Presence of Neovascularization in Torn Plantar Plates of the Lesser Metatarsophalangeal Joints

Background: Recent surgical techniques have focused on anatomic repair of lesser toe metatarsophalangeal (MTP) plantar plate tears, yet it remains unknown whether the plantar plate has the biological capacity to heal these repairs. Therefore, a better understanding of the plantar plate vasculature in response to injury may provide further insight into the potential for healing after anatomic plantar plate repair. Recently, a study demonstrated that the microvasculature of the normal plantar plate is densest at the proximal and distal attachments. The purpose of this study was to compare the intact plantar plate microvasculature network to the microvasculature network of plantar plates in the presence of toe deformity using similar perfusion and nano–computed tomographic (CT) imaging methods. Methods: Seven fresh-frozen human cadaveric lower extremities with lesser toe deformities including hammertoe or crossover toe were perfused using a barium solution. The soft tissues of each foot were counterstained with phosphomolybdic acid (PMA). Then using nano-CT imaging, the second through fourth toe metatarsophalangeal joints of 7 feet were imaged. These images were then reconstructed, plantar plate tears were identified, and 11 toes remained. The plantar plate microvasculature for these 11 toes was analyzed, and calculation of vascular density along the plantar plate was performed. Using analysis of variance (ANOVA), this experimental group was compared to a control group of 35 toes from cadaveric feet without deformity and the vascular density compared between quartiles of plantar plate length proximal to distal. A power analysis was performed, determining that 11 experimental toes and 35 control toes would be adequate to provide 80% power with an alpha of 0.05. Results: Significantly greater vascular density (vascular volume/tissue volume) was found along the entire length of the plantar plate for the torn plantar plates compared to intact plantar plates (ANOVA, P < .001). For the first quartile of length (proximal to distal), the vascular density for the torn plantar plates was 0.365 (SD 0.058) compared to 0.281 (SD 0.036) for intact plantar plates; in the second quartile it was 0.300 (SD 0.044) vs 0.175 (SD 0.025); third quartile it was 0.326 (SD 0.051) vs 0.117 (SD 0.015); and fourth (most distal) quartile was 0.600 (SD 0.183) vs 0.319 (SD 0.082). Conclusion: Torn plantar plates showed increased vascular density throughout the length of the plantar plate with an increase in density most notable in the region at or just proximal to the attachment to the proximal phalanx. Our analysis revealed that torn plantar plates exhibit neovascularization around the site of a plantar plate tear that does not exist in normal plantar plates. Clinical Relevance: The clinical significance of the increased vascularity of torn plantar plates is unknown at this time. However, the increase in vasculature may suggest that the plantar plate is a structure that is attempting to heal.

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A Comparison of Microvasculature of Normal versus Torn Lesser Toe Metatarsophalangeal Joint Plantar Plates Using Nano-CT Imaging

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00450 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0045

Author(s):

Natalie Singer ◽

David M. Walton ◽

James R. Holmes ◽

Paul G. Talusan

Keyword(s):

