ORL 2013;75:325–331 DOI: 10.1159/000355290 Received: May 31, 2013 Accepted after revision: August 20, 2013 Published online: December 13, 2013
© 2013 S. Karger AG, Basel 0301–1569/13/0756–0325$38.00/0 www.karger.com/orl
How I Do It
A New Temporal Bone and Cadaver Head Holder for Temporal Bone Surgical Technique Training Guodong Feng
Wei Lv
Xu Tian
Haiyan Wu
Zhiqiang Gao
Department of Otolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
Key Words Cadaver head holder · Temporal bone surgery · Dissection Abstract Objective: To design a new temporal bone and cadaver head holder, overcoming the drawbacks of the bowl-type holder and other existing holders for dissection, and thereby benefiting training and research on temporal bone surgery. Materials and Methods: We designed and fabricated a novel holder with a horizontal arm that can be connected with an object holder specific for the temporal bone or a three-pin fixture specific for cadaver heads. A separate hand support helps to stabilize the hand during examinations on the temporal bone and skull base. Results: The use of the temporal bone and cadaver head holder by 30 trainees during our temporal bone surgical technique courses held by the Department of Otolaryngology, Peking Union Medical College Hospital (PUMCH) worked better than other holders and saved laboratory time. It has become the standard equipment of the Temporal Bone Laboratory of PUMCH. Conclusions: The temporal bone and cadaver head holder we describe is compact, stable and easily adjustable. It offers considerable advantages to trainees. © 2013 S. Karger AG, Basel
Introduction
Training in temporal bone surgical techniques is very important for residents and surgeons in practice. Although several simulation systems have recently been developed [1–3], the value of temporal bone dissection in the training of middle ear surgery is not disputed [4–6]. Otologists are interested in making temporal bone dissections more convenient and practical. A type of temporal bone holder with a metallic bowl with screws that are tightened inwardly to secure the specimen has been used for many years [7–9]. It has many Zhiqiang Gao, MD Department of Otolaryngology, Peking Union Medical College Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100730 (China) E-Mail talllee @ sina.com
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DOI: 10.1159/000355290
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DOI: 10.1159/000355290
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Feng et al.: A New Temporal Bone and Cadaver Head Holder for Temporal Bone Surgical Technique Training
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Fig. 1. The temporal bone and cadaver head holder. a The components of the holder, the three-pin fixture (8) is connected with the linkage horizontal arm (4); b the object holder (9) is connected to the horizontal arm (4); c the installation of the hand support (10); d the object holder: 4 large teeth (lower arrow) on the lower part of the clamp, a lock screw on the upper part of the clamp, lock disk (upper arrow) with many small teeth connected with the lock screw tip by a sliding connection. 1 = Fixture base; 2 = vertical support column; 3 = release lever; 4 = horizontal arm; 5 = ball joint; 6 = connection; 7 = lock screw; 8 = three-pin fixture; 9 = object holder; 10 = hand support; 11 = hand support base; 12 = the vertical support of the hand support; 13 = the cap of the hand support.
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disadvantages; although some improved prototypes have been reported [9, 10], the ideal temporal bone holder, which can help the trainee maintain surgical positions of the temporal bone, adjust the position easily and perform operative procedures conveniently, has not yet emerged. With that in mind, we have designed a new temporal bone holder, overcoming the drawbacks of the bowl-type holder and other existing holders to facilitate dissection, and thereby benefit both training and research in temporal bone surgery. Description of the Temporal Bone and Cadaver Head Holder The holder incorporates a linkage horizontal arm (fig. 1a, 4) that can be connected with a three-pin fixture (fig. 1a, 8) specific for a cadaver head or an object holder (fig. 1b, 9) and therefore specific for a temporal bone. The hand support (fig. 1a, 10) stabilizes the hand during examinations of the temporal bone (fig. 1c). A plastic pan is placed on the fixture base (fig. 1a, b, 1) to collect irrigation fluids and bone dust. The height and horizontal orientation of the mechanical arm (fig. 1a, b, 4) can be adjusted by its displacement along the vertical support (fig. 1a, b, 2). It can be finely adjusted in all directions at the ball joint
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ORL 2013;75:325–331 © 2013 S. Karger AG, Basel www.karger.com/orl
DOI: 10.1159/000355290
Feng et al.: A New Temporal Bone and Cadaver Head Holder for Temporal Bone Surgical Technique Training
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Fig. 2. Schematic diagram of the horizontal arm. 1 = Fixture base; 2 = vertical support; 3 = release lever; 4 = horizontal arm; 5 = ball joint; 6 = connection; 7 = lock screw; 9 = object holder; 14 = spring; 15 = the adjustable support arm A; 16 = the adjustable support arm B.
