Basal cell carcinoma is not only the most common type of skin cancer, it is also the most common malignancy in humans. Like melanoma, it is more common in fair skin types, but unlike melanoma, it rarely metastasizes. The most common presenting complaint is a bleeding or scabbing sore that heals and recurs. Basal cell carcinomas tend to occur on the sun exposed areas of the head and neck, including the nose, ears and scalp. Rarely, a basal cell carcinoma will occur within a scar or other areas of trauma. Unfortunately, in the past there was a tendency to regard BCC as nonmalignant because the tumor rarely metastasizes. BCC advances by direct extension and destroys normal tissue. Left untreated or inadequately treated, the cancer can destroy the whole side of the face or penetrate subcutaneous tissue into the bone and brain. BCC occurs in many different clinical forms.
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Prof. Domenico Napolitano, Chief of Otorilaringology, Cardarelli Hospital, Napoli he neck dissection is a surgical procedure for control of neck lymph node metastasis. This can be done for clinically or radiologically evident lymph nodes or as part of curative surgery where risk of occult nodal metastasis is deemed sufficiently high. The aim of the procedure is to remove lymph nodes from the neck into which cancer cells may have migrated. Metastasis of tumours into the lymph nodes of the neck is one of the strongest prognostic indicators for head and neck cancer. The metastases may originate from tumours of the upper aerodigestive tract, including the oral cavity, tongue, nasopharynx, oropharynx, hypopharynx, and larynx, as well as the thyroid, parotid and posterior scalp. Neck nodal metastasis can sometimes also originate from lung cancer or intra-abdominal malignancy. However, neck dissection is rarely performed for such purposes. Lymph nodes in a particular region are numerous and generally referred to in groups. It is impossible to dissect through all the soft tissue to remove individual lymph nodes. As such the neck dissection is the en-bloc resection of all soft tissue in the region including all the lymph nodes and structures passing through them. In the case of a neck dissection, this entails the resection of everything within the superficial layer of deep cervical fascia (also known as the investing layer of cervical fascia). Where deemed excessively morbid, the structures within are conserved. These include the carotid and in some instances the three structures - IJV, SCM and Accessory Nerve. Memorial Sloan-Kettering Cancer Center developed the lymph node regional definitions most widely used today. To describe the lymph nodes of the neck for neck dissection, the neck is divided into 6 areas called Levels. The levels are identified by Roman numeral, increasing towards the chest. A further Level VII to denote lymph node groups in the superior mediastinum is no longer used. Instead, lymph nodes in other non-neck regions are referred to by the name of their specific nodal groups. Region I: Submental and submandibular triangles. Ia is the submental triangle bound by the anterior bellies of the digastric and the mylohyoid. Ib is the triangle formed by the anterior and posterior bellies of the digastric and body of mandible. Region II, III, IV: nodes associated with the IJV; fibroadipose tissue located medial to the posterior border of SCM and lateral to the border of the sternohyoid. Region II: upper third including the upper jugular and jugulodigastric nodes and the upper posterior cervical nodes. Region bound by the digastric muscle superiorly and the hyoid bone (clinical landmark), or the carotid bifurcation (surgical landmark) inferiorly. IIa contains nodes in the region anterior to the spinal accessory nerve and IIb postero-superior to the nerve. Region III: middle third jugular nodes extending from the carotid bifurcation superiorly to the cricothyroid notch (clinical landmark), or inferior edge of cricoid cartilage (radiological landmark), or omohyoid muscle (surgical landmark). Region IV: lower jugular nodes extending from the omohyoid muscle superiorly to the clavicle inferiorly. Region V: posterior triangle group of lymph nodes located along the lower half of the spinal accessory nerve and the transverse cervical artery. The supraclavicular nodes are also included in this group. The posterior boundary is the anterior border of the trapezius muscle, the anterior boundary is the posterior border of the sternocleidomastoid muscle, and the inferior boundary is the clavicle. Region VI: anterior compartment group comprises lymph nodes surrounding the midline visceral structures of the neck extending from the level of the hyoid bone superiorly to the suprasternal notch inferiorly. On each side, the lateral boundary is the medial border of the carotid sheath. Located within this compartment are the perithyroidal lymph nodes, paratracheal lymph nodes, lymph nodes along the recurrent laryngeal nerves, and precricoid lymph nodes.