Soft Tissues ◽

Proximal Phalanx ◽

Surgical Techniques ◽

Metatarsophalangeal Joint ◽

Phosphomolybdic Acid ◽

Ct Imaging ◽

Control Group ◽

Vascular Density ◽

Plantar Plate ◽

Plate Length

Category: Lesser Toes Introduction/Purpose: Recent surgical techniques have focused on anatomic repair of lesser toe metatarsophalangeal (MTP) plantar plate tears. MTP instability has been implicated in a number of common toe deformities as well as metatarsalgia. Recently, a study demonstrated that the microvasculature of the normal plantar plate is densest at the proximal and distal attachments. The purpose of this study was to compare the intact plantar plate microvasculature network to the microvasculature network of plantar plates in the presence of toe deformity using similar perfusion and nano-CT imaging methods. Methods: Eight fresh frozen human cadaveric lower extremities with lesser toe deformities including hammertoe or crossover toe were perfused using a barium solution. The soft tissues of each foot were counterstained with phosphomolybdic acid (PMA). Then using nano-CT imaging the second through fourth toe metatarsophalangeal joints of 8 feet were imaged. These images were then reconstructed, plantar plate tears were identified, and eleven toes remained. The plantar plate microvasculature for these eleven toes was analyzed and calculation of vascular density along the plantar plate was performed. Using ANOVA analysis this experimental group was compared to a control group of 35 toes from cadaveric feet without deformity and the vascular density compared between quartiles of plantar plate length proximal to distal. Results: Demonstrated in Figure 1, of the torn plantar plates the average percent vascular density (vascular volume/tissue volume) in the first quartile of length (proximal to distal) is 0.365 (SD 0.058) compared to 0.281 (SD 0.036) for intact plantar plates; in the second quartile it is 0.300 (SD 0.044) vs 0.175 (SD 0.025); third quartile it is 0.326 (SD 0.051) vs 0.117 (SD 0.015); and fourth (most distal) quartile is 0.600 (SD 0.183) vs 0.319 (SD 0.082) respectively. Using ANOVA testing all differences were found to be significant to p<0.001. Conclusion: Torn plantar plates demonstrate increased vascular density throughout the length of the plantar plate with an increase in density most notable in the region at or just proximal to the attachment to the proximal phalanx. The clinical significance of the increased vascularity of torn plantar plates is unknown at this time. However, the increase in vasculature may suggest that the plantar plate is a structure that is attempting to heal.

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Microvasculature of the Plantar Plate Using Nano–Computed Tomography

Foot & Ankle International ◽

10.1177/1071100718816292 ◽

2018 ◽

Vol 40 (4) ◽

pp. 457-464 ◽

Cited By ~ 2

Author(s):

Fred T. Finney ◽

Aaron McPheters ◽

Natalie V. Singer ◽

Jaron C. Scott ◽

Karl J. Jepsen ◽

...

Keyword(s):

Computed Tomography ◽

Soft Tissues ◽

Proximal Phalanx ◽

Surgical Techniques ◽

Phosphomolybdic Acid ◽

Vascular Density ◽

Plantar Plate ◽

Tibial Arteries ◽

Clinical Conditions ◽

Mtp Joints

Background: Lesser toe plantar plate attenuation or disruption is being increasingly implicated in a variety of common clinical conditions. A multitude of surgical techniques and devices have been recently developed to facilitate surgical repair of the plantar plate. However, the microvascular anatomy, and therefore the healing potential in large part, has not been defined. We investigated the microvasculature of the plantar plate by employing a novel technique involving microvascular perfusion and nano–computed tomography (nano-CT) imaging. Methods: Twelve human adult cadaveric lower extremities were amputated distal to the knee. The anterior and posterior tibial arteries were perfused with a barium solution. The soft tissues of each foot were then counterstained with phosphomolybdic acid (PMA). The second through fourth toe metatarsophalangeal (MTP) joints of 12 feet were imaged with nano-CT at 14-micron resolution. Images were then reconstructed for analysis of the plantar plate microvasculature and calculation of the vascular density along the length of the plantar plate. Results: A microvascular network extends from the surrounding soft tissues at the attachments of the plantar plate on both the metatarsal and proximal phalanx. The midsubstance of the plantar plate appears to be relatively hypovascular. Analysis of the vascular density along the length of the plantar plate demonstrated a consistent trend with increased vascular density at approximately the proximal 29% and distal 22% of the plantar plate. Conclusion: There is a vascular network extending from the surrounding soft tissues into the proximal and distal attachments of the plantar plate. Clinical relevance: The hypovascular midportion of the plantar plate may play an important role in the underlying pathoanatomy and pathophysiology of this area. These findings may have significant clinical implications for the reparative potential of this region and the surgical procedures currently described to accomplish anatomic plantar plate repair.

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Microvasculature of the Plantar Plate Using Nano-Computed Tomography

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00006 ◽

2018 ◽

Vol 3 (2) ◽

pp. 2473011418S0000

Author(s):

Fred Finney ◽

Jaron Scott ◽

Karl Jepsen ◽

James Holmes ◽

Paul Talusan

Keyword(s):