(fig. 1a, b, 5). All the joints of the horizontal arm are fixed by the spring attached in the arm and it can be released by the release lever (fig. 1a, b, 3). With this design, the specimen’s height and orientation can be fully adjusted by simply pressing the release lever. The lock screw can fix either the three-pin fixture or the object holder at the connection of the horizontal arm for a cadaver head or temporal bone, respectively. The object holder has 2 leaves with a locking screw on the upper part of the clamp and 4 large teeth on the lower part of the clamp; the locking disk with many small teeth is connected to the lock screw tip by a sliding connection. This structure ensures that the temporal bone is reliably fixed by more than 4 secure points of contact (fig. 1d). The working principles of the horizontal arm are illustrated in a schematic diagram (fig. 2). The force of the spring can be transferred to the ball joint via the adjustable support arm A and the release lever. The adjustable support arm B can be loosened by the release lever. The nylon hand support stabilizes the hand for precise movements. It can be adjusted along its vertical column by its internal screw mechanism.
Results
The instrument can fix either a temporal bone (fig. 3a, 14) or a cadaver head (fig. 3b, 15). There are two fixed positions for specimens: the horizontal arm, which establishes the orientation of the specimen, and the fixture base, which stabilizes the specimen on the dissection desk. The squamous part of the temporal bone, the occipital bone, the greater wing of sphenoid bone or the petrous apex can quickly and easily be fixed firmly in the holder , usually without having to remove parts of the specimen (fig. 4). The surgeon can adjust the height and orientation of the specimen quickly and easily by pressing the release lever. Fourteen temporal bone and cadaver head holders have been used successfully by a total of 30 participants in temporal bone surgical courses held by the Department of Otolaryngology, Peking Union Medical College Hospital. The holders have also been used in courses given by the Fisch International Microsurgery Foundation, including Advanced Microsurgery of the Temporal Bone and Microsurgery of the Skull Base in Zurich, Switzerland (fig. 4). The holder has proven to be an effective tool and has increased the efficiency of training courses. The holder’s convenience and the time saved using it were assessed qualitatively during surgical dissection courses.
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ORL 2013;75:325–331 © 2013 S. Karger AG, Basel www.karger.com/orl
DOI: 10.1159/000355290
Feng et al.: A New Temporal Bone and Cadaver Head Holder for Temporal Bone Surgical Technique Training
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17 Color version available online
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Fig. 3. The temporal bone (a, 17) and cadaver head (b, 18) were fixed by the holder, respectively. The labeling numbers are the same as in figures 1 and 2.
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Discussion
Orientation and stabilization of a part of the body for cadaveric dissection is a common problem for otolaryngologists. Laryngeal holders have been improved to meet the needs of surgical training [11–13]. Temporal bone dissection also has a long history in the training of otologists. The traditional bone cup, which provides 3 points of fixation, has been used in most temporal bone surgical dissection courses for many years. It has several disadvantages, including the following: (1) it is often difficult to fit the specimen in the correct surgical orientation because of the limitations of the positions of the pins and the shape of the cup. The bone tissue around the temporal bone has to be removed to fit inside the bowl. This step is timeconsuming and potentially dangerous for students; a potential removal or damaging of valuable adjacent structures may also occur. (2) The correct orientation of the bone is not
330
ORL 2013;75:325–331 DOI: 10.1159/000355290
© 2013 S. Karger AG, Basel www.karger.com/orl
Color version available online
Feng et al.: A New Temporal Bone and Cadaver Head Holder for Temporal Bone Surgical Technique Training
Fig. 4. The temporal bone and cadaver head holder (black arrow) was used in a temporal bone surgical technique course. The temporal bone was held at the petrous apex. The trainee’s right hand was supported by the hand support and his left hand was supported by the temporal bone. Fourteen holders were tested by 30 participants.
