This powerpoint describes the types of maxillectomy & operative steps for total maxillectomy. It also enumerates various flaps used for reconstruction of maxillectomy defect.
Maxillectomy and craniofacial resection Mamoon Ameen
all maxillectomy types in detail and maxillofacial resection ,indications ,contraindications ,preoperative asssessment and detail techniques and rehabilitations
Maxillectomy and craniofacial resection Mamoon Ameen
all maxillectomy types in detail and maxillofacial resection ,indications ,contraindications ,preoperative asssessment and detail techniques and rehabilitations
Transoral robotic surgery(TORS)has emerged as a technique thatallows head and neck surgeons to safely resect large and complex oropharyngeal tumors without dividing the mandible or performing a lip-split incision. These resections provide a reconstructive challenge because the cylinder of the oropharynx remains closed and both physical access and visualization of oropharyngeal anatomy is severely restricted. Transoral robotic reconstruction (TORRS) of such defects allows the reconstructive surgeon to inset freeflaps or perform adjacent tissue transfer while seeing what the resecting surgeon sees. Early experience with this technique has proved feasible and effective. Robotic reconstruction has many distinct advantages over conventional surgery,and offers patients a less morbid surgical course. Robotic-assisted head and neck cancer surgery is an alternative approach for the management of oropharyngeal tumors, but necessitates the development of appropriate reconstructive methods. TORR represents a bourgeoning robotic transoral reconstructive technique and may eventually be a critical part of any robust TORS program rational approach to the use of the robot in transoral reconstruction will help guide the development of this field.
Transoral robotic surgery(TORS)has emerged as a technique thatallows head and neck surgeons to safely resect large and complex oropharyngeal tumors without dividing the mandible or performing a lip-split incision. These resections provide a reconstructive challenge because the cylinder of the oropharynx remains closed and both physical access and visualization of oropharyngeal anatomy is severely restricted. Transoral robotic reconstruction (TORRS) of such defects allows the reconstructive surgeon to inset freeflaps or perform adjacent tissue transfer while seeing what the resecting surgeon sees. Early experience with this technique has proved feasible and effective. Robotic reconstruction has many distinct advantages over conventional surgery,and offers patients a less morbid surgical course. Robotic-assisted head and neck cancer surgery is an alternative approach for the management of oropharyngeal tumors, but necessitates the development of appropriate reconstructive methods. TORR represents a bourgeoning robotic transoral reconstructive technique and may eventually be a critical part of any robust TORS program rational approach to the use of the robot in transoral reconstruction will help guide the development of this field.
Discuss the differential diagnosis of midline neck masses?
Discuss the differential diagnosis of lateral neck masses and lumps?
What specific question you would ask in history to elicit the diagnosis?
Discuss about management (investigations and treatment plan) for midline neck masses?
Discuss about management (investigations and treatment plan) for lateral neck masses?
Assuming that this patient presents with a history of weight loss, night sweats and chronic cough, how would you proceed with diagnosis, management and treatment in this patient?
Neck masses are common in adults and can occur for many reasons. You may develop a neck mass due to a viral or bacterial infection.
Ear or sinus infection, dental infection, strep throat, mumps, or a goiter may cause a neck mass.
Clinically neck masses can be divided into:
Those in the midline
Those in the lateral aspect of triangles of neck which can be further divided according to triangles of neck
orthognathic surgery is very intresting and well knowing branch in oral surgery ....this presentation is dealing with jaw correction surgery in upper jaw.
An oroantral communication is an unnatural perforation between oral cavity and maxillary sinus.
Oroantral fistula is an epithelized, pathological, communication between these two cavities. A fistulous tract present more than 14 days should be considered as chronic fistula.
Dr. Ahmed M. Adawy, Professor Emeritus, Dep. Oral & Maxillofacial Surgery. Former Dean, Faculty of Dental Medicine
Al-Azhar University. There are four pairs of air sinuses making the boundaries of the nasal cavity. Maxillary sinus is the largest air cell. Anatomy and physiology of the maxillary sinus are given. Maxillary sinusitis is an inflammation of the sinus. Odontogenic causes represent nearly 30% of the etiology. Clinical and radiographic examinations are discussed together with treatment plan.
Oro-antral fistula is a rare complication of surgery at the posterior maxillary region. Several techniques for closure are presented. Additionally, information about sinus lift procedure is given.
To remember TNM staging is important for residents engaged in multidisciplinary tumour clinics. This slide provides a brief insight into the TNM staging of some common head & neck cancer. I have tried to make the staging concise and easy to remember for you guys. Hope it helps you all.
Mechanism of balance & vestibular function test Dr Utkal MishraDr Utkal Mishra
This powerpoint elaborates the mechanism of balance & anatomy of vestibular apparutus. It also depicts the anatomy & physiology of haircells in detail. I also explained the vestibular function tests used for diagnosis of various vestibular disorders.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
2.
Concept described by Lazars in 1826.
Syme first performed it in 1828.
Portman described sublabial transoral approach in 1927.
Smith described extended maxillectomy in 1954.
Fairbanks & Barbosa described infratemporal fossa approach
for advanced maxillary sinus tumors in 1961.