Computed Tomography ◽

Soft Tissues ◽

Proximal Phalanx ◽

Three Dimensional ◽

Surgical Techniques ◽

Phosphomolybdic Acid ◽

Vascular Density ◽

Plantar Plate ◽

Tibial Arteries ◽

Mtp Joints

Category: Basic Sciences/Biologics, Lesser Toes, Midfoot/Forefoot Introduction/Purpose: Lesser toe plantar plate attenuation or disruption is being increasingly implicated in a variety of very common clinical complaints including metatarsalgia, metatarsal-phalangeal (MTP) joint subluxation and dislocation, hammertoe, crossover toe, etc. A multitude of surgical techniques and devices have been recently developed to facilitate surgical repair of the plantar plate. However, the microvascular anatomy, and therefore the healing potential in large part, has not been addressed. We sought to answer this question by employing a novel technique involving microvascular perfusion and nano-computed tomography (Nano-CT) imaging. Methods: 12 human adult cadaveric lower extremities were amputated distal to the knee. The anterior and posterior tibial arteries were dissected and cannulated proximal to the ankle joint and were perfused with a barium solution. The soft tissues of each foot were then counterstained with phosphomolybdic acid (PMA). The 2nd through 4th toe MTP joints of 12 feet were imaged with Nano-CT at 14-micron resolution. Images were then reconstructed for three-dimensional analysis of the plantar plate microvasculature and calculation of the vascular density along the length of the plantar plate. Results: A microvascular network extends from the surrounding soft tissues at the attachments of the plantar plate on both the metatarsal and proximal phalanx. The mid-substance of the plantar plate appears to be relatively hypovascular. Analysis of the vascular density along the length of the plantar plate demonstrated a consistent trend with increased vascular density at approximately the proximal 30% and distal 20% of the plantar plate (Figure 1). Conclusion: There is a vascular network extending from the surrounding soft tissues into approximately the proximal 30% and the distal 20% of the plantar plate. The hypovascular mid-portion of the plantar plate may play an important role in the underlying patho-anatomy and pathophysiology of this area. We believe our findings likely have significant clinical implications for the reparative potential of this region, and therefore the surgical procedures currently described to accomplish anatomic plantar plate repair.

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Metatarsophalangeal Arthrodesis through the Modified Steel Basket Technique in Foal

Acta Scientiae Veterinariae ◽

10.22456/1679-9216.97973 ◽

2019 ◽

Vol 47 ◽

Author(s):

Jackson Shade ◽

Flávia Do Prado Augusto Amaro ◽

João Batista Poncio da Silva ◽

Eric Danilo Pauls Sotelo ◽

Luiza Costa Barcellos ◽

...

Keyword(s):

Clinical Care ◽

Proximal Phalanx ◽

Surgical Techniques ◽

Metatarsophalangeal Joint ◽

Dorsal Surface ◽

Joint Stability ◽

Cutaneous Wounds ◽

Systemic Antibiotic Therapy ◽

Flexor Muscles ◽

Metatarsophalangeal Joints

Background: The metacarpophalangeal and metatarsophalangeal joints are very demanded during high intensity exercises, and may be affected by osteoarthritis, fractures, luxations and rupture of the suspensory apparatus. Thus, arthrodesis may be indicated to restore joint stability and accelerate the ankylosis process. The most commonly used surgical techniques have been associated with postoperative complications, including infection and failure of the implants, so it is important to develop procedures that are less invasive procedures and promoting stable fixation. Therefore, the aim of this work is to report the use of the modified steel basket technique for metatarsophalangeal arthrodesis in a foal with hyperextension of the joint due to rupture of the digital flexor muscles. Case: A 2-day-old male foal was admitted to clinical care, presenting multiple cutaneous wounds caused by dogs bites, located in the tarsus and thigh of the hindlimb. The animal presented in standing position and had no difficulty of movement, being initially treated through daily cleaning of the cutaneous wounds and systemic antibiotic therapy. Hyperextension of the metatarsophalangeal joint was evidenced after 20 days, being approached through tenotomy and tendon shortening, followed by tenorrhaphy and immobilization for 30 days. Due to the failure of the treatment, it was opted for metatarsophalangeal arthrodesis by modified steel basket technique. The procedure involved the implantation of a steel basket of 25.0 mm in diameter x 25.0 mm long in a 24.0 mm hole created on the dorsal surface between the third metacarpal and the proximal phalanx. The basket was filled with bone extracted from drilling and fixed with two cortical screws at an angle of 25° toward proximoplantar and distoplantar direction. Immobilization of the limb was performed postoperatively with synthetic plaster cast for 45 days and, due to the persistence of lameness, maintained with Robert Jones banding and plantar splint for another 15 days. At 90 days after surgery, radiographic control showed signs of degeneration and joint fusion, and grade 2 claudication (1-5) was observed during locomotion. At six months after surgery, discrete claudication (grade 1/1-5) was evident. The aesthetic and functional result was considered satisfactory and the animal was then ridden and used for leisure. Discussion: In this report, arthrodesis was indicated due to hyperextension of the metatarsophalangeal joint caused by the rupture of the digital flexor muscles, since these structures, together with the suspensory apparatus, assist in the support of the joint. Several techniques have been descrited for arthrodesis of metacarpal/metatarsophalangeal joints in horses, being the technique described by Bramlage the most employed and successful one. However, complications related to the techniques such as infection and implant failure were evidenced in one study. The technique of the modified steel basket is characterized by the promotional of effective intervertebral arthrodesis in cases of cervical instability in horses. In this report, the technique was effective in promoting metatarsophalangeal arthrodesis, as well as easy and quick to perform. Therefore, it is suggested that the technique may be used as an alternative for metacarpal/metatarsophalangeal arthrodesis in horses with osteoarthritis or hyperextension of the joint due to suspensory apparatus failure. However, studies are needed to evaluate the effectiveness of the technique in metacarpophalangeal arthrodesis in adult horses.

