Describe the clinical features and treatment of Acute Abscess.

Answer.

Acute Abscess Clinical Features

• Fever with chills and rigours.
• Localized swelling which is smooth, soft, and fluctuant.
• Pus is visible
• Throbbing pain and pointing tenderness
• Brawny induration around
• Redness and warmth with restricted movement around a joint
• Rubor (redness), Dolor (pain), CALR (warmness), tumor (swelling), and function laesa (loss of localized and adjacent tissue/joint function) are quite obvious.

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Write briefly on Laser.
Or
Write a short note on Laser in surgery.

Answer. Molecules are placed in a compact area and power is passed through this to activate the molecules.

Molecules get activated at different periods and move in different directions, which they hit to each other releasing energy.

This energy is allowed to act through the optical system to the area, wherever required. It is named depending on the molecules used:

• Argon Laser.
• Neodymium Yttium Aluminum Garnet Laser (Nd: YAG Laser)
• CO2 Laser.
• Neon Laser.
• Holmium Laser.
• Erbium Laser.

Uses Of Laser

• In cranial surgery in children.
• In ENT it is used to treat vocal cord lesions and laryngeal lesions.
• In ophthalmology, it is very useful in retinal surgery
• In general surgery:
  • In bleeding duodenal ulcer.
  • For palliative decoring of tumors in carcinoma esophagus.
  • In carcinoma of the rectum.
  • In the treatment of hemorrhoids (first and 2nd degree).
  • In resection of bladder tumor.
  • In cervical cancer.
  • To achieve a bloodless field.
  • Often making incisions in the abdomen and other places.

Laser Precautions

• All reflecting instruments should be avoided otherwise laser gets reflected and injures normal tissues or the working team in the OT
• All should wear protective spectacles to their eyes.

Laser Advantages

• Provide bloodless field
• It is fast
• Small lesions can be removed easily and completely.

Laser Disadvantage

Availability and cost factors.

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Describe the causes of burn and management of face and neck burn.

Answer. Burn: A burn is a wound in which there is coagulation necrosis of tissue.

Causes Of Burn

• Ordinary causes: Dry heat, fire, hot metal, airplane crash.
• Due to moist heat, e.g. boiling liquid or lipids, it is called a scald.
• Electric burn: Due to high voltage current.
• Chemical burns: Due to strong acid and alkali
• Radiation burn: Due to X-ray and radiation
• Cold burn: It is caused by prolonged exposure to cold.

Management Of Face And Neck Burn

First Aid of Face and neck Burn

• Stop the burning process and keep the patient away from the burning area.
• Cool the area with tap water by continuous irrigation for 20 minutes.

Definitive Treatment of Face and Neck Burn

• The patient should be admitted.
• Airway, breathing, and circulation are maintained.
• Percentage, degree, and type of burn are assessed.
• Patients should be kept in a clean environment.
• The patient is sedated and proper analgesia is given.

Fluid resuscitation of Face and neck Burn

• Fluid replacement is done by calculating with various formulas such as Parkland regime, Muir and Buckley regime, etc.
• The fluids used are normal saline, Ringer lactate,
• Hartmann’s flid. Ringer lactate is the choice of fluid.
  Blood is transfused in a later period after 48 hours.

General Treatment Of Face And Neck Burn

• For the first 24 hours, only crystalloids should be given.
• After 24 hours up to 30–48 hours, colloids should be given to compensate for plasma loss. Plasma, haemaccel (gelatin), dextrans, and hetastarch are used. Usually at a rate of 0.35–0.5 mL/kg% burns is used in 24 hours.
• Urinary catheterization to monitor output; 30–50 mL/hour should be the urine output.
  Tetanus toxoid.
• Monitoring the patient: Hourly pulse, BP, PO₂, PCO₂ electrolyte analysis, blood urea, nasal oxygen, often intubation is required. Endotracheal intubation is secured in such a way as to minimize pressure necrosis of the lip.
• IV ranitidine 50 mg 8th hourly is given.
• Ryle’s tube insertion was initially for aspiration purposes later for feeding.
• Antibiotics: Penicillins, aminoglycosides, cephalosporins, and metronidazole should be given.
• Culture of the discharge; total white cell count and platelet count at regular intervals are essential to identify the sepsis along with fever, tachycardia, and tachypnea.
• In burns of the oral cavity, a tracheostomy may be required to maintain the airway.
• Total parenteral nutrition (TPN) is required for faster recovery, using carbohydrates, lipids, and vitamins.
• A tracheostomy/intubation tube may be required in impending respiratory failure or upper airway block.
  Intensive nursing care.

Local Management Of Face And Neck Burn

• Dressing at regular intervals under general anesthesia using paraffin gauze, hydrocolloids, plastic films, vaseline-impregnated gauze or fenestrated silicone sheet, or biological dressings like amniotic membrane or synthetic biobrane.
• Open method with application of silver sulfadiazine without any dressings, used commonly in burns of the face and neck.
• The closed method is with dressings done to soothe and protect the wound, to reduce the pain, and as an absorbent.
• Tangential excision of burn wounds with skin grafting can be done within 48 hours in patients with less than 25% burns.
  It is usually done in deep dermal burn wherein dead dermis is removed layer by layer until fresh bleeding occurs. Later skin grafting is done.
• In burns of the head and neck region, exposure treatment is advised.
• Slough excision is done regularly.
• After cleaning with povidone iodine solution silver sulfadiazine ointment is used. It is an antiseptic and soothing agent.