Просмотров: 34269 VideoSurgery
Oral submucous fibrosis (OSF) is a chronic, progressive, scarring disease, that predominantly affects the people of South-East Asian origin. This condition was described first by Schwartz (1952) while examining five Indian women from Kenya, to which he ascribed the descriptive term "atrophia idiopathica (tropica) mucosae oris". Later in 1953, Joshi from Bombay (Mumbai) redesignated the condition as oral submucous fibrosis, implying predominantly its histological nature. The WHO definition for an oral precancerous condition - "a generalized pathological state of the oral mucosa associated with a significantly increased risk of' cancer," accords well with the characteristics of OSF. Clinical features: The onset is insidious over a 2-5 year period. The Prodromal Symptoms (early OSF) This includes a burning sensation in the mouth when consuming spicy food, appearance of blisters especially on the palate, ulcerations or recurrent generalized inflammation of the oral mucosa, excessive salivation, defective gustatory sensation and dryness of' the mouth. There are periods of exacerbation manifested by the appearance of small vesicles in the check and palate. The intervals between such exacerbations vary from three months to one year. Focal vascular dilatations manifest clinically as petechiae in the early stages of the disease. This may be part of a vascular response due to hypersensitivity of the oral mucosa towards some external irritant like arena nut products. Petechiae are observed in about 22% of OSF cases , mostly on the tongue followed by the labial and buccal mucosa with no sign of blood dyscrasias or systemic disorders. Pain in areas where submucosal fibrotic bands are developing when palpated, is a useful clinical test. Histologically, they revealed a slightly hyperplastic epithelium, sometimes atrophic with numerous dilated and blood-filled capillaries juxta-epithelially. The inflammatory cells seen are mainly lymphocytes, plasma cells and occasional eosinophils. The presence together of large numbers of lymphocytes and fibroblasts as well as plasma cells in moderate numbers, suggests the importance of' a sustained lymphocytic infiltration in the maintenance of the tissue reaction in OSF, The advanced OSF As the disease progresses, the oral mucosa becomes blanched and slightly opaque and white fibrous bands appear. The buccal mucosa and lips may be affected at an early stage although it was thought that the palate and the facial pillars are the areas involved first. The oral mucosa is involved symmetrically (with possible exception) and the fibrous hands in the buccal mucosa run in a vertical direction. The density of the fibrous deposit varies from a slight whitish area on the soft palate causing no symptoms to a dense fibrosis causing fixation and shortening or even deviation of the uvula and soft palate. The fibrous tissue in the facial pillars varies from a slight submucosal accumulation in both pillars to a dense fibrosis extending deep into the pillars with strangulation of the tonsils. It is this dense fibrosis involving the tissue around the pterygomandibular raphae that causes varying degrees of difficulty in mouth opening. A factor, which seems to be overlooked by many investigators while recording the extent of mouth opening, is the acuteness of oral symptoms (persistent recurrent glossitis and stomatitis) at the time of recording. Sometimes the fibrosis spreads to the pharynx and down to the pyriform fossae. Upon palpation, a circular band can be felt around the entire rima oris (mouth orifice), and these changes are quite marked in the lower lip. All observers have noted impairment of tongue movement in patients with advanced OSF with significant atrophy of the tongue papillae. With progressing fibrosis stiffening of certain areas of the mucosa occurs leading to difficulty in opening the mouth, inability to whistle or blow and difficulty in swallowing. When the fibrosis involves the nasopharynx, the patient may experience referred pain to the ear and a nasal voice as one of the later signs in some patients.