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Effect of McGlamry Elevator Placement on the Plantar Plate Origin

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00452 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0045

Author(s):

Natalie Singer ◽

Fred Finney ◽

Paul Talusan

Keyword(s):

Soft Tissues ◽

Surgical Techniques ◽

Collateral Ligaments ◽

Collateral Ligament ◽

Dorsal Approach ◽

Deep Placement ◽

Plantar Plate ◽

Significant Difference ◽

Fresh Frozen ◽

Relationship Of

Category: Lesser Toes Introduction/Purpose: Lesser metatarsal phalangeal (MTP) joint plantar plate tears have been implicated in a variety of lesser toe pathologies, and plantar plate repair (PPR) through a dorsal approach has become increasingly popular as a treatment of lesser toe deformities and lesser MTP instability. With the aid of a McGlamry elevator, releasing the collateral ligaments and micro-suture passing techniques, the plantar plate is repaired under direct visualization. While this approach is seen as a reliable alternative, the consequence of this technique on local MTP joint anatomy is not yet well understood. The purpose of this study is to describe the proximal plantar plate attachment and to quantify the amount of soft tissue disruption of the lesser toe MTP joint anatomy with insertion of a McGlamry elevator. Methods: Fresh frozen human cadaveric feet were dissected, and the proximal plantar plate attachment of the second, third, and fourth toe MTP joints (n=6) were examined, focusing on the relationship of structures connecting the distal metatarsal shaft and head to the plantar plate. The accessory collateral ligament insertions and proximal plantar plate attachments were measured using digital calipers. Next, the second, third, and fourth rays (n=12) of separate fresh frozen cadaveric specimens were isolated. An 11mm McGlamry elevator was then inserted in standard surgical fashion in both a more shallow (limited exposure) and deeper (greater exposure) position. Using mini C-arm fluoroscopy, radiographs were taken in both positions, and the depth of insertion along the metatarsal was measured. Results: The proximal plantar plate attachment to the metatarsal is most robust just proximal to the lateral articular margin and this attachment extends an average of 10.42mm (SD= 2.71mm) proximally along the metatarsal neck and shaft. In addition there are stout proximal plantar plate attachments at the bilateral insertion sites of the accessory collateral ligament (ACL) which are thick and broad with an average insertion length of 9.01mm (SD=1.35mm). Insertion of a McGlamry elevator resulted in stripping of the distal plantar soft tissues over an average of 21.58% of the total metatarsal length (SD=4.43%) for shallow placement and 34.87% (SD=4.40%) for deep placement with a significant difference of 7.96% between the two positions (p<.00001). Conclusion: Current techniques of plantar plate repair through a dorsal approach require releasing collateral ligaments and proximal stripping of the plantar plate from the metatarsal for adequate visualization. We suggest that this significantly destabilizes the metatarsal from the plantar plate as it strips approximately the distal most one third of the metatarsal including all major proximal plantar plate attachments to the metatarsal. As surgical techniques continue to evolve and improve, surgeons should consider avoiding the placement of a McGlamry elevator as this can destabilize the proximal attachment of the plantar plate to the metatarsal.