Midfacial degloving approach was popularized in 1970.
History
2
4.
Malignant tumors involving maxilla – Sq Cell Carcinoma
Benign tumors of maxilla causing extensive bone destruction
(fibrous dysplasia)
Extensive fungal / Granulomatous infections (rare)
Malignant tumors of oral cavity with extensive involvement of
palate
Indications
4
5.
Lymphoreticular malignancies – Lymphoma and Pediatric
Rhabdomyosarcoma
Bilateral tumors with bilateral orbital involvement
Malignant tumors with skull base extension.
Systemic disorders like uncontrolled diabetes / poor cardio
respiratory reserve
Poor general condition of the patient
Patient not consenting to undergo the procedure
Contraindications
5
8.
General anaesthesia
Marking incision site
Corneal shield / Temporary tarsoraphy
Infiltration with 1% xylocaine with 1 in
100,000 adrenaline
Surgical Steps
8
9.
Hypotensive Anaesthesia.
Transoral Intubation is preferable.
E.T. Tube secured opposite the side of tumor in lower lip.
If Trismus present – Tracheostomy / Trans-nasal fibreoptic
intubation.
9
Anaesthetic Considerations
10.
Incision
Weber Ferguson’s incision is used.
Lateral rhinotomy incision with
horizontal infraorbital component and
midline lip split.
Extends 1cm lateral to lateral canthus.
3mm below lower Eyelash.
Along nasomaxillary groove.
Curves along alar margin.
Dividing upper lip over ipsilateral
philtrum.
10
11.
11
Incision
Extends round the upper gingivobucal
sulcus upto maxillary tuberosity.
Medially a midline incision given between
canine & lateral incisor extending upto
juncn. of hard & soft palate.
The palatal incision should lie 3mm lateral to
midline.
Incision carried laterally to join
gingivobuccal incision around posterior
maxillary tuberosity.
12.
Flap
12
Cheek flap elevated in subperiosteal
plane.
Infraorbital nerve divided.
Flap elevated till zygomatic process.
Inferior and medial periorbita is
elevated to expose the floor of the orbit,
lacrimal fossa, and lamina papyracea.
Nasolacrimal Duct transected &
Lacrimal sac is marsupialized.
14.
Bone cuts
14
Frontal process of Maxilla & lacrimal
bone.
Floor of orbit
Zygomatic process
Palatal osteotomy
Osteotomy to separate maxillary
tuberosity from pterygoid plates.
16.
Hemostasis
16
Bleeding from maxillary artery is controlled by ligation
Venous bleeding from pterygoid plexus is controlled with
packing.
Use of powered osteotomes results in less bleeding.
17.
Obturator Prosthesis
17
It prevents oro-antral & oro-nasal communication.
Designed preoperatively.
Attached to preserved dentition with wires
If obturator is used then the surgical defect is lined by
skin graft internally supported with cuticell@.
Disadvantage –
• Deficient aesthetic and functional reconstruction
• Rhinolalia
• Midface retrusion
• Inadequate prosthetic rehabilitation
• Difficult insertion in patients with trismus
19.
In early postoperative period, frequent oral irrigation is
encouraged.
Oronasal irrigations are encouraged after removal of Vaseline
gauze.
Jaw stretching exercise is advised to prevent development of
trismus.
Once the raw area has healed satisfactory (3–4 weeks),
patient may be referred to the prosthodontic department
for permanent prosthesis
19
Post op Care
21.
Bleeding
Mid face retrusion
Epiphora
Break down of skin graft
Numbness of cheek area
Complications
21
22.
Commonest site – Maxillary Artery
Breaking maxilla from pterygoid process will cause bleeding from
internal maxillary artery. Simple hot packs will help in reducing
bleeding during this stage.
Can be minimized by coagulating bleeders.
Angular vessels should be secured properly.
When lip splitting incision is used bleeding from labial vessels is
common and should be secured at the earliest
Bleeding
22
24.
Nasolacrimal duct is transected during maxillectomy thus
causing epiphora.
Simple transection of nasolacrimal duct rarely causes epiphora
unless followed by stricture which usually occurs following
radiotherapy
Marsupialization of lacrimal sac.
Insertion of silicone tube after transection of nasolacrimal duct.
Epiphora
24
25.
Caused due to transection of infraorbial nerve.
Infraorbital nerve can be conserved if not involved by the
tumor.
Numbness of cheek area
25
27.
Objectives
27
Closure of the surgical wound
Elimination of the maxillary defect
Restoration of Midfacial contour
Support Eyeball
Reconstruction of the palate
Restore normal mastication and deglutition.
28.
Classification of Maxillary Defect
28
Vertical
I. Maxillectomy not causing an oronasal fistula
II. Maxillectomy not involving the orbit
III. Maxillectomy involving the orbital adnexa with orbital
retention
IV. Maxillectomy with orbital enucleation or exenteration
V. Orbitomaxillary defect
VI. Nasomaxillary defect
Horizontal
(a) Palatal defect only, not involving the
dental alveolus
(b) Defect ≤ one half unilateral
(c) Defect ≤ one half bilateral or
transverse anterior
(d) Defect greater than one half
maxillectomy