#postauricular

[alphasurgical]

What the Parotid Tumor Surgery Are

➔ The procedure of parotid tumours surgery is known as a parotidectomy. The superficial lobe and the deep lobe are the two lobes that make up the parotid gland. A superficial parotidectomy is the name of the procedure used to remove a tumour from the superficial lobe. Total parotidectomy refers to the surgical procedure used to remove a tumour from the deep lobe or from both the deep and superficial lobes.

➔ The preauricular region of the parotid gland, which extends towards the cheek, is high in the neck and contains mostly serous salivary glands. The postauricular muscles, the posterior belly of the digastric muscle, and the stylohyoid muscles all get motor innervation from the extratemporal facial nerve and its branches, which pass through the parotid gland.

➔ Cervicofacial and temporofacial branches make up the motor branches for the face; the former supply the muscles in the mouth and neck, while the latter supply the muscles in the brow and eyes (there is some overlap in the nasal region).

➔ Almost all parotid gland tumours, whether malignant or benign, should be surgically removed. Despite the fact that the majority of tumours are non-cancerous and grow slowly, they frequently continue to grow and sporadically develop into cancer. The parotid gland must typically be removed as part of parotid tumour treatment (parotidectomy).

➔ Parotid surgery is frequently carried out through small incisions made in the skin folds behind and around the ear. Due to the fact that the gland is crossed by a nerve that controls facial movement, surgery may be challenging. Malignant tumours in the parotid gland may be surgically removed while still leaving most of the facial nerve intact, but if the tumour is encroaching on the nerve, the nerve must be sacrificed, which will cause facial paralysis.

➔ After surgery, radiation therapy is frequently advised for tumours that are malignant. This is normally given four to six weeks following the surgery in order to give the body enough time to recuperate before radiation treatment.

➔ The parotid gland is home to the majority of salivary gland tumours. The facial nerve, which regulates the facial muscles' movements, some aspects of taste, the ability to produce tears and saliva, and some aspects of skin sensation on the same side of the face, travels through the gland, making surgery in this area challenging. For these procedures, a skin incision is made that may go all the way down to the neck, just in front of the ear.

➔ The superficial lobe, which is located on the outside of the gland, is where most parotid gland tumours begin. These can be addressed by a superficial parotidectomy, which involves removing just this lobe. This typically results in no damage to the facial nerve and has no impact on taste, sensation, or face movement.

➔ The surgeon will remove the entire gland if your cancer has progressed deeper. Total parotidectomy is the name of this procedure. The facial nerve will also need to be removed if the cancer has spread there. Ask what may be done to treat the negative effects brought on by the removal of the nerve if your surgeon has suggested this procedure. These tissues may also need to be removed if the cancer has spread to nearby tissues that are close to your parotid gland.

➔ The surgeon will make a cut in the skin to remove the entire gland and maybe some of the surrounding tissue or bone if the malignancy is in the submandibular or sublingual glands. Movement of the tongue and the bottom half of the face, as well as sensation and taste, are all controlled by nerves that run through or close to these glands. The surgeon might have to cut some of these nerves, depending on the size and location of the cancer.

[help-im-a-medstudent]

The Famous Maculopapular Childhood Rashes 

A summary of rashes found in childhood with some additional notes below

Chicken pox

Starts on trunk 

Remains infectious until all vesicles have scabbed and dried

Roseola:

High fever occurs suddenly

Measles:

The height of the fever usually occurs before the rash appears

3 C’s (cough, coryza and conjunctivitis) lead up to the rash

Rash starts very small then spreads joins together within a few days

Rubella:

Infectious for 1 week before and 1 week after rash 

Classical sign of raised occipital lymph nodes (and occasionally postauricular)

Risk in pregnant women of congenital rubella (>90% if in first trimester)

Miscarriage, microcephaly, cataracts, congenital heart disease and deafness

Fifth disease:

Rash can come and go

Can cause anaemia

May not have a fever at time of rash

[er-cryptid]

Acute Mastoiditis

CLINICAL SIGNS -- lethargy -- abnormal tympanic membrane -- postauricular erythema -- tenderness -- fever -- narrowing of external auditory canal -- otalgia -- otorrhea

MANAGEMENT -- antibiotics -- surgical drainage

COMPLICATIONS -- meningitis -- epidural or subdural abscess -- facial nerve palsy -- hearing loss -- labyrinthitis -- osteomyelitis -- venous sinus thrombosis

[biomedres]

Branching Patterns of the Facial Nerve within the Parotid Gland Among Sudanese

Branching Patterns of the Facial Nerve within the Parotid Gland Among Sudanese  Biomedical Journal of Scientific & Technical Research

https://biomedres.us/fulltexts/BJSTR.MS.ID.006042.php

The extratemporal component of the facial nerve starts when the facial nerve exits the stylomastoid foramen [1,2]. In the adult, it is protected laterally by the mastoid tip, tympanic ring, and mandibular ramus, whereas in children younger than 2 years it is relatively superficial [3]. Postauricular incisions in this younger population must be carefully planned because the trunk of the facial nerve is a subcutaneous structure at this level [1,4]. After exiting the stylomastoid foramen, the facial nerve gives off motor branches to the posterior belly of digastric, stylohyoid, and the superior auricular, posterior auricular, and occipitalis muscles [5]. The facial nerve then travels along a course anterior to the posterior belly of the digastric and lateral to the external carotid artery and styloid process before dividing into its main motor branches at the posterior edge of the parotid gland. The facial nerve trunk is usually identified approximately 1 cm deep and just inferior and medial to the tragal pointer [6].

The parotid and superficial musculoaponeurotic system (SMAS) can then be carefully divided to expose the facial nerve for facial nerve reconstruction [7]. Alternatively, branches of the facial nerve can be identified distally as they exit the anterior border of the parotid gland. Here, the buccal branches of the facial nerve become quite superficial, lying immediately beneath the SMAS. Facial nerve branches are then traced posteriorly to the main facial nerve trunk. Advocates of this technique note that damage to a small branch of the facial nerve during the initial exploration is far less devastating than an inadvertent injury to the entire motor trunk. However, these peripheral branches are more difficult to identify because of their smaller size and a lack of consistent landmarks [8-10]. The barbarization of the extratemporal facial nerve typically begins within the substance of the parotid gland and ultimately gives rise to the cervical, marginal mandibular, buccal, zygomatic, and frontal (or temporal) nerve branches [11]. The aim of this study is to describe variations of the course and main divisions of the facial nerve in Sudanese people -cadaveric study.

For more articles in Journals on Biomedical Sciences click here

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[lupine-publishers-sjo]

Lupine Publishers | The Dermoid Cyst of the Auricle

Lupine Publishers | Journal of Otolaryngology

Abstract

Dermoid cysts of the auricle are extremely rare. A 13-year-old female patient was admitted to our clinic with the complaint of a painful, slowly growing mass that had been present behind her right ear since birth. Ear examination revealed a soft, approximately 2x2 cm cystic mass on the posterior aspect of the right auricle. Histopathological examination of the excised mass was reported as dermoid cyst. The patient, who had no problem after the operation, was called to the controls and discharged. We present this case because dermoid cysts of the auricle are extremely rare and should be considered in the differential diagnosis of congenital masses in children.

Introduction

Dermoid cysts are present at birth and predominantly occur in men. They are asymptomatic, slow growing, single cavity cystic masses. Most are in ovaries [1]. Less than 7% appears in the head and neck region [2].The most common location in the head and neck region is front orbital, in the upper outer part of the orbital. Other settlements are the midline of the nose,the neck, the sublingual region, and the sternal, perineal, scrotal, and sacral regions [3]. Dermoid cysts trapped in the ectoderm sac next to normal folds or surface is a developmental disorder caused by the failure of the ectoderm to leave the neural tube[4].The most valid theory about the dermoid cysts was proposed by New and Erich that was the persistence of the germ layers at birth, along the embryonic fusion line in the deep tissues in the neck. The irregular growth and differentiation of these cells causes the appearance of dermoid cysts. Dermoid cysts are divided into 3 histological types: epidermoid, dermoid and teratoma. Epidermoid cysts contain laminated keratin materials and does not contain a sebaceous gland around. Dermoid cysts are surrounded with a stratified squamous cell epithelium and they are subcutaneous tumors, and they contain various types of skin supplements such as hair follicle, sebaceous gland and sweat glands. Teratomas originate from totipotent cells, contain all three embryonic germ layers and are true neoplasms [4].

Case Report

Thirteen-year-old female patient with a mass complaint in the right auricle admitted to the Otorhinolaryngology outpatient clinic of Kadirli State Hospital. The patient’s mother told that the mass existed since the birth of the child. She stated that the mass was small and painless at the beginning. For the past few years, the mass was growing and became painful. In the otorhinolaryngologic examination of the patient, there was a soft, painless, cystic mass in the posterior part of the upper inner quadrant of the right auricle just lateral to the sulcus. The mass was about 2x2 cm in size. The mass is totally excised under local anesthesia. In the macroscopic examination of specimen, the cyst was surrounded by a stratified squamous cell epithelium and the hair follicles were seen in the lumen. In the 4x10 microscopic examination with hematoxylin-eosinophil stain the cyst was surrounded by the stratified squamous cell epithelium and sebaceous glands were present in the dermis and hair follicle structures were seen in the cyst lumen. Histopathological examination results were reported as dermoid cyst.