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Effect of Tai Chi Training on Plantar Loads during Walking in Individuals with Knee Osteoarthritis

BioMed Research International ◽

10.1155/2020/3096237 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Zhiwang Zhang ◽

Lingyan Huang ◽

Yu Liu ◽

Lin Wang

Keyword(s):

Clinical Trials ◽

Knee Osteoarthritis ◽

Education Program ◽

Tai Chi ◽

Peak Pressure ◽

Maximum Force ◽

Control Group ◽

Link Type ◽

Wellness Education ◽

Metatarsophalangeal Joints

Tai Chi is an available method for the treatment of knee osteoarthritis (KOA). The impacts of Tai Chi on plantar loads of individuals with KOA are not fully understood. 46 participants with knee osteoarthritis were randomly assigned into the Tai Chi group (n=23) or the control group (n=23). The Tai Chi group attended a 6-month Tai Chi program, and the control group participated in a wellness education program. Novel Pedar-X system was used to collect the peak pressure (PP) and maximum force (MF) during walking before and 6 months after the intervention. Significant higher peak pressure and maximum force were observed in the 4th and 5th metatarsophalangeal joints in the Tai Chi group. However, there were significant declines in the peak pressure of the whole foot and the 2nd and 3rd metatarsophalangeal joints and maximum force of the heel in the control group. These results suggested that individuals with KOA might change the pattern of plantar loads during walking through Tai Chi, and plantar loads would be useful as a parameter to assess the effect of Tai Chi on knee osteoarthritis. This trial is registered with Clinical Trials: CHiCTR-TRC-13003264.

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Efficiency Assessment of Multidetector-Row Computed Tomographic Angiography Using Reconstruction With Locoregional Perforator Flaps

Plastic Surgery ◽

10.1177/22925503211024750 ◽

2021 ◽

pp. 229255032110247

Author(s):

Pavlo O. Badiul ◽

Sergii V. Sliesarenko ◽

Nataliia O. Cherednychenko ◽

Olga V. Morgun

Keyword(s):

Perforator Flap ◽

Computed Tomographic Angiography ◽

Surgical Reconstruction ◽

Patient Treatment ◽

Controlled Study ◽

Control Group ◽

Perforator Flaps ◽

Multidetector Row ◽

Computed Tomographic ◽

Tomographic Angiography

Background: Reconstruction with the use of perforator flaps makes it possible to make the skin surface resistant to the influence of mechanical factors and as similar to the lost skin cover as possible. However, while planning any flap, along with the design of the required shape and size, its blood supply should be taken into account to ensure optimal viability. Therefore, the task to precisely determine the topographic–anatomical relationships suitable for the formation of a pedicle of perforators is still relevant. The aim of this study was to increase the efficiency of surgical reconstruction of wound defects by transposition of locoregional perforator flaps. Methods: The authors conducted a retrospective analysis of 72 cases of reconstruction by means of locoregional perforator flaps with vascular pedicle detachment to determine the efficiency of preoperative diagnostic preparation with the help of multidetector-row computed tomographic angiography (MDCT) in the process of reconstruction. Thirty-seven individual cases of surgical interventions were chosen using a case-controlled study from the study group when MDCT with angiography was used for preoperative planning of perforator flaps, as well as 35 control cases similar in terms of important predictive peculiarities with the reconstruction at the same level of difficulty. The patient groups were precisely matched by gender ( P = .950), age ( P = .804), flap area ( P = .192), and type of reconstruction that was performed. Results: In all cases, the location of the perforator with a diameter greater than 1.0 mm was marked. All perforators determined during MDCT scanning were faultlessly localized intraoperatively. The distance between the intraoperative position of the perforator and the position obtained in the result of the examination did not exceed 1 cm. There was no need to change the planned design of the flap intraoperatively. In all cases where MDCT was performed, the duration of the surgical procedure varied from 60 to 150 minutes (average: 120.77 [18.90] minutes) and was reduced by 49.40 minutes (95% CI: 39.17-59.63) compared with the patients who did not undergo preoperative visualization of perforators where the average duration of the operation was 170.17 (19.19) minutes (from 140 to 220 minutes). Among the patients examined by MDCT, surgical complications were noted in 5 cases (13.51%) compared to 14 cases (40.00%) in the control group. Conclusions: The preoperative MDCT for the locoregional perforator flap reconstruction makes it possible to increase the efficiency of patient treatment given the reduction in surgery duration by 49.40 minutes (95% CI: 39.17-59.63) on average and the reduction in the level of postsurgery complications from 40% to 13.5% compared with the group of patients in whom presurgical visualization was not performed ( P = .031).