Wound Coverage Of Face And Neck Burn

• Better outcomes can be achieved if the non-healing areas are excised (likely to take 3 weeks or more) and then skin grafted.
• The donor skin needs to be taken from the area above the nipple for the best color match.
  Many surgeons favor the scalp skin but, alopecia and hair growth from trans-planted skin are of concern whereas the upper part of the back has thick skin.
• Facial excision is carried out using Goulian knives or Versajet water dissector. Exposed cartilage needs excision with closure of the skin.
• Sheets of autografts are used as the meshed grafts are cosmetically unacceptable.
• Epinephrine lysis is essential to limit hemorrhage.
• A face mask should be placed to help immobilize of skin graft.
• Grafts should be placed in such a fashion as to mimic the esthetic units. Fibrin glue can be used to enhance graft adherence.
• Postoperative facial elastic mask compression helps in avoiding hypertrophic scars.

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Write briefly on types of skin grafts.

Answer. Skin grafts are of two types, i.e.
1. Partial thickness graft
2. Full-thickness graft.

Skin grafts Partial thickness Graft

• Skin grafts is also known as Hirsch graft or split-thickness skin graft
• In it, there is the removal of the full epidermis and part of the dermis from the donor area.
• Skin grafts can be thin, intermediate, and thick.
• Skin grafts is indicated in a well-granulated ulcer, clean wound, or defect which is not opposed and after the surgery to close and cover the created defect.
• Skin grafts should not be done over bone, tendon, cartilage and joint.

Skin grafts Full thickness Graft

• Skin grafts includes both the epidermis and the full dermis.
• Skin grafts should be done over the face, eyelid, hand, fingers, and the joints.
• Skin grafts is used only for small areas.
• Skin grafts functional and cosmetic results are excellent.

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Write short note on pulsatile swellings in neck.

Answer. Following are the pulsatile swellings in neck.

• Aneurysm

1.Arterial Hemangioma:

• An abnormal communication between artery and vein results in AV fitula.
• It is a soft, cystic, flctuant, transillumination negative, pulsatile swelling.
• A continuous bruit/murmur is characteristic.
• On compressing the feeding artery, venous return to heart diminishes which leads to fall in pulse rate and pulse pressure.

2. Cirsoid aneurysms:

• It is a rare variant of capillary hemangioma occurring in skin beneath which abnormal artery communicates with the distended veins.
• Variant of capillary hemangioma
• Pulsatile swelling
• Involves bone
• Treatment is ligation of feeding artery and excision of lesion.

The post Pulsatile Swellings In The Neck: Types And Management appeared first on BDS Notes.

Discuss emergency tracheostomy.

Answer. Emergency tracheostomy is performed within 2 to 3 minutes in an emergency when patient is anoxic and requires immediate oxygenation and verifiation to avoid cerebral hypoxia.

Emergency tracheostomy Procedure

• Step I and II: Preparation of skin and local anesthesia is not performed in emergency tracheostomy.
• Step III: Skin of the neck over second tracheal ring is identified and an incision is placed horizontally along natural cervical skin crease.
• Step IV: Sharp dissection following the skin incision is done to cut across platysma muscle.
• Step V: Blunt dissection is given parallel to long axis of trachea for separating submuscular tissues until isthmus is identified.
• Step VI: A cricoids hook engages the space between cricoids and fist tracheal ring pull trachea upward.
  Blunt dissection is continued longitudinally through pretracheal fascia.
• Step VII: Entrance in trachea
  • A linear incision is made through inter-space between second and third tracheal rings.
  • Mid-portion ofthird or fourth tracheal ring is removed for creating tracheal window.
  • An inferiorly placed U-shaped flap also known as Bjork flap incorporates the ring below the tracheal incision is raised and sutured to the skin at inferior margin.
• Step VIII: Tube is placed and is secured to neck.
  Tube is inserted vertically downward into the trachea avoiding damage to the tracheal mucosa of posterior wall.
  The tube is secured by suturing the flnges to the neck skin.
  This is followed by tying the flnges oftube with thread encircling the neck taking care to avoid strangulation.

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Write short note on diathermy.

Answer. It is also known as electrocautery
It is the method to control bleeding or to cut the tissues during surgery

Diathermy Types

• Based on type of current used:
  • Unipolar cautery
  • Bipolar cautery.
• Based on type of action:
  • Coagulation cautery
  • Cutting cautery
  • Blended current: Combination both coagulation and cutting cautery.

Diathermy Uses

• For coagulation of bleeding during surgery to achieve hemostasis.
• For cutting muscles, fascia, etc.
• For laparoscopic surgical procedures.
• To remove small cutaneous lesions.

Diathermy Disadvantages

• It leads to infection.
• For the cauterization of normal tissues.
• It has problem of explosion.
• It can cause diathermy burn to the patient at the site where diathermy plate is used.
• It can cause burn injury or electrical shock to surgeon and assisting personnel.

