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Task-oriented Learning in Head and Neck Anatomy
Using Virtual, Formalin-preserved,
Soft-embalmed, and Plastinated Cadavers
Ryner Jose D. Carrillo, MD, MSc,1,2 Karen June P. Dumlao, MD,1 Jacob Ephraim D. Salud, MD,2
Eljohn C. Yee, MD,2 Jose V. Tecson, III, MD, DHPEd1 and Charloe M. Chiong, MD, PhD2,3
1Department of Anatomy, College of Medicine, University of the Philippines Manila
2Department of Otolaryngology – Head and Neck Surgery, College of Medicine and Philippine General Hospital, University of the Philippines Manila
3Philippine National Ear Institute, National Institutes of Health, University of the Philippines Manila
ABSTRACT
Background and Objecve. The COVID 19 pandemic has changed the way the human anatomy is taught. A necessary
shi towards online instrucon, combined with a decrease in cadaver donaon has resulted in the need for maximizing
formalinized, so-embalmed, computerized, and plasnated cadaver specimens. Task-oriented acvies allow
students to demonstrate acquired knowledge and skills. It is the aim of this study to get the perspecve of students
in the ulizaon of available laboratory materials.
Methods. One hundred forty-three students parcipated in task-oriented acvies. Students demonstrated anatomy
of the facial nerve, recurrent laryngeal nerve, and phrenic nerve by parodectomy, thyroidectomy, and posterior
neck dissecon using formalinized cadaver and VH dissector™. Deep neck and sagial structures in the plasnated
specimen were idened using laser pointers. Ossicular mobility of the middle ear, and endoscopy of the nose and
larynx were demonstrated using the so embalmed cadaver. Students were surveyed on their percepons on the
ulity of each cadaver specimen.
Results. Formalinized and so-embalmed cadaver were observed to present the most accurate anatomy, while the
virtual dissector and plasnated specimens were seen to be the most sustainable and reusable.
Conclusion. Task-oriented learning in head and neck anatomy may use dierent cadaveric materials with varied
accuracy and ulity.
Keywords: anatomy, cadaver, medical educaon
INTRODUCTION
Since time immemorial, gross anatomy laboratory
dissection used formalinized cadavers, as these provided a
robustness for both basic dissection and clinical simulation.
However, in recent years, the study and art of human anatomic
dissection has evolved to incorporate various teaching
methods and technologies that have become more accessible
In 2017, the Department of Anatomy of the UP College
of Medicine (UPCM) started to utilize soft-embalmed
cadaver using the modied iel method to provide exible
human cadaver in demonstrating basic and clinical anatomy
in teaching and training.1-3 is was done in order to
augment the modied formalinized cadaver preservation,
wherein specimens are generally observed to have limited
mobility and exibility for joint movement, ne dissection,
and realistic surgical simulation. e soft-embalmed cadaver
eISSN 2094-9278 (Online)
Published: October 26, 2023
hps://doi.org/10.47895/amp.v57i10.7042
Corresponding author: Ryner Jose D. Carrillo, MD, MSc
Department of Anatomy
College of Medicine
University of the Philippines Manila
547 Pedro Gil St., Ermita, Manila 1000, Philippines
Email: rdcarrillo@up.edu.ph
ORCiD: hps://orcid.org/0000-0003-2439-7682
VOL. 57 NO. 10 202332
ORIGINAL ARTICLE
has been used in teaching medical students, and in training
surgical residents for basic and advanced clinical anatomy.
In 2020, the COVID-19 pandemic triggered the use of
a modied method of learning in anatomy that limits face to
face laboratory dissection. In addition, the supply of cadavers
became even more limited due to an increase in cremation
practices that was deemed necessary to curb the spread of the
virus. To supplement the very limited in-person laboratory
teaching of dissection, the Department of Anatomy used the
newly acquired touch screen human cadaver dissector table:
VH Dissector™ of www.toltech.net. It is a digitized actual
human cadaver that is stored as a program in a computer
with a touchscreen table interface. is tool allowed online
demonstration as well as potential limited face to face
dissection during the pandemic.
In 2021, to augment the lack of actual dissection of
human specimens, a bridging course in anatomy laboratory
dissection was done. It combined the use of the formalinized
cadavers, modied iel or soft embalmed cadavers,
and virtual cadavers in teaching dierent parts of the
human body.
In 2022, plastinated prosected cadaver specimens were
acquired as new materials for learning. ese are odorless, dry,
preserved and hardened cadaver specimen.4 e plastinated
human specimens were predissected to demonstrate anatomic
structures.