easy to maintain because of the bone cup’s round shape during dissection. (3) Students cannot observe the intracranial part of the specimen easily. The bone usually has to be removed from the cup. It is important for students to understand the anatomic relationship between extracranial temporal bone structures and their intra-cranial counterparts. (4) It takes a lot of time to adjust the combination of 3 threaded pins to orient, fit, balance and stabilize the bone in the cup. Although the bone can generally be adequately installed, it is not the simplest or most efficient solution. Several researchers have offered improved temporal bone holders. Gendeh et al. [9] designed a bone holder with a water inlet system. Somjee [10] developed an improved Somjee-Crabtree temporal bone support clamp. However, these designs did not overcome the shortcomings described above because the whole method of fixing the bone was not improved. Our temporal bone and cadaver head holder has the following advantages compared to the bone cup or the other existing designs: (1) the trainee does not need to remove the bone around the temporal bone. (2) The orientation and position of the temporal bone is the same as for a real surgery and is easy to maintain during dissection. (3) It is easy to check landmarks from the inside of the cranium during a simulated surgery because the position of the temporal bone can be changed by simply pressing the release lever once. (4) It is more convenient to attach and unload the temporal bone because there is only 1 fixed screw on the object holder instead of a combination of 3 screws as with the bone cup. The holder can easily accommodate any specimen, regardless of its shape. (5) The holder can also adjust the position of a cadaver head by simply changing just 1 component. The patent application number of the temporal bone and cadaver head holder is 201310276271.5 (CN). We designed the holder for research and surgical technique training. We also plan to offer it for other departments at low cost.
331
ORL 2013;75:325–331 DOI: 10.1159/000355290
© 2013 S. Karger AG, Basel www.karger.com/orl
Feng et al.: A New Temporal Bone and Cadaver Head Holder for Temporal Bone Surgical Technique Training
Conclusions
The temporal bone and cadaver head holder we described is compact, stable and easily adjustable. It overcomes the limitations of previous devices and offers considerable advantages. Acknowledgements Special thanks go to Prof. Ugo Fisch of the ENT Center, Hirslanden Hospital, Zurich, Switzerland, and Prof. Thomas Linder of the ENT Department, Lucerne Cantonal Hospital, Switzerland, for their advice on instrument design during Dr. Guodong Feng’s visiting fellowship at the Lucerne Cantonal Hospital. The authors would also like to thank the Beijing Yabolun Technological Co. Ltd. and Senior Engineer Li Guozheng for manufacturing the device, as well as Prof. Edwin M. Monsell of Wayne State University for this paper’s language editing. This work was funded by the Chinese National Science and Technology Pillar Program during the 12th Five-year Plan Period and the Chinese National Key Clinical Specialty Project.