Discussion

When we look at the literature, dermoid cysts of the auricle are extremely rare. Ikeda reported 2 cases of the dermoid cyst of the auricle.1 Later, Samper, Bauer, Meagher and DeSouza reported cases of postauricular dermoid cyst[4-7].In 2014, Horikiri et al. reported dermoid cyst of the auricle [8]. Jung et al. reported a case of the congenital dermoid cyst in the right auriculocephalic sulcus[9]. Byeon et al. reported a dermoid cyst on the posterior of the auricle[10]. Also,Wisevarver et al. reported a case of a dermoid cyst on the posterior of the right auricle [11]Nasirmohtaram et al. reported a case of a dermoid cyst located in the concha [12]. Kim et al. reported a case of acquired dermoid cyst and stated that it is not different from the congenital dermoid cyst. Congenital dermoid cyst is surrounded by normal tissues the acquired dermoid cyst is surrounded by fibrous scar tissue[13]. The differential diagnosis of the post auricular cyst includes the epidermal inclusion cyst, the trichilemmal cyst, the lipoma, and the hemangiomas. The trichilemmal or the sebaceous cysts are clinically similar to the epidermoid cysts. The diagnosis was confirmed histologically by the presence of the amorphous keratin material in the cyst cavity. The lipomas are common benign soft tissue adipose tumors and are similar to the dermoid cysts. Hemangiomas are present at birth and are benign tumors of the vascular endothelium and spontaneous involution is possible[8]. The treatment of the dermoid cyst is removal of the cyst wall with complete surgical excision. If it is not removed, it may result in relapse or infection[10].The treatment prevents the conversion to malignancy. As a result, the dermoid cysts are rare, usually benign, and very rarely malignant. They are congenital masses that can show transformation and can be seen in many parts of the body. They must be considered in the differential diagnosis of congenital ear masses, especially in the children.

For more Otolaryngology Journals please click on below link https://lupinepublishers.com/otolaryngology-journal/

For more Lupine Publishers Please click on below link https://lupinepublishers.com/

[kepcekulakameliyati]

Op.Dr.Ali Mezdeği Kimdir?

Ali Mezdeği Kahraman Maraş’ta 27 Ekim 1973 yılında dünyaya gelmiştir. İlk öğretimden liseye kadar eğitimini Kahraman Maraş’ta tamamladı. Tıp eğitimine 1991 senesinde Hacettepe Üniversitesinde başlayıp 1997 senesinde tamamladı.1998 senesinde İstanbul Üniversitesi Tıp Fakültesi (Çapa) Estetik,Plastik ve Rekonstrüktif Cerrahi Anabilim dalında başladığı ihtisasını 2004 yılında tamamladı.Ulusal ve uluslararası kongrelerde sunulmuş çok sayıda bildirisi ve poster sunumunun yanı sıra ulusal ve uluslar arası dergilerde kabul görmüş 13 adet bilimsel çalışması bulunmaktadır. Yurt içi ve yurt dışında düzenlenen bilimsel organizasyonları yakından takip etmektedir.Evli ve bir çocuk babasıdır.Özel ilgi alanları arasında Estetik Cerrahi ve Çene Cerrahisi ayrı bir yer tutmaktadır.Katıldığı Sempozyumlar, Kongreler ve Akademik Sertifika Programları:18-20 Haziran 2007 Estetik Plastik Cerrahi Derneği 11.Ulusal Kongre ve Yüz Estetik Cerrahi Kursu3-Mayıs-2007 Ortognatik Cerrahide Planlama Hacettepe Ünv.Tıp Fakültesi 21-25 Eylül 2004 26. Türk Plastik, Rekonstrüktif ve Estetik Cerrahi Ulusal Kongresi, ANKARA.18-20 Haziran 2004 Estetik Plastik Cerrahi Derneği 8.Ulusal Kongresi, İSTANBUL.27-29 Mayıs 2004 A.S.A.M.I. International 3. Kongresi-İSTANBUL13- Mart- 2004 Obstetrik Brakial Pleksus Yaralanmaları-Mezuniyet Sonrası Eğitim Toplantısı, İSTANBUL.25 Aralık 2003 ‘Yüzde Noninvazif Estetik Girişimler’ Paneli-İSTANBUL.6-7 Kasım 2003 ‘Maksillofasial Cerrahi ve Distraksiyon’ Kursu-ANKARA.18-20 Ekim 2002 Yeditepe Ünv.Diş Hekimliği Fak. Oral ve Maksillofasyal Cerrahide Güncel ve İleri Görüşler Sempozyumu- İSTANBUL.26-29 Mayıs 2002 ISAPS 2002(International Society of Aesthetic Plastic Surgery) XVI Kongresi, İSTANBUL.3-4 Mayıs 2002 GATA Plastik ve Rekonstrüktif Cerrahi AD. Maksillofasyal Cerrahi Çalıştay(Workshop) ve Kursu, ANKARA.27-30 Eylül 2001 23. Ulusal Türk Plastik Rekonstrüktif ve Estetik Cerrahi Kongresi, İSTANBUL.23-24 Kasım 2000 Turkish Symposium Contour Genesis Ultrasonic Assisted Lipoplasty, İSTANBUL.16-27 Ekim 2000 Şişli Etfal Hastanesi Plastik ve Rekonstrüktif Cerrahi Kliniği , Temel Mikrocerrahi Sertifika Programı, İSTANBUL.27-1 Ekim 2000 XXII. Ulusal Plastik Rekonstrüktif ve Estetik Cerrahi Derneği Kongresi, İZMİR.Yayınlanmış Yazıları: 1-Auricular reconstruction with prefabricated postauricular fasciocutaneous flap: Case reportVagıf KALENDER, Aret Çerçi ÖZKAN, Ufuk EMEKLİ, Aylin BİLGİN KARABULUT, Metin ERER, Atilla ARINCI, Ali MEZDEĞİ. Medical Bulletin of İstanbul Medical Faculty.2-Management of Donor Site of Prefabricated Temporalis Fascia Flap(Letter) Aylin Bilgin KARABULUT, Hülya AYDIN, Ali MEZDEĞİ. Plastic and Reconstructive Surgery.108(3):793-794, September 1, 2001.3-Recurrent Bleeding Following Rhinoplasty due to Factor XIII Deficiency(Letter) Aylin Bilgin KARABULUT, Hülya AYDIN, Ali MEZDEĞİ, Evin ADEMOĞLU. Plastic and Reconstructive Surgery. 108(3):808, September 1, 2001.4-Roberts Syndrome from the Plastic Surgeon’s Viewpoint(Letter) Aylin Bilgin KARABULUT, Hülya AYDIN, Metin ERER, Ali MEZDEĞİ, Erdem GÜVEN Plastic and Reconstructive Surgery. 108(5):1443-1445, October 2001.5-A fast and effective method of cartilage mincing:Turkish delight graft revisited(Letter) Ufuk EMEKLİ, Ali MEZDEĞİ, Burcu ÇELET ÖZDEN, Orhan ÇİZMECİ. European Journal of Plastic Surgery(2003) 26:164.6-The Effects of Hyperbaric Oxygen and Surgical Decompression in Experimental Compartment Syndrome. Figen AYDIN, Şamil AKTAŞ, Vakur OLGAÇ, Ali MEZDEĞİ, Sacit KARAMÜRSEL (Plastik Cerrahi tek isim ) Turkish Journal of Trauma and Emergency Surgery. 2003 Jul;9(3):176-182.7-Zone II fleksör tendon yaralanmalarında tendon protezi ile fleksör tendoplasti uygulamalarımız. Atakan AYDIN, Murat TOPALAN, Ali MEZDEĞİ, İlker SEZER, Türker ÖZKAN, Metin ERER,Zeynep HOŞBAY. Acta Orthopedica et Traumatologica Turcica 2003:37(5):374-378.8-Fleksör tendon yaralanmalarında tek seanslı fleksör tendoplasti. Atakan AYDIN, Murat TOPALAN, Ali MEZDEĞİ, İlker SEZER, Türker ÖZKAN, Metin ERER,Safiye ÖZKAN. Acta Orthopedica et Traumatologica Turcica 2004:38(1):54-59.9-Dorsal teknik ile el bilek artrodezi uygulamalarımız. Atakan AYDIN, Murat TOPALAN, Türker ÖZKAN, Metin ERER, Ali MEZDEĞİ, Gülnur ÖZTÜRK. Türk Plastik Rekonstrüktif Cerrahi Derneği dergisinde kabul edildi ve yayın sırası bekleniyor.10-Effects of amifostine on healing of microvascular anastomoses, flap survival, and nerve regeneration with preoperative or postoperative irradiation. Atakan AYDIN , Burcu ÇELET ÖZDEN , Ali MEZDEĞİ , Sıdıka KURUL , Rasim MERAL , Seyhun SOLAKOGLU. Microsurgery. 2004;24(5):392.Sunulmuş Bildiriler: 1-‘Posterior İnterosseoz Sinir Paralizisinde Rekonstrüksiyon’ Ayhan OKUMUŞ, Türker ÖZKAN, Atakan AYDIN, Ali MEZDEĞİ, Metin ERER, Safiye ÖZKAN. 27-1 Ekim 2000 XXII. Ulusal Plastik Rekonstrüktif ve Estetik Cerrahi Derneği Kongresi, İZMİR.2-‘Venöz Staz Sonrası Oluşan İskemi-Reperfüzyon Hasarında A ve E Vitamini Kombinasyon Tedavisi’ İrfan AYDIN, Aylin BİLGİN, Evin ADEMOĞLU, Ali MEZDEĞİ, Serdar TUNCER, Orhan ÇİZMECİ, Metin ERER. 27-1 Ekim 2000 XXII. Ulusal Plastik Rekonstrüktif ve Estetik Cerrahi Derneği Kongresi, İZMİR.3-‘Limitations in Mandibular Distraction; Istanbul Medical Faculty Experience’ Ali MEZDEĞİ, Burcu ÇELET ÖZDEN, Atilla ARINCI, Ufuk EMEKLİ 27-29 Mayıs 2004 A.S.A.M.I. International 3. Kongresi-İSTANBUL4-‘Endosteal Extra-Oral İmplant ile Kulak, Burun ve Soket Rekonstrüksiyonu’ Ali MEZDEĞİ, İsmail ERMİŞ, Sinan NUR KESİM, Ebru TUNCER, BanuKARAYAZGAN 21-25 Eylül 2004 26. Türk Plastik, Rekonstrüktif ve Estetik Cerrahi Ulusal Kongresi, ANKARA5-‘Mandibuler Distraksiyon Osteogenezis:İstanbul Tıp Fakültesi Deneyimi’ Ali MEZDEĞİ, Atilla ARINCI, İsmail ERMİŞ, Burcu ÇELET ÖZDEN, Sinan NUR KESİM 21-25 Eylül 2004 26. Türk Plastik, Rekonstrüktif ve Estetik Cerrahi Ulusal Kongresi, ANKARASunulmuş posterler: 1-‘Hemifasyal Mikrozomi Olgularında Mandibulanın Distraksiyon Osteogenezis Yöntemi ile Uzatılmasındaki Tecrübelerimiz’ Orhan ÇİZMECİ, Atilla ARINCI, İrfan AYDIN, Ali MEZDEĞİ 27-1 Ekim 2000 XXII. Ulusal Plastik Rekonstrüktif ve Estetik Cerrahi Derneği Kongresi, İZMİR.2-‘Bilateral Lateral Yüz Yarığı:Olgu Sunumu’Aret ÇERÇİ ÖZKAN, Ufuk EMEKLİ, Alp Aslan, Ali MEZDEĞİ, Sinan NUR KESİM 27-1 Ekim 2000 XXII. Ulusal Plastik Rekonstrüktif ve Estetik Cerrahi Derneği Kongresi, İZMİR.3-‘Ekspanse Edilmiş Prefabrike Supraklavikuler Deri Flebi ile Konjenital Dev Nevüs Rekonstrüksiyonu:Vaka Sunumu’Erdem GÜVEN, Aret ÇERÇİ ÖZKAN, Ufuk EMEKLİ, İsmail ERMİŞ, Ali MEZDEĞİ, İrfan AYDIN 27-30 Eylül 2001 23. Ulusal Türk Plastik Rekonstrüktif ve Estetik Cerrahi Kongresi, İSTANBUL.4-‘Deri Koruyucu Olmayan Mastektomide Doku Genişletici ile Genişletilmiş Göğüs Duvarı Derisinin Altına Dezepitelize Edilerek Yerleştirilen Pediküllü TRAM Flep ile Geç Meme Onarımı: Vaka Sunumu’ Aret ÇERÇİ ÖZKAN, Orhan ÇİZMECİ, Serdar EREN, Hülya AYDIN, Ali MEZDEĞİ, Serdar TUNCER, Erdem GÜVEN, Funda AKÖZ 27-30 Eylül 2001 23. Ulusal Türk Plastik Rekonstrüktif ve Estetik Cerrahi Kongresi, İSTANBUL.5-‘Vaka Sunumu:Masseter Absesi Sonrası Gelişen Masseterik Fibrozis ve Buna Bağlı Gelişen Ekstraartiküler Ankiloz’Ali MEZDEĞİ, Erdem GÜVEN, Orhan ÇİZMECİ, Alp Aslan, Metin ERER. 27-30 Eylül 2001 23. Ulusal Türk Plastik Rekonstrüktif ve Estetik Cerrahi Kongresi, İSTANBUL.6-‘Vaka Sunumu:İdiopatik Skrotal Kalsinozis’ Ali MEZDEĞİ 27-30 Eylül 2001 23. Ulusal Türk Plastik Rekonstrüktif ve Estetik Cerrahi Kongresi, İSTANBUL.7-‘Tırnak Yatağı Defektlerinin Steril Matriks Greftleri ile Rekonstrüksiyonu’ Serdar TUNCER, Ali MEZDEĞİ, Atakan AYDIN, Türker ÖZKAN, Metin ERER. 27-30 Eylül 2001 23. Ulusal Türk Plastik Rekonstrüktif ve Estetik Cerrahi Kongresi, İSTANBUL.8-‘Mandibula Kondiler Bölge ve Koronoid Çıkıntıdan Kaynaklanan Osteokondromlar’ Alp Aslan, Ufuk EMEKLİ, İsmail ERMİŞ, Orhan ÇİZMECİ, DefneÖNEL,Ali MEZDEĞİ, Erdem GÜVEN. 27-30 Eylül 2001 23. Ulusal Türk Plastik Rekonstrüktif ve Estetik Cerrahi Kongresi, İSTANBUL.Tez Çalışması: ‘Mandibuler Distraksiyon Osteogenezis’ adlı klinik tez çalışması Haziran-2003 de takdim edildi ve tez jürisi tarafından yeterli bulundu.Op. Dr. Ali Mezdeği ile operasyon randevusu almak için buraya tıklayınız. http://kepcekulakoperasyonu.com/op-dr-ali-mezdegi/