In the venue of multiple cadaveric materials in
learning and demonstrating knowledge in anatomy, the
question remains: what is the applicability of plastinated
and prosected specimen, virtual human dissector table,
soft-embalmed cadaver, and modied formalin preserved
cadaver in teaching basic anatomy? In this study, we aim to
determine student perception on the usefulness of dierent
types of human cadaveric materials in anatomy by task-
oriented activities: identication and pointing of the facial
nerve, phrenic nerve, and recurrent laryngeal nerve by
dening and measuring adjacent anatomic landmarks, sagittal
dissection of the aerodigestive tract, and deep dissection of
the infratemporal fossa and neck for arteries and nerves, and
lastly, by experiencing cadaveric endoscopy of the nasal cavity,
nasopharynx, and larynx as well as the middle ear.
MATERIALS AND METHODS
Learning Enhancement in Anatomy Program 2 (LEAP
2) was held from June 13 to 17, 2022. e activity involved
rotation of 200 students in dierent anatomy laboratory
stations represented by dierent organ system courses (OS),
e.g., the head and neck (OS 204), neuroanatomy (OS 202),
upper and lower extremities (OS 203), thorax (OS 205),
abdomen and pelvis (OS 206), and general histology.
In human body and mind III or OS 204, Head and Neck
course, there were task-oriented stations to utilize dierent
anatomic materials during anatomy.
Virtual Dissector Table
VH Dissector™ was presented to the students. ey
were tasked to dissect and show the facial nerve, phrenic
nerve, and recurrent laryngeal nerve with respect to adjacent
and removed structures. Students were asked to color
highlight the structures. (Figure 1)
Formalinized Cadaver Staon
Predissected head and neck formalinized cadaver was
presented to the students. e key topics were: facial nerve
and branches after supercial parotidectomy, phrenic nerve
after neck dissection, and recurrent laryngeal nerve after
thyroidectomy. (Figure 2)
Plasnated Models
Plastinated human cadavers are predissected human
cadavers that are preserved in a manner where it can be
Figure 1. VH Dissector™. In demonstrang the facial nerve,
remove the parod gland and highlight the main
trunk and branches of the facial nerve. In idenfying
the phrenic nerve, remove the sternocleidomastoid
muscle and the jugular veins. Highlight the phrenic
nerve and the anterior scalene muscle. In idenfying
the recurrent laryngeal nerve, remove the thyroid
gland, highlight the carod, trachea, and recurrent
laryngeal nerve.
VOL. 57 NO. 10 2023 33
Task-oriented Learning in Anatomy
odorless, dry, hard, and resilient. It is expensive such that
students are allowed to study the specimen using laser pointers
only. Students were tasked to point at specic anatomic
structures and state functions particularly in the infra-
temporal fossa and deep neck, and sagittal sections. (Figure 3)
So-embalmed (Modied Thiel) Cadaver
e modied iel method produces a soft cadaver where
structures mirror the fresh cadaver, but with the advantage of
a longer preservation. Structures are exible, and therefore
allow maneuvers that are done in actual surgical proce-
dures. e soft embalmed cadaver dissection was set-up to
demonstrate middle ear surgery and palpation of the ossicular
chain, and direct laryngoscopy and tracheoscopy. Because the
set-up required delicate instruments, the rst-year students
were not allowed to touch the specimen. Instead, they were
tasked to identify and annotate structures and relate these to
function. ey were also tasked to do endotracheal intuba-
tion on a cadaver in a suspended laryngoscopy. (Figure 4)
Head and Neck Anatomy Task-oriented Course
Survey
A qualitative survey using Google forms and a QR code
were given to 180 students participating in LEAP 2. e
students were enjoined to validate the utility of the materials
used in the bridging course by ticking the characteristics
to describe the stations they have rotated in the head and
neck course. e characteristics evaluated for each type of
cadaver preservation are: accurate anatomy, reproducible
activity, reversible dissection, simulates actual size, depth
and spatial orientation, touchable, odorless, soft and exible,
likely to provide long term memory, likely to provide skills,
likely to promote teamwork, simulate my rst patient (allows
actual procedure), reusable and sustainable, and versatile.
