Gross Anatomy Revisited
As a second-year resident in our program, I am given the opportunity to participate in the first-year medical student gross anatomy course during the head and neck section. My engaging in this type of activity, with a much broader knowledge base several years after having taken the same course, has helped me to solidify and encourage the teaching of these anatomic relationships. It has been an enlightening experience.
The teachers of the course are outstanding, just as they were during my first go-around. However, a shortcoming persists: anatomy is not taught surgically. In our specialty, we use terms such as hypopharynx not laryngopharynx, epidural as opposed to extradural, and innominate rather than brachiocephalic. A specialty-specific example includes 1 of the most fundamental anatomic principles of otolaryngology, the characterization of nodal levels of the neck. It is confusing, therefore, that we continue to teach medical students to subdivide the neck into triangles, rather than discussing each surgical level used in actual practice.
In addition, what is so important about the punctum nervosum? Also called Erb's point, its importance is the accessory nerve, which lies approximately 1 centimeter superior to this specific point along the sternocleidomastoid muscle. As the accessory nerve traverses this space, it is easily damaged in a lymph node biopsy of level V. In fact, this location is the most common site of injury to a cranial nerve, and the second most common iatrogenic major nerve injury overall.1 This example illustrates the importance of integrating specialty-specific terminology into the basic curriculum, a point further highlighted by the fact that otolaryngology is duly integrated into primary care practice. Upper respiratory symptoms comprise the fifth most common presenting category of illness in general outpatient clinics.2 The levels of the neck are important drainage pathways for these conditions of the aerodigestive tract.
If we begin teaching clinical terminology, then we all speak in a cohesive language from the beginning. With the ever-increasing amount of information presented to medical students, there is no utility in learning things twice, especially since anatomy is immutable, as the levels of the neck were described in 1972.3 I urge us all to have a stronger voice in the initial teachings of future physicians so that one day we can converse in a common, clinically centered, anatomic language that is reinforced early in our careers.
