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Facial Tenderness
1. Ask the patient to tell you if these maneuvers causes excessive discomfort or pain. ++
2. Press upward under both eyebrows with your thumbs.
3. Press upward under both maxilla with your thumbs.
4. Excessive discomfort on one side or significant pain suggests sinusitis.
Sinus Trans illumination 1. Darken the room as much as possible. ++
2. Place a bright otoscope or other point light source on the maxilla.
3. Ask the patient to open their mouth and look for an orange glow on the hard palate.
4. A decreased or absent glow suggests that the sinus is filled with something other than air.
Temporomandibular Joint 1. Place the tips of your index fingers directly in front of the tragus of each ear. ++
2. Ask the patient to open and close their mouth.
3. Note any decreased range of motion, tenderness, or swelling.
Suspect that a patient has a subphrenic abscess if he deteriorates, or recovers and then deteriorates, between the 14th and the 21st day after a laparotomy, with a low, slowly increasing, swinging fever, sweating, and a tachycardia. This, and a leucocytosis, show that he has ''pus somewhere', which is making him anorexic, wasted, and ultimately cachectic. If he has no sign of a wound infection, a rectal examination is negative, and his abdomen is soft and relaxed, the pus is probably under his diaphragm. The pus might be between his diaphragm and his liver, in (1) his right or (2) his left subphrenic space, or under his liver in (3) his right or (4) his left subhepatic space in his lesser sac. He may have pus in more than one of these spaces. Explore him on the suspicion that he might have a subphrenic abscess. Exploration is not a major operation; the difficulty is knowing where to explore, so refer him if you can. If you cannot refer him, explore him yourself. If you fail to find pus, you have done him no harm; missing a subphrenic abscess is far worse. If it is anterior, you can drain it by going under his costal margin anteriorly. If it is posterior, you can go through the bed of his 12th rib posteriorly.
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.
A lipoma is a growth of fat cells in a thin, fibrous capsule usually found just below the skin. Lipomas aren't cancer and don't turn into cancer. They are found most often on the torso, neck, upper thighs, upper arms, and armpits, but they can occur almost anywhere in the body. One or more lipomas may be present at the same time.
Hypothyroidism during pregnancy is treated with synthetic thyroid hormone, thyroxine (T4). Postpartum thyroiditis—inflammation of the thyroid gland—causes a brief period of hyperthyroidism, often followed by hypothyroidism that usually goes away within a year. Sometimes the hypothyroidism is permanent.
A giant abdominal wall hernia can develop from an existing ventral or incisional hernia, sometimes arising after one or more failed repair attempts. These hernias may also result from a traumatic injury where the abdomen was required to be left open and healing was delayed. In giant abdominal wall hernias, multiple loops of intestines and sometimes other abdominal organs reside within the hernia sac. The abdominal wall muscles then become conditioned to this and retract reducing the available space inside the abdomen.