[uni-med]

Griesinger Sign

Refers to oedema and tenderness of the postauricular soft tissues overlying the mastoid process as a result of thrombosis of the lateral sinus. It is a complication of acute otomastoiditis and may be associated with dural sinus occlusive disease (DSOD).

[cilein]

Base of skull fractures can produce the clinical signs seen in my caretoon:

‘Raccoon eyes’ AKA periorbital bruising This is bruising around the eyes, sometimes seen with tarsal plate sparing; this is where the bruising doesn’t cover the upper eyelid, which contains the ‘tarsal plate’, a small area of connective tissue which helps stop the eyelid inverting when opening and closing the eye.

Blood or CSF rhinorrhoea (nose leakage) and otorrhoea (ear leakage) These fluids may leak from the nose or ear. CSF is cerebrospinal fluid; the clear fluid which surrounds the brain and spinal cord.

Haemotympanum This is blood seen behind the eardrum (AKA tympanic membrane) when using an otoscope, the tool a doctor uses to look inside the ear canal.

‘Battle sign’ AKA postauricular bruising Bruising may appear behind the ear.

These clinical signs occur in base of skull fractures, when the cracked bone, or trauma that caused it, results in damage to the blood vessels or/and brains covering, allowing leakage of their contents into these areas of the head and neck.

They make up a classic set of signs emergency doctors will look for when assessing patients who have had a head injury. They can be a marker of how severe the trauma has been, and alert medics to consider further imaging (scans) to go looking for further damage or compromise to structures within the skull.

These signs are important ‘free information’ to pick up if you have a sharp eye!

Share, and follow artibiotics to keep up with my medical articles as they drop!

[smbalaji]

Anotia Defect Repair using Costal Grafts This gentleman was born with anotia of the right ear with only a peanut sized rudimentary structure in place. Anotia is the congenital absence of the external ear. There was also complete absence of the external ear canal. His parents presented to our hospital for management of his ear deformity. It was explained to them that reconstruction would be done in two stages and they consented to the treatment plan. A template was first made using the left ear to ensure that the reconstructed right ear was symmetrical to the normal left ear. Costal rib graft with perichondrium was then harvested from the patient. The graft was crafted using the template. Markings were made in the region of the deformed right ear and a subcutaneous pocket was created. The crafted cartilaginous graft was placed in the pocket and the incision was closed with sutures. The second stage was then performed in six months with lifting up of the cartilaginous graft along with placement of a skin graft in the postauricular region. Skin graft was harvested from the inguinal region. This resulted in perfect reconstruction of his absent right ear. He and his parents were ecstatic with the final results of the surgery and profusely thanked the surgical team. 📞 Phone: +91 44 4294 7222 📬 Email: smbalaji@gmail.com 🌍 Website: www.smbalaji.com 📍 Location: Chennai, India #anotia #costalgraft #drsmbalaji #smbalaji #balajidental #maxillofacialsurgeon #maxillofacialsurgery #india #chennai #tamilnadu #eardefect https://www.instagram.com/p/CDTo0Kgn8U1/?igshid=1vxdvckriymi7

[cirujanoplasticocirupla]

Earlobe Reconstruction With an Anterior Postauricular Flap

http://dlvr.it/RYHxVx

[hellothihaaung]

10 อันดับ คลินิกตัดกรามที่ดีที่สุด

สิ่งที่คุณต้องรู้เกี่ยวกับ Jaw Shaping ในวังทองหลาง

หรือที่เรียกว่า Mandibular Angle Reduction, V Line Surgery หรือ Jaw Line Surgery การรักษาประเภทนี้ดำเนินการโดยมีวัตถุประสงค์เพื่อลดส่วนล่างของใบหน้าโดยเน้นเฉพาะที่ขากรรไกรล่าง (ขากรรไกรล่าง) และสิ่งที่แนบมาของกล้ามเนื้อ มุมกรามกว้างอาจเกิดจากกล้ามเนื้อกระดูกหรือการรวมกันของทั้งสอง มุมกรามที่โดดเด่นหรือกรามสี่เหลี่ยมจัตุรัสถือเป็นลักษณะของผู้ชายโดยเฉพาะในประเทศแถบเอเชีย ดังนั้นคนจำนวนมากเลือกใช้การแก้ไขการผ่าตัดเพื่อให้ได้ลักษณะที่ต้องการ การผ่าตัดสามารถย่นกรามที่ยาวเกินไปและเปลี่ยนหน้ารูปสี่เหลี่ยมเป็นรูปวงรี  10-อันดับ-คลินิกตัดกรามที

มีองค์ประกอบที่สำคัญหลายอย่างที่เกี่ยวข้องในการผ่าตัดรวมถึงมุมของกราม, ร่างกายของขากรรไกรล่างและรูปร่างของคาง มันมักจะดำเนินการกับผู้หญิงที่มีกรามสแควร์ที่ต้องการดูเป็นผู้หญิงมากขึ้น สามารถทำได้ทั้งชายและหญิง อย่างไรก็ตามขั้นตอนนี้อาจไม่เหมาะสำหรับผู้ที่ต้องการทำให้ใบหน้าของผู้หญิงเป็นผู้ชายเพราะผู้ชายมักจะมีใบหน้าที่สูงและยาวกว่า ดังนั้นการผ่าตัด V Line จะทำให้ใบหน้าดูยาวขึ้นเท่านั้น

