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The exam should be performed in an orderly fashion as follows: 1. Have the patient stick out their tongue so that you can examine the posterior pharynx (i.e. the back of the throat). Ask the patient to say "Ah", which elevates the soft palate, giving you a better view. If you are still unable to see, place the tongue blade � way back on the tongue and press down while the patient again says "Ah," hopefully improving your view. This causes some people to gag, particularly when the blade is pushed onto the more proximal aspects of the tongue. It may occasionally be important to determine whether the gag reflex is functional (e.g. after a stroke that impairs CNs 9 or 10; or to determine if a patient with depressed level of consciousness is able to protect their airway from aspiration). This is done by touching a q-tip against the posterior pharynx, uvula or tongue. It is not necessary to do this during your routine exam as it can be quite noxious!
2. Note that the uvula hangs down from the roof of the mouth, directly in the mid-line. With an "Ah," the uvula rises up. Deviation to one side may be caused by CN 9 palsy (the uvula deviates away from the affected side), a tumor or an infection. CN9 Pasly Cranial Nerve 9 Dysfunction: Patient has suffered stroke, causing loss of function of left CN 9. As a result, uvula is pulled towards the normally functioning (ie right) side. 3. The normal pharynx has a dull red color. In the setting of infection, it can become quite red, frequently covered with a yellow or white exudate (e.g. with Strep. Throat or other types of pharyngitis).
4. The tonsils lie in an alcove created by arches on either side of the mouth. The apex of these arches are located lateral to and on a line with the uvula. Normal tonsils range from barely apparent to quite prominent. When infected, they become red, are frequently covered by whitish/yellow discharge. In the setting of a peritonsilar abscess, the tonsils appear asymmetric and the uvula may be pushed away from the affected side. When this occurs, the tonsil may actually compromise the size of the oral cavity, making breathing quite difficult.
5. Look carefully along the upper and lower gum lines and at the mucosa in general, which can appear quite dry if the patient is dehydrated.
6. Examine the teeth to get a sense of general dentition, particularly if the patient has a dental complaint. Pain produced by tapping on a tooth is commonly caused by a root abscess. Tooth Abscess: Tooth abscess involving left molar region. Associated inflammation of left face can clearly be seen. 7. Have the patient stick their tongue outside their mouth, which allows evaluation of CN 12. If there is nerve impairment, the tongue will deviate towards the affected side. Any obvious growths or abnormalities? Ask them to flip their tongue up so that you can look at the underside. If you see something abnormal, grasp the tongue with gauze so that you can get a better look. Left CN 12 Dysfunction: Stroke has resulted in L CN 12 Palsy. Tongue therefore deviates to the left.
8. Make note of any growths along the cheeks, hard palate (the roof of the mouth between the teeth), soft palate, or anywhere else. In particular, patients who smoke or chew tobacco are at risk for oral squamous cell cancer. Any areas which are painful or appear abnormal should also be palpated. Put on a pair of gloves to better explore these regions. What do they feel like? Are they hard? To what extent does a growth involve deeper structures? If the patient feels something that you cannot see, try to get someone else to hold the light source, freeing both your hands to explore the oral cavity with two tongue depressors.
Breast Implant Surgery - exchanging the breast implants. In this video you can see a Plastic Surgeon performing an exchange of breast implant surgery.As breast implants become more popular more breast implant exchange procedures are being performed. This video shows breast implant removal followed by insertion of a larger breast implant.
Spinal stenosis can put pressure on the spinal cord and the nerves within the spine. It commonly occurs in the neck and lower back. The condition is often caused by age-related wear and tear. Symptoms, if they occur, include pain, numbness, muscle weakness, and impaired bladder or bowel control. Treatment includes medication, physical therapy, and possibly surgery
The cause for TS is unknown. Early research suggested that TS is an inherited condition (often, the person's near or distant relatives have had some form of transient or chronic tic disorder or associated symptoms). Recent studies point to a combination of environmental and genetic factors as a cause of the disorder. The specific genes involved in the development of TS are still being investigated. Studies suggest that TS has a neurological basis and results from an abnormality which affects the brain's metabolism of certain neurotransmitters (chemicals in the brain that regulate behavior.) Current research being funded by the Tourette Syndrome Association (TSA) will help provide more information about the causes and genetic factors of TS.
The term dermoid cyst does not appear to be restricted to a single kind of lesion nor is it used in only a single medical discipline. The term dermoid cyst can be found in the vocabulary of dermatologists, dermatopathologists, general pathologists, gynecologists, neurosurgeons, or pediatricians. If asked, all of these clinicians would most probably define and describe dermoid cysts differently. For example, gynecologists and general pathologists might say that a dermoid cyst is a cystic tumor of the ovary. In contrast, neurosurgeons tend to view a dermoid cyst is associated with a congenital cyst of the spine or an intracranial congenital cyst. For pediatricians and dermatologists, dermoid cyst means subcutaneous cysts, which are usually congenital.[1]
Tooth colored composite fillings are chemically bonded to teeth. For this reason, the placement of white fillings does not always require numbing the area being restored. Numbing (anesthetizing) the area is often required if tooth decay has progressed beneath the enamel layer and into the underlying dentin layer which surrounds the nerve of the tooth. Once decay is removed, the tooth is cleaned and a primer (weak acid) is applied to the area being restored. The primer opens pores in the enamel and dentin. A bonding agent is then flowed into the open pores and cured. Curing prepares the bonding agent to adhere to the tooth colored filling material. The filling material is then placed inside the tooth. After shaping the tooth colored filling material to resemble the natural anatomy of your tooth it is hardened by curing with a strong curing light. Once the white filling hardens, your bite will be checked to make sure your teeth fit together properly. If the tooth filling extends into the space between your teeth your dentist will also make sure you can floss between your teeth properly. Adjustments will be made if necessary followed by smoothing and polishing of your new filling..
For open hernia repair surgery, a single long incision is made in the groin. If the hernia is bulging out of the abdominal wall (a direct hernia), the bulge is pushed back into place. If the hernia is going down the inguinal canal (indirect), the hernia sac is either pushed back or tied off and removed.
The patient has spasticity in the lower extremities greater than the upper extremities. The hips and knees are flexed and adducted with the ankles extended and internally rotated. When the patient walks both lower extremities are circumducted and the upper extremities are held in a mid or low guard position. This type of gait is usually seen with bilateral periventricular lesions. The legs are more affected than the arms because the corticospinal tract axons that are going to the legs are closest to the ventricles.
A voice prosthesis (plural prostheses) is an artificial device, usually made of silicone that is used to help laryngectomized patients to speak. During a total laryngectomy, the entire voice box (larynx) is removed and the windpipe (trachea) and food pipe (esophagus) are separated from each other.