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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.
This procedure describes one of the most versatile approaches to the anterior skull base for large tumors of the sinonasal cavity. It may be used with or without a craniofacial resection. The benefits of this approach are: wide access around the tumor; good postoperative cosmesis; & decreased operative & postoperative morbidity. We have used this approach for many bilateral tumors of the nasal & sinus cavities that approach &/or invade the skull base & brain. This video show the resection of a large esthesioneuroblastoma.
Cameron Underwood Face Transplant Surgical Animation 2018 Eduardo D. Rodriguez, MD, DDS, chair of the Hansjörg Wyss Department of Plastic Surgery, and the Helen L. Kimmel Professor of Reconstructive Plastic Surgery, details the recent face transplant he performed on Cameron Underwood in January 2018 at NYU Langone Health.
Teratomas are tumors made up of tissues, such as hair, muscle, and bone. They occur most often in the ovaries in women, and the testicles in men. They may be benign or malignant. Symptoms vary depending on the location. A painful lump or swelling may be apparent. Some babies have a mass that can be seen on an ultrasound before birth. Treatment often involves surgery. In rare cases when a teratoma is malignant, chemotherapy or radiation may be needed.
Sinus infections caused by viruses can use home (over-the-counter, OTC) treatments such as pain and fever medications (acetaminophen [Tylenol]), decongestants, and mucolytics. In addition, some health-care professionals suggest nasal irrigation or a sinus rinse solution to help relieve symptoms of sinus infections, even chronic sinusitis symptoms.
Scoliosis is a sideways curvature of the spine that occurs most often during the growth spurt just before puberty. While scoliosis can be caused by conditions such as cerebral palsy and muscular dystrophy, the cause of most scoliosis is unknown. Most cases of scoliosis are mild, but some children develop spine deformities that continue to get more severe as they grow. Severe scoliosis can be disabling. An especially severe spinal curve can reduce the amount of space within the chest, making it difficult for the lungs to function properly. Children who have mild scoliosis are monitored closely, usually with X-rays, to see if the curve is getting worse. In many cases, no treatment is necessary. Some children will need to wear a brace to stop the curve from worsening. Others may need surgery to keep the scoliosis from worsening and to straighten severe cases of scoliosis.
URBN Dental is here not only to take care of your tooth decay and prevent gingivitis, but also to give you the best at home dental care instructions as well. Do you find brushing your teeth confusing, or are you unsure whether or not you are brushing correctly? The golden standard when it comes to brushing teeth is brushing twice a day for two minute sessions each. You can break down the mouth into four quadrants: upper right, upper left, lower left, and lower right. By doing this, it will be easier for you to brush for thirty seconds in each area and focus on the correct movement instead of location. It is very important to angle the toothbrush at a forty five degree angle to the tooth and gums while using circular motions to remove food debris and plaque. When it comes to your front teeth, using the brush in a vertical position and combining it with circular motions is effective. Using the dental techniques will ensure healthier teeth that are cavity free and less bleeding gums.
Obesity is one of the most pervasive, chronic diseases in need of new strategies for medical treatment and prevention. As a leading cause of United States mortality, morbidity, disability, healthcare utilization and healthcare costs, the high prevalence of obesity continues to strain the United States healthcare system. Obesity is defined as excess adipose tissue. There are several different methods for determining excess adipose (fat) tissue; the most common being the Body Mass Index (BMI) (see below). A fat cell is an endocrine cell and adipose tissue is an endocrine organ. As such, adipose tissue secretes a number of products, including metabolites, cytokines, lipids, and coagulation factors among others. Significantly, excess adiposity or obesity causes increased levels of circulating fatty acids and inflammation. This can lead to insulin resistance, which in turn can lead to type 2 diabetes.
Hemophagocytic lymphohistiocytosis is a rare but life threatening condition characterised by activation of macrophages which result in phagocytosis of RBCs and cytokine mediated tissue damage. This presentation aims to discuss the genetic basis, clinical features, diagnostic criteria and management options in this serious condition. The management options in HLH include Etoposide, Dexamethasone, Cyclosorine, Tacrolimus, Alemtuzumab and stem cell transplant.
Removing a hump from the bridge is one of the most common things people want addressed during their rhinoplasty. Nasal humps can range widely in size. Perhaps you just have a small bump that you'd like refined? Or maybe you have more of a Roman Nose with a more dominating, distracting large hump? No matter if your nose falls on one of these extremes or somewhere in between rhinoplasty surgery can be used to reshape your nose. For anyone considering having a rhinoplasty to reduce a hump on their bridge there are several things to consider before having surgery.