ขั้นตอน

การพัฒนาพิการ แต่กำเนิดหรือความผิดปกติบางอย่างที่หายากเช่น acromegaly สามารถทำให้เกิดขากรรไกรล่างที่ขยายใหญ่ซึ่งสามารถแก้ไขได้โดยการผ่าตัดแนวกราม มันเหมาะสำหรับผู้ที่มีกรามมากเกินไปที่มีรูปสี่เหลี่ยมจัตุรัสหรือรูปตัวยูรูปร่างกรามลูกผู้ชายมากเกินไปแก้มป่องและคางสอง หากคุณกำลังพิจารณาการผ่าตัด V line คุณจะต้องมีสุขภาพร่างกายและจิตใจที่ดี ก่อนการผ่าตัดผู้ป่วยจะได้รับการตรวจด้วยเครื่องเอกซเรย์และการสแกน CT 3D โครงสร้างโดยรวมของขากรรไกรถูกวิเคราะห์และประเมินผลโดยศัลยแพทย์เพื่อสร้างแผนการในการสร้างผลลัพธ์ที่ต้องการ คุณจะต้องผ่านการทดสอบทางการแพทย์เช่นคลื่นไฟฟ้าหัวใจเพื่อให้แน่ใจว่าคุณมีเงื่อนไขที่อาจทำให้คุณตกอยู่ในอันตรายหรือประนีประนอมความสำเร็จของการผ่าตัด

การผ่าตัดจะดำเนินการภายใต้ยาชาทั่วไปผ่านการใส่ท่อช่วยหายใจและทำให้เกิดแผลเป็นน้อยที่สุด คุณจะต้องอดอาหารเป็นเวลา 8 ชั่วโมงก่อนการผ่าตัด เลื่อยสั่นจะใช้ในการปรับรูปร่างกราม การผ่าตัดสามารถทำได้ภายในช่องปาก (ในช่องปาก) หรือจากด้านนอกปาก (postauricular) วิธีการในช่องปากเป็นวิธีที่ใช้กันอย่างแพร่หลาย ด้วยวิธีนี้แผลจะถูกสร้างขึ้นระหว่างเหงือกและด้านหลังของแก้มถัดจากขากรรไกร จากนั้นกรามจะถูกแกะสลักออกเป็นรูปร่างที่ต้องการ ส่วนหนึ่งของกล้ามเนื้อ masseter ถูกโกนออกและส่วนนอกของกระดูกถูกตัดออก วิธีนี้เป็นวิธีที่ดีที่สุดสำหรับผู้ป่วยที่ต้องการลดมุมมองด้านหน้าเนื่องจากการเปลี่ยนแปลงนั้นบอบบางและเป็นธรรมชาติ

หากผู้ป่วยต้องการเปลี่ยนรูปลักษณ์ของมุมกรามจากมุมมองด้านข้างโครงร่างโดยรวมของกระดูกจะต้องมีการเปลี่ยนแปลง ซึ่งหมายความว่าผู้ป่วยต้องการการกำจัดกระดูกที่หนาอย่างสมบูรณ์ แม้ว่าจะสามารถทำได้ด้วยวิธีการทางหลอดเลือดดำ แต่ในทัศนะของศัลยแพทย์ในช่วงเวลานี้มีข้อ จำกัด อย่างมากซึ่งสามารถลดความแม่นยำของกระบวนการได้ ดังนั้นวิธีการที่ดีที่สุดมาจากด้านนอกของปากหรือ postauricular เพื่อให้สามารถเข้าถึงกระดูกโดยตรงศัลยแพทย์จะทำแผลซ่อนไว้ที่หู วิธีนี้สามารถกำจัดกระดูกจำนวนมากขึ้น เวลาในการพักฟื้นโดยใช้วิธีนี้จะสั้นกว่าวิธีการทางเดินหายใจเช่นกันเนื่องจากอาการบวมจะ จำกัด อยู่ที่บริเวณคอ

ระยะเวลาการเข้าพักในวังทองหลาง

ระยะเวลาโดยทั่วไปสำหรับ Jaw Shaping มักใช้เวลาประมาณ 2 ชั่วโมง อย่างไรก็ตามคุณต้องอยู่ในโรงพยาบาลเป็นเวลาประมาณหนึ่งถึงสองวันสำหรับการฟื้นฟูครั้งแรกซึ่งคุณจะได้รับการตรวจสอบเพื่อให้แน่ใจว่าทุกอย่างเรียบร้อยดี หลังจากออกจากโรงพยาบาลวางแผนที่จะอยู่ในวังทองหลางเป็นเวลา 10 ถึง 14 วันหรือจนกว่าศัลยแพทย์จะบอกว่าคุณสามารถกลับบ้านได้ โดยทั่วไปแผลจะถูกเอาออกภายในสองสัปดาห์หลังการผ่าตัดถึงแม้ว่าสิ่งนี้อาจแตกต่างกันไปในแต่ละผู้ป่วย

เวลาการกู้คืน

ทันทีหลังการผ่าตัดคุณจะต้องสวมหน้ากากใบหน้าที่กดแน่นกับผิวรอบ ๆ กรามเพื่อให้หลังการผ่าตัดบวมลง นอกจากนี้คุณจะไม่ได้รับอนุญาตให้กินอาหารที่ต้องเคี้ยวเพราะมันจะชะลอการฟื้นตัวและอาจทำให้เลือดออก หากคุณเข้ารับการฉีดยาเข้าทางช่องปากการบริโภคอาหารของคุณจะถูก จำกัด เป็นระยะเวลานาน คุณอาจรู้สึกว่ามีอาการบวมมึนงงและไม่สบายบริเวณรอบ ๆ แผลเป็นเวลาหลายวัน แต่ศัลยแพทย์จะสั่งยาเพื่อรักษาอาการปวด

ระยะเวลาพักฟื้นอาจแตกต่างกันไปในแต่ละบุคคล บางคนอาจกลับไปใช้ชีวิตตามปกติได้หลังจากเจ็ดถึงสิบวัน แต่คนอื่นอาจต้องการเวลามากขึ้นในการฟื้นฟูอย่างเต็มที่ หลีกเลี่ยงการออกกำลังกายอย่างหนักที่เพิ่มความดันโลหิตของคุณเป็นเวลาหลายสัปดาห์เช่นวิ่งเหยาะๆและออกกำลังกายอื่น ๆ อาการที่มองเห็นได้ส่วนใหญ่เช่นบวมและช้ำควรหายไปภายในสองสามสัปดาห์ อาการเช่นเลือดและการติดเชื้อเป็นเรื่องปกติและมักจะบรรเทาลงภายในสามถึงหกเดือนหลังการผ่าตัด

aftercare

คุณต้องทำตามคำแนะนำของศัลยแพทย์หลังจากการดูแลอย่างเคร่งครัดเพื่อเร่งการฟื้นตัวและลดความยุ่งยากให้น้อยที่สุด คำแนะนำจะมีคำแนะนำต่อไปนี้:

การทานอาหาร. คุณอาจต้องกินอาหารเหลวเป็นเวลาหนึ่งสัปดาห์หลังการผ่าตัดเนื่องจากการดื่มอาหารของคุณเจ็บปวดน้อยลงและป้องกันการบาดเจ็บที่บริเวณขากรรไกร คุณควรจะกินอาหารที่ยากภายในหนึ่งเดือน

สุขอนามัยช่องปาก. น้ำยาบ้วนปากที่ต้านเชื้อแบคทีเรียจะทำให้ปากและบริเวณแผลของคุณสะอาดซึ่งจะลดโอกาสในการติดเชื้อ

หลีกเลี่ยงยาสูบและแอลกอฮอล์ ควรหลีกเลี่ยงการสูบบุหรี่และดื่มแอลกอฮอล์ชั่วระยะเวลาหนึ่ง

ยกศีรษะให้สูง คุณควรรักษาระดับศีรษะให้สูงแม้ว่าคุณจะนอนหลับเพราะเป็นกุญแจสำคัญในการลดอาการบวม

ผ้าพันแผลบีบอัด คุณควรสวมผ้าพันแผลบีบอัดตลอดเวลาในช่วงสามวันแรกและในขณะนอนหลับในช่วงหนึ่งหรือสองสัปดาห์แรก

หลีกเลี่ยงกิจกรรมที่ใช้พลัง อย่ายกของหนักหรือออกกำลังกายอย่างน้อยหนึ่งเดือน อย่างไรก็ตามอย่าเดินไปรอบ ๆ และฝึกฝนการเคลื่อนไหวที่อ่อนโยน

เข้าร่วมติดตามการนัดหมาย ศัลยแพทย์จะตรวจสอบความคืบหน้าของคุณเพื่อหลีกเลี่ยงภาวะแทรกซ้อนใด ๆ

โอกาสสำเร็จ

ผู้ป่วยประมาณ 94% แสดงความพึงพอใจต่อขั้นตอนนี้ อย่างไรก็ตามสิ่งสำคัญคือต้องมีความคาดหวังที่สมจริง คุณควรตระหนักถึงความเสี่ยงที่อาจเกิดขึ้นจากการผ่าตัดนี้ ความเสี่ยงเหล่านี้รวมถึงการติดเชื้อไม่สมส่วนเซรั่มการอุดตันของหลอดเลือดดำลึกเส้นเลือดอุดตันที่ปอดและเลือด อาการชาบางส่วนของขากรรไกรสามารถเกิดขึ้นได้เนื่องจากความเสียหายของเส้นประสาท

ทางเลือกของ Jaw Shaping

หากคุณต้องการเปลี่ยนรูปร่างของขากรรไกร แต่ไม่ต้องการเข้ารับการผ่าตัดมีตัวเลือกที่ไม่ต้องผ่าตัด ทางเลือกที่ได้รับความนิยมมากที่สุดคือ Botox และ Dysport ซึ่งสามารถกรอรูปร่างของขากรรไกรได้อย่างมีประสิทธิภาพโดยการผ่อนคลายลักษณะที่ปรากฏของขากรรไกรแบบสี่เหลี่ยม ขั้นตอนนี้จะทำให้กล้ามเนื้อ masseter ลดลง ฉีดเหล่านี้ยังสามารถใช้ในการแก้ไขความไม่สมดุลของใบหน้ารอบ ๆ บริเวณกราม เนื่องจากมันไม่รุกรานคุณสามารถกลับสู่การเปิดใช้งานรายวันของคุณได้ทันทีและพวกเขาจะเสนอการเปลี่ยนแปลงที่ต่ำกว่าในรูปลักษณ์ของคุณ อย่างไรก็ตามเทคนิคเหล่านี้ถูก จำกัด ในกรณีที่นักการตลาดขยายและอาจไม่ทำงานเช่นเดียวกับการผ่าตัด V Line

