Folia Morphol. Vol. 76, No. 3, pp. 340–347 DOI: 10.5603/FM.a2016.0078 R E V I E W A R T I C L E Copyright © 2017 Via Medica ISSN 0015–5659 www.fm.viamedica.pl The Terminologia Anatomica matters: examples from didactic, scientific, and clinical practice B. Strzelec1, 2, P.P. Chmielewski1, B. Gworys1 1Division of Anatomy, Department of Human Morphology and Embryology, Faculty of Medicine, Wroclaw Medical University, Wroclaw, Poland 2Department and Clinic of Gastrointestinal and General Surgery, Wroclaw Medical University, Wroclaw, Poland [Received: 19 August 2016; Accepted: 20 October 2016] The proper usage of the anatomical terminology is of paramount importance to all medical professionals. Although a multitude of studies have been devoted to issues associated with the use and application of the recent version of the anatomical terminology in both theoretical medicine and clinical practice, there are still many unresolved problems such as confusing terms, inconsistencies, and errors, including grammar and spelling mistakes. The aim of this article is to describe the current situation of the anatomical terminology and its usage in practice, as well as explain why it is so important to use precise, appropriate, and valid anatomical terms during the everyday communication among physicians from all medical branches. In this review, we discuss some confusing, obsolete, and erroneous terms that are still commonly used by many clinicians, and surgeons in particular, during the process of diagnosis and treatment. The use of these ambiguous, erroneous, and obsolete terms enhances the risk of miscommunication. We also provide some edifying examples from everyday clinical practice. (Folia Morphol 2017; 76, 3: 340–347) Key words: anatomical terminology, anatomical nomenclature, clinical anatomy, clinical practice, coding system of Terminologia Anatomica, general anatomy, gross anatomy INTRODUCTION tomical vocabulary is based on Ancient Greek and Latin Unlike in other medical fields, in anatomy it is impor- words, contains casual eponyms, used especially by clini- tant to distinguish between terminology, which is the cians and surgeons, and the literal meaning of a term set of terms approved by the Federative Committee on may not lend insight into its definition. Moreover, the Anatomical Terminology (FCAT) and nomenclature, which terminology commonly used by health care profession- is the standardised system of precisely defined terms, als in hospitals may significantly differ from the official created within the scope of terminology [6, 10, 12]. terminology used by anatomists. Such discrepancy can Human anatomy is a fundamental science, and the be a source of confusion or erroneous diagnosis and proper usage of anatomical terminology is of para- treatment, which eventually can be pernicious. There- mount importance to both medical students and prac- fore, the use of the recent version of the anatomical ticing physicians [9, 18, 28, 29]. Learning, remembering, terminology [5] in clinical practice is highly recommend- and understanding the specialised anatomical terms ed [10–13]. Although a host of studies have focused are arguably the greatest challenges faced by first year on issues associated with the use and application of medical students. All the more so because the ana- anatomical terminology and nomenclature in prac- Address for correspondence: Dr. P.P. Chmielewski, Division of Anatomy, Department of Human Morphology and Embryology, Faculty of Medicine, Wroclaw Medical University, ul. T. Chałubińskiego 6a, 50–368 Wrocław, Poland, e-mail: [email protected] 340 B. Strzelec et al., The usage of the Terminologia Anatomica tice [9, 13, 14, 17–22, 27, 30–32], there are still many as the Basel Nomina Anatomica (BNA), which omitted unresolved problems. For example, there is currently many synonymous and eponymous terms. In 1897, no precise definition of fascia as a unit [15, 25, 26]. Professor Stanisław Krysiński incorporated the BNA Similarly, we lack an exact definition of an arteriole [8]. into the Polish anatomical terminology. The BNA was Moreover, numerous terms are stated as synonyms [13]. accepted in Europe and in America, although older It should be stressed, however, that any minor change clinicians continued to use the previous terminology. to the current version of the anatomical terminology [5] Moreover, the BNA was not accepted worldwide, e.g. should be introduced with utmost caution, and any in France and Great Britain. In 1928, a Committee of major change would do more harm than good. the Anatomists of Great Britain and Ireland was set The purpose of this article is to describe the current up. The committee adopted the nomenclature known situation of the anatomical terminology and its usage in as the