The post Diathermy In Surgery appeared first on BDS Notes.

Describe the pathology, diagnosis and management of carcinoma of tongue.

Answer.

• Wedge biopsy is the golden rule for confirmation of diagnosis
• FNAC of lymph nodes is done to rule out invasion of cancer in lymph nodes.
• Indirect and direct laryngoscopy is done to see posterior one-third growth.
• CT scan is done to see extension of posterior one-third growth or to see status of advanced secondaries.
• MRI can also be done to assess the extent ofprimary tumor.
• Chest X-ray is done to see bronchopneumonia
• Orthopantomogram (OPG) is done to assess the bony involvement.
• Staging should be done by TNM classifiation

The post Tongue Cancer – Symptoms And Causes appeared first on BDS Notes.

Question 1. Enumerate benign tumours around the oral cavity.

Answer. Following are the benign tumours around the oral cavity:

Epithelial tissue

• Papilloma
• Keratoacanthoma
• Squamous acanthoid
• Nevis.

Fibrous connective tissue

• Fibroma
• Fibrous hyperplasia
• Fibrous epulis
• Giant cell firoma
• Fibrous histiocytoma
• Desmoplastic firoma
• Myxoma
• Myxofiroma.

Cartilage tissue

• Chondroma
• Chondroblastoma
• Chondromyxoid firoma.

Adipose tissue

• Lipoma
• Angiolipoma.

Bone

• Osteoma
• Osteoid osteoma
• Osteoblastoma
• Torus palatines or torus mandibularis
• Osteomatosis.

Vascular tissue

• Hemangioma
• Lymphangioma
• Arteriovenous fitula
• Glomus tumor.

Neural tissue

• Neurofibroma
• Neurilemmoma
• Ganglioneuroma
• Traumatic neuroma
• Melanotic neuroectodermal tumor of infancy.

Muscles

• Leiomyoma
• Rhabdomyoma
• Granular cell myoblastoma.

Giant cell tumor

• Central giant cell tumor
• Peripheral giant cell tumor
• Giant cell granuloma
• Giant cell tumor of hyperthyroidism.

Teratoma.

Question 2. Describe etiopathology, clinical feature and management of Ca of tongue. 

Answer.

Etiopathology Of Carcinoma Of Tongue

Benzopyrenes and nitrosamines in cigarette smoke and tobacco products, arecoline in areca nut are the carcinogenic agents; alterations in activity of genes on 3p, 9p and 17; E6 and E7 proteins of human papilloma virus inactivate p53 and Retinoblastoma tumor suppressor gene later leading to overexpression of p16 presence of which is correlated with HPV
associated carcinoma.

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Classify oral mucosal lesions. Describe the clinical features and histopathological features of submucosal fibrosis.

Answer. Classification of oral mucosal lesions

Genodermatous

White sponge nevus

Hereditary benign intraepithelial dyskeratosis

Pachyonychia congenita

Porokeratosis

Darier’s disease

Pseudoxanthoma elasticum.

Non-infective Disease

1. Vesicular:

• Erythema multiforme
• Pemphigus
• Bullous lichen planus.

2. Non-vesicular:

Lichen planus.

3. Collagen disorders:

• Lupus erythematous
• Scleroderma.

4. Degenerative

• Oral submucous firosis.

5. Pigmentation:

• Anemia
• Addison’s disease
• Racial pigmentation

OSMF is defined as “An insidious chronic disease affecting any part of oral cavity and sometime pharynx.
Although occasionally preceded by and/or associated with vesicle formation, it is always associated with juxta-epithelial inflammatory reaction followed by firoelastic changes in lamina propria, with epithelial atrophy leading to stiffness of oral mucosa and causing trismus and inability to eat.” —Pindborg (1966)

submucosal fibrosis Clinical Features

• It is caused during 20 to 40 years of age.
• Females are affcted more than males.
• In OSMF firotic changes are frequently seen in buccal mucosa, retromolar area, vulva, tongue, etc.
• Initially patient complains of burning sensation in the mouth, particularly during taking hot and spicy foods.
• There can be excessive salivation, decreased salivation and defective gustatory sensation.
• In initial phase of disease palpation of mucosa elicits a“wet leathery” feeling.
• In advanced stage, the oral mucosa losses its resilience and become blanched and stif and thereby causing trismus.
• Palpation of mucosa often reveals vertical firous bands.

submucosal fibrosis Histopathology

Microscopically OSMF reveals following features:

• Overlying hyperkeratinized, atrophic epithelium often shows flttning and shortening of rete pegs.
• There can be variable degree of cellular atypia or epithelial dysplasia.
• In OSMF dysplastic changes are found in epithelium which include nuclear pleomorphism, severe intercellular edema, etc.
• Stromal blood vessels are dilated and congested and there can be areas of hemorrhage.
• Underlying connective tissue stroma in advanced stage of disease shows homogenization and hyalinization of collagen fiers.
• Decreased number of firoblastic cells and narrowing of blood vessels due to perivascular firosis are present.
• There can be presence of signet cells in some cases.

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