscles of the anterior thoracic wall and axilla that have a significant incidence that can be considered high and may, therefore, have clinical significance. For the most common of these muscles, which are axillary arch (Langer's) and sternalis muscle, the cadaveric incidence is 10.30% and 7.67%, respectively. In the current cadaveric study, accessory thoracic wall muscles were identified in two cadavers; namely a bilateral sternalis muscle (incidence 2.08%) extending both to the anterior and posterior surface of the sternum and a left-sided chondrocoracoideus muscle (of Wood) (incidence 2.08%). CONCLUSIONS: Despite the fact that accessory anterior thoracic wall and axillary muscles are considered to be rare, it is evident that the incidence of at least some of them is high enough to encounter them in clinical practice. Thus, clinicians' awareness of these anatomical structures is advisable.

The position of the mental foramen in dentate and edentulous mandibles: clinical and surgical relevance.

BACKGROUND: The knowledge of the exact location of the mental foramen (MF) in dentate and edentulous mandibles is clinically important when constructing complete dentures, performing anaesthetic block of the lower-anterior teeth area and intervening in the MF nearby area. In edentulous mandibles, the bone resorption after teeth loss makes the mental nerve (MN) prone to damage due to the extreme location of the MF very close to the alveolar crest (AC). Chronic compression on the MN may result in pain in the area of MN distribution (ipsilateral face and cheek area) and numbness at the lower lip. The purpose of the current study is to evaluate the exact position of the MF, calculating the distances MF-superior border of the AC and MF-inferior border of the mandible (IBM) in dentate and edentulous mandibles. MATERIALS AND METHODS: One hundred and two (36 edentulous and 66 dentate) adult dry Greek mandibles were studied. RESULTS: In 9 out of 36 edentulous mandibles (25%), the MF was found nearby the AC, while in 27 edentulous mandibles (75%), the MF was located at an average distance 6.4 mm from the AC and 12.6 mm from the IBM. In 38 out of 66 dentate mandibles (57.6%), the MF was located at an average distance 13.6 mm from the AC and 15.2 mm from the IBM. The dental status significantly affected (p = 0.001) the distances MF-AC and MF-IBM. Side symmetry was observed for both dentate and edentulous mandibles (p = 0.39 and p = 0.45). CONCLUSIONS: The MF is an important landmark and its location needs to be considered prior to dental implants placement in order to avoid the MN injury and related complications. The position of MF is altered in edentulous mandibles compared with the dentate ones. The MF is a symmetric structure in Greeks.

Median to ulnar nerve anastomosis: a review of the literature.

Median to Ulnar nerve anastomosis in the forearm has been shown to be of clinical significance leading to "anomalous" innervation and is correlated with misdiagnosis during the assessment of nerve lesions, injuries and Carpal Tunnel Syndrome (CTS). In 1763, Martin first described the anastomosis and Gruber next mentioning it, in 1870 thus referred to as Martin--Gruber anastomosis. Despite its long history, its nature remains unclear. Many anatomical, electrophysiological, histological and genetic studies have been published, reporting the anastomosis' frequency, citing its clinical importance and classifying it into various classes and types. Diagnosis is made mostly with electrophysiological studies whereby researchers have cited certain clues taking into consideration the asymptomatic nature of the anastomosis. The current literature on median to ulnar nerve anastomosis is reviewed, highlighting its frequency and clinical significance making an excellent tool for correct diagnosis in many clinicians.

Mandibular nerve entrapment in the infratemporal fossa.

The posterior trunk of the mandibular nerve (V(3)) comprises of three main branches. Various anatomic structures may entrap and potentially compress the mandibular nerve branches. A usual position of mandibular nerve (MN) compression is the infratemporal fossa (ITF) which is one of the most difficult regions of the skull base to access surgically. The anatomical positions of compression are: the incomplete or complete ossified pterygospinous (LPs) or pterygoalar (LPa) ligament, the large lamina of the lateral plate of the pterygoid process and the medial fibres of the lower belly of the lateral pterygoid (LPt). A contraction of the LPt, due to the connection between nerve and anatomic structures (soft and hard tissues), might lead to MN compression. Any variations of the course of the MN branches can be of practical significance to surgeons and neurologists who are dealing with this region, because of possibly significant complications. The entrapment of the MN motor branches can lead to paresis or weakness in the innervated muscle. Compression of the sensory branches can provoke neuralgia or paraesthesia. Lingual nerve (LN) compression causes numbness, hypoesthesia or even anaesthesia of the mucous of the tongue, anaesthesia and loss of taste in the anterior two-thirds of the tongue, anaesthesia of the lingual gums, as well as pain related to speech articulation disorders. Dentists should be very suspicious of possible signs of neurovascular compression in the region of the ITF.

Prevention of postoperative nausea and vomiting after laparoscopic gynaecological surgery. Combined antiemetic treatment with tropisetron and metoclopramide vs. metoclopramide alone.

BACKGROUND AND OBJECTIVE: Female patients undergoing gynaecological procedures, especially laparoscopically, are at high risk of postoperative nausea and vomiting. No available antiemetic is entirely effective. This double-blinded randomized trial examines the efficacy and safety of tropisetron and metoclopramide in combination and compares the results with metoclopramide alone in laparoscopic gynaecological surgery. METHODS: One hundred and twenty female patients scheduled for minor gynaecological laparoscopy, aged 27-43 years, were randomly allocated to receive pretreatment with metoclopramide 10 mg intravenously (n=57) or tropisetron 5 mg with metoclopramide 5 mg (n=63). RESULTS: Fewer patients in the combined treatment group experienced postoperative nausea and vomiting (14% vs. 37%, P=0.008) or needed rescue antiemetic treatment (3% vs. 16%, P=0.038). No significant adverse events were observed. CONCLUSIONS: The combination of the antiemetics was superior, which is probably explained by the fact that the two drugs have different sites of action, thus preventing emesis by blocking different pathways.