โรงพยาบาลกมล

กรุงเทพมหานคร, ประเทศไทย 4.8 16 บทวิจารณ์ 2009 ทรงสร้างรูปทรงที่โรงพยาบาลกมล

โรงพยาบาลกมลขอเสนอขั้นตอนการสร้างขากรรไกรในราคาระหว่าง 150,000 ถึง 157,000 บาท ศูนย์การแพทย์ตั้งอยู่ในวังทองหลางกรุงเทพฯและดำเนินการ 36 ขั้นตอนใน 7 พิเศษ ห่างจากตัวเมือง 14.8 กม. และก่อตั้งขึ้นในปี 2009 ม. ค. รู้สึกฟรีเพื่อขอใบเสนอราคาฟรีและทีมงานของเราจะเปรียบเทียบราคาและค่าใช้จ่ายสำหรับขากรรไกร Shaping ในวังทองหลางและสร้างรายการคลินิกที่เหมาะสมที่สุด

฿ 150,000

การสร้างขากรรไกร

ดูความคิดเห็นของผู้อื่นเกี่ยวกับ Jaw Shaping ในวังทองหลางที่โรงพยาบาลยันฮีและเปรียบเทียบราคาและราคา | BK-488

โรงพยาบาลยันฮี

กรุงเทพ, ประเทศไทย 4.4 388 ความคิดเห็น 1984 งานสร้างที่โรงพยาบาลยันฮี

โรงพยาบาลยันฮีเริ่มเปิดขั้นตอนการสร้างขากรรไกรด้วยราคาเริ่มต้นเพียง 110,000 บาท ศูนย์การแพทย์ตั้งอยู่ในเขตบางพลัดกรุงเทพฯและดำเนินการ 44 ขั้นตอนใน 8 พิเศษ ห่างจากสนามบินสุวรรณภูมิ 41.8 กม. และก่อตั้งขึ้นในปี 1984 ม.ค. รู้สึกฟรีเพื่อขอใบเสนอราคาฟรีและทีมงานของเราจะเปรียบเทียบราคาและค่าใช้จ่ายสำหรับขากรรไกร Shaping ในวังทองหลางและสร้างรายการคลินิกที่เหมาะสมที่สุด

฿ 110,000

การสร้างขากรรไกร

ดูความคิดเห็นของผู้อื่นเกี่ยวกับ Jaw Shaping ในวังทองหลางที่ Nirunda International Aesthetic Clinic และเปรียบเทียบราคาและราคา | BK-513

คลินิกความงามนิรันดาอินเตอร์เนชั่นแนล

กรุงเทพมหานคร, ประเทศไทย 4.9 10 รีวิว 2550 ทรงสร้างขากรรไกรที่คลินิกความงามนานาชาตินิรันดา

Nirunda International Aesthetic Clinic นำเสนอขั้นตอนการสร้างขากรรไกรด้วยราคาเริ่มต้นเพียง 126,000 บาท ศูนย์การแพทย์ตั้งอยู่ในเขตคลองเตยกรุงเทพฯและดำเนินการ 44 ขั้นตอนใน 5 พิเศษ ห่างจากตัวเมือง 2.2 กม. และก่อตั้งขึ้นในปี 2007 มก. รู้สึกฟรีเพื่อขอใบเสนอราคาฟรีและทีมงานของเราจะเปรียบเทียบราคาและค่าใช้จ่ายสำหรับขากรรไกร Shaping ในวังทองหลางและสร้างรายการคลินิกที่เหมาะสมที่สุด

สถาบันศัลยกรรมความงามภูเก็ต (PPSI)

จังหวัดภูเก็ต, ประเทศไทย 4.8 18 รีวิว 2016Jaw Shaping ที่สถาบันศัลยกรรมตกแต่งภูเก็ต (PPSI)

สถาบันศัลยกรรมความงามภูเก็ต (PPSI) กำลังเสนอขั้นตอนการขากรรไกรและราคาอยู่ในช่วงระหว่าง 200,000 ถึง 230,000 บาท ศูนย์การแพทย์ตั้งอยู่ในเมืองภูเก็ตภูเก็ตและดำเนินการ 39 ขั้นตอนใน 5 ความเชี่ยวชาญ ห่างจากสนามบินนานาชาติภูเก็ต 28.6 กม. และก่อตั้งขึ้นในปี 2559 คุณสามารถขอใบเสนอราคาฟรีและทีมงานของเราจะเปรียบเทียบราคาและค่าใช้จ่ายสำหรับขากรรไกร Shaping ในวังทองหลางและสร้างรายการคลินิกที่เหมาะสมที่สุด

฿ 200,000

การสร้างขากรรไกร

ดูความคิดเห็นของผู้อื่นเกี่ยวกับ Jaw Shaping ในวังทองหลางที่ V Plast Clinic Pattaya และเปรียบเทียบค่าใช้จ่ายและราคา | PA-50

V Plast Clinic Pattaya

พัทยา, ประเทศไทย 0 0 รีวิว 2001 ขาสร้างใน V Plast Clinic Pattaya

V Plast Clinic Pattaya ขอเสนอขั้นตอนการทำขากรรไกรด้วยราคาเริ่มต้นเพียง 120,000 บาท ศูนย์การแพทย์ตั้งอยู่ในเมืองพัทยาพัทยาและดำเนินการ 34 ขั้นตอนใน 5 ความเชี่ยวชาญ ห่างจากหาดพัทยากลาง 4.2 กม. และก่อตั้งขึ้นในปี 2544 เม.ย. รู้สึกฟรีเพื่อขอใบเสนอราคาฟรีและทีมงานของเราจะเปรียบเทียบราคาและค่าใช้จ่ายสำหรับขากรรไกร Shaping ในวังทองหลางและสร้างรายการคลินิกที่เหมาะสมที่สุด

[arrangoiz]

Merkel cell carcinoma (MCC) is the eponym for :

Primary cutaneous neuroendocrine carcinoma:

A dermal neoplasm with cytoplasmic, dense-core neuroendocrine granules and keratin filaments. 

MCC is a rare primary cutaneous neuroendocrine malignancy

The incidence of MCC in the United States has recently been reported to have increased by an estimated annual percentage change of 8% from 1986 to 2001:

Approximately 1500 new cases were predicted by the American Cancer Society in the United States alone in 2008. 

MCC is one of the few cancers found to be:

Associated with immune suppression

Polyomavirus has been shown to be integrated within the genome

Merkel cell carcinoma (MCC) is an uncommon and aggressive cutaneous neoplasm that lacks distinguishing clinical features. 

More than half of Merkel cell carcinomas (MCCs) occur in the head and neck of elderly people in areas of actinically damaged skin:

The most common site of occurrence is the periorbital region. 

Merkel cell carcinoma (MCC) has a propensity to recur and to cause:

Local (25% to 30% of the cases) and distant metastases (30% to 35% of the cases). 

Distant metastases indicate a condition that is nearly always fatal.

Merkel cell carcinoma (MCC) is a deadly disease with a poor likelihood for survival:

Local recurrence occurs in:

44% of patients:

Multiple local recurrences occur in 15% of patients. 

These tumors appear as:

Rapidly growing, painless nodules in elderly caucasian individuals or in young adults with ectodermal dysplasia syndromes. 

Merkel cell carcinomas (MCCs) usually appear as:

Indurated plaques or violaceous (red or deep purple) solitary and dome-shaped nodules. 

The surface is typically shiny, with telangiectasias and possibly ulceration. 

Most tumors measure 0.7 cm to 1.2 cm in diameter.

Merkel cell carcinomas (MCCs) usually occur in sun-damaged skin. 

They are often found near other lesions of actinically damaged skin, including skin involved with:

Bowen disease, squamous cell carcinoma, basal cell carcinoma, solar keratoses, or lentigo maligna. 

The mean age at presentation is 68 years:

No gender bias is observed. 

Merkel cell carcinoma (MCC) has also been linked to:

Previous radiation exposure and B-cell lymphoma.

The nonspecific characteristics of Merkel cell carcinoma (MCC) lead to a lengthy differential diagnosis that includes:

Basal cell carcinoma

Squamous cell carcinoma

Keratoacanthoma

Amelanotic melanoma

Epidermal cysts

Lymphoma

Metastatic carcinoma of the skin

As a result:

Merkel cell carcinoma (MCC) is rarely diagnosed until biopsy is performed

Approximately 53% of Merkel cell carcinomas (MCCs) occur in the head and neck:

35% occur in the extremities. 

In the head and neck:

46% of tumors occur in the periorbital region

29%, on the cheek

18%, on the eyelid

17%, on the forehead. 

Other sites in the head and neck include:

The lips (9%)

Ears (7%)

Nose and neck (5.4%)

Scalp (4%)

Tumors have also been reported in areas not exposed to sun, such as the:

Nasal cavity

Buccal mucosa

Gingiva

Hard palate

Postauricular skin

Approximately 3% of patients with Merkel cell carcinoma (MCC) have tumors at several sites. 

MCC is an aggressive tumor:

With an overall five-year survival of 40%

Reported five year survival rates of local, nodal and metastatic disease are:

64%, 39% and 18%, respectively

Reported rates of regional lymph node involvement at the time of presentation vary from 10% to 45%:

Around 50% of patients with lymph node metastases harbor concurrent distant metastases:

Most often in the:

Liver, lung, brain, bone or skin

MCC has high rates of local recurrence:

25% to 30% of patients.

MCC has high rates of distant metastasis:

30% to 35% of patients.

  Rodrigo Arrangoiz MS, MD, FACS a head and neck surgeon / endocrine surgeon / surgical oncologist and is a member of Sociedad Quirúrgica S.C at the America British Cowdray Medical Center in Mexico City:

He is an expert in the management Merkel Cell Carcinoma.

