Background

The use of the Pernkopf atlas of human anatomy in surgery presents ethical challenges due to the author’s association with the Nazi regime and the potential depiction of victims of this regime. The atlas was of particular utility to two surgical specialties: nerve surgeons and oral and maxillofacial surgeons. The representation of peripheral nerves and complex head and neck anatomy is probably unequaled in any other atlas of anatomy. While the ethical implications of the use of Pernkopf’s atlas among nerve surgeons have been previously assessed, this study focuses on the volume dedicated to detailed images of head and neck dissections, and the ethical implications of using this atlas by oral and maxillofacial surgeons.

Objective

To (1) assess the role of the Pernkopf atlas in oral and maxillofacial surgeons’ current practice and (2) determine whether a proposal of four conditions would provide ethical guidance for use in surgery and education.

Methods

Members of three American oral and maxillofacial surgical societies (ACOMS, ASTMJS, AAOMS) were surveyed and 181 responses collected. The survey introduced the historical origin of the Pernkopf atlas, and respondents were asked whether they would use the atlas under specific conditions that could be a recommendation for its ethical handling. An anatomical plate comparison between Netter’s and Pernkopf’s atlases was performed to compare accuracy and surgical utility.

Results

Forty-nine percent of respondents were aware of the Pernkopf atlas, and 9% of respondents were currently using it. Amongst those aware of the historical facts, 42% were comfortable using the atlas, 33% uncomfortable, and 25% undecided. The four conditions involving disclosure, bioethical and religious considerations, and remembrance led to 75% of those “uncomfortable” and “undecided” becoming “comfortable” with use.

Conclusions

Amid recent developments and controversy regarding the Pernkopf atlas, a proposal detailing conditions for an ethical approach may provide guidance in surgical planning and education. Furthermore, this approach has implications for the future preparation and publication of anatomical atlases and their use.

中文翻译：

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口腔颌面外科医生对 Pernkopf 图谱在外科实践中的作用的评估

背景

由于作者与纳粹政权的联系以及对该政权受害者的潜在描述，在外科手术中使用 Pernkopf 人体解剖图谱带来了伦理挑战。该图谱对两个外科专业特别有用：神经外科医生和口腔颌面外科医生。周围神经和复杂的头颈部解剖结构的表现在任何其他解剖图谱中可能是无与伦比的。虽然之前已经评估了神经外科医生使用 Pernkopf 图谱的伦理影响，但本研究侧重于头颈部解剖详细图像的卷，以及口腔颌面外科医生使用该图谱的伦理影响。

客观的

(1) 评估 Pernkopf 图谱在口腔颌面外科医生当前实践中的作用，以及 (2) 确定四个条件的建议是否会为手术和教育的使用提供伦理指导。

方法

对三个美国口腔颌面外科学会（ACOMS、ASTMJS、AAOMS）的成员进行了调查，并收集了 181 份回复。调查介绍了 Pernkopf 图集的历史起源，并询问受访者是否会在特定条件下使用该图集，这可能是对其道德处理的建议。进行 Netter 和 Pernkopf 地图集之间的解剖板比较，以比较准确性和手术实用性。

结果

49% 的受访者知道 Pernkopf 地图集，9% 的受访者目前正在使用它。在了解历史事实的人中，42% 的人对使用地图集感到满意，33% 的人不舒服，25% 的人不确定。涉及披露、生物伦理和宗教考虑以及纪念的四个条件导致 75% 的“不舒服”和“未决定”的人在使用时变得“舒服”。

结论

在最近关于 Pernkopf 图谱的发展和争议中，一项详细说明伦理方法条件的提案可能会为手术计划和教育提供指导。此外，这种方法对解剖图谱的未来准备和出版及其使用具有影响。