Figure 2. Formalinized cadaver. Task 1 – measure the main trunk
of the facial nerve from tragal pointer, tympanomas-
toid ssure, and mastoid p using a caliper. Indicate
depth and distance (horizontal, vercal or diagonal
distance). Task 2 – idenfy the phrenic nerve and its
relaonship with scalene muscles and prevertebral
fascia. Task 3 – idenfy the recurrent laryngeal nerve
by reecng the thyroid gland anteriorly while taking
note of the inferior thyroid artery.
Figure 3. Plasnated Model. Task 1 – Using laser pointer, idenfy and discuss the structures of the nose, pharynx, and larynx. Task
2 – Point at the bifurcaon of carod artery, hypoglossal nerve, vagus nerve, phrenic nerve, and brachial plexus.
VOL. 57 NO. 10 202334
Task-oriented Learning in Anatomy
RESULTS
One hundred forty-three students out of a total of 180
participants in the Learning Enhancement in Anatomy
Program 2 (LEAP 2) took part in the survey. Some students
missed the activity because of several reasons including
symptomatic COVID-19 infection.
Virtual Dissector (VH Dissector™) Characteriscs
e results of the student survey showed that virtual
dissectors allowed reversible dissection where structures that
had been deleted or removed can be restored. It is reusable
and sustainable, but may not simulate the “rst patient” or
rst actual human subject. It is denitely not exible and does
not allow realistic dissection as it does not provide depth and
spatial references. (Figure 5)
Figure 4. So-embalmed (Modied Thiel) Cadaver. Task 1 – Watch and idenfy the structures of the nose and nasopharynx, ear
and middle ear, and larynx during endoscopy. In the middle ear dissecon, observe the ossicular chain palpaon and
the movement of the uid over the round window (round window reex). Task 2 – Insert the endotracheal tube into the
suspended larynx. Observe the monitor and annotate. Watch how the endotracheal tube goes through the rima glodis.
Inate the balloon cu with air when it is past the level of glos. While a dierent laryngoscope is used when doing
endotracheal intubaon, this demonstrates the laryngeal structures which must be idened during the simulaon.
Figure 5. Virtual dissector or VH Dissector™ Student Survey. For students, the greatest aributes of the Virtual
dissector are its reusability and capacity for reversible dissecon. The least applicable aributes are the
ability to demonstrate so and exible structures, and to simulate rst paent.
VOL. 57 NO. 10 2023 35
Task-oriented Learning in Anatomy
Formalinized Cadaver Student Survey
Modied formalin preservation which used less pungent
reagents and fairly soft anatomic structures were predissected
and provided to students. Dissecting formalinized cadaver
showed accurate anatomy and were also the most touchable.
With clear tasks to identify depth and distance from anatomic
landmarks, palpating, probing, retracting, and identifying
structures provided the most accurate anatomy and touchable
set-up during laboratory dissection. is is more likely to
produce long-term learning memory. Teamwork was also
observed to be facilitated during the dissection process.
(Figure 6)
So-embalmed (Modied Thiel) Cadaver
e soft-embalmed cadaver had a exible neck and
oral cavity which allowed video-suspension laryngoscopy.
Intubation and ventilation were demonstrated. Lifelike
middle ear anatomy and ossicular chain mobility were also
shown. It provided the most accurate anatomy and skills
development based on the survey. However, since the students
were not allowed to handle the scope, the station scored low
with respect to touchable attribute. (Figure 7)
Plasnated Specimen
e plastinated specimen is a predissected and preserved
portion of human specimen. A lot of structures are removed
to highlight other anatomic structures and, in this sense, the
Figure 6. Formalinized Cadaver. Greatest aributes are accurate anatomy and touchable, while least aributes
are reversible dissecon and odorless.
Figure 7. So-embalmed (Modied Thiel) Cadaver. The greatest aributes are accurate anatomy and likeliness
to provide skills development. Least aributes are touchable (not allowed to touch the scopes) and
reversible dissecon.
VOL. 57 NO. 10 202336
Task-oriented Learning in Anatomy
plastinated specimen is a dissector rendition or artistic version
of anatomy. e specimen is odorless, well preserved, and
should not decompose. It provides accurate anatomy but has
irreversible dissection. Specimens cannot be touched because
of the possibility of breakage. Students used laser pointer in
studying the plastinated specimen. (Figure 8)
DISCUSSION
Task-oriented Learning
Task-oriented learning in anatomy requires various
learning materials as well as teaching methodologies in order
to achieve dierent goals at dierent levels of learning. In
outcome-based learning, rst year medicine students have
to demonstrate knowledge in basic anatomy and skills in
dissecting cadaver. e materials needed to conduct laboratory
classes in anatomy must be accurate, reproducible, sustainable,
and eective.