Training:

• General surgery:

• Michigan State University:

• 2004 al 2010

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• Fox Chase Cancer Center (Filadelfia):

• 2010 al 2012

• Masters in Science (Clinical research for health professionals):

• Drexel University (Filadelfia):

• 2010 al 2012

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• IFHNOS / Memorial Sloan Kettering Cancer Center:

• 2014 al 2016

#Arrangoiz#Teacher

#Surgeon

#Cirujano

#ThyroidExpert

#ThyroidSurgeon

#CirujanodeTiroides

#ExpertoenTiroides

#ExpertoenParatiroides

#Paratiroides

#Hiperparatiroidismo

#CancerdeTiroides

#ThyroidCancer

#PapillaryThyroidCancer

#SurgicalOncologist

#CirujanoOncologo

#CancerSurgeon

#CirujanodeCancer

#HeadandNeckSurgeon

#CirugiaEndocrina

#EndocrineSurgery

#CirujanodeCabezayCuello

http://www.cirugiatiroides.com

http://www.sociedadquirurigca.com

http://www.hiperparatiroidismo.info

Merkel Cell Carcinoma (MCC) Merkel cell carcinoma (MCC) is the eponym for : Primary cutaneous neuroendocrine carcinoma: A dermal neoplasm with cytoplasmic, …

[jerrytackettca]

Smell Our Most Underestimated Sense

We humans do not appreciate our sense of smell. Compared to other senses like vision and hearing, we tend to ignore the information from our sense of smell with the exception of flowers, food being prepared and, of course, those lucky people who have discovered aromatherapy.

But according to a recent documentary, "Smell — Our Most Underestimated Sense," our sense of smell affects us much more than we realize. Certainly, we know that it protects us from dangers like fire because we smell the smoke, explosions because we smell natural gas and food poisoning because we smell spoilage. But few realize our sense of smell also lets us "read" other people much like dogs "read" each other by sniffing.

Of course, the olfactory read that humans conduct is not as obvious as that of dogs sniffing but, according to this film, people will oftentimes sniff their hands after shaking hands with someone new, indicating that important information has been gained. The sense of smell also helps newborns bond with their mothers, and "smell dysfunction" can impair such bonding.

Nevertheless, smell is so underappreciated people interviewed in the documentary said they would rather lose it than their "access to technology," such as their smart phones. If you're inclined to agree, after watching this remarkable documentary, you just might change your mind.

Aromatherapy Takes a Clue From Nature

I am a big believer in aromatherapy, which is based on the use of essential oils, also called volatile oils. In addition to inducing relaxation and sleep, and reducing blood pressure1 and stress, aromatherapy may be beneficial for depression,2 anxiety,3 dementia4 and pain relief.5

According to "Smell — Our Most Underestimated Sense," plants and flowers also use these healing fragrances for themselves! For example, flowers deliberately emit the chemical signals of a female bee so that the male bee will "mate" with the flower and pollinate it. Certain birds, butterflies, bats, moths and even honey possum also pollinate flowers.

The irreplaceable services of these pollinators are seriously threatened by pesticides and chemicals, posing an environmental crisis. It is important to remember that every time you shop for organic food you vote against these harmful chemicals that are creeping into our daily life.

Interestingly, the least pretty flowers are often the most fragrant ones, because they cannot rely on their visual beauty to attract pollinators says the documentary, Moreover, plants can emit odors to warn other plants of impending insect attacks, just as animals warn others about imminent predators.

Sensing Others Through Our Sense of Smell

Many have heard of the phenomenon of menstrual synchrony in which women who live or work together can begin to have their periods at the same time.6 In a T-shirt sniff study, says the documentary, women's testosterone levels changed in response to the scent of another woman, depending on where that woman was in her monthly cycle — though, of course, the women were not consciously aware of this.

Paul Moore, a professor at Bowling Green State University who specializes in chemical ecology and the role chemical signals play in an organism's ecological role, explains the reaction like this:7

"The chemical senses, I call them ninjas — they're hidden. So, they go into our brain, and we're not aware of it, we're not conscious of it, so it makes us respond emotionally, respond physiologically, before we actually think about the response. So, it's very subtle and it's very hidden ...

Testosterone is tied very much to social dominance and in competitiveness and aggression. And up-regulating or down-regulating testosterone through chemical signals could change your competitiveness."

Why would this happen? From an evolutionary standpoint, fertility could be governed by a competition won by dominant females so that less "alpha" females would cease to compete for males at a certain time.

The Hidden Powers of a Handshake

Our sense of smell does not just determine sexual rivals and fertility competition. In one study cited by the documentary, a hidden camera filmed people meeting strangers for the first time and sometimes shaking their hands. Greeters who shook hands smelled their hands afterward twice as often as those who didn't shake hands, presumably accessing the "information" the handshake gleaned.

Shaking hands is likely a human version of dogs sniffing each other — a way of acquiring a lot of social information in one quick impression, says Moore. When dogs sniff each other upon meeting, for example:

"They're sniffing and saying, 'Oh, I played with you last week. You're a good dog to play with,' or 'I smell you from last week. You were a little mean, so I'm not going to play with you.' They're going to pick up their dominant status, social status, their reproductive status, what they've eaten. All that kind of stuff that you and I would share in a conversation with words, they share with chemical signals. Their whole world is sense of smell."

Man's Best Friend Can Save Our Lives

One of the most dramatic facts shared in "Smell — Our Most Underestimated Sense," is dogs' proven ability to detect cancer in humans from subtle smells in breath, skin and more. Dogs have up to 300 million receptor nerve cells that detect smell (compared to 5 million in humans) and some dogs have been successfully trained to detect human cancers.

In a 2015 study published in the Israel Medical Association Journal,8 two dogs picked out the breast cancer cell cultures that they had been trained to detect 100 percent of the time. These "detective" dogs even picked out cancer specimens they were not trained to detect, but they never picked out control (noncancer) specimens, meaning "false positives," which plague diagnostic methods that are more high-tech than dogs.

The dogs picked out early-stage cancer as well as advanced cancer with amazing accuracy and specificity — a skill that would clearly save lives. In a 2017 study published in the European Journal of Cardio-Thoracic Surgery,9 a trained dog was also able to detect early lung cancer from the exhaled breath of patients with remarkable accuracy. Here is what the researchers wrote:

"After appropriate training, we exposed the dog (a 3-year-old cross-breed between a Labrador retriever and a pitbull) to 390 samples of exhaled gas collected from 113 individuals (85 patients with LC [lung cancer] and 28 controls, which included 11 patients without LC and 17 healthy individuals) for a total of 785 times.

The trained dog recognized LC in exhaled gas with a sensitivity of 0.95, a specificity of 0.98, a positive predictive value of 0.95 and a negative predictive value of 0.98."

Other Cancers Are Being Detected by Dogs

Canine olfactory abilities are also being studied in the screening for colorectal cancer (CRC) which takes the lives of approximately 50,630 Americans per year.10 This is what researchers writing in a 2010 article in BMJ said:11

"Among patients with CRC and controls, the sensitivity of canine scent detection of breath samples compared with conventional diagnosis by colonoscopy was 0.91 and the specificity was 0.99.

The sensitivity of canine scent detection of stool samples was 0.97 and the specificity was 0.99. The accuracy of canine scent detection was high even for early cancer. Canine scent detection was not confounded by current smoking, benign colorectal disease or inflammatory disease."

Such noninvasive and economical methods for early detection of colorectal cancer that avoid colonoscopy are sorely needed. Currently the occult blood test is one of the few affordable tests in the doctors' colorectal cancer arsenal.

Dogs can also detect the specific volatile organic compounds associated with prostate cancer in urine samples with high estimated sensitivity and specificity according to a 2015 study.12

And, in a 2013 study, dogs correctly identified all 42 blood samples of patients with ovarian cancer, achieving an accuracy rate of 100 percent.13 Even more encouraging, the dogs could determine whether cancer cells remained after surgery, which is crucially important since doctors generally cannot determine if residual cancer cells remain.

How Were Dogs' Medical Abilities Discovered?

How did an awareness of such canine abilities and their possible use in medicine develop? Here is how the researchers trace the origins of such dog detections:

"The idea of using a dog's olfactory sense for the early detection of cancer was first raised by Williams and Pembroke and reported in The Lancet in 1989. These authors described the case of a patient who visited the clinic because her dog showed a particular interest in a skin nevus she had. Following its excision, the pathological examination revealed malignant melanoma."

A 2013 case report in BMJ (previously the British Medical Journal) reported a similar phenomenon.14

"Our patient is a 75-year-old man who presented after his pet dog licked persistently at an asymptomatic lesion behind his right ear. Examination revealed a nodular lesion in the postauricular sulcus. Histology confirmed malignant melanoma, which was subsequently excised."

Another Important Function of Our Sense of Smell

Do you like different flavored jelly beans? People tasting them in "Smell — Our Most Underestimated Sense" quickly discovered that most of the "taste" was from their sense of smell not their sense of taste. When they were asked to pinch their noses, most tasted nothing.

One subject said he tasted "nothing so far." Another said, the jelly bean had "like, a sweetness, but I don't know the flavor." Once the subjects unpinched their noses they could describe the exact flavor of the jelly bean — which was really a smell. The loss of smell had a profound effect on Anna Barnes, featured in the documentary.

"I had a bad hit to the head, so I was kind of recovering from that. And then about a week afterwards, I thought, 'Hold on, something's not quite right here.' It became very clear to me, when I was well enough to go outside, that I'd lost my smell, because back then, the sewerage was open sewerage.

So, I lost my appetite for the first, I would say, four months. I was kind of retraining myself to remember, 'Oh, no, you have to eat' ...

When I lost my taste, fruit tasted for me, terrible. It's just gross. Fruit just tastes really slimy. It's all about texture ... I also had some early, you know, mix-ups, of accidentally drinking vodka, thinking it was water. And, you know, all the kind of stereotypical things that I guess people worry about."