References 1 2 3 4 5 6 7 8 9 10 11 12 13
Nash R, Sykes R, Majithia A, Arora A, Singh A, Khemani S: Objective assessment of learning curves for the VoxelMan TempoSurg temporal bone surgery computer simulator. J Laryngol Otol 2012;126:663–669. Francis HW, Malik MU, Diaz Voss Varela DA, Barffour MA, Chien WW, Carey JP, Niparko JK, Bhatti NI: Technical skills improve after practice on virtual-reality temporal bone simulator. Laryngoscope 2012;122:1385–1391. Wiet GJ, Bryan J, Dodson E, Sessanna D, Stredney D, Schmalbrock P, Welling B: Virtual temporal bone dissection simulation. Stud Health Technol Inform 2000;70:378–384. George AP, De R: Review of temporal bone dissection teaching: how it was, is and will be. J Laryngol Otol 2010; 124:119–125. Fennessy BG, O’Sullivan P: Establishing a temporal bone laboratory: considerations for ENT specialist training. Ir J Med Sci 2009;178:393–395. Feigl G, Kos I, Anderhuber F, Guyot JP, Fasel J: Development of surgical skill with singular neurectomy using human cadaveric temporal bones. Ann Anat 2008;190:316–323. Fisch U, Linder T: Temporal Bone Dissection – The Zurich Guidelines. Fisch International Microsurgery Foundation, Switzerland, 2009. Nelson RA: Temporal Bone Surgical Dissection Manual, ed 3. Los Angeles, House Ear Institute, 2002. Gendeh BS, Gibb AG, Khalid BA: How I do it: an improved temporal bone holder. J Laryngol Otol 1995; 109: 644–645. Somjee S: The Somjee-Crabtree temporal bone support clamp. J Laryngol Otol 1997;111:54–55. Paczona R: A cadaver larynx holder for teaching laryngo microsurgery. J Laryngol Otol 1997;111:56–57. Dailey SH, Kobler JB, Zeitels SM: A laryngeal dissection station: educational paradigms in phonosurgery. Laryngoscope 2004;114:878–882. Mohamed AS, McCulloch TM: A larynx holder: a device for training in microlaryngeal surgery. Laryngoscope 2004;114:1128–1129.
Copyright: S. Karger AG, Basel 2014. Reproduced with the permission of S. Karger AG, Basel. Further reproduction or distribution (electronic or otherwise) is prohibited without permission from the copyright holder.
© 2013 S. Karger AG, Basel 0301–1569/13/0756–0325$38.00/0 www.karger.com/orl
How I Do It
A New Temporal Bone and Cadaver Head Holder for Temporal Bone Surgical Technique Training Guodong Feng
Wei Lv
Xu Tian
Haiyan Wu
Zhiqiang Gao
Department of Otolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
Key Words Cadaver head holder · Temporal bone surgery · Dissection Abstract Objective: To design a new temporal bone and cadaver head holder, overcoming the drawbacks of the bowl-type holder and other existing holders for dissection, and thereby benefiting training and research on temporal bone surgery. Materials and Methods: We designed and fabricated a novel holder with a horizontal arm that can be connected with an object holder specific for the temporal bone or a three-pin fixture specific for cadaver heads. A separate hand support helps to stabilize the hand during examinations on the temporal bone and skull base. Results: The use of the temporal bone and cadaver head holder by 30 trainees during our temporal bone surgical technique courses held by the Department of Otolaryngology, Peking Union Medical College Hospital (PUMCH) worked better than other holders and saved laboratory time. It has become the standard equipment of the Temporal Bone Laboratory of PUMCH. Conclusions: The temporal bone and cadaver head holder we describe is compact, stable and easily adjustable. It offers considerable advantages to trainees. © 2013 S. Karger AG, Basel
Introduction
Training in temporal bone surgical techniques is very important for residents and surgeons in practice. Although several simulation systems have recently been developed [1–3], the value of temporal bone dissection in the training of middle ear surgery is not disputed [4–6]. Otologists are interested in making temporal bone dissections more convenient and practical. A type of temporal bone holder with a metallic bowl with screws that are tightened inwardly to secure the specimen has been used for many years [7–9]. It has many Zhiqiang Gao, MD Department of Otolaryngology, Peking Union Medical College Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100730 (China) E-Mail talllee @ sina.com
326
ORL 2013;75:325–331 © 2013 S. Karger AG, Basel www.karger.com/orl
DOI: 10.1159/000355290
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7 6
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Color version available online
Feng et al.: A New Temporal Bone and Cadaver Head Holder for Temporal Bone Surgical Technique Training
3
2
a 1
9
7 6
5
4
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2
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b
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(For legend see next page.)