A dry, clean, and modern laboratory can be achieved with
the use of computerized touch-screen anatomy tables such as
VH Dissector™. Students were able to touch the screen in
order to open and dissect, color and enlarge, and even return
dissected anatomy parts. However, while it is from a digitized
3-dimensional rendering of an actual human cadaver, it is still
a 2-dimensional laboratory specimen that is lacking in spatial
and tactile references. e computer program and hardware
may also require updates in the future. Also, ne structures
are dicult to manifest in the VH Dissector™; this is perhaps
one of the greatest limitations of the computerized dissecting
table. Nevertheless, the use of virtual dissection tables is
perceived to have a role in supplementing anatomy education
in addition to traditional cadaver-based methods.5
e traditional formalinized cadaver dissection allows
students to plan incisions, nd structures, remove unnecessary
soft tissues, and tag key structures of interest. e preservation
and storage methods are inexpensive. e students are expected
to do a signicant amount of work, as well as to devote more
laboratory time in its study. It also usually entails division of
work and group dynamics. However, due to the pandemic,
there is a decreased number of donated cadavers. Hence,
there is a direction toward reusable cadaveric specimens after
initial dissection until there is an increase in available donated
cadavers. is will hopefully be achieved by using immersible
prosected cadavers. Modifying preservation methods may also
further decrease the smell of cadaver preserved in formalin.
e soft-embalmed cadaver demonstrated exibility
and softness of the cadaver that mimics a fresh cadaver
dissection. Nasopharynx and nasal cavity, larynx and trachea,
and middle ear structures and ossicular chain movement were
demonstrated endoscopically. e exibility of the neck and
the ossicular chain, the softness of the soft-tissues rendered
the specimen ideal for simulating the live specimen. However,
because the scopes used are expensive, delicate, and require
prior training for their use, students were not allowed to touch
the instruments, except for endoscope-guided intubation. For
future application of the soft-embalmed cadaver, a skill such
as intubation and cricothyrotomy are recommended as these
are important tasks which can be simulated early on while
studying anatomy.
Plastinated specimen are predissected and preserved
human specimen. Structures like nerves or vessels are clearly
demonstrated because the other intervening soft-tissues
are removed already. e plastinated specimen are hard and
potentially brittle. It is odorless and likely to last for a long
time. However, because the material is expensive, students
were not allowed to touch it. It, however, demonstrated spatial
and life-size anatomy.
To summarize, the students perceived the dierent
laboratory materials accurate, reproducible, with varied levels
of utility for particular tasks. (Table 1)
Figure 8. Plasnated Specimen. Greatest aributes are accurate anatomy and odorless. Least aributes are
reversible dissecon and touchable.
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Task-oriented Learning in Anatomy
CONCLUSION
In task-oriented learning, soft-embalmed and formalin-
ized cadaver are seen to present the most accurate anatomy
and exibility of structures, and produce additional
advantages in terms of skills development. e virtual
dissecting table and plastinated specimens on the other
hand are useful in that they have reusable and sustainable
materials. Combining these various teaching materials and
methodologies will upgrade and maximize the learning of
anatomy for beginning medical students.
Statement of Authorship
All authors certied fulllment of ICMJE authorship
criteria.
Author Disclosure
All authors declared no conicts of interest.
Funding Source
is study was funded by the Department of Anatomy,
College of Medicine, University of the Philippines Manila.
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Table 1. Student Perspecve on the Use of Dierent Anatomy Laboratory Materials
VH Dissector™
N=142
Formalinized Cadaver
N=143
So-embalmed Cadaver
N=143
Plasnated Specimen
N=142
Accurate anatomy 87.3 98.6 100.0 94.4
Reproducible acvity 90.8 84.6 76.2 85.9
Reversible dissecon 96.5 38.5 37.8 36.6
Simulates actual size and depth 59.9 95.8 93.7 89.4
Touchable 66.2 96.5 35.0 35.2
Odorless 94.4 50.3 75.5 90.8
So and exible 43.0 76.9 79.7 42.3
Provides long term memory 73.9 95.1 90.9 90.1
Provides skill development 62.7 94.4 94.4 75.4
Promotes teamwork 83.8 95.8 77.6 78.2
Simulates rst paent 44.4 88.1 86 58.5
Reusable and sustainable 95.1 60.1 63.6 83.1
Versale 76.8 67.1 72.7 66.2
Average score 74.98 80.14 75.62 71.24
Values are in % agree
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