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Long-Term Follow-Up of Early Cochlear Implant Device Activation

Audiology and Neurotology ◽

10.1159/000512760 ◽

2021 ◽

pp. 1-11

Author(s):

Stefanie Bruschke ◽

Uwe Baumann ◽

Timo Stöver

Keyword(s):

Speech Recognition ◽

Side Effects ◽

Cochlear Implant ◽

Surgical Techniques ◽

Control Group ◽

First Year ◽

Safe Procedure ◽

Sound Processor

Background: The cochlear implant (CI) is a standard procedure for the treatment of patients with severe to profound hearing loss. In the past, a standard healing period of 3–6 weeks occurred after CI surgery before the sound processor was initially activated. Advancements of surgical techniques and instruments allow an earlier initial activation of the processor within 14 days after surgery. Objective: Evaluation of the early CI device activation after CI surgery within 14 days, comparison to the first activation after 4–6 weeks, and assessment of the feasibility and safety of the early fitting over a 12 month observation period were the objectives of this study. Method: In a prospective study, 127 patients scheduled for CI surgery were divided into early fitting group (EF, n = 67) and control group (CG, n = 60). Individual questionnaires were used to evaluate medical and technical outcomes of the EF. Medical side effects, speech recognition, and follow-up effort were compared with the CG within the first year after CI surgery. Results: The early fitting was feasible in 97% of the EF patients. In the EF, the processor was activated 25 days earlier than in the CG. No major complications were observed in either group. At the follow-up appointments, side effects such as pain and balance problems occurred with comparable frequency in both groups. At initial fitting, the EF showed a significantly higher incidence of medical minor complications (p < 0.05). When developing speech recognition within the first year of CI use, no difference was observed. Furthermore, the follow-up effort within the first year after CI surgery was comparable in both groups. Conclusions: Early fitting of the sound processor is a feasible and safe procedure with comparable follow-up effort. Although more early minor complications were observed in the EF, there were no long-term wound healing problems caused by the early fitting. Regular inspection of the magnet strength is recommended as part of the CI follow-up since postoperative wound swelling must be expected. The early fitting procedure enabled a clear reduction in the waiting time between CI surgery and initial sound processor activation.

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Micro-CT imaging of Thiel-embalmed and iodine-stained human temporal bone for 3D modeling

Journal of Otolaryngology - Head and Neck Surgery ◽

10.1186/s40463-021-00522-0 ◽

2021 ◽

Vol 50 (1) ◽

Author(s):

Sebastian Halm ◽

David Haberthür ◽

Elisabeth Eppler ◽

Valentin Djonov ◽

Andreas Arnold

Keyword(s):

Soft Tissue ◽

Temporal Bone ◽

Middle Ear ◽

3D Modeling ◽

Soft Tissues ◽

Ct Imaging ◽

Micro Ct ◽

Data Set ◽

Iodine Staining ◽

Tissue Structures

Abstract Introduction This pilot study explores whether a human Thiel-embalmed temporal bone is suitable for generating an accurate and complete data set with micro-computed tomography (micro-CT) and whether solid iodine-staining improves visualization and facilitates segmentation of middle ear structures. Methods A temporal bone was used to verify the accuracy of the imaging by first digitally measuring the stapes on the tomography images and then physically under the microscope after removal from the temporal bone. All measurements were compared with literature values. The contralateral temporal bone was used to evaluate segmentation and three-dimensional (3D) modeling after iodine staining and micro-CT scanning. Results The digital and physical stapes measurements differed by 0.01–0.17 mm or 1–19%, respectively, but correlated well with the literature values. Soft tissue structures were visible in the unstained scan. However, iodine staining increased the contrast-to-noise ratio by a factor of 3.7 on average. The 3D model depicts all ossicles and soft tissue structures in detail, including the chorda tympani, which was not visible in the unstained scan. Conclusions Micro-CT imaging of a Thiel-embalmed temporal bone accurately represented the entire anatomy. Iodine staining considerably increased the contrast of soft tissues, simplified segmentation and enabled detailed 3D modeling of the middle ear.

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