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ORL 2013;75:325–331 © 2013 S. Karger AG, Basel www.karger.com/orl
DOI: 10.1159/000355290
Color version available online
Feng et al.: A New Temporal Bone and Cadaver Head Holder for Temporal Bone Surgical Technique Training
13
Fig. 1. The temporal bone and cadaver head holder. a The components of the holder, the three-pin fixture (8) is connected with the linkage horizontal arm (4); b the object holder (9) is connected to the horizontal arm (4); c the installation of the hand support (10); d the object holder: 4 large teeth (lower arrow) on the lower part of the clamp, a lock screw on the upper part of the clamp, lock disk (upper arrow) with many small teeth connected with the lock screw tip by a sliding connection. 1 = Fixture base; 2 = vertical support column; 3 = release lever; 4 = horizontal arm; 5 = ball joint; 6 = connection; 7 = lock screw; 8 = three-pin fixture; 9 = object holder; 10 = hand support; 11 = hand support base; 12 = the vertical support of the hand support; 13 = the cap of the hand support.
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disadvantages; although some improved prototypes have been reported [9, 10], the ideal temporal bone holder, which can help the trainee maintain surgical positions of the temporal bone, adjust the position easily and perform operative procedures conveniently, has not yet emerged. With that in mind, we have designed a new temporal bone holder, overcoming the drawbacks of the bowl-type holder and other existing holders to facilitate dissection, and thereby benefit both training and research in temporal bone surgery. Description of the Temporal Bone and Cadaver Head Holder The holder incorporates a linkage horizontal arm (fig. 1a, 4) that can be connected with a three-pin fixture (fig. 1a, 8) specific for a cadaver head or an object holder (fig. 1b, 9) and therefore specific for a temporal bone. The hand support (fig. 1a, 10) stabilizes the hand during examinations of the temporal bone (fig. 1c). A plastic pan is placed on the fixture base (fig. 1a, b, 1) to collect irrigation fluids and bone dust. The height and horizontal orientation of the mechanical arm (fig. 1a, b, 4) can be adjusted by its displacement along the vertical support (fig. 1a, b, 2). It can be finely adjusted in all directions at the ball joint
328
ORL 2013;75:325–331 © 2013 S. Karger AG, Basel www.karger.com/orl
DOI: 10.1159/000355290
Feng et al.: A New Temporal Bone and Cadaver Head Holder for Temporal Bone Surgical Technique Training
1
9
76
5
4
3
16
2 15
14
Fig. 2. Schematic diagram of the horizontal arm. 1 = Fixture base; 2 = vertical support; 3 = release lever; 4 = horizontal arm; 5 = ball joint; 6 = connection; 7 = lock screw; 9 = object holder; 14 = spring; 15 = the adjustable support arm A; 16 = the adjustable support arm B.
(fig. 1a, b, 5). All the joints of the horizontal arm are fixed by the spring attached in the arm and it can be released by the release lever (fig. 1a, b, 3). With this design, the specimen’s height and orientation can be fully adjusted by simply pressing the release lever. The lock screw can fix either the three-pin fixture or the object holder at the connection of the horizontal arm for a cadaver head or temporal bone, respectively. The object holder has 2 leaves with a locking screw on the upper part of the clamp and 4 large teeth on the lower part of the clamp; the locking disk with many small teeth is connected to the lock screw tip by a sliding connection. This structure ensures that the temporal bone is reliably fixed by more than 4 secure points of contact (fig. 1d). The working principles of the horizontal arm are illustrated in a schematic diagram (fig. 2). The force of the spring can be transferred to the ball joint via the adjustable support arm A and the release lever. The adjustable support arm B can be loosened by the release lever. The nylon hand support stabilizes the hand for precise movements. It can be adjusted along its vertical column by its internal screw mechanism.