Просмотров: 11191 Medinaz
Transforming Growth Factor Beta-1 has effects all over the body, especially in the liver, lungs & skin. It transforms healthy tissue into abnormal tissue, producing scar tissue and other problems. This is one of the many abnormalities that needs to be corrected when CIRS is treated.
Просмотров: 253 Raymond Oenbrink
This video shows and endoscopic examination of the trachea and larynx in a patient with indwelling T-tube which was inserted for the management of tracheal stenosis (narrowing). The upper end of the tube is sited well below the true vocal folds which allows uninterrupted phonation. The luminal surface of the tube was covered with yellowish-green layer resulted from its prolonged placement. Although the tube is made up from innert material, it is still possible to cause mucosal reaction with the potential of biofilm formation. This tube allows breathing and phonation to take place as well as providing the scaffold for the tracheal tissue to form sufficiently after surgical removal of the scar and stenotic area. It will be taken out after about a year to enable the tracheal lumen dimension to be restored adequately.
Просмотров: 25523 drrahmatorlummc
2018 UPDATE I believe I have stumbled on a cure for my swallowing problems: FLONASE. I use it every day for allergy relief and it has drastically reduced the number of swallow-panic episodes I experience. Here is an excerpt from an article I found online that backs up my findings: MEDICAL THERAPY Swallowed fluticasone (Flonase, using an inhaler) is the mainstay of therapy for both children and adults. In one case series, 21 adult patients with eosinophilic esophagitis received a 6-week course of swallowed fluticasone 220 μg/puff, two to four puffs twice daily. Symptoms completely resolved in all patients for at least 4 months, and no patient needed endoscopic dilation.29 In another study, 19 patients treated with fluticasone for 4 weeks showed dramatic improvement in both symptomatically and histologically. However, after 3 months, 14 (74%) of the 19 patients had a recurrence of symptoms, pointing to the chronic relapsing nature of this disease. Full article here: http://www.hespatientgroup.com/eosinophilic-esophagitis-an-increasingly-recognized-cause-of-dysphagia-food-impaction-and-refractory-heartburn/ Chances are good that you have a Schatzki's Ring. It's scary and painful, but you are actually not choking. You have food stuck in your lower esophagus. This is becoming more and more common in people of all ages, and there is not that much information on the internet about it. I'm not a doctor, I am simply putting this information out there for those people like myself who are looking for ways to lessen the frequency and severity of their symptoms; or needing clarity on what they might be suffering from.
Просмотров: 202358 John LaCarter
TRACO 2015: Pediatric Cancer - Case Reports Air date: Monday, November 23, 2015, 4:00:00 PM Category: TRACO Runtime: 01:46:41 Description: Pediatric cancer; Case reports For more information go to http://ccr.cancer.gov//trainee-resources-courses-workshops-traco Author: J. Wei, NIH; O. Olaku, NIH Permanent link: http://videocast.nih.gov/launch.asp?19346
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Cancer has emerged as the leading cause of death in low- and middle-income countries. Many countries, especially in sub-Saharan Africa are ill prepared to handle this evolving crisis in medical care. Building on the successful collaborative partnership centered on HIV-AIDS is the AMPATH-Oncology program (the Academic Model for Providing Access to Healthcare), which is focused on enhancing the research, educational and clinical care infrastructure for western Kenya. This presentation will provide the background and current status of this ongoing experiment in health care delivery. View the other videos in this series www.cancer.gov/globalhealth/events/seminarseries
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Common Pathology of the Temporal Bone, presented by Suresh K. Mukherji, MD, MBA, FACR, Chairman, MSU Department of Radiology, during the 2016 course "A Simplified Approach to Head & Neck Radiology". http://www.rad.msu.edu/media/Head&Neck/2016.html
Просмотров: 4944 MSU Radiology