It is clear that from "reading" other people to determining dangers to our enjoyment of food, our sense of smell is crucial — and certainly more important than our access to technology if we were asked to choose. Just as eye-opening is the ability of man's best friends to use their olfactory natural abilities to detect cancers as accurately as the most high-tech machines.

from http://articles.mercola.com/sites/articles/archive/2019/04/20/sense-of-smell.aspx

source http://niapurenaturecom.weebly.com/blog/smell-our-most-underestimated-sense

[moawadskininstitutes-blog]

Face and Neck Lifts by Moawad Skin Institute Via Flickr: A facelift has more impact than any other surgical procedure. First, the face is our prime identity and our seat of vanity and expression. Even the smallest facial blemishes can keep some people in the house. We are our faces. A patient can hide wrinkles, dark spots, and cellulite on their body but not on their face. Patients can cover poor results or scars on their body with clothes; the face (in most cultures) is exposed for the world to see. Because of this, no other cosmetic procedure carries the physical and emotional prowess of a well-done, natural-appearing facelift. Contrarily, an unnatural or botched facelift may cause a lifetime of problems that are impossible to hide. In evaluating the neck properly, the neck may be due to skin excess, fat accumulation, platysma laxity, digastric hypertrophy, submandibular gland abnormalities, or anatomic variants such as a low hyoid bone Surgical approaches to neck rejuvenation include liposuction, anterior or submental incision, or direct skin excision and Z-plasty. All other maneuvers used to address the aging neck may be performed through the submental approach except for skin excision and horizontal genioplasty. Direct neck procedures include the following: defatting superficial to the platysma, subplatysmal and interplatysmal defatting, medial platysmaplasty/platysma tightening, platysma plication over the submandibular gland resection and alloplastic anatomic chin implant placement when indicated. However, the most effective approach to the aging face and neck is through the facelift approach, either using a short scar technique for patients with minor neck laxity or using a standard pre- and postauricular incision for those with significant laxity in the neck.

[paullassiterca]

Smell, Our Most Underestimated Sense

We humans do not appreciate our sense of smell. Compared to other senses like vision and hearing, we tend to ignore the information from our sense of smell with the exception of flowers, food being prepared and, of course, those lucky people who have discovered aromatherapy.

But according to a recent documentary, “Smell — Our Most Underestimated Sense,” our sense of smell affects us much more than we realize. Certainly, we know that it protects us from dangers like fire because we smell the smoke, explosions because we smell natural gas and food poisoning because we smell spoilage. But few realize our sense of smell also lets us “read” other people much like dogs “read” each other by sniffing.

Of course, the olfactory read that humans conduct is not as obvious as that of dogs sniffing but, according to this film, people will oftentimes sniff their hands after shaking hands with someone new, indicating that important information has been gained. The sense of smell also helps newborns bond with their mothers, and “smell dysfunction” can impair such bonding.

Nevertheless, smell is so underappreciated people interviewed in the documentary said they would rather lose it than their “access to technology,” such as their smart phones. If you’re inclined to agree, after watching this remarkable documentary, you just might change your mind.

Aromatherapy Takes a Clue From Nature

I am a big believer in aromatherapy, which is based on the use of essential oils, also called volatile oils. In addition to inducing relaxation and sleep, and reducing blood pressure1 and stress, aromatherapy may be beneficial for depression,2anxiety,3dementia4 and pain relief.5

According to “Smell — Our Most Underestimated Sense,” plants and flowers also use these healing fragrances for themselves! For example, flowers deliberately emit the chemical signals of a female bee so that the male bee will “mate” with the flower and pollinate it. Certain birds, butterflies, bats, moths and even honey possum also pollinate flowers.

The irreplaceable services of these pollinators are seriously threatened by pesticides and chemicals, posing an environmental crisis. It is important to remember that every time you shop for organic food you vote against these harmful chemicals that are creeping into our daily life.

Interestingly, the least pretty flowers are often the most fragrant ones, because they cannot rely on their visual beauty to attract pollinators says the documentary, Moreover, plants can emit odors to warn other plants of impending insect attacks, just as animals warn others about imminent predators.

Sensing Others Through Our Sense of Smell

Many have heard of the phenomenon of menstrual synchrony in which women who live or work together can begin to have their periods at the same time.6 In a T-shirt sniff study, says the documentary, women’s testosterone levels changed in response to the scent of another woman, depending on where that woman was in her monthly cycle — though, of course, the women were not consciously aware of this.

Paul Moore, a professor at Bowling Green State University who specializes in chemical ecology and the role chemical signals play in an organism’s ecological role, explains the reaction like this:7

“The chemical senses, I call them ninjas — they’re hidden. So, they go into our brain, and we’re not aware of it, we’re not conscious of it, so it makes us respond emotionally, respond physiologically, before we actually think about the response. So, it’s very subtle and it’s very hidden …

Testosterone is tied very much to social dominance and in competitiveness and aggression. And up-regulating or down-regulating testosterone through chemical signals could change your competitiveness.”

Why would this happen? From an evolutionary standpoint, fertility could be governed by a competition won by dominant females so that less “alpha” females would cease to compete for males at a certain time.

The Hidden Powers of a Handshake

Our sense of smell does not just determine sexual rivals and fertility competition. In one study cited by the documentary, a hidden camera filmed people meeting strangers for the first time and sometimes shaking their hands. Greeters who shook hands smelled their hands afterward twice as often as those who didn’t shake hands, presumably accessing the “information” the handshake gleaned.

Shaking hands is likely a human version of dogs sniffing each other — a way of acquiring a lot of social information in one quick impression, says Moore. When dogs sniff each other upon meeting, for example:

“They’re sniffing and saying, ‘Oh, I played with you last week. You’re a good dog to play with,’ or 'I smell you from last week. You were a little mean, so I’m not going to play with you.’ They’re going to pick up their dominant status, social status, their reproductive status, what they’ve eaten. All that kind of stuff that you and I would share in a conversation with words, they share with chemical signals. Their whole world is sense of smell.”

Man’s Best Friend Can Save Our Lives

One of the most dramatic facts shared in “Smell — Our Most Underestimated Sense,” is dogs’ proven ability to detect cancer in humans from subtle smells in breath, skin and more. Dogs have up to 300 million receptor nerve cells that detect smell (compared to 5 million in humans) and some dogs have been successfully trained to detect human cancers.

In a 2015 study published in the Israel Medical Association Journal,8 two dogs picked out the breast cancer cell cultures that they had been trained to detect 100 percent of the time. These “detective” dogs even picked out cancer specimens they were not trained to detect, but they never picked out control (noncancer) specimens, meaning “false positives,” which plague diagnostic methods that are more high-tech than dogs.

The dogs picked out early-stage cancer as well as advanced cancer with amazing accuracy and specificity — a skill that would clearly save lives. In a 2017 study published in the European Journal of Cardio-Thoracic Surgery,9 a trained dog was also able to detect early lung cancer from the exhaled breath of patients with remarkable accuracy. Here is what the researchers wrote:

“After appropriate training, we exposed the dog (a 3-year-old cross-breed between a Labrador retriever and a pitbull) to 390 samples of exhaled gas collected from 113 individuals (85 patients with LC [lung cancer] and 28 controls, which included 11 patients without LC and 17 healthy individuals) for a total of 785 times.

The trained dog recognized LC in exhaled gas with a sensitivity of 0.95, a specificity of 0.98, a positive predictive value of 0.95 and a negative predictive value of 0.98.”

Other Cancers Are Being Detected by Dogs

Canine olfactory abilities are also being studied in the screening for colorectal cancer (CRC) which takes the lives of approximately 50,630 Americans per year.10 This is what researchers writing in a 2010 article in BMJ said:11

“Among patients with CRC and controls, the sensitivity of canine scent detection of breath samples compared with conventional diagnosis by colonoscopy was 0.91 and the specificity was 0.99.

The sensitivity of canine scent detection of stool samples was 0.97 and the specificity was 0.99. The accuracy of canine scent detection was high even for early cancer. Canine scent detection was not confounded by current smoking, benign colorectal disease or inflammatory disease.”

Such noninvasive and economical methods for early detection of colorectal cancer that avoid colonoscopy are sorely needed. Currently the occult blood test is one of the few affordable tests in the doctors’ colorectal cancer arsenal.

Dogs can also detect the specific volatile organic compounds associated with prostate cancer in urine samples with high estimated sensitivity and specificity according to a 2015 study.12

And, in a 2013 study, dogs correctly identified all 42 blood samples of patients with ovarian cancer, achieving an accuracy rate of 100 percent.13 Even more encouraging, the dogs could determine whether cancer cells remained after surgery, which is crucially important since doctors generally cannot determine if residual cancer cells remain.

How Were Dogs’ Medical Abilities Discovered?

How did an awareness of such canine abilities and their possible use in medicine develop? Here is how the researchers trace the origins of such dog detections:

“The idea of using a dog’s olfactory sense for the early detection of cancer was first raised by Williams and Pembroke and reported in The Lancet in 1989. These authors described the case of a patient who visited the clinic because her dog showed a particular interest in a skin nevus she had. Following its excision, the pathological examination revealed malignant melanoma.”

A 2013 case report in BMJ (previously the British Medical Journal) reported a similar phenomenon.14

“Our patient is a 75-year-old man who presented after his pet dog licked persistently at an asymptomatic lesion behind his right ear. Examination revealed a nodular lesion in the postauricular sulcus. Histology confirmed malignant melanoma, which was subsequently excised.”

Another Important Function of Our Sense of Smell

Do you like different flavored jelly beans? People tasting them in “Smell — Our Most Underestimated Sense” quickly discovered that most of the “taste” was from their sense of smell not their sense of taste. When they were asked to pinch their noses, most tasted nothing.

One subject said he tasted “nothing so far.” Another said, the jelly bean had “like, a sweetness, but I don’t know the flavor.” Once the subjects unpinched their noses they could describe the exact flavor of the jelly bean — which was really a smell. The loss of smell had a profound effect on Anna Barnes, featured in the documentary.

“I had a bad hit to the head, so I was kind of recovering from that. And then about a week afterwards, I thought, 'Hold on, something’s not quite right here.’ It became very clear to me, when I was well enough to go outside, that I’d lost my smell, because back then, the sewerage was open sewerage.

So, I lost my appetite for the first, I would say, four months. I was kind of retraining myself to remember, 'Oh, no, you have to eat’ …

When I lost my taste, fruit tasted for me, terrible. It’s just gross. Fruit just tastes really slimy. It’s all about texture … I also had some early, you know, mix-ups, of accidentally drinking vodka, thinking it was water. And, you know, all the kind of stereotypical things that I guess people worry about.”