Results
The instrument can fix either a temporal bone (fig. 3a, 14) or a cadaver head (fig. 3b, 15). There are two fixed positions for specimens: the horizontal arm, which establishes the orientation of the specimen, and the fixture base, which stabilizes the specimen on the dissection desk. The squamous part of the temporal bone, the occipital bone, the greater wing of sphenoid bone or the petrous apex can quickly and easily be fixed firmly in the holder , usually without having to remove parts of the specimen (fig. 4). The surgeon can adjust the height and orientation of the specimen quickly and easily by pressing the release lever. Fourteen temporal bone and cadaver head holders have been used successfully by a total of 30 participants in temporal bone surgical courses held by the Department of Otolaryngology, Peking Union Medical College Hospital. The holders have also been used in courses given by the Fisch International Microsurgery Foundation, including Advanced Microsurgery of the Temporal Bone and Microsurgery of the Skull Base in Zurich, Switzerland (fig. 4). The holder has proven to be an effective tool and has increased the efficiency of training courses. The holder’s convenience and the time saved using it were assessed qualitatively during surgical dissection courses.
329
ORL 2013;75:325–331 © 2013 S. Karger AG, Basel www.karger.com/orl
DOI: 10.1159/000355290
Feng et al.: A New Temporal Bone and Cadaver Head Holder for Temporal Bone Surgical Technique Training
6
9
17 Color version available online
5
a 2
Fig. 3. The temporal bone (a, 17) and cadaver head (b, 18) were fixed by the holder, respectively. The labeling numbers are the same as in figures 1 and 2.
3
4
5
6 7
8
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b
Discussion
Orientation and stabilization of a part of the body for cadaveric dissection is a common problem for otolaryngologists. Laryngeal holders have been improved to meet the needs of surgical training [11–13]. Temporal bone dissection also has a long history in the training of otologists. The traditional bone cup, which provides 3 points of fixation, has been used in most temporal bone surgical dissection courses for many years. It has several disadvantages, including the following: (1) it is often difficult to fit the specimen in the correct surgical orientation because of the limitations of the positions of the pins and the shape of the cup. The bone tissue around the temporal bone has to be removed to fit inside the bowl. This step is timeconsuming and potentially dangerous for students; a potential removal or damaging of valuable adjacent structures may also occur. (2) The correct orientation of the bone is not
330
ORL 2013;75:325–331 DOI: 10.1159/000355290
© 2013 S. Karger AG, Basel www.karger.com/orl
Color version available online
Feng et al.: A New Temporal Bone and Cadaver Head Holder for Temporal Bone Surgical Technique Training
Fig. 4. The temporal bone and cadaver head holder (black arrow) was used in a temporal bone surgical technique course. The temporal bone was held at the petrous apex. The trainee’s right hand was supported by the hand support and his left hand was supported by the temporal bone. Fourteen holders were tested by 30 participants.
easy to maintain because of the bone cup’s round shape during dissection. (3) Students cannot observe the intracranial part of the specimen easily. The bone usually has to be removed from the cup. It is important for students to understand the anatomic relationship between extracranial temporal bone structures and their intra-cranial counterparts. (4) It takes a lot of time to adjust the combination of 3 threaded pins to orient, fit, balance and stabilize the bone in the cup. Although the bone can generally be adequately installed, it is not the simplest or most efficient solution. Several researchers have offered improved temporal bone holders. Gendeh et al. [9] designed a bone holder with a water inlet system. Somjee [10] developed an improved Somjee-Crabtree temporal bone support clamp. However, these designs did not overcome the shortcomings described above because the whole method of fixing the bone was not improved. Our temporal bone and cadaver head holder has the following advantages compared to the bone cup or the other existing designs: (1) the trainee does not need to remove the bone around the temporal bone. (2) The orientation and position of the temporal bone is the same as for a real surgery and is easy to maintain during dissection. (3) It is easy to check landmarks from the inside of the cranium during a simulated surgery because the position of the temporal bone can be changed by simply pressing the release lever once. (4) It is more convenient to attach and unload the temporal bone because there is only 1 fixed screw on the object holder instead of a combination of 3 screws as with the bone cup. The holder can easily accommodate any specimen, regardless of its shape. (5) The holder can also adjust the position of a cadaver head by simply changing just 1 component. The patent application number of the temporal bone and cadaver head holder is 201310276271.5 (CN). We designed the holder for research and surgical technique training. We also plan to offer it for other departments at low cost.