Birmingham Revision (BR). In 1935, the Jena clinical practice, as well as to explain why it is so impor- Nomina Anatomica (JNA) reformed the system of ana- tant to use precise, appropriate, and valid anatomical tomical nomenclature, but this attempt received little terms during both the process of teaching anatomy to attention. Until 1955, the BNA and JNA remained the medical students and in the everyday communication standard international anatomical terminology. In 1955, among health care specialists from all medical branches. the International Anatomical Nomenclature Committee We discuss some confusing, obsolete, and erroneous (IANC) established the Nomina Anatomica (NA), which terms that are still commonly used by clinicians and contained 5640 terms (4311 items), of which 76% were surgeons during diagnosis and treatment, which can unchanged from the BNA [13]. easily lead to miscommunication and misunderstanding. We also provide some edifying examples from everyday A CRITICAL ANALYSIS OF THE didactic and clinical practice. TERMINOLOGIA ANATOMICA In 1997, the latest revision of the Latin and English THE HISTORICAL DEVELOPMENT terminology was approved by the FCAT and published OF THE ANATOMICAL TERMINOLOGY as Terminologia Anatomica (TA) in 1998 [5]. It contains The anatomical terminology has been a matter of 7635 items, which shows a trend of extension and sta- controversy and disagreement since time immemorial. bilisation of nomenclature. Nevertheless, several errors, The same anatomical structures were differently named, including typographical ones, as well as some inconsist- described, and defined by different authors. Many terms encies have been noted. Therefore, a new edition of TA designated the shape, resemblance to other structures, has been published online in 2011 along with several or the function of the anatomical structures or even corrections and remedies to these errors. Moreover, religious beliefs and misunderstandings like the issue it has emerged that the TA has several weak points, of Adam’s apple. Therefore, over the centuries, many discrepancies, and certain segments are insufficiently attempts have been made in order to establish a general rich as they do not contain new terms for some small or terminology that would be acceptable to all anatomists variant structures. Since these structures and appropri- throughout the world. ate terms for them are very important from a scientific Ancient authors like Galen used only a limited num- point of view, some authors selected the most important ber of terms, and they were usually colloquial Greek structures and proposed new terms for them in order words [23]. In the early 16th century, Andreas Vesalius, to ameliorate and extend the most recent version of the one of the founders of modern human anatomy, de- TA [14]. Modern anatomical terms used in TA designate: scribed many new structures with the help of detailed — the shape of structures or resemblance to some and magnificent illustrations in his books. The third other structures found in nature, e.g. arachnoidea stage of development of terminology in the late 16th mater, hippocampus, uncus, cochlea, cauda equina, century was marked by innovation of a large number of sella turcica, cartilago arytenoidea et cricoidea, mus- terms for the muscles, nerves, and blood vessels. Sylvius culus deltoideus et trapezius, os pisiforme, vomer; in Paris and Bauhin in Basel, were the most prominent — the size or dimension of structures, e.g. tuberculum figures at that stage of the development of anatomical majus et minus (humeri), trochanter major et minor terminology and nomenclature [23]. (femoris), musculus gluteus maximus, medius et In 1895, an international commission formulated minimus, m. latissimus dorsi, m. pectoralis major et a standardised and simplified nomenclature, known minor, vena saphena magna et parva; 341 Folia Morphol., 2017, Vol. 76, No. 3 — the location or spatial relations, e.g. ligg. collateralia, ally contain small departures (Table 1) from the ter- lig. coracoacromiale, planum transpyloricum, trigonum minology adopted by the FCAT [5]. Fortunately, such femorale, epigastrium, cardia, regio hypochondriaca; minor mistakes or inaccuracies do not usually lead to — the function, e.g. atlas, cisterna chyli, confluens sinu- miscommunication as they do not change the mean- um, vesica urinaria, vesica biliaris seu fellea, funiculus ing of the term. For example, if the carotid triangle is spermaticus, m. sphincter et dilatator pupillae; erroneously referred to as “the carotid artery triangle” [2], — the colour, e.g. ligamenta flava, linea alba, macula it is redundant but relatively harmless because of explic- lutea, substantia nigra, nucleus ruber, and some itness. Similarly, the common use