It is clear that from “reading” other people to determining dangers to our enjoyment of food, our sense of smell is crucial — and certainly more important than our access to technology if we were asked to choose. Just as eye-opening is the ability of man’s best friends to use their olfactory natural abilities to detect cancers as accurately as the most high-tech machines.

from Articles http://articles.mercola.com/sites/articles/archive/2019/04/20/sense-of-smell.aspx source https://niapurenaturecom.tumblr.com/post/184311369376

[ourhaileydavies]

Platysmal Myocutaneous Flap for Reconstruction of T1,T2 Tongue Cancer: Functional Assessment-Juniper publishers

Introduction

The platysma myocutaneous flap (PMF) was first used for intraoral reconstruction in 1978 by Futrell (Futrell et al., 1978) [1]. A platysma myocutaneous flap is a versatile, easy-to-perform, one-stage procedure, and the outcome is best in adequately selected patients, with minimum donor site morbidity. It is large enough to close most head and neck ablative skin or mucosal defects up to 70cm2 and no special equipment is required (Koch, 2002) [2]. The PMF is also an excellent alternative choice to microvascular flaps, especially in patients who are medically unfit for prolonged surgery [3]. But PMF is not as popular as other options of head and neck reconstructive, because of different reasons. The main limitations are lack of bulk, problematic blood supply and unreliability. Also the rates of complications between 10% and 40% have been reported, which includes partial or complete necrosis, fistula, dehiscence, hematoma and infection [4]. The rates of complications have been linked to surgeon’s experience, technique followed and other preoperative factors. In this study we describe our experience with the use of PMF in reconstruction of T1, T2 malignant lesions of tongue. The main objective of our study is to evaluate the feasibility of PMF in tongue reconstruction. And also to evaluate the functional outcome in terms of speech and swallowing, after tongue reconstruction with PMF.

Materials and Methods

In this descriptive study, a total of 75 non-consecutive patients of T1 and T2 tongue cancer, undergoing treatment at Dharamshila Narayana superspeciality Hospital, New Delhi were retrospectively evaluated by collecting data from the period from 2013 to 2016. In our series, newly diagnosed squamous cell carcinoma cases of tongue malignancy of only T1 and T2 lesions with no previous surgery and radiotherapy were included. All patients underwent adequate glossectomy and modified radical neck dissection. Histologically, we confirmed tumor free margin of resection by using a frozen section technique. The size of the flap was designed according to the anticipated defect resulting from the excision of the primary tumor.

Operative procedure

In this descriptive study, a total of 75 non-consecutive patients of T1 and T2 tongue cancer, undergoing treatment at Dharamshila Narayana superspeciality Hospital, New Delhi were retrospectively evaluated by collecting data from the period from 2013 to 2016. In our series, newly diagnosed squamous cell carcinoma cases of tongue malignancy of only T1 and T2 lesions with no previous surgery and radiotherapy were included. All patients underwent adequate glossectomy and modified radical neck dissection. Histologically, we confirmed tumor free margin of resection by using a frozen section technique. The size of the flap was designed according to the anticipated defect resulting from the excision of the primary tumor.

The anticipated skin paddle was outlined in the lower anterio-lateral neck making it an island. The parallel vertical incision was outlined, starting at the chin medially and the tip of the mastoid process laterally with extension of 2 to 2.5cm above the clavicle bone inferiorly. Depend the skin incision of designed skin paddle up to platysma muscle. Complete the neck incision from chin to mastoid tip and up to platysma muscle.Separate the myocutaneous paddle in supra platysmal plane by sharp dissection up to angle of mandible. External jugular vein is isolated for purpose to take it along the flap in subplatysmal plane for adequate venous drainage. Then elevate the paddle of flap in subplatysmal plane in an inferior to superior direction taking care to avoid underlying fat and lymphatic tissue with flap. Meticulous and sharp dissection preferably with bipolar cautery is done while removing submandibular gland and preserve facial vein and facial artery intact with its submental branch which serve as main arterial supply to flap [5] (Figure 1).

Post operatively, patients are evaluated for a period of six months to one year and assessment of tongue mobility, speech, swallowing, and surgical complications of flap as well as neck wound were done.

Speech was evaluated by AYJNIHH 7- point speech intelligibility rating scale [6].

This 7- point rating scale is as follows:

No noticeable differences from normal.

Intelligible though some differences occasionally noticeable.

Intelligible although noticeably different.

Intelligible with careful listening although some words unintelligible.

Speech is difficult to understand with many words unintelligible.

Usually is unintelligible.

Unintelligible.

Swallowing assessment was done by EAT-10 scale [7]. This scale rates swallowing function, based on the patient’s responses to questioning, on scale maximum points of 40. If the EAT-10 score is 3 or higher, it indicates swallowing difficulties. This scale have 10 questions with a score of 0 to 4. The score 0 indicates no problem and score 4 indicates severe problem. As the score increases the severity increases.

The questionnaire is as follows:

My swallowing problem has caused me to lose weight (0-4).

My swallowing problem interferes with my ability to go out for meals (0-4).

Swallowing liquids takes extra effort (0-4).

Swallowing solids takes extra effort (0-4).

Swallowing pills takes extra effort (0-4).

Swallowing is painful (0-4).

The pleasure of eating is affected by my swallowing (0-4 )

When I swallow food sticks in my throat (0-4).

I cough when I eat (0-4).

Swallowing is stressful (0-4).

Tongue mobility is evaluated by asking patient to touch the upper lip, right commisure and left commisure with tip of the tongue. The surgical complications of flap that are assessed, include partial and complete loss of flap, flap detachment, marginal necrosis, fistulisation and partial epidermolysis.

The neck wound healing status is also evaluated as follow: normally healed, wound dehiscence, skin flap necrosis and wound contraction. The criterion used to differentiate between extended or regular wound dehiscence was the presence of a “dehiscent area” ≥ 2cm2. Skin flap necrosis was defined as wide when it affected an area of 2 cm2 or more [7].

Mobility of tongue (To upper lip/Right commissure/Left commissure): Tongue mobility evaluated by asking patient to touch the upper lip, right commisure and left commisure with tip of the tongue.

Results

A total of seventy five patients with T1 and T2 tongue cancer were included in the study. The histologic diagnosis was squamous cell carcinoma in all cases. All patients underwent curative Adequate glossectomy with modified radical neck dissections. Complications of the flap, Status of the neck Flap, Swallowing and speech function and tongue mobility were evaluated 6 months to 1 year postoperatively.

Complications of the flap

Flap complications were noted in 17 patients (22.6%) with complete failure in 2 patients (2.6%), which was managed by complete wound debridment and allowed healing with secondary intension. Partial failure in 5 patients (6.6%) was managed by local measures, such as surgical wound debridement of necrotic tissue. Marginal necrosis and partial epidermolysis is seen in 4 patients (5.3%) and 6 patients (8%) respectively. These complications need prolonged nasogastric nutrition for 15 days (Table 1).

Neck wound complications

Neck wound complications were divided into four categories in which 55(73.3%) cases had normal healing of neck incision flap (Figure 2). Wound dehiscence and skin necrosis reported in 4(5.3%) and 2(2.6%) respectively, required surgical revision. Most of the patients 15(20%) reported with contraction and neck stiffness which was treated by neck physiotherapy (Table 2).

Speech

After excision of primary lesion and platysma flap reconstruction, intelligibility fell to grade 6 in two (2.6%) patient, Grade 5 in three (4%) patient, and grade 4 in five (6.6) patients. More patients showed intelligible although noticeably different in 27(36%) patients and intelligible though some differences occasionally noticeable in 38(50.6%) patients (Table 3).

(“1” = no noticeable differences from normal, “7” = unintelligible).

Swallowing

Mobility of tongue

In these adequate glossectomy patients with platysma flap reconstruction, tongue mobility was evidently recovering, and mostly adequate for producing intelligible speech. Tongue mobility in Upper lip, Right commissure, and Left commissure seen in 47 (62.6%) patients. One side restricted movements mostly towards reconstructed site in 13(17.3%) patients. Two side restricted movements and completely restricted tongue mobility is seen in 9(12%) patients and 6(8%) patients respectively (Table 5).

Discussion

The primary blood supply to PMF derives from sub mental artery which branches from a facial artery and additional blood supply comes inferiorly from the cervical transverse vessels, medially from thyroid vessels and laterally from occipital and postauricular vessels. This is a multiaxial blood supply as it has multiple anastomoses with ipsilateral and contralateral mental, labial and sublingual arteries [8-10].

In our study of the 75 patients we preserve the facial artery and external jugular vein. External jugular vein provides retrograde valve less communication with internal jugular vein through retromandibular and facial venous system, which allows adequate venous drainage.

The experience about reliability of platysma flap is not uniform among the various authors, some author claim excellent results, while others experienced the poor results [11]. Our results showed 77.3% of complete acceptance of the flap (Figure 3-5) while remaining 2.6% shows complete failure(2cases) and 6.6% (5 cases) were partial loss of the flap. Marginal necrosis and partial epidermolysis is seen in 4 patients (5.3%) and 6 patients (8%) respectively. The rates of necrosis of platysma myocutaneous flap found in many other studies ranged from 7.1 to 29.2% [11].

In tongue reconstruction, restoration of speech is an important component. After excision of primary lesion and platysma flap reconstruction, intelligibility fell to Grade 6 in only two (2.6%) of patients, Grade 5 in three (4%) patients, and grade 4 in five (6.6) patients. Majority of patients showed Grade 3 (intelligible although noticeably different) patients and Grade 2 (Intelligible though some differences occasionally noticeable) in patients. Similar results were reported in a study where majority had speech restoration without significant deficits in a month after surgery [12].

Thin and pliability of this flap allows reconstructed tongue with good mobility. Good mobility of tongue is seen in 47(62.6%) patients and restricted tongue mobility is seen in 15(20%).

Conclusion

In conclusion, surgeons should consider the option of using a platysma myocutaneous flap when reconstructing tongue defects. The main advantages are that this flap is readily available, easy to perform, can be obtained during neck dissection and the donor site can be closed in a primary way, with minimal flap complications and good functional outcome. Results can be compared with free flap reconstruction.

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