331
ORL 2013;75:325–331 DOI: 10.1159/000355290
© 2013 S. Karger AG, Basel www.karger.com/orl
Feng et al.: A New Temporal Bone and Cadaver Head Holder for Temporal Bone Surgical Technique Training
Conclusions
The temporal bone and cadaver head holder we described is compact, stable and easily adjustable. It overcomes the limitations of previous devices and offers considerable advantages. Acknowledgements Special thanks go to Prof. Ugo Fisch of the ENT Center, Hirslanden Hospital, Zurich, Switzerland, and Prof. Thomas Linder of the ENT Department, Lucerne Cantonal Hospital, Switzerland, for their advice on instrument design during Dr. Guodong Feng’s visiting fellowship at the Lucerne Cantonal Hospital. The authors would also like to thank the Beijing Yabolun Technological Co. Ltd. and Senior Engineer Li Guozheng for manufacturing the device, as well as Prof. Edwin M. Monsell of Wayne State University for this paper’s language editing. This work was funded by the Chinese National Science and Technology Pillar Program during the 12th Five-year Plan Period and the Chinese National Key Clinical Specialty Project.
References 1 2 3 4 5 6 7 8 9 10 11 12 13
Nash R, Sykes R, Majithia A, Arora A, Singh A, Khemani S: Objective assessment of learning curves for the VoxelMan TempoSurg temporal bone surgery computer simulator. J Laryngol Otol 2012;126:663–669. Francis HW, Malik MU, Diaz Voss Varela DA, Barffour MA, Chien WW, Carey JP, Niparko JK, Bhatti NI: Technical skills improve after practice on virtual-reality temporal bone simulator. Laryngoscope 2012;122:1385–1391. Wiet GJ, Bryan J, Dodson E, Sessanna D, Stredney D, Schmalbrock P, Welling B: Virtual temporal bone dissection simulation. Stud Health Technol Inform 2000;70:378–384. George AP, De R: Review of temporal bone dissection teaching: how it was, is and will be. J Laryngol Otol 2010; 124:119–125. Fennessy BG, O’Sullivan P: Establishing a temporal bone laboratory: considerations for ENT specialist training. Ir J Med Sci 2009;178:393–395. Feigl G, Kos I, Anderhuber F, Guyot JP, Fasel J: Development of surgical skill with singular neurectomy using human cadaveric temporal bones. Ann Anat 2008;190:316–323. Fisch U, Linder T: Temporal Bone Dissection – The Zurich Guidelines. Fisch International Microsurgery Foundation, Switzerland, 2009. Nelson RA: Temporal Bone Surgical Dissection Manual, ed 3. Los Angeles, House Ear Institute, 2002. Gendeh BS, Gibb AG, Khalid BA: How I do it: an improved temporal bone holder. J Laryngol Otol 1995; 109: 644–645. Somjee S: The Somjee-Crabtree temporal bone support clamp. J Laryngol Otol 1997;111:54–55. Paczona R: A cadaver larynx holder for teaching laryngo microsurgery. J Laryngol Otol 1997;111:56–57. Dailey SH, Kobler JB, Zeitels SM: A laryngeal dissection station: educational paradigms in phonosurgery. Laryngoscope 2004;114:878–882. Mohamed AS, McCulloch TM: A larynx holder: a device for training in microlaryngeal surgery. Laryngoscope 2004;114:1128–1129.
Copyright: S. Karger AG, Basel 2014. Reproduced with the permission of S. Karger AG, Basel. Further reproduction or distribution (electronic or otherwise) is prohibited without permission from the copyright holder.
